unit 3 Flashcards
normal temperature for newborn
97.7-99.7
normal respirations for newborn
30-60bpm
normal glucose for newborns
50-140(can be down to 45 for first 24hr)
what to do if there is an abnormal glucose
recheck in 30 min
if still low conduct interventions
most accurate place to take a temperature for babies to 3 months
rectal
how to take temperature for 3 months to 4 years
digital
rectal
axillary
when can you use tympanic temperature
at 6 months
why do baby’s struggle to regulate body temperature
-no fat storage (no insulation)
-lack of brown fat=cold stress
-blood vessels close to skin (lose heat)
-larger body surface to weight ratio
what is thermoregulation
balance of heat loss and heat production
how does muscle tone affect thermoregulation
affected by muscle tone
poor muscle tone=poor thermoregulation
what is PKU
newborn screening test
what does PKU do
-identify genetic diseases
-inborn errors of metabolism (thyroid problems, sickle cell)
what screening does not require parental consent
PKU
(but if parents refuse its a no)
what is important when having a PKU screening
-shouldnt be collected prior to 24hr of age
-timing of ample & amount is important
-results in 2 weeks
what screening test is required by law in every US state
PKU (newborn screening)
what other newborn screenings are important
hearing screen
critical congenital Heart Disease (CCHD)
new born reflexes
-babinski
-moro
-tonic
Babinski reflex
rub the bottom of baby’s foot
-toes should splay
Moro reflex
lean back
-stretch arms out
Tonic reflex
turn baby head
-fencing pose
asymmetric Moro reflex
indicate a problem
-birth trauma
-fractured clavicles
other reflexes
palmar grasp
plantar grasp
rooting/sucking
head righting
stepping
what does an absent reflex mean
indicate an underlying problem
Circumcision complications
decr urine output
bleeding
infection
revision
types of circumcisions
plastibell
yellen
Gomco
SGA
-small gestational age
-birth weight under 10th percentile
SGA causes
-preterm or term (any GA)
-hypoglycemia
-poor thermoregulation
SGA asymmetrical
head circumference WNL, weight less than 10th percentile
Head>body
-good head got needed nutrients
SGA symmetrical
head and weight less than 10th percentile
head=weight
-body and head got same nutrients (possibly underdeveloped)
LGA
-large for gestational age
-over 4000G (8lbs 13oz)
causes of LGA
larger parents
incr weight gain in pregnancy
diabetic mother
LGA effects
-hypoglycemia (hyperglycemic in utero)
-hypocalcemia
-tachypnea (respiratory distress syndrome)
-incr risk of perinatal asphyxia
-incr risk birth trauma
-incr risk of C section
why is Vitamin K important
coagulation occurs in liver, liver doesn’t work right away, at risk of bleeding
-activates clotting factors
-coagulation deficiency 2-5 day of life
-prevent hemorrhaging
how to assess for congenital hip dysplasia
-assess hip fold
-Barlow Ortolani maneuver
signs and symptoms of hip dysplasia
-popping
-cracking
-decr ROM
-asymmetry of skin folds
what does asymmetry in femoral pulses
coarctation of aorta
what is considered delayed cord clamping
30-90 seconds
benefits of delayed cord clamping
-more blood (incr blood volume & BP)
-decr risk on intracranial hemorrhage
Cons of delayed cord cramping
-incr jaundice risk (hemolysis incr)
-cross blood brain barrier
(brain damage, seizure, death)
meconium
stool in lower intestines AT birth
what causes meconium
-stress
-post date (after 42wk)
-cord compression
-placenta break down
when should meconium be passes
8-48hr
what can meconium cause
aspiration pneumonia
post term babies
after 42weeks
characteristics of post term babies
-poor oxygenation
-wasting syndrome
-hypoglycemia
-LGA
-skin like parchment (peeling)
what is wasting syndrome
-skinny legs & buttocks
-normal head
complications of post term babies
-oligohydramnios
-cord compression
-birth trauma
-hypoglycemia
-meconium aspiration
characteristics of preterm babies
-immature organ systems
-lack adequate nutrient reserves
-head larger than chest
-poor muscle tone
-undesended testes
-poorly formed pinna
-fused eyelids
-soft skull suture
-few creases
-vernix
-lanugo
-thin skin
-SGA
-lack of lung surfactant
immature organ systems results
-jaundice
-temperature regulation issues
-small
-trouble feeding
breastmilk nutrition
-0.5oz/day
-complete nutrition (not Vit D & iron)
-eat every 2-3hr
-6-8 wet diapers/day
-poop once a week or after meals
-gain 0.5-1oz daily
-jaundice
breastmilk jaundice
-late onset 5-10days of age
-feeding well, weight gain
-peak 2nd week
-factors in breast milk
what happens to birth weight
lose 10% of birth weight, back to birth weight by 2 weeks
formula nutrition
-1oz/day
-iron fortified formula
-feed every 2-4hr
-foul odor stools
-BM multiple times/day
transitioning to solids
-4-6 months
-1 every 3 days
-sippy cup at 6 months
foods babies don’t need
-juice never needed
-no whole milk till 1 yr
-no skim milk till 2 yr
-no honey until 1 yr
types of heat loss
conduction
evaporating
radiation
convection
convection
air/wind blows heat off the body
evaporating
baby is wet, loss of heat from liquid turning to vapor
conduction
loss of heat touching a cool surface
radiation
close to cool surface, heat radiates to it
result of cold stress
- incr RR
-respiratory distress
-acidosis
-oxygen diverted from Brian & growth & thermogenesis
thermogenesis
generates heat by increased muscle activity
signs & symptoms of a cold baby
-cry
-restless
-incr cellular metabolic activity
-dont shiver
-metabolize brown fat
where is brown fat metabolized
-axillae
-vertebral column
-kidneys
(depleted with cold stress)
signs & symptoms of respiratory distress
-grunting
-nasal flaring
-retractions
-color
(they only breathe like that for so long then they stop)
what causes respiratory distress syndrome
-prematurity (can affect some post term)
-lack of lung surfactant (less than 34wk less surfactant)(unstable chest wall, immature respiratory center)
causes of respiratory distress syndrome
-prematurity
-maternal diabetes
-acute antepartum hemorrhage
-asphyxia at birth
-males twice as often
respiratory distress prevention
-determine lung maturity
-administration of steroids (betamethasone/ dexamethasone)
resuscitation after delivery
-positive pressure ventilation
-compressions if HR less than 6-bpm
adjusting age
term - gestational age= weeks early
weeks early - weeks since birth= corrected age
physiological jaundice
-premies & term (delayed cord clamping)
-AFTER 24 hr
-incr eating resulting in urine & BM
-phototherapy
pathological jaundice
-ABO & RH factors
-BEFORE 24 hr
-can cause kernicterus, lethargy, poor feeding, hypotonia
-transfusion if phototherapy not work
thrush
-fungal infection
-sick, antibiotics, cleft lip, bottle feeder, pacifier users
-candida albicans
-topical/skin
candida albicans
-oral
-white/velvety
-DOESNT wipe off
topical/skin thrush
-red bumpy patches
-armpits, groin, trunk
treatment of thrush
-oral nystatin
-topical ointment/powder
vernix
-cheese like on skin
-protective/antimicrobial
-prevent fluid loss
acrocyanosis
-blue extremities (blood is going to vital organs)
-normal
central cyanosis
-cardiac/respiratory problem
-sepsis/toxins
-trunk is blue
mottling
-temporary
-vascular constriction (decr perfusion in vessels under skin)
-sepsis, cardiac defect, autoimmune
milia
-white dots on the face
-resolves
-common
mongolian spot
-common birth mark
-fades
-pigmented babies
erythema toxicum
-resolved in 2 weeks
-not sure why it happenes
telangiectatic nevus
-stork bite/angel kiss
-immature blood vessels
-fade
port wine stain
-swollen blood vessels
-dont go away
-neuro issues, glaucoma
nevus vasculosus
-vascular tumor
-can grow
-concerning on neck (compromised airway, bleeding)
risks for babies born from gestational diabetic mothers
-LGA
-hypoglycemia
-RDS
child life
-promotes coping
-therapeutic interventions
child life does NOT
-nursing process
-med administration
-invasive procedure
Necrotizing enterocolitis
-causes by asphyxia & hypoxemia injury in intestines
-necrotic injury to bowels (from decreased blood flow)
NEC sign
-behavior changes
-VS changes (temp, apnea, bradycardia/pnea)
-emesis
-abdominal growth(blood in stool)
treatment of NEC
-NPO
-bowel rest
-NG tube suction on low (mouth not nose till after 4weeks)
Apgar
-assess adaption from intruder to extrautero
-at 1 min and 5 min
(0,1,2)
categories of apgar
-respiratory (effort/crying)
-heart rate/ pulse
-muscle tone
-reflex/ irritability
-skin color
Apgar ranges
7-10 = normal (bulb suction)
4-6 = moderate distress(deep suction)
1-3 = severe distress (NICU, respiratory distress)
retinopathy
-high oxygen levels = vasoconstriction = stop in vessel growth = blindness & detached retina
who is at risk for retinopathy
-preterm/LWB
-anyone with O2 supplement
-2 3/4 lbs or less
-born under 32weeks
prevention of retinopathy
-low O2 concentration
-lower parameters (83-93%)
-early detection (ophthalmology)
-monitor ABG
retinopathy outcome
-90% resolve
-10% visual impairment
-laser surgery/cryotherapy (bad case)
-corective lenses
NICU care
-mimic uterine environment
-minimal stimulation(quiet, cluster care)
-skin to skin
-stimulate sucking reflex
-rice cereal in feed
STABLE
specialized NICU training
-sugar & safe care (fluids, correct glycemia)
-temperature regulation
-airway
-blood pressure
-lab work
-emotional support
NICU developmental care
-gentle handling
-temp stability
-minimal stimulation
-quiet/dark, cluster care
-sucking
-aids
-skin to skin
-parenteral involvement in care
car seat safety
-dont go home unless they have car seat
-rear facing as long as possible
-installed correctly
-45degree angel
sleep safety
-no swaddling (SIDs)
-baby on back to sleep
-tummy time when awake
-nothing in crib with baby
-GERD life head of entire crib
abstinence syndrome
-weeks to months to resolve
-encourage breastfeeding (helps with withdraw)
-symptoms–> methadone, phenobarbital
-babies are irritable, difficult to console, shaky
developmental milestone 4 months
roll belly to back
developmental milestone 6 months
roll back to belly
developmental milestone 7 months
start walking
developmental milestone 9 months
sit without support
pincer graps
crawling
developmental milestone 12 months
crawling
pulling up
causing on furniture
walking
one word
developmental milestone 18 months
6 words
walking
developmental milestone 2 years
20 words
two word sentences
developmental milestone 3-6 years
forming sentences
drawing basic shapes
developmental milestone 6-12 years
complex sentence structure
writing legible
developmental milestone 12+
concrete thoughts
words and meanings
manipulate objects
when should the first bowel movement occur
no later than 72 hr (obstruction, malrotation)
number one symptom of illness in neonate
change in mood (decr personality)
true apnea
-stop breathing longer than 20 sec
-Bradycardia (cardiovascular issues)
normal breathing
-breathe quick, stop, breathe slow
-learning how to breathe
-obligatory nose breather till 3-4weeks
abnormal breathing
-below 60, above 80
-seesaw breathing
-nasal flaring
-grunting
-retractions
-tachypnea
caput succedaneum
-MOVE across suture lines
-2-3 days resolve
-edema bruising
cephalhematoma
-DONT move across suture lines
-months to resolve
-can calcify
Erickson: infant(0-18mo)
trust vs. mistrust
-caregiver relationship
Erickson: toddler (18mo-3yr)
autonomy vs. shame & doubt
-independent from parent
Erickson: preschooler (3-6yr)
initiative vs. guilt
-purpose
-within family, exploring
Erickson: school-ager (6-12)
industry vs inferiority
-good with neighbors, friends
-please others
Erickson: adolescent (12-18)
identity vs. role confusion
-love, partners, friends
-their own person
Piaget: birth -2yr
sensorimotor
Piaget: 2-7yr
preoperational
Piaget: 7-11ye
concrete operational
Piaget: 12+
formal operational
