LEC 2: Newborn Assessment and Care Flashcards
1
Q
Priority Needs of the Newborn
A
- Initiation and maintenance of respirations
- Establishment of extrauterine circulation
- Control of body temperature
- Adequate nutrition intake
- Establishment of waste elimination
- Prevention of infection
- Establishment of an infant- parent relationship
- Developmental care which balances physiologic and neurodevelopmental needs
2
Q
Adaptation of the Newborn: Respiration
A
- Production of lung fluid dicreases 2 to 4 days before labour
- 80 to 100 mL remain in the air passage of a full-term neborn
- During birth, fetal chest is compressed and squeezes fluid out- known as thoracic squeez
- First breath = inspiratory gasp
3
Q
Why do you need to assess the airway imeddiatly for a newborn that was delivered through c-section?
A
- If a baby is born through C-section we need to be worried about airway because teh toracic squeeze did not occur.
- The thoraxix squeeze only occurs through vaginal delivery.
4
Q
What triggres the first brith in newborns?
A
- First breath is triggerd by pressure change and increased PcO2 and decrease in pH and pO2
5
Q
What needs to be assessed immediately after bith?
A
- ABC’s
- Rapid assessment of ABC’s is done witin the first minute
- Breathing or cring
- Muscle tone
- Term infant
- Be prapared to intervine as necessary to ensure opain airwau/ effective ventilation
- Intervention for aiway
- Bulb sunction
- Wall suction
- Not all baies are suctioned
- Not routinely done
- Want to suction the mouth first to ensure that there is nothing going into the chest. If the nose is suctioned first, the baby will gasp for air and the secretions will go into the airway.
- Intervention for aiway
- Assign APGAR score
- HR, colour, respirations, tone, reflex, irritability done at 1 and 5 minutes
- Compromise
- Decreased HR and BP, respiration effort, muscle tone, cyanosis
6
Q
APGAR Score
A
- APGAR score is done at 1, 5 and 10 minutes after birth
- 10 minutes is done if babye is compromised
- The higher the score the better
-
Heart Rate
- 2 = 100 and above
- 1 = Less than 100
- 0 = Absent
-
Respiration
- 0= Absent
- 1 = Slow-irreggular
- 2 = Good crying
-
Muscle Tone
- 0 = Flaccid
- 1 = Some flextion
- 2 = Well-flexed, active movment
-
Reflex Irritability
- 0 = None
- 1 = Grimace
- 2 = Vigorous cry
-
Colour
- 0 = Pale, Blue
- 1 = Body pink, exremities blue
- 2 = Completely pink
-
Heart Rate
7
Q
Cord Blood Gases
A
- Poor arterial gas and good venous gas = Issue with delivery
- Poor arterial gas and poor venous gas = Issue with the placenta
8
Q
Cord Blood Gases: Metabolic Acidosis
A
- pH <7.0
- Base excess > 12 mEq/L
- APGAR <3 for 5 minutes = increased risk for anozia brain damage
9
Q
Cord Blood Gases: Arterial Gases
A
- Unoxygenated blood
- Coming from the placenta function
- Reflection of placenta function
10
Q
Cord Blood Gases: Venous Gases
A
- Oxygenated blood
- Coming from the placenta to the baby
- Reflection of placenta function
11
Q
Newborn Care Immediately After Birth
A
- Assess vital signs q1h during first hours of transition
- Assess colour and level of alertness/ activity/ flexion
- General top to toe assessment
- Observe for evidence of trauma, anomalies
- Ensure accurate infant identificaiton
- Provide opportunites to promote family interaction and bounding
- Warmth
12
Q
What would you do if the pulse of the neworn is 100?
A
- Reassess the pulse
- If still <100, stimulate the infant
- Normal heart rate is 110-160 beats/ min
13
Q
Early Signs of Neonatal Respiratory Distress
A
- Tachypnea
- Circumoral cyanosis (central- late sign)
- Acrocyanosis: Seen in the first few hours
- Central Cyanosis: Has been compromosed for a while
- Grunting/ Cooing
- Cooing: Sounds gentel → Red Flage: Want to do a thorough assessment
- Nasal Flaring
- Done to intake more air
- Retractions/ Indrawing
- Visual assessment
- Looking at ribcage
- Accessory Muscle Use
- Poor feeding
- May be a later sign
- Apnea
- May be a later sign
14
Q
Neonatal Thermoregulation
A
- WARMTH: Maintenance of normal temperature
- Balcne heat production ⇔ heat loss to maintain body temperature within a certain “normal” range
- Normal Range: 36.4 to 37.5
- Thermometer placement: Warmth to have it more parallel with the baby’s body (up right) to ensure you are getting accurate reading
- First temperature is taken rectally
- Heat production in neonates
- Non-shivering thermogenesis (BAT)
- Breakdown adipose tissue
- Maintain neutral thermal environment (NTE)
15
Q
Why are newborn’s at risk for loosing heat?
A
- An infant can be chilled at 0.2 to 1.0 C/ minute
- The head is bigger than their body and we lose most off our heat from our head
- Have a thin dermis
- Immature temperature regulation
16
Q
How do babies stay warm?
A
- Baby goes in the felx position
- Way to preserve body heat
- Peripherally vasoconstrict
- May increase their basal matebolic rate
- Babies do not shiver
17
Q
Thermogenesis
A
- BAT is primary source of heat in hypthermic newborn
- Appears in fetus at 26 to 30 weeks
- Increases until 2 to 5 weeks after birth
- Oxidized in response to cold exposure
- Brown adipose tissue
- Premature babies will have less brown fat- high risk for becoming cold
18
Q
Types of Heat Loss
A
- Evaporation
- Wet with amniotic fluid
- Convection
- Removed from warmth
- Radiation
- Placing cold objects near incubator, window
- Conduction
- Cold stethescopes
- Cold equipment
19
Q
How can you prevent heat loss?
A
- Maintian a thermal environment
- Dry babies off quickly
- Warm the equipment before palcing it on baby
- Be mindful where you are placing the baby
20
Q
Risk Factores for Altered Thermoregulation
A
- First 8 to 12 hours of life
- Premature
- Small for gestational age
- Infants with CNS problems
- Prolonged resucitation efforts
- Sepsis
21
Q
What are some signs of cold stress?
A
- Vasoconstriciton
- Pallor, acrocyanosis
- Tachypnra/ Tachycardia
- Fussiness/ Hyperactive/ Irritable
- Temperature
22
Q
How to Prevent Cold Stress
A
- Area for delivery should be 23C to 25C
- Dry quickly (head) and remove wet linens
- Skin-to-skin contact with mother
- Fastest way to warm baby
- If needed, provide radiant warmer heat
- Keep away from drafts, aire conditioning vents, cold windows
- Warm items- sclaes, stethoscope
- Guard against hyperthermia
23
Q
Neonatal Hypoglycemia: Glucose Regulation
A
- Glucose is the main source of brain cells
- No glucose = Neurological compromise
- Healthy babies can respond to low blood glucose in 1st hour after delivery
- Hypoglycemia
- Not a single value of glucose
- Repeated levels of <2.6 mmol/L or single reading of <1.8 mmol/L in high risk infant need intervention
-
Normal newborn is usually 2.2 to 6 mmol/L
- React if under 2.6 mmol/L
24
Q
What do you do if glucose is under 2.6 mmol/L?
A
- Feed the bay (1st action)
- Give infants glucose gel (based on weight)
- Get another reading: babies who are at risk there is an algorithm to check blood glucose- underweight and preterm check blood glucose every 3 to 4 hours for 36 hours
- Babies who are large or of a diabetic mom- check every 3 to 4 hours, prior to feed for up to 12 hours
- Can stop checking if there is repeated normal values
50
Q
Hip Dysplasia
A
- Usually occurs when a baby is breached
- Three ways to check:
- Symmetry of creases
- Ortolani (Dislocation) Maneuver
- Puts downward pressure on the hip and then inward rotation. If the hip is dislocated, this maneuver forces the formula head over the acetabular rim with a noticable “clunk”
- Barlow Maneuver
- Baby’s thigh is grasped and adducted (placed together) with gental downward pressure. Dislocation is palpable as femoral head slops out of acetabulum.
51
Q
Assessment of Reflexes/ Neurological
A
- Suckin
- Rooting
- Grasping (Palmar and Plantar)
- Moror (Startle)
- Tonic Neck (Fencing)
- Babinski (Plantar)
- Should be gone after 24 months
- Abnormal if you see it after 24 months
- Stepping
- Galant
- Occurs if you stroke the spine
