Normal Newborn: Nursing Care Flashcards

1
Q

Early Care

Prophylactic Medications

Vitamin K intramuscular injection = 0.5-1mg

* Infants cannot synthesize Vitamin K in the intestines without food & normal bacterial flora

* Given to the neonate to prevent Vitamin-K deficiency bleeding

* One dose is administered, typically within the first hour after birth

A
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2
Q

___ - 0.5%

Prevents ophthalmia neonatorum (happens from gonorrhea)

May temporarily blur the infant’s vision, so give after first hour of life to allow for parental bonding

If mother is infected w/gonorrhea, infant may need antibiotics as well

A

Erythromycin Ointment

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3
Q

Cardiorespiratory Status

___ - time that is the first 2 hours after birth

Assessing rate & character of the heart & lungs

Use a bulb syringe as needed to suction secretions

Episodes of regurgitation, gagging, & brief episodes of cyanosis may occur during this period

Watch for respiratory distress

Suction mouth 1st & then nares

A

Transition period

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4
Q

Thermoregulation

* Identify early & intervene

* Radiant warmer

* Immediate actions at delivery

> Place on the maternal abdomen

> Dry the newborn to prevent evaporative heat loss

> Remove wet linens & replace w/dry as soon as possible

> Warm any items that are to touch the newborn’s body

> Position the crib in the mother’s room near head of bed

* Preferred route for assessment: ___ ?

A

axillary

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5
Q

Hepatic Function

Blood Glucose Levels / Conjugated Bilirubin

A
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6
Q

Blood Glucose Levels

* Assess for risk factors

* Hypoglycemia is a blood glucose LESS THAN ___ - ___ mg/dL

* If hypoglycemic follow agency policy & repeat glucose levels per agency policy

* Watch for ___ & ___

A

40-45 mg/dL

hypothermia; respiratory distress

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7
Q

Conjugated Bilirubin

* Hyperbilirubinemia

* Assess for jaundice by blanching the skin on nose or sternum

> Assess how far down the body the jaundice extends

* Transcutaneous or total serum bilirubin levels are required for any jaundice in newborns

* Prevent w/adequate infant feedings to promote passage of stool

Eat to excrete

A
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8
Q

?

Involves the abnormal type of jaundice

A

Unconjugated bilirubin

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9
Q

?

Is the nonphysiologic, “normal” type of jaundice

A

Conjugated [Bilirubin]

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10
Q

Ongoing Assessments and Care

* Complete assessments every 8 hours minimum

* Weigh once/day

A

Newborn Bath

* Removes blood & amniotic fluid

* If mother has bloodborne pathogens, bathe early

* Immersion tub bathing vs sponge bathing

* Perform w/parents present, if able

12-24 hours after birth; 100.4°

! Wash head last

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11
Q

Diaper Care

* Check & change diapers frequently

___ is a thick, sticky, tar-like stool & may be difficult to remove from the skin

> Wash the area w/plain water or a mild soap solution

* Commercial wipes should be free of detergent & alcohol

A

Meconium

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12
Q

Umbilical Cord Care

* Monitor for bleeding or oozing immediately after birth

* Cord clamp is applied at birth & remains in place for ___

* Falls off completely within approximately ___ ?

* Monitor for signs of infection

* Cleanse w/water if necessary, but keep the site clean & dry for best care

* Fold diaper below the cord to avoid contamination w/urine or stool

* Appearance of cord as gelatinous to dry; yellowish-white to brown-black

A

24 hours

10-14 days

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13
Q

SIDS Prevention

Place babies on their backs to sleep

A

Encourage “Tummy Time”

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14
Q

Protecting the Newborn

* Make sure newborn always returns to the correct parents

* Take precautions to prevent infant abductions

* Prevent or recognize the early signs of infection

A
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15
Q

Circumcision - Reasons for Choosing

* Higher risk of UTI’s, STD’s/STI’s, HIV, inflammation of the glans, & penile cancer (uncommon)

* Religious, cultural, or social influence

* Fear of ___

> a tightening of the prepuce that prevents retraction & requires circumcision

A

phimosis

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16
Q

Circumcision - Reasons for Declining

* Risk of conditions in uncircumcised male are low

* Do not want to cause their children pain

* Less frequent amongst Asian, Hispanic, Native American

* Not covered by insurance

* Risk of complications

* An unwell newborn

A

Pain Relief with Circumcision

Past belief that newborns “don’t feel pain”

* Dorsal penile nerve block

* Ring block - placed around base of penis

* Eutectic Mixture of Local Anesthetic (EMLA) Cream - takes longer to take effect

* Premedicate & treat pain w/acetaminophen

17
Q

Nursing Care for Circumcision

Assist

Evaluate

Assess

Monitor

Educate

A

* Assess & observe site at every diaper change

* Watch for any amounts of blood

* Loosely fasten diapers

* A yellow crust around the site indicates healing - don’t remove!

18
Q

Caring for the Uncircumcised Penis

* Wash the penis daily

* Cleanse when soiled diapers are changed

DO NOT RETRACT THE FORESKIN (starts at 3-6 years of age)

A

Hepatitis B

The first dose of the Hepatitis B vaccine is administered in the birth facility, usually within 12 hours of birth

If mother is Hepatitis B positive, newborn will also receive hepatitis B immunoglobulin (HBIG) immediately after birth

> Provides passive immunity until the infant can develop their own antibodies

Refer to pediatrician for subsequent 2 doses of HepB after discharge

19
Q

Hearing Screening

___ are the most common congenital abnormality in newborns

Early identification is key in preventing or reducing developmental delays

Hearing screen performed in the hospital

> If unsatisfactory results, rescreen

> If newborn does not pass hearing screen, refer for comprehensive audiologic evaluation no later than 3 months

A

Hearing disorders

20
Q

Additional Newborn Screenings

Requirements can vary by state, but common conditions often included are:

> Phenylketonuria (PKU) [inherited]

> Hypothyroidism

> Galactosemia

> Hemoglobinopathies

  • Sickle cell disease / thalassemia (lower hgb than normal)
A
21
Q

Requirements for Discharge

* Appropriate gestational age

* Normal physical examination

* Making transition from fetal to neonatal life w/o difficulty

* Normal vital signs

* At least two successful feeds

* Passed urine & stool

A

* No excessive bleeding from the circumcision for @ least 2 hours

* Newborn screening tests are complete

* Parents demonstrate knowledge & ability of basic infant care

* Appropriate infant car seat ready for discharge

* Provide education on necessary follow-up care