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Nursing Care Of The Newborn And Family Flashcards

1
Q

What level apgar may require more interventiosn
What initiates transition to extrauterine life

A

Less than 7

Respirations

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2
Q

Can provide skin to skin and delay full assessment after birth is what

A

Breathing effectively
Pink
No lifethreats

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3
Q

Immediate care following birth (6)

A

Skin to skin
Stimulate and dry
Place hat
Nasal and oral secretions
Matching ID bands
Place security bands

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4
Q

Promote breastfeeding while skin to skin withing when

A

First hour of life

AKA golden hour

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5
Q

When to warm a baby at warmer (3)

A

Preterm
Poor muscle tone
Not crying/breathing

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6
Q

APGAR stands for

A

Appearance (color
Pulse (HR)
Grimace (face/cry)
Activity (tone)
Respiratory

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7
Q

Apgar appearance(color)

A

0: blue/pale

1: body pink, extremities blue

2: completely pink

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8
Q

APGAR: pulse

A

0: absent

1: slow <100

2: >100

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9
Q

APGAR: grimace

A

0: no response

1: grimace

2: cry

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10
Q

APGAR: activity (muscle tone)

A

0: flaccid

1: some flexion of extremities

2: well flexed

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11
Q

APGAR: respiratory

A

0: absent

1: slow, weak cry

2: good cry

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12
Q

New born care

How long we allow skin to skin and baby fed before completing other admission items

Wt
Length
Head circumference

A

1-2hrs

Wt: 2700-4000g
Length: 19-21in
Head circumference 2cm>chest

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13
Q

Early interventions:

Eye prophylaxis
-prevents what
-where it goes

Vit K:
-route
-when given

A

Eye prophylaxis prevents:
-neonatal conjunctivitis
-thin ribbon on lower lid

Vit K:
-IM vastus lateralis
-1-2hr after birth

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14
Q

Classificialtion of gestational age and wt

A

AGA: appropiate for gestational age

LGA: >90% percentile

SGA: <10% percentile

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15
Q

Ballard score used to figure out what

A

Assesses gestational age based on physical maturity and neuromuscular maturity

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16
Q

Physical maturity characteristics (ballard score)

A

Skin
Lanugo
Plantar creases
Breast tissue
Eyes/ears
Genitalia

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17
Q

Ballard score: preterm vs term

Skin texture

A

Term: creases

Preterm: more smooth

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18
Q

Ballard score: preterm vs term

Lanugo

A

Term: balding

Preterm: alot of lanugo

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19
Q

Ballard score: preterm vs term

Plantar creases

A

Term: creases

Preterm: smooth plantar

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20
Q

Ballard score: preterm vs term

Breast tissue

A

Term: developed

Preterm: flat, not developed

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21
Q

Ballard score: preterm vs term

Eyes/ears

A

Eyes:
Term: can open
Preterm: still fused

Ears:
Term:cartilage stiff/recoil
Preterm:thin, no recoil if bent

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22
Q

Ballard score: preterm vs term

Genitalia

A

M:
Term: tesicles in scrotum/decended
Preterm: not descended

F:
Term: labia majora prominent
Preterm: everything there, clitoris prominent

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23
Q

Anthropometric measurements done during physical assessments

A

Length
Wt
Head and chest circumference

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24
Q

Skin assessment finding in babies:

-acrocyanosis
-vernix
-lanugo
-milia
-mongolian spots
-telegiectatic nevi (stork bites)
-nervus flammeus
-erythema toxicum

A

-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

25
Two skin conditions that dont go away
-erythema toxicum -nevus flammeus
26
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
27
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
28
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
29
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
30
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
31
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
32
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)
33
NIPS (neonatal infant pain scale)
Just know it is not 0-10 Looks at behaviors
34
Neonatal pain tx (nonpharm)
Swaddling Nonnutritive sucking (pacifier) Oral glucose Skin to skin Breastfeeding
35
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
36
Hep B vaccine Route 2nd and 3rd dose time
IM 2nd dose: 1-2 months 3rd dose: 6-18 months
37
Circumcision requirements
Least 12hrs old Recieved vit K Had urine output Informed consent
38
Different types of circumcision
Plastibell Mogen Gomco clamp
39
Pain management for circumcision
Penile nerve block (lidocaine) EMLA cream Sucrose
40
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
41
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
42
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
43
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
44
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
45
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
46
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
47
How to document amount of feed for breast feeding
Time latched till unlatched in minutes
48
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
49
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
50
Wt loss wanted vs concern
Want: 5-10% of birth wt loss Any more is concern
51
Storage of milk -room temp -refrigerator -freezer
Room temp: 4hr Refrigerator: 4days Freezer: 6mon to 1yr
52
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
53
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
54
Newborn discharge teaching Temp Respiratory
Temp: use axillary Respirator: Signs of resp distress Use bulb syringe
55
Nursing teaching discharge Stools
3 stools/day Formula less
56
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
57
When newborn gets wellness checkups
2-3 days
58
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

N330 (17 decks)

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