Newborn Flashcards
The First Breath
Intrapulmonary fluid absorbed
Reduces pulmonary resistance to blood flow
Facilitates initiation of air breathing
Surfactant
Decreases surface tension within alveoli
Lungs that have fluid dissipate out of tissues when baby is turning in cardinal movements
Cardiopulmonary Transition
Increased pulmonary blood volume
Conversion from fetal to neonatal circulation
Skin color
Respiratory rate
Breathing pattern – suction mouth and then nose
Change in pressure from circulatory system
Immediate Newborn Assessment
ABC
ABCs
Establish airway
Stimulate neonate to breathe deeply and cry
Observe respiratory effort, color, muscle tone
Provide warmth
Assess heart rate
Check umbilical cord vessels
Note obvious abnormalitiesAPGAR
Activity Pulse Grimace Appearance Respiration
When a baby is born…
Cord Clamped Vessels Vital Signs Weight Identification Measurements SGA, AGA, LGA
Baby receives two things when they are born…
Erythromicin ointment both eyes
Prevents STI’s and other infections baby can get while going through the birth canal
Vitamin K IM Vastus Lasteralis – cannot synthesize in intestines without bacterial flora –> increased risk for hemorrhagic disease
Injuries during delivery (6)
- Laceration
- Fractured clavicle
- Shoulder dystocia
- Brachial plexus injury – nerves from spine/shoulder are stretched, compressed
- Erb’s palsy – hands are turned out
- Torticollis – neck muscles contract causing head to turn to one side
Heelstick blood sugar
Indications (4)
Symptoms of hypoglycemia (6)
Pre or Post term IDM LGA, SGA, IUGR Delivery: Decelerations Nuchal cord Meconium-stained amniotic fluid
Sx? jitteriness, hypotonia, irritability, apnea, lethargy, temperature instability
Babies are ALWAYS at risk for Hypoglycemia with diabetic mom
Psychosocial Adaptation
3 periods
First period of reactivity – mouth open, moving around, some sounds, turn to breast, quiet and alert, interested, en face position, may latch, moving arms and legs
Period of inactivity/sleep – sleeping for 2 hours, decrease in RR and HR, meconium, bowel sounds
Second period of reactivity – shorter with quiet alert stage, feed, regurgitate
Bonding vs. Attachment
Bonding – initial attraction to baby after delivery as parents meet and identify their newborn; e/b talking to baby and gentle touch and enhanced by skin-to-skin
Attachment – establishment of relationship between parent and baby; reinforced through interactions and experiences – reciprocated
Bonding Delayed (6)
Using negative terms describing newborn
Discussing newborn in impersonal terms
Failing to call newborn by name – check culture
Refusing to hold newborn
Lack of eye contact with newborn
Increasing length of time of newborn in the nursery
Feeding
How often?
How Long?
Is it enough?
How often? 8 to 12 times per day
How long? As long as vigorously sucking, then burp ( switch breast) until too drowsy to suck
Is it enough? For the first week, each day should have one more than the day before, half with stool
Immunological Adaptation
Mom vaccinated or exposed
Mom antibodies – active acquired immunity
Baby passive acquired immunity
Initial Assessment
Bathed
In first 2 hrs by nursery/postpartum nurse
After assessment, if temp is stable, then baby is bathed (ideally ~6 hr), and double-wrapped in blankets until temp returns to normal x2
Precautions maintained until after the bath.
Baby needs to thermoregulate
Newborn Challenges
Hypoglycemia
Hypothermia
Hyperbilirubinemia
Complications
Respiratory Distress
Infection
Gestational Age determined by
Ballard score
Dubowitz
Neuromuscular and physical characteristics
Conditions Affecting LGA (8)
Large for Gestational Age
Infants over the 90th percentile on the growth chart
Chronic hyperglycemic state Transient tachypnea of the newborn Hypoglycemia Hypocalcemia Hypomagnesemia Birth injuries Brachial plexus injuries & Erb’s palsy Fractures - clavicle
Risk for Unstable Blood Glucose Level (11)
Risk factors: Infant of diabetic mother (IDM) LGA SGA Post-term Preterm Hypothermia Neonatal infection Respiratory distress Neonatal resuscitation Birth stress or trauma Intrauterine growth restricted (IUGR)
Symptoms of LOW sugar (7)
Jitteriness Hypotonia Irritability Apnea Lethargy Temperature Instability
Nursing Interventions Blood sugar (10)
Assess blood glucose
Assess vital signs (temperature, RR, HR)
Assess neurological status—observe for tremors, seizures, and specific characteristics in her crying pattern
Initiate early feedings (within the first hour)
Plan interventions to enhance conservation of infant’s energy
Maintain a neutral thermal environment
Administer glucose, calcium, and magnesium as prescribed
Reassess (blood glucose, abnormal vs or other findings)
Monitor calcium and magnesium levels if ordered
Teach normal newborn care
Learning Needs for low blood glucose
Provide the family with information about the relationship between gestational diabetes and neonatal risk factors.
Teach the family about the special needs of their baby.
Encourage family to participate in their baby’s care.
Discuss normal family coping and provide anticipatory guidance as to normal responses to expect when dealing with a baby with high risk factors.
Provide information about effective coping techniques.
Give the family information about support groups and additional resources.
Thermogenic Adaptation
4 Reasons why newborns are susceptible to cold stress
Newborns are homeothermic
Neutral thermal environment (first day might need 2 blankets and 2,3 days might need one, then Tshirt)
Large body area
Limited subcutaneous fat
Limited ability to shiver
Thin skin and blood vessels close to surface
Heat loss mechanisms
Convection
Conduction
Convection - flow of heat from the body surface to cooler surrounding air
Eliminating drafts such as windows or air conditioning, reduces convection
Conduction – the transfer of body heat to a cooler solid object in contact w baby
Covering surfaces with a warmed blanket or towel helps minimize conduction heat loss
Heat loss mechanisms
Radiation
Evaporation
Radiation – the transfer of heat to a cooler object not in contact with the baby
Cold window surface or air conditioning; moving as far from the cold surface, reduces heat loss
Evaporation – loss of heat through conversion of a liquid to a vapor
Form amniotic fluid; NB should be dried immediately
More prone to Hypothermia… (3)
Calorie intake restricted
Infection
Stressors
Cold Stress
Conditions Affecting SGA/IUGR
4
Hypothermia
Hypoglycemia
Polycythemia – increased erythrocyte count
Pain
Risk for Imbalanced Body Temperature: “Cold Stress”
Risk Factors (6)
Hypothermia = axillary temperature below 97.7° F
Prematurity SGA Hypoglycemia Prolonged resuscitation Sepsis Neurological, endocrine, or cardiorespiratory anomalies
Risk for Imbalanced Body Temperature: “Cold Stress”
Symptoms (9)
Cool skin Lethargy Pallor Tachypnea Hypoglycemia Jitteriness Hypotonia Irritability Weak suck
What does stress lead to in newborns?
In newborns, every stress leads to
hypoglycemia and hypothermia
and then results in respiratory distress
Hyperbilirubinemia Physiologic Pathologic Breastfeeding jaundice Breastmilk
Physiologic jaundice
onset 2 to 3 days after birth; transient
normal hemolysis of RBCs
bruising increases hyperbilirubinemia
Pathologic jaundice
present at birth or within 24 hours
Rh hemolytic, ABO incompatibility
Breastfeeding “jaundice” (dehydration)
onset 2 to 4 days
Breast milk jaundice
onset 7-10 days; peaks at 2 wks – 3 wks
Unconjugated vs. Conjugated
Unconjugated bilirubin (fat soluble) formed by the normal breakdown of RBCs is unready for excretion.
Conjugated bilirubin (water soluble) has been converted in the liver and is ready for excretion in stool and urine.
50% (term) -> jaundice
≈ 5% elevated enough -> tx
Hyperbilirubinemia
Assessment
Visual assessment is subjective and unreliable
Assessment
all babies should be assessed with transcutaneous bilimeter
If transcutaneous bili is too high (based on hospital policy) a total serum bilirubin should be drawn
prevent Kernicterus
If transcutaneous bilimeter is not available,
jaundice is assessed during blanching on mid-forehead
Phototherapy bili lamps, bili blanket
Pathologic Jaundice
Hemolytic Disease of the Newborn
Rh Antibodies (mom negative, dad positive, positive baby) ABO incompatibility (type O mom, type A, B, or AB baby)
At risk for development of
Etythroblastosis fetalis
all red blood cells are destroyed
Hydrops fetalis
multi-system failure – anemia that causes HF and edema – babies anemic from destruction of RBCs
Breastfeeding Jaundice
Breast milk jaundice
Breastfeeding “jaundice” (dehydration)
Onset 2 to 4 days
May need to supplement with formula
Onset 7 days
Peaks at 10-14 days
Reduced production of diphosphoglucuronic acid (UDPGA)glucuronyl transferase inhibits conjugation of bilirubin
Substances in breastmilk may increase absorption of bilirubin from intestine and interfere with conjugation
Neonatal Abstinence Syndrome
Behavioral
Feeding
Respiratory
Other signs
Behavioral Irritability Jitteriness, tremors Increased muscle tone Restlessness Exaggerated, startle reflex Prolonged high-pitched cry Difficult to console
Feeding Excessive suck Uncoordinated suck and swallow Frequent regurgitation or vomiting Diarrhea
Respiratory
Nasal stuffiness, sneezing
Tachypnea
Apnea
Other signs Poor sleeping patterns Yawning Seizures Diaphoresis
Narcan? NO – can result in seizure of baby
Nursing Interventions for neonatal abstinence syndrome
Assess for sx of drug withdrawal
Interventions
opiates – 48-72 hours
cocaine – 2-3 days
alcohol – within 3-12 hours
Obtain meconium and urine for drug screen
Feeding – more difficult may need to gavage
Rest – keep stimulation to minimum, reduce noise and lights, calm, slow approach
Promote bonding
Teach measures for frantic crying: rock, coo, dark room, avoid stimulation
Finnigan score to wean off medication
High risk for if mom is using
SGA
Preterm
Circumcision
Normal signs and symptoms post op
What influences the parents’ decision to have their newborn circumcised?
“Pending circumcision”
Surgical procedure - consent
Pre-op
Stable VS
NPO
Pain management
Post-op complications
Exudate with no scab; purulent drainage = HCP
Teaching
Health Promotion & Disease Prevention (7)
What needs to be done?
Car Seat Challenge Hearing Screening LATCH Newborn Screening (ex. PKU) Pulse Oximetry Transcutaneous Bilimeter Vaccination: Hepatitis B
Newborn Teaching
Family centered
Newborn care Dressing/Clothing Diapering, Circumcision care Bathing Feeding and diet Solid foods Bottle feeding Safety Back to Sleep Vaccinations Car seat
Normal growth & development Safety Normal appearance and activity Signs and management of illness Prevention Temperature Treatments
SIDS
“Crib Death” Sudden Unexpected Infant Death (SUID)
Unexplained death of infant >1 month
Decreasing the Risk of SIDS (7)
RISK FACTORS
Maternal smoking during pregnancy Use of soft bedding Sleeping prone Sibling w/SIDS Infections Prematurity Low birth weight
Back to sleep prone to play
Encourage…
Role model
Plagiocephaly
Purpose of Well-Child Visit
Immunizations Anticipatory Guidance Assessment of Growth Assessment of Developmental Milestones achieved SAFETY
Breastfeeding
Contraindications (chronic diseases, meds, newborns)
Chronic disease
HIV positive
Active Tb, leprocy
Herpes lesions on breasts
Meds
Chemo, nuclear dx testing, lithium, prozac, celexa, drugs
Contraindication
Newborn with PKU
Talk to moms – need to keep their weight up; not the time to lose weight
Hazards of Cold Stress (6)
Increased oxygen need Decreased surfactant production Respiratory distress Hypoglycemia Metabolic acidosis Jaundice
Kernicterus
Bilirubin crosses into brain and stains brain tissue
No tests to verify
Causes CP and inability to form emotional attachments
Caput Succedaneum
Area of localized edema that appears over vertex or head as a result of pressure against moms cervix – crosses sutures
Cephalhematoma
Bleeding between periosteum and skull as the result of pressure during birth – clear edges at end of suture lines
Vernix caseosa
Thick, white and covers body
Milia
Tiny white bumps that commonly appear on a baby’s face.
Lanugo
fine, soft hair, especially that which covers the body and limbs of a human fetus or newborn.
