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Maternal Infant > Newborn Assessment and Transition in Extrauterine life > Flashcards

Newborn Assessment and Transition in Extrauterine life Flashcards

1
Q

Nurse Role during the Transition to Extrauterine Life includes?

A

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
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2
Q

Phases of Transition

A

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)
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3
Q

Transition - First Breath:

A

-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)

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4
Q

Transition-Cutting the cord:

A 
-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)
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5
Q

IMMEDIATE NEWBORN CARE includes?

A 
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
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6
Q

NEWBORN THERMOREGULATION

A 
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
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7
Q

Danger of cold stress include?

A

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.

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8
Q

Newborn Thermoregulation: Heat loss in the newborn occurs in what four ways

A
  1. convection
  2. radiation
  3. evaporation
  4. conduction.
    Refer to diagram slide #11
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9
Q

APGAR SCORE

A

Refer to diagram slide #12

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10
Q

EARLY NEWBORN CARE includes:

A 
Identification
Weight
Measurements
Gestational age assessment
Medication administration for prophylaxis
Full physical examination
First bath (delayed)
Early initiation of breastfeeding
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11
Q

Prophylaxis

A 
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
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12
Q

Vital Signs: Temperature

A 
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

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13
Q

Vital Signs - Respirationa

A 
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

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14
Q

Gestational Age Assessment Includes:

A

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)

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15
Q

General Measurements - Weight

A

-Average: 2500-4000g
-Assess weight daily and
calculate loss/gain
-Acceptable weight loss
5-10% - first 3-5 days
-Notify Dr. if > 10% loss

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16
Q

General Measurements -Head circumference

A 
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

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17
Q

General Measurement -LENGTH

A

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.

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18
Q

What do you assess in a newborn assessment?

A 
Newborn Assessment:
Skin 
Eyes
Ears
Nose
Mouth
Neck
Abdomen and Chest
Genetalia
Back and Spine
Extremities 
Neuromuscular
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19
Q

What do you look for in a newborn skin assessment?

A

Skin:
Usually reddish/pink in colour, smooth and slightly edematous

Normal variations include:
Acrocyanosis
Mottling
Mongolian spots
Milia
Vernix
Birthmarks
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20
Q

Abnormal findings in a skin assessment include?

A 
Deviations from the norm
Jaundice within the first 24 hours
General or circumoral cyanosis
Petechiae
Pallor
Pigmented nevi
Hemangioma
21
Q

What are you looking for when assessing the HEAD of a newborn?

A 
Head
-Anterior and posterior 
 fontanel's-should be soft 
 and closed
-Sutures palpable
-Small separation between 
 suture lines
** Infant fontanels should be assessed for bulging (indicates increased intracranial pressure) or sunken (indicates dehydration)
22
Q

What are you looking for when assessing the EYES of a newborn?

A

-Slate blue or gray
-No tears for 2-3 weeks
-Fixation but can follow
objects to midline
-Blink reflex
-Pupils-equal and reactive
-Strabismus (cross-eyed)
due to poor muscle
control
-Deviations edema,
uncoordinated
movements

23
Q

Abnormal findings in a EYE assessment include?

A 
Deviations from the norm:
-Discharge
-Opaque lens
-Epicanthal folds not of 
 Asian descent
-Reflexes absent
-Subconjunctival 
 hemorrhage due to 
 maternal pushing
24
Q

What are you looking for when assessing the EARS of a newborn?

A 
-Pinna top horizontal line 
 with outer canthus of eye
-Startle reflex to loud 
 noise
-Flexible pinna with 
 cartilage
25
Abnormal findings in a EAR assessment include?
``` Deviations from the norm -Skin tags ? renal anomalies -Placement (low set- ? syndromes) -Malformations ```
26
What are you looking for when assessing the NOSE of a newborn?
-Midline -Nostrils patent -No discharge -May sneeze to clear nostrils *** Infants are obligatory nose breathers
27
What are you looking for when assessing the NECK of a newborn?
-Short and thick -Turns easily from side to side -Clavicles intact -Some head control
28
Abnormal findings in NECK assessment include?
``` Deviations from the norm: -Torticollis -Resistance to flexion -Webbing (Turner’s, Down’s Syndrome) ```
29
What are you looking for when assessing the ABDOMEN of a newborn?
``` Abdomen -Dome shaped -Abdominal respirations -Soft on palpation -Three vessel cord -Meconium within 24-48 hours ```
30
Abnormal findings in Chest and Abdomen assessment include?
``` Deviations from the norm: -Accessory nipples -Sternum depressed -Retractions -Nipples widely spaced -Bowel sounds within chest cavity -Umbilical hernia -Bowel sounds absent -Abdominal distention -Omphalocele (picture) -Gastroschisis -Two vessel cord -Inspect for imperforate anus ```
31
What are you looking for when assessing the Female Genetalia of a newborn?
``` -Edematous labia and clitoris-normal at birth -Hymenal tag (disappears in several weeks) -Pseudomenstruation -Increased pigmentation -Ecchymosis (breech birth) ```
32
Abnormal findings in Female Genetalia assessment include?
Deviations from the norm: - Labia fused - Fistula - Imperforate hymen - Ambiguous genitalia - Imperforate anus
33
What are you looking for when assessing the Male Genetalia of a newborn?
``` -Urinary meatus at tip of penis -Palpable testes in scrotum -Large pendulous scrotum with rugae ```
34
Abnormal findings in Male Genetalia assessment include?
``` Deviations from the norm -Non palpable testes -Hypospadius-urethral opening is on the underside of the penis -Epispadius-urethral opening at top or side of the penis -Smooth scrotum -Ambiguous genitalia -Hydrocele-accumulation of fluid in the scrotum ```
35
What are you looking for when assessing the Back and Spine of a newborn?
- Back and Spine - Intact - Patent anal opening - Wink reflex present
36
Abnormal findings in Back and Spine assessment include?
Deviations from the norm: - Limitation of movement - Fusion of vertebrae - Spina bifida - Tuft of hair - Anal fissures - Pilonidal sinus
37
What are you looking for when assessing the EXTREMITIES of a newborn?
``` Flexion, bilateral movement and tone -Ten fingers and toes -Legs slightly bowed -Feet appear flat -Palmar and solar creases present -Negative hip click -Grasp reflex present ```
38
Abnormal findings in EXTREMITIES assessment include?
``` Deviations from the norm -Abnormal tone and/or asymmetrical movement -Poly/syndactaly-extra digits -Unequal limb length -Dislocation of hip -Simean crease ```
39
What are you looking for when assessing the Neuromuscular system of a newborn?
``` -Maintains posture of flexion -When prone head turns to side -Ability to hold head momentarily erect ```
40
Abnormal findings in Neuromuscular assessment include?
Deviations from the norm - Hypotonia - Quivering/jittery - Clonic movements - Paralysis
41
Nursing Care: Urinary Output
Urinary Output -Monitor for first void and then q shift -Assess colour, concentration and amount -Review and document each void recorded by parents
42
Nursing Care: Bowel Habits
Bowel Habits: Monitor initial bowel movement within 24 hours (and almost all within 48 hours) Assess colour, consistency Observe for GI dysfunction (bile emesis, abdominal distention or no meconium)
43
Describe the characteristics of Jaundice.
Neonatal hyperbilirubinemia -50 - 60% of full-term and 80% of preterm Immature liver = inability to get rid of excess bilirubin (due to increased breakdown of hemoglobin) May need treatment with phototherapy Pathological condition = kernicterus
44
What is Group B Streptococcus (GBS)
``` -A bacterium Streptococcus agalactiae, which is commonly called "group B strep" or GBS - A newborn can develop septicemia if infected with GBS -First emerged as the most common agent causing neonatal sepsis in the 1970’s ```
45
What is Intrapartum Prophylaxis - GBS?
Penicillin G, 5 million units IV initial dose, then 2.5 million units IV every 4 hours ``` If penicillin allergic and at risk for anaphylaxis -Clindamycin 900 mg IV every 8 hours or -Erythromycin 500 mg IV every 6 hours until delivery. ``` If GBS resistant to Clindamycin or erythromycin or susceptibility unknown: -Vancomycin*1 g IV every 12 hours until delivery
46
Care of a Newborn: GBS
``` -Follow hospital protocols for GBS -Know if the infant is at risk -Monitor vital signs…what happens to the respirations, heart rate and temperature in the presence of infection? -Look for signs and symptoms of sepsis (infection) -Health teaching to family ``` ***Infants of GBS positive mothers who did not receive antibiotics in labour must be observed 24-48 hours before being discharged home.
47
Signs and Symptoms of Sepsis
-Chills -Tachypynea -Unexplained change in mental status -Tachycardia -Alteration in WBC count - Decreased # platlets -Decreased skin perfusion - Decreased urine output - Skin mottling - Poor capillary refill - Hypoglycemia - Petechiae/purpura
48
Signs and Symptoms of Sepsis
-Chills -Tachypnea -Unexplained change in mental status -Tachycardia -Alteration in WBC count - Decreased # platelets -Decreased skin perfusion - Decreased urine output - Skin mottling - Poor capillary refill - Hypoglycemia - Petechiae/purpura

Maternal Infant (5 decks)

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