OB TEST 2 CHAPTER 24 Flashcards
WHEN DOES CARE FOR A NEWBORN BEGIN?
• Care begins immediately after birth and focuses on assessing and stabilizing the newborn’s condition
o Initial assessment and Apgar scoring
Performed immediately after birth using the apgar score and a brief physical examination
Apgar scoreS ARE TAKEN
1 minute and 5 minutes after birth
Apgar scores
- Scores of 0-3 indicate severe stress…..4-6 indicate moderate difficulty…..7-10 indicate minimal or no difficulty
- Heart rate
- Respiratory rate
- Muscle tone
- Reflex irritability
- Generalized skin color
• Classification of Newborns by Gestational Age and Birth weight
o AGA: presumed to have grown at a normal rate regardless of the length of gestation.
o LGA: can be presumed to have grown at an accelerated rate during fetal life
o SGA: grown at a restricted rate during intrauterine life
o Preterm: before completetion of 37 weeks
o Late preterm: between 34 and 36
o Postterm: after week 42
o Postmature: after week 42 showing the effects of progressive placental insufficiency
• Airway maintainence
o Most secretions are moved by gravity and brought by the cough reflex to the oropharynx to be drained or swallowed
o Suctioning with a bulb syringe
Keep in crib
Mouth suctioned first
Bulb is compressed and inserted into one side of mouth
Nasal suctioned one side at a time
When cry does not sound bubbly suction can be stopped
o Suctioning with a nasopharyngeal catheter with mechanical suction apparatus
Adjust pressure to less than 80mmHg
Lubricate catheter in sterile water and insert either orally along the base of the tongue or up and back into the nares
Create suction as the catheter is rotated and gently withdrawn
Repeat until cry sounds clear and air entry into lungs is heard by stethoscope
• Maintain adequate oxygen supple
o Clear airway
o Effective establishment of respirations
o Adequate circulation, perfusion and cardiac function
o Adequate thermoregulation
• Maintaining body temp
o Ways to stabilize babys body temp include
Placing infant directly on the mothers chest and covering with warm blanket
Drying and wrapping the newborn in warmed blankets immediately after birth
Keeping the head well covered
Keeping ambient temperature of the nursery or mothers room at 22-26 degrees
• Eye prophylaxis
o Mandatory in the US
o Precautionary measure against ophthalmia neonatorum, which is an inflammation of the eyes resulting from gonorrheal or chlamydial infection contracted by the newborn during passage through the mothers birth canal
o Forms used are erythromycin, tetracycline and silver nitrate
• Vitamin K prophylaxis
o Single IM of 0.5-1mg of vitamin K is given soon after birth to prevent hemorrhagic disease of the newborn
• Umbilical cord care
o Asses stump and base of cord for edema, redness, and purulent drainage with each diaper change.
o Average cord separation time is 10-14 days. Dry blood may be seen
o Average cord separation time is
10-14 days. Dry blood may be seen
• Care management from 2 hours after birth till discharge
o Many of the procedures such as assessment of weight and measurement of head circumference and length, instillation of eye medication, administration of vitamin k and physical assessment, are carried out in the labor and birth unit