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NURS 372~ > W10b - Newborn Nursing Care > Flashcards

W10b - Newborn Nursing Care Flashcards

1
Q

When is skin-to-skin contact encouraged after birth?

A

Immediately after birth, unless the mother or baby is unstable and needs intervention

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2
Q

Why is skin-to-skin contact important after birth?

A

It supports newborn transition

regulates temperature

heart rate

promotes bonding

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3
Q

What assessments can be done during skin-to-skin contact?

A

Most newborn assessments including vitals and physical checks

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4
Q

When should skin-to-skin contact be interrupted?

A

Only if the mother or baby is unstable or requires immediate medical intervention

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5
Q

What are the benefits of skin-to-skin contact for newborns?

A

Stabilizes HR, RR, and O2

improves thermoregulation and blood glucose

promotes effective breastfeeding and prolactin release

reduces crying and stress.

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6
Q

How does skin-to-skin contact improve newborn blood glucose?

A

Reduces stress and supports thermoregulation, which prevents glucose depletion.

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7
Q

What are the benefits of skin-to-skin contact for the birthing parent?

A

Increases exclusive breastfeeding rates and duration

reduces anxiety and chest pain/engorgement at 3 days

improves birth satisfaction.

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8
Q

What is the WHO recommendation regarding skin-to-skin and breastfeeding during COVID-19?

A

WHO recommends continuing immediate skin-to-skin and exclusive breastfeeding, as benefits outweigh transmission risks

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9
Q

What is Sudden Unexpected Postnatal Collapse (SUPC)?

A

A sudden collapse of a newborn within the first week of life, often appearing initially healthy.

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10
Q

When do most cases of SUPC occur?

A

1/3 occur in the first 2 hours after birth

1/3 occur in the first 24 hours

1/3 occur during the first week

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11
Q

What common condition is present during many SUPC cases?

A

Baby lying face down during skin-to-skin contact with the birthing parent

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12
Q

What is the recommended position of the newborn’s face during skin-to-skin to prevent SUPC?

A

Face turned to the side, not directly down on the chest

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13
Q

How often were birthing parents alone during SUPC episodes?

A

In 77% of cases, the birthing parent or both parents were alone with the newborn

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14
Q

What nursing measures can reduce the risk of SUPC?

A

Frequent assessments

monitoring vitals

ensuring someone else is present if the nurse leaves

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15
Q

Why is education about SUPC important for parents?

A

Parents need to be taught safe positioning and signs of distress to reduce risk while alone with newborn

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16
Q

What is a “gentle” C-section and how does it relate to SUPC prevention?

A

A gentle C-section mimics aspects of vaginal birth by allowing the birthing parent to help “push” the baby out slowly.

This improves physiological transition for the newborn and may reduce stress-related complications.

In the context of SUPC, it may support better initial stabilization and smoother adaptation, potentially lowering collapse risk immediately after birth.

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17
Q

What are key positioning strategies to prevent SUPC during skin-to-skin?

A
  • Elevate the head of the birthing parent’s bed (35–80°)
  • Baby should be chest-to-chest, not on the shoulder
  • Baby’s neck should be aligned in a “sniffing” position (not flexed)
  • Ensure the nose and mouth are not obstructed
  • Blanket can cover the back, but not the face
  • Baby’s legs should be flexed in M-position
  • Birthing parent should stay alert and avoid distractions
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18
Q

What angle should the head of the birthing parent’s bed be to prevent SUPC?

A

35–80 degrees

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19
Q

How should the newborn’s head and neck be positioned to prevent airway obstruction?

A

In a “sniffing” position with a straight spine and neck not flexed

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20
Q

Where should the newborn be placed during skin-to-skin to prevent SUPC?

A

Chest-to-chest with the birthing parent, not on the shoulder

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21
Q

What is the recommended leg position for a newborn during safe skin-to-skin?

A

Well-flexed in an “M” position

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22
Q

What precaution should the birthing parent take during skin-to-skin?

A

Remain alert and avoid distractions like electronics

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23
Q

What is the normal newborn heart rate?

A

110–160 bpm

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24
Q

What is the normal newborn respiratory rate?

A

30–60 breaths per minute

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25
What is the normal axillary temperature range for a newborn?
36.5–37.5°C (WHO, AAP) 36.3–37.2°C (ACoRN)
26
What is the normal newborn blood pressure at birth?
Systolic 60–80 mmHg Diastolic 40–50 mmHg
27
What is the normal newborn blood pressure at 10 days of life?
Systolic 95–100 mmHg Diastolic 40–50 mmHg
28
What is the expected oxygen saturation in newborns at 1, 5, and 10 minutes?
1 min: ~60% 5 min: ~80% 10 min: 85–95%
29
What triggers the shift from intrauterine to extrauterine oxygenation?
Clamping the cord leads to a rise in blood pressure, increasing circulation and lung perfusion, shifting oxygenation from placental to pulmonary.
30
What are the four types of stimuli that help initiate newborn respirations?
1. Chemical (acidosis signals medulla) 2. Mechanical (lung compression and recoil) 3. Thermal (cold air activates temperature receptors) 4. Sensory (touch, crying, stimulation)
31
How does a vaginal birth assist in respiratory adaptation?
Vaginal birth provides chemical (acidosis) and mechanical (lung compression) stimuli that help initiate breathing.
32
How does thermal stimulation help initiate respirations?
Exposure to cooler air after birth stimulates temperature receptors, sending signals to trigger breathing.
33
How does sensory stimulation help newborn respiration?
Touch and crying increase positive pressure, helping expand alveoli and establish effective respiration.
34
What is the role of Wharton’s jelly in respiratory adaptation?
When exposed to cold air, Wharton’s jelly constricts, compressing umbilical vessels. This helps reduce prostaglandins, triggering the newborn to breathe.
35
What chemical stimulus initiates newborn respiration?
Respiratory acidosis from labor and birth stimulates the medulla to trigger breathing more effective with vaginal birth than C-section.
36
What mechanical changes support newborn breathing?
Lung compression in the birth canal increases intrathoracic pressure, which then drops after birth, helping expel fetal lung fluid and draw in air.
37
Why might C-section infants have more difficulty initiating respirations?
They often miss chemical and mechanical stimuli (e.g., acidosis and lung compression) provided during labor and vaginal delivery.
38
How do newborns typically breathe?
Through their nose (obligate nose breathers) with abdominal movements.
39
What kind of breathing pattern is common in newborns?
Shallow, irregular breathing with pauses under 20 seconds (normal).
40
When is apnea in a newborn considered abnormal?
If a pause in breathing lasts more than **20 seconds**.
41
What are common causes of apnea in newborns?
* CNS depressants (e.g., maternal narcotics, magnesium sulfate) * Meconium aspiration syndrome * Pneumonia * Sepsis
42
What should be heard on auscultation of a healthy newborn’s lungs?
Loud, clear, equal breath sounds bilaterally.
43
Which of the following is NOT a sign of respiratory distress in newborns? A) Grunting B) Nasal flaring C) Absent breath sounds D) Acrocyanosis
D) Acrocyanosis
44
What are signs of respiratory distress in a newborn?
* Nasal flaring * Retractions (intercostal or subcostal) * Abnormal breath sounds (crackles, wheezing, grunting, stridor, gasping) * Diminished or absent air movement *Seesaw/paradoxical respirations * RR <30 or >60 bpm * Central cyanosis * Pulse oximetry <95%
45
What is the significance of seesaw or paradoxical respirations in a newborn?
It indicates respiratory distress, where the **chest and abdomen move in opposite directions**.
46
What oxygen saturation level indicates respiratory distress in a newborn?
Less than 95%.
47
What is transient tachypnea of the newborn (TTN)?
Temporary rapid breathing as newborns expel fetal lung fluid; usually resolves within 1–2 hours after birth.
48
When does transient tachypnea become more concerning?
If tachypnea lasts more than **2 hours**, it may indicate a more serious respiratory issue.
49
What causes a decrease in right-sided heart pressures after birth?
**Expansion of fetal lungs with air** lowers pulmonary vascular resistance, reducing pressure in the right atrium, ventricle, and pulmonary artery.
50
What causes an increase in left-sided heart pressures after birth?
**Clamping the cord stops placental blood flow** Raising systemic vascular resistance and increasing pressure in the left atrium, ventricle, and aorta.
51
What causes the ductus arteriosus to close?
A drop in prostaglandins after birth promotes closure of the ductus arteriosus, forming a ligament.
52
What is the typical timeframe for ductus arteriosus closure?
It usually begins to close within minutes and can take **up to 48 hours**.
53
What causes the foramen ovale to close?
Left atrial pressure rises above right atrial pressure, pushing the foramen ovale closed.
54
What role does Wharton’s jelly play in circulatory changes at birth?
It contracts in response to cold air, compressing the umbilical vessels and contributing to cord clamping effects.
55
How can acrocyanosis present in newborns with darker skin tones?
It may appear more whitish or gray rather than blue.
56
What is a reliable way to assess for central cyanosis in newborns?
Check the mucous membranes inside the mouth.
57
Where is the apical pulse assessed in a newborn?
At the 4th intercostal space for a full minute.
58
How often should you reassess heart rate in newborns with variations?
Reassess within 30 minutes.
59
What heart sounds should you hear in a newborn?
S₁ and S₂ only (S₃ and S₄ are abnormal).
60
Are most heart murmurs in infancy concerning?
No, most have no pathological significance and resolve by 6 months.
61
What congenital heart condition might be heard as a murmur in newborns?
Patent ductus arteriosus
62
What signs would make a heart murmur in a newborn more concerning?
Poor feeding, apnea, cyanosis, or pallor.
63
What can be done if a newborn has a concerning murmur?
Further investigation like ECG, echocardiogram, or referral.
64
Why is it important to maintain a neutral thermal environment in newborns?
To minimize oxygen and glucose use rt thermoregulation
65
What is convection in the context of neonatal heat loss?
Loss of heat to cooler air (e.g., draft)
66
What is radiation in the context of neonatal heat loss?
Loss of heat to a cooler nearby surface not in direct contact (e.g., cement wall near crib).
67
What is evaporation in the context of neonatal heat loss?
Loss of heat when liquid (like amniotic fluid) turns to vapor (e.g., why newborns are dried after birth).
68
What is conduction in the context of neonatal heat loss?
Loss of heat from body surface to a cooler surface in direct contact (e.g., baby on a cold scale).
69
What temperature adjustment may help reduce neonatal heat loss?
Slightly raising the room temperature—but not too high to avoid maternal nausea.
70
Heat Loss Diagram
71
What is the normal axillary temperature range for a newborn?
36.5°C to 37.5°C
72
What is the preferred route for measuring temperature in a newborn
Axillary
73
What might a low temperature (e.g., 35.8°C) in a newborn indicate?
Preterm birth, infection (e.g., sepsis) dehydration environmental exposure
74
What might a high temperature in a newborn indicate?
Infection, dehydration, chemical dependence, or overheating from the environment
75
Why can't newborns shiver to generate heat?
Their nervous system is immature; they rely on nonshivering thermogenesis
76
What is nonshivering thermogenesis?
Heat production via metabolism of brown fat, increasing metabolic activity in the brain, heart, and liver
77
What is thermogenesis (general definition)
Heat generation through increased muscle activity (e.g., crying, restlessness)
78
Why is maintaining a neutral thermal environment critical in newborns?
To minimize oxygen and glucose use, avoiding cold stress
79
Why are newborns more vulnerable to temperature instability?
They cannot regulate temperature like children or adults
80
What acid-base imbalance results from cold stress in a newborn, and why?
**METABOLIC ACIDOSIS** Cold stress increases O₂ demand and RR, but vasoconstriction limits gas exchange. This leads to hypoxia and anaerobic metabolism, producing lactic acid.
81
What nursing interventions are appropriate for a temp of 36.1°C?
Warm blankets, skin-to-skin, hat, environmental assessment, reassess q15 min, encourage breastfeeding
82
Why does breastfeeding help in cold stress?
Provides glucose to prevent hypoglycemia caused by brown fat metabolism
83
How does cold stress affect oxygen use?
↑ oxygen consumption → ↑ respiratory rate → pulmonary vasoconstriction → hypoxia
84
How does cold stress lead to metabolic acidosis?
Hypoxia → anaerobic metabolism → ↓ PaO₂ and pH → metabolic acidosis
85
What causes hypoglycemia in cold stress?
Use of glucose stores to fuel non-shivering thermogenesis
86
How can cold stress be prevented?
Maintain thermal environment, educate parents, promote skin-to-skin, monitor frequently
87

NURS 372~ (7 decks)

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