C - Care of a newborn

Question 1

Thermoregulation - Osmosis video
How do neonates conserve heat? (1)

Answer 1

• by assuming a flexed position
• helps to decrease the amount of surface area exposed to the external environment.

Question 2

What are the four mechanisms of heat loss and corresponding interventions?

Answer 2

1. Evaporation
   - loss of heat by transferring liquid into gas
   - when moisture from skin and lungs
   - Dry infant immediately after birth
2. Conduction
   - transfer of heart from object to object through direct contact
   - Place on mothers body skin to skin
3. Convection
   - heat is carried away by cooler air when the baby leaves the cozy warm uterus and enters a cooler outside world
   - Cover with a blanket, wear a cap
4. Radiation
   - transfer of heat from the body to another object without touching it
   - Keep away from cold windows and
   cold objects

Question 3

newborn reflexes at birth? (6)

Answer 3

a) Babinski’s Reflex
- Stroking the sole of a baby’s foot from heel to toes causes the toes to fan out and the big toe to (point upward).

b) Moro/Startled Reflex
- Throw arms outward.
- Extend and spread their fingers.
- quickly bring their arms back toward the body

c) Palmer/Plantar Grasp your finger Reflex

d) Rooting/Suckling milk Reflex

e) Stepping on floor Reflex

f) Tonic Neck/fencing Reflex
- head iturned to one side, the arm on that side stretches out, and the opposite arm bends

Question 4

Safety Needs: Initial Assessment
What are the Vital Signs Expected Range & Physical Measurements Average Range for newborns?

Answer 4

HR (at rest) 120 – 160 beats per min (bpm)
RR 40 – 60 bpm
Rectal T: 36.5 – 37.5 0 C
BP: 50-75/30-45mmHg

Weight 2.5 – 4 kg
Length (head to heel) 44 – 52 cm
Head Circumference 32 – 38 cm

Question 5

Safety needs - Prevention of infection
What are the causes of infections? (5)

Answer 5

1. Immature immune system
2. Thin and fragile skin
3. Low level of phagocytes
4. Low level of antibodies
5. Rely on passive immunity from mother

Question 6

Immediate care for a newborn? (4)

Answer 6

1. Keep baby warm
2. Room temperature: 22 - 25C
3. Place infant under warmer
4. Monitor body temperature

Question 7

Safety needs - How to care for the umbilical cord stump? (3)

Answer 7

1. Cord clamp is 2 - 3 cm away from the umbilicus
2. first 24 hours, check the cord for bleeding
3. The umbilical stump needs particular attention as there are risks for
   infection.
4. Keep cord stump exposed, clean with moist cotton swab and to allow it to air-dry.

• Good umbilical care will help stump to dry up and fall off within the first 1-3 weeks after birth

Question 8

Safety needs - What is the normal vital signs for a newborn? (3)

Answer 8

RECTAL Temp : 36.5 – 37.5 0 C
HR: 120 – 160 beats/min
RR: 40 – 60 breaths/min

Document & reporting findings

Question 9

what’s APGAR score? When isit used?

Answer 9

APGAR score:
Appearance:
0: Blue-gray
1: Normal, except for extremities
2: Normal over entire body

Pulse:
0: Absent
1: < 100bpm
2: > 100bpm

Grimace - reflex irritability
0: No response
1: Grimace
2: Sneeze, cough, pulls away

Activity - muscle tone
0: Absent
1: Arms & legs flexed
2: Active movement

Respiration
0: Absent
1: Slow, irregular
2: Good, crying

• used 1 & 5 minutes after birth
• If there are problems, an additional score is given at 10minutes.

7 – 10 = Normal
4 - 7 may need some resuscitation
3 and less: immediate resuscitation

Question 10

Clinical manifestations of a cold infant? (5)

Answer 10

1. relatively pale and mottled skin (bluish-red, lace-like pattern under the skin) due to vasoconstriction
2. persistent acrocyanosis (Bluish discoloration of the extremities) and even central cyanosis (Bluish discoloration of the central body (e.g., lips, tongue, mucous membranes)
3. Respiratory distress
   - infant is using up more oxygen to keep warm -> if hypothermia continues: infant may experience apnea and bradycardia
4. lethargy, poor muscle tone
5. weak cry and weak suck

Question 11

same as above^ idk if need

Answer 11

Thermal Control
 Regulation of body temperature is immature in newborn. Also, energy
reserves are low which may compromise the ability to cope with
thermal stress.
 Even in tropical countries, infants may become hypothermic especially
when temperature dropsat night.

Measures to prevent hypothermia:
 Delivery in a warmenvironment
 Immediate drying of the infant to minimize heat loss by evaporation
 Proper clothing and wrapping up with linen including use of booties and
bonnets
 Keep out of drafts(circulation of air)
 Skin to skin contact with mother
 Regular feeds

Maintaining thermoregulation
 Referred to as maintaining a neutral thermal environment
– Heat loss isminimal
– Oxygen consumption needs are at theirlowest

 Hypothermia can cause
– Hypoglycemia
– Increased oxygen needs

 Overheating
– Large body surface area
– Limited insulation
– Limited sweating ability

Question 12

idk if need

Answer 12

!!!!! priority goals of care: prevent excessive heat loss & provide supportive care if cold stress occurs!!!

1. maintain a neutral thermal environment, or NTE
   - control the environment to maintain infant’s temperature within normal range
   - minimize infant’s metabolic rate and o2 consumption -> less energy expended for heat maintenance & more energy can be used for adaptation to extrauterine life
   - turn on a radiant warmer 20 to 30 minutes before birth, so you can do your initial assessments on a warm surface, decreasing heat loss by conduction
   - prewarm linens and any surface that will be in contact with the infant
   - as soon as the infant is born, immediately dry them off to remove amniotic fluid to prevent excessive fluid loss by evaporation
   - wrap them in warm blanket, and place a warm hat on their head
   - skin-to-skin contact with the mother will also help stabilize the infant’s temperature, and encouraging early breastfeeding will provide energy for heat generation.
2. Monitor infant’s temperature
   - ensure it stays between normal range of 36.4 to 37.2 C
   - temperature is stable -> bathe infant in a warm, draft-free environment
   - dry them thoroughly, wrap them in a warm blanket, and keep their head covered with a hat

Question 13

what to do if you are caring for an infant experiencing cold stress?

Answer 13

1. eliminate all mechanisms where heat could be lost by convection, radiation, evaporation, or conduction
2. slowly rewarm infant under a radiant warmer or incubator or use a heated water mattress in extremely cold infant
3. attach skin probe securely to the infant’s skin, and use servo-control
   - functions like a thermostat to maintain a constant temperature at the skin probe site
   - prevents overheating and hyperthermia
   - check their temperature frequently until it’s stable
   - monitor their glucose

Report to the HCP if:
- their glucose level is low
- initiate feedings per protocol or IV glucose, as ordered
- keep a close eye on their respiratory status
- report signs of respiratory distress, including tachypnea, retractions, nasal flaring, decreased oxygen saturation, or apnea
- provide warm, humidified oxygen, & prepare for further measures to support the infant’s respirations, as indicated.