the normal newborn Flashcards
what is the importance of surfactant in the initiation of breathing?
it’s necessary for lung compliance (ability to open up alveolar sacs in the lungs so that oxygenation can take place)
intrauterine fetal breathing movements
- fetus practices breathing movement while still in utero
- the purpose of this is so the lungs will be compliant when the baby comes out, it also exercises the chest muscles
baby’s first breath
inspiratory gasp from CNS response to mechanical, reabsorptive, chemical, thermal, and sensory changes
normal newborn respiratory rate
30-60/min
what are some potential signs of respiratory distress?
- increased resp rate
- GFR (grunting, retracting, flaring)
- color change (cyanotic)
ductus venosis
allows blood from the umbilical vein to bypass the liver and enter the right atrium
closes at 4 weeks
foramen ovale
allows blood flow from right atrium to left atrium to bypass the lungs
closes at 30 months
ductus arteriosis
allows blood flow from pulmonary artery to aorta; allows blood to bypass lungs
closes at 2 months
what is the normal fetal pulse ox?
50%
what is rhogam?
IM injection given to prevent antibody formation against subsequent pregnancies
when is rhogam given?
given intra/postpartum, after abortions, and any situation where fetal and maternal blood will mix
methods of heat loss
- convection
- radiation
- evaporation
- conduction
convection heat loss
air current (like a fan) and baby would lose heat
radiation heat loss
baby would lose its heat because there’s a surface or something around it that’s colder
evaporation heat loss
baby is moist and dry air makes it cold
conduction heat loss
baby loses its heat to a surface
ex: putting baby on cold scale
normal temp for a newborn
36.4-37.2
neutral thermal environment
allows for optimal oxygen use, metabolism, and internal temperature because of thermal balance
interventions for hypothermia
- verify temp reading
- double swaddle/place hat
- kangaroo care (skin to skin w/ mom or dada)
- radiant warmer or isolette
role of liver in newborns
**immature
- iron storage (make more RBCs)
- carbohydrate metabolism (baby’s blood glucose is lower than mom’s)
- conjugation of bilirubin (if not excreted = severe damage to organs like the brain)
what is jaundice?
a normal biologic response of a newborn d/t increased bilirubin levels
interventions for jaundice
- elevated transcutaneous bili level? –> follow up w/ a serum
- ensure hydration for excretion
- phototherapy (transfers through skin to excrete bili)
kernicterus
long term, irreversible brain damage
what can excess bilirubin lead to?
kernicterus
breastfeeding jaundice
associated with poor feeding and inadequate fluid intake
interventions for breastfeeding jaundice
encourage frequent feedings and lactation support
breast milk jaundice
begins after day 7; r/t breast milk causing reabsorption of bilirubin from intestine
some women contain breast milk that can inhibit conjugation
interventions for breast milk jaundice
there may be an order to stop breastfeeding
when can we expect the first bowel movement?
within the first 48 hours but typically happens in the first 8-24 hrs
what is the normal frequency of bowel movements?
can range from one BM every 2-3 days up to 10 BM in one day; typically see more BMs than less
meconium stool
formed in utero; contains amniotic fluid, intestinal secretions, and mucosal cells
tarry thick dark green
transitional stool
lasts 1-2 days
greenish, may look like it has raspberry seeds in it
formula stool
typically more formed than breast fed
when do we expect the first void?
within the first 24 hrs
at what point can children fully concentrate urine by?
by 3 months of age, because a newborns kidneys aren’t able to dispose of water rapidly (they have a lower GFR than adults)
nursing care of circumcised newborn
- pain assessment (NIPS)
- pain meds (topical cream, tylenol)
- monitor active bleeding
- beefy red and raw
- liberally applied petroleum jelly
- monitor ability to void
- teach parents about care
first period of reactivity
prime time for bonding and breastfeeding
- HR and RR elevated
- alert from birth-30 min
period of inactivity
should reassure mom that this is normal
- HR and RR decrease
- may sleep up to 4 hrs
second period of reactivity
- HR and RR may increase
- awake and alert for 4-6 hrs
deep sleep
- eyes closed, no eye movement, breathing regular
- HR 100-120 bpm
light sleep (REM)
- irregular RR, sucking motions, minimal activity
drowsy but awake
open or close eyes with fluttering eye lids
quiet alert
alert and may fixate on attractive object
active alert
eyes are open and motor activity is intense
crying alert state
intense state of being alert
grasping reflex
put finger in palm of baby’s hand and will close hand around finger
rooting reflex
lightly stroke cheek and will move towards it, in attempt to suck
disappears by 4 months
stepping reflex
hold baby up right over flat surface, makes stepping/walking motion
disappears at 4-8 weeks
babinsky reflex
gently stroke sole of foot –> fans and extends toes
tonic neck reflex
turn head to one side while infant lays on back, arms extended on side that infant faces, opposite arm and leg are flexed
what does the average baby weigh at birth?
7 lbs 8 oz.
large for gestational age
larger than the 90th percentile
small for gestational age
smaller than the 10th percentile
why do we administer erythromycin eye ointment?
protects against gonorrhea and chlamydia
erythema toxicum
newborn rash
milia
little acne, white heads
don’t pick or put any meds
stork bites
common around nape of neck or forehead and become brighter when baby cries
often fades away w/ time
port wine stain
typically doesn’t fade away w/ time
mongolian spots
seen on darker skin tones; similar to bruising
anterior fontanel
larger, diamond shape, closes at 18 months
posterior fontanel
smaller, triangle shape, closes at 8-12 weeks
what do bulging fontanels indicate?
increase intracranial pressure
what do sunken fontanels indicate?
dehydration
molded head
asymmetrical appearance of the head caused by sutures overriding each other during birth process d/t compression
caput
soft edematous area on the scalp caused by long labor or vacuum extraction
more superficial swelling that may cross suture line
cephalhematoma
collection of blood b/w the surface of the cranial bone and the periosteal membrane
what are our concerns with cephalhematomas?
- will the hematoma absorb itself? –> most do
- increased # of broken down RBCs –> liver immature = risk for jaundice
what does not cross the suture line?
cephalhematoma
strabismus
poor eye muscle control that will develop by 3-4 months of age
doll’s eyes
turn baby’s head R or L and baby’s eye will go opposite direction
epstein’s pearls
- hard white marks in the mouth
- non significant and disappear within a couple of weeks
when assessing the baby’s neck, what would indicate an abnormality?
webbing
when assessing the baby’s abdomen, we want to ensure that…
it’s soft with no distention noted
ortolani’s maneuver
knees together and move legs back, assess for hip click to see that baby’s hips are intact
club foot
do the feet turn inward? this could be positional; from position when baby was in utero
when assessing the baby’s back, what can indicate an abnormality?
- be sure it’s fully closed (no open neural defect)
- assess for hair in this area = indicator of abnormality
jitteriness in newborn
could be a sign of low blood sugar or other issues
when assessing neuro status, what could be a concern?
high pitched cry
what kind of cry do we expect?
strong, lusty, and medium pitched
