Powerpoints Test 2 Module 5 Flashcards
When does the transition from intrauterine to extrauterine life begin?
Once the umbilical cord is clamped and the infant takes the first breath….. the transition from intrauterine to extrauterine life begins.
Newborns Thermogenic Adaptation
Cold stress
Large body area
Limited subcutaneous fat
Limited ability to shiver
Thin skin and blood vessels close to surface
Non-shivering thermogenesis uses brown adipose tissue
How soon to start the apgar scoring?
At 1 minute and 5 minutes
Immediate nursing care at birth includes?
Mother–infant identification
•Infection/injury prevention
Eye prophylaxis
Vitamin K injection
Hepatitis B vaccine (parental consent required)
- Assess blood glucose
- Hematocrit and hemoglobin
Skin assessment of the neonate
Mongolian Spots
Erythema Toxicum
Lanugo
Milia
Dark spots on back
Red dry areas on face
Fine thin hair
White pustules
Assessment of the Infant’s Head
eyes?
Ears?
Lips?
Chin?
Symmetry of head
Eyes: shape, size, placement, coordinated lid movement; red reflex; gross vision
Ears: shape, size, placement, hearing
Lips: movement, color
Chin: appropriate size
How to assess Head: Fontanels
Estimate size
•Fullness without bulging: normal
•Bulging and tense with large head circumference: increased intracranial pressure
•Sunken: dehydration
Head-
Diffuse edema, crosses suture lines, disappears in few days
Caput succedaneum
Subperiosteal hemorrhage
Does not cross suture lines
Persists for weeks
Cephalhematoma
Newborn mouth and neck assessment
Mouth
Epstein pearls
Teeth
Ability to suck
Hard and soft palate
Neck
Torticollis
Facial features
Respiratory system assessment newborn
- Symmetry in chest movement
- Breast tissue
- Nasal patency
- Respiration rate, pattern, and use of accessory muscles
- Auscultate lungs, anterior and posterior
- Abdominal movements should be synchronous with the chest movements
- Skin color
- Capillary refill
- Signs of distress
Cardiovascular system assessment of newborn
Inspection and auscultation Point of maximum impulse Heart rate Capillary refill Peripheral pulses Auscultate all areas: murmurs
GI system assessment
Abdominal inspection, including umbilical cord
Auscultate bowel sounds, upper abdomen for gastric bubble, and heart sounds of the abdominal aorta
Palpation
usually passes within the first 8-24 hours of life
- Absence of this by 72 hours of life may be indicative of an obstructive bowel problem
- Consists of particles found in amniotic fluid such as vernix, skin cells, hair and cells that have been shed by the intestinal tract
•Greenish-black and viscous at first
•Gradually change to transitional stools:
-thinner and greenish-brown to yellowish brown
-1-10 times over a 24 hour period
Meconium
Conditions that warrant further assessment in newborns in GI
Abdominal distention
Absence of bowel sounds
Discharge from umbilical cord/site
Abdominal mass
Urinary system assessment in newborn
Hips abducted Palpate and inspect scrotum, testes, and penis Male: retract foreskin Palpate and inspect female genitalia Anus and anal wink reflex
Common findings in male newborns
Scrotal swelling
Smegma
Hypospadias-ventral
Epispadias-dorsal
What to assess in newborns urine
Nursing assessments
•Careful monitoring of I/O
-Normally void 2-6 times in a 24 hour period during the first 2 days of life
-by fourth day of life, output should increase to more than 6 voids in a 24 hour period
•Assess appearance of urine
•Rusty colored urine can be normal with first voiding and is related to the kidneys having difficulty removing waste products from the blood
-Small amounts of protein and glucose are present in the urine
-Urate crystals: pink-red in color are excreted in urine.
-Disappear after the first few days of life
-Can be mistaken for blood
Common findings in female newborns
Hymenal tags
Vernix caseosa on labia
Pseudomenstruation
Conditions that warrant further assessment in perineal area newborn
Undescended testicles Micropenis Ambiguous genitalia Imperforate hymen Imperforate anus
Musculoskeletal system assessment in newborn
Observe infant’s movements in crib
Inspect for differences in extremity length and size
Assess muscle tone and symmetry
Gentle passive ROM to assess joint rotation
Assess head lag
Skin folds on thighs
Musculoskeletal issues that warrants further assessment
Fractured clavicle- Palpate for separation of bone ends and for crepitus.
-bruising/swelling/pain
•Polydactyly- Extra digits
•Syndactyly- Webbing
•Simian crease- Single, straight crease in the middle of the palm of one or both hands.
-Down’s syndrome
Neurological assessment in newborn?
Reflexes- Breathing and Blinking Swallowing Stepping Babinski Grasping Moro Startle Galant
Neurological issues that warrant further assessment
Erb’s palsy
•brachial plexus injury
•
Cerebral palsy
•
Spina bifida
Newborn care
Newborn metabolic screening tests Circumcision Ensuring optimal nutrition Discharge planning for the infant and family Child care
Jaundice in babies - complications
Normal biliruban?
Tx?
Jaundice (cont’d)
Complications
Bilirubin encephalopath
?
Light phototherapy
Cover eyes and genitals
No lotion
Car seat safety
Middle Rear facing in car
Remove heavy outerwear of infant prior to placing and buckling
Buckle Harness fastened and placed at infants armpit level.
Newborn Metabolic Screening Tests
cystic fibrosis
sickle cell anemia
phenylketonuria (PKU)
A lack of proper conversion results in a buildup of toxic blood levels of phenylalanine, a condition that causes central nervous system damage
High risk newborns
Gestational age?
Gestational age (GA): length of time in utero •Preterm (delivered at or before the completion of 37 weeks’ gestation) •Term (delivered any time from 38 to 41 completed weeks’ gestation) •Post-term (newborn delivered on or after 42 weeks’ gestation)
High risk newborns
Birth weight?
Birth weight:
Low birth weight (LBW) (< 2,500 g)
Very low birth weight (VLBW) (< 1,500 g)
Extremely low birth weight (ELBW) (< 1,000 g)
High risk newborns
Small for gestational age infants
SGA newborns are those born at any GA with a birth weight that falls below the 10th percentile on the growth charts
High risk newborns
Large for gestational age newborns
Infants born > 90th percentile on the growth chart
Can be genetically large
More commonly, exposed to imbalance of nutrients in utero
Example: newborn who weighs 3,750 g (8 lb 4 oz) at 40 weeks’ gestational age
High risk new born
Premature
Prematurity classified by weeks of gestation:
Severe prematurity: birth at 23 to 26 weeks
Moderate prematurity: birth at 26 to 34 weeks
Late preterm: birth at 34 to 37 weeks
High risk infants
Respiratory distress
Cause?
S/s
Developmental respiratory disorder
Affects preterm newborns (what is given prior to delivery to help present?)
Due to lack of lung surfactant
Signs and symptoms Expiratory grunting Nasal flaring Cyanosis in room air Rapid breathing (tachypnea) Labored breathing (retractions) Decreased breath sounds, often with rales
Note: Beractant (Survanta) lowers minimum surface tension and increases pulmonary compliance and oxygenation in preterm newborns
high risk
Neonatal absence syndrome NAS
S/s
Nursing care?
How often to score infant?
signs and symptoms IRRITABLE TREMORS LOOSE STOOLS SNEEZING INCESSANT CRYING
Nursing care Provide quiet and dark environment Provide comfort measures Gently rock and hold infant Some infants prefer not to be held
Score infant every 3 hours using neonatal abstinence scoring tool
High risk
SIDS
Sudden infant death syndrome
Prevention?
Prevention: Recommendations from American Academy of Pediatrics for safe sleep environment include:
“Back to sleep” for every sleep
Firm mattress
Keep newborn in parent room; NOT in parent’s bed
Remove all soft objects and loose bedding from crib
Decrease smoking in pregnancy and in the house of a newborn
Offer pacifier at nap time and bedtime
Do not let newborn get overheated
Amniotic fluid supports newborns respiratory system how?
Supports fetal lung development
Intrapulmonary fluid supports newborns respiratory system how?
Reduce his pulmonary resistance to bloodflow
Initiation of air breathing
Surfactant supports newborns respiratory system how?
Lung expansion stimulates surfactant
Decreases surface tension within alveoli
34-36 weeks gestation production supports enough for alveolar stability
Reduced production in diabetics mothers
Pulse within 30 minutes beats how many bpm?
Newborn
110-160
Newborn capillary refill should be?
Less than 3 seconds
Adequate
Greater than 4 seconds, possible underlying problem
Ph issues with newborn exposure to cold
Increases respiration’s — vasoconstriction—-decreases o2 to tissues ——increases glucose—— decreases po2 —-=
Metabolic acidosis
Mechanisms for neonatal heat loss
17-8 in book
Fetal hgb carries how much more oxygen than adults ?
What vitamin infants have none of
17-2 lab values for infants
Increase 12 hours after birth
20-50%
Vitamin k - risk for bleeding issuesn
Establish airway how?
Suction - mouth then nose 18-1
Provide warmth how?
Dry infant
Place on mother abdomen , heated blankets
Place beneath radiant heater
Cap
The immediate neonatal assessment
Establish airway first
Provide warmth
Observe respiratory effort, color , muscle tone
Stimulate neonate to breathe deeply and cry
Assess heart rate, temperature
Note obvious abnormalities
Check and record number of umbilical cord vessels
S/s of neonatal distress
Cyanosis Tachycardia above 160 Tachypnea greater than 70 Sternal or rib retractions Grunting Nasal flaring
Later neonatal assessment
Body positioning 18-3
Skin color
Body size
Level of reactivity
Measurements and determination of gestational age - Ballard tool 18-13
Normal newborn findings
WT
Head and chest circumstance
Skin
Movement
2500-4000gram - loses 5-10% of weight in first 3 days
Head and chest aprox the same
Skin may have acrocyanosis
Normal spontaneous movement bilat extremities
What to teach parents about newborn care?
18-38 and 18-39
Temperature assessment - axillary
Bathing
Nail care and unbelical cord care
Clothing
Diapering - below umbilical cord stump
Attachment
Hyperbilirubinemia risk factors
Physiologic jaundice
Pathologic jaundice
Breastfeeding
Breast milk jaundice
17-2
Appears 25-48 hits after birth
At birth - 24 hours
2-4 days
10 days
Jaundice tx
19-18 and 19-19
Fetal lung maturity is determined by the ?
L/S ratio and PG values
At birth 3 fetal shunts ?
close and promote circulation to accommodate oxygen intake by the lungs
DFD
Ductus arteriosus,
foramen ovale,
ductus venosus
The neurological system including the pns, sns are what at birth?
Underdeveloped
Term used to denote a lack of intrauterine fetal growth
Usually results in a small for gestational age newborn
Intrauterine growth restriction
S/s or characteristics of a SGA small for gestational age newborn?
Wasted muscle tissue
Lack of brown fat
Abdominal is often sunken in or scaphoid
Eyes appear large with a wise old man look
Fingernails are often long
Meconium stained thin cord is often present
19-4
Conditions affecting the SGA newborn
Cold stress such as prolonged hypothermia
Pain
Hypoglycemia (preterm or high risk are considered hypoglycemic when bs 50-60
Polycythemia (elevated hemocrit) greater or equal to 65%
Newborns large for gestational age risks
Newborns with a diabetic mother
TTN (transient tachypnea of newborn) delayed clearance of fetal lung fluid
Hypocalcemia
Hypo-magnesia
Birth injuries
Brachial plexus injuries 19-8
Fractures
Normal newborn calcium levels
Low calcium can produce what in newborns? May also have low what?
Greater than 7.5 or 8 in prematures
Seizures
Low bs
19-5
Ballard assessment?
?
RDS- resp distress syndrome in newborn
Priority intervention
Airway maintenance and oxygenation
Types of oxygen therapy for newborn
Humidifier oxygen
continuous positive airway pressure (cpap)
