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Care of newborn Flashcards

1
Q

What is the transition from intrauterine environment?

A

Intrauterine :

  • Oxygen
  • Nutrition
  • Excretion
  • Thermoregulation
  • Free from infection
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2
Q

What are the adaptions to extra- uterine life?

A

The newborn needs to establish breathing within 1 min

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3
Q

What is the stimuli to establish breathing within 1 minute?

A
  • Chemical – rise in CO2, fall in O2 level
  • Mechanical – chest compression, compression & decompression of the
    head
  • Sensory – Temperature, touch, noise, lights
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4
Q

What are the respiratory system adaptations?

A
  • Initiation of respirations: adjusting from a fluid-filled intrauterine environment
    to gaseous extrauterine environment
  • Role of surfactant: surface tension reducing lipoprotein that prevents alveolar surface
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5
Q

What is the difference in respiratory system between fetus and newborn?

A

Fetus :
Fluid-filled, system causes blood to be shunted from the lungs through ductus arteriosus to the rest of the body

Newborn :
Air-filled, low-pressure system encourages blood flow through the lungs for gas exchange., increased oxygen concentration in the lung contributes to the closing of ductus arteriosus ( becomes a ligament )

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6
Q

What is the difference in site of gas exchange between fetus and newborn?

A

Fetus : Placenta

Newborn : Lungs

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7
Q

What is the difference in site of circulation through heart between fetus and newborn?

A

Fetus : Pressures in the right atrium are greater than in the left, encourages blood flow through foreman ovale.

Newborn : Pressure in the left atrium are greater than the right, causing the foreman ovale to close

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8
Q

What is the difference in site of hepatic portal circulation between fetus and newborn?

A

Fetus :
Ductus venous bypasses, maternal liver performs filtering functions

Newborn :
Ductus venosus closes ( becomes a ligament ), hepatic portal circulation begins

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9
Q

What is the difference in site of thermoregulation between fetus and newborn?

A

Fetus :
Body temperature is maintained by material body temperature and the warmth of the intrauterine environment

Newborn :
Body temperature is maintained through a flexed posture and brown fat

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10
Q

What are the inital assessment?

A 
Heart rate ( at rest ) : 120 - 160 bpm 
Respiratory rate : 30 - 60 bpm
Rectal Temperature : 36.5 - 37.5
Blood pressure : 
Systolic : 50 - 75 mmHg
Diastolic : 30 - 45 mmHg
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11
Q

What is the average range of term newborn?

A

Weight : 2.5 - 4kg
Length : 44 - 52cm
Head circumference : 32 - 38cm

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12
Q

What is the apgar score?

A

It is a score for each sign at 1 & 5 minutes after birth. If there are problems an additional score is given at 10 mins.

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13
Q

What are the ranges for apgar score?

A

7 - 10 : Normal
4 - 7 : may require some resuscitation
3 and below : requires immediate resuscitation or below, requires immediate resuscitation

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14
Q

APGAR :

A 
A : appearance ( skin colour )
P : pulse
G. : grimace ( reflex irritability )
A : activity ( muscle tone )
R : respiration
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15
Q

Appearance score

A

0 : blue-gray, pale all over
1 : normal, except for extremities
2 : Normal over entire body

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16
Q

Pulse score

A

0 : Absent
1 : Below 100 bpm
2 : above 100 bpm

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17
Q

G : Grimace score

A

0 : No response
1 : Grimace
2 : Sneeze, cough, pull aways

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18
Q

A : Activity

A

0 : Absent
1 : Arms and Legs flexed
2 : Active movement

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19
Q

R : Respiration

A

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

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20
Q

Immediate care of the newborn

- get ready equipment for resuscitation

A
  1. ambient temperature
  2. resuscitate
    - Oxygen
    - Suction apparatus
    - Suction catheters ( 6,8,10F)
    - warmer
    - linen ( towels ), cord clamp
    - emergency drugs
    - air viva
    - Intubation equipment
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21
Q

Whar are the requirements to extra-uterine life?

A
  • Mature respiratory centre
  • Mature lungs
  • Adequate surfactant
  • Clear airway
22
Q

What is airway clearance?

A
  • wipe away excess mucus from the mouth
23
Q

What are the respiratory rate and pattern?

A

40 to 60 breaths per minute ; irregular, shallow, unlaboured ; short periods of apnea ( < 15s. ) ; symmetrical chest movements

24
Q

What are the different mechanisms of heat loss?

A
  1. Radiation
  2. Convection
  3. Conduction
  4. Evaporation
25
What is conduction?
Transfer of heat from object to object when the two objects are in direct contact with each other
26
What is convection ?
Flow of heat from body surface to cooler surrounding circulating over a body surface
27
What is evaporation ?
Loss of heat when a liquid is converted to a vapor
28
What is radiation?
Loss of body heat to cooler, solid surfaces in close proximity but not in direct contact
29
What are the measures to prevent hypothermia?
- Delivery in a warm environment - 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
30
Evaporation
Dry infant immediately
31
Conduction
Place on mother's body skin to skin
32
Convection
Cover with a blanket and wear a cap
33
Radiation
Keep away from cold windows and cold objects
34
What is maintaining thermoregulation?
- It is referred to as maintaining a neutral thermal environment Heat loss is minimal Oxygen consumption needs are at their lowest
35
What hypothermia can cause?
- Hypoglycemia | - Increased oxygen needs
36
Overheating
- Large body surface area - Limited insulation - Limited sweating ability
37
What is the immediate care to keep baby warm?
1. room temperature : 22 - 25 2. Place infant under warmer 3. monitor body temperature
38
What other interventions to prevent heat loss?
1. Place under warmer 2. Dry infant well at birth (especially the head) 3. Remove wet linen & wrap with warm dry towel & blanket (cover head) 4. Initial bath when temperature is stable (not a routine) – discontinued 5. Avoid unnecessary exposure 6. Adjust room temperature as required 7. Change clothing/ linen when wet/ moist 8. Cover weighing scale, warm hands, warm stethoscope 9. Add blanket, cap, booties 10. Monitor temperature (axilla: 36.5 - 37 C) 11. If temperature < 36.5 C, rewarming (caution: hyperthermia) 12. Initiate Skin to skin care (Kangaroo Care) with the mother
39
What are the immediate actions the nurse must perform to ensure the well-being of the newborn?
1. Clear airway 2. Ensure heart rate is above 100 beats per min. 3. Keep infant warm
40
What is the first physical examination in ( delivery suite)?
- Exclude birth injury - Detect malformations - Assess maturity
41
What is the first physical examination in ( delivery suite)?
1. Identify gender of baby 2. Examine head to toe 3. Any obvious abnormalities, birth injury 4. Presence of cleft lip & palate 5. Cord clamp is secured 6. Congenital dislocation of the hips 7. Abnormality of the spine 8. Imperforate anus
42
What are the safety needs of the newborn?
- Correct identification – right baby to right parent (mother) - Identification tags X2 at ankle(s) or wrist - Ensure tag is not too tightly applied - Radio-frequency identifier (RFID) tag
43
What is the care of the umbilical cord stump?
Cord clamp ( 2 to 3cm from umbilicus ) - In the first 24 hours, check the cord for bleeding - The umbilical stump needs particular attention as there are risks of infection - Keep cord stump exposed, clean with moist cotton swab and to allow it to air dry
44
When should the umbilical cord stump drop?
Good umbilical cord care will help the stump dry up and fall off within the first one to three weeks after birth.
45
What is the prevention of bleeding in newborn?
Prevention of haemorrhage
46
What is vitamin K prophylaxis?
``` • placenta transfer is poor • sterile bowel • low levels in breast milk • administering vitamin K to mothers before birth does not prevent deficiency ``` • Single intramuscular dose is sufficient
47
What is newborn at risk for?
Newborns are at risk for vitamin K deficiency bleeding (VKDB) caused by inadequate prenatal storage and deficiency of vitamin K in breast milk.
48
what is the prevention of infection?
- Immature immune syste - Thin & fragile skin - Low level of phagocytes - Low level of antibodies - Rely on passive immunity from mother
49
What is the normal vital signs?
Temperature : 36.5 - 37.5 Heart Rate : 120 - 160 beats / min Respiration rate : 40 - 60 breaths / min
50
What are the psychological needs?
Parent-infant interaction - Rapport with parents - Skin to skin contact - Cuddling - Put baby to the breast - Parental involvement (cutting cord, bathing) - Infant behaviour

Women's health (9 decks)

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