Newborns Flashcards
vital signs how often?
Vital signs are taken q 15-30 minutes for the first hour of life, then q 1 hour x 4, then q 4 hours
apical HR
is heard best on the left side of the chest between the sternum and the nipple.
The rate is normally 120- 160, although variations can occur related to activity (example, during sleep as low as 90 or vigorous activity such as crying to 180. However, any heart rate below 100 or above 160 should be reported. The heart rate should be counted for a period of one full minute, due to normal fluctuations in rate.
RR
are shallow, rapid, irregular and abdominal in the newborn. Chest and abdomen move together. Normal respiratory rate is 30-60 breaths/ minute. Any rate above or below normal should be reported. Respiratory rate should be counted for one full minute, because newborns have very irregular breathing patterns. Take respirations by observing chest or abdominal wall. Use stethoscope to determine if breath sounds are equal in both lungs. Listen to lungs both front and back
temp
. Normal axillary newborn temperature is 36.5 C to 37 C (97.7- 98.6).
eye Prophylaxis
ophthalmia neonatorum (blindness
resulting from a gonococcal infection in the eyes). Prophylaxis can be delayed up to two hours after birth so that it does not interfere with the bonding between parent and infant. Erythromycin Ophthalmic Ointment is one of the medications approved in California for eye prophylaxis.
vitamin K
e Vitamin K, about 75% of all normal newborns have
decreased clotting factors - prolonged prothrombin time.
The prothrombin time is most prolonged at
3-4 days of life and continues for 2-3 additional days.
vitamin K injections
Vitamin K 1.0 mg. IM is given to all newborns shortly after birth. It is given in the thigh as this is the largest (therefore safest) muscle in the infant’s body. No injections are given into the buttocks of the newborn.
hematocrit
The time of greatest hemoconcentration is at 3-4 hours of life. Some hospitals check the hematocrit by heelstick at 4 hours. The heel must be warmed first. Normal value for hematocrit is 45-65 %. If the value does not fall WNL, a central hematocrit is obtained via venipunctur
glucose
Glucose evaluation is the most common blood test done on neonates. Glucometers are usually used. Normal blood sugar level in the newborn is equal to or greater than 40 mg.%. If the value obtained is low, or if the infant shows symptoms of hypoglycemia (jittery, tremors, lethargy) blood is obtained by venipuncture for a more accurate blood glucose level.
urine
arefully recorded, especially the first voiding. Report to the nurse when an infant does not void by 24 hours. Occasionally, red or peach-colored specks appear in the urine and are uric acid crystals. This is a normal finding, and may last for several days. This should be noted and explained to the parents. Hematuria is not normal.
stools
Bowel movements for the first 2-4 days are meconium. Meconium is present in the intestine of the fetus at birth. Meconium is a black, tarry, sticky, unformed stool. After the infant has been feeding for a couple of days, he passes transitional stools, which are greenish-black (part meconium), green-yellow, or yellow-seedy material. The transitional stools are also unformed.
The normal breast fed stool is
light yellow, loose, soft, putty-like, with an acid pH, which makes it almost odorless. The breast fed baby usually has very frequent stools, more than the bottle fed baby.
The bottle fed stool is .
darker yellow, more formed, often containing undigested curds. It has an alkaline pH, and a stronger odor.
The diarrhea stool is
green or yellow, very watery, loose, frequent, foul smelling, and leaves a watery ring on the diaper.
When the reflexes are present in a newborn, it affirms that
this newborn has an intact nervous system. It is normal for term newborn infants to have immature, uncoordinated, random jerky movements.
warmth
Babies should be pink all over. They often have cool hands and feet, which is normal. They
should have on at least as many layers of clothing as the adult plus one more. Check the color of their hands and feet after dressing for an indication of warmth. The hands and feet can be pale or even slightly blue if the infant is cold. On the other hand, do not over bundle. Keep away from drafts. Dress a little warmer than usual after a bath.
feeding
Breastfed babies often feed every 1-3 hours.
Breast fed babies usually will need to eat more frequently than bottle fed babies.
Bottle fed babies usually need to eat every 3-4 hours.
With breast-fed babies, the need for food and sucking may be
satisfied simultaneously, however, both breast and bottle babies may need additional sucking beyond the normal feeding period. An orthodontic-type pacifier may be helpful at these times.
sleep
Sleep requirements vary, but most infants benefit from periods of time each day and night when they can sleep undisturbed. Some newborns sleep as much as 18- 20 hours each day, others seem to only “catnap” during the day.
