Chapter 21: Care Of The Normal Newborn Flashcards

1
Q

APGAR Score

A

Method for rapid evaluation of the infant’s cardiorepsiratory adaptation after birth

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2
Q

What does APGAR stand for?

A
A - Appearance (color)
P - Pulse (HR)
G - Grimace (reflex response)
A - Activity (muscle tone)
R - Respirations (respiratory effort)
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3
Q

What is a normal APGAR score?

A

8-10

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4
Q

An APGAR score of < 7 indicates

A

Need to watch out for neurological damage.

Watch baby closely.

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5
Q

How is an APGAR score obtained?

A
  • Nurse scores an infant at 1 minute and 5 minutes in each of the five areas.
  • Assessments are arranged from most important to least
  • Infants are assigned a score of 0-2 in each of the five areas and the scores are totaled.
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6
Q

Resuscitation should NOT be delayed until

A

The 1 minute score is obtained.

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7
Q

General guidelines for infant’s care is based on 3 ranges of 1 minute scores:

A
  1. 0-2
  2. 3-6
  3. 7-10
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8
Q

Vitamin K (Phytonadione): Indication

A

Given to neonates because they receive only small amounts of the vitamin from the mother and cannot synthesize vitamin K in the intestines without bacteria.

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9
Q

What is the action of vitamin K?

A

Promotes the formation of clotting factors by the liver (II, VII, IX, X)

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10
Q

What is the usual dose of vitamin K?

A

0.5 to 1 mg

IM, usually within 1 hour after birth.

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11
Q

What are adverse effects of Vitamin K?

A
  • Erythema, pain and edema at injection site.

- Anaphylaxis, hemolysis and hyperbilirubinemia

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12
Q

Nursing Considerations for Vitamin K:

A
  1. Protect the drug from light until just before administration
  2. Observe all infants for signs of Vitamin K deficiency (ecchymoses or bleeding from any site)
  3. Check that the infant had Vitamin K before a circumcision is performed.
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13
Q

Erythromycin Opthalmic Ointment: Indications

A

Prophylaxis against organisms Neisseria gonorrhoeae and clamydia trachomatis.

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14
Q

Erythromycin Ophthalmic Ointment helps prevent:

A
  • ophthalmia neonatorum in infants of mothers infected with gonorrhea
  • conjunctivitis in infants of mothers infected with chlamydia
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15
Q

Prophylaxis against gonorrhea

A

Is required by law for all infants, even if the mother is not known to be infected.

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16
Q

Normal Dosage and Route of Erythromycin Ophthalmic Ointment

A
  • A ribbon of ointment (~1 cm long)

- Applied to lower conjuctival sac of each eye within 1 hour after birth.

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17
Q

What are adverse reaction of Erythromycin Ophthalmic Ointment?

A
  • Burning, itching
  • Irritation may result in chemical conjunctivitis lasting 24-48 hours
  • May cause temporary blurred vision.
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18
Q

Nursing Considerations for application of Erythromycin Ophthalmic Ointment

A
  • Cleanse infant’s eyes as need before application.
  • Hold tube horizontal rather than vertical to prevent injury to eye from sudden movement
  • Administer from inner to outer canthus
  • Do not touch tip of tube to any part of the eye (may spread infectious material from one eye to another)
  • Do not rinse. Ointment may be wiped from outer eye after 1 minute.
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19
Q

If any discharge from the eyes, especially purulent, is noted, this should alert the nurse to

A

A possibility of infection. (Culture may be ordered and drainage should be removed with sterile saline and cotton ball)

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20
Q

Erythromycin Ophthalmic Ointment can be delay until

A

The end of the first hour after birth without adverse effects.

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21
Q

Hepatitis B Vaccine: Indications

A
  • Prevents hep B in exposed and unexposed infants

- Provides immunization against hep B infection

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22
Q

Hep B Vaccine: Dosage and Route

A

-5mcg (recombivax HB)
-10 mcg (energix-B):
1st dose: before discharge
2nd dose: age 1-2 months
3rd dose: 6-18 months

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23
Q

What are contraindications to Hep B vaccinations?

A

Hypersensitivity to yeast

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24
Q

What are adverse reactions to Hep B?

A

Pain or redness at site
Fever
Fatigue
Headache

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25
Q

Nursing Considerations for administration of Hep B Vaccine

A
  • If used vial, shake well before preparing.
  • Give vaccine within 12 hours of birth to infants of infected moms
  • Parenteral administration NOT IV or intradermally (need to obtain parental consent)
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26
Q

Administration of Injections in Newborn: Preparation

A
  • Wash infants thigh if the bath has not been given yet.
  • Use a 1 mL syringe and a 5/8 inch, 25 gauge needle.
  • Use filter if drawing medication from glass ampule.
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27
Q

Administration of Medication in Newborns: Injection

A
  • Cleanse area with alcohol wipe.
  • Stabilize leg firmly while grasping thigh between the thumb and fingers.
  • Insert needle at 90 degree angle
  • Withdraw the needle and apply gentle pressure to the site with an alcohol wipe.
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28
Q

Where is the best site for injection in newborns?

A
  • Vastus lateralis muscle.
  • Divide area between the greater trochanter of the femur and the knee into thirds.
  • Give the injection in the middle third of the muscle, lateral to the midline of the anterior thigh.
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29
Q

Monitoring Safe Glucose Levels

A

Assess all newborns for risk factors associated with decrease blood glucose levels.

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30
Q

A newborns temperature should be assessed PRIOR to **

A

Accucheck

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31
Q

Blood glucose levels should be noted it they are at what levels?

A

< 40-45 mg/dL

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32
Q

Interventions for Hypoglycemia

A
  1. Feed the newborn if glucose screening shows a level of <40-45 mg/dl to prevent further depletion of glucose.
  2. Infants with severe hypoglycemia may need IV feedings to provide glucose rapidly. (For most infants, breastfeeding or giving formula is sufficient)
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33
Q

For hypoglycemia, agency protocols usually allow the nurse to

A

Intervene for hypoglycemia and then notify the physician of the infant’s response.

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34
Q

Planning for hypoglycemia revolves around the nurses role including:

A
  1. ) assess for signs of hypoglycemia
  2. ) Notify physician about signs of hypoglycemia or follow hospital protocol for infant’s with signs of hypoglycemia and then notify physician
  3. ) Intervening to minimize hypoglycemia.
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35
Q

Why is glucose-water alone not recommended for newborns?

A

Increases glucose level = increases insulin production = decrease glucose level.

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36
Q

What can provide a longer-lasting supply of glucose?

A

Milk

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37
Q

If infants do not have enough glucose, what can happen?

A

They may experience a drop in temperature -> respiratory distress as oxygen is needed for NST

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38
Q

Hearing Screening

A
  • Is done on every baby.
  • Auditory screening is performed within the first month.
  • Most common congenital abnormality.
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39
Q

Infants who don’t pass the screening should be

A

-Re-screened.

If they still don’t pass -> audiologic and medical evaluation no later than 3 months of age

40
Q

What is the goal of healthy people 2020 for hearing screenings?

A
  • Newborns screened for hearing impairment: by age 1 month
  • Audiologic evaluation by 3 months of age
  • Enrolled in appropriate intervention services by 6 months of age
41
Q

Types of Hearing Tests include:

A
  • Otoacoustic emissions test

- Acoustic brainstem response test (can be done during sleep)

42
Q

Screening Tests

A
  • Easy and inexpensive

- Requires a blood sample taken from infant’s heel (only one is needed for all tests)

43
Q

When are screening tests performed on infants?

A

24-48 hours after birth.

Further testing is done to confirm any abnormal results.

44
Q

What is the difference between tests done within the first 24 hours of life than those performed after 24 hours of life?

A

Tests done within first 24 hrs of life are less sensitive than those performed after 24 hrs of life.

45
Q

Infants tested before age 12-24 hours should have repeat tests at what ages?

A

1-2 weeks

46
Q

PKU

A

Genetic condition in which the infant cannot metabolize amino acid phenylalanine (common protein foods such as milk).

47
Q

Accumulation of amino acid phenylalanine can lead to

A

Severe intellectual disability

48
Q

Treatment for PKU should be started when?

A

by the third week of life.

49
Q

What is used to treat PKU?

A

Special low-phenylalanine diet

50
Q

How often are complete assessments of newborns done?

A

Q8hrs or according to hospital policy

51
Q

How often are infants weighed?

A

Once daily.

Gain or loss is documented.

52
Q

Assessment of the skin of an infant

A
  • Assess for new marks or changes in old ones
  • Marks on scalp may not be obvious if covered by abundant hair
  • Assess skin turgor
53
Q

What is used to determine when to bathe the infant?

A

A temperature of 98 degrees F (36.7 C) or higher is often used to determine when to bathe the infant.

54
Q

What is the benefit of early bathing of an infant?

A

Early bathing decreases exposure to maternal blood and possible blood borne organisms on the infant’s skin. (i.e hepatitis B or HIV)

55
Q

The bath should be given before

A

The performance of any invasive procedures such as injections or heel sticks that might draw organisms on the skin into the infant’s SQ tissue or bloodstream.

56
Q

What is the benefit of tub bathing versus sponge bathing?

A

Infants maintain their temperatures better during tub bathing than during sponge bathing.

57
Q

Tub Bathing

A
  • In order to keep the infant warm, they should be immersed in water that covers their shoulders.
  • Water temperature should be approximately 38 degrees C (100.4 F)
58
Q

Sponge Bath

A
  • Can be done with infant under the radiant warmer to help maintain infant’s temperature.
  • Should be performed quickly and the infant thoroughly dried to prevent heat loss by evaporation.
59
Q

After bath procedures

A
  • Combing infant hair during bath to remove blood and after bath to hasten drying of the hair.
  • Infant is dried thoroughly.
  • Infant remains under radiant warmer until hair is dry and temperature returns to previous level.
  • Infant is dressed and wrapped in two warm blankets and a cap is placed on head before he or she is removed from radiant warmer.
  • The temperature is rechecked within 1 hour to ensure the infant is maintaining thermoregulation adequately**
60
Q

Diaper Rash can be caused by

A

Frequent stools
Infrequent changing of diaper
Prolonged exposure to diarrhea/urine

61
Q

What is used for cleaning the diaper area?

A

Plain water or mild soap solutions may be used for cleaning the diaper area.

62
Q

If commercial diaper wipes are used, they should be

A

Detergent free and alcohol free

63
Q

Breast feeding needs to occur how often?

A

2-3 hours

64
Q

How often does a baby need to be fed if they are drinking formula?

A

3-4 hours

65
Q

Characteristics of the anterior fontanel

A
  • 4-5 cm from bone to bone (although this varies d/t molding and individual differences)
  • should be flat (level with surrounding bones) or only slightly sunken
  • should feel soft
66
Q

When does the anterior fontanel close?

A

By 18 months of age.

67
Q

Abnormal findings of anterior fontanel

A
  • bulging at rest

- depressed

68
Q

What can cause bulging of the anterior fontanel in newborns?

A

May indicate increased intracranial pressure

69
Q

What can cause a depressed fontanel in a newborn?

A
  • Molding

- After molding resolves, can be a sign of dehydration.

70
Q

The posterior fontanel

A

A triangular area where the occipital and parietal bones meet.

71
Q

Characteristics of the posterior fontanel

A
  • Smaller than anterior fontanel, measuring 0.5-1 cm

- Feels like a dimple at the juncture of occipital and parietal bones

72
Q

When does the posterior fontanel close in a newborn?

A

2-4 months of age

73
Q

What may complicate identification of the posterior fontanel?

A

Molding because it causes overlapping bones to impinge on that space

74
Q

Caput Succedaneum

A

Is a collection of fluid, edematous swelling of the scalp.

75
Q

What causes caput succedaneum?

A
  • Often appears over the vertex of the newborn’s head as a result of pressure against the mother’s cervix during labor.
  • This pressure interferes with blood flow from the area, causing localized edema at birth.
  • May also occur when a vacuum extractor is used to hasten second-stage labor.
76
Q

Characteristics of Caput Succedaneum

A
  • Edematous area crosses suture lines
  • Is soft
  • Varies in size
  • Present at birth or shortly thereafter
77
Q

When does caput succedaneum resolve?

A

Resolves quickly and generally disappears within 12-48 hours**

78
Q

Cephalhematoma

A

Bleeding between the periosteum and the skull as a result of pressure during birth.

79
Q

Characteristics of Cephalhematomas

A
  • Occurs on one or both sides of the head over the parietal bones or occasionally over the occipital bones.
  • Swelling may not be present at birth but may develop within the first 24-48 hours.
  • Does not cross suture lines
  • Does not increase in size with crying
80
Q

How long does it take for a cephalhematoma to resolve?

A

Reabsorbs slowly and may take 2-3 months to completely resolve.

81
Q

Cephalhematoma increases the risk for

A

Jaundice d/t breakdown of RBCs within the hematoma and bruising.

82
Q

Both caput succedaneum and cephalhematoma may be frightening to parents. Therefore, the nurse should

A

Reassure parents that the conditions are not harmful to the infant.

83
Q

Newborn Assessment: Face

A

Should be examined for:

  • Symmetry
  • Facial features
  • Movement
  • Expression
84
Q

Transient Asymmetry of the face

A

Can be a used by intrauterine pressure.

Lasts a few weeks or months.

85
Q

Drooping of the mouth in an newborn

A
  • Appears as a one-sided cry.

- May be caused by facial nerve trauma.

86
Q

Infections in a newborn can be indicated by what signs?

A

Instead of a fever, the infant’s temperature may decrease.

The infant may feed poorly, be lethargic, or have periods of apnea without obvious cause.

87
Q

Average number of stools in bottle fed neonates

A

@ least 1 stool/day

88
Q

Average number of stools in breast fed neonates

A

@ least 4 stools per day

89
Q

What temperatures should baths be for newborns?

A

100-104 degrees F

90
Q

When does the umbilical cord fall off?

A

With in 10-14 days

91
Q

The umbilical cord turns black within

A

2-3 days

92
Q

Yellow scab or crust after circumcision

A

Expect a yellow crust or scab to form over the circumcision site.
This is a normal part of healing and should not be removed.
The scab will fall off within 7 to 10 days

93
Q

Signs of complications of circumcision include the following:

A
  • Bleeding more than a few drops with first diaper changes
  • Failure to urinate
  • Signs of infection: fever or low temperature, purulent or foul-smelling drainage
  • Displacement of the PlastiBell ring
94
Q

Parents of uncircumcised infants should be taught

A

not to retract the foreskin until it becomes separated from the glans later in childhood.

95
Q

Risks of circumcision include

A
  • hemorrhage
  • infection
  • unsatisfactory cosmetic effect
  • urinary retention
  • urethral stenosis or fistulas
  • adhesions
  • necrosis
  • injury to the glans
  • pain during and after surgery.
96
Q

Nonpharmacologic pain relief methods during and after the circumcision include

A

pacifiers, oral sucrose, soothing music, recordings of intrauterine sounds, decreased lights, and talking softly to the infant.

97
Q

The nurse is preparing a newborn for a circumcision. Which pharmacological interventions should the nurse implement to alleviate pain?

A
Acetaminophen may be given throughout the first day for postprocedure pain. 
EMLA cream (eutectic mixture of local anesthetics) may be applied to anesthetize the skin before the procedure.