Class 9 newborn uncomplicated Flashcards
What are the 3 priority assessments for newborn?
- Are they TERM
- Are they CRYING
- Do they have good TONE
What are the 2 most important thing we are checking when assessing the head?
1.symmetrical
2.fontanels soft and level
Respiratory distress
Nasal flaring, intercostal or substernal retractions, stridor, grunting, gasping, apnea lasting 20 seconds or longer
What are the three most important things to watch from birth to the first 2 hours of life?
- respirations
- regulat temperature
- eliminate waste
What connects the umbilical vein to the inferior vena cava?
ductus venosus
what shunts blood from the pulmonary artery to the descending aorta ?
ductus arteriosus
how long do we wait to do cord clamping?
30 sec to 1 min
how do babies tend to breathe mouth or nose?
nose breathe
do we suction all babies?
no, we only suction if indicated
what is meconium aspiration syndrome?
resp distress in newborns
d/t meconium-stained amniotic fluid
- symptoms can’t otherwise be explained
What are the interventions for a baby with meconium aspiration syndrome?
- EFM
- Neonatal team at delivery: suction, intubate
What do we NEVER do with mecoinum aspiration syndrome baby?
DO NOT RUB BABY
What is the O2 % goal for each min from 1-5min and then 10 min at delivery?
1 min= 60-65%
2 min- 65-70
3 min = 70-75%
4 min = 75%-80%
5 min = 80-85%
10 min = 85-95%
what HR do we start positive pressure ventilation?
<100 BPM
at what HR do we start CPR?
<60 BPM
What does pH help us know ?
- the wellbeing of the baby
- Rh - birthers
what is the normal pH value for arterial blood?
7.2-7.34
What is normal pH for venous blood?
7.28-7.4
How do we help baby with their thermoregulation?
- skin to skin
- put hat on baby or replace if wet
- warm blankets
- check BG if they are still cold
What 3 things does neutral thermal environment help?
- minimizes oxygen and glucose consumption
- prevents hypothermia
- prevents hyperthermia
What can flexion be a sign of?
babies attempt to get thermogenesis - newborns trying to generate heat by increasing muscle activity
If we suspect cold stress, what two things do we check?
blood gas
blood glucose
what can cold stress lead to?
metabolic acidosis
respiratory acidosis
hypoglycemia
What can cause hypoglycemia in babies?
- diabetic/gestational diabetic birther
- cold stress
What are the 4 aspects of heat loss prevention?
Convection- temp 24C
radiation- no drafts - use radiant warmer if skin to skin not working
evaporation - dry baby off
conduction - skin to skin!
Why does cold cause metabolic acidosis?
baby burns more energy
uses glucose
less oxygen available so lactic acid builds
pH goes lower
What is the first intervention with a cold baby?
skin to skin contact
What is the rapid assessment of the newborn?
APGAR score
A- appearance (skin colour)
P- Pulse (heart rate). we want >100
G- grimace (reflex irritability )
A- activity (muscle tone) no floppy babies
R- Respirations (resp rate) crying and auscultate RR
When do we do APGAR?
min 1
min 5
What is severe distress for APGAR score?
0-3
What is moderate difficulty for APGAR score?
4-6
What is normal transition, little difficulty for APGAR?
7-10
If the score is <7 when do we repeat APGAR?
10 min
20 min
What is a normal temp for baby?
37
(36.5-37.5)
What is a normal HR for baby?
110-160 BPM
(80-100 when sleeping)
(180 BPM if crying)
What is normal RR in baby?
30-60 breaths per min
apnea <20 sec is normal
what’s the last vital we should check on baby and why?
temp
cuz it stresses them out
Do we assess BP in newborns?
NO- not routinely
if birther is GBS pos. how often do we check temps?
q 4 hrs
q 8 hours until discharge home unless worried about infection, etc
What is the priority assessment with newborn?
- observe
- auscultate
- temp & reflexes
- head circumference
How do we help prevent newborn infections?
hand hygiene
do not visit if sick
What is the Ballard scale used for?
gestational age
where do we measure baby?
top of the head to heel
where do we measure head circumference ?
above the ears
occipitolfrontal circumference
what is acrocyanosis?
extremeties are blue. this can be normal. we want centrally pink/healthy
7-10 days
what is vernix?
white all over baby.
more with preemies
what is Lanugo hair?
fine hair over body
what hair placement is not normal?
lower tailbone hair
could be NTD
What skin things are normal?
-cracking/peeling of hands & feet
- mottling to extremities
- congenital dermal melanocytosis
- telangiectatic nevi (stork bite)
- erythema toxicum (newborn rash)
- petechiae
- sweat glands - white little pimples
What 4 skin issues are NOT normal?
- bruising
- Jaundice within first 24 hours
- central cyanosis
- pallor
what do we want the fontanals to be like?
- symmetrical
- soft and level
what shape is the anterior fontanel?
diamond shape 5 cm
what shape is posterior fontanel?
triangular 3 cm
What is moulding?
cone head
What is cephalohematoma?
Collection of blood between skull & bone, and its periosteum
What is the relationship with cephalohematoma and suture lines?
does not cross suture lines
What are the signs of cephalohematoma?
Does not cross suture lines
Does not pulsate/bulge when baby cries
Appears several hrs/day after birth
Largest on 2nd or 3rd day
Fullness resolves in 3-6 weeks
What is subgaleal hemorrhage?
Bleeding into the subgaleal compartment
What is the relationship with subgaleal hemorrhage and suture lines?
Crosses suture lines
Which is most dangerous, cephalohematoma or subgaleal hemorrhage?
Subgaleal hemorrhage
What are the symptoms/signs of Subgaleal hemorrhage?
Crosses suture lines
Potential space: loosely arranged connective tissue; blood loss in this space can be severe
What is a normal head related issue?
caput succedaneum
why are low set ears concerning?
could be congenital concern
what is a normal finding of the chest that changes over time?
a prominent sternum
What is normal for the respiratory system?
-Lungs contain approximately 20 mL of fluid/kg
-Air replaces the fluid during newborn transition
-Some lung fluid retention can be experienced
-Surfactant reduces surface tension
-Immature respiratory control
-Newborns tend to nose breathe
-Abdominal breathing is normal
What is a signs of respiratory distress?
Nasal flaring,
intercostal or substernal retractions, stridor,
grunting,
gasping,
apnea lasting 20 seconds or longer
what is TTN- transient tachypnea of the newborn?
parenchymal lung disorder
-pulmonary edema d/t not absorbing fetal alveolar fluid
What is the most common cause of resp. distress in late preterm and term infants, benign, self limited?
TTN transient tachypnea
when does TTN resolve?
within 24 hours
how many RR max can a baby with TTN have?
up to 100 breaths/min
what are the symptoms of TTN?
RR up to 100 breaths/min
Intermittent grunting
Nasal flaring
Mild retractions
how do we help babies with TTN?
-Support with feeding
-Neutral thermal environment
-O2 supplementation may be provided to maintain O2 sats b/w 90-95%
why do we give Vit K IM?
gut bacteria is nonexistent and vit K needs it. so we give vit K till they’re eating
what are the 3 vessels o the umbilical cord?
2 umbilical arteries
1 umbilical vein
are the arms of babies longer or shorter than legs?
longer
which way do babies toes go with babinski?
toes span out
what is the startle response called?
Moro
how long do babies sleep in a day?
up to 17 hours
if a baby is inconsolable what do we suspect?
possibly withdrawl baby
If crying is shrill- high pitched what could that indicate?
neurological issues
what is the goal of vitamin K?
reduce risk of bleeding - helps baby clot their blood
what is the timing of vitamin K?
within 6 hours of birth
where do we give vitamin k?
vastus lateralis
what is erythromycin ointment giving for?
ghonorrhea and chlamydia birther for sure
we give to all babies (with birther consent) regardless of STBBI status
