Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NUR360 LS1 > Newborn Care Fundamental > Flashcards

Newborn Care Fundamental Flashcards

1
Q

Sensory capabilities of newborns

A
  • Fetuses have their own temperament
  • Readiness for social interaction – with healthy, term newborns
  • Newborns can see (blink reflex), can see the parents face further away at 6mths, black and white contrast to start, develop colour later
  • Newborns are also drawn to round objects - built in survival feature to know where to go (the breast)
  • Newborns can hear (same amniotic fluid left can cause muffled sound) – 1 in 3000 will have a hearing deficit upon newborn screening; can cause speech and learning deficits
  • A lot is going on inside before they are able to vocalize it
  • Babies can recognize and hear heart sounds, voice, smelling and voice of parent
  • When born; place baby S2S with ammonitic fluid on parent to recognize smell
  • Newborns can hold eye contact (not for as long as us); but have the ability to focus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Influencing factors of newborn behavioural adaptations

A

1) Gestational age – premature babies have a much lower threshold around stimulus, coping with stimulation, they becomes overwhelmed easier
2) Time – from birth, from last sleep, from last feed; newborns become more organized over time
3) Stimuli – loud noises, bight lights; can sense a nervous or tense parent who is holding them; smoothing effect of oxytocin helps
4) Medication – IM injection of different types of meds for labour goes directly into fetal bloodstream; can cause drowsiness; effect of epidurals and regional anesthesia still under research and inconclusive (need to account while assessing newborn)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Sleep-Wake States

A

Sleep states (2)
• Deep sleep
• Light sleep

Awake States (4)
• Drowsy
• Quiet alert – best state to interact with a newborn
• Alert
• Crying – can indicate their needs and wants; there are many different types of crying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Newborn Assessment Phases

A

1) Immediate (at birth)
2) Complete (head-to-toe)
3) Ongoing (until discharge home)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Purpose of the immediate newborn assessment

A
  • Swift evaluation of adaptation to extrauterine life (including APGAR)*
  • Airway maintenance
  • Body temperature maintenance*
  • Brief focused physical exam*
  • Promote parent-newborn bonding*
  • Universal medication administration*
  • Overall are looking for: Gross abnormalities, congenital deformations, how they are adjusting to extrauterine life
  • Done while skin-to-skin (S2S)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Nursing interventions during the immediate newborn assessment

A
  • Assess HR, RR, Temp
  • Measurements – head circumference (occipital to frontal), length, sometimes will do a chest circumference
  • Weight – can compare before discharge
  • ID bands – security; anti-infant abduction system
  • Diaper, cap, safe swaddle
  • Vitamin K and Erythromycin prophylaxis

*Requirements for S2S: there are not ABC issues, both the baby and the adult are healthy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

APGAR Score Pneumonic

A

• 1 and 5mins after birth (baby nurse and/or peds)
• Then regulated intervals when sustained ressetation is required
A – appearance
P – pulse
G – grimace
A – activity
R – respirations

  • Determines if interventions are requires immediately (ABCs)
  • APGAR does not predict furutre neurological outcomes; only for in the moment
  • Highest score is out of 10
  • Usually lose 1 for acrocinaosis (purple/blueish hands and feet due to sluggish initial circulation, usually resilves a few hours ater birth)
  • Usually done in our heads; start at 10 then subtract from there
  • Assess HR at umbilical stump; can palpate until 5-10mins after birth (before it is clamped) for 6 seconds to assess quickly
  • Score of 7-10 means baby is transitioning well and may need some intervention
  • 4-6 means baby needs intervention
  • 0-3 indicates severe distress
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Newborn vital signs parameters

A

• Usually every 15min-every 30mins

P: 100-160 bmp – for one full minute
RR: 30-60 breaths/min – for one full minute
T: 36.5-37.5C (ax)
BP: 60/40 to 80/50 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Benefits of immediate S2S

A

Early S2S for clients and their healthy newborns is associated with:
• Enhanced breastfeeding success and duration
• Improved early maternal attachment behaviours
• No short- or long-term side effects (when done safely)
• *Don’t allow baby or adult fall asleep in this prone position – increase risk of SIDS

Associated newborn benefits:
• Thermoregulation
• Respiratory status
• Oxygenation status 
• Higher blood glucose
• Decreased crying
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Benefits of immediate S2S post C/S

A
  • Physiologic stability of birth parent and neonate – required to do it
  • Emotional well-being of birth parent and neonate
  • Potential reduction of pain for birth parent
  • Improved parent-neonate communication – cue reading, closeness
  • Improved breastfeeding outcomes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Universal newborn medications

A

1) Eye Prophylaxis – Erythromycin Ointment
• Indication: prevention of ophthalmia neonatorum (can lead to blindness)
• Action: prevent infection
• Dose: 1-2cm ribbon of 0.5% ointment within 2 hours of birth
• Postpartum nurse – Adverse reactions: 24-48hr conjunctivitis; temporary blurring of vision

2) Vitamin K Prophylaxis IM Injection
• Indication: prevention/tx of hemorrhagic disease in the newborn
• Action: promotion hepatic formation of clotting factors
• Dose: 0.5-1mg IM within 2-6 hours of birth
• Postpartum reaction – Adverse reactions: edema, erythema, discomfort/pain at site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Key newborn respiratory adaptations

A

• Multiple factors trigger first breath

  • Recoil of chest while clears the vaginal canal; noise, light, birth attending touching baby all help trigger breath
  • Meconium aspiration can prevent baby from taking first few deep breaths to cry

• Establishment of respirations is most critical and immediate adjustment
- Makes shunts close

• Cutting of umbilical cord initiates rapid and complex physiologic changes
- Those respirations are key to starting the shifting. Process for everything else

• Initially respirations shallow and irregular, fine crackles may be heard
- Vaginal birth benefit from squeezing out and clearing some mucus/fluid from lungs but still some will be left

• Apnea lasting <20 secs WNL

  • WNL is “within normal limits”
  • Normal variations where they stop breathing

• Apnea lasting >20 secs concerning

  • Can be due to condition, disease or pathological infection; needs to be assessed by physician
  • Baby cannot be discharged if apnea is happening
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Key newborn cardiovascular adaptations

A

• Fetal circulation turning into neonatal circulation

  • In utero the placenta maintains the gas exchange and little blood is needed though the lungs
  • Pressure of the air in the lungs causes the blood pressure in the body to change and blood flow occurs; pressure also closes shunt
  • Closure of shunts
  • Lung inflation/cutting of cord into pressure and resistance changes which allows pulmonary blood flow
  • Ave HR 120-140 bpm (variations 90-180 bpm)
  • Post term babies who are more mature and can have a lower resting HR
  • There can also be pathological or abnormal reasons why (i.e. heart block)
  • Above normal range: infection, dehydration, crying
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

The ‘Transition’ Period

A

Stages:

1) First period of reactivity
2) Period of decreased responsiveness
3) Second period of reactivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

First period of reactivity

A
  • HR: increases to 160-180bmp and gradual decrease to baseline
  • RR; irregular 60-80 breaths/min
  • Activity; alert state, startles, crying
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Period of decreased responsiveness

A
  • Sleep period that can last 1-4 hrs (need to be woken to feed)
  • HR; normal baseline
  • RR; rapid, shallow, up to 60 breaths/min, transient
  • Activity; sleep or marled decrease in motor activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Second period of reactivity

A
  • Can be 6-8hrs post birth
  • HR; transient, brief tachycardia
  • RR; transient, brief tachypnea
  • Activity; increase in muscle tone, colour, mucus
  • Mucus can last a few days
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Thermogenic system: Cold stress

A

• Thermoregulation critical to survival
• The balance between heat loss and heat production in the body; the ideal is to have newborns in neutral environments
• Newborns are unable to regulate their body temperature
• Contributing factors
- Larger boy surface to body mass
- Higher metabolic rate with limited stores
- Poorly developed shivering response (they depend on non-shivering thermogenesis)
- Due to the presence of brown fat to be able to do this
- Heat loss though any of 4 modes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Brown fat sites

A
  • If it needs to be activated for non-shivering thermogenesis it does a good job
  • Richer blood and nerve supply than ordinary fat
  • Can increase newborn heat production up to 100%
  • Makes up about 5% of newborns total body fat
  • Newborns should not have to use their brown fat reserves; but if cold they will start to use them up
20
Q

Modes of heat loss

A

• Convention: flow of heat from the body surface to the cooler air in the room
- Why rooms warmer than the hallways, cannot open windows, keep them wrapped and a hat on their head

• Radiation: heat lost form the body to the cooler solid surfaces that are not in direct contact with the body but nearby

• Evaporation: vaporization of water to air
- Especially when baby has bath; ensure to dry them and not in contact with wet material

• Conduction: loss of body heat from the body surface to colder objects that are in direct contact with the body
- Why skin to skin is so important, table is warmed up before birth

21
Q

Effects of cold stress on newborn

A
  • Increase O2 consumption
  • Increases resp rate
  • Causes pulmonary vasoconstriction
  • Decreases O2 uptake by lungs and decreases O2 to tissues
  • Increases anaerobic glycolysis
  • Decreases in PO2 and pH
  • Causes metabolic acidosis
  • Also causes acrocynaosis, centro-cynaosis
22
Q

Complete physical assessment (head-to-toe)

A

• Done within first 24 hours of life once neonate has stabilized

  • Usually when the order that the baby can be discharged has occurred at 24hr
  • Needs to be follow up for another assessment within the week with the family health provider

• Nursing assessment: Vital signs, general appearance, skin, growth parameters, HEENM, chest, abdomen, genitalia, extremities, back, anus, reflexes/neuro, ins & outs
- Head, Eyes, Ears, Nose, Mouth (HEENM)

  • MD/Midwife/NP assessment: all of the above + pulses, hips, red reflex, pupillary light reflex
  • Post discharge follow up assessment typically within 1st week
23
Q

On-going assessment

A

• A constant, on-going, essential component of newborn nursing care
- One a shift, once every 8hr (at minimum); if there is more need it becomes more frequent
• May be a formalized process but also conducted throughout all care giving activities
• Critical in identifying subtle changes in the newborn
• Promoting parent support, education, reassurance, boning with newborn

24
Q

Nursing assessment of newborn cardiopulmonary system

A 
Respiratory Assessment
• Colour – pink 
• Observe respiratory rate (abdominal breathers)
• Auscultate breath sounds 
• One full minute 
Cardiovascular Assessment
• Colour
• Auscultate apical pulse (PMI) - 3-4th intercostal space mid-clavicular line
• One full minute 
• Pulses

Repeat abnormal findings

25
Q

Nursing assessment of Ins and Outs

A 
Renal
• Urine colour – pale and straw coloured
• Urine output: 1 void in first 24hrs
• Increases by number of days e.g. day 2 = 2 voids
• Up to 1 week old = 6-8 voids daily

Gastrointestinal
• Stool transitions
• Meconium
• 1 stool within 24hrs

26
Q

Newborn respiratory assessment red flags

A

• Tachypnea (>60) – that is persistent (when baby is not crying)
- Septic, cold stress, respiratory distress, etc.
• Bradypnea (<30)
- Narcotic analgesia from labour or illicit drugs, etc.
• Retractions/indrawing/grunting
- Grunting: sounds newborns makes upon expiration
• Unequal breath sounds
- Embolism, lung infection, congenital malformation of the lungs, etc.
• Poor colour
• Apnea
- Can be common in newborn, <20secs os bad

27
Q

Newborn cardiovascular assessment red flags

A 
• Tachycardia (>180)
- Dehydration, infection, pneumonia, respiratory distress 
• Bradycardia (<80)
• Abnormal heart sounds
- Extra sounds, murmurs
• Abnormal location of heart sounds 
- Enlarged heat, displaced heart, heart is on right side of the body instead of left 
• Weak, absent or unequal pulses
28
Q

Newborn CNS assessment red flags

A 
• Jitteriness/tremors 
- And/or seizure activity 
• Lethargy
- Lasts, persists no matter what you do
• Irritability 
• Bulging fontanelles
- Can indicate pressure in the brain, increased ICP, can see and palpate
• Hyper or hypotonic 
- Muscle tone; too tight vs flaccid, number of conditions contribute 
• Seizure activity
29
Q

Sudden Infant Death Syndrome (SIDS)

A
  • Definition: the sudden death of an infant less than one year of age, which remains unexplained after a thorough case investigation, including the performance of a complete autopsy, an examination of the death scene, and a review of the clinical history
  • Cause: unknown
  • Incidence: anytime during 1st year, peaks at 2-4 months
  • High risk: male babies, premature babies, and babies of indigenous community
30
Q

Modifiable risk factors for SIDS (50% decline)

A
  • “Back to sleep” – reducing the risk of SIDS since the 90s (public health initiative), has reduced the incidence of SIDS by 50% or more
  • Smoking in pregnancy
  • Sleep environment
  • SIDS increased 12-fold when baby sleeps prone
  • RNAO: no pillows, no toys, no bumper pads, light jumper or sleep sac, spine position, firm CSA mattress, distance between bars meets CSA guidelines
  • Baby not share sleep surface with anyone else to reduce risk of SIDS
  • Room sharing is good for first 6mths; but not sharing the sleep surface
31
Q

Pros of swaddling

A
  • Effective age-old practice
  • Soothes, calms fussy young babies
  • Promotes womb-like environment
  • Improved sleep
  • Risk of SIDS equivocal
  • No evidence that safe swaddling is harmful
  • Can provide relief for painful procedures
  • Cost effective(?)
32
Q

Cons of swaddling

A
  • Can reduce S2S time (reduced touch, communication between baby and parent, impact on breastfeeding)
  • Greater risk of SIDS with prone position
  • Increased risk for hip dysplasia
  • Increased risk for respiratory illnesses
  • Increased risk of overheating, asphyxia, strangulation
  • Limited use (until baby can roll)
  • Cost prohibited?
33
Q

Safe swaddling

A

• Swaddling not a pre-requisite for sleep: informed decision to swaddle
• Thin lightweight breathable blanket/wrap to prevent overheating
• Snug enough but not too loose: ensure enough room for chest expansion and for legs and hips to move freely
• “Back to sleep” and safe sleep environment
• Stop swaddling when baby can roll (2months of age)
• Always be combined with ABCs of sleep
- Alone (without people, blankets or objects)
- Back to sleep
- Crib (or other approved sleep surface)

34
Q

Sucking and rooting reflex

A
  • Touch infant’s lip, cheek, or corner of mouth with nipple or finger
  • Infant turns head toward stimulus and opens mouth
  • Difficult to elicit after baby has been fed
  • Response disappears after 3-4 months but may persist up to 1yr
35
Q

Swallowing reflex

A
  • Feed infant; swallowing usually follows sucking and obtaining fluids
  • Swallowing is usually coordinated with sucking and breathing and usually occurs without gagging, coughing, apnea or vomiting
36
Q

Palmas reflex

A
  • Place finger in palm of hand
  • Infant’s fingers curl around examiner’s fingers
  • Response lessens 3-4 months
37
Q

Plantar reflex

A
  • Place finger at base of foot
  • Toes curl downwards
  • Response lessens by 8 months
38
Q

Tonic neck or “fencing” reflex

A
  • With infant in a supine neutral position, turn head quickly to one side
  • With infant facing left side, arm and leg on that side extend; the opposite arm and leg flex
  • Turn head right and extremities assume opposite postures
  • Complete response disappears 3-4 months
39
Q

Moro or “startle” reflex

A
  • Hold infant in semi-sitting position, allowing head and trunk to fall backwards (with support)
  • or place infant on flat surface; make a loud, abrupt noise
  • Symmetrical abduction and extension of arms are seen; fingers fan out and form a C with thumb and forefinger
  • Legs may follow similar pattern
  • Complete response seen until 8 weeks
40
Q

Stepping or “walking” reflex

A
  • Hold infant vertically under arms or on trunk, allowing one foot to touch table surface
  • Infant will simulate walking, alternating flexion and extension of feet
  • Present for 3-4 weeks
41
Q

Crawling refelx

A
  • Place newborn on abdomen
  • Newborn makes crawling movements with arms and legs
  • Presents until 6weeks
42
Q

Deep tendon reflex

A
  • Use finger to elicit patellar (kne jerk) reflex

- Newborn must be relaxed

43
Q

Babinski (plantar) reflex

A
  • On sole of foot, beginning at heel, stoke upward along lateral aspect of sole, the move finger across ball of foot
  • All toes hyperextend, with dorsiflexion of big toe
44
Q

Newborn physiological responses to pain

A

Vital signs

  • Increased HR
  • Increased BP
  • Rapid, shallow respirations

Oxygenation

  • Decreased tanscutaneous oxygen saturations
  • Decreased arterial oxygen saturation

Skin - observe colour and character

  • Pallor or flushing
  • Diaphoresis
  • Palmar sweating

Lab evidence of metabolic or endocrine changes

  • Hyperglycemia
  • Lowered pH
  • Elevated corticosteriods

Other observations

  • Increased muscle tone
  • Dilated pupils
  • Decreased vagal nerve tone
  • Increased intracranial pressure
45
Q

Newborn behaviour responses to pain

A

Vocalizations - Observe quality, timing and duration

  • Crying
  • Whimpering
  • Groaning

Facial expressions - Observe characteristics, timing, orientation of eyes and mouth

  • Grimaces
  • Brow furrowed
  • Chin quivering
  • Eyes tightly closed
  • Mouth open and squarish

Body movements and posture - Observe type, quality, and amount of movement

  • Limb withdrawal
  • Trashing
  • Rigidity
  • Flaccidity
  • Fist clenching

Changes in state - Observe sleep, appetite, activity level

  • Changes in sleep-wake cycles
  • Changes in feeding behaviour
  • Changes in activity level
  • Fussiness, irritability
  • Listlessness
46
Q

Newborn Normal Vitals

A

T: 36.5-37.5 C
R: 30-60 breaths/min
HR: 110-160bmp
BP: 60-80/40-50 mmHg

NUR360 LS1 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions