Toni - Week 4/5 - Exam 3 Flashcards
when are APGAR scores done?
done during newborn assessment at 1 min and 5 min of age
what does an APGAR score assess?
assesses how well newborn is adapting to extrauterine life
what happens when the score is less than 7 at the 5 minute assessment?
an additional score is done at 10 minutes
what do low APGAR scores indicate?
low scores indicate baby needs assistance adapting to extrauterine environment
what does APGAR stand for?
Activity, Pulse, Grimace, Appearance, and Respiration
what does acrocynosis mean?
baby’s body is pink and extremities are blue.
what’s an APGAR score of 0-3 indicate?
very concerned
what’s an APGAR score of 4-6 indicate?
may need a little help
what’s an APGAR score of 7-10 mean?
non concerning.
Newborn Respirations: what is the first breath triggered by?
- ↓ O2, ↑ CO2, ↓ pH levels
- Temperature change, noise, light
- ↓ external pulmonary pressure
Newborn Respirations: what are the 4 characteristics of newborn lungs/respirations?
- lungs lined with surfactant
- excess lung fluid is normal in the first hour
- obligate nose breathers (don’t block nose, may not breath through mouth)
- breaths = irregular and raise abdomen
T/F; the first breath is the biggest breath.
TRUE
Newborn Respirations: what is surfactant?
substance that keeps alveoli open - like putting soapy substance in a balloon - doesn’t adhere to each other.
Newborn Respirations: what are 5 things to assess?
- listen to breathing (wheezes/grunts)
- observe effort (look at chest - retracting/shadowing by ribs is abnormal)
- observe skin color (make sure central is pink)
- check cap refill at sternum
- ausculatate lungs anteriorly and axillary areas
Newborn Respirations: what are 3 interventions that we can do to improve respirations?
- reposition to facilitate drainage
- bulb syringe mouth then nose
- percussion/postural drainage
what does grunting sound like?
sounds like singing - respiratory distress`
Temperature Regulation: what are the 4 reasons that babies are predisposed to heat loss?
- large body surface: body weight ration
- head proportionally larger (1/4 body)
- thin skin; vessels near surface
- small musculature; cannot shiver to warm up
Temperature Regulation: what are the 3 characteristics of brown adipose tissue?
- one time supply
- found in term infants
- generates heat first day of life
Temperature Regulation: how does brown adipose generate heat?
- non-shivering thermogenesis, relies on O2 + glucose
- can cause hypoxia + hypoglycemia
- *energy inefficient - we don’t want a baby to do this
Temperature Regulation: what are 7 things we can do to regulate temperature?
- remove wet blankets and dry
- skin to skin contact or under warmer
- maintain flexed position
- no drafts/cold surfaces
- delay bath until temp stable
- apply hat and warm blankets
- monitor temp and actively warm if < 97.7 F (36.5)
- ***recheck temp after 15 minutres
Temperature Regulation: what do we do if low temps persist even after warming?
Report!!! Because chronic hypothermia is a sign of sepsis
Temperature Regulation: what should be done if a baby is too hot?
take hat off, unswaddle
what are the three different stages of transitioning to extrauterine life?
- 1st period of reactivity
- period decreased responsiveness
- 2nd period of reactivity
what occurs during the 1st period of reactivity?
- 30 min - 2 hr after birth
- awake/alert
- nursing/attachment (vigorous suck reflex)
what occurs during the period decreased responsiveness?
- 2 - 4 hrs deep sleep
- HR/RR slow
- difficult to awaken
what occurs during the 2nd period of reactivity?
- awakes from deep sleep
- alert; increased tone
- may exhibit hunger cues
what are some hunger cues?
- hand in mouth (early sign)
- crying (late sign of hunger)
what are the different newborn reflexes?
- morro reflex (arms extended C with hands)
- palmar grasp
- sucking reflex
- stepping reflex (may prepare for develop of walking)
- babinski reflex (stroke heel to toe - 6 - 24 mo)
- rooting reflex
- thumb below toes - curl around finger ( if -, concerning)
what are the 3 characteristics of a newborn head?
- 1/4 body length
- 32 - 37 cm
- fontanels (anterior - close 18mo; posterior - 6 wks)
what are the two conditions that can happen to a newborn head?
- caput succedaneum - edema under skin; bubble across suture line (won’t last long)
- cephalohematoma - takes 6 wks to resolve; hard, colorful blood beneath periosteum; ↑ bilirubin → breakdown of RBC
what are normal/abnormal findings concerning newborn eyes?
normal: subconjunctival hemorrhage - pressure from vaginal delivery
abnormal: discharge
what is abnormal concerning newborn nose?
discharge from the nose is abnormal
where are the ears normally sitting?
normally at eye level
what are the 5 characteristics of a newborn GI system?
- meconium within 24 hrs (thick,black)
- yellow stools by day 5 (teach - this is how you know getting enough breast milk)
- no intestinal bacteria (need vitamin K shot)
- digest proteins/carbs easily
- regurgitation common - teach difference b/t vomit and spit up
what are the 5 characteristics of the newborn GU system?
- 6-8 voids per day by 1 week of age
- genitalia edematous and pigmented (expression of maternal hormone)
- uric acid crystals (orangey pink - teach)
- female pseudomenstruation (expression of maternal hormone)
- undescended testicle (cryptorchidism - should come down over time )
newborn skin: what does the color look like?
depends on activity and H+H levels
- mostly ruddy (red) d/t an increased H + H - glows red
- can be moddled - pink/white color
newborn skin: what 7 skin conditions can a newborn have?
- petechiae/ecchymosis (tiny hemorrhages/bruising)
- acrocyanosis (hands/feet blue)
- erythema toxicum (flea bite rash - small pustules on new born skin - temporary)
- milia (normal finding - disappears)
- lanugo (hair/furry - disappears)
- vernix caseosa (creamy/cheesy coating, early born babies, protective, rub it in skin)
- mongolian spots (blue pigment in body - dark skinned infants - bruise-like - disappears at age 4)
newborn skin: what occurs with newborn nipples?
nipple engorgement and discharge - maternal hormones
- happens in both male and females
- temporary
newborn skin: what should we assess the spine for??
observe spine for dimple or tuft of hair - spina bifida
what are the 5 newborn behavioral responses?
orientation, habituation, motor maturity, self-quieting, and social behaviors
behavior: describe orientation.
response to human voice - “look how baby widens eyes - he’s looking at you” - also helps with bonding
behavior: deceive habituation.
the ability of infant to respond less to stimulation over time - some do, some don’t - parents will create environment that’s quiet and less light
behavior: describe motor maturity.
hunger, pain, temperature, handling, cry or awaken -> tremor of chin -> motor immaturity common -> startling is normal, jerky movement. consistent? now bring to attention.
behavior: describe self-quieting.
ability of infant to bring to a lower stage (ie thumb to mouth) others need to be consoled -> should be consolable -> inconsolable may have something wrong (trust gut)
behavior: describe social behavior.
swaddling; not cuddling? thrashing/arching.. may thing baby doesn’t like me - some babies prefer not to be close - like to look around - adds belly pressure
what is normal range for newborn HR?
100-150 bpm
what is normal newborn RR?
30-60 breaths per minute
what is a safe range for newborn temperature?
36.5-37.5C (97.7-99.5F)
when and where is BP taken?
BP taken at birth in R arm and R leg - we don’t do this - BP followed up only if abnormal
how can we assess pain?
high pitches cry, difficult to calm - use NIPS scale
when and where is O2 sat taken on a newborn?
O2 sat taken on right arm and right leg
- assessed before DC to rule out congenital heart disease
what should O2 sat be in a newborn?
O2 sat greater or equal to 95% in both extremities
- difference between upper/lower < 3%
T/F: vital signs reflect baseline even when a baby is crying.
FALSE. not baseline - take again when baby is consoled
what are the benefits of breastfeeding in relation to the mother?
- decreased risk of cancer (ovary, breast, and uterus)
- decreased risk of osteoporosis
- decreased risk of CV disease
- decreased risk of type 2 DM
- decreased risk of PP depression
- decrease ovulation - delay menses
- increased weight loss
- promotes involution
- facilitates bonding
why is breastmilk the superior infant food?
- absorbable (use breast milk so well; may be little left to make stool)
- fresh and safe
- living tissues (full of Ig - treated like blood in hospital)
what benefits do infants get from breast milk?
- passive immunity from mom
- decreased illness + allergies
- decreased incidence of SIDS
- decreased risk of obesity
- decreased risk of RSV, UTI, Type 1 DM, lymphoma
- increased IQ (cognitive development)
what is the process map of breast feeding anatomy?
alveoli produce milk - muscle around alveoli send milk forward - pores allow milk transfer - oxytocin produces let down reflex
what “law” does breast milk follow?
the law of supply and demand. more milk removed; the more milk produced (pump pump pump!)
what is a good breast feeding position?
- mom sitting up straight with baby at chest level
- place nose to nipple, chest to chest, chin to breast, and wait for wide open mouth
describe the cross cradle?
hand same side as breast forms nipple and areola to U shape; other hand supports neck and shoulders
describe the football hold.
infant head and shoulders in palm of hand, body supported on forearm. Nipple and areola formed in C shape.
what does pain indicate during a feeding?
malpositioning
how should a baby look when latched?
- lips flanged on areola (cover 1 - 1 1/2 inches of areola, and bottom lip covers more than upper)
- audible swallowing
how can a baby be detached from the breast?
Mom breaks latch with finger between areola and lip
what should be assessed after detachment?
nipple shape (look like lipstick tube → straight)
what does LATCH (score system) stand for?
latch, audible swallowing, type of nipple, comfort (breast/nipple) and hold
when is the LATCH score taken?
at least once during shift
how much milk do breasts make in a day?
25 - 35 oz/day
how much does an infant (1 - 6 mo) drink in a day?
25 - 35 oz/day
what is an average size of a breast milk “meal”?
3 - 5 oz
what is the pattern of normal infant weight gain?
- loses 5 - 10% of birthweight; > 10% loss pathological
- regain birthweight by day 10
- 1 oz/day first 3 to 4 months
- doubles by 6 months; triples by 1 year
what is a newborn’s stomach size at day 1, day 2, one week, and one month?
day 1: size of cherry (5 -7 mL)
day 2: size of walnut (22 - 27 ml)
week 1: size of apricot (40 - 60 ml)
month 1: size of large egg (80 - 150)
how often should breastfeeding be offered?
feed on demand 8 - 12/day
one or both breasts per feed
alternate 1st breast each feed
what are 4 hunger cues?
rooting, sucking on fists, clenched fists, and crying (late sign)
what is an intervention for flat/inverted nipples?
nipple/breast shield (we don’t initiate → lact. specialist does)
what are 4 interventions for sore nipples?
- reposition
- lanolin in b/t feeding
- hydrogel pads (ordered)
- assess for candida (red nipples/thrush in baby)
what are 4 interventions for low milk supply?
- frequent feedings (wake baby up q2hr)
- offer both breasts
- “finish” one side before switching
- pump after feeds
what can be used as galactagogues? (promotes more milk supply)
- fenugreek (OTC, teas, pills, etc)
- domperidone (↑ prolactin; antiemetic)
if mothers can’t/won’t breastfeed, what is recommended?
American Academy of Pediatrics (AAP) recommends breastmilk or FORMULA for 1st year.
what are the different types of formula?
powdered, concentrated, and ready-to-feed
what are the 4 recommendations when it comes to handling formula?
- sterilization of equipment recommended
- pathogens found in powered formula → mix with boiled water > 70C (158F)
- Don’t microwave → bring to room temp in warm water
- discard any unused formula after 2 hrs
what 10 things should be implemented for bottle feeding?
- feed on demand q 3 - 4 hrs
- watch for hunger cues
- avoid use as first calming option
- allow baby to pace feeding
- hold close, head elevated
- allow baby to take nipple
- keep nipple full of formula
- alternate sides
- pause to burp during and after feeding
- allow baby to determine when finished
what is the 3 steps to newborn heel sticks?
- warm heel for 5 min prior
- avoid milking
- 1 drop is wiped away
what are the 3 complications of heel sticks?
scarring, infection, and osteomyelitis (delays walking)
what are the 3 newborn screen tests?
- phenylketonuria (PKU)
- Galactosemia
- Congenital hypothyroidism
what is PKU and how can it be treated?
- cannot metabolize phenylalanine (protein), causes mental retardation if untreated
- treatment: diet - controlled
what is galactosemia and how can it be treated?
- cannot metabolize galactose, can cause mental retardation and dehydration if untreated
treatment: diet - controlled
what can congenital hypothyroidism cause and how can it be treated?
can cause intellectual disability if untreated
tx: hormone replacement
what 3 things occur for newborn prophylaxis?
erythromycin opthalmic ointment
vitamin K
Umbilical cord kept clean and dry
what is erythromycin opthalmic ointment for and when do we apply
prevents newborn eye infections
apply within 1 hr of birth; leave on 1 minute - wipe off excess
what is vitamin K for and when do we admin?
to prevent newborn hemorrhage; newborn gut sterile; cannot make vitamin K; Admin IM within 1 hr of birth into the thigh
what is the hepatitis vaccine and when is it given?
Immunization against Hep B virus; Admin IM vastus lateralis; recommended for all infants; only vaccine given to newborn; requires MD order, obtain parent consent
what is the recommended schedule for hep B vaccine?
0, 1, and 6 months
what is the AAP statement on circumcision?
has health benefits/outweighs the risks; should be option for parents; explain benefits and risks to parents; obtain informed consent; analgesia must be provided
what are the benefits of circumcision?
prevention of UTI, penile cancer, STI including HIV,
what are the 5 things to teach parents regarding circumcision?
- wash gently with water
- apply neosporin or petroleum jelly as ordered (to diaper too)
- expect crusted yellow exudate for 2 - 3 days
- monitor for bleeding and infection
- should void by 8 hrs post procedure
what are the 2 different methods of circumcision?
plastibell and gomco clamp
