Ch 43 Neonatal Care Flashcards
What is the difference between a newborn and a neonate? (pp 2378–2380)
newborn : an infant in the first 24 hrs of life
neonate : an infant in the first month after birth.
What are antepartum (pre-birth) risk factors for neonatal resuscitation? (p 2379)
maternal conditions such as diabetes, hypertension, and infections.
Age of mother <16, >35
Polyhydramnios (excessive amount of amniotic fluid)
Drug abuse
Lack of prenatal care
Hx of perinatal morbidity
What are intrapartum (during birth) risk factors for neonatal resuscitation? (p 2379)
premature labor
prolonged labor
fetal distress
meconium-stained amniotic fluid
Prolapsed cord
Placenta Previa
Breech presentation
What is the process of transitioning from a fetus to a newborn, fetal transition? (pp 2379–2380)
Fetal circulation has 3 major blood flow shunts from that oof adults. At birth, the 3 ducts, foramen ovale, ductus venous, and ductus arteriosus close off.
The transition involves physiological changes such as the initiation of breathing (triggered by mild hypoxia), circulation changes, and thermoregulation.
What are the causes of delayed transition in newborns? (pp 2380–2381)
Hypoxia
Acidosis
Meconium or blood aspiration
Hypothermia
Hypotension
Sepsis
What measures should be performed for neonatal resuscitation? (pp 2384–2387)
Warm, dry, suction, stimulate
Labored breathing? PPV
HR below 60? CPR
Intubate
Epi
What equipment is needed for neonatal resuscitation? (p 2382)
BVM, O2, suction, cardiac monitor, medications, stethoscope, OB kit.
What are the initial steps of assessment for neonates? (pp 2380–2387)
Initial steps include drying and warming, positioning, suctioning, and stimulation.
How do you measure essential parameters for neonates? (pp 2380–2387)
pulse rate
color
respiratory effort
Assess visually and with monitoring devices
What are Apgar scores and when are they obtained? (pp 2383–2384)
Apgar scores assess a newborn’s health at 1 and 5 minutes after birth, evaluating heart rate, respiratory effort, muscle tone, reflex response, and color.
How do you determine if a neonate requires resuscitation? (pp 2380–2387)
Assessment includes evaluating heart rate, respiratory effort, and overall color and tone of the neonate.
What methods improve oxygenation during neonatal resuscitation? (pp 2388–2392
Methods include using positive end-expiratory pressure, free-flow oxygen, oral airways, and bag-mask devices.
What is the technique for using a bag-mask device on a neonate? (pp 2389–2390)
The technique involves proper positioning, cleared of secretions, sniffing position, creating a seal, and delivering breaths at 40-60. Peak inspiratory pressure is 25mm hg for newborns, lower for preemies.
First few breaths after birth will frequently require higher pressures (around 30mm hg) because the lungs are not fully expanded and are still full of fluid.
When is endotracheal intubation required in a neonate? (pp 2390–2392)
Intubation is required when meconium stained fluid is present, congenital hernias (when intestines are on the outside of the body) severe respiratory distress, inability to maintain airway, or when bag-mask ventilation is ineffective.
What are vascular access considerations in the neonate? (pp 2394–2395)
IO are used most commonly, umbilical vein (uncommon) can be used if you’ve been trained to and your local protocols allow.
What are pharmacologic considerations for neonates? (p 2395)
Considerations include dosing adjustments based on weight. Epi is usually the only drug used for neonates, when a HR is persistently below 60. Most newborns can be resuscitated with effective ventilatory support.
What family and transport considerations apply to neonatal emergencies? (pp 2395–2396)
A.) Keep family informed. Do not be specific about survival statistics. A lot of factors are in play and you do not want to mislead the family.
B.) Local hospital for stabilization, then transport to specialty hospital.
What are the pathophysiology, assessment, and management of emergencies in neonates? (pp 2397–2401)
apnea, bradycardia, acidosis, and respiratory distress, requiring prompt assessment and intervention.
What is the pathophysiology, assessment, and care of premature or low-birth-weight infants? (pp 2401–2402)
Care involves monitoring for complications such as respiratory distress and ensuring adequate nutrition and thermal regulation.
Clearing airway, stimulation, O2, PPV & CPR if necessary.
What is the pathophysiology, assessment, and management of seizures in neonates? (pp 2402–2404)
Management includes identifying the cause, providing supportive care, and considering anticonvulsant therapy.
What is the pathophysiology, assessment, and management of hypoglycemia in neonates? (pp 2404–2406)
Management includes monitoring blood glucose levels and administering glucose as needed.
What is the pathophysiology, assessment, and management of vomiting in neonates? (pp 2406–2407)
Some vomiting after birth is normal.
Persistent vomiting suggests obstruction of upper GI tract or increased ICP.
Dark blood suggests GI bleed.
ABC’s
Suction
O2
Gastric tube if necessary to decompress the stomach
Possible fluid resuscitation.
Transport newborn on their side.
What is the pathophysiology, assessment, and management of diarrhea in neonates? (pp 2407–2408)
5-6 avg daily stools for an infant
Most common cause of diarrhea is virus’
Another common cause is lactose intolerance
ABC’s
Fluids
What is the pathophysiology, assessment, and management of neonatal jaundice? (p 2408)
Caused by immaturity of the liver, affects the body’s ability to conjugate & excrete bilirubin from RBC breakdown in the 1st week of life.
Can result from hemolysis, ABO group incompatibility, Rh incompatibility, RBC disorders, polycythemia.
Cholestasis can present after the 1st 2 wks of life, resulting in hepatitis, metabolic disorders, and malnutrition.
What is the pathophysiology, assessment, and management of thermoregulation emergencies in neonates? (pp 2408–2410)
Newborn Norm is 99.5 F or 37.5 C
Neonate norm is 97.9 F or 37.2 C
Fever is considered 100.4F/38C
Infections can cause hypothermia
Fever can cause dehydration, hypoglycemia & metabolic acidosis, can present with petechiae
Do not sweat when hot, to allow cooling, they do not shiver to raise temps when cold
What is the pathophysiology, assessment, and management of common birth injuries? (pp 2410–2412)
Can occur d/t baby size or positioning. Conditions associated with include 1st pregnancy, prolonged or rapid labor, cephalopelic (mom’s pelvis is inadequate), abnormal presentation, prematurity, deliveries involving instruments.
Caput succedaneum - swelling of soft tissues of baby’s scalp
Cephalohemtoma - area of bleeding over any cranial bones
Linear Skull fxs
Brachial Plexus injury - nerve damage; Erb Palsy (C5-C6) or Klumpke paralysis (C8-T1), rare and results in weakness of hand muscles.
Diaphragmatic Paralysis - cervical roots injured, causing respiratory distress, hypoxemia, hypercapnia, & acidosis.
Laryngeal nerve injury
Spinal Cord Injury
Clavicle Fx
Long bone fx
Intra-abdominal injury - liver contusion, splenic rupture, or adrenal hemorrhage 4
An abnormal opening in the heart wall or septum that separates the atrial chambers of the heart.
Atrial Septal Defect
What time of gestation is considered Term?
38-42 weeks
What time of gestation is considered Preterm?
Prior to 38 weeks
What gestation time is considered Postterm?
After 42 wks
Agar Scoring is based off of 5 things. What are they?
Appearance
Pulse
Grimace/irritability
Activity
Respiration
Highest score of 2 for perfect score on each
Lowest score of 0 for worst condition
Highest score that can be obtained is 10
Lanugo is the fine hairs that cover the entire body of preterm babies. If it is present on the face at time of birth, you can estimate that the baby is what gestational age?
Between 32-37 wks
Potential cause of Neonatal Seizures.
Developmental defects
Drug withdrawal
Encephalopathy
Epilepsy
Hypocalcemia
Hypoglycemia
Intracranial Hemorrhage
Intracranial Infections
Meningitis
Other Metabolic disturbances
What is the most commonly fx’d bone in newborn during birth?
Clavicle
An abnormal opening that separates the ventricles of the heart.
Ventricular Septal Defect
A narrowing of the aorta
Coarctation of the Aorta
When the pulmonic valve becomes damaged, causes is a decrease in blood flow to the lungs.
Pulmonary Stenosis
When the pulmonary artery & aorta are combined.
Truncus Arteriosus
When the tricuspid valve is missing….
Tricuspid Atresia
Underdeveloped L side of the heart. Mitral & Aortic Valves may be underdeveloped of closed, extremely small aorta, small L ventricle.
Hypoplastic Left Heart Syndrome
Combination of 4 heart defects; ventricle septal defect, pulmonary stenosis, R ventricle hypertrophy, an overriding aorta (the aorta lies directly over the ventricular septal defect.
Tetralogy of Fallot
When the positions of the pulmonary artery and aorta are reversed
Transposition of the great arteries
A rare congenital defect in which the 4 pulmonary veins do not return to the left atrium as they should.
Total anomalous pulmonary venous return.
What are these the S/S of: Decreased urinary output, skin turgor, mucous membranes, sunken eyes can be signs of dehydration.
Diarrheal Emergency
Risk factors for hypothermia:
All newborns 8-12hrs after birth
endocrine disorders
hypoglycemia
home births
inadequate warming after birth
small for gestational age
cardiorespiratory abnormalities
CNS abnormalities
infections
prematurity
Methods for treating hypothermia in newborns:
Blankets, caps, skin-to-skin contact, never use hot water bottles, IF heat packs are used, never place directly on skin.
Read on each of the cardiac complications in newborns. Too much technical info to put in flash cards.
