Newborn Care- EXAM 2 Flashcards
Normal Vital Signs of a Newborn
Respirations
Apical Pulse
BP
Temp
30-60 breaths per minute
Apical pulse: 12-=160 bpm
65/30 to 95/60
36.5-37.3 in Celsius // 97.7-99.5 in Fahrenheit
Murmurs
90% of them are not associated with anomalies
Usually due to incomplete closure of ductus arteriuosis or foramen ovale
Thermoregulation in newborns
Want to prevent heat loss!!
Keep them dry and covered, avoid cold surfaces and keep away from drafts
Important liver functions
Maintain bg levels
Conjugate bilirubin
Necessary production for blood coagulation
Store iron and metabolism drugs
Describe why conjugation of bilirubin is important in newborns
Turns yellow lipid to water soluble
Newborn liver must begin to conjugate once born or can be toxic and increased susceptibility to jaundice
Relevant in babies with high beta-D-glucuronidase
Hyperbilirubinemia
Occurs after the first 24 hours of life due to large load of bilirubin; liver immaturity
What is Breast milk jaundice
Is caused by a lack of sufficient intake
late onset jaundice
Occurs after 3-5 days of life from breastmilk
3 weeks to 3 months to resolve
Risk factors for elevated bilirubin
Excess production of erythrocytes
Short RBC life
Liver immaturity
Blood incompatibility
Preterm and late preterm infants
Lack of intestinal flora
Delayed feeding
Trauma resulting in bruising
Diabetic mother
Hypoglycemia, infection
Stool transition
Progress from thick greenish black ,meconium, to loose greenish brown ,transitional stool, to milk stools
Breastfeed= frequent, seedy and mustard colored
Meconium stool
passes within first 8-24 hours
Formed in utero
Thick, tarry black or dark green
Transitional stools
Occurs next day or two after meconium
Part meconium part fecal matter
Thin brown to green
Entirely fecal
Stools of breastfeed newborn
Pale yellow or pasty green
More liquid and frequent
Less pale then those of formula fed newborns
Urination
First void should occur within 24 hours
Normal diuresis after birth causes a 5-10% weight loss since they are composed of a greater percentage of water; 75%
Immune system and antibodies present
Not fully activated until some time after birth
IgG, IgM, IgA
IgG
Crosses the placenta in utero and provides a newborn with passive temporary immunity
IgM
Helps protect against gram-negative bacteria
IgA
Does not cross the placenta and must be produced by the infant
Visual capacity
Ability to be alert and follow visual stimuli
Prefers human face and eyes, high contrast objects and patterns
Uses vision to become familiar with family, friends and surroundings
Healthcare team that works with newborn
Pediatrician or neonatal specialist
Nurse, lactation consultant and audiology speacialist
Clamping the cord
Placed after identification of vessels
1.3-2.5 cm from abdomen, abdomen skin must not be clamped
Clamp is removed 24 hours after cord has dried
Newborn identification and security
ID band on wrist and ankle, mother and partner, 4 in total
Baby is kept on side of the bed, away from window
Should be retuned to nursery when mother naps or showers if no other family member is present
ABDUCTORS OFTEN POSE AS MEDICAL PERSONNEL
Ballard tool
Used to establish gestational age
Less accurate
<28 weeks >43 weeks
What physical characteristics do you assess when establishing gestational age
Vernix, HAir, Skin firmness and Nails
Telanglectatic nevi
“stork bite” Pink discoloration found on eyelids, between eyes or neck
faded within 18 months. can be genetic
Rooting reflex
Head is turned
Light touch of finger on the cheek close to the mouth, the infant will turn toward the stimuli
Rooting reflex
Head is turned
Light touch of finger on the cheek close to the mouth, the infant will turn toward the stimuli
Sucking reflex
Infant tries to suck thumb
Finger or nipple is inserted into the infants mouth and will begin to suck on the object
Moro reflex
Infant lies on its back with arms and legs raised
When an infant is suddenly lowered after being lifted, it will straighten arms, hands and flex its knees
What do you do if someone is Vitamin K deficient
Prophylactic injection is given, Prevents hemorrhage
Given IM in middle third of vistas laterals muscle
Prevention of eye infection
Ophthalmic ointment is given in lower sac of the eye
Infection caused by gonorrhea or chlamydia exposed through birth canal
Why is circumsison done
To prevent certain conditions
Religious reasons
Parental preference
Lack of knowledge regarding care of the foreskin
Complications for circumcision
Hemorrhage
Infection
Urinary retention
Stenosis or fistula
Adhesions
Necrosis
Injury to glans
Pain during and after surgery
Safety: Positioning
Newborn needs to be put on his back at night to sleep, no pillow at the head!
If they are put down after they eat, position head on the side
Swaddling baby reason
Helps maintain body temperature
Provides feeling of safety
Effective in quieting baby
Car seat saftey
Should never be placed un front seat of the car with passenger side bags
Should face rear of care until the baby is 2 years old
Apgar scoring
Done 1-5 min after birth
Scoring of 0-2 in 5 topics
HR, Resp.,Muscle tone, Reflex, Skin color
0-3 total= Beverly depressed
4-6 total= moderately depressed, additional help needed ( oxygen, suctioning or stimulation
7-10=excellent condition
If scored under 7 REPEAT EVERY 5 MIN FOR 20 MIN
Nonphysiologic jaundice`
Begins in first 24 hours, phototherapy will be needed
Nevus flammeus
Purple/red discoloration. Permenant
Port wine stain
Mongolian spots
now known as dermo melanocytosis
Blue/purple pigment on buttocks and back, looks like bruises
Nevus vasculosus
Strawberry shape mark
Heel stick steps
Warm heel
Cleanse with alcohol and let dry
Use spring activated lancet on medial or lateral, NEVER on soles
Apply pressure with dry gauze and bandage
Medications given after delivery
Erythromycin or tetracycline Ophthalmic Ointment
Vitamin K or Phytonadione
Hepatitis B Vaccine
