Newborn Care Flashcards
First period of reactivity
Lasts up to 30 minutes after birth
Newborn’s heart rate increases from 160 to 180 beats/min
Decreases after 30 minutes to baseline
Infant is alert and has spontaneous startles, crying, and head movement
Period of decreased responsiveness
Lasts from 60 to 100 minutes
Infant is pink
Respirations are rapid and shallow up to 60 breaths/min
Sleeps or has a marked decrease in motor activity
Second period of reactivity
Lasts from 10 minutes to several hours Occurs between 2 and 8 hours after birth Tachycardia, tachypnea occur Meconium passed Increased muscle tone, changes in skin color, and mucus production
Signs of Respiratory Distress
Newborn Infants: Nose breathers (until 3 weeks)
Warning Signs
Nasal flaring
Intercostal or subcostal retractions
Grunting with respirations
Acrocyanosis-Can be NORMAL the first 24 hours
Cardiovascular system
Heart rate 120-160 bpm
Signs of cardiovascular problems Persistent tachycardia (>160bpm)
What Happens when the Umbilical Cord is Cut?
Most critical adjustments: Air inflates lungs with first breath Three shunts close in heart to allow oxygenated blood flow to lungs and arterial blood pressure in heart readjusts Ductus arteriosus Ductus venosus Foramen ovale
Thermogenic system
Newborns do not shiver to produce heat
Have brown fat deposits, which produce heat
Evaporation (keep dry and well wrapped)
Radiation (keep away from cold objects and outside walls)
Convection (Shield from drafts)
Conduction (Perform all treatments on a warm, padded surface)
Effects of cold stress
Cold Stress
Increase of oxygen consumption
Pulmonary and peripheral vasoconstriction occur
Decreases oxygen uptake by the lungs and oxygen delivery to the tissues
Anaerobic glycolysis increases
Decrease in partial pressure (PO2) of oxygen and pH
LEADS TO METABOLIC ACIDOSIS
Renal system
Weight loss of 5%-10% occurs during 1st week of life
Frequency of voiding varies (2-6x/day) and increases after 2 days
Monitor I & O
Signs of renal system problems
Dehydration
Physiologic Jaundice
Appears > 24 hours of age No injury to baby 50% incidence Keep well hydrated Feed to stooling Monitor intake and output
Pathologic Jaundice
Usually occurs when additional problem present Prematurity Blood type (ABO) or Rh incompatibility Appears < 24 hours of life Risk of brain damage
Immune System
Passive Immunity = Placenta and Colostrum
Risk for Infection: Use aseptic technique/Handwashing
integumentary system
Vernix caseosa: Cheese-like, whitish substance: Protective covering
Sweet glands: Milia, first 24 hours babies don’t sweat
Mongolian Spots: Bluish black areas of pigmentation
Signs of Integumentary system problems: Pallor Plethora (deep purplish color from increased circulating RBCs) Petechia Central Cyanosis Jaundice
Reproductive
Swollen or enlarged genitalia
Inspect for ambiguous genitalia
Skeletal system
Caput succedaneum Cephalhematoma Subgaleal hemorrhage Extremities Signs of risk for skeletal problems
Neuromuscular System
Sucking and rooting Swallowing Moro Startle Pull-to-sit Babinski’s sign/Plantar reflex
Behavioral Adaptations
Babies learn from interactions
The nurse’s role… in 48 hours
Care begins immediately after birth Assess and stabilize infant Maintain and monitor health of mother Facilitate family bonding Teach infant care skills Ensure safety at home Document assessments, findings, teaching
Birth through first 2 hours
Initial asessment and APGAR scoring
Physical assess, appearance, vital signs
Gestational age assessment
Classification of newborns by gestational age
Vital signs
Range Considerations
Respiratory rate
30 to 60/ min
Considerations
OK:Short periods of apnea, abdominal breathing, panting
Abnormal-transient tachypnea, grunting, nasal flaring, see- saw breathing
Heart rate
110 to 160 beats/min
Considerations
Listen for full minute, apical pulse
Temp
97.7 to 99.5 F
Considerations
Axillary, avoid cold stress
Kangaroo care
swaddling
Immediate Interventions
Airway maintenance
Maintaining adequate oxygen supply
Suction with bulb syringe
Maintaining body temperature
Eye prophylaxis (STI in eye)
Vitamin K prophylaxis
Promoting parent-infant interaction
Cord care and separation
Clamp removed ~24 hrs.
Cord separation ~ 10-14 days.
Keep dry-open to air
Common newborn problems
Birth injuries
Physiologic problems
Hyperbilirubinemia
Hypoglycemia
Hypocalcemia
Care Management: From 2 Hours After Birth Until Discharge
Laboratory and diagnostic tests Universal newborn screening Newborn hearing screening Critical congenital heart disease Venipuncture
Interventions
Therapeutic and surgical procedures
Hep B
Circumcision
Parental decision