test 4 Flashcards
neonate period
first 30 days. Baby has to adjust to extrauterine life.
They need to complete this list
physiological adjustments baby needs to make after birth
establishing and maintaining respirations
adjusting to circulatory changes
regulating temp
ingesting, retaining, and digesting nutrients
eliminating waste
regulating weight
first period of reactivity
first 30 mins of life
stabilization of HR, RR
alert, responsive, usually hungry
golden hour- Use this time to do skin to skin and get baby breast feed. Allows bonding before baby goes to sleep
sleep phase
after first period of reactivity
may last from minutes to hours, difficult to awake
second period of reactivity
2-8 hours after birth
peristalsis increases
first meconium may occur, gagging, spiting up
when are babies weighed
they are weighed every 24 hours
not weighed right after birth typically
what gets suctioned first if needed
mouth before nose!
what causes initiative of breathing
chemical- increased co2
mechanical- Negative thoracic pressure, baby cries and draws air into lungs
thermal- cold environment
sensory- drying baby off, suctioning
normal new born breathing
nose breathers- not mouth
chest and abdomen rise synchronously
shallow and irregular pattern with pauses lasting under 20 secs
30-60 breaths/min
abnormal newborn breathing
grunting
nasal flaring
retractions- skin is retracting with ribs
seesaw respirations
persistant cyanosis
tachypnea >60
gasping
newborn resp distress
around 120 breaths per minute. Intubation needed
TTN (transient tachypnea of newborn)
baby isn’t transitioning as well as should. Encourage more skin to skin or if its bad then possibly nursery
2 cardio changes that occur with birth
Foramen ovale - closes quickly after baby starts breathing
Ductus arteriosus- doesn’t shut for 24-48 hours.
Murmur could be heard as ductus arteriosus is closing
If ductus doesn’t close- cardio symptoms may occur
acrocyanosis
bluish discoloration of hands and feet
normal if within first 24 hours bc of extrauterine circulation transition.
does not occur in all babies
why are babies at risk for heat loss
Blood vessels are closer to skin, don’t have much fat, they don’t shiver
how can baby warm up
We want a thermo environment that is warm - skin to skin, hat, blankets, flexion of muscles, metabolize brown fat
thermogenesis- baby makes own heat by moving
4 heat loss mechanisms
conduction- occurs if touching something cold- heat transfers to it
convection- from air moving toward them like fan
evaporation- could occur if wet
radiation- heat transfer from one object to another without physical contact. ex- cold wall near by
brown fat
only in newborns
amount increases with gestational age
usually present for several weeks unless cold stress
Once it is burnt off its gone.
Metabolized, could warm a infant, but calories and oxygen will be burned to do this
what could happen when a baby is cold
hypoglycemia- due to a increased metabolic rate to produce heat
acidosis- Brown fat converted to heat and fatty acids, fatty acids lower pH
Hypoxia- requires extra o2 to produce heat
desired temp for baby
36.5 to 37.5 C
(97.7 to 99.5 F)
what can cause hyperthermia in newborns
they dont sweat, too much heat/clothes
what should 24 hour bilirubin be
under 7
bilirubin in babies
Unconjugated bilirubin- cant be excreted. Must go to liver to get conjugated to get excreted by stool.
if bilirubin to high in baby, could cause kernicterus (neuro issues)
Why are all babies at risk for elevated bilirubin
there RBC have a shorter life, and there livers are immature
this would be physiologic hyperbilirubinemia
what puts babies at even more risk to develop elevated bilirubin
Coombs positive, breast feeding if not effective, prematurity, family history
this would be pathologic hyperbilirubinemia
when should baby have first stool and pee
first day of life
harlequin sign
half of babys face turns red
petechiae in newborn
could be from traumatic birth or sign of menigitis
mottling
purple rings occur when baby is cold
vernix caseosa
waxy white substance found on newborns.
more common in preterm
desquamation
newborn peeling skin. more common in post term
nevus vasculosus or “strawberry mark”
raised red bits on newborn. they go away with time
nevus flammerus “port wine stain”
red mark on newborn face. Skin will not blanch with this and it does not go away
caput succedaneum
edema of scalp. goes away on its own
subgaleal hemorrhage
collection of blood between skull and periosteum. goes away on its own
cephalohematoma
bleeding under scalp, treatment is needed
if newborns are tremoring at rest, what may the issue be
NAS, hypoglycemia, neuro issue
newborn reflexes
sucking and rooting
swallowing
grasp
extrusion
glabellar
tonic neck
moro
stepping
babinski
what sense is not fully developed when baby is born
vision
six sleep-wake states
deep sleep
light sleep
drowsy
quiet alert
active alert
crying
APGAR meaning
activity
pulse
grimace
appearance
respiration
best score is a 10
0 points for APGAR
activity absent
pulse absent
grimace floppy
appearance blue
respiration absent
1 point APGAR
flexed arm and leg
pulse below 100 bpm
grimace- minimal response to stimulation
appearance- blue extremities pink body
respirations slow and irregular
2 point APGAR
Active activity
pulse over 100
grimace- prompt response to stimulation
pink appearance
vigorous cry (respirations)
what to worry about for LGA babies
BG
where is head circumference measured at
above eyebrows
where should babys ears line up
eye length
what to assess in umbilical cord
number of vessels
hernia
sign of infection
hydrocele
fluid in scortal sac
what on hand may be a indication of down syndrome
simian crease
what do you need to know to graph bilirubin
hours of age
lab result (TSB)
gestational age
risk factors
phototherapy
for jaundice
baby needs eye protection, skin care, turned q2, monitor temp
how are infants lab drawn
by heel
when should umbilical cord fall of
2 weeks
do sponge bath until its off
what is common find for labia in newborns
edema
there also may be some discharge or pink stains in diaper
what can u do for baby hip dysplasia
ortolani maneuver
scale that estimates baby’s gestational age
Ballard scale
benefits of skin to skin
faster and easier transition
better temp, resp and glucose reg
lower stress levels
breastfeed longer
improved maternal bonding
less anxiety for mother
meds for newborn
vitamin K for clotting
hep B vaccine
eye prophylaxis for gonorrhea as it may cause blindness
circumcision care
monitor for bleeding
monitor for infection
don’t bathe until circumcision looks normal
wrap penis with Vaseline and gauze until healed to prevent scab from falling off
what hormone prepares mom for milk
prolactin
what are breast feeding moms at lower risk for
postpartum hemorrhage
what can occur when breast feeding early on
after pains
how many feeds should newborns have in 24 hours
8-12 feedings
should be done every 2-4 hours but as baby is hungry
how many pee/poos should baby have on day one
one pee and one poo
day 2- two pee , two poo
day 3- three pee, three poo
by day 5 of life, how much should baby pee/poo
they should have 3 stools and 6-8 wet diapers
how long is breast milk good for
room temp - 5 hours
refrigerator - 5 days
freezer- at least 5 months
dont microwave breast milk!
how much should babys eat
day 1-2 - 15-30 mL per feeding
then should be increased 5-10 mL per day and should be 90-150 mL by end of second week
newborn birth injuries
skull fractures- linear or depression
fractured clavicle
peripheral nervous system injury
facial paralysis
neuro injury (such as from o2 injuries, blood flow issues, etc)
fractured clavicle signs and symptoms
crepitus over the area
absence of moro reflex on that side
feeling of dislocation
immobilize arm by swaddling them
when dressing baby- use affected arm first, and when taking clothes off use nonaffected arm
peripheral nervous injury
also called erbs palsy
nerve injury- branchial plexus
could heal in 3-6 months if not permanent
avoid pulling on arms
do PROM exercises in a week or 2. baby cant move arm
teach parents how to dress and undress
do not immobilize
facial paralysis care
cant close mouth so may need to be tube feed at first
eye may dry out wince one cant close so we will need to prevent this
Hypoxic ischemic brain injury (HIE)
Brain injury due to lack of oxygen
what puts babies more at risk for neuro injuries
the lower the gestational age, the higher the risk
examples of neuro injury problems
cerebral palsy
seizures
hydrocephalus
therapeutic hypothermia
used for hypoxic ischemic brain injury
we cool them because it slows the neurological damage
early onset sepsis in newborns
acquired in perinatal period
from direct contact with GI/GU tracts- UTI, frequent cervical checks, meconium stained fluid
most common organisms- GBS, E coli
usually manifests within 72 hours of birth
high morality- 3-40%
progresses rapidly
late onset neonate sepsis
acquired in hospital/community
most common cause- Staph. could also be E coli, enterobacter cloacae, canida
usually occurs at 7-30 days of age
mortality rate 2-20%
signs of neonate sepsis
apnea, bradycardia
tachypnea
grunting
nasal flaring, retractions
tachycardia
hypotension
temperature instability
irritability
seizures
lethargy
decreased perfusion
jaundice
pallor
feeding intolerance
abdominal distention
petechiae
TORCH acronym
5 infectious diseases
these are harder diseases to identify
Toxoplasmosis
Other (like hep B, HIV, syphilus)
Rubella (german measles)
Cytomegalovirus (CMV)
Herpes simplex virus (HSV)
signs of withdrawl in newborns from substance abuse
irritability
hyperactivity
exaggerated moro reflex
high pitched cry
tremor
fever
diaphoresis
mottled skin
poor feeding
frantic uncoordinated suck
dehydration
V/D
disrupted sleep patterns
temp instability
how to drug test baby
urine sample of baby and mom tells what mom took recently
meconium of baby tells us a bigger picture
common congenital defects
congenital heart disease
abdominal wall defects
imperforate anus
neural tube defects
cleft lip or palate
club foot
developmental dysplasia of hip
preterm infant risk factors
previous preterm
maternal infections
multiple gestation
htn
placental issues
diabetes
heart disease
kidney disease
smoking
drug use
poor nutriton
weakened cervix
younger than 17 or older than 35
conceiving via IVF
multiple miscarriages/abortions
nursing care for substance abuse
cluster care
decrease stimuli
NAS scoring
skin care
swaddle tight
encourage breastfeeding
bonding
hydration
if mom is RH- and baby is RH+ what needs to be done
rho-gam within 72 hours of delivery in case of another future pregnancy
if mom gets pregnant again, rho-gam will need to be given again at 26-28 weeks
if we don’t do this, moms antibodies will attack future baby
baby will most likely need phototherapy
when is indirect vs direct coombs test given
indirect when mom is pregnant
direct when mom is post partum
infants of diabatic mother issues
congenital abnormalities
RDS
extreme prematurity
macrosomia
hypoglycemia
mom needs to maintain euglycemic status to prevent these!
high risk problems related to preterm infants
thermoregulation
hypoglycemia
hyperbilirubinemia
sepsis
resp function
cognitive and motor delays
why is RDS common in premies
they dont have surfuctant yet
necrotizing enterocolitis (NEC)
The most common neonatal intestinal emergency, characterized by intesntinal ischemia. could lead to bowels spilling into perineum
Goals: Stabilize infant, treat infection, rest intestinal tract
needs to be treated with abx. discontinue feedings, NG tube for abdomen depression, Initiate IV fluids. monitor vitals.
encourage mom to breast pump and freeze
s/s of NEC
*not tolerating feeds, poor perfusion, mottled skin, bilious vomiting, grossly bloody stools, abdominal distention, decreased UO, hypotension, lethargy, jaundice, unstable body temp
care of high risk infant
assess
resp suport
thermoregulation
protect from infection
hydration
nutrition
