Newborn Assessment and Transition in Extrauterine life Flashcards
Nurse Role during the Transition to Extrauterine Life includes?
Most significant challenge for the newborn is to transition from intra to extra uterine life
Nursing role is to: -assess and assist with successful transition -assess of the newborn immediately at birth and ongoing -detect any complications
Phases of Transition
Behavioural Changes
-Initial period of reactivity
(first up to 30 minutes)
-Period of decrease
responsiveness (lasts 60
to 100 minutes)
-Second period of Reactivity (between two and 8 hours after birth and lasts from ten minutes to several hours)
Transition - First Breath:
-The lungs expand
-Alveoli inflate forcing fluid
out, capillaries vasodilate
allowing increased blood
flow to the lungs
-Results in decreased
pulmonary vascular
resistance and decreased
pressure in the right side
of the heart
-The ductous arteriosis
constricts (closes
permanently within 3-4
weeks)
Transition-Cutting the cord:
-Separates the newborn from the placenta which causes increased systemic vascular resistance increased pressure in the left side of the heart closing the foramen ovale (within 1-2 hours of birth)
-Clamping of the cord causes the ductous venosus to constrict forcing perfusion to the liver (closes within 3-7 days)
IMMEDIATE NEWBORN CARE includes?
Immediately after vaginal birth
-Provide warmth, clear
the airway, and dry the
baby quickly and
thoroughly
-Skin-to-skin contact
preferred to maintain
warmth
Immediately after cesarean birth -Follow regular resuscitation and admission procedures -Immediately receive newborn at the radiant warmer; suction, dry, and position baby for further assessment -Apgar scoring
NEWBORN THERMOREGULATION
THERMOREGULATION -The maintenance of balance between heat loss and heat production -Newborns attempt to stabilize their core body temperatures within a narrow range -Shivering mechanism of heat production is not well developed in the newborn -Nonshivering thermogenesis is accomplished primarily by brown fat, which is unique to the newborn -Premature infants have not developed brown fat
Danger of cold stress include?
Respiratory rate increases in response to increased need for O2
02 Energy diverted from maintaining normal brain and cardiac functions.
Vaso-constriction occurs
jeopardizing pulmonary perfusion.
PaO2 drops and blood pH drops.
Transient respiratory distress can exacerbate existing distress.
Newborn Thermoregulation: Heat loss in the newborn occurs in what four ways
- convection
- radiation
- evaporation
- conduction.
Refer to diagram slide #11
APGAR SCORE
Refer to diagram slide #12
EARLY NEWBORN CARE includes:
Identification Weight Measurements Gestational age assessment Medication administration for prophylaxis Full physical examination First bath (delayed) Early initiation of breastfeeding
Prophylaxis
Vitamin K -Required for blood clotting -Does not cross the placenta -Prevention of hemorrhagic disease of the newborn; clotting mechanisms remain immature at birth -1.0 mg given IM soon after birth to prevent hemorrhagic disorders -By Day 8, newborns are able to produce own Vitamin K
Eye antibiotic prophylaxis -Prevention against ophthalmia neonatorum from gonnorheal or chlamydial infection contracted in birth canal -Mandatory in some provinces -Should be delayed for 1-2 hours so parents have time to bond with infant
Vital Signs: Temperature
Temperature (Normal 36.5-37.5 C)
-Assess by axilla
-Stabilizes in 8-10 hours
after delivery
-Crying may elevate
temperature
-Cold stressed infants
may exhibit normal
temps due to
metabolism
of brown fat
-Infants with poor
peripheral perfusion may
exhibit lower temps
-Temperature is not a
reliable indication of
infection in the newborn
One of the most effective ways to stabilize the temperature of a newborn is skin-to-skin contact
Vital Signs - Respirationa
Respirations (Normal 30-60 / minute) -Assess when at rest -Often irregular -Observe abdominal and thoracic movements -Note rate, rhythm and depth and air entry to all lobes
Deviations: tachypnea, indrawing, grunting, central cyanosis, nasal flaring, apnea, asymmetry of movements, sighing respirations
Gestational Age Assessment Includes:
Appropriate for gestational age (AGA)—An infant whose birth weight falls between the tenth and ninetieth percentiles on intrauterine growth curves
Small for gestational age (SGA)—An infant whose rate of intrauterine growth was restricted and whose birth weight falls below the tenth percentile on intrauterine growth curves (ie. Infants of mothers who smoke)
Large for gestational age (LGA)—An infant whose birth weight falls above the ninetieth percentile on intrauterine growth curves (ie. Infants of mother with gestational diabetes)
General Measurements - Weight
-Average: 2500-4000g
-Assess weight daily and
calculate loss/gain
-Acceptable weight loss
5-10% - first 3-5 days
-Notify Dr. if > 10% loss
General Measurements -Head circumference
Head circumference (Normal ranges from 33-35 cm) - should be 2-3 cm larger than chest circumference
*Common variation molding (normal variation to accommodate passage through the birth canal)
Deviations: Caput
General Measurement -LENGTH
LENGTH (Normal 45-55 cm)
Measure length from top of head to heel.
Measuring is difficult in term infants because of moulding and incomplete extension of knees.
What do you assess in a newborn assessment?
Newborn Assessment: Skin Eyes Ears Nose Mouth Neck Abdomen and Chest Genetalia Back and Spine Extremities Neuromuscular
What do you look for in a newborn skin assessment?
Skin:
Usually reddish/pink in colour, smooth and slightly edematous
Normal variations include: Acrocyanosis Mottling Mongolian spots Milia Vernix Birthmarks
