Newborn Care Flashcards
What is the age range of the neonatal period ?
birth to 28 days
What are some adjustments newborns go through in extra-uterine life ?
- establish respirations
- adjust to circulatory changes
- regulate temperature
- ingest, retain and digest nutrients
- eliminate waste
- regulate weight
What is the major difference in a newborns circulatory flow after birth ?
- in the uterus= left to right flow
- outside mom= right to left flow
Why is vaginal delivery important when related to the liquid in the baby’s lungs ?
compression of the newborn chest during vaginal delivery helps squeeze fluid out of chest and draw air into the lungs
- not as effective with C/S and premature delivieries
When does the newborn’s lungs start to exchange gases ?
right after the umbilical cord is cut
- this causes the placenta to no longer work as the lungs
What does clamping of the cord cause for prostaglandin levels ?
causes a decrease which can inhibit respirations
What sensory stimuli’s helps establish respirations ?
- handling of infant by person doing delivery
- suctioning of mouth and nose
- drying by nurse
- pain associated with birth
- lights, sounds, and smells
Why is surfactant important for newborns ?
surfactant is released when the lungs expand after birth
- lines the alveoli and respiratory passages
Why is the function of surfactant ?
prevents alveolar collapse and lowers surface tension which increases lung compliance
What is a sign of a baby not having adequate surfactant levels ?
at the end of exhalation, the baby will make a “grunt” sound
- this them popping back open those alveoli
What are the 3 signs of respiratory distress ?
- nasal faring
- grunting
- retracting
Why is nasal flaring a sign of respiratory distress ?
they are increasing the surface area of their nose to get more air into their lungs
- early sign of distress
When doing the respiratory assessment, what do we look for ?
- 30-60 breaths per min
- listen for a full min since they are irregular breathers
- when auscultating for lung sounds make sure that their abdomen matches with the air sounds
- may have short pauses of < 15 secs (periodic breathing) which is normal
What is meconium ?
first bowel movement of newborn
- ASPIRATION RISK
- black, tarry, sticky
- should be passed within 24 hrs
What are some expected findings of the CVPV assessment ?
- fast HR (120-160) and even faster when crying
- irregular S1 and S2
- may hear little of a murmur and swooshing (is normal but monitor if they are compensating well for this)
When does the ductus arteriosus close ?
- functionally= 24 hours
- permanently= 3-4 wks
What causes the functional closure of the foramen ovale ?
increased pressure in L atrium caused by 1st breath
How do we regulate their temp ?
- dry quickly after birth
- place cap on head
- delay 1st bath (unless mom has known pathogen like Hep B or a STD)
- skin to skin contact (kangaroo care)
- radiant warmer (last resort)
Why are they vulnerable to heat loss ?
large surface area, only thin layer of fat and unable to shiver to produce heat
- first 12 hours they are the most vulnerable to heat loss
What is the feeding schedule for breastfeeding or formula ?
- Breast: 2-3 hrs
- Formula: 3-4 hrs
What are infants at risk for is they are born before 32 weeks in relation to surfactant ?
they do not have adequate surfactant levels
What is their stomach capacity ?
30 mL (size of marble)
What is the urine schedule ?
- voids 2-6x in first 24-48 hrs
- 6-8x per day after
When is urine formed in utero ?
4th month
When is the bacteria establish and when are bowel sounds heard after birth ?
- bacteria in gut in first week
- bowel sounds heard shortly after birth
What does the feces of a breastfed baby look like ?
yellow seedy stool w/ each feed
What does the feces of a formula baby look like ?
soft brown
- 1-2x day
What does weight looks like after birth ?
- typical loss of 5-10% of birth weight in first 3-5 days of life
- should regain by 14 days
Why do baby’s look all puffed up after birth ?
they are very fluid heavy and that’s why they look all puffed up
- its a survival instinct because it protects from potential dehydration
What is the temp range ?
97.7-99.5 F
- if they have a physiological problem their temp will do down instead of up
- temp decreasing is more significant
What is the RR, HR, and BP ?
- RR: 30-60
- HR: 110-160
- B/P: 60-80/40-50 (mean arterial BP should correspond with weeks gestation)
What is an APGAR score ?
systematic method for assessing infant’s condition and transition to extra-uterine life at birth
- used at birth to ensure infants are observed for need of resuscitative care
What are the different APGAR scores ?
- 0-3: severe distress
- 4-6: moderate difficulty
- done at 60 secs and repeated at 5 mins of life
- doesn’t predict neurological outcomes
What should the Babinski reflex look like ?
positive Babinski
- toes flare out
What is Jaundice ?
yellowish discoloration of the skin and other organs caused by high levels of bilirubin
- phototherapy may be needed
What is physiological jaundice ?
self-limited caused by immature liver and enzyme system
- 3-4 days after birth
- in 60% of neonates
- may resolve on its own
- baby can compensate and resolve
- cephalocaudal progression
What is pathologic jaundice ?
caused by hemolytic disease, RH/incompatibility, prematurity
- seen within 24 hrs of birth
When performing phototherapy for jaundice what are steps we should take ?
- protect the eyes
- max skin exposure
- monitor heat loss, fluid balance status
- blankets or lights
Which babies are at risk for hypoglycemia ?
- preterm
- low birth weight
- small/large for gestational age
- infants of mom with diabetes
- distress during birth
What is hypoglycemia in babies ?
may occur in first few hours of life
- early and regular feeding will prevent this
- treat per hospital protocol
How is their immune system ?
- immunosuppressed (defenses not well developed)
- term infants have acquired natural immunity through maternal antibodies which were transferred in last 3 months of pregnancy
- colostrum and breastmilk provide needed antibodies
What are some immediate nursing care ?
- assess respiratory status
- suction mouth and nose with bulb
syringe- maintain adequate 02 supply
- dry and stimulate infant
- maintain temp (skin to skin, under
warmers, hat & blankets - assess temp (axillary)
- place ID bands
- footprint baby and mom’s fingerprints
- obtain measurements & vitals
What are some baseline measurement and vital signs taken ?
- obtain vital signs
- obtain body measurements
- weight, head circumference (OFC), chest circumference, length, gestational age using Ballard tool
3 physical assessment
What is Caput Succedaneum ?
lump or bump on head shortly after birth
- more superficial
- goes across multiple plates and sutures
What is Cephalohematoma ?
deeper injury than just a surface level tissue injury
- contained to one plate of the skull
What is Acrycyanosis ?
the extremities are not perfusing enough because of the blood flow first goes to the core and the head
- extremities/limbs look slightly bluish
What is Molding ?
elongated head
- baby took a long time in the birth canal
- just have to wait it out because it will be reversed naturally
What is milia ?
normal plugged up skin cells
- look like small pimples
- the less you do the better
- don’t apply oils or creams or anything
What is mottling ?
white and red appearance of the skin
- happens when baby is very cold and “freezing”
What is a Mongolian spot ?
type of birth mark on baby’s
- is on the sacrum or buttock and looks like a bruise
What is Erythema Toxicum ?
a common rash found on newborns
What is the Erythromycin Ophthalmic Ointment used for ?
eye prophylaxis to prevent ophthalmia neonatorum(eye infection)
- due to gonorrhea or chlamydia
- put ribbon of medicine in eye from inner to outer canthus
- administer 1-2 hours of birth
When is the Hep B vaccine administered ?
IM at birth then 1-2 months and 6 months
- must obtain parental consent
Why is the Vitamin K vaccine important ?
prevents hemorrhagic disease
- within 2 hrs of birth
- bacteria necessary to synthesize Vit. K not present for 1 week (no intestinal flora yet)
When, how and why do we perform the hearing test ?
- When: 24-48 hrs before they leave the hospital
- important because they are already learning about their environment and speech
When and how do we perform the genetic, endocrine, and metabolic screening ?
- When: they have to have eaten something before because they have to be metabolizing something to know if its functioning properly
- How: blood test
When do we perform the congenital heart disease screening ?
within 24 hrs
What do we educate the family on ?
- needs of newborn can be overwhelming to families
- education should occur throughout the hospital day and not all at once
- be aware of any specific cultural needs when planning education
- encourage early bonding with parents (skin to skin contact)
What is some bathing education ?
- no more than every other day
- daily cleansing of perineum and face
- wash hair 1-2x per week
What is some umbilical cord care ?
- clean cord with warm water and a washcloth with baths or if soiled with urine or stool
- let cord air day (keep outside of diaper)
- clamp is removed once the stump is dry & baby is ready for discharge (24-48 hrs after birth)
When does the umbilical cord usually fall off ?
10-14 days
What is some circumcision care ?
- assess for bleeding every 15-30 mins the first hour, then hourly for the next 4-6 hours
- avoid baby wipes (cleanse with water only)
- apply vaseline with every diaper change (don’t want penis sticking to diaper)
What are the sleep needs ?
sleep correlates with rate of growth
- 80% at birth
- 12 hrs at 12 months
- sensitivity to sleep cycles so develop rituals
- not firm “schedule” because they won’t keep it consistent
What is Sudden Infant Death Syndrome (SIDS) ?
- 3rd leading cause of death
-unknown cause - nurse role is family coping/grief
What are some risk factors to SIDS ?
- prone sleeping
- exposure to tobacco smoke
- soft sleeping surfaces
- hyperthermia
- bed sharing
- lack of breast-feeding
- SIDS sibling
- preterm
What are some recommendations for safe sleep ?
- sleep alone, on their back in a crib
- offer pacifier
- breastfeed
- firm sleeping surface
What is some motor vehicle safety ?
car seats
- rear-facing safety seat for up tp 2-3 years of age
- always in the back seat
heat stroke
- dangerous temps occur in 15 to 30 mins if left unattended
nurse implications
- teach safety and provide resources
