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OB > nursing care of normal newborn (unit 2) > Flashcards

nursing care of normal newborn (unit 2) Flashcards

1
Q

first period of reactivity

A
  • birth-30 min
  • inc. HR
  • irregular resp.
  • alert, inc. motor activity
  • dec. body temp
  • meconium/saliva possibly
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2
Q

sleep period (relative inactivity)

A
  • dec. in motor activity 30-100 min after birth
  • VS recovery
  • temp may dip, so need warmer
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3
Q

second period of reactivity

A
  • 4-8 hours after birth
  • periods of tachypnea/apnea
  • periods of tachycardia
  • inc. muscle tone
  • inc. mucous (bulb)
  • meconium
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4
Q

mechanical stimuli initiating breathing

A
  • compression/recoil of chest during birth
  • tactile sim during/after birth
  • suctioning
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5
Q

sensory stimuli initiating breathing

A

•temp (chill)
•noise
•light
*obligate nose breathehrs

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6
Q

signs of respiratory distress

A
  • nasal flaring
  • retractions
  • grunt w/ expiration
  • accessory muscle use
  • seesaw resp.
  • rate < 30 or > 60
  • low surfactant levels
  • apnea r/t analgesics or rapid cool/warm
  • diaphragmatic hernia
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7
Q

surfactant

A
  • lines alveoli, inc. SA
  • suff. levels 34-36 wk
  • deficiency leads to RDS
  • measured by L/S ratio
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8
Q

L/S ratio

A
  • determines fetal pulmonary maturity
  • 2 or > means more mature
  • 1.5 of < means inc. r/o RDS
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9
Q

fetal structures that close postnatally

A

•foramen ovale
•ductus arteriosus
•ductus venosus
*allows unoxygenated blood to circulate thru lungs

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10
Q

foramen ovale

A
  • b/t RA & LA

* allows blood to bypass pulmonary circulation

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11
Q

ductus arteriosus

A
  • b/t aorta & PA

* allows majority of RV output to bypass lungs

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12
Q

ductus venosus

A
  • b/t umbilical vein & IVC

* allows ½ blood from umbilical vein to bypass liver/GI tract

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13
Q

clamping of the cord

A

•umbilical arteries/vein and ductus venous are functionally closed and converted to ligaments

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14
Q

newborn blood volume

A

•300 mL

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15
Q

newborn H&H

A

•14-24 g/dL
•44%-64%
*shorter lifespan of RBC

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16
Q

newborn leukocytes

A

•WBC of 18,000
•inc. after birth, then declines rapidly
*susceptible to infection

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17
Q

newborn clotting factors

A

•levels decrease b/c unable to synthesize vitamin K

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18
Q

nonshivering thermogenesis

A
  • metabolism of brown fat (inter scapular, axillae, vertebrae, kidney)
  • critical newborn heat production
  • rapid depletion w/ cold/stress
  • PT have less brown fat
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19
Q

heat loss via convection

A
  • heat from body to cooler air

* keep wrapped in blanket and warm room

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20
Q

heat loss via radiation

A
  • heat from body to cooler surface

* NOT direct contact

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21
Q

heat loss via evaporation

A
  • insensible water loss
  • can occur via respirations
  • dry baby well and delay first bath if thermoregulation issues
  • only expose one body part at a time
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22
Q

heat loss via conduction

A
  • heat from body to cooler surface
  • direct contact
  • warmer
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23
Q

newborn hypothermia

A
  • common b/c have inc. heat loss d/t thin skin, vessels close to surface, little fat, and high SA to body mass ratio
  • s/sx: < 36.5 or 97.7 temp; cyanosis; tacypnea
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24
Q

newborn heat conservation

A
  • flexed positon
  • constriction of peripheral vessels
  • brown fat metab.
  • crying, restless, movement
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25
Q

cold stress

A
  • ineffective thermoregulation

* can lead to hypoxia, acidosis, and hypoglycemia

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26
Q

cold stress s/sx

A
  • drop in temp
  • RR inc.
  • tachy then brady
  • mottled skin; acrocyanosis
  • dec. activity if RD
  • inc. activity if not RD
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27
Q

hyperthermia

A
  • rapid BMR increase
  • increase in glucose/O2 requirements
  • nonfunctioning sweat glands
  • vasodilation w/ increased insensible water loss
  • may lead to cerebral damage, dehydration, heat stroke, death
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28
Q

neutral thermal environment

A

•where infant can maintain stable body temp w/o increase in metabolic rate

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29
Q

neonate renal system

A
  • urine @ 12 wks GA
  • kidney fully developed @ 35 wks
  • blood flow inc. after birth -> inc. UOP
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30
Q

expected infant UOP

A
  • once in 1st 24 hr
  • twice 2nd 24 hr
  • 3 times 3rd 24 hr
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31
Q

newborn sucking coordination

A
  • after 1500 g

* 32-34 wks GA

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32
Q

first stools of newborn

A
  • meconium (24-48 hr)
  • transitional (day 3)
  • milk (day 4)
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33
Q

neonate hepatic system fxn

A
  • iron storage
  • carb metab
  • bilirubin conjugation
  • coagulation
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34
Q

iron storage

A
  • proportional to body weight
  • maternal Fe transfer from 3rd trimester stored for 4-6 months
  • PT have smaller stores (2-3 months)
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35
Q

carbohydrate metabolism

A
  • glucose transplacentally
  • glucose dec. at birth
  • neonate higher glucose needs than fetus
  • glycogen stored last 4-8 wks GA
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36
Q

hypoglycemia in infant

A 
• < 40 mg/dl (term)
•jittery
•RDS
•apnea
•lethargy
•poor suck
•seizures
*if no tx, possible brain damage
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37
Q

infant r/o hypoglycemia

A
  • preterm
  • SGA
  • LGA
  • stress
  • maternal diabetes
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38
Q

coagulation of bilirubin

A

•short living RBC brobken into unconjugated bilirubin (fat soluble)
•liver must convert unconjugated into conjugated for metab/excretion (water soluble)
*hepatic immaturity causes accum. of unconjugated

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39
Q

unbound bilirubin

A
  • conjugated
  • water soluble
  • yellow pigment that may leave vascular system and go to skin, sclera, oral membranes (jaundice)
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40
Q

why do neonates have hyperbilirubinemia

A
  • excess production of bilirubin
  • liver immaturity
  • shortened life span of RBC
  • delayed feeding
  • trauma
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41
Q

r/o hyperbilirubinemia

A
  • prematurity
  • Rh or ABO incompatibility
  • cephalhematoma, bruising
  • delayed/poor intake
  • cold stress
  • sepsis
  • breast feeding
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42
Q

physiologic jaundice

A
  • hyperbilirubinemia
  • appears after 1st 24 hrs
  • benign- not normal, but common
  • s/sx 2nd-3rd day of life
  • usually resolves by day 4
  • bili < 12 (unless PT or BF)
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43
Q

pathologic jaundice

A
  • hyperbilirubinemia
  • appear w/in 1st 24 hrs
  • r/t abnormalities that cause excessive RBC destruction
  • bili levels higher and remain high
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44
Q

kernicterus

A
  • bilirubin encephalopathy
  • severe jaundice
  • bili > 25 mg/dl
  • causes severe neurological damage
  • only ½ infants survive
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45
Q

BF/milk and jaundice

A
  • BF: early onset
  • milk: late onset
  • r/t ineffective BF patterns or substances in milk causing reabsorption of bill from stool
46
Q

apgar score

A
  • take at 1 and 5 minutes

* highest (best) score is 10

47
Q

heart rate apgar scores

A

0- none
1- < 100
2- > 100

48
Q

respiratory apgar score

A

0- apnea
1- irregular/shallow
2- crying

49
Q

muscle tone apgar score

A

0- flaccid
1- some flexion
2- well flexed

50
Q

reflex irritability apagar score

A

0- non
1- grimace/withdraw
2- crying

51
Q

color apgar score

A

0- central cyanosis
1- peripheral cyanosis
2- pink

52
Q

ballard score

A
  • 12 criteria that represents neuromuscular and physical maturity of newborn
  • scores from -1 to 5 in each area
  • must be done w/in 48 hrs
53
Q

classification of gestational age

A
  • preterm- before 37 wks
  • term- 38-42 wks
  • postterm- after 42 wks
54
Q

postmature

A
  • greater than 3 wks past delivery date
  • placenta can begin to fail, causing dec. in O2/nutrients to fetus
  • must induce to prevent fetal death
  • fetus LBW, dry, long hair/nails
55
Q

expected newborn weight

A
  • 2500-4000g
  • 5-10% wt loss in first few days
  • regain 10-14 days
  • after regain, gain 1.5 lbs/month for 5 months
56
Q

expected newborn measurments

A
  • length: 45-55 cm
  • head circ.: 32-36.8 cm
  • chest circ.: 30-33 cm (2-3 smaller than head)
57
Q

expected newborn VS

A
  • 97.7-98.9 deg.
  • HR: 110-160
  • RR: 30-60
  • BP: 70/45
58
Q

IUGR baby

A
  • wt less than 10th percentile
  • thin, pale, loose, dry skin
  • r/t maternal dz and UPI
59
Q

expected newborn integumentary system

A
  • thin
  • erythematous after birth (resolve in few hrs)
  • blotchy/mottled extremities
60
Q

vernix caseosa

A

•cheese-like substance fused w/ epidermis as protective coating

61
Q

acrocyanosis

A
  • blue hands and feet

* normal vasomotor instability

62
Q

lanugo

A
  • fine hair

* more common in darker complected persons and preterm babies

63
Q

simian crease

A
  • single palmar crease
  • may be genetic (asian)
  • also indicates Downs
64
Q

desquamation

A
  • peeling of skin
  • indication of post maturity if present at birth
  • normal few days after birth in term
65
Q

milia

A
  • nonfunctional sweat/oil glands
  • look like pimples
  • hyperplasia from hormones at birth
66
Q

mongolian spots

A
  • bluish-black areas of pigmentation that blanch
  • back and butt
  • fade gradually
  • often mistaken for bruises
67
Q

telangiectatic nevi (stork bites; angel kisses)

A
  • pink, easily blanched patches

* upper eyelids, nose, upper lip, lower occipital area, nape of neck

68
Q

nevus vasculosus (strawberry mark)

A
  • capillary hemiangioma
  • entire dermal and subdermal layer
  • most often on head
69
Q

nevus flammeus (port wine stain)

A
  • plexus of newly formed capillaries
  • red to purple
  • not elevated
  • do not blanch
  • most frequently on face
70
Q

erythema toxicum (newborn rash)

A
  • hive-like spots that appear suddenly anywhere

* no clinical significance or tx

71
Q

cephalhematoma

A
  • collection of blood b/t skull bone and periosteum
  • DOESNT cross suture
  • resolves 3-6 wks
72
Q

caput succedaneum

A
  • edematous area of scalp
  • most often occiput
  • spontaneous disappearance 3-4 days
  • labor/vacuum extraction
73
Q

expected eye assessment

A
  • blue/gray (permanent color 3-12 mo)

* tears indicate mature lacrimal gland

74
Q

low set ears indicate…

A

•fetal alcohol syndrome
•downs
•congenital abnormalities
*should be above canthus of eye

75
Q

abnormal size/shape of ears indicates

A
  • deafness

* downs (round)

76
Q

assessing patency of nares

A

•have baby suck while occluding one nostril at a time
•look for nasal flaring
*obligate nose breathers

77
Q

circumoral cyanosis

A

•normal for first 24-28 hr (cardiopulmonary adaptation)

78
Q

epstein’s pearls

A

•yellowish, white cysts that hang from newborn gums/roof of mouth

79
Q

assessing neck/clavicles

A
  • hyperextend to visualize trachea placement

* palpate along entire clavicle to rule out crepitus, edema, fracture, etc

80
Q

newborn PMI

A
  • 4th ICS LMCL (visible)

* auscultate for min while sleeping

81
Q

newborn BP range

A
  • 60-80/40-50 mmHg

* take in arms and legs on first VS check

82
Q

RR indicating RDS

A

•apnea lasting > 15-20 sec.

“true apnea”

83
Q

pectus excavatum

A

•sternum bows inward

84
Q

pectus carinatum

A

•sternum bows outward

85
Q

newborn diastasis recti

A
  • d/t weakness of fascia b/t rectus abdominus muscles
  • not a herniation- will disappear
  • most often seen when crying
86
Q

checking anal patency

A
  • passage of meconium

* first rectal temp

87
Q

newborn female genitalia assessment

A
  • labia majora and minora visible
  • light pink
  • central orifice b/t labia minora
  • clitoris covered by labia in adducted position
88
Q

newborn male genitalia assessment

A 
•tight foreskin
•urethra should be midline
-hypospadias (under)
-epispadias (top)
•observe urine stream for patency
•descended testes
•check for hydroceles (assume. fld. around testes)
89
Q

difference b/t hydroceles and inguinal hernias

A
  • hydroceles cannot be reduced b/c fluid in enclosed space
  • hernias can be reduced w/ digital pressure
  • bay have bowl sounds over hernia mass
90
Q

talipes eqinovarus

A

•club foot

91
Q

tonic neck

A

•fencing

92
Q

moro

A
  • startle reflex w/ spreading of arms and legs and crying

* indicates proper CNS fxn

93
Q

Babinski reflex

A
  • stimulation of sole of foot causes big toe extension and other toe fanning
  • normal in newborn b/c neurologically immature
94
Q

galant reflex

A
  • hold baby prone while supporting belly w/ hand
  • stroke along one side of spine
  • body should curve toward stroked side
95
Q

erythromycin ophthalmic ointment

A

•prophylaxis against ophthalmia neonatorum in the event of maternal infection with gonorrhea or chlamydia

96
Q

vitamin K (IM)

A
  • given to newborn b/c sterile intestines don’t produce

* prevents hemorrhagic dz

97
Q

newborn immunizations

A

•hep B series initiated
•hepatitis B immune globulin (HBIG) if exposed to HBsAg positive mom
-also give pos. mom hep B vaccine

98
Q

screening before newborn DC

A 
•hearing
•genetic 
-PKU
-congenital hypothyroidism
-galactosemia
-hemoglobinopathies
99
Q

galactosemia

A

•absence of NZ for conversion of milk sugar to glucose

100
Q

signs of circumcision site infection

A 
•red
•warm
•swollen
•draining pus
*yellow, non draining scab is NORMAL and will resolve in wk
101
Q

criteria for newborn DC

A 
•normal exam/VS
•feed successfully 2x
•pass urine/stool
•no excessive circumcision site bleeding
•no sig. jaundice
*48 hr stay vag. 
*96 hr stay C/S
102
Q

cord care

A
  • Early - check for bleeding/oozing, security of cord clamp
  • Remove clamp at 24 hrs if end dry
  • Keep the cord dry and keep the top of the diaper folded under
  • Avoid submerging in water until the cord falls off (sponge bath)
103
Q

breast feeding

A
  • start immediately
  • on demand or q2-3 hr
  • alternate breasts (10 min each)
104
Q

bottle feeding

A
  • start 2-4 hrs

* on demand or q3h

105
Q

skin to skin (SNS) contact benefits

A
  • improves BF
  • thermoregulation
  • calm mom and baby
  • stimulates digestion
  • regulates HR and RR
106
Q

infant caloric intak 1st 3 months

A
  • 110 kcal/kg/day

* human milk/formula 20 kcal/oz (67 kcal/100 mL)

107
Q

what site recommended for newborn IM injections

A

•anterolateral thigh

108
Q

When performing nursing care for a newborn after birth, which of the following nursing interventions is the highest priority?

A

•covering head with cap

*r/o cold stress, so need to prevent heat loss via evaporation

109
Q

A newborn was not dried completely after delivery. The nurse understands that what causes the newborn to lose heat?

A

•evaporation

110
Q

why is it important to keep the nipple full of formula when bottle feeding

A

•prevents newborn from swallowing air when sucking

111
Q

how to know if newborn receiving enough to eat

A
  • content b/t feedings
  • gains weight
  • 6-8 wet diapers/day

OB (17 decks)

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