Newborn Care Flashcards
1
Q
Normal axillary temperature range
A
36.5 to 37.4 Celsius
2
Q
Four physiologic risk factors for hypothermia
A
- newborn has decreased subq fat and thin epidermis
- newborns blood vessels are closer to the skin surface
- newborns head is larger than body
- newborns body surface is large compared to their weight
3
Q
Aside from physiologic risk factors, what are others newborn risk factors for hypothermia
A
- all newborns during first 8-12 hrs of life (first half day of life)
- premature newborns
- prolonged resuscitation efforts
- sepsis
4
Q
How long after birth does a newborns temperature stabilize
A
About 72 hours (3 days)
5
Q
What three defenses does the newborn have to combat decreasing body temperature
A
- flexed posture
- brown fat
- peripheral vasoconstriction
6
Q
What does a flexed posture do for a newborn
A
decreases surface area exposed to the colder environment, thus keeping baby warmer
7
Q
What is brown fat and what is it’s purpose
A
It is fat located around the shoulders and down the sternum and spine of a baby, and it helps to warm the baby after birth
8
Q
At what point does brown fat begin to develop in fetus
A
26-30 weeks
9
Q
How does brown fat help to keep baby warm
A
Compared to ordinary fat, a baby’s brown fat is more vascular with a richer nerve supply which increases the heat production by 100%
10
Q
What is acrocyanosis
A
blue discoloration of a part of the body
11
Q
conduction v. convection
A
conduction = loss of heat from cool surface convection = loss of heat from cool air
12
Q
radiation type of heat loss is
A
loss of body heat to cool surfaces that are not in contact with the body
13
Q
example of radiation heat loss
A
body heat lost due to cold window nearby
14
Q
5 ways to reduce baby’s risk for heat loss
A
- dry them immediately after birth
- place skin to skin with mother
- hat, shirt, and wrap to promote flexion
- do not place directly on cold surfaces like a scale
- if no skin to skin available, please baby under radiant warmer
15
Q
initial signs of hypothermia in infant
A
increased movement, flexed position, increase HR and RR
16
Q
later signs of hypothermia in infant
A
mottled(patchy)/pale skin, lethargy, hypoglycemia, weak cry
17
Q
During the initial newborn assessment what is done immediately after birth
A
vital signs and assessment every 15 minutes for first hour (total of 4 times)
18
Q
During the 1-4 hours after birth what assessments/actions are done
A
- gestational age evaluation
- erythromycin ointment
- vitamin k injection
- weight, length, head/chest circumference
- identification
- Hep B vaccine (if mother consented)
19
Q
What is involved in the identification process after birth of a baby
A
- maternal thumbprint
- infant thumbprint
- banding
- security alarm
20
Q
What are the 6 neuromuscular indicators of gestational age
A
- posture
- square window
- arm recoil
- popliteal angle
- scarf sign
- heel to ear
21
Q
What are the 6 physical criteria for the gestational age assessment
A
- skin
- lanugo
- plantar surfaces
- breast buds
- eye/ear
- genitals
22
Q
By how many weeks give or take is the gestational age assessment accurate by
A
accurate within 2 weeks
23
Q
Gestational Age: Preterm
A
born before 37 weeks, no matter the birth weight
24
Q
Gestational Age: Term
A
born b/w 39 wks and end of 42 wks
25
Gestational Age: Postterm
born after 42 wks
26
Gestational Age: Postmature
born after week 42 wks and is a sign of placental insufficiency
27
What is normal newborn weight
2500g to 4200g
28
Avg gestational age (AGA)
weight between 10th and 90th percentile
29
Small for gestational age (SGA)
weight below 10th percentile
30
Large for gestational age (LGA)
weight above 90th percentile
31
Does birth weight classification take into consideration gestational age at birth?
no it is regardless of gestational age
32
LBW
low birth weight
| less than or equal 2500g
33
VLBW
Very Low Birth Weight
| less than or equal 1500g
34
ELBW
Extremely Low Birth Weight
| less than or equal 1000g
35
IUGR
Intrauterine Growth Restriction
36
What are some IUGR risk factors
multiple births, smoker, AA mother, HTN, pre-eclampsia, malnutrition, substance abuse
37
Average newborn weight measurement is (in lbs, oz)
7lbs, 8 oz.
38
Average head circumference of newborn (cm)
32-37 cm
39
What does the modified Ballard Assessment determine
gestational age
40
What is assessed in the modified ballard assessment (there are 15)
- axillary temp
- pain score
- heart
- lungs
- head and face
- neck
- clavicles
- chest
- abdomen
- umbilicus
- extremities
- hips
- genitalia
- anus and rectum
- trunk and spine
41
ballard assessment: heart
- apical pulse rate and rhythm
- murmur
- brachial and femoral pulse
42
ballard assessment: lungs
- resp. rate
- effort
- sounds
- grunting
- rales
43
ballard assessment: head and face
- symmetry
- fontanels
- molding
- cephlohematoma
- caput succuduem
- vacuum extracter
- forcep marks
44
ballard assessment: eyes
- shape
- subconjuctival hemorrhage
- edema
45
ballard assessment: eyes
- development of cartilage
- ear canal
- position
46
ballard assessment: nose
- flaring
| - patency (obligatory nose breather)
47
ballard assessment: mouth
- lip color
- cleft
- Epstein's pearls
- natal teeth
- palate
48
ballard assessment: tongue
- movement
- frenulum
- suck
49
ballard assessment: neck
- nodes
- swelling
- ROM (range of motion)
50
ballard assessment: clavicles
- symmetry
| - fracture
51
ballard assessment: chest
- symmetry
- sternum shape
- breast buds
- retractions
52
ballard assessment: abdomen
- bowel sounds
- contour
- palpate for distention
53
ballard assessment: umbilicus
- AVA (two arteries, one vein)
| - cord clamp
54
ballard assessment: extremities
- posture
- ROM
- symmetry
- skin folds
- number of digits
- capillary refill
- pulses
- reflexes
55
ballard assessment: hips
- ortolani's sign
56
ballard assessment: male genitalia
- penis (precipice not easily retractable, opening of urethral meatus)
- scrotum (testes descended 90% of time)
57
ballard assessment: female genitalia
- labia majora covering labia minora
- white discharge is normal
- pseudomenstruation is normal
58
ballard assessment: anus and rectum
- anal wink reflex
- voids
- stools
59
ballard assessment: trunk and spine
- palpate spine fully
- gluteal folds even
- tufts of hair
- pilonidal dimple
- cleft
60
what is caput succedaneum
bulging on head as a result of fluid
61
what is cephalhematoma
bulging on head as a result of blood buildup
62
what are Epstein pearls
protein filled white or yellowish cysts in newborn mouth
63
what is ankyloglossia
front of newborns tongue attached to base of mouth
64
what is a sacral dimple
dimple right above baby's butt crack
65
what is normal blood glucose of newborn
40-100 mg/dl
66
how is a newborn's blood glucose level sampled
obtained through a heelstick, either on the lateral or medial aspect of heel
67
what is considered hypoglycemia in a newborn
BG less than 45 mg/dl
68
most likely risk factors for hypoglycemia
cold stress or infant diabetic mother (IDM)
69
what is IDM
infant diabetic mother
70
less likely risk factors for hypoglycemia
asphyxia, sepsis, respiratory distress, LGA, SGA, LBW, IUGR
71
newborn symptoms of hypoglycemia
jitteriness, pallor, cyanosis, temp instability
72
first interventions for hypoglycemic baby
- feed
| - skin to skin to warm if hypothermic
73
if BG instability is severe or persistent what might be needed
IV dextrose
74
pathologic jaundice v. physiologic jaundice
pathologic jaundice is a more like a disease process rather than a symptom, whereas physiologic jaundice should resolve once what is causing it is resolved
75
what percentage of newborns experience physiologic jaundice
50%
76
what is jaundice
increase in unconjugated bilirubin - hyperbilirubemia
77
what is breastmilk jaundice
when baby experiences jaundice as a result of a factor in milk that increases the absorption of bilirubin
78
what interventions are there for breastmilk jaundice
most don't need any intervention
79
when would breastmilk jaundice develop
in second week of life
80
when does physiologic jaundice usually develop
more than 24 hrs after birth
81
what are normal bilirubin levels for premature babies
8, 12, 15, 15
82
what are normal bilirubin levels for full term babies
6, 10, 12, 10
83
what are the major risk factors for physiologic jaundice
- gest. age 35-36 wks
- prev. sibling received phototherapy
- bruising or cephalohematoma
- east Asian race
- exclusive breastfeeding, especially if not going well
84
treatment of physiologic jaundice
- feedings frequently
- monitor stool (amount, color, consistency)
- doctor follow up 1-2 days after leaving hospital
- phototherapy
85
what can cause pathologic jaundice
- rH incompatability
- blood group incompatability
- metabolism and excretion disorders
86
what can result from pathologic jaundice if untreated
bilirubin deposits in brain resulting in hearing loss, mental retardation, cerebral palsy, and death
87
what does phototherapy for jaundice involve
exposure of newborn to high intensity blue light spectrum, use of eye protectors, 30 mins out for feedings, monitor intake and output
88
how does phototherapy treat jaundice
facilitates biliary excretion of unconjugated bilirubin
89
how long do you do sponge baths for newborns
until the cord stump falls off and circumcision is healed
90
how often do you bath newborn
two to three times a week
91
when does umbilical cord usually fall off
7-10 days
92
can alcohol be used to clean umbilical cord
no
93
should umbilical cord be covered by diaper or shirt or exposed to air
exposed to air, fold shirts and diapers
94
signs of infection as umbilicus
- fever
- redness or pus
- swelling or moistness 2 weeks after stump falls off
- bulging after stump falls off
95
at what point should umbilical cord be clamped
within 24 hrs of birth
96
important procedures for circumcision care
- use clear water to clean plastibell ring until it falls off
- petrolatum gauze or Vaseline in front of diaper for 12-24 hrs if gomco/mogen
97
is yellowish film over glans normal or abnormal after circumcision
normal part of healing
