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Obstetrics > Newborn Assessment and Care > Flashcards

Newborn Assessment and Care Flashcards

1
Q

8 Priority Needs of the Newborn

A
  1. respirations
  2. extrauterine circulation
  3. body temperature
  4. nutrition
  5. elimination
  6. infection
  7. parents relationships
  8. developmental care
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2
Q

Production of fetal lung fluid ________ __ to __ days before labour

A

decreases 2-4 days

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3
Q

___ to ___ml fetal lung fluid remains in the air passage of a _______ newborn

A

80-100
full term

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4
Q

What occurs during birth to the fetal chest?

A

Compressed and squeezes fluid to rid body as much fluid as possible

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5
Q

What 2 things trigger the first breath in a newborn?

A
  1. The exit/recoil from the vaginal squeeze/chest compression
  2. partial pressure changes (increased PCO2 and decrease in pH and PO2)
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6
Q

What type of newborn would you anticipate having a greater amount of fluid in the lungs?

A

Short labour or c-section

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7
Q

What respiratory nursing diagnosis would occur for a c-section baby?

A

diagnosis would occur for a c-section baby?
Inadequate airway resulting in inadequate gas exchange

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8
Q

APGAR HR Score 0, 1, 2

A

0- absent
1- < 100
2- < 100

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9
Q

APGAR Respiration Score 0, 1, 2

A

0- absent
1- slow/irregular
2- crying

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10
Q

APGAR Activity Scoring 0, 1, 2

A

0- flaccid
1- some flexion
2- active movement

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11
Q

Apgar Grimace Scoring 0, 1, 2

A

0 - none
1 - grimace
2- vigorous cry

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12
Q

Apgar Appearance Scoring

A

0- pale, blue
1- acrocyanotic
2- pink

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13
Q

Why ask about expected gestational age before delivery?

A

Maturity of lungs (risk factor for respiratory issues in prematurity)

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14
Q

Why ask about colour of amniotic fluid before delivery?

A

Presence of meconium makes it harder for fetus to breath

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15
Q

How many arteries v veins are in the umbilical cord and what type of blood do they carry?

A

2 arteries (UNOXYGENATED) 1 vein (OXYGENATED)

opposite than adult circulation

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16
Q

What does venous blood tell us when collecting cord blood gases and why

A

Oxygenated, returning from placenta

THEREFORE

tells us about placental function

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17
Q

What does arterial blood tell us when collecting cord blood gases and why

A

Deoxygenated, goes back to maternal circulation

THEREFORE

tells us about fetal tolerance of birth

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18
Q

What is Warton’s jelly?

A

Covers umbilical vessels to prevent cord compression in utero

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19
Q

3 values that demonstrate metabolic acidosis in newborn assessment

A

pH < 7

base excess > 12

APGAR < 3 for 5 min

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20
Q

What does metabolic acidosis increase the risk for in newborn?

A

Anoxia brain damage

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21
Q

Normal venous pH, pO2, pCO2, and base deficit in cord blood gases

A

pH: 7.3-7.35
pO2: 28-32
pCO2: 38-42
Base: 5

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22
Q

Normal arterial pH, pO2, pCO2, and base deficit in cord blood gases

A

pH: 7.24-7.29
pO2: 12-20
pCO2: 45-50
Base: 10

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23
Q

Newborn priorities immediately after birth/golden hour

A
  1. skin to skin and stimulation
  2. APGAR
  3. cord blood gases
  4. bonding/feeding

> only removed during 1st hour if baby requires resuscitation

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24
Q

One hour neonate assessments

A
  1. medications
  2. weight, length, head
  3. head to toe/vitals
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25
Q

Interventions for 4 hours post birth neonate

A

VS q1h x4

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26
Q

Newborn temperature

A

36.5-37.5

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27
Q

Newborn heart rate

A

110-160

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28
Q

Newborn respirations

A

30-60

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29
Q

Newborn BP

A

50-75/30-45

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30
Q

Early neonatal signs of respiratory distress

A
  1. tachypnea
  2. circumoral cyanosis
  3. nasal flaring and accessory muscle use
  4. grunting/cooing
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31
Q

How long is acrocyanosis normal for?

A

24-48hr

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32
Q

What APGAR indicates need for resuscitation

A

< 7

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33
Q

Why is the newborn at risk for hypothermia?

A
  1. large SA related to body mass
  2. no ability to shiver
  3. lower adipose tissue
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34
Q

What is the primary source of thermoregulation in newborns?

A

Non-shivering thermogenesis/Brown adipose tissue

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35
Q

How does brown fat contribute to thermoregulation in new borns

A

Brown fat contains a high number of mitochondria, the cell’s energy factories, and it can burn stored fat and glucose to produce heat directly.

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36
Q

Define evaporation as source of heat loss and why is it a concern in newborn

A

loss of heat when liquid is converted to vapor

Wet with amniotic fluid

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37
Q

Define convection as a source of heat loss and why is it a concern in newborn

A

flow of heat from body to cool surround ing air

heat from body into cooler air circulating over if not maintaining NTE

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38
Q

Define radiation as source of heat loss and why is a concern in newborn

A

loss of body heat to cooler solid surfaces that are in proximity but not direct contact

placing cold objects near incubator/window

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39
Q

Define conduction as source of heat loss and why is it a concern in newborn

A

the transfer of heat when there is direct contact

cold stethoscopes

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40
Q

When is newborn at risk for altered thermogenesis

A

first 8-12hr of life

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41
Q

5 risk factors for altered thermogenesis

A
  1. premature
  2. SGA
  3. CNS problems
  4. prolonged resuscitation efforts
  5. sepsis
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42
Q

Signs of cold stress

A
  1. vasoconstriction - acrocyanosis/pallor
  2. tachypnea and tachycardia
  3. fussiness, hyperactivity, irritable
  • won’t shiver
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43
Q

True or false: if a baby is acrocyanotic, tachypneic, tachycardiac, and fussy, these things only indicate hypothermia

A

False

All of these are common indicators of anything being wrong (ex. Hypoglycemia); assess further

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44
Q

Common temperature of delivery room

A

23-25 degrees; not optimal for infant

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45
Q

How can you prevent cold stress

A
  1. dry baby quickly
  2. hat r/t large area for heat loss
  3. skin to skin with prewarmed blanket
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46
Q

Why is neonatal hypoglycemia a large concern?

A

no glucose = neurological compromise

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47
Q

When are babies most susceptible to hypoglycemia and why?

A

In 1st hour r/t no umbilical flow for glucose delivery AND insulin is still being made at steady rate expecting steady flow from umbilicus

48
Q

BGM of hypoglycemic neonate

A

repeated readings of <2.6 or single reading of < 1.8

49
Q

Normal newborn glucose

A

2.2 - 6

50
Q

Infants at risk for hypoglycemia and why

A

SGA: decreased glycogen stores

LGA: hyperinsulinism

IDM: hyperinsulinism

Premature: decreased glycogen store

Sick/stressed/cold: increased metabolism

51
Q

S+S of hypoglycemia in newborn (10)

A

· Jitteriness or tremor
· Apathy
· Cyanosis
· Convulsions
· Apneic spells or tachypnea
· Weak or high-pitched cry
· Limpness or lethargy
· Difficulty in feeding -poor suck, refusal to feed
· Eye rolling
· Sweating, sudden pallor hypothermia and cardiac arrest (less common)

52
Q

What does vitamin K admin @ 1 hr prevent

A

to prevent… hemorrhagic disease of the newborn (HDN) or vitamin K deficiency bleeding (VKDB). HDN can occur in the first few days to weeks of life and is characterized by uncontrolled bleeding, which can be life-threatening.

53
Q

Reason vitamin K admin is necessary

A

Newborns are typically born with low vit K levels because
a) it doesn’t cross placenta
b) they have a sterile gut so they do not produce it

54
Q

Vitamin K dose order:

A

1mg IM within 6 hours OD

vastus lateralis

55
Q

Besides a sterile gut, what other reasons are newborns at increased risk for bleed?

A

Prothrombin levels are low

56
Q

What does erythromycin prevent?

A

Gonorrhea transmission

57
Q

Describe administration of erythromycin at birth

A

both eyes inner to outer canthus in lower conjunctival sac with single application tube

58
Q

1st Period of Reactivity; newborn behaviour patterns

A

30min-2hr
- awake/active
- hungry
- natural opportunity to start BF
- encourage en-face
- elevated vitals

59
Q

Period of Decreased Responsiveness; newborn behaviour patterns

A

After 2 hours, next 2-3 hours (so hours 3-6)
- sleep
- HR RR decrease
- difficult to awake
- no interest in feed

60
Q

2nd Period of Reactivity; newborn behaviour patterns

A

3rd period lasting 2-8 hours (hours 5-14)
- HR RR increase
- be aware of apneic period
- passess meconium, voids, sucks, roots, swallows

61
Q

Vital signs of newborn until d/c

A

q1h x 4, q4h x 24 - 48 hours , then BID.

62
Q

how often is a head to toe done on newborn before d/c

A

twice, once at 1hr then once before leaving

63
Q

how often are weights done on newborn before d/c

A
  • birth weight
  • OD
  • prior to d/c
  • weight loss = daily
64
Q

Expected weight changes of newborn

A

By day 3-4, a drop of < 10% is normal, if over 10% weight occurences will increase

65
Q

When should a baby begin to regain weight?

A

By 2 weeks

66
Q

What interventions regarding cord care for the newborn must occur?

A

air dry, will fall off 5-15 days

intervention: keep dry to avoid infection

67
Q

When is a TCB done?

A

24 hours - if abnormal blood draw because other blood work is also being done at this time

68
Q

Usual head circumference

A

33-37 cm

69
Q

Usual chest circumference

A

30-33cm

70
Q

Usual weight

A

2500-4000g

71
Q

Usual length

A

45-55cm

72
Q

What is a stork bite (salmon patch)?

A

a cluster of pink to reddish-purple blood vessels (capillaries) that appear on a newborn’s skin on the back of their head or neck

harmless and fade over time

73
Q

Why is it important to assess palm creases?

A

should be 3

1 indicates trisomy 21

74
Q

Describe posteriorfontanelle

A

<1cm, triangle, ossifies in 8 weeks

75
Q

Cephalohematoma location, cause, description, when it appears

A

collection of blood between bone and periosteal membrane

hemorrhage causes by forceps/vaccum that seperated membrane

does not cross sutures

appears later, takes 2-3 weeks to disappear

76
Q

caput succedaneum location, cause, description, when it appears

A

collection of fluid/edema on scalp - not bone

caused by pressure or trauma

crosses suture lines

present at birth and resolves in a few days

77
Q

Dermal melanocytosis/slate grey nevus

A

(Mongolian spots): blue discolorations of skin in patches on buttocks and lower back in non-white babies

NORMAL

78
Q

Is acrocyanosis normal finding?

A

Yes in 24-48hr

79
Q

Epstein’s Pearls

A

small, harmless cysts that form in a newborn’s mouth during the early weeks and months of development. They contain keratin and usually go away within a few weeks

80
Q

Telangiectatic nevi

A

Stork bites, salmon patch, angel kiss

small dilated blood vessels near the surface of the skin or mucous membranes that commonly develop on the face around the nose, cheeks and chin

NORMAL

81
Q

Molding

A

Shaping of the fetal head during movement through the birth canal.

NORMAL

82
Q

vernix caseosa

A

cheesy substance covering the skin of the fetus

should decrease as baby gets closer to gestational age

83
Q

Lanugo

A

fine, soft hair, especially that which covers the body and limbs of a human fetus or newborn.

84
Q

Milia

A

Benign, keratin-filled cysts that can appear just under the epidermis and have no visible opening

NORMAL

85
Q

Erythema toxicum

A

newborn rash

86
Q

What are you assessing for eyes of newborn?

A
  • placement relative to ears
  • subconjunctival hemorrages
  • tearless for 2 months
  • follow stimuli for short periods
  • immature muscular control x 3mos
87
Q

What you assessing for mouth of newborn?

A
  • palate
  • tongue ties
  • epstein’s pearls
  • selective response to taste
88
Q

What are you assessing for ears of newborns?

A
  • recoil of cartilate
  • pre-auricular skin tags
  • response to stimuli
89
Q

What are you assessing the nose for in newborns?

A
  • preferential nose breathing
  • patency
90
Q

Blinking reflex disappearance

A

persists into adulthood

91
Q

Moro reflex disappearance

A

4 months

92
Q

grasp reflex disappearance

A

3-4 months

93
Q

stepping reflex disappearance

A

1-2 months

94
Q

tonic neck reflex description and disappearance

A

fencing reflex; When a baby’s head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow.

3-4 months

95
Q

sneeze reflex disappearance

A

persists into adulthood

96
Q

rooting reflex disappearance

A

4-6 months

97
Q

gag and cough reflex disappearance

A

persist into adulthood

98
Q

babinski sign disappearance

A

12 months

99
Q

Define cold stress

A

The excessive heat loss that requires a newborn to use compensatory mechanisms (non-shivering thermogenesis)

100
Q

Describe posterior fontanelle

A

<1cm, triangle, ossifies in 8 weeks

101
Q

what reflexes are present at birth

A

stepping and rooting

102
Q

important teaching points about newborn baths

A
  • no interruptions/drafts
  • low water level
  • soap not initially recommended
  • organization
  • 37 degree for water
  • clean to dirty

-dry cord area and creases well r/t infc

  • vaseline to butt
  • q2-3 days
103
Q

Describe normal progression of stool

A
  1. meconium within 48 hours
  2. transitional: thin brown- green
  3. varies based on breast or bottle fed
104
Q

Describe breastfed infant stool

A

yellow-gold, soft, seedy, turns mushy after 2-3 days, more 1x a day

105
Q

Describe bottlefed infant stool

A

pale yellow, formed and pasty, may not go everyday

106
Q

_____ void by _____ hour after birth

A

93, 24

107
Q

Initial bladder volume of infant

A

6-44ml

108
Q

If no void within 48 hours:

A

assess adequacy of intake, bladder distention, restlessness, symptoms of pain

109
Q

Is brick colored urine a concern?

A

No - Urate crystals, normal in first week of life; immature kidney function

110
Q

Normal colour of urine and appropriate number of voids

A

6 per day after day 6, pale - clear

111
Q

What is pseudomenses

A
  • Female - pseudomenses - r/t maternal transfer of hormones.. blood in urine continue after week contact physician
112
Q

Average amount of times mom should be feeding

A

8 feeds in 24 hours (every 1-3 hours

113
Q

Care on uncirumcised infant

A
  • keep clean/no special care
  • do not pull back/force
  • fully retractable by age 3-5
114
Q

Sleeping in the same bed as your baby can lead to

A

SIDS, or Sudden Infant Death Syndrome, is a term for the unexplained death of an otherwise healthy baby under one year of age, typically occurring during sleep. It is a devastating and mysterious condition with no clear cause. To reduce the risk of SIDS, it’s recommended that babies sleep on their backs, in a separate crib or bassinet with no loose bedding, pillows, or stuffed animals, and in a smoke-free environment.

115
Q

Physiological Outcome Criteria for Newborn

A
  1. vitals WNL
  2. feeding 8x/24 hours
  3. no jaundice in 24 hours
  4. meconium in first 24
  5. regular pale, colourless urination
  6. TCB done
  7. no more than 10% weight loss
116
Q

description of skin, lanugo, plantar surface, breast, eye/ear, genitals of LARGE GESTATIONAL AGE INFANT

A

leathery, cracked, wrinkled

bald lanugo

creases over plantar surface

full areola

thick stiff ear cartilage

pendulous testes with deep rugae/majora covers clitoris and minora

117
Q

description of skin, lanugo, plantar surface, breast, eye/ear, genitals of SMALL GESTATIONAL AGE INFANT

A

sticky, friable, transparent

no lanugo

40-50mm no crease

imperceptible breast tissue

lids fused, pinna flat/folded

scrotum flat/smooth
clitoris prominent/labia flat

Obstetrics (12 decks)

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