4500 Class 9 — NEONATAL Flashcards
Health assessment techniques and diagnostic tests r/t to the neinate
MAIN physiological processesof neonatal transition to extra-uterine life
Jaundice — neonate
Signs of integumentary problems in neonates
Name important newborn reflexes
Sucking and rooting
Swallowing
Palmar grasp
Plantar grasp
Moro (or startle)
Stepping or “walking”
Crawling
Babinski (plantar)
Pull to sit postural tone
Add
What is the therapy for hyperbilirubinemia
Newborn Nursing Interventions related to the postpartum period
MAIN physiological processes of neonatal transition to extra-uterine life
What ARE IMPORTANT changes/adaptation in the first 2 hours of life
ESTABLISH RESPIRATIONS
Adjust to circulatory changes
Regulate temp
Eliminate waste
What indicates poor sdaptation in fetal heart monitoring?
Minimal variability. Heart rate not in range, LATE DECELERATIONS
What does late deceleration indicate?
POOR OXYGENATION
WHAT DO WE ASSESS IN THE FIRST STAGE OF LABOUR
Fetal positioning/presentation
Internal electronic fetal monitoring
Length
Rupture of membranes — time of ROM (length of ROM), note presence of Scalp
Scalp sampling?
Any sign of fetal distress?
Any complication in labour? Bleeding, eclampsia, tx with magnesium sulphate)
Birther analgesia/anesthesia (fentanyl, morphine)
When GBS pos? How to treat?
1 initial dose of 5M units of PENICILLIN
What is a meconium?
Color? When does it usually pass?
Where does it pass?
What can cause it
First stool
Green-black in colour, viscous and sticky!
Usually passes within 12-24 hours after birth
May pass in utero — chnages of passing meconium increases in utero after 38 weeks gestation. It is common in breech presentation. Common in anything after 40 weeks — postdates.
It can be caused by hypoxia (induced peristalsis), and spihincter relaxation
Fetal Circulation?
Top CHANGES in the heart FROM FETAL TO NEWBORN CIRCULATION
DUCTUS VENOSUS
FORAMEN OVALE
Shuts
Why are preterm infants at higher risk of ineffective osygen supply
Has immature alveoli
Decrease elasticity, recoil
Less surfactant
How can meconium present itself? (Meconuim Aspirarion Syndrome) MAS
How do we manage
Abnormal / atypical FHR patterns
Complications include terminal airway obstruction, respiratory distress, inflammation, and infection
Persistent pulmonary hypertension of newborn!
EFM in labour!!! ⭐️
When during birth, not breathing or crying, has a flat tone
- may intubate to suction below the cords, may need ventilate! ⭐️
What are three things we look for before starting a NEONATAL RESUSCITATION?
- Term gestation? ~over 37 weeks?
- Crying or breathing>
- Good tone?
If mo, STAR RESUS
What’s the routine care for neonatal transition?
A. Prone on birther’s chest (skini to skin) — maintain warmth/normal temp
B. Clear secretions as needed
C. Dry and stimulate to breathe
D. Delayed cord clamping
E. Newborn stays w parents
F. Ongoing observations
ESTABLISH EFFECTIVE RESPIRATIONS
What are potential benefits of delayed cord clamping in preterm newborns?
Decreased mortality
Higher bp and blood volume
Less need for blood transfusion after birth
FEWER brain hemorrhages and
Lower risk of necrotizing enterocolitis
Potential benefits of cord clamping in term newborns
Decrease chance of developing iron-deficiency anemia
Maybimprove neurodevelopmental outcomes
Potential adverse effects of DELAYED CORD CLAMPING
Delaying resuscitation for compromised newborns
Increased risk of POLYCYTHEMIA (high red blood cell concentration)
Jaundice
CONTRAINDICATIONS of delayed cord clamping (DCC)
those who require immediate resus
For infants less than 37 weeks gestational age, DCC only for at least 1 minute
For infants 37 weeks or more. DCC for 1-2 minutes!
COMTRAINDICATIONS OTHERS:
Known or suspected placental abruption
Uncontrolled maternal hemorrhage
Vasa previa
Fetuses with pre-existing volume overload such as hydrops fetalis
Multiple gestation deliverieswhere the second twin is in distress
When do we expect an o2 of 10p%
10 mins after birth
Body pink, extremities blue
Acrocyanosis
Apgar score that means newborn is on severe distress
0-3
Apgar score that means normal transition, little difficulty
7-10
What physiological mechanisms happen when a newborn is cold (hypothermia)
- Thermogenesis - newborns attempt to generate heat by increasing muscle activity, could appear restless and cry, could feel cool due to vasocontriction
- Increase in cellular metabolic activity — which increases consumption of oxygen and glucose
- Flexiom to reduce exposure
- Constriction of blood vessels
- Shovering mechanism is not operable in new born — in turn brown fat metabolism — these are higher in preterm infants (increases metabolic activity in the brain, heart, and liver)
What can cold stress lead to? Adverse effect
- RESPIRATORY DISTRESS
/metabolic distress - HYPOGLYCEMIA!! They would need more glucose
WEIGHT
Average finding?
Normal VARIATION?
Average finding: *3400-3500 grams
Normal bariation: *2500-4000 grams
Average finding for LENGTH of newborn
45-55 cm
What is the method of assessment of *head circumference of a newborn
OCCIPITOFRONTAL CIRCUMFERENCE
What is the headcircumference of a newborn
AVERAGE FINDING
NORMAL VARIATION
AVERAGE FINDING: 33-35 cm
NORMAL VARIATION: 32-36.8 cm
TEMPERATURE IN NEWBORN
Average finding
Normal Variation
Average: 37
Normal variation: 36.5 - 37.5
HEART RATE IN NEWBORNS
Average finding
Normal variations
Average findings: 110-160 bpm
Variations: as low as 80-100 when asleep
Up tp 18- bpm if actively crying
RESP RATE IN NEWBORNS
Average finding
Normal Variations
Average findings: 30-60 bpm
Normal variation: >20 s ,
Stabilization occurs by day 1-2 days
SKIN ASSESSMENT (normal findings or variation?)
Acrocyanosis
Skin pigmentation begins to deepen after birth
General p\plump appearance
Vernix caseosa (soft cheeselike/whiteish substance —protective)
Lanugo hair
SKIN ASSESSMENT
(normal variation or normal finding??)
— superficial cracking/peeling of hands and feet
— mottling extremities due to instability of the newborn circulation
— congenital dermal melancytosis—common to back and buttocks, fade over months
— Nevi / telangiectases / stork bites —flat, pink capillary hemangioma—easily blanched, most fade in fist and second years of life
— erythema toxicum — transient rash (appeards 24-72 hours; can last up to 3 weeks), no clinical significance, no tx required
— petechiae
— MILIA (sweat glands on the face, normal)
Normal variation
Erythema Toxicum
What is it?
When do we see it?
How long does it last?
Tx?
It is a transient rash; erythematous macules, papules, and small vesicles
Appears around w4-72 hours after birth / can last up to 3 weeks
No clinical significance, no tx reauired
What is vernix caseosa?
Is it a normal finding or normal variation?
It is sof cheeselike/whitetish substance, protective
It is a normal finding
What is a milia?
Is it a normal finding or normal variation?
It is a small sweat-gland spots, usually found on the face
It if a normal variation
What is a telangiectatic nevi?
On a newborn?
Is it a normal finding or a normal variation?
It is a stork bite
It is a normal variation
What would be a potential concern on SKIN ASSESSMENT
- Bruising
- Jaundice
- Central cyanosis
- Pallor
Moulding in the head/face normal?
Yes. May or may not be present
Head a _______ (size) as compared to body length
A fourth
Fontanels and sutures should be? Should not be/
Suture lines should be palpable
Both should not be bulging, swollen or sunken
Discharge in the eyes on newborn?
Should be none
What is caput succedaneum?
Is it normal finding? Or normal variation? Unexpected?
It is generalized edematous areas of the scalp.
Can be accompanied by exxhymosis.
Crosses suture lines.
It is a normal c]variation.
It is the collection of blood between a skull bone and its periosteneum.
(common in forcept birth)
(can result in jaundice)
Does not cross suture lines.
Does mot pulsate or bulge when baby cried
Appears several hours or the day after birth — usually largest on the 2nd or 3rd day
Fullness evolved in 3-6 weeks
CEPHALHEMATOMA
It is the bleeding into the subgaleal compartment.
Dangerous!
Crosses suture lined
Potential space — loosely arranged connective tissue — blood lss in this space can be severe (*do head circumference assessments!)
SUBGALEAL HEMORRHAGE
EDEMA AT THE BACK OF THE NECK
MASSES FOR NEWBORNS DELIVERED BY VACUUM EXTRACTION
Potential:
BOGGY SCALP
TACHYCARDIA
INCREASING HEAD CIRCUMFERENCE
FORWARD POSITION IN OF THE NEWBORN’S EARS
CHANGES IN NEWBORN LOC
What does these assessment findings suggest?
What might the the order?
SUBGALEAL HEMORRHAGE
May require blood transfusion
Thyroid in newborn
Palpable or not?
NOT
Webbing, masses in neck??
No expected
Prominent tip of sternum
Normal? Or not
Normal
Breast nodule in a newborn
What is a normal findong
What is a normal variation
Normal finding: ~6mm
Normal variation: 3-10 mm/ potential for discharge
Where can fluid retention lead to?
TTNB (transient tachypnea of the newborn)
Abd breathing
Normal variation
What is the normal interuterine o2
60%
After 10 mins (newborn), what should o2 be
95%
What are signs of respiratory distress
Nasal flaring
Intercoastal or substernal retractions
Stridor
Grinting
Gasping
Apnea lasting 20nseconds or longer
Mottling
Not expected
Tachypnea is its most common feature. It is a parenchymal lung disorder from delayed resorption and clearance of fetal alveolar fluod
1-2 hours: RR up to 100 breaths/min along with some grunting, nasal flaring, mild retractions
*usually resolves within 24 hours
Transient tachypnea of the newborn (TTN)
Ttnb care?
Support on feeding
Promote thermal emvironment
Maintain o2 at 90-95%
Nb blood vol
80-100 ml/kg
Heart murmur on nb?
Does not signify pathological defect
> 50% disappear by 6 months
It should be assessed in conjunction with overall status(color, appearance, behaviour, feeding)
Note to provider
Irregular HR in the first few hourd
Not uncommon
CVS assessment on a newborn
Inspect for visible pulsation in midclavicular line (4th intercoastal space)
Palpate apical pulse (4th intercoastal sapce)
Auscultation of apical pulse for FULL MINUTE for rate (4th intercoastal space)
Auscultate heart sounds (S1 and S2)— should be sharp and clear
What does greenish umbilical cord imdicate
Meconium staining
Important fo synthesis of blood coagulation factors
VIT K
When do we expect the first stool? Of a newborn
24-48 hours
How does a newborn’s ABDOMEN look like
Round and prominent — like a dome
Soft
Cold be a few visible veins
Movement with resp should be noted
When to expect bowel sounds in a newborn
After a few minutes
How does the umbilical cord look like on assessment
Has two arteries, one vein
Clamp should not be bleeding
Usually white\ish grey
Should be odourless
What is vernix caseosa?
Normal Finding or variation?
It is a sof cheeselike/whitish substance
It is a NORMAL FINDING
What is lanugo hair
Is it a NORMAL FINDING ORRR VARIATION
It is fine hairs over favc3, shoulders, and back
It is a N FINDING
