4th stage of labour - Immediate care of the Newborn

Question 1

What are newborn physical examination findings used by to estimate? What have the been found to do?

Answer 1

Newborn physical examination findingsare used by clinicians to estimate gestational age, using thenew Ballard score.

Newborn clinical assessments of gestational age have been found to overestimate gestational age in preterm infants and underestimate gestational age in small-for-gestational-age infants

Question 2

When/how is the ballard score accurate?

Answer 2

The Ballard score is accurate only within plus or minus 2 weeks.

Question 3

If a child weight is at the 50th percentile line, what does it mean? (same thing for the 75th percentile line)

Answer 3

If a child’s weight is at the 50th percentile line, that means that out of 100 normal children her age, 50 will be bigger than she is and 50 smaller.

Similarly, if she is in the 75th percentile, that means that she is bigger than 75 children and smaller than only 25, compared with 100 children her age.

Question 4

What does a normal rate of growth mean on the growth chart?

Answer 4

A normal rate of growth means the child’s growth points closely follow a percentile line on the chart.

Question 5

What is the APGAR score? What is it based off of?

Answer 5

It is a rapid assessment of the newborn’s transition to extrauterine life

Based on 5 signs indicative of physiological status

Question 6

What weeks gestation is considered post term (postdate)?

Answer 6

Postterm (postdate) – born after completion of week 42

Question 7

What does drying the infant with vigorous rubbing prevent/do?

Answer 7

Drying the infant with vigorous rubbing removes moisture to prevent evaporative heat loss and provides tactile stimulation to stimulate respiratory effort

Question 8

What is a normal newborn HR, RR, and Temp?

Answer 8

Heart rate - (110-160 bpm)

Respirations - (30-60/min)

Temperature - (36.5-37.5)

Question 9

What is the period of decresed responsiveness? When does it occur?

Answer 9

The period of relative inactivity takes place 2 -3 hours after birth.

The newborn becomes less interested in external stimuli and falls asleep for a few minutes to several hours

Question 10

When is the Ballard score typically used?

Answer 10

, Ballard score is usually used in the first 24 hours).

Question 11

When does the cord stump usully dry and fall off?

Answer 11

The cord stump usually dries and fall within 7 to 10 days leaving a granulating area that heals on the next 7 to 10 days.

Question 12

What is the normal range and average length of a full term baby?

Answer 12

The average length of full-term babies at birth is 50 cm (20 in.).

The normal range is 46 cm (18 in.) to 60 cm (22 in.).

In the first month, babies typically grow 4 cm (1.5 in.) to 5 cm (2 in.).

Question 13

If parent refuse vitmian K IM what can be done? Why is it not recommed tho?

Answer 13

• If parents refuse Vitamin K IM, an oral dose of 2 mg can be given at the first feeding, with follow-up doses given at 2 to 4 weeks of age and 6 to 8 weeks of age

-This treatment is not recommended because it is less effective in preventing late hemorrhagic disease of the newborn

Question 14

What weeks gestation is considered post mature? What do they typically show?

Answer 14

Postmature - born after completion of week 42 and showing signs of placental aging (insufficiency)

Question 15

What does skin-skin care involve? When is it facilitated?

Answer 15

the placement of baby in an upright position, on the mother or partner’s chest with no clothing or blankets placed between the infant and the parent.

Skin to skin care is facilitated immediately after birth and should be uninterrupted for the first 1-2 hours, unless mom or baby needs special medical attention.

Frequent skin to skin care is encouraged in the early days of baby’s life.

Question 16

Where will identifications bands be placed after delivery?

Answer 16

2 on the newborn; 1 on the birth parent and 1 on the support person (when applicable).

Question 17

What does an APGAR score of 4 - 6 mean?

Answer 17

. A score of4 to6 may mean that the baby needs some rescue breathing measures (oxygen) and careful monitoring

Question 18

What is the APGAR score usefual in gauging?

Answer 18

It is useful in gauging the response to resuscitation but should not be used to extrapolate outcomes, particularly at 1 minute as this does not hold any long-term clinical significance.

Question 19

What are the two broad goals of nursin care for immediate care of the newborn?

Answer 19

1.) To promote the physical well-being of the newborn (assessing & stabilizing)

2.) To support the establishment of a well-functioning family unit

Question 20

What should all infants with a murmur have done?

Answer 20

All infants with a murmur should have blood pressure taken in the upper and lower extremities to assess for coarctation of the aorta.

If there is an upper and lower pressure gradient difference greater than 20 mm Hg or abnormal femoral pulses, transthoracic echocardiography should be done to evaluate for coarctation of the aorta.

Question 21

What is the first period of reactiity? When does it occur?

Answer 21

It occurs in the first 30-60 minutes of life and is described by an alert, exploratory and active newborn.

Question 22

What are the Ballard score characteristics?

Answer 22

Scores are given for 6 physical and 6 nerve and muscle development (neuromuscular) signs of maturity. The scores for each may range from -1 to 5.

The scores are added together to determine the baby’s gestational age. The total score may range from -10 to 50.

Question 23

What are the characteristics of the first period of reactiity? What may this time period represent?

Answer 23

Suck is strongest at this time therefore this is the best time to breastfeed.

“Early skin to-skin contact (SSC) begins ideally at birth and involves placing the naked baby, covered across the back with a warm blanket, prone on the mother’s bare chest…

This time may represent a psychophysiologically ‘sensitive period’ for programming future behavior, and may benefit breastfeeding outcomes, early mother-infant attachment, infant crying and cardiorespiratory stability.” (Cochrane Database, 2007).

Question 24

What does a HR below 100 signify? What does a HR above 160 signify?

Answer 24

A heart rate below 100 signifies an asphyxiated baby and a heart rate above 160 signifies distress.

Question 25

What is the ballard score? What is it based on? What is it commonly used to determine?

Answer 25

-it is commonly used to determine gestational age

The Ballard score is based on the neonate’s physical and neuromuscular maturity and can be used up to 4 days after birth (in practice

Question 26

Charcteristics of a normal infant cry? If the cry is not normal what should we observe for? (what are the 3 different abnormal cries?)

Answer 26

The normal infant cry is loud and husky. Observe for the following abnormal cry:

High, pitched cry – indicates hypoglycemia, increased intracranial pressure.

Weak cry – prematurity

Hoarse cry – laryngeal stridor

Question 27

What is the average head circumfrance at birth? What does it increase to by the end of the first month?

Answer 27

The average head circumference at birth is about 34.5 cm (13.5 in.)

By the end of the first month, it increases to about 37.6 cm (15 in.).

Question 28

What weeks gestations is considered early term and late term?

Answer 28

Early term – born between 37 and 38+6 weeks gestation

Late term – born in the 41st week

Question 29

What should an APGAR score alone not be interprest as evidnce for?

Answer 29

Apgar score alone should not be interpreted as evidence of asphyxia and its significance in outcome studies while widely reported is often inappropriate.

Question 30

What caridac alternation is normal in newborns on the first day that is not normal in adults?

Answer 30

Neonatal murmurs on the first day of life are common and are usually transient

Question 31

Charateristics of the period of decresed responsiveness? (3 main things)

Answer 31

During deep sleeps, the baby is difficult to arouse.

Feeding may be difficult. Heart rate should stabilize at 100 - 140 bpm and the respiratory rate decrease to 40 to 60 breaths per minute.

The newborn should be centrally pink with clear breath sounds and show no signs of respiratory distress.

Question 32

What does an APGAR score of below 3 mean?

Answer 32

A score of3 or below means that the baby needsrescue breathing and lifesaving techniques.

Question 33

What is Transient tacypena of the newborn (TTN)? What does it result in?

Answer 33

Transient tachypnea of the newborn (TTN) occurs when fluid is retained in the lungs resulting in tachypnea and increased work of breathing.

Question 34

Characterisitcs of the second period of reactivity?

Answer 34

. Heart and respiratory rates may increase but should remain within normal limits (Zainchkin & Askin, 2009).

Question 35

On growth charts what do the percentile lines mean?

Answer 35

You will see thepercentile lineson the chart running parallel to each other. The percentile lines include 5%, 10%, 25%, 50%, 75%, 90%, 95% and 97%.

Question 36

When will the nurse identify all newborns? (6 times)

Answer 36

1.) on admission;

2.) prior to the transfer of the newborn from the birthing area or operating room;

3.) prior to the separation of birth person and newborn; upon transport to another facility or unit;

4.) following shift handover; prior to medication administration

5.) prior to undergoing procedures

6.) prior to discharge.

Question 37

What is the primary goal in the first moments of life?

Answer 37

-To establish effective respirations

Question 38

What is the average weight for a baby? What is the normal range for a babys weight?

Answer 38

The average birth weight for babies is around 3.5 kg (7.5 lb),

although between 2.5 kg (5.5 lb) and 4.5 kg (10 lb) is considered normal.

Question 39

What is considered to be a “normal” APGAR score?

Answer 39

A score of 7 to 10 is considered normal

Question 40

What should be done if there is an upper and lower pressure gradient difference greater than 20 mm Hg or abnormal femoral pulses? What are we evaluating?

Answer 40

If there is an upper and lower pressure gradient difference greater than 20 mm Hg or abnormal femoral pulses, transthoracic echocardiography should be done to evaluate for coarctation of the aorta.

Question 41

What 5 things does the APGAR score rate?

Answer 41

1.) Respirations - crying

2.) Reflexes - irritability

3.) Pulse - Heart rate

4.) Skin color of body and extremities

5.) Muscle tone

Question 42

What are the 3 abnormal crys? What do they indicate?

Answer 42

following abnormal cry:

High, pitched cry – indicates hypoglycemia, increased intracranial pressure.

Weak cry – prematurity

Hoarse cry – laryngeal stridor

Question 43

What kind of ballard score do prematrue babies and late term babies have?

Answer 43

Premature babies have low scores. Babies born late have high scores

Question 44

When is the cord clammped and cut?

Answer 44

The cord is clamped and cut approximately within 30 seconds after birth. In the delivery room, the cord is clamped twice about 8 inches from theabdomenand cut in between.

-When the newborn is brought to the nursery, another clamp is applied ½ to1 inchfrom theabdomenand the cord is cut at second time.

Question 45

Intrustions for cord care? (6 things)

Answer 45

1.) No tub bathing until cord falls off. Do sponge bath to clean the baby. See to it that cord does not get wet by water or urine.

2.) Do notapplyanything on the cord such as baby powder or antibiotic, except the prescribed antiseptic solution which is 70% alcohol.

3.) Avoid wetting the cord. Fold diaper below so that it does not cover the cord and does not get wet when the diaper soaks with urine.

4.) Leave cord exposed to air. Do notapplydressing or abdominal binder over it. The cord dries and separates more rapidly if it is exposed to air.

5.) If you notice the cord to be bleeding,applyfirm pressure and check cord clamp if loose and fasten.

6.) Report any unusual signs and symptoms which indicates infection.

Question 46

What weeks gesteration is considered late preterm?

Answer 46

Late preterm – born between 34 0/7 and 36 6/7 weeks

Question 47

What 3 things are we measuring for term infants?

Answer 47

Length – top of head to heel

Weight – scale

Head Circumference – greatest diameter occipitofrontal

Question 48

Symptoms of infections that are related to the umbilical cord?

Answer 48

1.) Foul odor in the cord
2.) Presence of discharge
3.) Redness around the cord
4.) The cord remains wet and does not fall off within 7 to 10 days
5.) Newborn fever

Question 49

When may the cord clamp be removed?

Answer 49

Cord clamp maybe removed after 48 hours when the cord has dried.

Question 50

If a child’s weight, height, or head size is below the 5th percentile what is it imporant to see?

Answer 50

If a child’s weight, height, or head size is below the 5th percentile, it’s important to see if her growth points have always paralleled the 5th percentile line – which would mean her growth rate is normal – or if she is suddenly falling further behind, which is more concerning.

Question 51

What is considered preterm (premature) birth?

Answer 51

Preterm (premature) – born before 37 completed weeks, regardless of birth weight

Question 52

Treatment for Transient tacypena of the newborn (TTN)? When does it usually resolve?

Answer 52

TTN may require supplemental oxygen therapy; however, it usually resolves within 48 hours.

Question 53

Advantages of skin-skin contact? (6 main ones)

Answer 53

1.) Decreasing stress in both baby and parents

2.) Allowing parents to learn about baby through touch, sight, smell and hearing
Promoting bonding and breastfeeding

3.) Stabilizing baby’s body temperature, heartbeat, breathing and blood oxygen levels

4.) Strengthening baby’s digestion and immune systems
Encouraging baby to spend more time in deep sleep and quiet alert states

5.) Producing a stronger milk supply in breastfeeding moms

6.) Reducing postpartum bleeding in moms

Question 54

Why/how is the Apgar score limited?

Answer 54

the Apgar score is limited in that it provides somewhat subjective information about an infant’s physiology at a point in time.

Question 55

According to the WHO, what does essential newborn care include?

Answer 55

1.) Immediate care at birth (delayed cord clamping, thorough drying, assessment of breathing, skin-to-skin contact, early initiation of breastfeeding)

2.) Thermal care

3.) Resuscitation when needed

Question 56

To stimulate crys what should you do instead of slapping the buttocks?

Answer 56

Do not slap the buttocks rather rub the soles of the feet.

Stimulate to cry after secretions are removed.

Question 57

In terms of grwoth charts and child development, what don’t we usually worry about? When do we start to have concerns?

Answer 57

We usually don’t worry about insufficient (or excessive) growth until a child’s growth rate has crossed at least two percentile lines (e.g., from above the 90th percentile to below the 50th).

Question 58

What is the second period of reactivity? When does it occur/how long will it last for?

Answer 58

The second period of reactivity occurs between 4 - 6 hours after birth.

This will last from 10 minutes to several hours

Question 59

What should always take precedence over calculating a clinical APGAR score?

Answer 59

Resuscitation

Question 60

When will the babys head grow the fastest than at any other time? Why?

Answer 60

Baby’s head will grow at its fastest rate during the first 4 months after birth than at any other time.

This increase is due to rapid brain growth

Question 61

What does the 1min and 5min APGAR score indicate?

Answer 61

The one minute score indicates the necessity for resuscitation.

The five minute score is more reliable in predicting mortality and neurologic deficits.

Question 62

In the immediate period after birth of the newborn, what stabalizes for them? What dictates aftercare?

Answer 62

In the immediate period after birth, the newborn’s temperature, respirations, and cardiovascular systems stabilize.

The newborn’s ability to stabilize dictates aftercare

Question 63

What do growth charts tell us?

Answer 63

The growth percentiles by themselves don’t say much….What really matters is the rate of growth