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Women's health > Care of newborn > Flashcards

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
Q

What is conduction?

A

Transfer of heat from object to object when the two objects are in direct contact with each other

26
Q

What is convection ?

A

Flow of heat from body surface to cooler surrounding circulating over a body surface

27
Q

What is evaporation ?

A

Loss of heat when a liquid is converted to a vapor

28
Q

What is radiation?

A

Loss of body heat to cooler, solid surfaces in close proximity but not in direct contact

29
Q

What are the measures to prevent hypothermia?

A
  • 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
Q

Evaporation

A

Dry infant immediately

31
Q

Conduction

A

Place on mother’s body skin to skin

32
Q

Convection

A

Cover with a blanket and wear a cap

33
Q

Radiation

A

Keep away from cold windows and cold objects

34
Q

What is maintaining thermoregulation?

A
  • It is referred to as maintaining a neutral thermal environment
    Heat loss is minimal
    Oxygen consumption needs are at their lowest
35
Q

What hypothermia can cause?

A
  • Hypoglycemia

- Increased oxygen needs

36
Q

Overheating

A
  • Large body surface area
  • Limited insulation
  • Limited sweating ability
37
Q

What is the immediate care to keep baby warm?

A
  1. room temperature : 22 - 25
  2. Place infant under warmer
  3. monitor body temperature
38
Q

What other interventions to prevent heat loss?

A
  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
Q

What are the immediate actions the nurse must perform to ensure the well-being of the newborn?

A
  1. Clear airway
  2. Ensure heart rate is above 100 beats per min.
  3. Keep infant warm
40
Q

What is the first physical examination in ( delivery suite)?

A
  • Exclude birth injury
  • Detect malformations
  • Assess maturity
41
Q

What is the first physical examination in ( delivery suite)?

A
  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
Q

What are the safety needs of the newborn?

A
  • 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
Q

What is the care of the umbilical cord stump?

A

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
Q

When should the umbilical cord stump drop?

A

Good umbilical cord care will help the stump dry up and fall off within the first
one to three weeks after birth.

45
Q

What is the prevention of bleeding in newborn?

A

Prevention of haemorrhage

46
Q

What is vitamin K prophylaxis?

A 
• 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
Q

What is newborn at risk for?

A

Newborns are at risk for vitamin K deficiency bleeding (VKDB) caused by inadequate prenatal storage and deficiency of vitamin K in breast milk.

48
Q

what is the prevention of infection?

A
  • Immature immune syste
  • Thin & fragile skin
  • Low level of phagocytes
  • Low level of antibodies
  • Rely on passive immunity from mother
49
Q

What is the normal vital signs?

A

Temperature : 36.5 - 37.5
Heart Rate : 120 - 160 beats / min
Respiration rate : 40 - 60 breaths / min

50
Q

What are the psychological needs?

A

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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