Newborn Flashcards
Review APGAR, fontanels, birthmarks, normal and abnormal findings, jaundice, reflexes, and complications.
What is an APGAR assessment?
An APGAR assessment is done on the newborn at 1 minute and 5 minutes after birth to assess for immediate complications.
It is done more often if there are complications.
What is the highest and best score a newborn can get for an APGAR score?
Highest APGAR score = 10
Many newborns get a 9 due to cyanotic feet or hands.
What are the 5 categories of an APGAR assessment?
- Activity/muscle tone
- Pulse
- Grimace/response to stimulation
- Appearance/skin color
- Respiration effort
What is the possible score for each APGAR category?
The newborn can be assigned a 0, 1 or 2 for each category of APGAR.
- 0 is the worst score
- 2 is the best score
What is the scoring for APGAR Activity/muscle tone?
- 0 = flaccid/limp
- 1 = minimal flexion
- 2 = good flexion/active
What is the scoring for APGAR Pulse?
- 0 = absent
- 1 = < 100 beats/minute
- 2 = >100 beats/minute
What is the scoring for APGAR Grimace/response to stimulation?
- 0 = absent
- 1 = grimace to suction or slap on soles of feet
- 2 = responds promptly with cry or active movement
What is the scoring for APGAR Appearance/skin color?
- 0 = pallor or cyanosis (blue color)
- 1 = cyanotic extremities
- 2 = all normal color / pink
What is the scoring for APGAR Respiration effort?
- 0 = absent
- 1 = slow and weak
- 2 = vigorous cry and respirations between 30 - 60
What are the 2 interventions immediately following the birth of a newborn?
- suction mouth and nares with a bulb syringe
- dry the newborn and stimulate crying by rubbing the back
How is cold stress avoided in a newborn?
- dry infant immediately
- place skin-to-skin contact on mom
- put hat on baby
If client is not available, wrap baby in blankets and place in warmer.
What is a normal heart rate for a newborn?
Heart rate for newborn: 110 - 160
- if sleeping: down to 80 beats/minute
- if crying: up to 180 beats/minute
What are normal respirations for a newborn?
Respirations for newborn: 30 - 60 breaths/minute
Irregular breathing is common.
What is a normal temperature for a newborn?
Normal temperature for a newborn: 96.8oF - 99oF (37oC - 37.2oC)
Where is the anterior fontanel of a newborn located?
Anterior fontanel is located on the top of the head.
Where is the posterior fontanel of a newborn located?
Posterior fontanel is located on the back of the head.
When does the anterior fontanel close on a newborn?
The anterior fontanel closes between 12 and 18 months of age.
When does the posterior fontanel close on a newborn?
The posterior fontanel closes between birth and 3 months.
What is caput succedaneum?
Caput succedaneum is edema of soft tissue over bone on the newborn’s head.
It crosses the suture line and subsides within a few days.
What is cephalhematoma?
Cephalhematoma is swelling on the head caused by bleeding.
It does not cross the suture line. It is usually absorbed by 6 months and does need treatment.
What is thrush?
Thrush is a fungal infection in the newborn’s mouth. It looks like white, patchy areas in the mouth.
It may clear up in a few days. If it doesn’t, oral antifungal medicine will be given.
What is vernix caseosa?
Vernix caseosa is a normal finding of a cheesy-white looking substance covering a newborn’s skin.
It’s a protective cover over the skin from amniotic fluid.
What does a stork bite birthmark look like?
Stork bite birthmark looks like a red patch.
What does a port-wine stain birthmark look like?
A port wine stain birthmark looks like a dark red patch.
What does a strawberry birthmark (or hemangioma) look like?
Strawberry birthmark (hemangioma) looks like a dark red patch.
What does a mongolian spot birthmark look like?
Mongolian spot birthmark looks like purple-blue patches usually on the sacrum.
What is lanugo?
Lanugo is fine body hair on a newborn.
It is found on term infants (39 weeks and later) and helps to hold vernis caseosa on the skin which protects it from amniotic fluid.
How many vessels should the umbilical cord have and what are they?
A normal umbilical cord should have 3 vessels:
- 2 arteries
- 1 vein
What should be assessed after circumcision?
bleeding and urinary retention
What is the first stool of a newborn?
The first stool of a newborn is meconium: it is black and tarry.
When should the first stool pass (meconium)?
The first stool should pass within 24 hours of being born.
What do the baby’s first stools look like after the meconium has passed?
The baby’s first stools are yellow and look like there are small seeds in it.
What is physiological jaundice?
Physiological jaundice is an increase in bilirubin that causes yellowing of the skin. It is caused by an immature liver.
It occurs after 24 hours and is a mild and common condition.
Immediate complication
What is pathological jaundice?
Pathological jaundice is an increase in bilirubin and yellowing of the skin. It is caused by a hemolytic disease such as Rh incompatibility or liver disease.
It occurs before 24 hours and is a serious life-threatening condition.
What is the pathophysiology of jaundice in a newborn?
Jaundice is from an increase of bilirubin in the blood. Bilirubin is a waste product of red blood cells and is a yellow color. The liver is unable to get rid of the bilirubin.
Lab value:
bilirubin in a newborn born at term (not premature)
< 12 mg/dL (180 mcmol/)
What complication can occur if jaundice is not treated?
Brain damage can occur if jaundice in the newborn is not treated.
High levels of bilirubin can enter the newborn’s brain and cause toxicity.
What are the interventions for jaundice in a newborn?
-
frequent feedings
- to flush bilirubin out
-
phototherapy
- light makes it easier for liver to break down and remove bilirubin
-
vitamin K injection
- to prevent bleeding disorders from an immature liver
In how many days after birth should the birth weight be regained by the newborn?
10 - 14 days after birth.
Do newborns shiver when they are cold?
No
Newborns do NOT shiver when they are cold.
How do newborns keep warm?
Newborns have brown fat deposits that keep them warm. They also should be wrapped in a blanket with a hat on.
What is the sucking (rooting) reflex?
An automatic response by the newborn when they turn their face toward the stimulus and make a sucking or rooting motion with the mouth when the cheek or lip is touched.
The rooting reflex helps to ensure successful breastfeeding.
What is the swallowing reflex?
An automatic response by the newborn to swallow without gagging or coughing.
What is the tonic neck (fencing) reflex?
An automatic response by the newborn when the arm is extended and the face points in that direction.
Reflex goes away at about 4 months old.
What is the palmar grasp reflex?
An automatic response by the newborn when an object is placed in the infant’s hand and they involuntary grasp it tightly.
Reflex goes away between 3 - 6 months old.
What is the moro (startle) reflex?
An automatic response by the newborn when the arms go out to the sides if they feel like they are falling.
What is the babinski reflex?
An automatic response by the newborn when the sole of the foot is firmly stroked. The big toe then moves upward or toward the top surface of the foot. The other toes fan out.
What is the parent teaching on how to bathe a newborn?
- keep room warm
- cold rooms cause too much oxygen demand
- use a mild soap
- clean from the cleanest spot to the dirtiest spot last
- clean eyes from inner to outer area
- dress in layers and put a hat on baby
How should an uncircumcised baby be cleaned?
- there is no special cleaning
- never pull on foreskin or underneath foreskin
- clean with mild soap and water
What are the safety measures for a newborn in a hospital to prevent infant abduction?
- ID bracelet is applied to both mom and baby
- every person caring for baby must have ID on
- baby is wheeled in a bassinet when leaving the room, never carried by staff
What is the gestational age for a preterm newborn?
< 37 weeks
What is the gestational age for a post-term baby?
> 42 weeks
What is the most common complication of a post-term newborn?
The most common complication of a post-term newborn is hypoglycemia.
Infant does not have enough stored glucose at birth.
Immediate complication
What can cause respiratory distress syndrome in an infant?
Respiratory distress syndrome is caused by the newborn unable to produce enough surfactant. It can occur in preterm infants.
Surfactant helps open up the lungs to breathe better.
Medications:
respiratory distress syndrome in an infant
give surfactant through the ET tube
Describe:
Meconium aspiration syndrome
Immediate complication
Meconium aspiration syndrome is when meconium gets into the lungs and causes respiratory distress and/or pneumonia.
Interventions:
Meconium aspiration syndrome
- oxygen
- antibiotics
- ventilator if severe
Describe:
Dysplasia
Dysplasia is chronic inflammation of the lungs when the newborn has been oxygen dependent for more than a month.
Medications:
Dysplasia
- surfactant
- bronchodilators
- steroids
Describe:
Erythroblastosis fetalis
Erythroblastosis fetalis is when the red blood cells get destroyed due to an Rh incompatibility.
Treatment:
Erythroblastosis fetalis
give Rh-negative blood infusions to the infant
Describe:
Addicted newborn and fetal alcohol spectrum disorders
Addicted newborn and fetal alcohol spectrum disorders is when the infant is born addicted to alcohol or other substances.
The infant is highly irritated and has an increase in metabolism.
Interventions:
Addicted newborn and fetal alcohol spectrum disorders
- wrap baby snuggly
- seizure precautions
- reduce stimulation
- let mom express guilt and encourage treatment for mom
What are the priority assessments of a newborn from a diabetic mother?
- assess for respiratory distress
- assess blood sugar
Increased insulin from mother can cause delayed production of surfactant, which is needed for lung development
Lab value:
blood glucose in a one day old infant
40 - 60 mg/dL (2.3 mmol/L)
Interventions:
Hypoglycemic newborn
- feed baby
- give glucose if needed
Why is newborn assessment important?
- detects early recognition of problems
- ensures proper evaluation and care
What are the expected values for NB vital signs?
- Normal HR: 110–160 beats/min (if in deep sleep, as low as 70 beats/min; if crying, up to 180 beats/min)
- Normal RR: 30–60 breaths/min
- Rectal temp: 36.6-37.2° C (97.8-99° F)
- Axillary temp: 36.5-37.2° C (97.7-99° F)
- BP: 70/45 to 50/30 mmHg at birth
What are the weight ranges of a NB for SGA, AGA & LGA?
SGA: below the 10th percentile
AGA: 3405 g (7 lb, 8 oz), range: 2500–4000 g (5 lb, 8 oz to 8 lb, 13 oz)
LGA: above the 90th percentile
What are normal newborn measurements (length, head circumference etc)
- Length: 48 - 52 cm (18 - 22 in)
- Average: 50cm (20 in)
- Grows 2.5 cm/1 in per month for first 6 months
- Head circumference: 32 - 37 cm (12.6 - 14. 6 in)
- Average: 33 - 35 cm (13 - 14 in)
- Chest circumference: 30-35 cm (11.8 - 13. 4 in); 2 cm smaller than head
- Average: 32cm (12.6 in)
- Abdominal circumference: Same as chest circumference
What will you be assessing on a NB head to toe (and what will you start with)?
Each clinician is different but typically:
- Respirations for a full minute while baby is quiet
- HR
- temp
- Fontanelles - shouldn’t be bulging or sunken
- Outer canthus of eye lines up with top of ear
- Skin tags on ear?
- Blanch skin on nose over bridge to assess for jaundice
- Sclera of eye for jaundice, scleral hemorrhage?
- Mouth symmetry, epstein pearls, palate intact, extra teeth?
- Listen to lung sounds in 6 places w/o clothes
- Listen to heart sounds - close to nipple on baby’s left side, left side of chest (you might hear a murmur here)
- Abdominal sounds - all 4 quadrants for bowel sounds
- skin - cuts, bruises, birthmarks
- umbilicus - no yellow/green discharge
- genitals (don gloves) - urethra at end and middle if male, push to make sure there is a teste on each side, female - discharge (ie. pseudomensruation)
- mongolian spots, cap refill on top of foot, birthmarks
- bracelets on?
- stork bites?
- assess spine - intact?
- base of spine - gluteal folds, dimples? (spina bifida)
- Nose - flaring? retractions?
- reflexes - moro, grasp, sucking, rooting
How do the NB’s lungs adapt to extrauterine life?
- In utero, the placenta is the organ for gas exchange.
- The lungs are filled with fluid and fetal circulation is different from neonatal circulation
- With a newborn’s first breath everything changes
- First breath functions to:
- Empty the airway of fluid
- Establish volume and function of the newborn’s lungs o Cause fetal circulation - neonatal circulation
- Large heart reduces lung space
- Lung expansion is restricted due to weak intercostal muscles, a rigid rib cage, horizonal ribs, and a high diaphragm
- Increased airway resistance compared to adults
- Initial reparations may be largely diaphragmatic, shallow, and irregular in depth and rhythm – seen in abdominal movements
- Breathing patterns may be irregular and have periods of apnea – count for 1 FULL minute
Define preterm, late preterm, early term, term, late term, post term.
Preterm: less than 36.6 weeks
Late preterm: 34.0 - 36.6 weeks
Early term: 37.0 - 38.6 weeks
Term: 39.0 - 40.6 weeks
Late term: 41.0 - 41.6 weeks
Post term: greater than 42 weeks
Describe skin to skin and when/why it’s used.
After baby is born, the baby is placed on mom, dried and stimulated as soon as possible–this prevents heat loss, provides ample external stimulation for first breath, promotes bonding and allows for quick first feed (important for blood sugar and bili levels).
What are some normal head variations?
- caput
- cephalohematoma
- molding
Cephalohematoma vs. Caput
- Caput
- collection of fluid, edematous swelling of scalp
- crosses suture lines
- present at birth or shortly after
- reabsorbed within 12 hours or a few days after birth
- Cephalohematoma
- collection of blood between cranial bone and periosteal membrane
- does not cross suture lines
- appears b/n first and 2nd day
- disappears after 2-3 weeks or sometimes up to months
What are the 2 main types of circumcision?
Gomco and Plastibell
What is the nurse’s role during a circumcision?
Provide comfort measures: stroke baby’s head, provide pacifier, talk to baby, baby should be held following the procedure but watch for cues of overstimulation.
What are pain control methods used for circumcision?
EMLA cream (local) and other analgesics
Describe newborn circumcision care.
Assess q30 mins for 1st 2 hours following procedure for hemorrhage, check for signs of infection, monitor for 1st void following procedure.
For Gomco:
- clean w/warm water following each diaper change
- apply petroleum ointment for for next few diaper changes
- if bleeding occurs, apply light pressure with sterile gauze to stop bleeding
- if bleeding doesn’t stop, contact provider
- granulation tissue is normal – petroleum jelly can help support
For Plastibell:
- Plastibell should fall off within 8 days (usually earlier), any later than that, contact physician
- no ointment is applied while plastibell is in place, but petroleum ointment can be applied to protect granulation tissue afterward
For an infant to thermoregulate, heat produced must equal ___________.
heat lost
What are some risk factors for decreased ability to thermoregulate?
- infant is pre-term/SGA/IUGR (less brown fat)
- infant is postterm - stress during birth causes infant to burn brown fat
What temperature range is considered cold stress in a neonate and what temperature range is considered moderate hypothermia in a neonate?
cold stress - 36-36.4 °C (96.8 to 97.5 °F)
moderate hypothermia - 32-35.9 °C (89.6 to 96.6 °F)
What assessment cues would you see in a neonate that is experiencing cold stress or moderate hypothermia?
- restless
- crying
- pale and mottled
- Skin feels cool, especially the extremities
- tachypnea
- temp below 97.7
- possible transient respiratory disease or RDS
What are the ways that a newborn can experience heat loss?
- conduction - cold object
- convection - cold room
- evaporation - from amniotic fluid, after a bath, baby’s clothes are wet
- radiation - cold object is placed near the infant
Why are neonates at risk for heat loss?
Heat transferred from newborn orgas to skin surfaces is increased due to a decrease in SQ fat
Newborns rely on the metabolism of brown adipose tissue “brown fat”
If a neonate has less brown fat, then the ability to thermoregulate is diminished.
What are priority labs for an infant experiencing heat loss?
- chest xray (hypothermia can cause pulmonary constriction/pressure and respiratory distress, decreased surfactant release)
- ABG-PO2 decr and low pH (risk for metabolic acidosis)
What are priority interventions to reduce heat loss in a neonate?
- place infant skin-to-skin
- slowly warm infant on radiant warmer (over 2-4 hour period)
- apply warm blankets/clothing
What are priority nursing interventions to prevent heat loss in neonates?
- keep the room warm
- bathe neonate when temp is stable and quickly dry infant
- avoid exposing infants to drafts
- remove any wet clothing, blankets, diapers
- swaddle the infant
- monitor temp closely for first 24 hours
- report alteration in temp to HCP
What is the patient education pertaining to thermoregulation?
- dress the infant appropriately for the environment air temp. Rule of thumb: one layer more than you are wearing
- remove any wet clothing, blankets, and diaper from the infant
- teach parents how to take axillary temp
- signs to report to hcp
How do you determine if an infant is LGA?
- weight > 4000 g (8lbs 8 oz)
- Plot FOC (frontal-occipital circumference) /Weight/Length on growth chart to determine if LGA
Define LGA and describe the risk factors.
LGA infants are at or above 90th percentile on growth chart or over 4000 grams
Risk factors:
- Diabetic mother
- Multipara
- Male
- Erythroblastosis syndrome
- Beckwith-Wiedemann syndrome
- Transposition of great vessels
What are the priority labs for LGA?
- Serum glucose (risk for hypoglycemia)
- Chest x-ray (risk for RDS)
- CMC
- BMP
What are the priority meds/treatments for LGA infants?
- if low blood glucose levels, IV glucose or dextrose gel
- frequent feedings
What are the priority interventions for LGA?
- Monitor vital signs
- Complete a gestational age assessment
- Monitor signs of respiratory distress
- Screen for hypoglycemia and polycythemia
- Observe s/s r/t birth trauma
- Prevent cold stress
- Address parental concerns
What is the priority education for LGA infants?
- alert nurse of any signs of difficulty breathing or unable to feed infant
- if broken clavicle, teach how to hold infant
- reassure parents bruising is temporary
What are the assessment cues for hypoglycemia of the newborn?
- lethargy, sleepiness
- poor feeding
- hypothermia, temperature instability
- pallor, cyanosis
- apnea, irregular respirations/respiratory distress
- jiterriness, jerkiness, tremor
- high-pitched cry
- exaggerated moro
Define and describe the risk factors for hypoglycemia.
- Blood glucose concentration less than adequate to support neurologic, organ, and tissue functions
- Symptomatic newborn
- Newborn of mothers w/ diabetes
- LGA newborn
- SGA/IUGR
- Newborn w/ perinatal stress
What are the priority labs for hypoglycemia of the newborn?
- blood glucose level less than 40 mg/dL
- glucsoe via glucometer per protocol
- Serum glucose prn
What are the priority treatments/meds for hypoglycemia of the newborn?
- feed infant by breastfeeding or formula
- if infant cannot stabilize blood glucose levels by feeding, may need IV glucose or glucagon
Screening for hypoglycemia should occur for which at-risk populations?
- Symptomatic newborn
- Newborns of mothers with diabetes
- LGA newborn
- SGA or IUGR newborns
- Neonates born with perinatal stress (e.g., MAS, polycythemia, hypothermia, birth asphyxia, cesarean birth for fetal distress, preterm, postmature, or born to mothers with pre-eclampsia or hypertension).
What is transient hypoglycemia of the newborn?
Most babies will have asymptomatic hypoglycemia that is transient in nature after birth that will resolve on its own through gluconeogenesis, glycogenolysis, ketogenesis, or external support with feedings or IV fluids.
What are the two types of IUGR?
Symmetric and Assymetric.
Priority interventions for hypoglycemic infants.
- Maintain neutral thermal environment
- Provide optimal nutrition
- For at-risk infants, monitor BG levels and provide necessary treatment
What is the priority education regarding hypoglycemic infants?
- Feed infant every 2-3 hours to maintain BG levels
- Teach family s/s of hypoglycemia
Distinguish between pathological and physiological jaundice.
Pathological - always bad, present at birth
Physiological - shows up after 24 hours, peaks 3-5 days
What assessment cues indicate pathological jaundice?
- Yellowing of the skin and sclera before 24 hours of life
- elevated bilirubin level
Why does pathological jaundice occur?
- hemolytic disease of the newborn
- maternal antibodies enter fetal circulation, then attach to and destory the fetal RBCs
- fetal system responds by increasing RBSs resulting in jaundice
- -occurs before 24 hours of life
What are the priority labs for pathological jaundice?
- Rh negative or Type O blood mother have cord blood tested to determine infant’s blood type
- Coombs test
- Serum bilirubin levels
- CBC–pay attention to hemoglobin and reticulocytes
What are the priority meds/treatments for pathological jaundice?
- Phototherapy
- Frequent feedings
- Exchange transfusion (not common anymore)
What are the priority interventions for pathological jaundice of the newborn?
- from the cord blood, determine infant’s blood type and Coombs test
- monitor bilirubin levels closely
- educate importance of phototherapy to parents
- notify HCP if notice jaundice before 24 hours of life
What is the patient education for pathological jaundice?
- Encourage frequent feedings
- Educate parents on importance of phototherapy lights and limiting the time infant is off the lights
What are some considerations for phototherapy?
- protect eyes and gonads
- monitor VS
- cluster care
- checking lights
- DC eye patches for feedings plus parent visits
- adequate fluids
- monitor I and O
- daily weight
- 12inches away from light
- test warmth
• Working if: yellow tone lessens, stool turns green, changing 5 plus diapers a day with stool
What are the assessment cues for physiological jaundice?
- yellow of the skin and sclera
- elevated bilirubin level
- Blanch the skin with digital pressure on the forehead, midsternum or knee to reveal underlying color of skin
- physiological jaundice not present at birth (after 24 hours)
- same as pathological jaundice cues but timeline differs
Define physiological jaundice and what are the risk factors?
Newborns have increased red cell mass, shorter red cell lifespan, slower uptake of bilirubin by liver, lack of intestinal bacteria, poorly established hydration for initial breastfeeding
Seen AFTER 1st 24 hours postnatally, typically 3-5 days of life
Risk factors: exclusively breastfeeding, family hx of neonatal jaundice, bruising, assisted delivery, maternal age, male gender, (pre-term) gestational age
What are the priority labs for physiological jaundice.
- hour specific bilirubin measurement via bilirubinometer
- serum bilirubin levels prn
What are the the priority medications/tx for physiological jaundice?
- frequent feedings
- phototherapy
What are the priority interventions for physiological jaundice?
- encourage early and frequent feedings
- assess for jaundice q8-12hrs
- monitor stool for amount and characteristics
- check bilirubin level prior to discharge and earlier if indicated
- monitor daily weight
What is the pt education for physiological jaundice?
- Frequent feedings are important because bilirubin is eliminated in the feces
- If under phototherapy, explain limiting the time infant is not under lights (cluster care) and protect eyes
What are the assessment cues for SGA infants?
- plotted on growth chart below 10th percentile
- plot weight/length on growth chart to determine if SGA
Define SGA and identify risk factors.
- SGA infants are at or less than 10th percentile for birth weight
- Commonly seen with mothers who smoke or have high blood pressure, causing the infant to have an increased incidence of perinatal asphyxia and perinatal mortality
What are priority labs for SGA infant?
- CBC
- glucose via glucometer per protocol
- serum glucose
- ABG
- CXR
What are priority meds/tx for SGA infants?
- IVF if needed
- respiratory support such as oxygen
What are the priority interventions for SGA?
- monitor vital signs
- monitor for s/s of hypoglycemia, respiratory distress
- encourage frequent feedings
- maintain temp
- supplement oral feedings if necessary either gavage or IV
- monitor daily weights
- minimize heat loss
- monitor glucose levels
What is the priority education for SGA?
- Keep infant wrapped or skin-to-skin to maintain temperature
- Feed infant frequently; every 2-3 hours
- How to promote normal growth and development
What are the assessment cues for IUGR?
- symmetric: prolonged restriction of growth in size of organs, body weight, body length and especially head circumference
- asymmetric - head circumference larger than abdomen
- plot weight/length on growth chart to determine if SGA
Define symmetric and asymmetric IUGR and risk factors.
- symmetric: prolonged restriction of growth in size of organs, body weight, body length and especially head circumference
- asymmetric - head circumference larger than abdomen
- plot weight/length on growth chart to determine if SGA
What are the priority labs for IUGR?
- CBC
- glucose via glucometer per protocol
- serum glucose prn
- ABG
- CXR
What are the priority meds/tx for IUGR?
- IVF if needed
- respiratory support such as oxygen
What are the priority interventions for IUGR?
- monitor vital signs
- monitor for signs and symptoms of hypoglycemia, respiratory distress
- encourage frequent feedings
- maintain temperature
- Supplement oral feedings if necessary either gavage or IV
- monitor daily weights
- minimize heat loss
- monitor BG levels
What is the priority education for IUGR?
What are the assessment cues for the infant of a diabetic mother?
- macrosomia
- ruddy in color
- excess adipose tissue
- thick umbilical cord
Define macrosomia dt diabetic mother and list risk factors.
- excessive growth dt high levels of maternal glucose
- fetus responds by ^ insulin production
- once delivered, infant continues to make high levels of insulin causing hypoglycemia
What are the priority labs for the infant of a diabetic mother?
- BG levels less than 40 mg/dL
- Glucose per glucometer per protocol
- Hour-specific bilirubin measurement via bilirubinometer
- Serum bilirubin PRN
- BMP
- CBC
- CXR
- Gestational age assessment
What are the priority meds/tx for the infant of a diabetic mother?
- IVF
- suppl oxygen
- CPAP
- mechanical ventilation
What are the priority inteventions for the infant of a diabetic mother?
- Monitor blood glucose levels
- monitor vital signs
- initiate early feedings
- maintain a neutral thermal environment
- Monitor for S/S of respiratory distress
What is the priority education for the infant of a diabetic mother?
- feed infant every 2-3 hours to maintain blood glucose levels
- teach s/s of hypoglycemia
- alert nurse if signs of difficulty breathing
Compare caput and cephalohematoma.
Caput: localized,soft area on scalp, crosses suture line. Present at birth or shortly thereafter.
Cephalohematoma: scalp feels loose and slightly edematous; unilateral or bilateral, but doesn’t cross suture line. Appears on first or second day
Describe the pathophysiology of cephalohematoma and caput.
cephalohematoma: Cephalohematoma: collection of blood between cranial bone and periosteal membranes
caput: collection of fluid, edematous, swelling of scalp from long and difficult labor or vacuum extraction
What are the priority labs for cephalohematoma?
- FOC
- Hour-specific bilirubin measurement via bilirubinometer
- Serum bilirubin PRN
What are the priority meds/tx for caput/ cephalohematoma?
caput: no tx needed
cephalohematoma: monitor FOC
What are the priority interventions for cephalohematoma?
- determine if caput or cephalohematoma
- observe for any changes in size
- reassure parents
What is the priority education for caput vs. cephalohematoma?
- For caput: inform parents that will reabsorb w/in 12 hours to a few days after birth
- For cephalohematoma: will disappear in 2-3 weeks, but may take several months
Describe the timeline for bathing a newborn and how to bathe.
- Newborn baths should be completed 6-24 hours after birth - leave vernix on
- baths should be less than 5 minutes
- AVOID powders, lotions, and adult soaps
- Triple dye and or alcohol has no significant advantage; alcohol may kill “good” bacteria and cause cord to stay on longer
- Curl diaper down away from cord - dampness from urine or sweat causes cord infections
What are the newborn medications given shortly after birth and why are they given? Dosage? Route?
- Vitamin K (phytonadione)
- Prophylaxis
- Dose 0.5 within 1 hour of birth; may be delayed until after first breastfeeding in birthing are
- If the mother received anticoagulants during pregnancy, additional dose may be ordered by HCP and is given 6- 8 hours after the first injection
- Treatment of vitamin K deficiency bleeding (hemorrhagic disease of the newborn)
- At birth, newborn does not have bacteria in the colon for synthesizing fat-soluble Vitamin K
- Administered IM in vastus lateralis
- Erythromycin ophthalmic ointment:
- Prophylactic for ophthalmia neonatorum, due to bacteria Neisseria gonorrhoeae
- Administer along the lower conjunctival surface of each eye, starting at the inner canthus
- Hepatitis B (energix - B) vaccine:
- Deferred for infants with birth weight less than 2,000 g
- If mother is HBsAg negative at the time of infants birth •
- Hepatitis B immune globulin (human):
- 0.5 ml admin IM within 12 hours of birth
- Efficacy decreases if treatment is delayed beyond 48 hours
What are considerations for feeding a newborn?
- No complications – skin to skin with mom
- Promote breast feeding – bonding, passing of meconium, prevent hypoglycemia, immunological protection from colostrum, stimulates milk
- production
- Newborns most alert in first 2 hours of life - ready to breastfeed
- Formula fed: still do skin to skin, fed when showing feeding cues or per facility policies
- Breastfed and formula fed early feedings – stimulates peristalsis – eliminate by products of bilirubin conjugation, passing of meconium lowers
- jaundice risk
- Extreme fatigue (tachypneic, dusky in color, diaphoretic) while feeding - resp or cardiac problems
- Regulation of mucus, fluid, or milk shortly after feeding is normal - prevent by holding baby up for 15-20mins after each feeding
Briefly explain the nursing interventions for NAS.
- Provide quiet, dimly lit area
- perform neonatal abstinence
- small, frequent feedings
- meds as ordered
- swaddle with hands near mouth and provide pacifier
- gentle rocking
- protect from excoriation
- protective barrier to groin every diaper change
- morphine, methadone, buprenorphine, phenobarbital, clonidine (po)
- meds shown to reduce hospital stay
What are the nursing interventions for FAS?
- min stim
- consistent caregivers
- adequate nutrition
- support parents/ +ve reinforcement
What are some concerns for LGA infant?
- Birth trauma CPD
- breech presentation
- shoulder dystocia - fractured clavicles, brachial palsy, facial paralysis, phrenic nerve palsy, dpressed skull fracture, cephalohematoma, intracranial hemorrhage
- polycythemia
- hypoglycemia
- hyperviscosity
What are congenital dermal melanocytes?
Mongolian spots - macular areas of bluish-black or grey-blue pimentation - dorsal area of buttocks - Asian, African, Hispanic descent usually
Describe the nursing management of a premature infant
- Monitor respiratory function
- maintain neutral thermal environment
- monitor fluids & electrolytes
- I&Os
- daily weight
- support fam
What are some common complications of the infant of a diabetic mother?
- hypoglycemia
- hypocalcemia
- hyperbilirubinemia
- birth trauma
- polycythemia
- RDS
- congenital birth defects
Discuss discharge teaching points for baby.
- 5-6 voids per day
- 1 stool min per day
- keep cord site clean and dry (no drainage)
- feed on cue
- Call HCP for temp >100.4
- Teach normal newborn care (ie. swaddling, diapering, bathing, circ care)
How often should breastfed/bottlefed babies eat?
Breastfed: 2-3 hours
Bottlefed: 3-4 hours
Describe mottling and if it’s normal or abnormal.
lacy pattern of dilated vessels under the skin. Result of general circulation fluctuations. May last several hours to weeks or may come and go periodically. Can be related to many factors:
- chilling
- prolonged apnea
- sepsis
- hypothyroidism.
What are some types of congenital anomalies?
- Congenital Heart Defects
- Diaphragmatic Hernia
- Myelomengocele
- Cleft lip/Cleft palate
- TE Fistula
- Gastroschisis
- Omphalocele
- Hydrocephalus
What are general nursing interventions for congenital anomalies?
- Maintain thermoregulation
- Monitor vital signs
- Start IV and administer IVF as ordered
- Prepare for intubation on some of these defects
- Administer medications as ordered
- Prepare infants for surgery
- Support parents
What are some post-surgery interventions for congenital anomalies?
- Maintain ventilator settings
- Obtain blood gases as ordered
- Administer pain medication as ordered
- Maintain fluid & electrolyte balance
- Monitor I&Os
- Assess wounds
- Support parents
When do you suspect NAS, FAS?
- Maternal history of drug abuse
- No prenatal care
- Obtain meconium and urine
- Physical assessment
What are the characteristics of a premature infant?
- Born before 37th week of gestation
- Thin, shiny, pink or red skin with visible veins
- Little body fat
- Lots of lanugo
- Weak cry and poor tone
- Genitals small and underdeveloped
What are some of the possible complications of a premature infant?
- Respiratory Distress Syndrome
- Retinopathy of Prematurity
- Apnea of Prematurity
- Patent Ductus Arteriosus
- Intraventricular Hemorrhage
- Necrotizing Enterocolitis
Describe the nursing management of premature infants.
- Monitor respiratory function
- Maintain a thermal neutral environment
- Monitor fluids & electrolytes
- Monitor I&Os
- Monitor weight daily
- Supporting the families
Describe the clinical manifestation of a newborn with HIV/AIDS.
- Newborns Asymptomatic
- Some will show symptoms within 2 months
- Early signs are fever, lymphadenopathy, liver & spleen enlargement, either hyporeflexia or hyperreflexia, and developmental delays
- Prognosis is based on timing of infection & treatment modality
What is the Tx of a newborn with HIV/AIDS?
- Antiretroviral therapy does not cure
- Most important factor is treatment of mother
- Bathe infant as soon as possible
- Antiretroviral therapy started within first 12 hours of life
What is the Zika virus associated with?
microcephaly
Describe the s/s of sepsis.
- Non-specific
- Infant just not looking right
- Temperature instability
- Feeding intolerance
- Jitteriness
- Tremors
- Apnea
- Tachycardia
- Bradycardia
How do you determine if infant is septic?
- Blood cultures
- CBC
- CRP
- Lumbar Puncture
- Suprapubic tap
- Straight cath for UA
What are the nursing interventions for sepsis?
- Maintain a neutral thermal environment
- Monitor VS
- Monitor I&Os
- Obtain labs as ordered
- Administer IVFs and antibiotics as ordered
- Support parents
Describe cardiac findings (normal/abnormal) in a newborn.
- HR in the first week of life: 110- 160 bmp; up to 180 with crying
- BP highest at birth, descends to lowest level at 3 hours of age. Variable due to gestational age. Crying CAN elevate blood BP
- Cardiac murmurs are often present as the newborn transitions from fetal to neonatal circulation due to closure of the ductus arteriosus (between pulmonary
- artery and descending aorta) and foramen ovale (hole between the atria)
- Murmurs heard in the transitional period of 48 hours should be followed up
Describe how weight changes in a newborn during the first days and weeks of life.
- Infants lose weight directly after birth due to
- Passage of meconium
- Low fluid intake
- Loss of extracellular fluid
- Not worrisome unless more than 10 percent of birth weight lost
- Regain birth weight within 7-10 days after DOB
- Then continuous pattern of weight gain
