Newborn baby Flashcards
APGAR scoring
a) when?
b) what assess for?
c) What score are OK?
a) 1 and 5 min of life
b) rapidly extrauterine adaption
c) 7-10
What is the New Ballard score?
a newborn maturity rating score
range from -1 to 5
Vital sings for newborn
What is the order and normal range.
RR
-before NB becomes active 30-60b/m
HR
-110-160/m
BP
-60-80/40-50
Temp
97.7-98.6
What is vernix caseosa?
Normal
Protective cheesy curving
More prominent in preemies
What is Lanugo?
Normal
Covering hair
More prominent in preemies
What is Milia?
Small raised white spots o nose, chin, forehead
Resolve without treatment
What is a Mongolian spots
A round blue/black mark on the baby’s sacrum,\
Normal and more common in dark-skinned NB
What’s are they?
Telangiectatic Nevi = Stork bites
-flat pink/red marks on back of the neck, nose, upper eyelids, forehead
-fade in 2years
-
a) What is the acrocyanosis?
b) What is the central cyanosis?
a) bluish tint if hands and feet
b) bluesish color in the central body
(face, lips, chest)
What is Desquamation?
Peeling occur few days post birth
Nevus flammeus = port wine stain
Normal
Permanent
flat dark red to purple vascular lesion
nevus vasculosus =strawberry mark
Normal capillary hemangioma
What is the erythema toxicum?
Pink rash
Normal, no treatment required
Head assessment
Caput succedaneum
-Swelling of the scalp in a newborn
-Cross suture line
-By pressure from the uterus
-Gravity
Resolve 3-4 days/ no treatment needed
Head assessment
Cephalohematoma
-Does not cross suture
-Skull bone bleeding
-Result from trauma during birth
Risk for jaundice
Resolves in 2-8 weeks
What are the sings of respiratory distress?
flaring of bares
flared nostrils
tachypnea
retraction
central cyanotic
grunting
Babinski reflex
Open— positive
Close– negative
Expected lab
a) Hbg
b) HCT
c) glucose
d) WBC count
a) 14 TO 42g/dl
b) 44%-64%
c) grater than 40 t0 45 mg/dl
d) 9,000 tp 30,000
What methods can the nurse use to manage pain in the newborn? 5
-Allowing a parent to hold
-Breastfeeding
-Swaddling with arms and legs “tucked”
-Souse solution,
-Pacifiers
Neonatal Infant Pain Scale (NIPS)
How does the nurse know if an infant is in pain?
-Crying
-Grimacing
-Active movement/especially legs
-increased resp
What is the #1 PRIORITY for NB?
Thermoregulation
Keep the warm!!!
What is first period of reactivity?
Alert (mom + baby wide awake)
↑ HR(160-180) & RR
Lasts ~ 30 minutes
What is the “Golden Hour” ?
The best time to initiate breastfeeding (30min to 1hr)
What is the 1st sleep phase?
difficult to arouse/ 目を覚まさせる
Lasts 2-4 hours
What is the 2nd period of reactivity?
Teach family warning signs
Will probably want to eat
Lasts ~ 2-4 hours
a) Metabolic screening done by when?
b) And NB must have what before have the test?
a) A capillary heel stick should be dine 24 hr
b) formula or breastmilk
What is the PKU?
A defect in protein metabolism
can result in mental retardation
(treatment in the first 2 months of life can prevent mental retardation)
How is the Vit K shot administered?
IM injection into the Vastus Lateralis
Administer the NB shots while baby is skin-to-skin with mom to help with pain.
Why NB needs a Phytonadione vitamin K₁ shot?
A one-time dose of 0.5 ml will help prevent vitamin K deficiency bleeding
Vitamin K— for blood clotting
Circumcision care
What are 2 things to important watch out?
1: bleeding=medical emergency!
2: Document first post circ void
If the baby does not pee within 6-8 hours notify the provider
Circumcision care
Other importance 4
1: use of petroleum jelly to avoid site sticking to the diaper
2: Diaper tight enough to avoid friction rub
3: Fold diaper tp prevent pressure on the area
4: Don’t try to remove the yellow film
Respiratory complication
a)Respiration less than or equal to 30/min?
b) Respiration greater than or equal to 60/min?
a) Bradypnea
b) Tachypnea
Respiratory complication
intervantion
Bulb syringe
suction mouth/nose, aspirate mouth then one nostril at a time
Maintain thermoregulation
Expecting finds
Respiratory distress
Tachypnea
Nasal flaring
Exploratory grunting
Retractions
Cyanosis
Fine crackles
Why does thermoregulation so important for NB?
Newborns cannot shiver or sweat to control temp > Burning brown fat > O2 is required to burn fat >An increase in O2 demand leads to respiratory distress
acidosis
a) Regular temp for NB
b) Hypothermia
a) 97.9-98.6
b) less than 97.7 (36.5)
NB should void?
Once within first 24hr
then 2nd change 2diapar till day 5th
The best method for thermoregulation is?
Early skin to skin!!!
Heat loss
Conduction
resulting from direct contact with a cooler surface.
-warm stethoscope
-pad on scale before weighting NB
-NB should placed direct on the mom’s chest
and covered with warm blanket
Heat loss
Radiation
Loss of heat from body to a cooler solid surface close to, but not in direct contact
-Baby away form the window
Heat loss
Convention
Flow of heat from body surface to cooler environmental air
-Place bassinet put of the direct line of a fan or air conditioning
Infection control
a) Risk of infection during first few months d/t ?
b) Newborns lack the ability to what?
a) immature immune system
b) localize infection= SEPSIS
a) What is a meconium?
b) When have that?
a) A newborn’s first poop
sticky, thick, dark green poop
b) Within 24-48hr
Heat loss
Evaporation
Loss of heat as surface liquid is converted to vapor (baby being wet)
-Dry newborn immediately
Oxygen Saturation in Transition
What is the normal range of
1min
5min
10min
1 minute: 60-70%
5 minutes: 80-85%
10 minutes: 85-95%
Umbilical cord care
a) how long should we keep the clamp?
b) most cords fall off within?
a) in place for 24-48
b) first 10-14days
Erythromycin?
Prevent eye infection
apply to the lower conjunctival sac each eye
Hypoglycemia
a) T or F
An initial drop in blood glucose after birth is common
b) The rang that the nurse start intervention for hypoglycemia
a) T
b) within the first 4hr <40
4 to 24 hr <45
Expecting findings
Hypoglycemia
poor feeding
Hypothermia
weak cry
lethargy 無気力
diaphoresis
jittery, apneic, problems feeding, seizures
What the way stabilized blood sugar level?
Non pham
Skin-to- skin
When to when?
a) Neonate
b) Preterm
c) Term
d) Post-term
a) Birth to 28 days
b) 20 weeks-36 6/7 weeks
c) 37-42 weeks gestation
d) After 42 weeks
What is Ballard gestational assessment?
Less than 37 weeks gestation
evaluates a baby’s appearance, skin texture, motor function, and reflexes
Post-mature infant
a) dysmaturity d/t?
b) dysmaturity result what?
a) placental degeneration and uteroplacental
insufficiency
(placenta functions effectively for 40 weeks)
b) Chronic fetal hypoxia
Neonatal respiratory distress
Post-mature infants can be either SGA
(small for gestational age) or LGA(Large for gestational age), depend what?
Depending on how well the placenta functions during the last week of pregnancy
Post-mature infant findings
Peeling, cracked skin
dry, leathery skin
Meconium stain of fingernail
Difficulty establishing respirations
Wight loss
a) first 48 hr
b) within 10 days
c) Lose more than the normal range, why?
a) <7%
b) 5-10%
c) dehydrated/malnourished
Breastfeeding
a) how many times
b) position
a) Feed every 2-3 hrs (8-12 times/day)
b) Football hold
Cradle
Modified cradle
Side lying
Breastfeeding
benefit 7
Infant
Dec risk of infection(pass antibodies from mom milk)
Contains electrolytes and minerals
Easy for baby to digest
Colonizes the newborn gut
Dec incidence of SIDS, allergies, childhood obesity
Promotes attachment
Always available & @ the right temperature
Breastfeeding
Benefit
Mom 3
Dec postpartum bleeding
Inc uterine involution
Dec risk for ovarian/breast cancer, diabetes, HTN, CVD, RA
Bottle Feeding
a) How many times should feed?
b) Never heat in what?
c) A prepared formula can be refrigerated for up to?
d) What position should the baby be?
a) Feed every 3-4 hrs
b) microwave
c) 48 hrs
d) Cradled in a semi-upright
What action by the NB indicates readiness to feed? 準備
Head to mouth movement
sucking
motions
rooting
mouthing
Discharge
a) Vaginal birth
b) Cesarean birth
a) after 48 hrs
b) after 72 hrs
What is Habitation?
Newborns have the ability to diminish or shut down sound, stimuli
Discharge teaching
Safe sleep/Wake cycle
Newborns sleep 18 hrs a day
Place newborn supine when sleeping (“back to sleep”)
Keep the environment dark and quiet
Nothing in the crib w/ baby
dress them in one more layer
Preventing positional plagiocephaly
-infant can be on their stomach while supervised when awake
Discharge teaching
Car seat
A rear-facing car seat until at least age 2
Car seats should always be in the center/middle rear seat to avoid airbags
Discharge teaching
Clothing
Dress baby as you dress + 1 more layer
Cover baby’s head
Soft clothes made of cotton
Discharge teaching
Cord Care
Keep the cord open to the air
diaper folded down below the cord
No special treatments for the cord
Avoid submersion baths until the cord falls off
The cord should fall off at 10-14 days
Report any d/c or foul smell
When to call the provider
Fever ver 100.4
Bleeding or purulent drainage from umbilical cord
Dec in voids/stool (No wet diapers for 18 – 24 hours OR fewer than 6 wet diapers a day)
Sings of jaundice or cyanosis
Projectile vomiting
Poor feeding
Refusal to eat for more than two feedings
This baby is at increased risk for what?
a) Parental rejection
b) Hyperbilirubinemia
c) Hypoglycemia
d) Low self-esteem
b
Breast milk and formula are what % water?
a) 95%
b) 90%
c) 80%
d) 75%
b
Which infant would be most at-risk for developing hyperbilirubinemia? The infant who is:
a) Bruised
b) Post dates
c) Asian
d) Preterm
d
Increased levels of unconjugated bilirubin require treatment in order to prevent:
a) Hemorrhage
b) Erythema toxicum
c) Neurotoxicity
d) Infection
c
Physiological Jaundice
a) Caused?
b) peak day?
a) Common
immature liver
a short lifespan of fetal RBCs
cold stress
b) 3-5 days
Never occurs in the first 24 hr
Physiological Jaundice
Those at risk
ALL newborns
preemies
respiratory depression/distress
cold stress
hypothermia
Physiological Jaundice
Intervention
Early feeding to stimulate pooping
Maintain normal body temp
If jaundice occurs within 24 hr, what is this called?
Pathologic jaundice
caused by hemolysis ABO incompatibility
very BAD
Phototherapy
Hyperbilirubinemia
Place baby under light wearing just a diaper (phototherapy)
Protect baby’s eyes with a mask
Turn baby every 2 hr
Monitor temp and dehydration
DO NOT lotion on the baby
What do you know about Heb B vaccine?
Give at the birth
IM administer the other side of the thigh(of vitamin K shot)
Need singed informed consent
Which one is a finding of a baby was born in prematurely？
a) Dec amount of vernix
b) Leathery/cracked skin
c) Dec planter surface crease
d) No lanugo
C
B is post term
Which one needs more education?
a) I should be feeding my baby every 2-3 hr
b) My baby should have at least 4 wet diapers on day 4th
c) I should allow my baby adequate rest for growing and skip feeling if he is asleep
d) I should expect to see the baby’s stool lighten by day 3
C
Which one is the lowest risk of becoming jaundice?
a) Premature baby
b) baby who has cephalohematoma
c) A baby whose mom is diabetes
d) A baby had a circumcision done
d
cephalohematoma
Head/ bone bleeding
What are the hunger cues?
Hand-to-mouth motions
Sucking
Rooting (looking around)
Mouthing
Before the baby cry
NB does not need to be given water
What is a correct latch?
Baby’s nose, cheeks. and shin touch the breast with a portion of the areola in the baby’s mouth
What are the preemie characteristics?
Thin transparent skin
Lanugo
Vernix
Testes palpable in inguinal canal
lack of creases
What are the term baby characteristics?
Cartilage on ear
1cm breast bud
Rugae on scrotum
Deep creases noted
Noninverting thermogenesis
Infants produce heat by the metabolism of their blown fat
O2 needs more= become jaundice
What NB’s regular temp?
97.7-99.5
Less than 97.7 = hypothermia
