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NURS 4500: Final Material > Class 9: Physical Assessment of Newborn > Flashcards

Class 9: Physical Assessment of Newborn Flashcards

1
Q

what is the method of assessment of temp in the newborn (NB)

A
  • axillary
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2
Q

what is the average finding for temp in NB? normal variation?

A
  • average finding: 37
  • normal variation: 36.5-37.5
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3
Q

what is the method of assessment for HR/pulse

A
  • auscultation
  • palpation
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4
Q

what are the average findings for NB pulse?

A
  • 110-160
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5
Q

what is the normal variation for HR in NB

A
  • 80-100 when asleep
  • up to 180 if actively crying
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6
Q

what is the method of assessment for RR of NB

A
  • observe effort
  • auscultate
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7
Q

what are the average findings of RR in NB

A
  • 30-60 breaths/min
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8
Q

what is normal variation of RR in NB

A
  • short periodic breathing episodes
  • stabilization occurs by day 1-2
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9
Q

what is concerning r/t short periodic breathing episodes in NB

A
  • no apnea >20 sec
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10
Q

by days 1-2, describe RR in NB

A
  • usually then 30-40 breaths/min
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11
Q

how long should RR of NB be assessed?

A
  • for full min due to irregularity
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12
Q

what is the protocol for VS of the NB

A
  • shortly after birth
  • then q1h x3
  • then q8h for up to 24 h after birth
  • then q12h until discharge
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13
Q

describe assessment of BP in NB

A
  • not routinely assessed in healthy newborns
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14
Q

what are the guidelines for physical exam of NB (7)

A
  • provide normothermic & non-stimulating exam area
  • hand hygeine
  • undress only body area to be examined to maintain newborn temp
  • proceed quickly to avoid stressing NB
  • comfort infant throughout
  • involve parents
  • document findings
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15
Q

what findings from the physical assessment of the NB should be communicated to the PCP?

A
  • all normal variations and abnormal findings
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16
Q

ideally, perform NB assessment when NB is… (2)

A
  • quiet
  • alert
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17
Q

describe the order of physical assessment in NB

A
  • perform procedures that require quiet first –> skin color, tone, auscultation, overall condition
  • perform more disturbing procedures last –> temp, testing reflexes
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18
Q

describe antibodies present in the NB, how are they transported?

A
  • born with some antibodies
  • most transported across the placenta from maternal circulation
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19
Q

antibodies transported to NB from placenta & maternal circulation provides microbial protection to the NB for how long?

A
  • 1st 3 months of life
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20
Q

describe the risk of infection in NB

A
  • high risk
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21
Q

what is included in prevention of infection in NB (2)

A
  • good hand hygiene
  • staff should avoid unit if actively infectious
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22
Q

describe the general appearance of NB(2)

A
  • should have general plump appearance
  • flexed posture
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23
Q

what are the normal values of activity/state of alertness in the NB (3)

A
  • sleeping
  • quiet alert
  • active alert
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24
Q

what measurements are done for the NB (3)

A
  • length (measured initially & plotted for gestational age)
  • weight (measured initially & plotted for gestational age)
  • head circumference
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25
Q

describe the method of assessment of weight in NB

A
  • naked w protective liner/pad/towel
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26
Q

what are the average findings of weight in newborn? normal variation?

A
  • average: 3400-3500
  • normal variation: 2500-4000g
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27
Q

describe the method of assessment of length in NB

A
  • top of head to heel
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28
Q

what are the average findings of NB length?

A
  • average: 45-55 cm
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29
Q

describe the method of assessment of head circumference in NB

A
  • occipitofrontal circumference
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30
Q

what are the average findings of head circumference in NB? normal variation?

A
  • average: 33-35 cm
  • normal variation: 32-36.8
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31
Q

what are normal findings of skin assessment in NB (8)

A
  • generally/centrally pink
  • acrocyanosis common
  • skin intact, smooth
  • general plump appearance
  • vernix caseosa
  • lanugo hair
  • warm
  • some mottling in limbs
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32
Q

what is vernix caseosa? what is its function?

A
  • soft cheeselike/whiteish substance on skin
  • protective function
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33
Q

what is lanugo hair

A
  • fine hair over face, shoulders, back
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34
Q

describe changes to skin pigmentation after birth

A
  • begins to deepen
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35
Q

what are normal variations of skin assessment in NB (7)

A
  • superficial crackling/peeling hands & feet
  • mottling extremities
  • mongolian spots
  • stork bites
  • erythema toxicum
  • petechiae
  • sweat glands
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36
Q

superficial cracking/peeling of hands & feet is more common with?

A
  • postterm babies
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37
Q

what causes mottling to extremities in NB

A
  • due to instability of newborn circulation
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38
Q

what are mongolian spots

A
  • congenital dermal melancytosis
  • bluish spots common to back & buttocks at birth
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39
Q

describe the duration of mongolian spots in NB

A
  • fade over months
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40
Q

what are stork bites/nevi/telangiecases

A
  • flat, pink capillary hemangiomas
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41
Q

describe blanching of stork bites

A
  • easily blanched
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42
Q

describe duration of stork bites in newborn

A
  • most fade in 1st and 2nd years if life
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43
Q

what is erythema toxicum

A
  • transient rash
  • erythematous macules, papules, and small vesicles
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44
Q

what is the clinical signif of erythema toxicum? treatment?

A
  • no clinical significance
  • no treatment required
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45
Q

petechiae in the NB are especially present where?

A
  • over presenting part
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46
Q

what can occur r/t sweat glands in NB

A
  • milia –> tiny white bumps that most often appear on a newborn’s upper cheeks, nose, chin, or forehead
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47
Q

what skin assessment findings have potential for concern?(4)

A
  • bruising
  • jaundice
  • central cyanosis
  • pallor
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48
Q

where might bruising occur in the NB (2)

A
  • facial bruising
  • bruising to head d/t face presentation
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49
Q

what may cause bruising to NB (2)

A
  • forceps assisted birth
  • vacuum extraction
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50
Q

jaundice is never normal in NB what PP period

A
  • first 24 h
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51
Q

central cyanosis in the NB is…

A
  • abnormal
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52
Q

pallor in the NB is…

A
  • abnormal
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53
Q

what is assessed r/t head & face of NB (5)

A
  • appearance
  • shape
  • size
  • facial symmetry
  • moulding
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54
Q

describe the presence of moulding in the NB

A
  • may or may not be present
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55
Q

describe the size of NB head

A

~ a fourth of NB body length

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56
Q

describe symmetry of the face in NB

A
  • should be symmetrical
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57
Q

fontanels and sutures of the NB are impacted by?

A
  • degree of moulding
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58
Q

fontanels and sutures of NB should not be… we should be able to..

A
  • should not be bulging or swollen
  • should be able to palpate suture lines
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59
Q

describe the shape & size of anterior fontanel

A
  • diamond shaped
  • 5cm
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60
Q

describe the shape and size of posterior fontanel

A
  • triangular shaped
  • 3cm
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61
Q

the chin of the NB should be ?

A
  • distinct
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62
Q

what should be assessed r/t eyes of the NB (4)

A
  • placement
  • symmetry for size and shape
  • discharge
  • presence
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63
Q

describe the eyebrows of NB

A
  • should be distinct
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64
Q

describe the eyes & space between eyes in NB

A
  • each 1/3 the distance from outer left to outer right canthus
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65
Q

describe discharge in eyes of NB

A
  • should be none
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66
Q

describe pupils of NB (4)

A
  • present
  • equal in size
  • assess reactivity to light
  • physician or nurse will check red reflex
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67
Q

what should be assessed r/t NB ears (4)

A
  • size
  • placement
  • cartilage
  • open auditory canal
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68
Q

describe placement of ears in NB

A
  • line drawn thru inner and outer canthi of eyes reaching to top notch of ears (at junction w scalp)
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69
Q

describe cartilage of ears in NB

A
  • well formed & firm
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70
Q

NB should respond to sounds. this is influenced by?

A
  • state of alertness/activity
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71
Q

what is assessed r/t NB nose (4)

A
  • shape
  • placement
  • patency (both nares should be patent)
  • discharge
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72
Q

what is assessed r/t mouth of NB (7)

A
  • color
  • appearance
  • symmetry
  • soft & hard palate
  • tongue
  • saliva
  • presence of teeth
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73
Q

describe presence of natal teeth in NB

A
  • not usually present
  • if present, risk for aspiration = usually extracted
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74
Q

describe symmetry of lips in NB

A
  • should have symmetrical lip mvmt
  • no clefts
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75
Q

describe tongue of NB (4)

A
  • tongue not protruding
  • freely movable
  • symmetrical shape/mvmt
  • pink
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76
Q

what is a normal variation of NB tongue

A
  • tongue tie –> needs to be noted
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77
Q

describe the soft & hard palate of NB

A
  • should be intact
  • no clefts
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78
Q

describe uvula of NB

A
  • should be midline
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79
Q

describe color and moisture of mouth of NB

A
  • should be moist & pink throughout
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80
Q

describe chin of NB

A
  • should be distinct
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81
Q

what reflexes r/t mouth should be present in NB? these can be affected by?

A
  • rooting & sucking reflexes
  • can be affected by state of alertness/hunger
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82
Q

what are epstein pearls?

A
  • very small cysts that can appear in a baby’s mouth that look like tiny, white bumps
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83
Q

where can epstein pearls present in NB (2)

A
  • along soft/hard palate
  • gums
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84
Q

define: caput succedaneum

A
  • generalized edematous areas of scalp
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85
Q

caput succedaneum can be accompanied by? what relationship does it have w suture lines

A
  • can be accompanied by ecchymosis
  • crosses suture lines
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86
Q

how long does it take for caput succedaneum to resolve

A
  • 3-4 days
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87
Q

describe the risks of caput succedaneum to NB

A
  • normal variation
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88
Q

define: cephalhematoma

A
  • collection of blood between a skull bone and its periosteum
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89
Q

describe the relationship between cephalhematoma and suture lines

A
  • does not cross suture lines
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90
Q

describe the appearance of cephalhematoma when baby crued

A
  • does not pulsate or bulge when baby cries
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91
Q

describe onset & duration of cephalhematoma

when is it largest?

A
  • onset: several hrs or day after birth
  • largest on 2nd or 3rd day
  • duration: fullness esolves in 3-6 weeks
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92
Q

cephalhematoma is more common with…

A
  • assisted birth
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93
Q

define: subgaleal hemorrhage

A
  • bleeding into subgaleal compartment
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94
Q

describe the risk of subgaleal hemorrhage

A
  • most dangerous
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95
Q

describe the relationship between subgaleal hemorrhage and suture lines

A
  • crosses suture lines
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96
Q

subgaleal hemorrhage is associated with?

A
  • vacuum assisted birth
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97
Q

why is subgaleal hemorrhage considered dangerous

A
  • potential space - loosely arranged CT - blood loss in this space can be severe
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98
Q

what is vital w subgaleal hemorrhage

A
  • early detection
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99
Q

what assists in detected of subgaleal hemorrhage (2)

A
  • serial head circumference measurements for newborns w vacuum assisted birth
  • assessment of back of neck for edema & masses w vacuum extraction
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100
Q

what are potential assessment findings associated w subgaleal hemorrhage (6)

A
  • boggy scalp
  • pallor
  • tachycardia
  • increasing head circumference
  • forward position in of the NB ears
  • changes in NB LOC
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101
Q

what may be required w subgaleal hemorrhage

A
  • blood transfusion
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102
Q

what is assessed r/t NB neck (3)

A
  • freedom of movement (flexion & extension)
  • flexibility
  • bruises
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103
Q

what should not be present in NB neck (3)

A
  • webbing
  • masses
  • bruising
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104
Q

bruising of NB neck can potentially be from…

A
  • nuchal cord
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105
Q

the head of NB should be ______, trachea should be ____

A
  • head should be midline
  • trachea should be midline
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106
Q

describe the thyroid of the NB

A
  • should not be palpable
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107
Q

NB necks are generally ___ with lots of ____

A
  • generally short w lots of skin folds
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108
Q

what is assessed r/t NB chest (3)

A
  • shape
  • appearance
  • color
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109
Q

what shape of the NB chest is normal?

A
  • circular
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110
Q

describe the ribs of NB (3)

A
  • should be symmetrical
  • intact
  • should have symmetrical mvmt with respirations
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111
Q

describe the nipples of NB

A

are usually:
- prominent
- well formed
- symmetrically placed

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112
Q

breast nodule of NB is ~ ___. what is the normal variation? theres the potential for ___?

A
  • ~6mm
  • normal variation: 3-10 mm
  • potential for discharge
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113
Q

what is prominent w NB chest? what should be intact ?

A
  • tip of sternum can be prominent
  • clavicles intact with no crepitus
114
Q

crepitus of NB clavicles should be especially assessed with ___

A
  • shoulder dystocia
115
Q

what plays a role in adequate O2 supply of newborn (4)

A
  • clear & maintained airway
  • effective resps
  • adequate circulation, perfusion, and cardiac function
  • adequate thermoregulation, maintain body temp
116
Q

at term, lungs contain approx how much fluid?

A
  • 20mL of fluid/kg
117
Q

in NB transition, what happens to the fluid in the lungs?

A
  • air replaced the fluid
  • some lung fluid retention can be experienced
118
Q

retention of lung fluid can lead to??

A
  • transient tachypnea of the NB (TTNB)
119
Q

what impact do pulmonary surfactants have on NB lungs?

A
  • reduces surface tension = increases NB lung compliance
120
Q

what impact does decreased surfactant have on NB respiration? this is more common with?

A

= requires more P for inspiration = tiring

  • more common w preterm infants
121
Q

NB have immature resp control. what might this cause?

A
  • apneic periods in NB
122
Q

how do newborns tend to breathe?

A
  • tend to nose breathe
123
Q

what kind of breathing is normal with NB

A
  • abdominal breathing is normal = ribs and abdomen move w respirations
124
Q

what is a normal variation of NB respirations

A
  • occassional retractions, especially with crying
125
Q

when should resp be assessed?

A
  • when at rest & with resp effort
126
Q

how are resp assessed in NB? breath sounds?

A
  • count resps for full minutes
  • auscultate breath sounds
127
Q

NB breath soundes should be …

A
  • clear and equal bilat
  • some fine crackles may be heard during initial transition after birth
128
Q

describe mvmt of chest & abdomen during respirations

A
  • chest & abdomen move together w resps
129
Q

what are S&S of NB resp distress (6)

A
  • nasal flaring
  • intercostal or substernal or subclavicular retractions
  • stridor
  • grunting
  • grasping
  • apnea lasting 20 sec or longer
130
Q

what are other signs of abnormal NB breathing

A
  • tachypnea/bradypnea
  • abnormal breath sounds
  • seesaw or paradoxical resps
  • central cyanosis or mottling of skin
  • pulse ox <95%
131
Q

define: transient tachypnea of the NB

A
  • a parenchymal lung disorder characterized by pulmonary edema resulting from delayed resorption & clearance of fetal alveolar fluid
132
Q

what is the most common cause of resp distress in late preterm & term infants

133
Q

describe the risk of TTN

A
  • usually benign and self-limiting
134
Q

what is the most common feature of TTN

135
Q

when does TTn occur?

A
  • during first 1-2 hrs
136
Q

what are signs of TTN (4)

A
  • resp rate up to 100
  • intermittent grunting
  • nasal flaring
  • mild retractions
137
Q

how long does it take for TTN to resolve?

A
  • within 24 hrs
138
Q

what is included in supportive care for TTN? (2)

A
  • support w feeding
  • promote neutral thermal enviro
139
Q

what is included in resp support of TTN? Target sats?

A
  • O2 supplementation may be provided to maintain O2 sat between 90-95%
140
Q

TTN is more common after…

A
  • elective c-section d/t no labor process to squeeze fluid out of lungs
141
Q

how long does it take for ductus venosis to convert to ligaments in the NB

A
  • occurs within 2-3 months
142
Q

how long does it take for the ductus arteriosis to functionally close after birth? permanently close?

A
  • functionally = within hours after birth
  • permanently within 3-4 weeks
143
Q

how can a patent ductus arteriosis be detected?

A
  • auscultated as a heart murmur
144
Q

what leads to functional closure of foramen ovale? when does permanent closure occur?

A
  • increased pulmonary blood flow after birth leads to functional closure
  • permanent closure within months – years
145
Q

when does rapid construction of umbilical arteries & veins occur after birth? closure? conversion to ligaments?

A
  • rapid construction within minutes of birth
  • closed w cord clamping/severing
  • coverts to ligaments within 2-3 months
146
Q

what is the blood volume of CVS of NB

A
  • 80-100 mL/kg
147
Q

describe the chest wall of NB

A
  • have thin chest wall
148
Q

what should be inspected r/t chest wall of NB

A
  • inspect for visible pulsation in midclavicular line (4th intercostal space)
149
Q

describe assessment of HR of NB

A
  • auscultate apical pulse for full minute for rate –> 4th intercostal space
150
Q

describe auscultation of heart sounds (S1 and S2) in NB

A
  • should be sharp and clear
151
Q

most heart murmurs in infancy are..

A
  • not significant pathologically
152
Q

describe the duration of heart murmurs in NB

A
  • > 50% disappear by 6 months
153
Q

assessment of heart murmurs should be done in conjunction with… (4)

A

overall status
- color
- appearance
- behavior
- feeding

154
Q

identification of heart murmurs in NBs should be…

A
  • noted to provider
155
Q

describe HR of NB in first few hours

A
  • irregular heart rate not uncommon
156
Q

what types of pulses are assessed with extremities

A
  • femoral pulses
157
Q

what should be assessed r/t NB abdomen (3)

A
  • umbilical cord
  • inspect & palpate abdomen
  • auscultate BS
158
Q

what is assessed r/t umbilical cord of NB (6)

A
  • 2 arteries & 1 vein
  • clamp –> should not be bleeding
  • color
  • should be odorless
  • dry/drying around base
  • clear demarcation between cord & skin
159
Q

describe the color of the umbilical cord

A
  • whitish grey color
160
Q

what is a sign of meconium r/t umbilical cord

A
  • greenish color of umbilical cord
161
Q

what should not be present r/t umbilical cord

A
  • no intestinal structures within cord
162
Q

what is the tone and contour of NB abdomen

A
  • round & prominent (like a dome)
  • soft
163
Q

describe mvmt of NB abdomen

A
  • mvmt w respirations should be noted
164
Q

what may be visible of NB abdomen

A
  • could be a few visible veins on surface
165
Q

when should BS be present in NB

A
  • within minutes after birth
166
Q

describe the presence of bacteria in the GI tract at birth

A
  • lacks bacteria
167
Q

normal intestinal flora supports.. what is this imp for?

A
  • synthesis of vitamin K
  • vitamin K imp for synthesis of blood coagulation factors
168
Q

within hrs of birth, what occurs r/t NB GI tract

A
  • stool passed contains bacteria
169
Q

when should the first stool of NB be passed?

A
  • within 24-48 hrs
170
Q

define: omphalocele

A
  • herniation of abdominal contents thru the cord opening
171
Q

describe the appearance of female genitalia in NB

A
  • increased pigmentation
172
Q

describe the appearance of clitoris & labia in NB

A
  • can both be edematous
173
Q

describe the appearance of female discharge/spotting in NB

A
  • may occur r/t hormones of pregnancy
174
Q

describe the appearance of female urinary meatus in NB (2)

A
  • below clitoris
  • can be difficult to see
175
Q

describe the appearance of vagina in NB

A
  • open orifice
176
Q

what may be present in between labia of NB?

A
  • vernix caseosa
177
Q

describe appearance of male genitalia in NB

A

may have:
- increase in size
- pigmentation

d/t pregnancy hormones

178
Q

describe appearance of penis of NB

A
  • urinary meatus at tip of penis in center
179
Q

if the urinary meatus of the penis is below the center of the penis, what is this called?

A
  • hypospadias
180
Q

describe appearance of male scortum in NB

181
Q

describe palpation of testes of NB

A
  • should be descended & palpable on each side
182
Q

when should the NBs first void occur?

A
  • within first 24 hrs , often pee right after birth
183
Q

describe the length of NB arms vs legs

A
  • arms should be longer than legs
184
Q

what should be assessed r/t NB extremities (8)

A
  • general appearance (color, intactness)
  • general flexion / muscle tone
  • range of motion
  • symmetry
  • hands & fingers
  • legs & feet
  • hips
  • birth injuries ex. shoulder dystocia
185
Q

what should be assessed r/t NB hands & fingers (3)

A
  • count # of fingers
  • grasp reflex
  • nails should be present
186
Q

what should be assessed r/t NB legs and feet (6)

A
  • number of toes
  • nails should be present
  • feet do not have appraent arches
  • gluteal folds
  • grasp/babinski reflex
  • soles of feet
187
Q

describe the soles of feet of NB (2)

A
  • wrinkles
  • gestational age assessments
188
Q

describe gluteal folds of legs & feet in NB, what could it mean if they are not?

A
  • should be even
  • if uneven, could be signs of hip dysplasia
189
Q

what pulses are assessed in the extremities?

A
  • femoral –> should be equal bilaterally
190
Q

define polydactyly

A
  • extra digit
191
Q

define syndactyly

A
  • when digits are infused
192
Q

define oligodactyly

A
  • missing digit
193
Q

polydactyly, syndactyly, and oligodactyly can indicate?

A
  • chromosomal abnormality
194
Q

what are signs of hip dysplasia (4)

A
  • asymmetry of gluteal & thigh folds with shortening of the thigh
  • limited hip abduction
  • shortening of the femur
  • ortolani test w femoral head moving in & out of acetabulum
195
Q

what should be assessed r/t NB back (2)

A
  • shoulders, scapulae, iliac crests –> symmetry
  • inspect & palpate spine
196
Q

escribe the normal spine of NB (3)

A
  • should appear straight
  • easily flexed
  • skin intact
197
Q

describe head control in the NB

A
  • should be able to momentarily raise & support their head/turn to the side in a prone position
  • gain head control at ~3 months of age
198
Q

what are abnormal findings of the NB back (3)

A
  • pilonidal dimple or tuft of hair
  • sinus (opening of spinal cord)
  • mass
199
Q

what is a pilonidal dimple? what can it or a tuft of hair be associated w?

A

= sacral area of the spine
- can be associated w spina bifida or abnormalities of the spine

200
Q

what is assessed r/t NB anus (5)

A
  • should have 1 anus
  • good sphincter control
  • inspect & palpate placement
  • patency
  • meconium passed?
201
Q

at birth, what is the development of the NB neuromuscular system

A
  • almost completely developed
202
Q

what does the NB brain require? (2)

A
  • glucose for energy
  • large supply of oxygen
203
Q

what are abnormal signs of the neuromuscular system

A
  • tremors & jitteriness
  • seizure activity
204
Q

describe normal assessment of the NB neuromuscular system (4)

A
  • generally have normal tone
  • some resistance to pass mvmt
  • reflexes
  • behavior
205
Q

what are the primitive NB reflexes (7)

A
  • sucking & rooting
  • swallowing
  • grasp (palmar & plantar)
  • moro (startle)
  • stepping or “walking”
  • crawling
  • babinski (plantar)
206
Q

presence and then disappearance of primitive reflexes reflect ??

A
  • a mature and intact nervous system and normal brainstem activity
207
Q

describe the palmar grasp reflex

A
  • when placing a finger or stroking the inside of the infant’s palm the hand will close around it…hence grasp it.
208
Q

describe the plantar grasp reflex

A
  • when a finger is placed under the toes, the toes will curl.
209
Q

describe the moro reflex

A
  • This reflex occurs when the infant hears a sudden loud noise or experiences unexpected movement.
  • Example: when placed in the supine position (with the head supported) and the head is allowed to fall lower than the body this reflex will occur.
  • Response? the infant will throw out the arms (hence extend them) with the palms up and then move the arms back to the body.
210
Q

describe the rooting reflex

A
  • When the infant’s cheek or side of mouth is stroked, the head will turn towards it and the infant will open its mouth in an attempt to suck. This helps the baby find its food source when feeding
211
Q

describe the sucking reflex

A
  • When something touches the top of the infant’s mouth (specifically the hard palate of the mouth….so the roof of the mouth) the infant will automatically suck
  • this helps with feeding by allowing the infant to pull food from the source….breast or a bottle
212
Q

describe the babinski reflex

A
  • When the bottom of the foot is stroked from the heel upward along the outward part of the foot, the big toe dorsiflexes (bends back) and the other toes fan or spread out.
213
Q

describe the crawling reflex

A
  • When the infant is placed on the stomach and pressure (such as a hand) is applied to the sole of the foot, the infant will attempt to push against the hand and move the arms and legs in a crawling like motion.
214
Q

describe the stepping reflex

A
  • When holding the infant upright with legs and feet touching a surface, the infant will move the legs like taking steps or walking.
215
Q

what is included in assessment of behavioral characteristics of the NB (2)

A
  • sleep-wake states
  • responsiveness to enviro, people etc.
216
Q

how much can NBs sleep?

A
  • up to 17 hrs a day, with periods of wakefulness gradually increasing
217
Q

in the early newborn period, newborns fluctuate between?

A
  • sleep and wakefulness states
218
Q

what are the wake states of the NB? (4)

A
  • crying
  • active alert
  • quiet alert
  • drowsy
219
Q

what are the sleep states of the NB (2)

A
  • light sleep
  • deep sleep
220
Q

what factors may influence behaviors of NBs? (3)

A
  • gestational age (ex. preterm = not as developed)
  • stimuli
  • meds
221
Q

describe the development of NB vision (3)

A
  • cannot see far
  • clearest visualization is close (~17-25 cm), usually distance when feeding
  • sensitive to light
222
Q

at what age is NB vision the same as adults?

A
  • at 6 months
223
Q

describe the development of NB hearing (2)

A
  • similar to adult when AF clears out of ears
  • loud sounds elicit strong response in NB
224
Q

describe development of smell of NB

A
  • highly developed
225
Q

describe development of taste in NBs

A
  • can distinguish some different flavors
226
Q

describe development of touch in NBs (2)

A
  • very responsive to touch
  • imp to be held and touched lots for development
227
Q

what terms describe NB responses to enviro stimuli (6)

A
  • temperament
  • habituation
  • consolability
  • cuddliness
  • irritability
  • crying
228
Q

describe habituation of the NB

A
  • protective mechanisms of the NB
  • ability to respond to and then inhibit responding to discrete stimulus (ex. light, rattle, pinprick etc.) while asleep
  • avoid overload in terms of stimuli in their enviro , habituated to enviro stimuli
229
Q

what does habituation promote? (2)

A
  • sleep in their home enviro
  • promote continued learning
230
Q

describe consolability of the NB

A

-variability in ability to self- console or be consoled

231
Q

what are examples of how the NB can be consoled (3)

A
  • hand-to-mouth mvmts/non-nutritive sucking
  • being alert to voices, noises, visual stimuli
  • held/rocked
232
Q

why is cuddliness of NBs important?

A
  • parents gauge their ability to care for the child by child’s responses to their actions
233
Q

what cna cause irritability in NBs? (5)

A
  • hunger
  • wetness
  • noises
  • cold
  • new experiences
234
Q

what is imp to note w irritability in NBs

A
  • some are more irritabile than others
235
Q

what is the language of the newborn?

236
Q

why is responsivness to crying imp?

A
  • creates trust
237
Q

rying in the NB shouldn’t be… (4)

A
  • high pitched
  • shrill
  • hoarse
  • prolonged
238
Q

what vitamin is given to NBs? when?

A
  • vitamin K
  • within 6 hrs of birth
239
Q

what dose and route of vitamin K is given to newborns weighing greater than 1500g

A

1mg IM injection

240
Q

vitamin K is typically synthesized by? describe this at birth

A
  • synthesized by intestinal flora
  • no flora present at birth
241
Q

what is the goal of giving vitamin K to NBs

A
  • reduce risk of bleeding due to vitamin K deficiency
242
Q

describe eye prophylaxis in the NB

A
  • involves erythromycin ointment instilled into eye of newborn to prevent chlamydia or gonorrhea
243
Q

when is eye prophylaxis given to the NB

A
  • within 1st 24 hrs
244
Q

describe the use of eye prophylaxis in the NB

A
  • highly debated, some parents refuse
  • offerred to all NB
245
Q

do NBs experience pain?

246
Q

what is included in assessment of pain in the NB (7)

A
  • crying / irritability
  • grimacing, eye squeeze, brow contraction, open mouth, chin quizer
  • attempts to withdraw from painful stimulus
  • changes in HR (increased)
  • changes in RR (increased, shallow)
  • skin pallor or flushing/diaphoresis
  • changes in state, appetite, activity lvl
247
Q

what kind of crying can indicate pain?

A
  • whimpering to high pitched
248
Q

assessment of pain in the newborn depends on..

A
  • state of alertness
249
Q

what is the goal of nonpharmacological mngmt of pain in the NB

A
  • minimize the intensity, duration, and physiological cost of pain
  • maximize coping
250
Q

what is included in nonpharmacological mnmgt of pain in the newborn (5)

A
  • holding/cuddling/rocking newborn
  • non-nutritive sucking/pacifier
  • oral sucrose
  • skin to skin contact
  • breast/chest feeding
251
Q

oral sucrose is used for what kind of pain? what route is used?

A
  • admined orally
  • for relief of pain caused by minor procedures up to 12 months of age
252
Q

pharmacological mngmt of pain in the NB

A
  • usually used w procedures
253
Q

what is included in care for the NB from 2 hrs after birth until discharge (7)

A
  • ongoing monitoring & assessment of newborn
  • newborn bath & other care
  • newborn screening
  • parental education
  • family bonding –> promote parent-infant interactions
  • common newborn problems
  • confidence w newborn feeding
254
Q

what is included in ongoing monitoring & assessment of the NB from the 2hrs after birth until discharge (5)

A
  • VS
  • feeding
  • elimination
  • behavioral characteristics
  • sleep-wake states
255
Q

describe screening for metabolic, endocrine, and congential disorders in the NB; what is collected? when is this done?

A
  • early detection of certain disorders
  • blood sample collected –> screens for over 40 disorders
  • done prior to discharge & at least 24 hrs of age
256
Q

describe hearing screening in NBs

A
  • Universal Newborn Screening Act –> must be offerred to all parents
  • screening provides info about the pathways from the external ear to the cerebral cortex
257
Q

what is 1 of the most common congential disorders in NBs

A
  • hearing loss
258
Q

what is done for screening for jaundice in NBs

A
  • transcutaneous bilirubin (TcB) at 24hrs of age and q24 hrs or prn (as ordered)
259
Q

what is the importance of pulse ox screening in NBs

A
  • enhances early detection of critical congential heart disease
260
Q

when and why is pulse ox screening done in NBs

A
  • done to determine the ox sat for newborns between 24-26 hrs of age
261
Q

describe how pulse ox screening is done in NBs

A
  • right hand (pre-ductal) and either foot (post ductal) are used for the screening test
  • monitored for 30 secs, record highest number achieves
262
Q

what pulse ox results are considered normal in the NB

A

> = 95% in right hand
AND <= 3% difference bwteen them

263
Q

what is considered borderline pulse ox screening result in NBs?

A

90-94% in rigtht hand
OR >3% difference between them

264
Q

what is considered an abnormal pulse ox screening result in NBs?

A
  • <90% in right hand or foot
265
Q

what is included in promoting parent-infant interaction w NBs (3)

A
  • encourage responsiveness to infant cues
  • support parents to identify cues & infant’s social capabilities
  • encourage, validate, and involve the parents
266
Q

when is the NB bath completed

A
  • prior to discharge
267
Q

what are ways to prevent heat loss during the NB bath (5)

A
  • be efficient
  • dry thorouhgly
  • temp of room at 24*C
  • immersion = less heat loss than sponging technique
  • be prepared, supplies gathered
268
Q

how should the temp of the water w NB baths feels?

A
  • pleasantly warm to the elbow
269
Q

what are imp things to note w newborn baths? (4)

A
  • do not hold under running water
  • never leave alone
  • work from clean to dirty
  • do not use soap on face
270
Q

what determines the technique for umbilical cord care

A
  • hospital protocol
271
Q

what is the recommended care for the umbilical cord

A
  • initial cleaning w water & subsequent cleaning w water
  • keep clean & dry

there is no difference in dry cord compared w those treated w antiseptics

272
Q

when is the umbilical cord clamp usually removed? when does the umbilical cord usually fall off?

A
  • clamp removed once stump is dry = 24-36 hrs
  • umbilical cord falls off at 10-14 days
273
Q

what is included in NB discharge teaching r/t maintaining normal temp

A
  • if comfy for you, comfy for them
  • if sweating = too hot
274
Q

what is included in NB dc teaching r/t what to do if infant appears to be choking (2)

A
  • back clows
    -encourage participation in course
275
Q

what is included in NB dc teaching r/t protecting the infant from resp infections & 2nd hand smoke (3)

A
  • encourage to smoke outside
  • no visitors w cold
  • hand hygeine imp
276
Q

what is included in NB dc teaching r/t car seat safety (2)

A
  • note expiry date
  • use federally approved seat
277
Q

what is included in NB dc teaching r/t when to seek help (6)

A
  • weak cry
  • lethargic
  • less active
  • hypotonic
  • not able to settle
  • overly fussy
278
Q

what plays a role in reducing the risk of sudden infant death syndrome (6)

A
  • safe place to sleep
  • smoke-free setting
  • maintain normal infant temp
  • breast/chest feeding
  • sharing a room (not a bad) w parents for first 6 months
  • safety w night feedings
279
Q

what position should the NB sleep in to prevent SIDS

A
  • lay on back
280
Q

what is included in a safe place to sleep to help prevent SIDS (6)

A
  • alone in approved crib or craddle
  • flat surface
  • firm mattress
  • tight fitting sheets
  • no pillows, quilts, toys, heavy blankets
  • only light blanket
281
Q

when do NB immunizations usually begin?

A
  • usually begin at 2 months
282
Q

when does infant follow up with public health occur? primary care provider? if midwifery care?

A
  • public health = usually within few days in the home
  • PCP = within 2 weeks of discharge in office
  • midwifery care = will follow NB for 6 weeks

NURS 4500: Final Material (16 decks)

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