Chapter 26 Nursing Care of Newborn and Family Flashcards
14 Questions on exam (and chapter 25)
What are the primary Newborn Needs after birth?
- Physiological Monitoring and Intervention
- Protection
- Warmth, body hygiene and nutrition
- Nurturing needs
What two Assessments are performed after birth?
Initial assessment using APGAR score and an initial physical assessment
What is body systems and physiology is part of the nurses Initial Physical Assessment?
- General appearance
- Central nervous system
- Cardiovascular system
- Respiratory system
- Skin
- Eyes, ears, nose, and throat
- Genitourinary system
- Gastrointestinal system
What is the APGAR assessment?
Rapid assessment of the newborn’s transition to extrauterine life; Based on 5 signs, each scored from 0-2
1) Appearance, colour
2) Pulse
3) Grimace, reflexes
4) Activity, muscle tone
5) Respirations
How often is the AGPAR assessment done?
At 1 and 5 minutes after birth
Reassessed at 10-20 minutes if their score was less than 7
What do the AGPAR scores indicate?
Score 0-3: severe distress
Score 4-6: moderate difficulty
Score 7-10: the newborn is having minimal or no difficulty adjusting to extrauterine life
Nursing Care involved in Airway Maintenance for newborns
- Side-lying position to help clear secretions then returned to supine
- Suction secretions in the nasal passage (obligatory nose breathers) and mouth if necessary
- Listen to respirations and auscultate lung sounds for crackles, rhonchi, stridor
How long should the nurse suction for?
No more than 5 seconds at a time to prevent vagal stimulation and hypoxia
Keep wall suction pressure to less than 80 mmHg
What are the four conditions essential for maintaining adequate O2 supply?
1) Clear Airway
2) Effective Respirations
3) Adequate Circulation, Perfusion and Cardiac function
4) Adequate Thermoregulation
Signs of Complications or Respiratory Distress in a newborn
- Abnormal respirations resulting in tachypnea or bradypnea (<30 or >60 breaths/min)
- Abnomal breath sounds (wheezing, rhonchi, stridor, grunting, diminished/absent air movement, crackles)
- Nasal flaring, retractions, apnea
- Cyanosis or mottling
- O2 sats <95%
Are crackles normally present upon auscultation after birth?
Yes. Crackles can be heard in the first few hours after birth.
How do Nurses maintain proper Body Temperature in a newborn?
- Adequate drying and wrapping after birth
- Early skin-skin contact with parents to stabilize temperature
- Keep the head well covered and the ambient temperature between 22-26 C
- ## Use of warmers when parent and child are separated
What are the benefits of early skin-to-skin contact?
- Strengthens parent-child relationship
- Increased oxytocin and prolactin in the mother
- Improved initiation of suckling activity in the newborn
- Temp stabilization
- Reduced crying
What is a thermistor probe used for?
Detects minor changes in temperature from the external environment or newborn factors (peripheral vasoconstriction, vasodilation, or increased metabolism)
How often should a newborn axillary (armpit) temperature be checked?
Every hour or more if needed until their temperature stabilizes
What is Ophthalmia neonatorum?
Inflammation of the eyes from gonorrheal or chlamydial infection.
The newborn can contract this during passage through the birth canal
What Eye Prophylaxis treatment is available to prevent Ophthalmia neonatorum after vaginal birth?
Erythromycin, an antibiotic.
Why is Vitamin K Prophylaxis administered after birth?
Prevents hemorrhagic disease of the newborn (HDNB). Vitamin K promotes the formation of clotting factors. Vitamin K is made by intestinal flora which is not present at birth but is introduced through the first feedings. Newborns can produce their own vitamin K by day 7.
What is the importance of assessment of gestational age?
It is important because perinatal morbidity and mortality rates are related to gestational age and birth weight
What is the New Ballard score?
Measures gestational ages of newborns between 20 weeks-36 weeks gestation.
Assesses 6 external physical and 6 neuromuscular signs, each with a numbered score that will cumulate to a maturity rating (gestational age)
What is classified as Large for gestational age (LGA)?
above
ninetieth percentile
What is classified as Small for gestational age (SGA)?
below tenth percentile
