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nur 112 > normal newborn > Flashcards

normal newborn Flashcards

just for normal babies

1
Q

Neonatal Period

A

From birth to 28 days.
AFTER 38-42 weeks of gestation

for normal newborn

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2
Q

Weight

A

⚫Between 2500 to 4100 grams.
⚫Between 5.5 – 9 Lbs.

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3
Q

Head

A

⚫Between 32-36 cm or 12.5-14 inches

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4
Q

Chest

A

⚫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

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5
Q

Respiratory System

A

Infants must obtain oxygen from the environment

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6
Q

What causes neonates to take their first breath?

A

Mechanical

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7
Q

Mechanical

A

⚫Birth process increases thoracic pressure
, fluid pushed out and recoil of chest wall after birth and increases intrathoracic pressure 🡪 passive inspiration of air

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8
Q

Chemical

A

⚫↑ PCO2, ↓ pH and ↓ O2 🡪 chemoreceptors send message to respiratory center in medulla 🡪 diaphragm contracts 🡪 baby breathes

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9
Q

Thermal and Sensory
⚫

A

Thermal – decrease in environmental temperature can stimulate baby to breathe

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10
Q

◦Tactile =

A

Tactile= rubbing the cloth on the baby to clean

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11
Q

Circulation

A

Significant changes occur from fetal circulation 🡪 neonate
Fetus: O2 from mom via umbilical vein

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12
Q

⚫Fetal Circulation: (3)

A

◦Ductus Venous
◦Foramen Ovale
◦Ductus Arteriosus

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13
Q

Foramen Ovale

A

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.

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14
Q

Ductus arteriosus

A

closes as pO2=50 and as a response to decrease in prostaglandin (within 1-2 days after birth; serious problems if doesn’t close)

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15
Q

Ductus venosus

.

veins do what…

A

closes as placenta is delivered.delivers blood to the inferior vena cava

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16
Q

Birth weight

A

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.

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17
Q

Nutrition/Hydration

A

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.

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18
Q

infant stomach capacity

A

30-90 ml

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19
Q

Transitional
Milk stool
Bottle vs Breast

A

24-48 hrs

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20
Q

Thermal Instability d/t:
A. Decreased threshold for temperature variations:
Cold:

A

Immature heat-generating abilities

Do not shiver ( cant move put hands in pocket) cant sweat

Do not have muscle movement

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21
Q

Non-shivering thermogenesis

A

◦ 1st –Brown fat
&
◦ secondarily through
increased metabolic activity
of brain, heart, and liver

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21
Q

Brown Fat

A

⚫Provides: Non-shivering thermogenesis
◦Brown Adipose Tissue (BAT)
◦Easily metabolized
◦Lasts several weeks
◦Depleted rapidly with cold
stress
◦Lower in premature
infants

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22
Q

Infants have Sweat Gland Mechanisms …. T or F

A

they are present but not functioning

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23
Q

fetal position helps to conserve

A

heat

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24
Q

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 -

A

⚫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

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25
Q

Nursing Interventions for Cold Stress

A

⚫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

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26
Q

site for temp

A

axillary

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27
Q

The Golden HourFirst breath

A

At 1 hour: Vit K (clotting), eye
ointment (protect from blindness) ,
Hep B (optional)

28
Q

The Golden Hour Hat on baby WHY?

A
  1. heat-evaporation
    2) Inc heat – radiation
    3) Conduction
    4) Hypothermia can occur quickly
    5) Poor thermoregulation
29
Q

The Golden Hour Hat on baby

A

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

30
Q

TEMPERATURE:
At birth: (° F )

Within 12
hrs: (F)

PULSE
At birth:

Within 12 hours:

A

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

31
Q

Respirations
At birth:

◦Short apnea -
✔Suction
✔Respirations may be irregular
✔Any apnea greater than _____- report
✔ S/S of respiratory distress:

After 12 hours:

A

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

32
Q

WBC & RBC At birth:

average, at birth, after

A

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

33
Q

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:
⚫

A

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%

34
Q

Bilirubin*****
Bilirubin is a =

At birth:
⚫
Changes to:

⚫Day 0 – 1 =
⚫Day 1 – 2=
⚫Day 2 – 5 =

A

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)

35
Q

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
⚫

A

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
⚫

36
Q

First Period of Reactivity

⚫Neonatal characteristics:

⚫NURSING INTERVENTIONS

A

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

37
Q

First Period of Sleep / Inactivity

⚫Neonatal Characteristics:

⚫NURSING INTERVENTIONS

A

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

38
Q

Second Period of Reactivity

Neonatal characteristics: awake,

NURSING INTERVENTIONS

A

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

39
Q

active alert

A

crying

40
Q

APGAR

⚫

A

⚫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

41
Q

APGAR Scoring
⚫0-3 –
⚫4-6 –
⚫7-10 –

Evaluations are made at

A

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

42
Q

Establish Ventilation and Circulation
Action Rationale

first steps once doctor pulls baby out

A

1) Suction oral cavity 1st
⚫
2) Suction nasal cavity gently
3) APGAR score at 1 min.
4) Blow by oxygen prn

43
Q

Assess Nutritional Status
Diabetic Mom, LGA, SGA, post-dates, pre-term (per protocol)
Action

A

1)Heel stick - At birth and 4 hrs later
2) Early feeding
3) Glucose water prn NEVER
4) Maintain temp

44
Q

Rationale for nutritional status

think about paul blart

A

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

45
Q

Ensure Safety and Identification of Infant
Action Rationale

A

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

46
Q

Encourage Bonding

A

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

47
Q

Health teaching for parents-
⚫BATHING –

⚫Gentle

⚫CORD CARE –

A

⚫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

48
Q

Circumcision Care

A

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

49
Q

Temperature Regulation
⚫TEMPERATURE REGULATION –

A

Temperature Regulation
⚫TEMPERATURE REGULATION –watch in first 24 hrs especially for signs of COLD STRESS

50
Q

Diapering
◦ Voiding –

A

6-8 wet diapers/day
indicate/ adequate fluid intake;
diaper counts.

51
Q

◦ Stools – meconium =
 Breastfed:
 Bottle Fed:

A

◦ Stools – meconium -1st 24 hrs
 Breastfed: Yellow/seedy/ pasty
 Bottle Fed: Greenish/firm

52
Q

Safety -
⚫Asepsis –

A

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)

53
Q

Physiologic Needs / Safety

A

⚫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.

54
Q

Feeding
HT parents-schedules; burping…
Nutritional Needs

⚫ Newborns eat

A

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

55
Q

NYS Newborn Screening
Screen for approximately

A

disorders including PKU, CF,
Sickle Cell Anemia
* Hearing

56
Q

Infant states of consciousness

  1. —Deep sleep
    —
    2.Light sleep

—3. Drowsy

—4. Quiet alert
—5. Active alert
—6. Crying

A

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

57
Q

Day one (stomach eating)
Day three
One week
One month

A
58
Q

5 s’s

A
  1. swaddle/football hold/ swing/”shhhhh’ them= fluid when they was in the womb/pacifier

2.

3.

4.

5.

59
Q

Normal Newborn

A
  • Protruding belly
    • Bowel sounds
      *
  • 1st nose breathers then Diaphragmatic
    breathing
60
Q

Chemical Norms vs newborn

PO2

PCO2

Ph

A

20-30. / norm is 50-70

45-50./ norm is 35-45

7.25/ norm 7.35

61
Q

murmur may be heard T or F

A

especially in the first 24 hrs as shunt are closing. T or F

62
Q

stork bite

A

hemangiomas

63
Q

cyanosis of hands and feet are normal findings,

T or F

A

T

64
Q

slate gray patches

A
65
Q

eye prophylaxis

A

Eye drops or ointment containing an antibiotic medication are placed in a newborn’s eyes after birth

66
Q

epstein pearls

A
67
Q

“briick dust”

A

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