mgmt of newborn Flashcards
at birth assessment
-APGAR
-length & weight
-VS
-gestational age assessment
-physical maturity
-neuromuscular maturity
-place id bands before leaving room
newborn distress
-nasal flaring
-chest retractions
-grunting
-labored breathing
-cyanosis
-flaccid tone
-tachypnea/bradypnea
-tachycardia/bradycardia
-abnormal size, LGA & SGA
-periods of apnea greater than 15 seconds
APGAR
-appearance
-pulse
-grimace
-activity
-respiratory
newborn vitals
-hr: 100-160
-rr: 30-60bpm
-temp: 97.7-99.5
-bp: systolic- 50-75, diastolic: 30-45
AGA
appropriate for gestational age
SGA
-small for gestational age
-malnutrition, vascular comp., IUGR, maternal smoking, poor weight gain, htn
LGA
-large for gestational age
-maternal DM, maternal obesity
physical maturity assessment
-skin texture
-lanugo: soft downy hair, absent in preterm, appears with maturity then disappears with post-maturity
-plantar creases: slick feet- premature, more creases- more mature
-breast tissue: thickness and size of breast and areola increase with maturity
-eyes and ears: eyelids can be fused or open, ear cartilage stiffness increases with maturity
-genitals: males, testicular descent and scrotum appearance; female, premature clitoris, mature labia
interventions for immediate newborn period
-maintain patent airway, mouth before nose
-ensure proper id
-thermoregulation
-meds: aquamephyton (vit. K), erythromycin ointment, hep. b vaccine (im, consent, vastus lateralis, change legs)
thermoregulation interventions
-dry immediately after birth
-skin to skin
-warm blanket/hat
-place warmed blanket over scale
-warm stethoscope and hands
-avoid placing near vents
-delay inital bath
-avoid cribs near cold outer walls/windows
-place under warmer
-prevent cold stress
vernix caseosa
-thick white, cheesy substance
-protects infant, dont remove, absorbs into the skin
telangiectactic nevi
-stork bites
-back of the neck, eyelids, between eyes, upper lips
-fade within 1 year, blanches
-milia
unopened sebaceous gland
-small white spots- nose, chin, forehead
-disappear in 2-4 weeks
-mongolian spots
mimic bruising
-dark blue, gray, brown, black spots- back or buttocks
-more common in darker ethnicities
-disappears within 4 years
erythema toxicum
-new born rash
-pink/red, generalized location
-no tx needed
-appears around 24hrs in all ethnicities
harlequin sign
-dilation of blood vessels on one side of the body
-transient, lasts up to 20 minutes
-no intervention needed
nevus flammeus
-port wine stain
-capillary angioma, purple or red in color
-doesn’t blanch or disappear
nevus vasculosus
-strawberry hemangioma
-resolves by 3 years
head variations
-molding, usually resolves in a week
-caput succedaneum, fluid underneath the scalp, crosses suture line
-cephalohematoma, doesn’t cross suture line, reddish color, may not show until 203 days after birth, collection of blood, risk for jaundice
ortolani maneuver
-abduct hips at 90 degrees while applying upward pressure
-listen for any noise, should not hear a click
barlow maneuver
-adduct the thighs while applying outward and downward pressure to the thighs.
-Feel for the femoral head slipping out of the acetabulum; also listen for a click.
-inspect back
sucking and rooting reflex
stroking cheek, mouth- infant head should move to that side/sucks
palmar grasp
infant curls fingers around examiner’s finger
moro
infant should stretch arms and then abduct at elbows when falling backwards
tonic neck
-fencer position
-turn head to side, will extend arm and leg to the side head is facing with opposite arm and leg flexed
babinski
stroke the outer sole of the food, infant should fan toes outward
stepping
hold infant upright with feet touching surface, infant should start stepping
cord care
-s/s infection
-air exposure, helps dry out
-stump will dry, darken in color
-will fall on own, dont pull
circumcision risks
-infection
-hemorrhage
-skin dehiscence
-adhesions
-ureteral fistula
-pain
circumcision benefits
-easier hygiene, less UTI & STI, lower rate of penile cancer
criteria for circumcision
-atleast 12 hours old
-vit. k prophylactically
-voided normally atlease once
-no food 1hr prior
-correct id
circumcision mgmt
-cover with petroleum jelly immediately
-clean with mild soap and water
-assess for bleeding, s/s infection
-need to void within 8hr post
newborn screening
-phenylketonuria (pku), 24-48hrs, infant can’t break down phenylalanine
-hearing screen, risk factors: family hx, CMV, rubella, herpes, head trauma, hyperbilirubinemia, ototoxic drugs
transient tachypnea of newborn (TTN)
-slow or incomplete removal of fluids in the lungs
-resp. distress present at birth or within first 6 hrs
-usually revolves around 24-72 hrs
TTN assessment
-resp. distress
-rr rate 100-140
-decreased breath sounds
TTN tx
-O2, if low
-warmth, prevent cold stress
-observe resp. status
-allow time for pulmonary capillaries and lymphatics to remove remaining fluid
hyperbilirubinemia
-imbalance in bilirubin production and elimination rate
-pathologic v. physiologic
pathologic hyperbilirubinemia
-also called kernicterus
-within first 24hrs
-Rh isoimmunization; ABO incompatibility
physiologic hyperbilirubinemia
-normal
-after 24hrs, usually 3 or 4th day
-more common in preterm
-bilirubin levels peak on days 3-5
-good feedings essential
hypoglycemia
-glucose less than 30 in the first 72 hrs of life
-higher risk: DM mothers, SGA, LGA
hypoglycemia s/s
-most asymptomatic
-jitteriness
-lethargy
-cyanosis
-apnea
-seizures
-high pitched, weak cry
-hypothermia
-poor feeding
interventions for hypoglycemia
-rapid acting glucose: dextrose gel, breastfeeding, formula feeding, iv glucose
-provide warmth, prevent cold stress
-reassess glucose levels, monitor for sx
nutrition mgmt
-calorie requirements: 110-120/kg body weight
-fluid requirements: 1001-150mL/kg daily
-breast feeding: q2-3 hrs, 8-12x in 24hrs
-formula q3-4 hrs
breastmilk changes
-colostrum: thick, yellow “syrup”, first few days
-transitional: thinner, less yellow, 3-10 days (approx.)
-mature milk: approx. day 10, appears more like cow’s milk, even thinner
breastmilk containments
-carbs
-protein
-fat
-water
-minerals
-enzymes
-vitamins
-mom’s immunities
benefits to breastmilk
-low risk for SIDS & infection
-easily digested
-low risk for allergies and obesity
-promotes bonding and attachment
breastfeeding concerns
-sore nipples: express colostrum and allow to dry
-engorgement: breasts full & tight, get in shower or place hot towel on breasts, opens milk ducts to dilate
-mastitis: infection of clogged milk ducts, s/s infection, call dr. if suspected
discharge prep: when to call dr
-temp above 100.4 or below 97.8
-forceful, projectile vomiting
-refusal of two feedings in a row
-cyanosis with or w/out feedings
-no wet diapers for 18-24hrs, or fewer than 6-8 wet/day after 4days of age
-2 or more consecutive green, watery diarrheal stools
-lethargy
-abd. distention
-diff. breathing
-color: pale, dusky, cyanotic
-circumcision: s/s of infection
