Newborn Care Fundamentals Flashcards
Describe newborn capabilities in vision
- Newborns can see distance between themselves and caregiver’s face when held
- Vision is black and white, attracted to black and white contrast
- begins to see colour around 2 months
- drawn to round objects
When are newborn hearing tests done?
first 24-48 hours
Why is it important that babies are screened for hearing impairment?
Hearing is crucial to learning, language development and comfort
- caregiver’s heart beat sounds provide comfort
- 1 in 3000 babies will have hearing deficit
Newborn’s behavioural adaptations are influenced by:
- gestational age (preterm babies fatigue sooner)
- time
- stimuli (newborns can sense stress and tension)
- medication (certain meds, transferred from mother, can cause drowsiness)
What are newborn’s various sleep states?
Light sleep
Deep sleep
What are newborns’ various wake states?
Crying
Quiet Alert (optimal state for feeding and interaction)
Alert
Drowsy
How do newborns show readiness for social interaction?
Newborns will act to regulate their own behaviour in response to environment
i.e. Gaze or push away overstimulation
What are the three assessment phases for newborns?
Immediate (at birth)
Complete (head-to-toe)
Ongoing (until discharge home)
What is included in the Immediate Assessment?
- Swift evaluation of adaptation to extrauterine life (APGAR)
- Airway maintenance
- Body temperature maintenance
- Brief focused physical exam
- Promote newborn-parent bonding
- Universal medication administration
What nursing interventions are done during Immediate Assessment?
- Assess HR, RR, Temp
- Measurements (Head diameter, length, chest circumference)
- ID Band (for security)
- Diaper, cap, safe swaddle (for warmth)
- Vitamin K and Erythromycin prophylaxis
- Promote skin to skin
What does APGAR stand for and how often should they be done?
A ppearance (colour) P ulse (HR) G rimace (reflex/irritability) A ctivity (muscle tone) R espirations
Done at 1 minute and 5 minutes after birth
What are the signs of an APGAR score of 10?
HR above 100 bpm Good resp effort, crying Active movement, well flexion Good cry Pink all over
What does the APGAR score mean?
Score of 7-10 = adapting well
Score of 4-6 = minor intervention needed
Score 0-3 = severe distress
What are the newborn VS parameters?
P: 110-160 bpm RR: 30-60 breaths/min T: 36.5-37.5C (ax) BP: 60-80/40-50 mmHg O2 sat: 97% or higher
What are some benefits of skin to skin?
- enhanced breastfeeding success and duration
- improved early maternal attachment behaviours
- thermoregulation
- respiratory status
- oxygenation status
- higher blood glucose
- decreased crying
What might prevent S2S contact?
- mother falling asleep
- risk of infection
- health issue with birth parent (such as PPH)
How do newborns in NICU receive S2S?
Kangeroo care
intermittent S2S
Benefits of S2S post C/S
- physiologic stability of birth parent and baby
- emotional well-being of birth parent and baby
- potential reduction of pain for birth parent
- improved parent-baby communication (bonding)
- improved breastfeeding outcomes
What are the two universal newborn meds and what are they for?
Erythromycin Ointment
- prevention of ophthalmia neonatorum
Adverse reaction: 24-48 hour conjunctivitis, temporary blurry vision
Vitamin K Prophylaxis IM injection
- prevention/Tx of hemorrhagic disease
- promote hepatic formation of clotting factors
Adverse reaction: edema, erythema, discomfort/pain at site
Ophthalmia neonatorum
infection of the surface lining of the eye which can lead to blindness
What activity initiates rapid and complex physiologic changes in newborn?
Cutting of umbilical cord
How was respiration maintained before birth?
Fetal lung is maintained by gas exchange in placenta
Placenta functions replace the lung and liver
Newborn Respiratory Adaptations
- Lungs are filled with fluid in utero, these fluids are expelled during a vaginal birth when mother pushes
- establishment of respirations is most critical and immediate adjustment
- initially shallow and irregular breaths - fine crackles may be hear
What are normal vs concerning respiration signs?
Apnea lasting < 20 secs are within normal limit
Apnea lasting > 20 secs are concerning -> paediatrician or RT intervention
What is core blood collection?
Storying stem cells from core blood that come from bone marrow
What cardiovascular adaptations take place?
- from fetal circulation to neonatal circulation
- closure of shunts
- pressure and resistance changes which allow pulmonary blood flow
Average HR 12-140 bpm (variations 90-180 bpm)
What are the 3 Transition Stages for newborns?
- First Period of Reactivity (alert, crying) - 30 mins to an hour
- Period of Decreased Responsiveness (sleep, reduced motor activity) - up to a couple of hours
- Second period of reactivity (increased muscle tone, colour, mucus) - next 6 hours or more
Describe the HR and RR changes during the 3 transition stages?
- HR increase to 160-180 and gradually decrease to baseline, can be irregular. 60-80 breaths/min
- Normal baseline HR, rapid, shallow breaths up to 60 breaths/min
- Transient, brief tachycadia; transient/brief tachypnea
How do babies regulate temperature?
Thermoregulation is critical to survival
- new borns are unable to shiver
- glycogen stores (brown fat)
What factors contribute to decreasing temperature (cold stress) in newborns?
- larger body surface to body mass
- higher metabolic rate with limited stores
- poorly developed shivering response
- heat loss through any 4 modes
What are the Modes of Heat Loss?
- Convection
- Radiation
- Evaporation
- Conduction
Convection
Flow of heat from body surface to cooler air in the room
Nursing interventions: wrapper, swaddled, hat, windows closed, warmer thermostat
Radiation
Heat loss from the body to the cooler solid surfaces that are not in direct contact with body but nearby
Nursing interventions: place away from windows
Evaporation
Losing heat when fluid on skin turns from liquid to gas
Nursing interventions: dry baby immediately when wet
Conduction
Loss of boy heat from colder surface that are in direct contact with body
Nursing interventions: place on warm towel during any procedure or assessment
Acrocyanosis
Bluish or purplish hands and fee caused by slow circulation
What does the Complete Physical Assessment include?
- Vital signs
- General Appearance
- Skin
- Growth parameters
- HEENM
- Chest
- Abdomen
- Genitalia
- Extremities
- Back
- Anus
- Reflexes/Neuro
- Ins & outs
When is the Complete Physical assessment done?
Within first 24 hours of life, once neonate has stabilized (before discharge!)
What is the purpose of an Ongoing Assessment?
- critical in identifying subtle changes in the newborn
- promote parent support, education, reassurance and bonding with newborn
- it may be a formalized process but also conducted throughout all care giving activities
What is included in Ongoing Assessment?
- Resp Assessment
- colour
- observe RR (abdomen)
- auscultate breath sounds
- one full minute - Cardiovascular Assessment
- colour
- auscultate PMI (3-4th intercostal)
- pulses
- one full minute - Renal function
- how many wet diapers
- what colour - GI
- stool transitions
- how many
What is the appropriate nursing interventions when something is abnormal during assessment?
Repeat finding!
Respiratory Assessment RED FLAGS
a. tachypnea (>60)
b. bradypnea (<30)
c. retractions/indrawing/grunting
d. unequal breath sounds
e. poor colour
f. apnea
What might tachypnea signify?
Systemic infection
Cardiovascular Assessment RED FLAGS
a. tachycardia (>180)
b. bradycardia (<80)
c. abnormal heart sounds (murmur)
d. abnormal location of heart sounds (enlarge or displaced heart)
e. weak, absent or unequal pulses
CNS Assessment RED FLAGS
a. jitteriness/tremors
b. lethargy
c. irritability
d. bulging fontanelles
e. hyper or hypotonic
f. seizure activity
Sudden Infant Death Syndrome (SIDS)
sudden death of an infant less than one year of age, unexplained after a thorough case investigation
- incidence peaks at 2-4 mos
Risk factors for SIDS
- male babies
- premature babies
babies from indigenous communities
modifiable factors (can reduce incidence of SIDS by 50%) - prone position when sleeping
- smoking during pregnancy
- sleep environment
What is a safe sleep environment?
- no pillow
- no stuffed animal
- no “prone” position
- no blanket
- no bumper pads
- no sharing of sleep surface
Babies are recommended to sleep in the same room for how long?
6 months
What are some pros for swaddling?
a. effective age old practice
b. soothes, calms fussy young babies
c. promotes womb-like environment
d. improves sleep
e. provide relief for painful procedure
What are some cons for swaddling?
a. reduce S2S time
b. risk of hip dysplasia (too tight!)
c. risk of respiratory illnesses (too tight!)
d. risk of overheating, asphyxia, strangulation (unsafe use!)
Asphyxia
condition arising when body is deprived of oxygen; suffocation
Strangulation
State of being strangled
Principles of Safe Swaddling
a. swaddling is not a pre-requisite; informed decision to swaddle
b. thin lightweight breathable blanket (prevent overheating)
c. snug enough but not too loose; ensure room for chest expansions and leg/hip movement
d. stop swaddling when baby can roll
What are the ABCs of sleep?
Alone (no people, blanket or objects)
Back to sleep
Crib
