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NU472 > Week 3: Reproduction, Newborn Care & Prematurity > Flashcards

Week 3: Reproduction, Newborn Care & Prematurity Flashcards

1
Q

Newborn Skin, Hair & Nails

A

Skin

  • Thin, smooth skin that may be ruddy = well-perfused
  • Vernix = white, creamy protective biofilm covering the baby during last trimester and delivery

Lanugo = thin hair all over body

Nails should be fully grown
- Short nails may indicate prematurity

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2
Q

Newborn mouth, throat, nose and sinus

A

Mouth

  • Assess tonsils when crying
  • No saliva until 3-4 months
  • Once saliva comes in, infant drools a lot because they don’t know how to swallow secretions

Nose

  • Newborns are obligate nose breathers
  • Use bulb syringe and show parents how to clear secretions from nose and mouth
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3
Q

Newborn Lungs

A

Lungs should be fully developed in full term infants

@ birth, the decrease in pulmonary pressure at birth closes the foramen ovale –> ductus arteriosus closure within first hours of life

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4
Q

Newborn breasts

A

Usually enlarged d/t mom’s hormones (estrogen)

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5
Q

Newborn heart (sounds, assessment, HR)

A

Heart sounds should be normal
- Systolic murmur possible and normal

Assessment
- check apical pulse @ 4th intercostal space, just L of midclavicular line

HR

  • Newborn: 120-160 bpm
  • 6 months: ~120 bpm
  • 1 year: ~110 bpm
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6
Q

Newborn Peripheral Vascular System

A

Ruddy complexion indicates good perfusion

  • Cyanosis may indicate cold –> place baby under warmer
  • If warmer doesn’t resolve cyanosis, check for heart defects

Femoral pulses

  • If weak: check for coarctation of aorta
  • If bounding: check for patent ductus arteriosus
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7
Q

Newborn abdomen (appearance)

A

Cylindrical

Visible peristalsis could indicate pyloric stenosis

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8
Q

Newborn genitalia

A

Females

  • Labia and clitoris may appear engorged d/t mom’s hormones
  • External genitalia should return to normal size within weeks

Males

  • Testes drop @ 8 months gestation
  • Assess for both testes
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9
Q

Newborn anus, rectum & prostate

A

Meconium should pass within 24 hours

If no meconium during that time, check for anal patency

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10
Q

Early Gross Motor Development

A

Newborn: turn head side to side when prone

3-4 mo: no head lag, can push up to prone

5 mo: rolling

6-7 mo: sit unsupported

9 mo: pull to stand

10 mo: crawls

12 mo: walk with hand holding

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11
Q

Early Fine Motor Development

A

Newborns: grasp reflex is present at birth

1 mo: grasp reflex strengthens

3 mo: grasp reflex fades; infant can hold a rattle

5 mo: voluntary grasping

7 mo: hand-to-hand transfers

9 mo: pincher grasp develops, helping infants pick up smaller objects

12 mo: build a block tower

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12
Q

Sensory Perception Development (visual, auditory, olfactory, tactile)

A

Visual
- Unfocused, with colors indistinguishable until 8 mo

Auditory
- Newborns can distinguish sounds and turn towards noise

Olfactory
- Smell is fully developed at birth, and newborns are comforted by the smells of their parents

Tactile
- touch is developed at birth, and especially sensitive in lips and tongue

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13
Q

Language development

A

Newborns
- Can really only cry; different pitched cries indicate different needs

1 mo: cooin

3-4 mo: laughing, babbling, consonant sounds

6 mo: imitations

8 mo: combined syllables (mama, dada)

9 mo: understands “no-no”

10 mo: Mama and Dada said with meaning/understanding

12 mo: 2-4 words

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14
Q

Newborn health assessment - Apgar score

A

Appearance

  • 0: Cyanotic, pale
  • 1: pink body with acrocyanotic extremities
  • 2: pink body + extremities

Pulse

  • 0: absent
  • 1: < 100 bpm
  • 2: >100 bpm

Grimace/reflex irritability (stroke back or soles of feet)

  • 0: no response
  • 1: grimace, some motion
  • 2: crying, cough

Activity/muscle tone (extend legs and arms and observe degree of flexion and resistance in extremities)

  • 0: flaccid, limp
  • 1: flexion of extremities
  • 2: active flexion

Respirations

  • 0: absent
  • 1: slow, irregular
  • 2: good, lusty cry

Scores (taken at 1 + 5 mins, + 10 mins prn)

  • < 8 indicates a poor transition
  • => 8 indicates good transition
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15
Q

Newborn health assessment - vital signs (normal limits, abnormality indications)

A

Axillary temp

  • Normal: 97.5-99 degrees
  • <97.5: sepsis
  • > 99: infection

Apical pulse @ 4th intercostal space

  • Normal: 120-140 @ rest
  • <100 or >180 may indicate heart problems

Respirations
- Normal: 30-60 breaths per minute

Lung sounds
- Clear, easy and non laborious

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16
Q

Newborn health assessment - weight, length, head circumference and chest circumference normal limits

A

Weight: 2500-4000g

Length: 44-55cm

Head circumference: 33-35.5 cm

Chest circumference: 30-33 cm

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17
Q

New Ballard Scale

A

assesses neuromuscular and physical maturity for gestational age estimate

Results

  • < 35 indicates prematurity
  • > 45 indicates post maturity

Square window sign - bend wrist toward ventral forearm until resistance, then measure the angle

  • Normal range: 0-30 degrees
  • Premature range: < 30 degrees

Scarf sign - lift arm across chest to opposite shoulder until resistance and compare elbow to midline

  • Normal/FT range: elbow < midline
  • Preterm: elbow at midline or further
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18
Q

Newborn health assessment - tonic neck/fencing, rooting and palmar reflexes (assessing, reaction, duration, absence or persistence indication)

A

Tonic neck

  • Duration: appears at 2 mo, disappears at 4-6 months
  • Persistence > 6 mo: brain damage
  • Assessing: turn nb head to one side until jaw reaches shoulder
  • Reaction: arm and leg on side nb is facing extend, while opposite arm and leg flex (fencing position)

Rooting

  • Duration: present at birth, gone by 3-4 mo
  • If absent at birth: serious CNS disease
  • Assessing: while wearing gloves, touch cheek or upper/lower lip
  • Reaction: infant’s head turns toward touched side and opens mouth

Palmar

  • Duration: present at birth, gone by 3-4 mo
  • If absent at birth: prematurity or neurological defects
  • If present >4 months: cerebral dysfunction
  • Assessing: press finger against newborn’s palm; test both palms
  • Reaction: Grasps finger
    • Asymmetry: cerebral dysfunction
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19
Q

Visual Acuity Assessments

A

Eyes
- External eye (position, slanting, epicanthal folds, swelling/discharge)

  • Visual acuity –> checking if nb can fixate on an object
  • @ birth, visual acuity = 20/100-400
  • @ 4 weeks: nb can fixate on object
  • @ 6-8 weeks: nb can follow object
  • @ 3 mo: nb can reach for object
  • @ 1 yo, visual acuity = 20/200
  • Extraocular muscle tests (Herschberg test = shine light at nb cornea)
    • Normal: light reflects symmetrically in pupils
    • Abnormal: un= reflection may indicate strabismus (lazy eye)
  • Ophtalmoscopic exam
    • HCP typically performs
    • Goal: looking for red lens when shining light into eye; no red lens may indicate cataracts
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20
Q

Newborn health assessment - subsequent physical assessments (genitalia and anus)

A

Males

  • Inspect penis and meatus
    • Hypospadias = meatus on underside of penis-scrotum
    • Epispadias = meatus on top of penis - thorax
    • Check for rashes and lesions
    • Determine if foreskin is retractable OR if circumcision site looks ok
  • – Phimosis = unretractable foreskin
  • Inspect/palpate scrotum and testes
    • check both testes are descended; if not, may indicate cryptorcanism (retraction into inguinal canal) which is normal
    • hydrocele = fluid accumulation along spermatic cord, aeb swelling; resolves by 1 yo

Females

  • Inspect external genitalia
    • Appearance: pink and moist
    • Maternal hormones causes…. enlarged labia; red/pink discharge; orange urine
  • Ambiguous genitalia = enlarged clit fused with labia majora

Anus/Rectum

  • Inspect anus using gloved hand to spread nb cheeks
    • Assess patency, lesions and meconium
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21
Q

General newborn care parent teaching (bathing & hygiene)

A

2-3 baths/week during 1st year

Avoid…

  • lotions
  • baby oil
  • NO POWDER (d/t aspiration risk)

Sponge bathe quickly until umbilical area and circumcision are healed

Keep baby warm & safe
- gather all supplies beforehand to allow for quick bathing and no unattended time

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22
Q

Nursing Interventions: elimination and diaper care

A

6-12 diapers/day = adequate hydration

Meconium passes within 48 hours

Transition stools appear by day 3 of feeding

  • Breast fed stool: mustard yellow, soft, seedy
  • Formula fed stool: yellow-brown, soft, pasty

***use gloves

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23
Q

Nursing Interventions: cord care

A

Frequently assess for and notify PCP of….

  • bleeding
  • discharge
  • redness
  • foul odor

Keep clamp in place until UC dries out, usually within hours after birth

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24
Q

Parent teaching: cord care

A

Healing

  • Dries out within hours of delivery
  • Blackened in 2-3 days
  • Sloughs off and heals within 7-10 days

Notify PCP if noticing bleeding, discharge, redness or odor

Avoid tub baths until healed; sponge bathe only

Expose to air often

Fold diaper to avoid irritation

NEVER PULL OR ATTEMPT TO LOOSEN, allow UC to fall off on its own

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25
Circumcision (definition, methods, nursing interventions)
= surgical removal of all/part of foreskin -- strongest factor = dad's circumcision status Methods - Gomco clamp (most common) Pre-operative requirements - Infant >= 12 hours old - Infant has received vitamin K prophylaxis - Infant has voided 1+x - No food for 1+ hour prior - Parental consent obtained - Correct ID of infant - Pain relief!!!!! (sucrose paci, EMLA, nerve block) Post-op requirements - Apply petroleum jelly to area after px to prevent sticking to diaper - Assess bleeding q30 min x2 hours - Document first void to assess for obstruction/edema
26
Parent teaching: circumcision care
Use petroleum jelly generously during diaper changes - Fasten diaper loosely Do not submerge until area is healed, sponge bathe for 7-10 days - Squeeze soapy water over area and rinse with warm water --> pat dry Avoid placing on abdomen
27
Nursing interventions to enhance bonding
Immediate skin-to-skin contact after initial nb assessment Cluster care to allow for uninterrupted bonding Demonstrate how to wake newborn gently for feedings Offer commendations and suggestions Soothing an upset newborn - feeding and burping - rubbing back and speaking softly; swaying side to side - make eye contact - get outside for fresh air - change position (only with supervision) - singing, poetry, music, reading - lots of physical contact :) - swaddling
28
Small for gestational age (definition, common risk factors, intrauterine conditions, SGA characteristics)
Weight < 2500 g (5lb8oz) at term, OR below 10th percentile on growth chart R/fs: smoking, drug use, chronic maternal illness, multiples, genetic disorders Intrauterine conditions - <28 weeks gestation: overall growth restriction, never catch up in size - >28 weeks gestation: intrauterine malnutrition, will catch up with optimal post natal nutrition IUGR = when fetus does not meet expected growth patterns in utero - Asymmetric = brain growth develops normally but body does not - Symmetric = brain and body both have poor growth rates Characteristics - disproportionately large head - wasted extremities, sunken abdomen - reduced subcutaneous fat storage - jittery d/t hypoglycemia *** - wizened appearance with lots of lanugo - poor muscle tone over butt and cheeks - thin umbilical cord
29
Large for gestational age
Weight > 4000 g (8lb13oz) at term, or greater than 90th percentile
30
Low birth weight
Weight < 2500 g (5.5lb)
31
Very low birth weight
Weight < 1500 g (3lb5oz)
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Extremely low birth weight
Weight < 1000 g (2lb3oz)
33
SGA Common Problems: Perinatal asphyxia (patho, s/s, NIs)
Patho - Poor tolerance to stress of labor - Placental insufficiency & hypoxia - Difficulty adjusting to extrauterine life S/s - Fetal distress (decels) during labor - low Apgars - Possible meconium in amniotic fluid NIs - Assess for maternal risk factors - Initiate resuscitation post delivery
34
Meconium Aspiration (risk factors, etiology, assessment findings, nursing implications)
Risk factors: SGA Postterm --> r/o pneumonia and perinatal asphyxia Chronic intrauterine hypoxia Etiology: Release of meconium into amniotic fluid before birth Inhalation of meconium-containing amniotic fluid Often d/t fetus struggling with respiratory efforts --> bearing down and expelling meconium Assessment: Green amniotic fluid with ROM during labor Green staining of umbilical cord or fingernails Difficulty initiating respirations Nursing Interventions: Initiate resuscitation ASAP Suction airways Support ventilation
35
Newborn Hypoglycemia (risk factors, patho, s/s, nurse interventions)
Risk factors: SGA LGA Postterm Patho: SGA --> inc metabolic rate and lack of adequate glycogen stores to meet newborn's metabolic needs LGA --> commonly associated with diabetic moms; abrupt cessation of mom's high blood glucose supply with birth; limited ability to breakdown glucagon Postterm --> hypoxia r/t depleted glycogen stores; placental insufficiency r/t placental aging S/S: SGA - lethargy - tachycardia - respiratory distress LGA - Jittery - Drowsy - Poor feedings - Hypothermia - Diaphoresis - Weak cry - Seizures Postterm - Hypotonia - blood glucose < 40 for term, < 20 for preterm Nursing Interventions: - Monitor blood glucose (q1h) - Maintain f+e - Initiate oral feedings if possible, or administer 10% dextrose in water IV
36
Newborn dehydration s/s
- sunken fontanelles - scaphoid abdomen - sunken abdomen or prominent rib cage
37
SGA Nursing Management
- weight, length and head circumference - serial blood glucose monitoring - vs monitoring - early and frequent oral feedings OR 10% IV dextrose in water - Monitor for polycythemia - - s/s: HCT > 65%; tachypnea; ruddy skin; weak sucking reflex - Anticipatory guidance for parents
38
Maternal conditions likely to cause LGA newborns
Most common r/f: Maternal DM or glucose intolerance - poor placental perfusion (FGR) - multiparity - prior hx of macrosomic infant - > 40 weeks gestation - maternal obesity - male fetus - genetics
39
Common LGA newborn issues
Birth trauma - s/s visible deformities Hypglycemia - s/s: blood glucose <40; lethargic; irritable/jittery Polycythemia - s/s HCT >65% Hyperbilirubinemia - s/s: jaundice, tea colored urine, clay colored stool
40
Nursing Interventions for Phototherapy
- keep eyes covered - monitor for polycythemia and hypoglycemia - hydrate and feed early
41
Prematurity =
= any birth less than 37 weeks gestation = body system immaturity affects transition to extrauterine life
42
Premature newborn assessment characteristics
- weight <5.5 lb, scrawny appearance with poor muscle tone - lots of lanugo and vernix - fused eyelids - absent or few creases in soles and palms - barely visible breast and nipple tissue - minimal scrotal rugae; large labia and clitoris
43
Preterm nursing management
oxygenation thermal regulation nutrition and fluid balance infection prevention stimulation pain management growth and development parental support - high risk status for perinatal loss discharge prep
44
Preterm resuscitation evaluation
Rapid resuscitation assessment (if any are no, begin resus) - Newborn HR >100? - Gestational age? Color of meconium fluid? - Breathing or crying? - Good muscle tone? ABCDs - Airway - - Suction mouth, nose then trachea if meconium-stained - Breathing - - Ventilate for apnea, gasping or pulse <100 bpm - Circulation - - Start compressions if HR <60 after 30 seconds of PPV - - 3 compressions: 1 breath q2 seconds - Drugs - - Give epi if HR <60 after 30 seconds of PPV and compressions - Epinephrine - - 1:10,000 concentration (0.1-0.3 mL/kg IV) Resuscitate until newborn is... - Crying vigorously - HR > 100 - Pink tongue
45
Preterm newborn thermal regulation
Use radiant warmer and cluster care to reduce stimulation/O2 requirements Avoid... - drafts near newborn (convection) - warm everything before touching newborns (conduction) - keep isolettes away from cold sources (radiation) - keep newborn dry and delay 1st bath until temperature is stable (evaporation) Assess temp q1h until stable Monitor for hypothermia complications - Respiratory distress/cyanosis - lethargy - hypoglycemia - abdominal distention - apnea - bradycardia - metabolic acidosis Monitor for hyperthermia complications - tachycardia - tachypnea - apnea - warm to touch - flushed skin - weak or absent cry - CNS depression
46
Preterm newborn nutrition and fluid management
- daily weights plotted on growth charts - monitor I&Os - assess fluid status - - daily weights - - urine output - - BUN, creatinine, hct, electrolytes - - skin turgor - - fontanelles (sunken = dehydrated; bulging = overhydrated) - assess for enteral feeding intolerance - - measure abdominal girth - - auscultate bowl sounds - - measure gastric residuals before next feeding
47
Preterm infection prevention
Infection = most common cause of morbidity/mortality in NICU - preterm births at increased risk d/t... - - lack of maternal antibody transfers - - thin/fragile skin - - asphyxia at birth *HANDWASHING EDU* Early identification of infec - apnea - temperature instability - tachycardia and tachypnea - poor feeding - respiratory distress Nursing interventions - take off jewelry - avoid tape on newborn skin - hand hygiene and glove wearing during changes/baths/feedings - abx as rx'd - avoid coming to work when ill
48
Preterm appropriate stimulation
Cluster care to keep O2 requirements low Sensorimotor interventions - rocking, massage, holding - nonnutritive sucking, breastfeeding - skin-to-skin - swaddling - music Overstimulation in NICU can lead to - decreased HR and RR - periods of apnea
49
Managing preterm newborn pain (NIs, goals, s/s, pharma and nonpharma tx)
Assess pain frequently, as newborns cannot rate or share pain Goals - minimize amount, duration and severity of pain - assist with coping - avoid overstimulation by clustering care - use pharm agents prn S/S - sudden, high-pitched cry - facial grimacing - increased m. tone - oxygen desaturation - increased pulse, BP, RR - body posturing (squirming, kicking) - limb withdrawal and thrashing - fussiness, irritability Nonpharma pain management - gentle handling with rocking and cuddling - rest periods - kangaroo care/skin-to-skin during px - breast-feeding - sucrose paci - swaddling Pharma pain management - Narcotics limited (usually morphine or fentanyl IV) - Acetaminophen for mild pain - Benzos for sedatives - topical anesthetics
50
Preterm growth and development (NIs, self-regulation)
Cluster care to conserve energy, reduce noise Self-regulation promotion - Flexed, swaddled positions to simulate in utero environment - Skin-to-skin contact - Sucrose paci - Objects to grasp Welcome parents into NICU
51
Preterm parental support
- relaxation techniques and coping strategies (breathing, guided imagery) - review events since birth with parents - encourage parental involvement in NICU, frequent visits - validate anxieties as normal response to stress - provide anticipatory guidance for home care
52
Preterm discharge preparation
Assess physical status of mom and newborn - s/s of complications - infant should by physiologically stable Parental education - s/s complications - infant care and safety - CPR - breast, bottle or gavage feeding edu - provide support and stability - demonstrate special care techniques (dressing changes, ostomy care, chest PT, suctioning)
53
Preterm labor (define)
= regular uterine contractions with cervical effacement and dilation between 20-37 weeks gestation
54
Therapeutic management of preterm labor
Risk predictions based on gestational age Antibiotic prophylaxis for women with group B strep - usually done @ 37 weeks Corticosteroids to decrease r/o respiratory distress - given between 24-34 weeks Pharm: Tocolytic drugs - no clear first-line drugs - tocolytics may prolong pregnancy for 2-7 days --> enough time to admin steroids to promote fetal lung maturity AND promote uterine relaxation
55
Risk factors for preterm labor
Black patients (2x risk) Maternal age extremes (<16, >40) Low SES, low edu Substance use (cigs, alcohol, cocaine) Poor maternal nutrition Hx of prior preterm birth (3x the risk) Low or high pregnancy weight for height Pre-existing DM or HTN Multiples PROM Late or no prenatal care Short cervix, cervical insufficiency STIs, bacterial vaginosis
56
Assessing preterm labor
Subtle signs - change or inc in vaginal discharge - pelvic pressure - low, dull backache with menstrual like cramps - UTI symptoms - GI upset - uterine contractions w or w/o pain >6x/hour Contraction pattern - 4 contractions q 20 minutes, or 8 contractions/hour Lab testing - CBC - Urinalysis - Amniotic fluid analysis - Fetal fibronectin - Cervical length via US - - >= 3 cm --> delivery within 14 days unlikely - - <= 2.5 cm --> increased r/o preterm birth
57
Fetal fibronectin test
Evaluates whether vaginal discharge contains fetal fibronectin and can predict rupture of membranes within 7-14 days - + > 0.05 mcg/mL + result: indicates fetal fibronectin is present in cervical secretions -- if + comes between 22-34 weeks, inc risk of premature birth w/in 7 day - result: indicates that preterm labor in next 2 weeks is unlikely
58
Pt edu re: preterm labor
S/s: - uterine contractions, cramping or low back pain - increased pelvic pressure - increased vaginal discharge, or leaking of fluid from vagina - n/v/d If you experience any of the above... - stop and rest for 1 hour - empty bladder - lie down on side - drink 2-3 glasses of water - feel abdomen during contractions, and describe to HCP as mild (tip of nose), moderate (tip of chin) or strong (forehead)
59
Mongolian spot
Usually seen in Black or Asian babies = benign birthmark over the lumbar/sacral region Bluish green - black color
60
Normal Breath Sounds in a Neonate
Obligate nose breathers RR: 30-60 breaths per minute Breath sounds - may sound louder than usual d/t fine skin of neonate - should be bilaterally clear and equal - hyperresonance over lungs - no labored breathing, nasal flaring, adventitious sounds
61
Imperforate anus (when to suspect)
= no butthole suspect if no poop for 48 hours pp

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