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NUR 360 Lifespan 1 > Newborn Care Fundamentals > Flashcards

Newborn Care Fundamentals Flashcards

1
Q

Describe the different sensory capabilities in a newborn

A
  • Neonates show signs of readiness for social interaction
  • Sight: newborns can see within breastfeeding distance
    - can see some colour, prefer black and white
    contrast, sensitive to light
    - drawn to round shapes (i.e. face, breasts, eyes, etc)
  • Hearing: Baby can hear voices and mom’s heartbeat can calm baby
  • Hearing deficits can affect speech and language development
  • Smell/taste: baby can differentiate between mother’s breastmilk and other breastmilk
  • Baby’s can sense nervousness and anxiety
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2
Q

What are some influencing factors that can affect a newborn’s behavioural adaptations?

A
  • Gestational age (i.e. premature babies have lower threshold to coping with stimulus)
  • Time (late at night=sleepy baby, early morning=alert baby)
  • Stimuli (i.e. light, sound, touch)
  • Medication (i.e. higher epidural doses can affect baby as well)
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3
Q

What are the 6 sleep-wake states of a newborn? BONUS: Which states are ideal for breastfeeding?

A
  1. Deep sleep
  2. Light sleep
  3. Drowsy
  4. Quiet alert
  5. Awake alert
  6. Crying

Quiet and awake alert are the optimal times for breastfeeding, you don’t want it to reach the crying phase

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4
Q

What are the purposes of an immediate assessment (at birth) of a newborn?

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*

*Can be done skin to skin

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5
Q

What are the nursing interventions done upon immediate assessment?

A
  • Assess HR, RR, Temp
  • Measurements
  • Weight
  • ID bands
  • Diaper, cap, safe swaddle
  • Vitamin K and Erythromycin prophylaxis
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6
Q

What are the signs tested in an APGAR test? When is an APGAR test done?

A

Appearance, Pulse, Grimace, Activity and Respirations

- Done at 1-minute mark and 5-minute mark after birth

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7
Q

What are the criteria for each score in each category of the APGAR test?

A 
Heart rate (pulse)
0=absent, 1=below 100bpm, 2=above 100 bpm
Respiratory effort (respirations)
0=absent, 1=weak, irregular, gasping 2=good, crying
Muscle tone (activity)
0=flaccid, 1=some flexion of arms and legs, 2=well flexed or active movement of extremities

Reflex/irritability (grimace)
0=no response, 1=grimace or weak cry, 2=good cry

Colour (appearance)
0=blue or pale all over, 1=body pink, hands and feet blue, 2=pink all over

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8
Q

What are the vital parameters for a newborn?

A

P: 110-160 bpm
RR: 30-60 breaths/min
T: 36.5-37.5C (ax)
BP: 60/40 to 80/50 mm Hg

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9
Q

What are the benefits of skin-to-skin (S2S) for the client?

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)

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10
Q

What are the benefits of skin-to-skin (S2S) for the client?

A 
Associated newborn benefits:
• Thermoregulation
• Respiratory status
• Oxygenation status
• Higher blood glucose
• Decreased crying
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11
Q

What are the benefits of immediate skin-to-skin (S2S) after C/S?

A
  • Physiologic stability of birth parent and neonate
  • Emotional well being of birth parent and neonate
  • Potential reduction of pain for birth parent
  • Improved parent neonate communication
  • Improved breastfeeding outcomes
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12
Q

What are the 2 universal newborn medications?

A
  1. Eye Prophylaxis Erythromycin Ointment

2. Vitamin K Prophylaxis IM Injection

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13
Q

Describe the indication, action/purpose, dose and adverse reactions for both mediations

A

Eye prophylaxis
Indication: prevention of ophthalmia neonatorum
Action: prevent infection
Dose: 1-2 cm ribbon of 0.5% ointment within 2 hours of
birth
Adverse Reactions: 24-48 hour conjunctivitis; temporary
blurring of vision

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

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14
Q

What are the key respiratory adaptations after birth?

A

• Multiple factors trigger the first breath
• Establishment of respirations is most critical and immediate adjustment
• Cutting of umbilical cord initiates rapid and complex physiologic changes
• Initially respirations shallow and irregular,
fine crackles may be heard
• Apnea lasting < 20 secs WNL
• Apnea lasting >20 secs concerning

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15
Q

What are key cardiovascular adaptations that occur after birth?

A
  • Fetal circulation transitions to neonatal circulation (no placenta)
  • Closure of shunts (foramen ovale and ductus arteriorosis closes)
  • Lung inflation/cutting of cord pressure and resistance changes allows pulmonary blood flow
  • Average HR 120 140 bpm (Variations 90-180 bpm)
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16
Q

What are the contributing factors to thermoregulation/the thermogenic system?

A
  • Larger body surface to body mass
  • Higher metabolic rate with limited stores
  • Poorly developed shivering response
  • Heat loss through any of 4 modes
17
Q

What are the 4 modes of heat loss? Describe each one

A

Radiation: Loss of heat from the body surface to a cooler solid surface not in direct contact, but in relative proximity.
Convection: Flow of heat from the body surface to cooler air.
Evaporation: Loss of heat that occurs when a liquid is converted to a vapor.
Conduction: Loss of heat from the body surface to cooler surfaces in direct contact.

18
Q

What is the purpose of brown fat sites in babies?

A

Sites, where brown adipocytes are found, are capable of producing heat via a process called non-shivering thermogenesis. In this process, triglycerides are burned into heat, thereby increasing body temperature

19
Q

Describe the effects of cold stress (see diagram on google doc)

A

Cold -> increased oxygen consumption -> increased respiratory rate -> leads to pulmonary vasoconstriction -> leads to decreased oxygen uptake in lungs

ALSO
Increased respiratory rate -> leads to peripheral vasoconstriction -> leads to decreased oxygen in tissues -> results in anaerobic glycolysis -> leading to decreased partial pressure of oxygen and pH which results in METABOLIC ACIDOSIS

20
Q

When does a complete assessment occur for newborn? When is the post discharge followup?

A

Within the first 24 hrs of birth

Post-discharge followup is within the first week of birth, typically 3-4 days

21
Q

What is the Midwifery/MD/NP-complete assessment?

A

All of the above + pulses, hips, red reflex, and pupillary light reflex

22
Q

What is the nursing complete assessment?

A

Nursing assessment: Vital signs, general appearance, skin, growth parameters, HEENM, Chest, Abdomen, Genitalia, Extremities, Back, Anus, Reflexes/Neuro, Ins & Outs

23
Q

What is an ongoing assessment of the baby?

A
  • A constant, on going, essential component of newborn nursing care
  • 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, bonding with newborn
24
Q

What are the components of a nursing assessment of the cardiopulmonary system? What should you do if findings are abnormal?

A

Respiratory Assessment: Colour, Observe respiratory rate (abdominal breathers), auscultate breath sounds, one full minute

Cardiovascular assessment: colour, auscultate apical pulse (PMI), pulse, one full minute

  • If findings are abnormal, repeat assessment
25
Q

Describe an “Ins and Outs” nursing assessment

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

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

26
Q

What are some red flags during a respiratory assessment?

A
  • Tachypnea (> 60)
  • Bradypnea (<30)
  • Retractions/indrawing/grunting
  • Unequal breath sounds
  • Poor colour
  • Apnea
27
Q

What are some red flags during a cardiovascular assessment?

A
  • Tachycardia (> 180)
  • Bradycardia (< 80)
  • Abnormal heart sounds
  • Abnormal location of heart sounds
  • Weak, absent or unequal pulses
28
Q

What are some red flags during a Central Nervous System (CNS) Assessment?

A
  • Jitteriness/tremors
  • Lethargy
  • Irritability
  • Bulging fontanelles
  • Hyper or hypotonic
  • Seizure activity
29
Q

Define SIDS

A

Sudden Infant Death Syndrome:
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.

30
Q

What is the cause and when is the incidence of SIDS?

A

Cause is unknown

Occurs anytime during the first year, peaks at 2-4 months

31
Q

What are the key modifiable factors (50% decrease in SIDS)?

A
  • “Back to sleep”
  • Smoking in pregnancy
  • Sleep environment (ex. pillows, or stuffed animals in crib)
32
Q

What are the Pros to swaddling?

A
  • Effective age-old practice
  • Soothes calms fussy young babies
  • Promotes a womb-like environment
  • Improved sleep
  • Risk of SIDS is equivocal
  • No evidence that safe swaddling is harmful
  • Can provide relief for painful procedures
  • Cost-effective
33
Q

What are the Cons to 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 (tight, burrito-style swaddling)
  • Increased risk for respiratory illnesses (tight, burrito-style swaddling)
  • Increased risk of overheating, asphyxia, strangulation (unsafe swaddling)
  • Limited use ( til baby can roll)
  • Cost prohibitive?
34
Q

What are the rules to safe swaddling?

A
  • Swaddling not a prerequisite 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” + safe sleep environment
  • Stop swaddling when baby can roll
  • Always be combined with ABC s of sleep:
    Alone (without people, blankets or objects)
    Back to sleep
    Crib (or other approved sleep surface)

NUR 360 Lifespan 1 (2 decks)

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