week 10: nursing care of the newborn Flashcards
define the newborn period + physiological adaptation
- birth to day 28 of life
physiological adaptation:
- establishing and maintaining respirations
- adjusting to circulating changes
- regulating temperature
- nutritional intake and digestion
- regulating wt
describe APGAR scoring
- rapid assessment of newborn’s transition to extrauterine at 1 and 5 min of life; repeat at 10 and 20 mins if less than 7 at 5 min
HR
0 - absent
1 - less than 100 bpm
2 - greater than 100 bpm
RR
0 - absent
1 - slow, weak cry
2 - good, crying
Muscle Tone
0 - flaccid
1 - grimacing
2 - cry or active withdrawal
reflex irritability
0 - no response
1 - grimacing
2 - cry or active withdrawal
colour
0 - blue, pale
1 - body pink, extremities blue
2 - completely pink
what is the APGAR mnemonic
A = appearance (skin colour)
P = pulse
G = grimace (reflex irritability)
A = activity
R = respiratory
skin to skin benefits of birthing parent
- breastfeeding (increased rates of exclusive breastfeeding and longer duration)
- less anxiety 3 days after birth
- less chest engorgement/pain at 3 days after birth
- higher satisfaction
benefits of skin to skin for infant
- newborn physiological stabilization (HR, RR, O2 stable)
- improved blood glucose
- thermoreg
- more effective sucking during initial breastfeeding
- comfort (less crying)
sudden unexpected postnatal collapse (SUPC)
- sudden collapse within the first week of life
- 1/3 cases -> infant becomes rapidly unstable within the first 2 hours after birth
- appears initially healthy but often internal health problem
- studies have found that 74% of cases occurred while the baby was lying face down during skin-to-skin contact with their birthing parent
- 77% of cases, the birthing parent or both parents were alone w the newborn at the time of the episode
strategies to prevent SUPC
- increase direct time and observation during first 2 hrs of birth
- educate parents
- elevate head btwn 35-80 degrees so newborn is not flat
- alignment of newborn’s neck and ensure that nose and mouth are not blocked
norm newborn vital signs
HR: 110-160
RR: 30-60
Ax Temp: 36.5-37.5 (WHO, AAP) or 36.3-37.2 (ACoRN)
BP:
@ birth systolic 60-80/40-50
at 10 days systolic 95-100/40-50
describe first period of reactivity
up to 30 min
- alert, startles, cries, movement of head
- HR increases rapidly to 160-180
- HR then falls to baseline 100-160
- RR may be irregular w increase to 60-80
- fine crackles, audible grunting, nasal flaring, retractions but should resolve within first hr after life
- BS audible and meconium may be passed
describe period of decreased responsiveness
(60-100 mins)
- sleeps or marked decrease motor activity
- skin colour pink
- resp may be rapid and shallow (up to 60 bpm) but not laboured
describe second period of reactivity
(btwn 2-10 hrs after birth and lasts 10 min to several hrs)
- brief periods of tachycardia and tachypnea
- increased muscle tone
- skin colour changes
- mucous production
- meconium commonly passed
very preterm infants do not experience this transition due to physiological immaturity
4 ways respiration is induced
- shift from intrauterine oxygenation via transplacental gas exchange to extrauterine oxygenation via lungs
- clamping the cord -> rise in blood pressure -> increase circulation and lung perfusion
- chemical
- mechanical
- thermal
- sensory
describe chemical respiration
During contractions blood flow decreases, leading to decreased oxygenation of baby and respiratory acidosis which send a signal to the infant brain to initiation respirations after birth
describe mechanical respiration
While the baby goes through the birth canal lungs are compressed, and then will recoil when they come out. This change in pressure helps bring air into the lungs and fluid fluid out.
describe thermal respirations
Change in temp from amniotic fluid to the air creates a thermal response sending signals to the brain to start breathing.
describe sensory respirations
Stimulating the baby helps in initiating breathing.
normal resp findings
Preference nose breathers with abdominal breathing and acrocyanosis
Shallow and irregular; may have periods of apnea less than 20 seconds
30-60 RR
On auscultation should hear loud, clear breath sounds equal bilaterally
how should transient tachypnea appear in a newborn
*Transient tachypnea of the newborn should resolve within 1-2 hrs after birth, more serious tend to last longer than 2 hrs after birth.
signs of respiratory distress
Nasal flaring, intercostal or subcostal retractions
Abnormal breath sounds like crackles, wheezing, grunting, stridor or grasping
Diminished or absent air movement
Seasaw or paradoxical respiration
Central cyanosis
RR <30 or >60 and SPO2 <95%
3 categories of the neborn CVS sys
- Expansion of collapsed fetal lungs with air lowers pulmonary vascular resistance, and pressure in right atrium, ventricles and artery decreases
- Loss of placenta blood flow causes high systemic vascular resistance, pressure in the left atrium, ventricle and aorta increase
- Drop in prostaglandins after delivery of the placenta triggers closure of the ductus arteriosus and ligament.
describe HR and sounds
Apical pulse is at the 4th intercostal space
HR should be 110-160 bpm with S1 and S2 sounds, may be variations during sleep and wake periods (reassess within 30 mins)
Most heart murmurs during infancy have no pathological significance and disappear by 6 months
Open ductus arteriosus can be detected as a heart murmur
Concerns with heart murmur include apnea, cynanosis, pallor or poor feeding.
heat loss w newborns
- Aim to maintain a neutral thermal environment to minimize oxygen and glucose use. When baby is cold will use up more oxygen and glucose putting them at risk for hypoxia and hypoglycemia
- Babies are more susceptible to temperature loss as they are smaller and have less brown fat/subQ tissue, greater water content and no ability to shiver
what are the 4 sources of heat loss
- Convection:
Flow of heat from the body to cooler air - Radiation:
Loss of heat from the body to a cooler surface not in direct contact but relative proximity - Evaporation:
Loss of heat when liquid is converted to a vapour - Conduction:
Loss of heat from body surface to cooler surfaces
describe temperature in newborns
- Normal range 36.5-37.5 and auxiliary is preferred route for measuring
- Subnormal may be seen in preterms, infection, dehydration or the environment
- Increase may be seen with infection, dehydration, chemical dependence, environmental
*delay newborn bath as heat loss can occur
thermogenesis
increased muscle activity (crying, restlessness) to generate heat in response to a cooler environment.
nonshivering thermogenesis
metabolism of brown fat and increased metabolic activity of the brain, heart and liver. Causes decreased glucose stores leading to hypoglycemia, and increase use of oxygen which may cause hypoxia
describe newborn physical examination for vital signs
Pain assessment: newborns feel pain and may have different responses such as crying, resistance, grimace, clenched hands, increased BP & HR. Use tools such as premature infant pain profile (PIPP) and neonatal infant pain scale (NIPS). Need to provide comfort measures for painful procedures.
- Skin to skin
- Breastfeeding
- Sucrose
- Swaddled
- Pharmacological pain control
newborn physical exam measurements
Average BW: 2500g-4000g, acceptable for term infants to lose up to 10% (dont want it to be >7%) of their BW and regain it in the first two weeks
Head circumference: 32-36.8 cm (average 34)
Length: 45-55cm
growth and development newborn physical examination
General appearance: There will be size differences in newborns due to diabetic mothers, IUGR, etc.
Newborn rash/erythema toxicum
blotchy red rash with small bumps filled with fluid that can appear on skin after birth, common & harmless usually clearing in 2 weeks.
