T6: Nsg Care of Newborn Flashcards
respiratory adaptations of the newborn
o Increase pressure blood pressure in the baby, it activates the respirations and increased perfusion to the lungs
Delay cord clamping…
increases blood volume to the baby and it decreases premature baby chances of having to do a blood transfusion
Mechanism’s baby uses to clear fluid from alveoli are
GRUNTING, NASAL FLARING, AND RETRACTIONS
Chemical factors for respirations
activation of the chemoreceptor in the carotid arteries
mechanical factors for respirations
as baby comes through the birth canal, the baby chest is squeezed and helps get out extra secretions
sensory factors for respirations
temperature lower on the outside, stimulates the receptors in the baby skin and the respiratory center in the brain (medulla oblongata)
what do c-section babies have more respiratory secretions
· because they do not go through the birth canal so there is no mechanical factor to get out extra secretions
what happens when the baby cries
opens up the alveoli and keeps the lungs open
premature babies do not have ..
surfactant
surfactant
substance that lines the alveoli and allows it to remain open
Betamethasone (Celestone)
a steroid given to mom to help with surfactant development in fetus
what do we suction first in the newborn
suction MOUTH FIRST
signs of respiratory distress
nasal flaring, intercostal retraction or if RR is <30 or >60
Acrocyanosis
hands and soles of feet are cyanotic for 24 hours
Central cyanosis
entire body looks cyanotic, this is not normal
cardiovascular adaptations of the newborn
o Increase of BP from clamping of cord, it increases pulmonary flow from left side of the heart and causes CLOSURE OR FORAMEN OVALE, closed at birth
What is the foramen ovale?
in utero it is used as a shunt between left and right atrium CLOSED RIGHT AFTER BIRTH
when is ductus arteriosus closed
closes in 24 hours
when is ductus venosus closed
§ closes in 2-3 months along with the umbilical 2 arteries and 1 vein (dry up and becomes ligaments)
hematopoirtic adaptations of the newborn
Higher concentration of hemoglobin because liver produces and stores hemoglobin in uterine
Coombs test
a test for the presence of anti-Rh factor antibodies in the blood (this is often given to pregnant women that are Rh- to see if they will mount an immune response against the blood of their fetus)
thermogenic adaptations of the newborn
o Baby doesn’t have shiver mechanism, so we have to help baby do that they don’t use O2, glucose and brown fat to maintain their temperature
what does a newborn use to maintain their temperature
O2, glucose and brown fat
during cold stress what does the baby use
brown fat
convection
when heat flows from body surface to cooler ambient air
intervention for heat loss through convection
Keep baby wrapped and with a hat on in an open bassinette keep away from an open window to help maintain temperature; shield baby from drafts
radiation
lost of heat from body surface through nearby object
intervention for heat loss through radiation
Keep baby away from cold objects and outside walls; don’t keep baby near window
evaporation
liquid converted to vapor
intervention for heat loss through evaporation
§ Dry baby completely and wrap in a blanket
conduction
loss of heat form body surface through direct contact
intervention for heat loss through conduction
§ Turn on warmer on bed
Normal infant temperature
36.6-37.5
If umbilical cord only has 1 artery and 1 vein…
INDICATES KIDNEY DEFECT
GI adaptations of the newborn
o Missing pancreatic amylase and lipase enzymes at birth, at 3 months salivary gland produces it and then at 6 moths the pancreas takes over
o First stool is meconium color is due to occult blood (brown/greenish color)
-Healthy baby passes it in 12-24 hours of life
Liver significance
role is break down bilirubin (when RBCs are breaking down)
baby becomes jaundice if
the liver cannot breakdown the RBC waste product (bilirubin)
jaundice
yellow color of skin
Physiological jaundice
· appears after 24 hours of age and DOES NOT REQUIRE TREATMENT
Pathological jaundice
within 24 but can last for over 2 weeks, REQUIRES TREATMENT
what should be initiated early to keep bilirubin level low
o Feed early to stimulate intestinal activity and keep bilirubin level low
what happens if pathological jaundice is not treated
irreversible BRAIN DAMAGE
-Acute bilirubin encephalopathy
-Kernicterus
Acute bilirubin encephalopathy
bilirubin is so high that is caused toxicity and they baby will exhibit signs like lethargy, hypotonia, irritability, seizures, coma, and death
Kernicterus
can cause delay in motor skills, hearing gloss and cerebral palsy if jaundice is not fixed (!!!)
vernix caseosa
cheesy substance covering the skin of the fetus
erythema toxicum
NORMAL RASH of neonate; pink rash that appears suddenly anywhere on the body of a term newborn during the first 3 weeks.
Caput Succedaneum
Swelling under the skin due to coming through the birth canal (mainly over occiput- back of head), CROSSES THE SUTURE LINE, NORMAL FINDING
Cephahematoma
o collection of blood between the skull bone, does not cross suture line
Amniotic bands
as placenta develops it wraps around the limb of baby, it prevents the development of wherever it is wrapped around (hence why baby is born without digits or limbs)
Oligodactyly
missing digits
Polydactyly
extra digits
Syndactyly
Fusion of digits
female newborn reproductive adaptations
o may be born with mucoid vaginal discharge (smegma) it is normal, it is because of the high levels of estrogen during pregnancy
- Can also be born with pseudomenstruation (spotting)
- Labia minor and majora can be swollen especially if they are breach presentation
male newborn reproductive adaptations
o hydrocele (fluid around the testes), undescended testes
- Foreskin; covers glans penis
Breast feeding is highly encourage during
during first 30 minutes of birth: this period is called FIRST PERIOD OF REACTIVITY (baby is awake, best time to breast feed)
first period of reactivity
Period beginning at birth in which newborns are active and alert. It ends when the infant first falls asleep. first 30 minutes
APGAR score is done at
1 minute and 5 minutes after birth
what does the first APGAR tell us
tells you how baby did during labor
what does the second APGAR tell us
tells you how baby is transitioning from inuterine to extrauterine life
If APGAR score is <5, then
they will repeat it 10 minutes after
Most babies have score of 9/10 i=on APGAR because
because 1 is taken out for color (acrocyanosis: cyanosis of hands and feet, usually resolves in 24 hours)
APGAR
activity, pulse, grimace, appearance, respiration
normal HR of newborn
110-160bpm
normal RR for newborn
30-60
newborn measurements include
head, length, chest
ballard chart
tells you if the baby is large, average, or small for gestational age
LGA
large for gestational age
AGA
average for gestational age
SGA
small for gestational age
molding
asymmetry of the head resulting from pressure of the birth canal, disappears after 72 hours
Mongolian spots
bluish purple spots of pigmentation; o must document and show it to the parents, it can be mistaken for abuse
Average weight of a newborn
2500-4000g
Average length of a newborn
45-55cm
Average head of a newborn
33-35 cm
Average chest of a newborn
30-33cm
Moro reflex
refers to an involuntary motor response that involves the infant suddenly splaying their arms and moving their legs before bringing their arms in front of their body.
Babinski reflex
plantar reflex; start at sole of foot and go up, you will see the baby FLEX their toes
sucking reflex
happens when the roof of a baby’s mouth is touched, baby will begin to suck when this area is stimulated, which helps with nursing or bottle feeding
rooting reflex
when the corner of the baby’s mouth is stroked or touched the baby will turn his or her head and open his or her mouth to follow and root in the direction of the stroking.
Palmar-plantar grasp
o finger is placed in newborn’s hand and the fingers will cirl around examiners finger
preterm
reached 20 weeks gestation but before complete 37 weeks
late preterm
between 34 weeks 0 days and 36 weeks 6 days
term
37 weeks
post term
reached 42 weeks 0 days gestation
postmature
born after 42 weeks
IUGR: intrauterine growth restriction
Born at term but they weren’t receiving nutrients because of what mom was doing (this is what makes it different from preterm)
o Can happen to someone who mom is on illicit drugs, cigarrete smoking, or alcohol
ERYTHROMYCIN OINTMENT
o Protects baby against gonorrhea if mom delivers vaginally and wasn’t screened
Vitamin K prophylaxis: IM injection
o Baby is born they don’t have vitamin K so it helps with clotting mechanism to prevent hemorrhage
Hepatitis B Vaccine
o CONSENT IS REQUIRED
o 3 shots: one done at hospital, 2-3 months later 2nd dose is given, 6-10 months 3rd dose is given
IF MOM IS HEP B POSITIVE
o then baby needs to get Hep B Immune Globulin (HBIG)
Vaccine needle for newborn
25 gauge, 5/8 inches
Umbilical cord care
keep area clean and dry
o Within 7 days cord will dry up and fall off
therapy for jaundice
· Prevention is best therapy
· PHOTOTHERAPY is treatment (bilirubin light)
nursing considerations for jaundice
o PROTECT BABY EYES, cover the eyes
o Baby must be WITHOUT clothing so light is directly on skin
o KIDNEYS CAN HELP TO GET RID OF BILIRUBIN so make sure baby is well hydrated
Hypoglycemia
abnormally low level of glucose (<45mg/dL)
normal BG in newborn
45-60 mg/dL
prevention of hypoglycemia in newborns happens through
early feedings
GBS POSITIVE MOM; if mom did not receive 2 does on antibiotics then
o CBC and blood cultures will be done before getting antibiotics
PKU (phenylketonuria) Test
o Blood in each circle from HEEL STICK
o Newborn has to be 24-48 hours old
o Arizona screens for 31 conditions
Heel Stick Location
lateral surface of heel
CRIES Neonatal pain scale
Crying
Requiring increased oxygen
Increased vital signs
Expression
Sleeplessness
Management of neonatal pain
o Swaddling, non-nutritive sucking, kangaroo care
non-nutritive sucking
- Infant’s chief pleasure
- Using fingers, thumb, or pacifier
- Excessive pacifier use
- Pacifier use and decreased SIDS
Feeding patterns
o Feed on demand or every 2 hours
