Nursing Care Of The Newborn And Family Flashcards
What level apgar may require more interventiosn
What initiates transition to extrauterine life
Less than 7
Respirations
Can provide skin to skin and delay full assessment after birth is what
Breathing effectively
Pink
No lifethreats
Immediate care following birth (6)
Skin to skin
Stimulate and dry
Place hat
Nasal and oral secretions
Matching ID bands
Place security bands
Promote breastfeeding while skin to skin withing when
First hour of life
AKA golden hour
When to warm a baby at warmer (3)
Preterm
Poor muscle tone
Not crying/breathing
APGAR stands for
Appearance (color
Pulse (HR)
Grimace (face/cry)
Activity (tone)
Respiratory
Apgar appearance(color)
0: blue/pale
1: body pink, extremities blue
2: completely pink
APGAR: pulse
0: absent
1: slow <100
2: >100
APGAR: grimace
0: no response
1: grimace
2: cry
APGAR: activity (muscle tone)
0: flaccid
1: some flexion of extremities
2: well flexed
APGAR: respiratory
0: absent
1: slow, weak cry
2: good cry
New born care
How long we allow skin to skin and baby fed before completing other admission items
Wt
Length
Head circumference
1-2hrs
Wt: 2700-4000g
Length: 19-21in
Head circumference 2cm>chest
Early interventions:
Eye prophylaxis
-prevents what
-where it goes
Vit K:
-route
-when given
Eye prophylaxis prevents:
-neonatal conjunctivitis
-thin ribbon on lower lid
Vit K:
-IM vastus lateralis
-1-2hr after birth
Classificialtion of gestational age and wt
AGA: appropiate for gestational age
LGA: >90% percentile
SGA: <10% percentile
Ballard score used to figure out what
Assesses gestational age based on physical maturity and neuromuscular maturity
Physical maturity characteristics (ballard score)
Skin
Lanugo
Plantar creases
Breast tissue
Eyes/ears
Genitalia
Ballard score: preterm vs term
Skin texture
Term: creases
Preterm: more smooth
Ballard score: preterm vs term
Lanugo
Term: balding
Preterm: alot of lanugo
Ballard score: preterm vs term
Plantar creases
Term: creases
Preterm: smooth plantar
Ballard score: preterm vs term
Breast tissue
Term: developed
Preterm: flat, not developed
Ballard score: preterm vs term
Eyes/ears
Eyes:
Term: can open
Preterm: still fused
Ears:
Term:cartilage stiff/recoil
Preterm:thin, no recoil if bent
Ballard score: preterm vs term
Genitalia
M:
Term: tesicles in scrotum/decended
Preterm: not descended
F:
Term: labia majora prominent
Preterm: everything there, clitoris prominent
Anthropometric measurements done during physical assessments
Length
Wt
Head and chest circumference
Skin assessment finding in babies:
-acrocyanosis
-vernix
-lanugo
-milia
-mongolian spots
-telegiectatic nevi (stork bites)
-nervus flammeus
-erythema toxicum
-acrocyanosis: blue hand and feet
-vernix: white on baby (cheesy)
-lanugo: small hairs
-milia: milk spots
-mongolian spots: i know it
-telegiectatic nevi (stork bites): red speckled spot on neck/forehead
-nervus flammeus: red patch
-erythema toxicum: rash
Two skin conditions that dont go away
-erythema toxicum
-nevus flammeus
Head physical assessment
-size we want
When anterior/posterior fontanel go away
-other things you may see
2-3cm larger than chest circumference
Anterior/posterior fontanel: go away @ 12-18months
Caput: cross over suture line, edema/swelling
Cephalohematoma: bleeding/firm/bruising
Face physcial assessment
Eyes
Ears
Nose
Mouth
Eyes: red reflex present (to light), strabismus (cross eyed)
Ears: inspect for low set ears (=down syndrome), skin tags (kidney form at same time as ears so sign of kidneys)
Nose: nose breathers, sneezing normal
Mouth: epsteins pearls(white pearls on gums)
-natal teeth (useless teeth=risk of aspiration)
-white tongue (thrush=fungal) cant wipe off
Chest
Abdomen
Chest:
-barrel chest early on is okay
-swelling in breast
-witchs milk (galactorrhea) =discharge from babies breast
Abdomen:
-bowel sounds present within a few mins
Extremities
Spine/back
Extremtiies:
Ortolani barlow maneuver:
test hip ROM (hear click when moving leg in circle (assess for congenital hip dysplasia)
Oligodactly (to few)
Polydactly
Syndactlyly (webbed)
Spine/back:
-pilonidal dimple: spina bifida
-tuft of hair
Newborn reflexes (primitive)
Primitive=born w/ and go away within 1 year
Rooting/sucking
Palmar and plantar grasp
Tonic neck
Moro
Babinski
Stepping
Trunk incurvation
Rooting/sucking
Palmar and plantar grasp
Tonic neck: pull arm one way, neck follows
Moro: reflex like their falling
Babinski: toes fan out when foot is rubbed
Stepping: hold on surface and look like their walking
Trunk incurvation: rub side of back theyll turn that way
Anogential physcial assessment
Check if what is present
Want what to pass within what amount of time
Anus present/patent
Meconium passed in first 24 hours
Urine passed within 24 hours
Male and female genitalia physcial assessment
Male:
hydrocele, rugae, hypospadias, epispadias
Females:
-what should cover mose
-pseudomenstuation
Male:
Hydrocele: fluid filled sac
Scortum should have rugae(wrinkle)
Hypospadias: bottom side (ventral)
Epispadias: top side (dorsal)
Female:
-labia majora cover labia minora and clitoris
-pseudomenstruation (pink discharge)
NIPS (neonatal infant pain scale)
Just know it is not 0-10
Looks at behaviors
Neonatal pain tx (nonpharm)
Swaddling
Nonnutritive sucking (pacifier)
Oral glucose
Skin to skin
Breastfeeding
Universal newborn screening
Other two screenings
Mandated by us law
Early detection of metabolic and genetic d/os
(CF, PKU, SCA)
Others:
Hearing screening
Screening for critical congentical heart disease
-pulse ox on R hand for pre ductal
-L hand for postductal
Hep B vaccine
Route
2nd and 3rd dose time
IM
2nd dose: 1-2 months
3rd dose: 6-18 months
Circumcision requirements
Least 12hrs old
Recieved vit K
Had urine output
Informed consent
Different types of circumcision
Plastibell
Mogen
Gomco clamp
Pain management for circumcision
Penile nerve block (lidocaine)
EMLA cream
Sucrose
Cricumcision care and teaching
What to do for first 24 hrs
Monitor what 2 things
How to clean/ what to avoid
No what until healed
Dont pick at what
Report what
1st 24 hrs apply petroleum and gauze (clamp methods only
-mogen and gomco
Monitor bleeding and first urination
Clean with warm water/ avoid baby wiped w/alcohol
No tub baths/ used sponge bath until healed
Dont pick at yellowish scab/mucus
Report:
-frank bleeding
-foul smelling discharge
-lack of void
Nutrition
Gold standard
Acceptable alternative
AAP recomends what
What to do during second 6mon period
Human milk = gold standard
Iron fortified formula acceptable alternatvie
AAP recommends:
Exclusive breastfeeding of human milk for 1st 6mon and continued breastfeeding for at least 12mon
Second 6mon: solid foods added to diet
Breast feeding benefits to infant
Reduce mortality
Enhance neurodevelopment
Immunity
Reduce risk for:
GI infection
Inflammatory bowel
Asthma
Lower resp tract infection
SIDS
Obesity
DM
Leukemia
Benefit of breast feeding for mom
Promotes uterine involution
Reduce postpartum bleeding
Increased maternal role
Save money
Reduce risk for:
Ovarian/endometrial/breast cancer
Osteoporosis
PP depression
DM
HTN
High cholesterol
CVD
Lactogenesis
Significant drop in progesterone after birth triggers a release of prolactin from anterior pituitary gland
-prepares breast to secrete milk
-supply-meets-demand system
Oxytocin with breast feeding
Milk ejection reflex (MER) = let-down relfex
Same hormone stimulated uterine contraction during labor = mother who breast feed decrease risk of PP hemorrhage
Intiating breast feeding
Intitiate within when
How want baby and mother
Feed on demand (minimum amount per hr)
Position
Latch vs unlatching
Hungercues
Intitiate within 1st hr of life
Skin to skin
Feed q2-3hrs
Position belly to belly
Proper latch: mouth completely open, tongue under nipple
Unlatching: put pink to roof of mouth
Hunger cue:
Hand to mouth
Sucking/mouth motions
Rooting reflex
How to document amount of feed for breast feeding
Time latched till unlatched in minutes
Teaching with breast feeding
Duration
Alternate what
Burp when
Avoid what
No longer than 30 mins
Alternate breasts
Burp in between and at end of feeding
Avoid caffeine/alcohol
Indicators of effective breastfeeding
Urine/poo/wt
6-8 wet diapers daily/ pale yellow urine
2-5 loose yellow seedy stools daily
Steady wt gain after 1st week of age
Wt loss wanted vs concern
Want: 5-10% of birth wt loss
Any more is concern
Storage of milk
-room temp
-refrigerator
-freezer
Room temp: 4hr
Refrigerator: 4days
Freezer: 6mon to 1yr
Formula feeding
How often
Technique
Dont warm bottle how
Common concerns
Q3-4hrs
Technques: should be help for all feedings, bottle at 45degree, never propped
No warming in microwave
Common concerns:
-Proper burping, spitting up
-avoid overfeeding
Formula feeding prep. And safety
Never do what
Type of water to use
Throw away what
Prepared powder formula can be stored in refridgerator for how long
Never dilute bottle
Tap water can be used but must be boiled first (distilled water)
Throw away any remaining formula left in bottle
Prepared powder can be stored 24 hrs
Newborn discharge teaching
Temp
Respiratory
Temp: use axillary
Respirator:
Signs of resp distress
Use bulb syringe
Nursing teaching discharge
Stools
3 stools/day
Formula less
Newborn discharge
Umbilical cord care
-how long
-what we want
Dont do what
Use what to clean
Bathing:
No more than every what
How to do it
Umbilical:
10-14 days
Keep clean/dry
Dont tuck in diaper
Use water to clean
Bathing:
-No more than every other day
-Sponge bath until umbilical stump seperate/circumcision healed
When newborn gets wellness checkups
2-3 days
Newborn discharge teaching
Manifestations to report immediately: (10)
Temp >100.4 or <97.9
Poor feeding
Forceful vomiting or freq
Decreased urination
Diarrhea or decreased bowel movements
Jaundice
Cyanosis
Resp depression
Difficulty waking
Bleeding or purulent drainage from umbilicus/circumision
