UNIT 5 NEW BORN CARE & CHANGES CHAPTER 22 Flashcards
What is the normal Respiratory Rate for a newborn
30-60breaths per minute
breath pattern may be irregular
On assessment, you new born patient’s chest is retracting , he also presents with nasal flaring, and grunting. Is this an expected finding in new borns?
A. Yes
B. No
B. No
These songs indicate respiratory distress, Intervention must be made
What is the normal heart rate of a new born?
*110-170
* Foramen Ovale closes
* Ductus arteriosis constricts
WHAT DOES THIS ACRONYM STAND FOR, When is the time frame it is done?
A
P
G
A
R
A- Appearance
P- Pulse
G- Grimace (Irritability
A-Activity and muscle tone
R-Respiratory Tone
Done 1-5 minutes after the delivery of the baby
Each letter is graded from 0 1 2
The higher the APGAR score , the greater the baby’s well being.
What is this baby’s APGAR SCORE?
Appearance
Baby is centrally cyanotic
Puulse
No pulse detected
Grimace
Facial reaction to stimulation
Activity(Muscle Tone)
No spontaneous movements noted
Respiration
No Respirations noted
2- APGAR
Steps of Neonatal Rescuitation
1.Stimulate baby by rubbing NOT SHAKING, suctioning, warm dry rubbing
2.Administer oxygen, blow by(oxygen in there facet directly on their face), incubate
3.Final Step , Cheast compressions ( Medications such as Epinephrine)
What is usually done during the first two hours of life of the baby with the Mothers Consent?
Immediate interventions
* Eye prophylaxis
* Vitamin K prophylaxis
Benefits of Eye prophylaxis
The American Academy of Pediatrics (AAP Committee on Infectious Diseases, 2021) and the U.S. Preventive Services Task Force (USPSTF, 2019) recommend instilling a prophylactic agent in the eyes of all newborns to prevent ophthalmia neonatorum or neonatal conjunctivitis.
To prevent ophthalmia neonatorum in newborns of mothers who are infected with N. gonorrhoeae. Eye prophylaxis for ophthalmia neonatorum is required by law in most U.S. states and in some Canadian provinces.
Is it only recommended that babies that are delivered through vaginal birth only receive eye prophylaxis
A. Yes
B. No
B. No
Because ascending infection can occur, eye prophylaxis is recommended for all newborns, including those born by cesarean
In the United States, erythromycin 0.5% ophthalmic ointment is the recommended prophylactic medication to prevent infection from Neisseria gonorrhoeae (see Medication Guide: Eye Prophylaxis: Eryth- romycin Ophthalmic Ointment, 0.5%). Without prompt treatment, this infection can lead to blindness. Eye prophylaxis is usually admin- istered within the first hour after birth. It may be delayed up to 2 hours until after the first breastfeeding so that eye contact and parent-infant attachment and bonding are facilitated
Neonatal Dosage for Eye prophylaxis
Apply a 1- to 2-cm ribbon of ointment to the lower conjunctival sac of each eye.
Vitamin K prophylaxis benefits
To prevent vitamin K deficiency bleeding (hemorrhagic disease) of the newborn.
Should male patient who are candidates for circimscion who’s parents has refused Vitamin K injection, be able to get a circumscion?
A. No
B. Yes
A. No
Male infants who do not receive the vitamin K injection are significantly more likely to bleed post-circumcision, and many provid- ers will decline performing this procedure when the newborn has not received vitamin K
Should you administer the vitamin K injection before or action skin to skin bonding with mom?
A. Before
B. After
B. After
recommend that every newborn receive a single dose of phytonadione 0.5 to 1 mg to prevent vitamin K deficiency bleeding (VKDB). Administration of this injection should be delayed to allow the infant to spend some skin-to-skin time with the parents and for the first breastfeeding.
\Clotting factor-prevents hemorrhagic complications
* Newborn sterile bowel;
* E-coli makes vitamin K
* IM injection 0.5mg to 1 mg
* Normal newborns start to produce own vitamin K by day 8
-sufficient quantity at 4 months
Why is it important to be maintain post temperature in a New Born?
Effective newborn care includes maintenance of a neutral thermal en- vironment (see Chapter 22). Cold stress increases the need for oxygen and can deplete glucose stores. The infant can react to exposure to cold by increasing the respiratory rate and can become cyanotic.
If the newborn does not remain skin-to-skin with the mother dur- ing the first 1 to 2 hours after birth, the nurse places the thoroughly dried infant under a radiant warmer or in a warm incubator until the body temperature stabilizes. The infant’s skin temperature is used as the point of control in a warmer with a servo-controlled mechanism. The control panel is usually set between 36°C and 37°C (96.8°F and 98.6°F) to maintain the healthy term newborn’s skin temperature at approximately 36.5°C to 37°C (97.7°F to 98.6°F).
What tool would you use for a newborn to maintain a clear and patent Airway?
Bulb syringe
In general, the healthy term infant born vaginally has little difficulty clearing the airway. Most secretions are moved by gravity and brought by the cough reflex to the oropharynx to be drained, swallowed, or wiped away. If the airway is obstructed, then the mouth and nasal pas- sages can be gently suctioned with a bulb syringe
Should vigorous Suctioning be used in a newborn?
A. Yes
B. No
B. No
Vigorous suctioning should be avoided; it can cause trauma to fragile tissues. Routine chest percussion and suctioning of healthy term or late- preterm infants should be avoided.
Is fine crackles an expected finding during an assessment after a cesarean birth?
. The nurse should auscultate the infant’s chest with a stethoscope to assess for abnormal breath sounds or inspiratory stridor. Fine crackles may be auscultated for several hours after birth, especially in neonates born by cesarean
Function of Bulb syringe
clear secretions from mouth &
nose
* Remove air from syringe away
from infant’s face
* Clear mouth first
First period of reactivity
First period of reactivity-up to 30
minutes after birth
Assessment findings
30 MINUTES
* Heart rate increases to 160-180 beats/min
* Decreases after 30 minutes to baseline
* Infant alert, spontaneous startles, crying, & head
movement
Period of decreased responsiveness 60-
100 minutes
Infant is pink
* Respirations rapid & shallow to 60
breaths/minute
* Sleeps or has a marked decrease in motor activity
Second
period of
reactivity
Lasts from 10 minutes to several
hours
* Occurs between 2 & 8 hours after
birth
* Tachycardia, tachypnea can occur
* Meconium passed
* Increased muscle tone, changes in
skin color, and mucus production
Normal Newborn Weight
Normal Newborn Weight
* Average 2500-4000 g. ( 5 lbs. 5 oz.- 8 lbs. 8 oz.)
* Female 3400 g. (7 lb. 5 oz.)
* Male 3500 g. (7 lbs. 7 oz.)
- Normal newborn length
- Average 50 cm (19 ½ in)
- 45-55 cm (17¾ - 21½ in)
- Head circumference: 33-35 cm (12.9-13.7
in.)
When is the gestational assessment done?
A. 10hrs after birth
B. 5hrs after birth
C. 4hrs after birth
D. 2hrs after birth
Gestational Assessment:
done first 2 hrs. of age
Assess maturity markers
in newborn to correlate
with gestational age
Your newborn patient weighs 2500 grams and was born at 37 weeks gestation? Which answer best fits the classification of their weight?
A. appropriate for gestational age
B. large for gestational age- 90%
C. small for gestational age-10%
D. Intrauterine growth
A. appropriate for gestational age
Sleep wake cycle of baby
- Sleep 16-18 hours per day
- Deep sleep
- Light sleep
- Drowsy
- Quiet alert
- Active alert
- Crying
- 50% REM sleep gradually decreases
When can baby’s see in color?
- Term can see up to 2 ½ feet away
- Clearest vision about 17-20 cm (6-7
in.) away - See color about 2 months of age
- Newborn can track parents’ eyes
Normal findings for male & female genital area
- Edema of genitals common
in both sexes - Note maturational
characteristics - Female labia majora cover
labia minora - Male testes are down,
scrotum pendulous with good
rouge
Does cold stress increases oxygen and glucose needs?
- Cold Stress increases oxygen & glucose
needs
THERMOREGULATION FOR BABY
* Normal temperature 36.5-37.5 C (97.6-99.5
F)
Stabilization OF Temperature(* Minimize heat loss with procedures)
* Skin to skin
* Dry skin immediately
* Warm blankets, hat, shirt, pants, socks
* Radiant warmer
* Minimize heat loss with procedures
When should a baby defecate meconium stool?
A. within 4 hours of delivery
B. within 72 hrs of delivery
C. after 30 days
D. with 24 hrs of delivery
D. with 24 hrs of delivery
Newborn Stool
* At birth meconium lines bowel, large bilirubin content
* Dark green-black, thick, sticky
* Mucous plug possible with first meconium
* Pass first meconium usually by 24 hours of age
* Meconium ileus suggestive of cystic fibrosis
Your female new born patient is expelling pink to bloody discharge from her vagina. The mother is concerned. What is the correct teaching?
A. the baby is hemorrhaging internally due to dystocia
B. I understand your concerns, This is an expected finding for female new borns.
C. I will contact the doctor
D. this is a normal finding for macrocosmic babies
B. I understand your concerns, This is an expected finding for female new borns.
Males 90% testicles descended at birth
* Females thick mucous vaginal discharge;
can be pink or bloody
An increase in estrogen during pregnancy followed by a drop after birth causes female newborns to have mucoid vaginal discharge (Fig. 22.5) and even some slight bloody spotting. In term neonates, the labia majora and minora cover the vestibule
Urogenital Presentation
Urine present before birth
* “Brick dust” urine, orange, uric crystal
stains normal
* 1 wet diaper/day of age to day 4; then 6-
8 wet/day
- Common for breast swelling in both
sexes - Males 90% testicles descended at birth
- Females thick mucous vaginal discharge;
can be pink or bloody
How many wet diapers per day should a 4 day old new born have?
A. 4 wet diapers
B. 13 wet diapers
C. 10 wet diapers
D. 20 wet diapers
A. 4 wet diapers
You notice there is a Brick dust” urine, orange, uric crystal stains present during your new born assessment? What is your next action?
A. document the finding
B. Inform HCP of the in finding
C. Initiate IV access
D. Advocate for your patient by asking for Tylenol to be ordered
A. document the finding
Urine present before birth
* “Brick dust” urine, orange, uric crystal
stains normal
Common New Born Complications
Birth injuries
* Soft-tissue; skeletal injuries(broken clavikal , brachial plexus)
* Lacerations
* Physiologic problems
* Jaundice-hyperbilirubinemia-yellow hue
to skin
* Phototherapy
* Exchange transfusions
* Hypoglycemia-tremor, jittery
* Hypocalcemia-tremors , seizures, numbness and tingling
Is facial bruising a;life threatening disorder in a newborn who was delivered through vaginal birth?
A. Yes
B. No
B. No
Benefits of Vernix>
It may have antibacterial properties. Vernix could protect your newborn baby from getting a skin infection shortly after birth. It has antioxidant properties. Vernix contains antioxidants like vitamin E and melanin, which help slow down cell damage due to free radicals
It has emollient and antimicrobial properties and prevents fluid loss through the skin; it also has antioxidant properties
Caput succedaneum
Caput succedaneum is a generalized, easily identifiable edematous area of the scalp, most often on the occiput (Fig. 22.15A). With vertex presentation, the sustained pressure of the presenting part against the cervix results in compression of local vessels, slowing ve- nous return.
usually disappears spontaneously within 3 to 4 days. Infants who are born with the assistance of vacuum extraction usually have a caput in the area where the cup was applied. Bruising of the scalp is often seen in the presence of caput succedaneum.
CROSSES SUTURE LINE
Cephalhematoma
is a collection of blood between a skull bone and its periosteum; it does not cross a cranial suture line (see Fig. 22.15B). A cephalhematoma is firmer and better defined than a caput.
AT RISK FOR JAUNDICE
What causes a Jaundice in new borns?
Increased levels of bilirubin
What are the prerequisites in order for a new born to get Phototherapy secondary rot jaaundice?
EYE PROTECTION
DIAPER
NO OINTMENT TO CREAMS ON BABY CAN INDUCE BURNS
What is this diagnostic test used for
Transcutaneous
Bilirubin Test
Transcutaneous
Bilirubin Test
Blood test more
reliable, this test
more convenient
& not invasive
Lab and diagnostic test for new borns
Universal newborn screening
Genetic diseases
Inborn errors of metabolism
Critical congenital heart disease
Newborn hearing screening
* Collection of specimens
* Heel stick
* Venipuncture
* Obtaining urine specimen
Common Congenital Skin Anomalies
Congenital dermal melanocytosis or slate gray nevi (formerly known as Mongolian spots) bluish black areas of pigmentation, can appear over any part of the exterior surface of the body, including the ex- tremities. They are most common on the back and buttocks (Fig. 22.8). These pigmented areas occur most frequently in newborns whose ethnic origins are Latin America, Asia, Africa, or the Mediterranean area, but can occur in White infants.
NEVI
Nevus simplex, also known as salmon patches, telangiectatic nevi, “stork bites,” or “angel kisses,” is the result of a superficial capillary defect and occurs in up to 80% of newborns. They are usually small, flat, and pink and are easily blanched
A port-wine stain, or nevus flammeus, is usually visible at birth and is due to an asymmetric postcapillary venule malformation. It is usually pink and flat at birth but darkens with time, becoming red or purple and pebbly in consistency. True port-wine stains do not blanch on pressure or disappear. They are found most commonly on the face and neck (
Erythema toxicum, a transient rash, is also called erythema neonato- rum, newborn rash, or flea bite dermatitis. It first appears in term neo- nates during the first 24 to 72 hours after birth and can last up to 3 weeks of age. It has lesions in different stages: erythematous macules, papules, and small vesicles
Distended, small, white sebaceous glands noticeable on the newborn face are known as milia (Fig. 22.7). Although sweat glands are present at birth, term infants usually do not sweat for the first 24 hours. By day 3, sweating begins on the face, then progresses to the palms.
ONGOING INTERVENTIONS
Protective environment
* Positioning:Infants should be placed in the supine position for sleep during the first year of life to reduce the incidence of sudden infant death syn- drome (SIDS)
* Infection control factors
* Support development of relationships
* Establish thermal regulation
* Temperature
* Establish feedings and GI function
* Feeding patterns
* Preventing infant abduction
New Born Reflex
Babinski
Rooting
Sucking
Moro
Plantar
Palmar
Crawl reflex
What is an indicated fining in hip dysplasia
Folds in one leg than the other
Therapeutic and surgical procedures
Circumcision
* Recommendations
* Parental decisions: religion,
tradition, culture, social norm,
hygiene
* Procedure
* Care of the newly circumcised infant
What are the different types of circumcision procedures?
Gomco Circumscision
Plastibell circumscision
How do you manage Neonatal pain?
Non-pharmacologic
* Oral sucrose, breastfeeding,
nonnutrive sucking
* Skin-to-skin, kangaroo care, swaddling
* Pharmacologic
-Tylenol
Does mother need to sign consent in order for a hearing test to be done on baby?
A. Yes
B. No
A. Yes
occurs in about 1:1000 live
births.
Early detections = better
outcomes
Important Discharge Instructions for mom
Parental teaching
* Car seat safety
* Nonnutritive sucking
* Bathing
* Umbilical cord care
* Infant follow-up care
* Cardiopulmonary resuscitation
* Practical suggestions
Are these signs of Integumentary problems?
“Any pallor, plethora (deep purplish color from increased circulating RBCs), petechiae, central cyanosis, or jaundice”
YES
NO
YES
Close observation of the newborn’s skin color can lead to early detection of potential problems. Any pallor, plethora (deep purplish color from increased circulating RBCs), petechiae, central cyanosis, or jaun- dice is noted and documented. The skin is examined for signs of birth injuries such as forceps marks and lesions related to fetal monitoring. Bruises or petechiae can be present on the head, neck, and face of an
What is the best position babies should be in to prevent SIDS?
a. Side lying
b. prone
c. supine
d. leg lateral
c. supine
Infants should be placed in the supine position for sleep during the first year of life to reduce the incidence of sudden infant death syndrome (SIDS)\
Safe sleep parameters
Always lay the baby flat in bed (in the bassinet or crib) on his or her back for sleep, for naps, and at night. Do not place your infant on the abdomen for sleep.
* Room-sharing, but not bed-sharing, is recommended for the first year; this is most important for the first 6 months.
* Never put your baby on a cushion, pillow, beanbag, or waterbed to sleep. Your baby may suffocate.
* Avoid soft bedding, including bumper pads, blankets, pillows, stuffed toys, or other soft objects in the baby’s crib because of the risk for suffocation.
* Donotcoverthebabywithblanketsorquilts;dressthebabyinlightsleep clothing such as a sleep sack or one-piece sleeper.
* Checkyourbaby’scribforsafety.Slatsshouldbenomorethan2.25inches apart. The space between the mattress and sides should be less than two finger widths. The bedposts should have no decorative knobs.
* Thecribmattressshouldbefirmandshouldfitsnuglyagainstthecribrails.
* Donotuseacribwithdroprails.
* Coverthemattresswithatight-fittingsheet.
* Supervised,awaketummytimeisrecommendedeachdaytofacilitatemo-
tor development.
* Donotrelyonhomemonitorsordevicesthataremarketedtodecreasethe
risk of sudden infant death syndrome (SIDS) (e.g., wedges or positioners).
* Offerapacifieratnapandbedtime.
* Do not tie anything around your baby’s neck. For example, a pacifier tied
around the neck with a ribbon or string can strangle your baby.
* Avoid exposing your bab to cigarette or cigars moke inyourhomeorother places. Passive exposure to tobacco smoke greatly increases the likelihood that your infant will have respiratory symptoms and illnesses. It also in-
creases the risk for SIDS.
Should the bay be front facing or rear facing when in a car seat?
A. Rear
B. Front
- Always place your baby in an approved car safety seat when traveling in a motor vehicle (car, truck, bus, van), train, or airplane.
- Your baby should be in a rear-facing infant car safety seat from birth for as long as possible until exceeding the car seat’s limits for height and weight. The car safety seat should be in the back seat of the car (see Fig. 23.21).
Should mom use a car sear that has been in a accident?
Yes
No
No
If the parents do not have a car safety seat, arrangements should be made to make an appropriate seat available for purchase, loan, or donation. Parents need to be cautioned about purchasing a secondhand car safety seat without knowing its history. They should never use a car seat that was involved in a moderate to severe crash, is too old, has visible cracks, does not have a label with the model number and manufacture date, does not come with instruc- tions, is missing parts, or was recalled
Risk factors for SIDS
Prematurity
* Male infant
* Age 2-3 months, reported to 1yr
* African, Native American, Inuit family history
* Secondhand smoke
* Parents under 20 years
* Overheat/excessive bedding
* Prone sleeping
What is Lanugo
Lanugo is soft, fine hair covering a fetus while inside the uterus. It helps protect them and keeps them warm while they grow.
THERMOREGULATION
What is the normal range of head circumference for a new borns head?
Term: 32.5–37.5 cm (12.5–14.5 in)
Normal range length of new born?
Term: 46–56 cm (18–22 in)
Normal range for chest circumference
Term: 30–33 cm (11.8–13 in)
Normal range of weight for new born?
2700–4000 g (6–9 lb)
Acceptable weight loss: 5%–10%
or less in the first 3–5 days
ABNORMAL
Weight #2700 g (preterm, small for gesta- tional age, rubella syndrome)
Weight 4000 g (large for gestational age, maternal diabetes, heredity—normal for these parents)
Weight loss more than 10% (growth fail- ure, breastfeeding difficulty, dehydration)
Signs of umbilical cord infection
Signs of umbilical cord infection are moistness, oozing, discharge, and a reddened base around the cord.
Moro
Moro
A loud noise bumping the surface of the crib, suddenly lowering the newborn’s head while holding him/her causing sudden extension and abduction of the arms ending up in an embracing like motion.
Tonic
Turn the infant’s head to one side, and the arm and leg will extend on
that side. with flexion of the opoosite arm and leg. (Assumed by sleeping infants)
Palmer
Placing an object or finger in hands of new born . They will grasp it tightly
Planter
applying pressure at the base of the foot and the toes will curl
Babinski
Stroke the sole of the foot. the his toe dorsiflexes and the other toes
Flare outwards fanning out
Blinking
Bringing an object close to the eye at a fast pace will induce closure of
the eye.
Check blood flow
check right hand and left foot
left foot 95
right hand 97
NO MORE THAN 5 DIFFERENCE TO INDICATE PROPER PERFUSION
