Newborn Flashcards
What is the neonatal period?
First 28 days
Switch from fetal to newborn circulation
from Placental to pulmonary gas exchange
what does a successful transition from fetal to newborn circulation require?
Increased pulmonary flow, removal of placenta, closure of foramen ovale, ductus venosus, & ductus arteriosus
How does the foramen ovale close?
Pressures in the left atrium are greater than the right after birth.
how do umbilical vessels close?
shifts in pressure in the heart and lungs.
Circulatory changes in newborn
umbilical cord is clamped. First breath is taken & lungs begin to function. There is a rapid decrease in pulmonary vascular resistance and an increase in pulmonary blood flow.
Newborn normal heart rate
110-160’s decreases to 120-130 bpm
T or F: Murmurs are usually benign
True
Most Crucial Adaptation for the newborn
Respiratory
What does surfactant do on inspiration in a newborn?
Prevents atelectasis and facilitates elastic recoil
What are the signs of respiratory distress?
Cyanosis, tachypnea, expiratory grunting, sternal retractions, and nasal flaring.
What is the temperature range for a newborn?
97.9F-99.7F (36.6C-37.6C)
Newborn characteristics that make them prone to heat loss
- Thin skin with blood vessels close to the surface
- Increased skin permeability to water
- Lack of shivering till 3 months
- Limited metabolic substrates (glucose, glycogen, fat)
- Limited use of movement to produce heat
- Large surface area to body mass ratio
Convection heat loss & nursing action
flow of heat from the body to cooler
ambient air-wrap the baby
Radiation heat loss & nursing action
loss of heat from body surface to a cooler
solid surface not in direct contact but in close
proximity-drafty window
Evaporation heat loss & nursing action
loss of heat when liquid evaporates-dry
infant well
Conduction heat loss & nursing action
Loss of heat from body surface to cooler
surfaces in direct contact-pre warm the infant warmer
The newborn attempts to conserve heat and increase heat production by
non-shivering thermogenesis of brown fat
What is non-shivering thermogenesis
a process in which brown fat (adipose tissue) is oxidized in response to cold exposure.
What is cold stress?
Excessive heat loss that requires a newborn to use compensatory mechanisms (such as nonshivering thermogenesis and tachypnea) to maintain core body temperature
How to prevent cold stress?
*Pre-warming blankets and hats
*Drying the newborn completely after birth
*Encouraging skin-to-skin contact with the mother if the newborn is stable
*Promoting early breastfeeding to provide fuels for nonshivering thermogenesis
*Using heated and humidified oxygen
*Deferring bathing until the newborn is medically stable
Hepatic
newborn’s liver slowly assumes functions of the placenta during fetal life
Iron Storage
if mother’s intake of iron was adequate, iron has been stored in newborn’s liver until 6 mo of age.
how does hepatic function differ from the adult?
Fetal circulation less efficient at O2 exchange; so fetus needs
additional RBC;s for transport of O2 in utero; therefore, the
levels of RBCs, hemoglobin, and hematocrit are higher than
those in the adult.
What is bilirubin?
is the yellow-to-orange bile pigment produced by the breakdown of RBCs.
Bilirubin
circulates in plasma, is taken up by liver cells, and is changed to a water-soluble pigment that is excreted in the bile. This conjugated form of bilirubin is excreted from liver cells as a constituent of bile.
What causes hyperbilirubinemia?
Results from the overproduction of bilirubin. Occurs after day one
and can last up to a week.
What is bilirubin encephalopathy?
extremely elevated blood levels of bilirubin during the first week of life can cause bilirubin encephalopathy, a permanent and devastating form of brain damage.
Newborn Jaundice
Visible yellowish color of the skin and
sclera due to elevated serum levels of
bilirubin (hyperbilirubinemia)
What increases the risk of a newborn for hyperbilirubinemia?
Higher red blood cells at
birth and shorter lifespan of these cells.
What is the best way to prevent jaundice?
Early, frequent, and effective breastfeeding is
associated with reducing the incidence
hyperbilirubinemia.
How to screen for newborn jaundice?
transcutaneous bilirubinometer, if elevated
obtain total serum bilirubin level.
how is newborn jaundice treated?
Phototherapy
Light treatment to eliminate bilirubin in the
blood
Skin and blood absorb light waves and change
bilirubin into products that pass through their
system.
Nursing considerations for Phototherapy
Monitor temperature
Adequate hydration
Monitor stools
Regular feeding schedule
Eye protection needed
Diaper
Oral feedings
Special mechanism in newborns coordinates the breathing, sucking, and swallowing reflexes
Meconium
Meconium is composed of amniotic fluid, shed mucosal cells, intestinal secretions, and blood. It is greenish black, has a tarry consistency, and is usually passed within 12 to 24 hours of birth.
Nursing considerations for meconium?
Document time, color, characteristics of first stool
Transitional stool
After feedings are initiated. Is greenish brown to yellowish brown, thinner in consistency, and seedy in appearance.
Transitional Breast-fed stool
light mustard with seed-like particles
Transitional Formula-feed stool
Tan or yellow in color and firmer
Breast-fed milk stool
Yellow-gold, loose, stringy to pasty in consistency, and typically sour-smelling.
Formula-fed milk stool
vary depending on the type of formula ingested. They may be yellow, yellow-green, or greenish and loose, pasty, or formed in consistency, and they have an unpleasant odor.
Neuro in newborns
*Nervous system is immature as it
develops in the first year of life.
*The brain increases its size three-fold during the first year of life.
*Newborn reflexes are assessed to
evaluate neurologic function and
development.
First Period of reactivity
30 minutes up to two hours
Period of alertness and may appear hungry.
Period of decreased responsiveness
30 to 120 minutes of age
Quiet time
Difficult to arouse or interact with the newborn
Second period of reactivity
Lasts 2-8 hours
First stool & void
Good time for parents to ask questions
Newborn shows an interest in environmental stimuli.
Immediate care of the newborn
Close observation and assessment is essential.
Focus is on assessing and stabilizing
newborn.
Be aware of prenatal and intrapartum history-provides
insight to potential risk factors.
Nurses must be aware of what is
normal to detect disorders in adaptation after birth.
What is RAPP?
Newborn assessment tool used to quickly assess physiologic condition
RAPP
RA-Respiratory Activity
P-Perfusion/color
P-position/tone
What is APGAR score?
Rapid assessment of transition to
extrauterine existence based on
five signs that indicate physiologic
state of newborn. Done at 1 minute and 5 minutes after birth.
APGAR
A: appearance (color)
P: pulse (heart rate)
G: grimace (reflex irritability)
A: activity (muscle tone)
R: respiratory (respiratory effort)
how to assess for heart rate/pulse?
Stethoscope or
palpation of the umbilical cord
Normal APGAR score
A normal newborn’s score should be 8 to 10 points.
how to assess respiratory effort?
observation of chest rise and fall
how to assess for muscle tone/activity?
Degree of flexion and
movement
how to assess for Reflex irritability/grimace?
Response to
suctioning, sneezing, coughing
how to assess appearance?
Skin color-observation
Normal head circumference, length and weight
Length: 17-22 inches
Weight: 5 lb. 8 oz to 8 lb.
14 oz
Head: 13-15 inches
Normal Vital signs
Temperature 97.7 -99.5 F
(36.5-37.5 C)
Heart rate 110-160 bpm
(higher if crying)
Respirations 30-60
breaths/minute
Gestational Age Assessment
Uses Ballard Gestational Age
Assessment
Assessment of neuromuscular Maturity and Physical Maturity
Initial Nursing Care
Maintain Airway (bulb syringe)
Identification ID bracelets
Medications
Maintain Thermoregulation
How to maintain airway?
Remove fluids and mucus from the mouth and nose. Mouth is suctioned first with a bulb syringe to remove debris and then the nose is suctioned.
Common medications for newborn?
Vitamin K, Erythromycin,
Hepatitis B
Vitamin K
promotes blood clotting by increasing the synthesis of prothrombin by the liver.
Erythromycin
Provides bactericidal and bacteriostatic actions to prevent Neisseria gonorrhoeae and Chlamydia trachomatis conjunctivitis
Prevents ophthalmia neonatorum
Newborn Assessment
History
Skin
Head to toe
Reflexes
Acrocyanosis
NORMAL. Persistent cyanosis of fingers, hands, toes, and feet with mottled blue or red discoloration and coldness.
Skin Vernix Caseosa
thick white substance that protects the skin of the fetus. It will be absorbed into the skin.
Stork Bites
Back of the neck, eyelids, between the eyes and upper lip
Fade within first year
Normal
Milia
early-white or pale yellow
Unopened sebaceous glands
Frequently on nose
40% of newborns
Disappear on their own
Mongolian Spots
blue or purple splotches that appear solitary on the lower back and buttocks of newborns.
Tend to occur in dark-skinned newborns
of all races.
Will disappear in first 4 years of life.
Benign
Erythema Toxicum
Newborn rash
small papules or pustules on the skin resembling flea bites.
Benign
Portwine Stain
a capillary angioma located directly below the dermis. It is flat with sharp demarcations and is purple red.
Port-wine permanent
(some may attempt
laser treatment).
strawberry hemangioma
tend to resolve by age 3
without treatment.
Benign capillary hemangioma in the dermal and subdermal layers. It is raised, rough, dark red, and sharply demarcated
Head moulding
elongated shaping of the fetal head to accommodate passage through the birth canal.
Caput Succedaneum
localized edema on the scalp that occurs from the pressure of the birth process.
swelling will gradually dissipate
Cephalhematoma
localized subperiosteal collection of blood of the skull which is always confined by one cranial bone.
It occurs after prolonged labor and use of obstetric interventions such as low forceps or vacuum extraction.
Face, neck, and chest
Nose
Mouth-suck, tongue
(free-moving), palate
Eyes
Ears
Neck & Clavicles (edema
& crepitus)
Abdomen
Shape: protuberant but not distended.
Bowel sounds
Bowel Movement
Umbilical cord (AVA) &
Care of: correct amount of blood vessels (two arteries and one vein)
Female Genitalia
Female – swollen
perineum; vaginal
discharge
May have pseudomenstruation
Male Genitalia
swollen scrotum;
testes not descended
Breast Tissue
swollen on both male and female
Sucking reflex
Gently stimulating the newborn’s lips by touching them.
Placing a gloved finger in the newborn’s mouth will also elicit a sucking motion
Moro Reflex
Embrace reflex, occurs when the neonate is startled.
Stepping Reflex
Holding the newborn upright and inclined forward with the soles of the feet touching a flat surface. The baby should make a stepping motion or walking, alternating flexion and extension with the soles of the feet
Tonic Neck Reflex
Stance of a fencer and is often called the fencing reflex. Test this reflex by having the newborn lie on the back. Turn the baby’s head to one side. The arm toward which the baby is facing should extend straight away from the body with the hand partially open.
Rooting Reflex
stroking the newborn’s cheek. The newborn should turn toward the side that was stroked and should begin to make sucking movements
Babinski Reflex
Present at birth and disappears at approximately 1 year of age. It is elicited by stroking the lateral sole of the newborn’s foot from the heel toward and across the ball of the foot. The toes should fan out. A diminished response indicates a neurologic problem and needs follow-up.
Palmar and Plantar Gasp
The baby’s hand will close around the finger.
Place a finger just below the newborn’s toes. The toes typically curl over the finger.
Blinking, sneezing, and gagging
protective reflexes and are elicited when an object or light is brought close to the eye (blinking); something irritating is swallowed or a bulb syringe is used for suctioning (gagging and coughing); or an irritant is brought close to the nose (sneezing).
Nursing Care: Bathing
*bathe the newborn 48 hours after birth versus waiting only 24 hours after birth was more effective in preserving the body temperature of the newborn
*Parents should not fully immerse the newborn into water until the umbilical cord area has healed—up to 2 weeks after birth.
*Give the infant a sponge bath until the umbilical cord falls off and the navel area has healed completely.
Nursing Care: Diapering
*six to 12 diapers a day indicates adequate hydration.
*keep the top edge of the diaper folded down below the umbilical cord area to prevent irritation and to allow air to help dry the cord.
Nursing Care: Cord Care
*Single-use agents for cleaning are recommended to prevent cross-contamination with other newborns. Expect to remove the cord clamp approximately 24 hours after birth by using a cord-cutting clamp.
*Cord bleeding is abnormal and may occur if the cord clamp is loosened. Any cord drainage is also abnormal and is generally caused by infection, which requires immediate treatment.
Circumcision
Removal of foreskin from the
glans
Discussion involves cultural,
religious, medical, emotional,
and social issues.
Benefits and Risks of circumcision
Risks include cold stress,
bleeding, infection,
hypoglycemia, aspiration, or
trauma to penis
Benefits include reduction in
UTI, penile cancer and STIs
Newborn Safety
Car Safety
Sleep Safety
Infection Prevention
Soothing a crying baby
Screening of newborns
Screening tests for genetic and
inborn errors
(PKU, Galactosemia. Sickle
Cell, Hypothyroidism)
Hearing
Hyperbilirubinemia
Hypoglycemia
Heart
Promoting Nutrition
Supporting Choice of Feeding
Breastfeeding
Formula Feeding
Breast Milk Storage &
Expression
Discharge Planning
Education
Follow up Care
Immunization
