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NUR360 > Newborn Care Fundamentals > Flashcards

Newborn Care Fundamentals Flashcards

1
Q

Describe newborn capabilities in vision

A
  • 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
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2
Q

When are newborn hearing tests done?

A

first 24-48 hours

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3
Q

Why is it important that babies are screened for hearing impairment?

A

Hearing is crucial to learning, language development and comfort

  • caregiver’s heart beat sounds provide comfort
  • 1 in 3000 babies will have hearing deficit
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4
Q

Newborn’s behavioural adaptations are influenced by:

A
  • gestational age (preterm babies fatigue sooner)
  • time
  • stimuli (newborns can sense stress and tension)
  • medication (certain meds, transferred from mother, can cause drowsiness)
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5
Q

What are newborn’s various sleep states?

A

Light sleep

Deep sleep

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6
Q

What are newborns’ various wake states?

A

Crying
Quiet Alert (optimal state for feeding and interaction)
Alert
Drowsy

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7
Q

How do newborns show readiness for social interaction?

A

Newborns will act to regulate their own behaviour in response to environment
i.e. Gaze or push away overstimulation

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8
Q

What are the three assessment phases for newborns?

A

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

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9
Q

What is included in the Immediate Assessment?

A
  1. Swift evaluation of adaptation to extrauterine life (APGAR)
  2. Airway maintenance
  3. Body temperature maintenance
  4. Brief focused physical exam
  5. Promote newborn-parent bonding
  6. Universal medication administration
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10
Q

What nursing interventions are done during Immediate Assessment?

A
  1. Assess HR, RR, Temp
  2. Measurements (Head diameter, length, chest circumference)
  3. ID Band (for security)
  4. Diaper, cap, safe swaddle (for warmth)
  5. Vitamin K and Erythromycin prophylaxis
  6. Promote skin to skin
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11
Q

What does APGAR stand for and how often should they be done?

A 
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

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12
Q

What are the signs of an APGAR score of 10?

A 
HR above 100 bpm
Good resp effort, crying
Active movement, well flexion
Good cry
Pink all over
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13
Q

What does the APGAR score mean?

A

Score of 7-10 = adapting well
Score of 4-6 = minor intervention needed
Score 0-3 = severe distress

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14
Q

What are the newborn VS parameters?

A 
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
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15
Q

What are some benefits of skin to skin?

A
  • enhanced breastfeeding success and duration
  • improved early maternal attachment behaviours
  • thermoregulation
  • respiratory status
  • oxygenation status
  • higher blood glucose
  • decreased crying
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16
Q

What might prevent S2S contact?

A
  • mother falling asleep
  • risk of infection
  • health issue with birth parent (such as PPH)
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17
Q

How do newborns in NICU receive S2S?

A

Kangeroo care

intermittent S2S

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18
Q

Benefits of S2S post C/S

A
  • 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
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19
Q

What are the two universal newborn meds and what are they for?

A

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

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20
Q

Ophthalmia neonatorum

A

infection of the surface lining of the eye which can lead to blindness

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21
Q

What activity initiates rapid and complex physiologic changes in newborn?

A

Cutting of umbilical cord

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22
Q

How was respiration maintained before birth?

A

Fetal lung is maintained by gas exchange in placenta

Placenta functions replace the lung and liver

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23
Q

Newborn Respiratory Adaptations

A
  • 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
24
Q

What are normal vs concerning respiration signs?

A

Apnea lasting < 20 secs are within normal limit

Apnea lasting > 20 secs are concerning -> paediatrician or RT intervention

25
Q

What is core blood collection?

A

Storying stem cells from core blood that come from bone marrow

26
Q

What cardiovascular adaptations take place?

A
  • 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)

27
Q

What are the 3 Transition Stages for newborns?

A
  1. First Period of Reactivity (alert, crying) - 30 mins to an hour
  2. Period of Decreased Responsiveness (sleep, reduced motor activity) - up to a couple of hours
  3. Second period of reactivity (increased muscle tone, colour, mucus) - next 6 hours or more
28
Q

Describe the HR and RR changes during the 3 transition stages?

A
  1. HR increase to 160-180 and gradually decrease to baseline, can be irregular. 60-80 breaths/min
  2. Normal baseline HR, rapid, shallow breaths up to 60 breaths/min
  3. Transient, brief tachycadia; transient/brief tachypnea
29
Q

How do babies regulate temperature?

A

Thermoregulation is critical to survival

  • new borns are unable to shiver
  • glycogen stores (brown fat)
30
Q

What factors contribute to decreasing temperature (cold stress) in newborns?

A
  • larger body surface to body mass
  • higher metabolic rate with limited stores
  • poorly developed shivering response
  • heat loss through any 4 modes
31
Q

What are the Modes of Heat Loss?

A
  1. Convection
  2. Radiation
  3. Evaporation
  4. Conduction
32
Q

Convection

A

Flow of heat from body surface to cooler air in the room

Nursing interventions: wrapper, swaddled, hat, windows closed, warmer thermostat

33
Q

Radiation

A

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

34
Q

Evaporation

A

Losing heat when fluid on skin turns from liquid to gas

Nursing interventions: dry baby immediately when wet

35
Q

Conduction

A

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

36
Q

Acrocyanosis

A

Bluish or purplish hands and fee caused by slow circulation

37
Q

What does the Complete Physical Assessment include?

A
  1. Vital signs
  2. General Appearance
  3. Skin
  4. Growth parameters
  5. HEENM
  6. Chest
  7. Abdomen
  8. Genitalia
  9. Extremities
  10. Back
  11. Anus
  12. Reflexes/Neuro
  13. Ins & outs
38
Q

When is the Complete Physical assessment done?

A

Within first 24 hours of life, once neonate has stabilized (before discharge!)

39
Q

What is the purpose of an Ongoing Assessment?

A
  • 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
40
Q

What is included in Ongoing Assessment?

A
  1. Resp Assessment
    - colour
    - observe RR (abdomen)
    - auscultate breath sounds
    - one full minute
  2. Cardiovascular Assessment
    - colour
    - auscultate PMI (3-4th intercostal)
    - pulses
    - one full minute
  3. Renal function
    - how many wet diapers
    - what colour
  4. GI
    - stool transitions
    - how many
41
Q

What is the appropriate nursing interventions when something is abnormal during assessment?

A

Repeat finding!

42
Q

Respiratory Assessment RED FLAGS

A

a. tachypnea (>60)
b. bradypnea (<30)
c. retractions/indrawing/grunting
d. unequal breath sounds
e. poor colour
f. apnea

43
Q

What might tachypnea signify?

A

Systemic infection

44
Q

Cardiovascular Assessment RED FLAGS

A

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

45
Q

CNS Assessment RED FLAGS

A

a. jitteriness/tremors
b. lethargy
c. irritability
d. bulging fontanelles
e. hyper or hypotonic
f. seizure activity

46
Q

Sudden Infant Death Syndrome (SIDS)

A

sudden death of an infant less than one year of age, unexplained after a thorough case investigation

  • incidence peaks at 2-4 mos
47
Q

Risk factors for SIDS

A
  • 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
48
Q

What is a safe sleep environment?

A
  • no pillow
  • no stuffed animal
  • no “prone” position
  • no blanket
  • no bumper pads
  • no sharing of sleep surface
49
Q

Babies are recommended to sleep in the same room for how long?

A

6 months

50
Q

What are some pros for swaddling?

A

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

51
Q

What are some cons for swaddling?

A

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!)

52
Q

Asphyxia

A

condition arising when body is deprived of oxygen; suffocation

53
Q

Strangulation

A

State of being strangled

54
Q

Principles of Safe Swaddling

A

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

55
Q

What are the ABCs of sleep?

A

Alone (no people, blanket or objects)
Back to sleep
Crib

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