newborn assessment and care 2 Flashcards
tonic neck
supine, turn head, extremities on that side straighten, other side flex
0-4 mo
fencer
palmer
0-4/6 mo
plantar
0-9/12mo
moro
startle, arms straighted, hands out, knees flexed, arms to chest, fingers = “c”
0-6mo
rooting
harder if recently fed
0-4mo
babinski
toes flare
change 1 yr -> toes curl
stepping
0-3/4 mo
bladder
void by 24 hr (most) - 48 hr (notify hcp if not)
6-8 diapers/day
bowel
meconium = thick, sticky, get off
breastfeed = yellow and seedy, easier to digest (more BM)
formula = less BM, firmer and browner
imperforate anus
at risk neonates
low SES (mom), limited access to care, env dangers, preexisting conditions, medical conditions related to pregnancy, pregnancy complications
factors for at risk neonates
birth weight, GA, IUG, type and length of illness, env factors, maternal factors, maternal-neonatal separation
preterm
20 - 36^6
late preterm
34 - 36^6
full term
39 - 40^6
early term
37 - 38^6
late term
41 - 41^6
post term
42+
low birth weight
<2500g or 5.5lb
very low birth weight
<1500g or 3.3 lbs
extremely low birth weight
<1000g or 2.2 lbs
small for gestational age
plot below 10th percentile
appropriate for gestational age
plot between 10th and 90th percentile
large for gestational age
plot above 90th percentile
>4000g
intrauterine growth restriction
rate of growth does not meet expected growth patterns
symmetric IUGR
weight, length, head circumference all affected
asymmetric IUGR
head normal but body small <10th percentile
preT causes
DM, chronic htn, preE
obstetric disorder or rf in pregnancy (abruption, previa, gallbladder disease)
medical disorder that affects pregnancy (heart disease, VTE, asthma, HIV, active HSV, obesity)
advanced maternal age
fetal disorder (IUGR, poly.oligo, hydrops, birth defect, multigestational)
newborn assessment
GA
LGA/SGA
heel stick (glucose) want 40mg+, 30 min after feed
maternal DM, LGA, SGA
s/s hypogly: jittery, hypotherm, breathing issues
neuromuscular and physical maturity -> want higher score
neonatal resuscitation protocol
sniffing position (dont hyperextend neck)
stimulate, if <100bpm -> CPAP and pulse ox, still <100 -> intubate, <60 -> CPAP with compressions
vitamin K
no bacteria to synthesize
bleeding, not enough in breast milk
6mo risk for bleed
attachment
skin to skin, rooming in
erythromycin
conjunctivitis (chlamydia or gonorrhea) within 30 min, remove secretions before
bath
6hr+, prevent cold, bonding, 1-2x/wk, water on face, sponge until cord off (3wk), not right after feed, do under warmer, genitals last, folds and creases
periods of reactivity
1st: 30 in, active, awake, hungry, strong suck reflex, bond, breastfeed
sleep: HR and RR drop, 2-4 hr
2nd: awake, alert, longer (4-6hr), HR and RR increase
nutrition
cals: 45.5 - 52.5 per pound per day or 100-115 cal per day
64 - 73mL per pound per day or 140-160mL/day
gain 1oz/day for first 6 mo on formula
gain 0.5oz/day for first 6 mo with breastfeed
breastfeed
ideal balance of nutrients, composition varies for GA and stage of lactation
immunologic
return to prepreg weight
bonding, hormones (PPD), societal barriers, work
maternal diet matters, save money, pump, special bra, fridge
convenient (temp, preparation), mom must be available, discomfort
formula
additives, missing ingredients, nutritional value stays same, overfeeding, feed less freq - slower digestion
no immunologic properties, allergies, contamination
when mom milk not available
both parents participate
expensive
prepare (time), less convenient for travel and night feeding, mother not needed
nutrition: assessment
readiness: rooting, sucking, head bob
infant: awake, alert, assess physiologic status during feed
breast v formula (q3-4)
breast: q2-3, on demand, place on mothers chest, can begin in birthing room ASAP, supply and demand, burp btw breast, formula = 1/2, support head
daily assessment
VS, weight, feedings, I+O, umbilical cord care, skin color change
umbilical cord care: clamp until dry, out of diaper, dye or not, 7-10 days
jaundice
RBC breakdown
pathological: 1st 24hr, phototherapy (diaper, eye protection, hydration, bonding), blood transfusion, caused by Rh, liver issue, BAD
physiological: PreT, after first 24hrs, increase feedings 8-12x/day, phototherapy
nc: warm, monitor stools, early feedings
NAS: cm
high pitch cry, hyperirritable, increased tone, exaggerated reflex, tremors/jerks, seizures, sneeze, hiccups, yawns, short sleeps
disorganized/vigorous suck, excessive suck, v, poor weight gain, sensitive gag reflex, d, poor feed (little and/or takes long time)
stuffy nose, mottled, tachypnea, sweat, hyperthermia
excorlated butt, knees, elbows, facial scratch, pressure point abrasions
NAS: complications
resp distress, jaundice, congenital anomalies (already present), IUGR, behavior abn, withdrawal, and preT complications
hospital for 5 days
NAS: assessment
finnegan: severity of opioid withdrawal
monitor response to withdrawal, dynamic scoring of 21 symptoms (periods)
known hx or s/s
2hr after birth, q4hr, after each feed until better -> after feed
8+ = q2 until meds started -> q4 or after each feed
NAS: nc
skin to skin, swaddle, gentle wake, quiet, low stim, low light, calm music or massage therapy
mild s: support/comfort cafe
cluster care
parents involvement, rooming in
breast feed delays onset and decrease severity and pharm treatments
moms on methadone or buprenorphine should breastfeed
NAS: pharm
NICU, match drug selection to cause of withdrawal
1st line: morphine and methadone; sublingual buprenorphine better than oral morphine, decrease length of stay
adjunct phenobarbital or clonidue for opioid withdrawal
buprenorphine to prevent intrauterine fetal seizures
before d/c
hearing: fluid in ears (repeat)
guthrie for PKU 24 hr after feeding (heel stick)
immunizations: hep B (2nd at 1 mo, 3rd at 6-18 mo) + hep B IG if mom +
circumcision: gomco, plastibell, mogen clamp, watch for excess bleed/drainage, careful with diaper change (stick)
parent edu: swaddle (arms tight, legs loose), back to sleep, car seat (rear facing), infant CPR, routine appt (1-2 days)
prematurity G+D
earlier = more effect
wont perform as others of same age -> age of all premies adjusted when dev is evaluated
preT d/c 36-40 wk GA: no headlag, vigorous cry when hungry, good growth curve, neuro response appropriate for corrected age
s of newborn illness
T >100.4 or <97.7, continual increase
forceful or freq v, refuse 2 feeds in a row, hard to wake, cyanosis, no breath <20s, inconsolable, constant high pitch cry, discharge or bleed, 2 green watery stools, no wet diapers for 18-24 hr, <6-8 diapers after 4 days old, eye drainage
injections
vastus lateralis, 90 degrees, dose should be 0.5-1 mL, L = 5/8”
