normal newborn Flashcards
just for normal babies
Neonatal Period
From birth to 28 days.
AFTER 38-42 weeks of gestation
for normal newborn
Weight
⚫Between 2500 to 4100 grams.
⚫Between 5.5 – 9 Lbs.
Head
⚫Between 32-36 cm or 12.5-14 inches
Chest
⚫Usually measures 2cm less than head circumference ⚫Between 12-13 inches or 30.5-33 cm
Length
⚫Between 46 – 52 cm or 18-20.5 inches
Respiratory System
Infants must obtain oxygen from the environment
What causes neonates to take their first breath?
Mechanical
Mechanical
⚫Birth process increases thoracic pressure
, fluid pushed out and recoil of chest wall after birth and increases intrathoracic pressure 🡪 passive inspiration of air
Chemical
⚫↑ PCO2, ↓ pH and ↓ O2 🡪 chemoreceptors send message to respiratory center in medulla 🡪 diaphragm contracts 🡪 baby breathes
Thermal and Sensory
⚫
Thermal – decrease in environmental temperature can stimulate baby to breathe
◦Tactile =
Tactile= rubbing the cloth on the baby to clean
Circulation
Significant changes occur from fetal circulation 🡪 neonate
Fetus: O2 from mom via umbilical vein
⚫Fetal Circulation: (3)
◦Ductus Venous
◦Foramen Ovale
◦Ductus Arteriosus
Foramen Ovale
the blood bypasses the pulmonary artery. goes to the left atrium. bc blood doesn’t need to be oxygenated
closes as first breath taken and the pressure in the left atrium exceeds the pressure in the right atrium.
Ductus arteriosus
closes as pO2=50 and as a response to decrease in prostaglandin (within 1-2 days after birth; serious problems if doesn’t close)
Ductus venosus
.
veins do what…
closes as placenta is delivered.delivers blood to the inferior vena cava
Birth weight
A newborn is expected to lose some weight during the first five to seven days of life.
◦5 – 10% weight loss is normal in the first week
◦ Sometime between days 10 and 14 after birth, the infant will return to birth weight.
Nutrition/Hydration
The newborn takes in and excretes approximately 600-700 ml of fluids per day.
* The mucous membranes of the mouth is moist and pink; the hard and soft palates are intact.
* The infant is unable to move food from the lips to the pharynx; therefore, placing the nipple well inside the baby’s mouth is necessary.
infant stomach capacity
30-90 ml
Transitional
Milk stool
Bottle vs Breast
24-48 hrs
Thermal Instability d/t:
A. Decreased threshold for temperature variations:
Cold:
Immature heat-generating abilities
Do not shiver ( cant move put hands in pocket) cant sweat
Do not have muscle movement
Non-shivering thermogenesis
◦ 1st –Brown fat
&
◦ secondarily through
increased metabolic activity
of brain, heart, and liver
Brown Fat
⚫Provides: Non-shivering thermogenesis
◦Brown Adipose Tissue (BAT)
◦Easily metabolized
◦Lasts several weeks
◦Depleted rapidly with cold
stress
◦Lower in premature
infants
Infants have Sweat Gland Mechanisms …. T or F
they are present but not functioning
fetal position helps to conserve
heat
At risk for– Cold Stress
⚫Quickly depletes
⚫Reponses by neonate:
◦O2 requirements rise =↑ RR (can cause reopening of ( DA)
⚫Reponses by neonate:
◦O2 requirements rise =↑ RR (can cause reopening of DA) ◦Increased use of glucose—for heat maintenance and not for growth
◦Increased BMR -
⚫Quickly depletes brown fat
⚫Reponses by neonate:
◦O2 requirements rise =↑ RR (can cause reopening of ( DA)
⚫Reponses by neonate:
◦O2 requirements rise =↑ RR (can cause reopening of DA) ◦Increased use of glucose—for heat maintenance and not for growth
◦Increased BMR - can lead to metabolic acidosis and ↑ bilirubin levels
Nursing Interventions for Cold Stress
⚫Assess respiratory status
⚫Warm newborns slowly–
◦double wrap and cap or
◦Skin to skin contact
⚫Monitor temp q 30min (axillary)
⚫Place under warmer
⚫Check blood glucose
⚫At home – dress as parents dress
site for temp
axillary
The Golden HourFirst breath
At 1 hour: Vit K (clotting), eye
ointment (protect from blindness) ,
Hep B (optional)
The Golden Hour Hat on baby WHY?
- heat-evaporation
2) Inc heat – radiation
3) Conduction
4) Hypothermia can occur quickly
5) Poor thermoregulation
The Golden Hour Hat on baby
1) Dry infant immediately
after birth
2) Place under radiant
warmer
3) Use warmed items –
blankets, etc
4) Assess temp q1h x 4
5) Keep infant capped and
wrapped
TEMPERATURE:
At birth: (° F )
Within 12
hrs: (F)
PULSE
At birth:
Within 12 hours:
TEMPERATURE:
At birth:
⚫97.7-99° F / 36.5-37.2° C
Within 12 hrs:
⚫97.6° – 98.6° F
⚫36.5°– 37° C
⚫PULSE
⚫PULSE
At birth:
⚫110 – 160
Listen for a full
minute
Murmurs are
common – usually
gone by 6 months
Apical pulse over
4th intercostal
space
Respirations
At birth:
◦Short apnea -
✔Suction
✔Respirations may be irregular
✔Any apnea greater than _____- report
✔ S/S of respiratory distress:
After 12 hours:
Respirations
At birth:
⚫30 – 60
◦ irregular
◦ occasional crackles
◦Short apnea - < 15 sec (OWLET)
✔Suction mouth, then nose – newborn gasp
✔Respirations may be irregular
✔Any apnea greater than 20 seconds - report
✔Important that you remember these S/S of respiratory distress: nasal flaring, grunting, intercostal retractions, and a RR> 60. ✔
After 12 hours:
⚫30 – 60
◦ irregular
◦no crackles
WBC & RBC At birth:
average, at birth, after
9000 – 30,000
Average = 20,000
Changes to:
23,000 to 24,000
first day after birth’
Decreases to 11,500
At birth:
4 -6.6
million/mm
Changes to:
4 million /mm
in
2 – 5 days
Unnecessary
cells begin to
HGB HCT
At birth:
⚫
Changes to:
⚫
At birth the infant’s blood contains about _______fetal hemoglobin, in order to carry enough O2 for cells to function during labor.
At birth:
⚫
Changes to:
⚫
HGB HCT
At birth:
⚫15 – 19 Gm
Changes to:
⚫12 – 15 GM at one month
At birth the infant’s blood contains about 80% fetal hemoglobin, in order to carry enough O2 for cells to function during labor. At birth:
⚫44 – 64%
Changes to:
⚫35 – 49%
Bilirubin*****
Bilirubin is a =
At birth:
⚫
Changes to:
⚫Day 0 – 1 =
⚫Day 1 – 2=
⚫Day 2 – 5 =
yellow pigment derived from the hemoglobin released with the breakdown of RBC’s . Extra RBC’s break down causing jaundice.
At birth:
⚫< 2 mg/dl
Changes to:
2
2
⚫Day 0 – 1 =< 6 mg
⚫Day 1 – 2=< 8
⚫Day 2 – 5 =< 12
Extra RBC’s break down causing jaundice.
(more later)
Glucose
At birth:
⚫ ______mg/dl
⚫Avg ______
⚫Avg=
________ rapidly when
Mom’s blood supply
stopped
⚫
After 12 hours:
⚫
Essential to keep
glucose level _____for
neurological
functioning
⚫
Glucose
At birth:
⚫30 – 60 mg/dl
⚫Avg 40-50 mg/dl
⚫Avg 40-50 mg/dl
Drops rapidly when
Mom’s blood supply
stopped
⚫
After 12 hours:
⚫50 – 70 mg/dl
Essential to keep
glucose level ↑ for
neurological
functioning
⚫
First Period of Reactivity
⚫Neonatal characteristics:
⚫NURSING INTERVENTIONS
First 30-40 minutes after birth
⚫Neonatal characteristics: alert, hungry, increased RR, mucous, crackles in lungs
⚫NURSING INTERVENTIONS
◦Watch Respirations
◦Keep warm and Dry
◦Breast feed (Bottle feed)
◦Bonding with Mom and Dad ASAP
First Period of Sleep / Inactivity
⚫Neonatal Characteristics:
⚫NURSING INTERVENTIONS
First Period of Sleep / Inactivity
⚫30-40 post birth to next 2-4 hours
⚫Neonatal Characteristics: deep sleep, HR, RR and temp decrease ⚫NURSING INTERVENTIONS
◦Skin to skin
◦Radiant warmer to stabilize temp
◦Allow to rest
Second Period of Reactivity
Neonatal characteristics: awake,
NURSING INTERVENTIONS
Second Period of Reactivity
Time when baby is stable
Neonatal characteristics: awake,
hungry, crying, alert to
surroundings, gaggy
NURSING INTERVENTIONS
◦ Bonding with Mom and Dad
◦ Feed – especially breast feed
◦ Maintain patent airway
◦ Maintain Neutral Thermal
Environment
active alert
crying
APGAR
⚫
⚫Appearance
⚫Pulse
⚫Grimace
⚫Attitude (activity)
⚫Respiration
Rapid assessment of the need for resuscitation based on five signs that indicate the physiologic state of the newborn
APGAR Scoring
⚫0-3 –
⚫4-6 –
⚫7-10 –
Evaluations are made at
APGAR Scoring
⚫0-3 –needs aggressive measures
⚫
⚫4-6 – needs prompt interventions
⚫7-10 – indicative of good adjustment to extrauterine life
1 and 5 minutes after birth
Establish Ventilation and Circulation
Action Rationale
first steps once doctor pulls baby out
1) Suction oral cavity 1st
⚫
2) Suction nasal cavity gently
3) APGAR score at 1 min.
4) Blow by oxygen prn
Assess Nutritional Status
Diabetic Mom, LGA, SGA, post-dates, pre-term (per protocol)
Action
1)Heel stick - At birth and 4 hrs later
2) Early feeding
3) Glucose water prn NEVER
4) Maintain temp
Rationale for nutritional status
think about paul blart
1, 2, 3) Glucose levels fall rapidly after birth d/t drop in maternal blood supply. Brain, heart, lungs, liver are dependant on glucose for cell function. Decrease affects LOC, RR, hypothalamus function 4) Hypothermia increases glucose need
Ensure Safety and Identification of Infant
Action Rationale
1) Name band on baby
2) Baby’s name band on Mom and Dad
3) Compare names and numbers each baby transfer (on unit)
4) Sensor on baby – ankle or umbilicus
Encourage Bonding
Action:
1) Baby to Mom ASAP when stable
2) Dad/SO to attend birth when possible
3) Cluster care to decrease interruptions
4) Include all family in teaching
5) Help Mom with personal care and baby care until confident
Health teaching for parents-
⚫BATHING –
⚫Gentle
⚫CORD CARE –
⚫BATHING – no tub bath until cord falls off
⚫Gentle wiping of eyes inner to outer canthus
⚫CORD CARE – nothing needed – will dry / deteriorate by self. May get sticky after few days –leave it alone. Fall off ~ 1 week – 10 days ◦Call pediatrician if bloody, redness, pus. diaper underneath belly
Circumcision Care
Circumcision Care
MAKE SURE THEY VOID FIRST
⚫Depends on device used for circumcision
⚫Monitor for 1st void prior to circ
⚫Tylenol prn
⚫Assess bleeding – Q 15 mins for 1 hour, then Q 2-3 hours/ hosp policy
⚫NO soap or packaged wipes
⚫Glans penis
*Normally red during healing
Temperature Regulation
⚫TEMPERATURE REGULATION –
Temperature Regulation
⚫TEMPERATURE REGULATION –watch in first 24 hrs especially for signs of COLD STRESS
Diapering
◦ Voiding –
6-8 wet diapers/day
indicate/ adequate fluid intake;
diaper counts.
◦ Stools – meconium =
Breastfed:
Bottle Fed:
◦ Stools – meconium -1st 24 hrs
Breastfed: Yellow/seedy/ pasty
Bottle Fed: Greenish/firm
Safety -
⚫Asepsis –
Safety -
⚫Asepsis –
◦Erythromycin eye ointment
◦Vitamin K - Phytonadione
◦Cover gown
◦Hand washing
●Scrub before entering nursery
●Parents and visitors before ALL baby contact (home too)
Physiologic Needs / Safety
⚫All of the following before D/C
⚫“Back to Sleep”/SIDS = can sleep on their backs, not loose bedding
⚫Car Seat/police & fire station
⚫Shaken Baby Info.
Feeding
HT parents-schedules; burping…
Nutritional Needs
⚫ Newborns eat
Feeding
HT parents-schedules; burping G ( MORE IN BOTTLE FEED BC THEY HAVE MORE AIR)
Nutritional Needs
⚫ Caloric requirements
⚫ Basal Fluid Requirements of Infant
⚫ Infant Stomach Capacity
⚫ Nutrient Requirement
⚫ Infant Stomach Capacity ⚫ Nutrient Requirement
⚫ Newborns eat q 2-4hrs ATC 2
NYS Newborn Screening
Screen for approximately
disorders including PKU, CF,
Sickle Cell Anemia
* Hearing
Infant states of consciousness
- Deep sleep
2.Light sleep
3. Drowsy
4. Quiet alert
5. Active alert
6. Crying
Infant states of consciousness
Deep sleep= no body movement
Light sleep = easily startled
Drowsy= eyes open and close
Quiet alert= neonate eyes are open with a bright look
Active alert = fusiness
Crying= crying
Day one (stomach eating)
Day three
One week
One month
5 s’s
- swaddle/football hold/ swing/”shhhhh’ them= fluid when they was in the womb/pacifier
2.
3.
4.
5.
Normal Newborn
- Protruding belly
- Bowel sounds
*
- Bowel sounds
- 1st nose breathers then Diaphragmatic
breathing
Chemical Norms vs newborn
PO2
PCO2
Ph
20-30. / norm is 50-70
45-50./ norm is 35-45
7.25/ norm 7.35
murmur may be heard T or F
especially in the first 24 hrs as shunt are closing. T or F
stork bite
hemangiomas
cyanosis of hands and feet are normal findings,
T or F
T
slate gray patches
eye prophylaxis
Eye drops or ointment containing an antibiotic medication are placed in a newborn’s eyes after birth
epstein pearls
“briick dust”
