Unit 3 & 25 Normal Newborn/AGA/Newborn Variations Flashcards
What is early premature and late premature?
Early Premature 21-33 weeks
Late Premature 34-37 weeks
What is is considered postmature and what happens to the placenta?
42 weeks and greater
-Placenta starts to die from lack of O2/blood supply
Physically how do postmature babies look?
Long, skin flakey, long lashes and nars
When does the greatest weight gain occur in pregnancy?
The third trimester specifically 8th and 9th months
What is the babies weight during the weeks of pregnancy?
<23 weeks = 1 pound 23 weeks = 1 pound 32 weeks = 3 pounds 36 weeks = 4.5 pounds 40 weeks = 7 pounds
What is the assessment 5 minutes after delivery?
- Done under radiant warmer
- Temperature leads attached to chest
- Listen to report from Labor and Delivery
- Know type of pain management, length of labor, type of delivery, medications used in labor
What is ampicillin used for while in labor?
Lowers chance that baby will contract Group beta strep (GBS) given 2 doses
What is Magnesium Sulfate used for in labor and what could happen to newborn?
Pregnancy Induced Hypertension (PIH) could cause hypocalcemia in newborns-newborn will be lethargic(little relfex action)
Why is Vitamin K and Erythromycin ointment given to Newborns?
Vitamin K- given to babies to increase their clotting factor (1mg on admission into thigh w/ 25G 5/8inch TB syringe)
-Erythromycin ointment given to prevent neonatal conjunctivitis (pink eye) within 1 hour of delivery
What are the normal newborn vital signs and how are they assessed/counted?
HR- 120-160, irregular, COUNTED BY APICAL PULSE
Respirations 30-60, short bursts of apnea, count full minute, nose breathers only
Temp- 36.5C to 37C/ 97.7F to 98.6F axillary ONLY (newborns have poor thermo control…keep warm and watch temperature leads) *DONE RECTALLY 1ST TIME
BP- 80/60 (done normally)
Normal glucose 40-60 done through heelstick
What are Newborn body measurement norms?
Weight average 7.8 lbs
Length average 50 cm/20inches
Head Circumference 32-37cm 12 1/2 to 14 1/2 inches
(Chest and Belly smaller then the head)
When is Rhogam started?
at 28 weeks
What is critical info on Nursery Admission placed on kardex?
- Birth date, time, sex, weight, gestational age, type of delivery
- Blood type; Mother and Baby; Coombs test(positive means mother didnt get enough Rhogam)
- Bonded (Golden Hour)
- Breast of Bottle
- Instructions given
- No formula if breastfeeding as per mom/MD
What is assessed in the nursery including levels/ranges?
Rectal temperature upon admission (never oral, temporal, tympanic) axillary thereafter
Assess Hematocrit 40-70 normal
<40 give blood infusion through umbilical to increase level
>70 contact HCP because of hypercalcemia
> 10 = hyperbilirubinemia/jaundice
phototherapy done
Assess for hypocalcemia caused by meds from labor-baby will be lethargic & flaccid
What are SEPSIS SUSPECT maternal factors?
- Poor prenatal nutrition
- Low socioeconomic status
- Substance abuse
- History of STI’s
- Recurrent abortion
- Prolonged rupture of membranes >12-18 hrs
- Vaginal Group B strep
- maternal tachycardia
- invasive procedures during L and D
- UTIs
- Premature labor
Why and when is metabolic screening done on newborn?
heelstick 24 hours after birth
blood test which works to screen for metabolic conditions (ex: PKU-phenylketonuria)- low Phenylalanine which is amino acid for growth and development
Describe what is done for Hyperbilirubinemia/Jaundice in the newborn.
Phototherapy, using protective eye-ware
- Need sufficient feedings/water to prevent dehydrations
- Exchange transfusions
- Stools green due to release of bilirubin
[85% of preterms have it]
What are Neonatal Factors for Sepsis Suspect?
- Prematurity
- Birth weight <2500 grams
- Meconium Staining
- Need for Resuscitation
- Congenital anomalies
- Males
- Multiples
What are examples of Congenital Malformations minor and major?
Minor- Extra digits, webbing, club foot
Major-neural tube defects (spina bifida, anencephaly)
Down syndrome
Heart defects.
gastrointestinal and kidney malformations.
What are common congenital anomalies?
- Tracheosophageal fistula (trachea and esophagus formed together)
- Diaphragmatic hernia (Bowels where left lung is)
- Omphalocele (Stomach on outside)
- Anencephaly (frog baby- lives few hours)
- Cleft lip and palate(fissure connecting oral and nasal cavity)
- Spina Bifida
- Gastroschisis (intenstines outside babies body)
Where/When is the hearing screen done?
In the nursery before discharge
What are risk factors for late onset hearing loss?
- Family hx of childhood hearing impairment
- Craniofacial anomalies
- Syndrome associated with hearing loss
- NICU admit greater than 5 days
- Mechanical ventilation for more than 5 days
- Hyperbilirubinemia requiring exchange infusion
- Congenital/perinatal infection (syphilis, herpes, etc.)
- Meningitis (bacterial or viral)
- Ototoxic Medications (-mycins)
What are important newborn nursery orders?
- Repeat axillary temp hourly until stable 36.5-37C
- Infant may be bathed when temp greater than 36.5C
- Weight on admission and then daily
- Cord care-apply triple dye to base after admission bath
- If cord bilirubin is greater than 4mg notify physician and begin phototherapy
-Put infant to skin in delivery room as soon as mother if able
- Encourage feeding 8-12 times in 24hrs
- Pacifiers and bottles are discouraged
- Feed non-demanding infants if 4 hours pass
What needs to be verified prior to discharge?
-Infant guardian has car seat, copy of discharge instructions and hearing screen has been done
What is the protocol regarding Hep B with the mother and baby?
Mother negative: give baby Hep B vaccine
Mother positive: give baby Hep B vaccine IM stat and at seperate site hep b immune globulin IM stat
Mother Unknown: give baby Hep B vaccine stat
Describe the Newborn’s head.
-Two fontanels: anterior (closes around 12-18 months) and posterior (closes 8-12 weeks) **if the buldges increase that means ICP. If they decrease in means dehydration.
-1/4 of body size 12-14.5 inches circumference
head is 1 inch larger than chest circumference
May see molding/caput if C-section
- Eyes slate blue, real color by 1 year
- No tears until 2 months
- Note presence of nystagmus(flickering eyes)
What is assessed regarding the Newborn’s Head, Neck, ears to eye, and arms?
- Rooting and sucking reflexes
- May pass NG tube through nostril to check to patency
- Ear tips should be symmetrical to outer canthus of eyes, if lower indicates kidney defects
- Should show tonic neck reflex(fencer position)
- Check for brachial and Erb’s palsy
Describe high pitched crying or no cry and lethargy from newborn.
High pitched usually due to increased ICP from traumatic birth or substance abuse
No cry and lethargy from respiratory depression, too much maternal sedation, low blood glucose, or cold
What is Congenital Hydrocephalus?
- Spinal cord problem where there’s an excess of cerebral fluid in the head
- Enlarged head, fontanelles, split or widened sutures, setting sun eyes
- Head circumference >90% on growth chart
What can be assed in the Newborn’s chest if they have a diaphragmatic hernia?
- Asymmetric chest expansion
- Breath sounds might be absent usually on the left side
- Might hear heart sounds displaced to right
- Bowel sounds may be heard in thoracic cavity
What is typically assessed for the Newborn’s heart?
- apical pulse 120-160
- palpate for brachial, femoral, radial, and pedal pulses (compare brachial bilaterally with femoral)
- might hear a transitory murmur
What is Meconium and what follows?
Babies 1st stool -black tarry
2nd Stool- transitional yellow/green
3rd stool and so on yellowy
Stools differ in consistency from breast fed babies to formula babies
What should be inspected regarding the newborn’s abdomen/cord?
- Should be same circumference as chest
- Baby should have 1 vein “the heart” and 2 arteries “kidneys” on the cord. If only 1 of each then congenital kidney issues
Describe Omphalocele.
- Abdominal internals (stomach, etc.) on the outside
- May have closed transparent sac covering
- Treatment is surgical intervention
What is important regarding circumcision of the newborn?
- Should have vaseline gauze on
- Never pull, it will bleed
- Vitamin K for clotting factor
How many diapers should the newborn have in 24 hrs?
-Should have 6-8 wet diapers in 24 hrs
What should be assessed in the newborn regarding hips/extremities?
- Check for hip placement through Otrolani’s Sign (if hips dislocated you’ll hear clicking) looking for congenital hip dysplasia
- Looking for extremities to be equal with equal digits
- Assess for webbing, missing or extra digits, or clubfoot (abnormal turning of foot inward or outward)
What is a Mongolian spot?
- grayish blue spot on lower area of baby as they are forming
- should eventually fade away*
What are pilonidal cysts?
- sacs filled with hair and skin debris that form at the top of the crease of the buttocks above the sacrum.
- considered birth defect like whine stain*
What is Spina bfida?
Spina bifida is a type of birth defect called a neural tube defect. It occurs when the bones of the spine (vertebrae) don’t form properly around part of the baby’s spinal cord.
-Spina bifida can be mild or severe. The mild form is the most common.
Explain the different types of newborn reflexes. Moro, Tonic Neck, Gag, Swallow, Stepping, Rooting, Grasp.
Moro- infant feels like it’s falling. Involves spreading out the arm and crying (usually)
Tonic Neck Reflex- fencing position when infants head is turn to one side. Knee bent and opposite side arm extended.
Gag Reflex- self explanatory, prevents from choking
Swallowing Reflex- self explanatory
Rooting Reflex- triggered when newborn baby’s cheek is touched or stroked along the side of mouth. Will turn head and open her mouth toward the touched side as newborn seeks something to suck.
Grasp Reflex- Stroking or touching the palm of newborn’s hand which makes them clench fist.
Briefly describe weight gain in the newborn.
- Weight doubles by 6 months and triples at 12 months
- Weight gain in 4 to 6 ounces per week
What are the clinical assessments/symptoms and intervention of hypoglycemia in the newborn?
- blood glucose <40
- symptoms include tremors, jittery movements, irregular respirations, apnea, poor feed, hypothermia
Give feed of 5-10% glucose or a bolus dose of D10W IV rate followed by D5 or D10 IV drip
**remember test blood from heelstick
Where is hypoglycemia mostly seen in newborns?
- Often seen with premature, SGA, and newborns of diabetic mothers
- More often seen in newborns with problems of asphyxia, cold stress, sepsis, or polycythemia
- Maternal epidural anesthesia can alter maternal fetal glucose
What happens to newborns during cold stress and what are the complications?
- They increase their oxygen consumption and use glucose for physiological process
- Complications include respiratory distress, resp. and metabolic acidosis, hypoglycemia, and jaundice
What are signs used to assess gestational age?
- plantar creases
- scarf sign (wrist bends like adult means premature baby)
- recoil of ear cartilage
- leg recoil
- square window
- arm recoil
Describe IUGR/SGA babies physically.
- Large appearing head in proportion to chest and abdomen
- Loose dry skin
- Scarcity of subcutaneous fat, emancipated appearance
- Long, thin appearance
- Sunken abdomen
- Sparse scalp hair
- Anterior fontanelle may be depressed
- May have vigorous cry
- Birth weight below 10th percentile
Briefly describe infant of a diabetic mother.
- Considered to be macrosomic
- Upmost importance of careful maternal blood glucose during pregnancy
- Delivered early to due large size
- Appears fat and large
- Has enlarged spleen, liver, and heart
- Cushingoid facial and neck features
What is considered a miscarriage?
Anything under 20 weeks
What is viability weight for premature newborns?
1 lb 6 ounces
How much weight is lost at birth?
10%
Why to newborns come early (premature)?
- Overstretch from multiples
- Short stature of mother
- Incompetent cervix
- Low hormone levels
- Maternal stress
- Excessive physical exercise
- Maternal illness
Describe premies.
- Tend to be ruddy with transparent skin reddish
- Lack subcutaneous fat
- Lanugo plentiful (fine, thin hair usually on shoulders)
- Possible fused eyelids
- Resting position flaccid
- Reflex poor/ unable to suck
- Undescended testies
- hyperbilirubinemia
- anemia
- hypotension
- apnea 10-15 secs
- bradycardic <100 min
- weak cry
After 40 weeks what happens to the placenta?
-Develops infarcts and begins to have localized areas of dead perfusion
-Describe postmatures.
- Dry, cracked skin
- Long finger and toe nails
- Skin loose with long thin body contour
- Often meconium stained due to hypoxia
What are neonatal risk factors associated with jaundice?
- Rh immunization or ABO incompatibility (blood issue)
- Maternal aspirin use
- Sulfonamides or antimicrobial drugs
- Native American, Japanese, Chinese, Korean
- Yellow amniotic fluid on rupture
What are clinical factors associated with Hyperbilirubinemia?
- East asian race
- Cephalohematoma or significant bruising
- Gestation age less than 38 weeks
- Blood type incompatible with positive Coombs
- Exclusive breast feeding
- Jaundice in first 24 hours
What are neonatal behaviors associated with presence of jaundice?
- Poor feeding
- Lethargy
- Tremors
- High pitched cry
- Absent Moro Reflex
- Late signs: vomiting, seizures, rigidity
When should you call the pediatrician post discharge?
- Temp greater than 100.4F
- Persistant lethargy or irritability
- Refusal to eat [skips 2 feedings]
- Vomiting 2 or more feedings
- No wet diapers for more than 8 hours
- Swelling, redness, drainage at umbilical cord
What are some post labor and delivery discharge instructions?
- Schedule appointment to see pediatrician as soon as arrive home
- Healthy full term infants should be placed on their backs to sleep; decreases SIDS. Some infants may need to sleep on their side or belly with certain conditions
- Umbilical cord will dry out and fall off within weeks. Keep clean when diapering, fold diaper down to not cover cord.
- No bath until cord has fallen off and area is dry and healed
- Do not use baby powder
- Use unscented baby wipes
- Minimize # of ppl handling baby
- Vaseline to tip of penis until circumcision heals
What does fetal hypoxia lead to?
Meconium release/aspiration
What is the medical management for post-matures?
- Immediate suctioning
- Oxygen
- Hematocrit
- Blood glucose monitoring (low oxygen means using more glucose for energy)
Describe Meconium Aspiration Syndrome, what the nurse will see, and medical treatment.
- Significant mortality
- Airway becomes obstructed
- Hyperinflation of alveoli
- Chemical pneumonia
- Decreased surfactant
Nurse will see: Barrel chest, respiratory effort, ABG’s, Rales/Rhonchi, Green/Yellow staining
Treatment: Surfactant therapy, Assisted ventilation, sedation with assisted ventilation
What is Persistent Pulmonary Hypertension?
Increased respiratory effort/hypoxia - ending with heart failure, liver damage, kidney damage, hearing loss, neuro deficits, death.
What are risk factors for LGA babies?
- Maternal diabetes*
- Multiparty
- Previous macrosomic baby
What are LGA neonates at risk for?
- Hypoglycemia
- Hyperbilirubinemia
- Breech presentation
- Shoulder dystocia (fractured clavicle, brachial, or facial nerve damage)
- Cesarean births/ operative vaginal delivery
What is the risk factor for Bronchopulmonary Dysplasia and what do the lungs become like?
- Neonates on mechanical ventilation
- Lungs become like leather, hard to expand and relax
What are complications of Bronchopulmonary Dysplasia?
- Pneumonia
- Ear infections
- Cerebral palsy (congenital disorder of movement, muscle tone, or posture.)
- Retinopathy (disease of the retina that results in impairment or loss of vision.)
- Sudden death
What is Necrotizing Enterocolitis (NEC)?
- SERIOUS inflammation/necrosis of bowel
- Caused by anything that will decrease perfusion to the bowel
- 30% will die
How to support parents during premature birth complications/etc?
- Encourage bonding
- Orient to NICU - provide info as appropriate
- Trusting rapport
- Active listening
- Help parents participate
What Intraventricular hemorrhage (IVH)?
- bleeding into the fluid-filled areas (ventricles) inside the brain.
- occurs most often in babies that are born early (premature)
what is a porferated anus?
anus not connected to anything
What is hypospadias? epispadias? pseudo menstruation?
- Check for hypospadias (condition in which the opening of the penis is on the underside rather than the tip.)
- Check for epispadias (malformation of the penis in which the urethra ends in an opening on the upper aspect of the penis. It can also develop in females when the urethra develops too far anteriorly.)
- Females might have pseudomenstruation (small discharges)
How often to VS need to be taken for infants between 34-37 weeks gestation?
-Vitals signs need to be taken Q4hrs for the first 24 hrs on infants between 34 and 37 weeks gestation
Meconium and Urine should be passed during what time frame other what should the nurse do?
-Notify physician if infant fails to pass meconium or urine in 24hrs
