Week 2 Flashcards
When is the new born period?
Birth to 28 days
How long does the first period of reactivity last
Up to 30 mins after birth
What are the 3 phases of transition to extrauterine life?
- First period
- Period decreased responsiveness
- Second period of reactivity
What happens to RR AND HR during the first period of reactivity
HR AND RR may increase
may hear crackles, grunting etc but will cease within the first hour of birth
How is the newborn digestive in the first period of reactivity?
Bowel sounds are present
Might pass meconium
What happens period of decreased responsiveness?
Newborn sleeps
may have decrease in motor activity
Infant is pink
Respirations may be rapid and shallow
When does the second period of reactivity occur?
2-8 hours after birth
Lasts 10 mins to several hours
What happens in the second period of reactivity?
Tachycardia and tachypnea
Meconium is commonly passed
Increased muscle tone, changes in skin colour, and mucus production
How does oxygenation of the fetus occurs?
through trans placental gas exchange
What happens when the cord is clamped?
Causes a rise in blood pressure which increases circulation and lung perfusion
What initiates breathing in a new born
combination of factors such as:
1. Chemical
2. Mechanical
3. Temperature
4. Sensory
How does breathing get initiated chemically
Decreased levels of oxygen and increased levels of carbon dioxide may stimulate the respiratory centre in the medulla
How does breathing get initiated mechanically
Crying increases the distribution of air in the lungs and promotes expansion of alveoli
How does breathing get initiated by temperature?
Usually lower I’m extrauterine life and stimulates receptors in the skin. Stimulating the respiratory centre
How does breathing get initiated by sensory
touch, light, sounds, and smell cans stimulate respiratory centre
What are signs of respiratory distress
nasal flaring, retractions, grunting and RR under 30 or over 60
What should nurse assess when newborn has apnea episodes?
Temperature because it could be hypothermia, hypoglycaemia, or sepsis
What is the normal HR for newborns
120 to 160 bpm
What are red flags for cardiac issues?
Hearing heart murmurs and cyanosis
What are Red blood cells, hemoglobin and leukocytes like in newborn babies
Higher than adults but then return to normal a bit later
Will the baby’s white blood cell count go higher if they have sepsis
It can but not always
What is the platelet count like for newborns
Same as adults
Why do babies need a vitamin k injection?
Because they cannot synthesize vitamin k initially
How do we see a newborns rh and blood type?
Take cord blood for testing
How is thermogenesis done?
By using brown fat and increasing metabolic activity
How can newborns lose brown fat or heat loss?
- Convection from body to cooler air (room at 24 degrees)
- Radiation from body to cooler surfaces (cot away from window)
- Evaporation liquid is converted to vapor (dry infant well and fast)
- Conduction loss from body to cooler surfaces (skin to skin)
How do we keep the baby warm
Keep room at 24 degrees
Check baby’s temperature before initial bath (usually 36.9 axilla)
How much urine does the newborn bladder compose of?
up to 40 mils
How often should a newborn void?
at least 1 void in 24 hours
day 2 - 2 voids
day 3 - 3 voids
day 4 - 4 to 6 voids
day 5 - 5 to 8 voids
Is bacteria present in newborns?
not at first but gets introduced later
What is a newborns stomach capacity?
Only 30 to 90 mils
When are bowel movements expected?
day 1 to 3
Should be black or dark green (meconium)
How does the stool change throughout the days of a newborn?
Day 3-4: starts changing to light green to brown, 3 times a day
Day 5-7: More than 3 times a day and changes to a yellow colour
How is the storage for iron in a newborn?
Lots of storage of iron from utero that lasts up to 4-6 weeks after birth
Hemoglobin stores iron
How long does the stored glycogen last in a newborn?
Gets depleted quickly due to increased energy needs making it very important for the baby to feed
How soon should feeding be initiated?
first 30 minutes of life
When is jaundice normal and not normal
Normal after the first 24 hours (physiological)
Not normal in the first 24 hours (pathological)
How are newborn coagulation factors activated?
by vitamin k and helps prevent clotting problems
How is a newborns immunity system?
Cells are not activated for weeks/months but are present
In the first 3 months the baby has passive immunity from the mother
How can more present immunity be present in newborns?
If they are breast fed
What is Caput Succedaneum
Edema over the scalp in the occipital area
Can extend across suture lines and disappears in 3-4 days
What is Cephalohematoma?
Collection of blood between skull and periosteum
Does not cross suture lines
Resolves in 3-6 weeks
When is Cephalohematoma largest
On 3rd day
How can we treat Cephalohematoma
No asprations because there is a risk of infection
Why can’t we always see Cephalohematoma
Sometimes can’t see until caput succedaneum is resolved
What is Subgaleal Hemmorhage
Bleeding in a subgealeal compartment, vessels torn in spaces and blood is trapped in those spaces
Can occur during vacuum extraction
What could Subgaleal Hemmorhage lead to?
Blood loss which can result in hypovolemic shock and disseminated intravascular disease or even death
Does not heal on its own
What information is needed at report?
Assessment of preconception, prenatal and intrapartum risk factors
Date, Time and type of delivery
APGAR score
Summary of initial assessment
Vital signs/any signs of distress/deviations from normal
Last time fed/voided/had stool
Weight and weight loss
Bonding (mother and baby)
What is APGAR score?
Allows us to have a rapid assessment of the newborns transition to extrauterine life
Includes: HR, RR, Muscle tone, Reflex irritability, and Colour
When is APGAR score done?
1 min and 5 min after birth
Can be done while mom is doing skin to skin
What happens if the APGAR score is lower than 7?
Means there is some distress - usually call a code
How to maintain airway for newborn?
Ensure effective respirations and cardiac function
Adequate circulation/perfusion/thermoregulation
Why is eye prophylaxis with erythromycin ointment
Put eyes to prevent ophthalmia neonatorum
Recommended for newborns and required by law
When does eye prophylaxis need to be done
Can be done up to 2 hours after birth
Administered from inner to outer cannthus
Why would a newborn have to take oral erythromycin
If baby has chlamydia conjugatitus may require 14 day course
How is vitamin K administered
Intramuscularly never administer via IV unless newborn is preterm and has no muscle mass
Why is vitamin K administered
To prevent hemorrhagic diseases for newborn
Can we give oral vitamin K
Not recommended at all
When can newborns produce their own vitamin K
7 days
How quickly should a new born be given vitamin K
6 hours after birth
What is current recommendation for umbilical care
Include just cleaning with water and cleanser to remove debris for initial bath
What should be assessed regarding the stump and base of umbilical cord
edema, arrhythmia, erythema, and drainage at each diaper change
How should the umbilical cord be kept
dry, clean, loose to air and loosely covered with clothing
what are signs of infection for umbilical cord
foul odour, redness, purulent discharge
When can cord clamp be removed?
When cord is dry in 24 to 36 hours
Some hospitals may discharge with clamp
When would the cord drop off?
10 to 14 days after
Should be no active bleeding
What method should be used for newborn’s initial bath
the tub method as it preserves heat and less crying
How often should a bath for newborns be done?
Once every 3 days
Wash face and bottom often
How often should a newborn be breastfed?
2 to 3 hours
What are abnormal breath sounds for newborns?
Nasal flaring, retractions, stridors, apnea lasting 20 seconds or longer
How often should you weigh the baby?
once every 24 hours
Use disposable path
How do we monitor newborns bilrubin
instructment called transcutaneous bilirubin meter
done 24 Horus after birth
How can we prevent hyperbilirubin?
By frequent feedings because is excreted with meconium
What is phototherapy
A single or double lamp, ensure that baby is naked with only a diaper and placed under isolate under plank of light (45- 50 cm)
What must the baby always wear during phototherapy?
an opaque mask to protect their eyes
Why is phototherapy done?
to treat jaundice if the bilirubin is too high
How often should we check temperature when baby is doing phototherapy
every 2 to 4 hours
What should you NOT use on baby’s bum if they’re doing phototherapy
Vaseline cuz they may burn
Why are screening tests done?
to protect the newborn from different disorders, if screened early
When is the newborn screening tests done?
24 hours after birth
cannot be done prior
What is the most common newborn screening test
PKU
it can cause cognitive impairment
How long is baby NPO during circumcision
2 to 3 hours prior to procedure to prevent aspirations
What method is most common for circumcision?
The bell method and usually falls off 5-7 days after the procedure
Why should you use petroleum jelly after circumcision?
To prevent sticking of the diaper on plastic bell
How often should you check for bleeding after circumcision?
Check every 15 - 30 mins for the first hour
then every 4 hours after the procedure
What do we need to make sure happens before baby is discharged after circumcision?
Voided
How many voids should a baby have after circumcision
5-6 voids after the first few days
What should we teach the parents after circumcision?
How to monitor baby’s void after the procedure while bell is on because it can be displaced and block the urethra causing kidney damage
what is healthy baby, healthy children
Community support program in Ontario for all moms no matter how many children they have
What happens in the health baby, healthy children program?
a survey is completed, pt can refuse but nurse still needs to submit the paperwork
When the hep B vaccine given
Within 12 hours of birth
Where is the preferred injection site for hep B vaccine
Vatus Lateralis
