support until the lungs clear O2 hold PO feeds IVF with expected recovery in 24-72 hours

Care of the Neonate Flashcards by Lindsay Paxton

Within minutes after birth…

-a newborn has to initiate respirations -adapt a circulatory system to extrauterine oxygenation

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Within 24 hours…

-neurologic, renal, endocrine, and GI functions must be operating competently for life to be sustained

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Fetal breathing starts…

11 weeks

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Fetal breathing is characterized by…

minimal circulation to the pulmonary bed

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intrauterine oxygenation occurs via..

placenta -no gas exchange in fetal lungs

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Fetal lungs are…

fluid filled -some reduction in this prior to birth -there is still 100mL of fluid remaining in the respiratory passages at delivery

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Intrauterine role of surfactant

-promotes lung maturity by overcoming surface tension inside and outside the alveolar sacs in the fetus -surfactant peaks at 35 weeks and remains high

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How is blood shunted

-shunted away from the pulmonary (right side) circulation via the foramen ovale and ductus arterisus

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Extra uterine circulation begins…

with the first breath

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Respiratory gas exchange in conjunction with marked circulatory changes…

must occur immediately for the baby to begin life as a separate being

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what 2 changes are needed to maintain life

-lungs must expand and allow for pulmonary ventilation -marked increase in pulmonary circulation

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Initiation of Respirations

-thoracic squeeze decreases fluid further -chest wall recoil-small amount of air in, more fluid out -chemoreceptor response to decrease pO2, pH, and increase in CO2 -cold air means less resp effort -sensory stimuli including tactile, auditory, and visual that stimulate resp effort

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What happens after umbilical cord is clamped and respirations are initiated

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3 Anatomic Shunts that normally close after delivery

Foramen Ovale
Ductus Arteriosus
Ductus Venosus

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Why do the 3 shunts close after delivery?

due to the response to pressure gradient shifts following the first few breaths

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What happens to pulmonary blood flow with first few breaths?

lung fluid has been removed
pulmonary vascular resistance decreases and pulmonary blood flow increases
sometimes this doesn’t happen right away and the baby develops Transitory Tachypnea of the Newborn (TTN)

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Tx for TTN

support until the lungs clear
O2
hold PO feeds
IVF with expected recovery in 24-72 hours

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Initial steps for newborn

drying
warming
stimulation
positioning
clear airway
necessary for all newborns

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Immediately after delivery, look at…

general appearance
color and cry
ease of breathing

first exam begins as nurse is drying, stimulating and wrapping infant or when infant is placed on mothers abdomen after being born

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Skin to skin

promotes bonding and breastfeeding

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Immediate newborn care

wear gloves
maintain airway
- suction, O2 prn
- RR: 30-70’s
- Apgar score
Neutral thermal environment
- warmer, maintain temp of 36.5-37.2 C
Safety ID Bands

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Convection

losses from circulating air

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Radiation

body heat transferring to nearby objects

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Evaporation

heat loss when moisture on baby vaporizes into air

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Conduction

body heat lost when baby in direct contact with cold object

Increase in muscular activity

shown by crying and restlessness (increases BMR)

Non-shivering thermogenesis

unique to newborns -uses the infants stores of brown fat

brown fat

found in the midscapular area, around the neck, axillas, trachea, kidneys, and adrenal glands

Cold Stress

* Hypothermia 1. ↑ O2 consumption (to keep warm) that leads to ↑ RR 2. Pulmonary vasoconstriction and Peripheral vasoconstriction 3. ↓ O2 to tissues causing Anaerobic glycolysis OR metabolic acidosis

Metabolic acidosis

↓O2, ↑ CO2 leading to ↓ pH (acid)

Cord Clamping

* keep at level of uterus * approx 45 second delay in clamping has benefits * place clamp approx 1 inch from abdomen * Assess for 2 arteries and 1 vein * Remove plastic clamp in about 24 hours and offer save it for parents

Apgar Scoring System

Taken at 1 minute and 5 minutes * 7-10 good condition * 4-6 moderately depressed * 0-3 severely depressed

Normal neonate axillary temp

36.5-37.2

Normal neonate respirations

30-60

Normal neonate apical pulse

120-160

Normal neonate BP

not generally done 80-60/45-40

Normal neonate weight

2500-4000g

Normal neonate length

46-56cm

Normal neonate head circumference

32-37cm

Immediate care

* vit k injection * check cord clamp * footprints and ID bands * security tag

Vitamin K Injection

Protection from hypoglycemia

* closely monitor * SGA, LGA, IUGR * Stressed infants * infants of DM * Cold stress * symptomatic * feed as soon as possible

Hypoglycemia Heel Stick Procedure

* blood sugar norm: 45-60 * blood sugar \<45 * requires feeding * blood sugar \<20-25 * requires parenteral glucose * warm heel, select size and correct heel location

Newborn screening

* Development - orderly and predictable * newborn screening * Metabolic disorders * phenylalanine/phenylketonuria PKU * several genetic disorders * F/U care home health after d/c home * 2 weeks, then 2-4-6-9-12 months

SGA

small less than 2500

LGA

large over 4000g

IUGR

intrauterine growth restriction

Vernix Caseosa

Arocyanosis

Erythema Toxicum

Milia

Fontanels

Anterior: Posterior:

Molding of head influenced by vaginal birth

Caput succedaneum

Cephalohematoma

Digits/Polydactyly

Palmar Crease - Simian Crease

Male Genitalia Exam

Determine meatus location: Hypospadias Epispadias Warm hand when inspecting scrotum Palpate testes separately Assess for hydrocele

Female Genitalia Exam

* Examine * Labia majora * Labia minora * clitoris * Observe for pseudo-menstration

Reflexes

1. Root 2. Suck 3. Swallow 4. Moro 5. Babinski

2 parts to Gestational Age Assessment

1. External physical characteristics 2. Neurological characteristics

Physical Maturity Charcteristics

* resting posture * skin * lanugo * plantar creases * breast tissue * ear formation and cartilage development * evaluation of genitals

Early assessment of neonatal distress

* parental teaching * observe for: * changes in color or activity * grunting or sighing sounds * rapid breathing * chest retractions * facial grimacing

Non Breastfed Feeding guidelines

* 1st feeding by 5 hours of age, 2nd period of reactivity * enfamil, similac, good-start 20 kcal/oz * various bottles and nipples available NUK nipple vs. standard and high flow versus normal. DR. brown bottles may help with reduction in gas * no honey on pacificer - risk of botulism

General Feeding Guidelines

* establish a feeding routine after the first week or so * incorporate baby's cues into feeding routine * initially feed q3-4 hours * identify signs of intolerance including reflux, emesis, diarrhea * burping q 1-2 ounces * keep mixed formula in the fridge * dilute correctly when using concentrate

Care of the Neonate Flashcards

(66 cards)