Newborn Flashcards
Neonate
Birth - 28 days
Preterm
20 wks- 36 6/7 wks
Term
37 - 42 wks
Postterm
AFTER 42 wks
NURSING GOAL for ALL newborns
we want them PINK, WARM & SWEET
PINK refers to baby being
adequately OXYGENATED
WARM refers to baby
maintaining their own TEMP
SWEET refers to baby having
adequate BLOOD GLUCOSE levels
compromised Maternal Perfusion affects
baby oxygenation
Comprmised perfusion from placenta & umbilical artery affects
baby oxygentaion
Prolonged O2 deficits leads to
Metabolic acidosis => dificult baby transition from fetus to neonate & may even cause permanent neurological damage
1st PRIORITY of nurse After Birth of baby
Clear Airway
Establish Respirations
prevention of Cold Stress
Cord Blood Collection
what does prevention of cold stress have priority over
manuel establishment of respirations
Cord Blood Collections is necassary for
analysis of cord blood gases to determine severity of Acidosis at birth OR for ABO & Rh incompatibility testing
Why is the establishment of respiration (PINK) important
initiation of 1st breath begins cardiopulmonaty adaptation that MUST occur to transition from placenta-dependent fetus to independent air-breathing neonate.
What changes are necessary for the progression of transition ?
increased O2 saturation & systemic BP
What causes the shunts to reopen further compromising oxygenation
decrease O2 or systemic BP
Normal RR
30-60 bpm
During transition RR may be
as high as 80
Lung fluid should be CLEAR w/in
2 hrs of birth
Lung fields may sound … during time they have fluid.
wet
Signs of Respiratory Distress
Grunting
Retractions
Nasal Flaring
Central Cyanosis
Tachypnea
Grunting occurs when
Baby tries to keep the alveoli open through partially closed-glottis expiration.
Retractions
Visible when the baby has to work so hard to inhale that the skin of the chest is pulled against the ribs, making them visible, especially along the lower border.
Nasal flaring
Caused by greater force being exerted with inspiration.
Central cyanosis
Bluish-color on the face or trunk, pale or dusky color are all signs of poor oxygenation, either from severe anemia, or inadequate respiratory function.
Tachypnea in baby
RR greater than 60 breaths/min is compensation to increase oxygen. Its frequently accompanied by tachycardia.
Surfactant coats the inner surface of fetal alveoli w/….
surface-active phospholipids lecithin & sphingomyelin
Alveolar ducts form
from 20-24 weeks gestation
Surfactant production increases from
28-32 wks through delivery
What is the needed ration of lecithin/sphinogomyelin to have adequate respiratory function
2:1
Risk factors for decrease surfactants
premarute baby & mothers with diabetes
T/F: (artificial) surfactant be administerd via an endotracheal tube through the lungs
TRUE
T/F: newborn oxygenation jump up right away to 98%
False
Whats the targeted preductal O2 saturation in transition
1 min:
5 mins:
10 mins:
1 min: 60-70%
5 mins: 80-85%
10 mins: 85-95%
What should you keep in mind when taking pulse ox of newborn
whats normal for them depending their age, may vary bc of shunts depending where you take it
When is the APGAR score performed
1 min & 5 mins after birth
If APGAR score is below 7 it is done
every 5 mins until a 7 or above is reached
APGAR score is used for
measure newborn transition to extrauterine life
What do LOW APGAR scores indicate
that the newborn is having trouble with transition (being independent from mom) impacting O2, blood glucose & put infant at greater risk fro physiological jaundice
When is the 1st nursing assesment done with a newborn
usually done as the newborn is 1st born
1st nursing assessment involves
Color, Respiratory effort, HR, Temp., General appearance,
neurologic, musculo-skeletal
When perfoming general survey on a newborn
survey of facial features, body, limbs and genitalia for intactness and function, then skin color, muscle tone and respiratory effort
Thermoregulation is
balancing heat loss & heat production
When do baby thermoregulate
during the 1st 12 hrs of life
Normal temp for infants
97.7 - 99.5
What places infants at risk for heat loss
having a larger surface to body ration & thin layers of subcutaneous fat & skin
What do baby do to assist in regulating their temp?
may cry & increase muscle activity => increase metabolic activity => increases O2 consumption & glucose consumption
what may infants do to decrease surface area
flex their body
Can newborn shiver?
Yes some may shiver but its not an effective mechanism for heat production
Non-shivering thermogenesis occurs through
metabolism of brown fat & increase metabolic activity in the brain, heart, & liver
How do infants produce heat?
by metabolism of their brown fat
Brown Fat is located where
the interscapular region, axillae, vertebral column and around the kidneys
When can brown fat be depleted quickly
during cold stress
Who have a smaller reserve of brown fat
premature babies
What are the 4 methods of Heat Loss
Evaporation, Radiation, Conduction, Convection
Evaporation is the
loss of heat through moisture (failing to dry infant well after birth)
Ratiation is the
loss of heat to cooler objects in the environment not in direct contact (placing crib next to an exterior wall)
Conduction is the
loss of heat through direct contact with a cooler object (placing infant on cold surface)
Convection is the
flow of body heat from the body surface to cooler ambient air (placing infant near a draft)
why is thermoregulation such a major concept in newborn care?
attempt to increase his core temp increases his need for oxygen, then the infant will start breathing faster to compensate for the increased need for oxygenation.
drying the infant at birth and placing them under a radiant warmer has priority over
respiratory intervention such as bag and mask resuscitation
Neutral thermal environment
Place infant on warm surfaces and use warm blankets
Dry infant well at birth and be sure temperature is 98.0 before bathing
Head cover (hat) & dress in layers
Prevent drafts
Educate parents on cold stress as well as overheating
Is an axillary temp of 97.4 a gray area
NO, its too low & needs assessment, take temp under other arm
Cold stress is serious in newborns & can result in
DEATH
Plasma glucose levels for the 1st few hrs after birth
50-60 mg/dl
Plasma glucose levels for the 1st week
60-80 mg/dl
What happens when the umbilical cord is clamped?
hint: blood glucose
maternal nurtrition is stopped => * blood glucose will decrease
What helps stabilize glucose
initial feeding
Hypoglycemia (<45) symptoms
jittery, lethargic, apneic, problems w/ feeding,
seizures,
OR may show NO symptoms at all
Risk factors of hypoglycemia
mother is a diabetic, traumatic delivery, cold stress, asphyxia or the infant is LGA, SGA or LBW
Prematurity; have less reserve & usually dont feed well
Be proactive w/ at RISK for Hypoglycemia babies by
early feedings, thermoregulation, and decrease energy consumption
Whats the typical intervention choice for BG <45 (hypoglycemia)
formula supplementation
T/F: Maternal-fetal infection transmission is a major cause of morbidity and mortality in newborns
True
Newborns immune system is limited in its ability to …
recognize, localize & destroy invasive bacteria, allowing infection to go systemic
Immature hypothalamus has poor pyrogenic response so …
temp. instability is more reliable than fever to Dx infection
The provider should be notified if the infant is portraying what s/s (early signs)
poor feeding, irritability, vomiting or diarrhea, lethargy, pale or mottled skin color or any symptoms of respiratory distress
Newborn risk factors for infections include
any infection in the mother such as : HIV & syphilis, hepatitis, HSV, chlamydia, gonorrhea or Group B strep.
maternal colonization w/ group B strep
prolonged rupture of membrane (>18hrs)
prematurity
What are the most common infections aquired with prolonged rupture of membranes?
Group B strep & E. coli
there is the risk of any organisms in the vagina ascending into the uterus and causing infection if …
the membranes are ruptured longer than 18 hrs
Why are premature babies at greater risk for infection
their immune systems are even more immature than term babies
Nursing implications for infections
monitor for early signs
practice asepsis; hand washing for personel & visitors, clean stethoscope/equipment shared
identify infants at risk
erythromycin eye prophalaxis
H-BIG, hep B vaccine
Who’s at RISK for physiological jaundice?
ALL newborns; the lower the gestational age the greater the risk!
The liver in all newborns is …
immature which gets overwhelmed about 3-5 days
Bilirubin is a byproduct of …
RBC breakdown
Newborns have an abundance of FETAL RBCs which have a
shorter life span than regular RBCs ; when they die they release bilirubin
Whats the best way to excrete the bilirubin ?
proative management; early feeding to stimulate pooping & pee
Jaundice
yellow pigment from circulating bilirubin in the bloodstream
Newborn jaundice preogresses
cephalocaudal; more yellow in their face than in their legs
Newborn jaundice occurs after
24 hrs of life
Risk factors of jaundice
bruising, cold stress, hypoglycemia, hypoxia, poor feeding, delayed stooling
When should jaundice be resolved ?
between 5-10 days if baby is eating & pooping/ peeing appropriately
Is it normal for bilirubin to increase as hrs of life increase
YES
T/F : filtered sunlight, such as through a plastic canopy, is as effective if not more so than traditional bililights to reduce newborn jaundice.
TRUE
A term newborn should be able to coordinate
sucking, swallowing and breathing without distress or choking
Meconium (first stool) is
black sticky substance that is in the newborn’s GI track before birth
Stools should transition from
meconium (black) to milk stools (yellow)
When should the newborn have their 1st void & stool ?
before they are 24 hrs old
What may early urine contain?
rusty-colored usic acid crystals that the parents may interpret as blood
What may some female babies experience
passing small amount of blood between days 3-5
pseudomenstuation; shedding of uterine linning d/t mothers hormones withdrawing from infants system warn parents (teaching)
What is one of the most important nursing interventions
monitoring infants I&O
GI/GU nursing care
Monitor infants I&O
Infants should be feeding well & voiding/stooling prior to discharge
parent teaching crucial
monitor weight loss
Most hospitals weight babies every…
24 hrs to asees weight loss
Weight loss should be
<10% & plateau by day 4-5
Feedings should be based on
infants feeding cues
Infants feeding fues are
crying, sucking on hands, lip smacking
Breastfed babies cluster feed by
nurisng 5-10times in 2hrs then sleep for several hrs
need to feed 1 1/2 to 3 hrs or have 8-12 feedings/day
T/F: Once the mother’s milk is established, babies only tend to cluster feed during times of rapid growth.
True
Bottle fed babies need to be feed
every 3-4 hrs or have 6-8 bottles a day
How is the adequacy of feeding measured?
in urinary output & stool pattern & signs of satiety after feedings
Whats the general guideline for breastfeeding babies
1 diaper for each day of life until they are 5 days old
Once mothers milk is eatablish on day 3-5, the infant should be voiding
6-8 times a day & should have multiple bowel movements as well
What are some signs of satiety
the baby stopping the feed, relaxing the body and limbs, and/or falling asleep
Whats normal for either feeding methods
regurgitation of small amounts after feedings called “wet burps”
1st period of reactivity
usually quietly alert
increase HR & RR
encourage skin to skin
best time to initiate breastfeeding
lasts ~30 mins
2nd period of reactivity
variable physiologic responses
increased production of respiratory & gastric mucous
teach family warning signs
will probably want to eat
lasts ~4-8 hrs
1st sleep phase
difficult to arouse
lasts ~2-4 hrs
newborn procedures that cause pain
shots, circumcision, blood draws
What are some methods to manage pain in newborns
Holding the baby, breastfeeding, swaddling with arms and legs tucked, sucrose solution, pacifiers, holding, soothing language
signs of infants in pain
Crying, grimacing, active movement; especially legs, increased RR
Neonatal infant pain scale (NIPS)
Whats Vernix
thick gunk that we try to wash off
Caput succedaneum
has fluid under head skin that will move through the suture lines (bump on head that can be squishy)
Cephalohematoma
collection of blood, will not cross the suture line, brusing check for jaundice (bump on head)
Benefits of breastfeeding
decrease risk for GI infection, celiac disese, asthma, resp. tract infections, otitis media, SIDS, obesity, DM 1&2, acute lymphocytic & myeloid leukemia
colonize newborn gut
more easily digestible
available & free from contamination
always at the right temp
How do you determine if a baby is getting enough milk
Diaper count (voids and stools)
Baby is relaxed and is no longer demonstrating feeding cues
Baby falls asleep and remains asleep until the next feeding or at least an hour
Weight loss stays within normal range
T/F: when bottle feeding should you prop the bottle
FALSE = never prop bottle it increases RISK for CHOKING!
What causes physiologic jaundice?
Short life span of fetal RBCs
Polycythemia-excessive breakdown of RBCs after birth
immature liver
Bilirubin levels range 24 hrs
2-6mg/dl
Bilirubin level range 48 hrs
6-7 mg/dL
Bilirubin level range 3-5 days
4-6 mg/dL
Metabolic disorders
PKU
Galactosemia
Hypothyroidism
How much % of weight is loss for formula fed infants in the 3-4 days of life
generally lose up to 3.5%
Breast fed infants should not lose over
7%
during the 1st month baby should gain
5-7 oz a week
circumcision care - educate
-CHECK FOR BRIGHT RED BLEEDING- Call the health care provider if there is bleeding.
-Don’t try to remove the yellow film over the head of the exposed glans
-Liberal use of petroleum jelly to avoid site sticking to the diaper
-Diaper should not be too loose to avoid friction rub or too tight to cause pain
-Do not use premoistened diaper wipes – they may contain alcohol
-Circ site should be completely healed in a couple of weeks
-Do not submerge in a bath until site is completely healed.
What are some Infant Safety
car seats, home safety; falls, sleeping, drowning, infant cpr, pets, sibilings/other children
Reasons to bring baby back to see provider
Temp greater than 100.4
Forceful or frequent vomiting (not spitting up)
Refusal to eat for more than two feedings
Cyanosis
Apneic periods of longer than 20 seconds
Newborn that has a high pitched cry or inconsolable cry
No wet diapers for 18 – 24 hours OR fewer than 6 wet diapers a day
Yellowing of the skin
Watery stools that are increasing in frequency
Increased levels of unconjugated bilirubin require treatment in order to prevent:
neurotoxicity
