newborn assessment and care 1 Flashcards
suction
at delivery
bulb
catheter if meconium or place, limp, no resp effort or tone
cord
clamp and cut - wait 30-60s
milk cord towards baby a few times to increase blood, then clamp and cut
delivery stabilization
dry (blanket) and stimulate - slap sole of feet, flick heel, rub back
do on mom if stable
warm - kangaroo care/warmer, blankets/hat
1 min apgar
identification
mom finger, baby foot, ID bands (2 parents, 2 baby, remove at discharge)
security band - educate parents
apgar - HR
0 = none
1 = <100
2 = >100
apgar - resp effort
0 = none
1= slow, irregular
2 = good cry
apgar - muscle tone
0 = flaccid
1= some flexion
2 = active
apgar - reflex
0 = none
1= grimace
2 = vigorous cry
apgar - color
0 = pale blue
1= pink body, blue extremities
2 = pink
VS: HR
110-160
sleep = 80
cry = 180
apical for 1 min
VS: Temp
97.7 - 99.5
axillary
VS: RR
30-60 (1min)
initiation of respiration: mechanical changes
80-100mL of fluid in lungs at delivery, decreased production of lung fluid 2-4 days before
chest compressed during delivery -> fluid out of lungs
altered by c/s and fast deliveries
initiation of respiration: chm changes
1st breath triggered by increasing PCO2, decreasing pH and PO2
trigger brains respiratory center
natural result of vaginal birth
initiation of respiration: thermal changes
decreased env temp, newborn responds with increasing RR
avoid prolonged exposure to cold -> cold stress/apnea
initiation of respiration: sensory changes
light, sound, gravity (no amniotic fluid), touch
RR
60-70 for first 2 hours -> 30-60
periodic: <20s
apneic: >20s, abn
respiratory variations: s of distress
nasal flare, intercostal or xiphoid retractions, expiratory grunt or sigh, seesaw respirations, tachypnea
clear airway
bulb suction, chest percussion (loosen secretions)
transient tachypnea of newborn
progressive respiratory distress 6-72 hrs after birth
transient tachypnea of newborn: causes
LGA, late preterm, maternal over sedation, maternal bleed, prolapsed cord, breech, maternal DM, c/s
transient tachypnea of newborn: tm
CXR: hyper expanded lungs, clear by 72hr
oxyhood <40%, O2 cannula -2L
possible IV fluids or tube feed bc r/o aspiration d/t tachypnea
RDS
alveoli are last to form, younger GA = less alveoli = more severe RDS
surfactant production: betamethasone, ROM
RDS: tm
O2 therapy: continuous + airway pressure therapy (CPAP), mechanical vent, high frequency vent
surfactant admin: beractant, poractant, calfactant, lucinactant, colfosceril
thermoregulation: incubator
ecmo: severely ill, modified heart/lung machine allows baby’s lungs to rest/heal
HR
assess at rest
newborn circulation: increased systemic vascular resistance, decreased pulmonary vascular resistance, enhance perfusion of body system; foramen ovale close w/n 1-2hr, ductus arteriosus close, ductus venosus close (liver perfusion)
assess brachial and femoral with arms extended, bilaterally
BP
in nursery or before going home
cap refill <2-3s
highest right after birth, lowest 3hr after
sensitive to change in volume, varies by birth weight and GA
heat loss
stabilize internal core temp in narrow range
thermoregulation by metabolic rate and O2 consumption
flexion decreases SA and retains heat
convection (air), radiation (no contact), evaporation (moisture), conduction (contact - warm stethoscope, scale, blanket)
issues with thermoregulation: causes of heat loss
higher SA to body mass ratio, low SQ fat, higher body water content, immature skin (higher evaporation), poor metabolic mechanism for responding to thermal stress (cant shiver), altered skin blood flow (peripheral cyanosis)
preT at higher risk bc lack of flexes posture for preserving heat, very thin skin with capillaries close to surface
hypothermia s/s
acrocyanosis and cool, mottled, pale skin
hypoglyc, transient hypergly, brady, tachypnea, restless, shallow and irregular resp, resp distress, apnea, hypoxemia, metabolic acidosis, decreased activity, lethargy, hypotonia, feeble cry, poor feed, decreased weight gain
hyperthermic: causes
incubator, radiant warmer, ambient env, maternal fever, epidural anesthesia, phototherapy lights, sun, excessive bundling, infection, CNS disorder (asphyxia), dehyd
hyperthermic: s/s
tachy, tachypnea, apnea, warm extremities, flushing, perspiration (term), dehyd, lethargic, hypotonia, poor feed, irritable, weak cry
hyperthermic: consequences
hypoT and dehyd: d/t water loss
seizures and apnea: bc increased core temp
hyperNa
resp distress
hyperthermic: management
adjust env, move way from heat source, undress, decrease air temp, feed freq to replace fluids
brown fat
non shivering thermogenesis, skin receptors sense temp change, use brown fat for heat
26-28 weeks gestation -> 3-5 weeks after birth
temperature management
kangaroo care for stable infants
radiant warmers for c/s, unstable, close assessments
measurements
double weight by 6 months, triple by 12
head circumference > chest circumference (nipple line)
term: lose 5-10%
preT: lose 15%
skin
color: pink, acrocyanosis (ok after birth and first 24 hours), central cyanosis (circum oral, bad oxygenations, assess)
preT: thin and transparent with veins prominent, less lines on feet
T: opaque and disappearance of vernix (lipid rich)
postT: peeling
resting posture
extended: preT
flexed: term
head
1/4 body
fontanelles: soft and flat, bulge with cry, separated, approximated, overlapping sutures (molding)
forceps/vacuum marks
head: cephalohematoma
collection of blood between cranial bone and periosteal membrane, increased jaundice and anemia and hypoT, does not cross sutures, btw 1st and 2nd day, disappears after 2-3 weeks or may take months
head: caput succedaneum
soft tissue swelling - collection of fluid, edematous swelling of scalp, crosses sutures, present at birth or shortly after, reabsorbed in 12 hours or a few days after birth
eye variation
subconjuctival hemorrhage: will resolve, increased P, normal, vessels in sclera break
transient strabismum: cross eyed, eyes still developing, not treated at birth
dolls eyes: turn baby, eyes move in opposite direction, under developed head-eye coord
ears
low set = in line with eye (intellectual disability)
preT: shapeless and flat, no recoil
terms: some cartilage and slight incurring of upper pinna, good recoil
mouth
suck, cleft lip and palate (aspiration), precoscious teeth, epstein’s pearls (cysts, harmless)
back
spine - straight and flat
sacral dimple: pit at base, may have tuffs of hair, US if it doesnt close (hole) bc r/o spina bifida occulta or tethered cord s
spina bifida occulta
spine doesnt close properly around spinal cord
tethered cord s
tissue attached to cord limits its movement - causes weakness, numbness and bladder and bowel problems
lanugo
decreased with increasing GA
more with non White
breastbud
term = 0.5 to 1cm
umbilical cord
3 vessels (2A, 1V)
observe for umbilical hernia (AA, close by 2yr)
genitalia: M
withold circ if issue - consult urologist
hypospadias, epispadias, phimosis (cant retract foreskin), hydrocele (fluid collection around testes), cryptorchidism (dont drop)
preT: small scrotum, few rugae, testes palpable in inguinal canal
T: testes in lower scrotum which is pendulous and covered with rugae
genitalia: F
preT: clit prominent, labia majora small and separated
T: labia majora covere minora and clit
pseudomenstruation: vaginal discharge tinged with blood d/t withdrawal from maternal hormones
vernix
lubricate skin
milia
clear sponatneous (1mo), exposed sebaceous glands, white spots, face and nose, dont bother them
telangiectatic nevi
pale pink or red spots, fade by age 2
mongolian spots
non white, note, look like bruise, back or butt, 4yrs, non white
nevus flammeus
capillary angioma, below dermis, non elevated, red-purple, face, dont go away or fade
strawberry mark
capillary hemangiomas, dermal and subdermal, raised, dark red, grow rapidly but may shrink and go away (9-10yr), leave alone
fractured clavicle
birth, large, shoulder dystocia, move both arms equally
erbs palsy
5th and 6th cervical roots of brachial plexus, move extremities equally
simian crease
down s
1 transverse palmar crease
syndactyly
webbing
polydactyly
extra digits
clubfoot
cant turn midline or realign
sole (plantar) creases
higher GA = proceed to heel
hip dislocation
barlows maneuver: will feel demur move out of acetabulum (pop out)
ortolanis maneuver: + = hip click (pop in)
RDS: rf
preterm, c/s, infection, cold stress/hypothermia
maternal DM -> hyperinsulinemia and hypergly reduce fetal surfactant production
