Week 4-Newborn Flashcards
Study Guide
Newborn Circulatory System; blood flow from umbilical vessels & placenta stops at birth
*Closure of: Ductus Arteriosus, Foramen Ovale, Ductus Venosus
*Increased pulmonary Circulation
*Transition murmurs-stops w/in first 24 hours to 2 days
*Hands/ feet acrocyanosis
*HR 110-160 BPM
Newborn Heat loss due to evaporation?
*moisture/ wet from skin and breathing lungs
-keep warm/ dry
Newborn Heat loss due to convection?
*body heat to cool air flow (drafts)
-keep ambient temperature warmer than the baby
Newborn heat loss due to conduction?
*body heat to blankets, ets., body heat to a cooler surface in direct contact
-keep all surfaces prewarmed
Newborn heat loss due to radiation?
*heat loss to cool object nearby, an a/c unit
-keep baby warm
Chilling S&S (name five)
*increases O2 consumption
*increased utilization of glucose and brown fat (hypoglycemia < 45 mg%)
*increased need for calories
*increased risk for metabolic acidosis
*decreased surfactant production
How many hours per day do newborns sleep within the first 2 weeks?
*16-20 hours a day
General Characteristics: average length?
*48 cm to 53 cm
*19 inches to 21 inches
General Characteristics: weight
*term (37-40 weeks): 2,500 to 4,000 grams
*usually 5 to 10% weight loss-1st few days
*regains withing 10-14 days
General Characteristics: head
*molding-> elongated
*caput succedaneum->edema
*measurement-> 33 cm to 35 cm (13-14 inches)
*head= 2-3 cm > than chest circumference
*fontanels-> bulging? or sunken?
What can extremes head size indicate?
*microcephaly
*hydrocephaly
*intercranial pressure
General Characteristics: umbilical cord
*2 arteries and 1 vein
*obtain a blood sample in the delivery room
Lung maturation
*lung function after 26th week gestation
*surfactant O.K. at 35th week gestation
Respiratory System: Effort: w/in first minute of birth? (7)
*Loud/ lusty crying
*no dyspnea
*no retractions
*respiration rate 30-60/ minute
*diaphragmatic & abdominal muscles used
*nose breather
*mouth= circumoral cyanosis
Describe the ductus venosus (first)
*a shunt, bypasses liver and connects umbilical vein to inferior vena cava
*small amount of blood preserved in liver
*closes with clamping (umbilical cord) & decreased blood flow to umbilical vein
*permanently closes by end of first week (day 3)
Describe the foramen oval (second)
*anatomical opening between the R+L atrium
*allows blood to bypass right ventricle+ lungs
*closes when L. arterial pressure is higher than right, 1-2-hours after birth
*reopen with severe hypoxia, permanently closed by sixth month-year
Describe the ductus arteriosus (third)
*shunt which bypasses the lungs+ connects main pulmonary artery to the descending aorta
*closes w/in 15 hours (full-term), a few days (preterm) due to pulmonary resistant < systemic resistance-permanent closure 3 months
*reopens/ remain open from lung issues, low O2 levels, or increased pulmonary vascular resistance
Explain the intrauterine blood flow?
- blood from vena cava mostly deflected through the foramen ovale to the left atrium, then left ventricle, then ascending aorta, then to head/ upper body (most oxygen)
Describe fetal circulation
*function to carry highly oxygenated blood to vital arteries (heart/ brain), shunting away from lungs/ liver
What acts as the babies lungs during gestation?
*lungs are still developing, won’t fully develop until after birth, placenta (babies lungs)
Describe what the one vein and two arteries of the umbilical cord do…
*one vein delivers oxygenated blood, two arteries carry waste/ deoxygenated blood away from the baby
What are the routine medications given after birth?
*Erythromycin Ophthalmic Ointment (0.5%)
*Vitamin K1 (Phytonadione)
*Hepatitis B Vaccine
-HBIg-neonate exposed to Hep B, think extra protection
Vitamin K1-Phytonadione
*why: prevention of hemorrhage/ Vitamin K deficiency bleeding (VKDB)
*when: within 1 hour of birth
*how: IM; 0.5-1 mg
Erythromycin Ophthalmic Ointment (0.5%)
*Why: Prophylaxis for gonococcal or chlamydial eye infections (ophthalmia neonatorum)
*When:
*How: 1/4 inch lower eyelid of each eye, first hour of birth
Hepatitis B vaccine
*why: routine prevention
*when: within 24 hours of birth 1st does, 2nd at 1-2 months, 3rd at 6-18 months
*how: injection (shot)
neonatal period (birth to 28 DOL)- nursing priorties
*maintaining body heat
*maintaining respiratory function
*decreasing risk of infection
Newborns transition from womb to world, respiratory
*begins w/ first breath/ cord clamping triggering resp./cardio changes immediately
-crucial of adaption from fetus to newborn
What happens to the lungs and heart after birth?
*lungs clear of fluid & expand with air
*heart closes fetal shunts, shifting gas exchange from placenta to the lungs
Breathing-first change after birth-what three factors initiate breathing?
*mechanical
*chemical
*sensory
Stimuli causing initial breathing- sensory
*temperature changes, sound, light, drying, touch, skin-to-skin contact
Stimuli causing initial breathing- chemical
*mild hypoxia and surfactant
Stimuli causing initial breathing- mechanical
*being squeezed through the birth canal, contraction clear fluid
*most baby’s clear lung fluid w/in hours, 60-90% O2 w/in 5-10 in minutes then at 95%
Risk factors for crackles after birth
*C-section or a precipitous delivery (not undergone squeezing that comes with vaginal delivery)
Newborn signs of respiratory distress
*central cyanosis
*apnea >20 seconds
*tachypnea (rapid breathing)
*grunting
*nostril flares
*retractions of chest
*hypotonia (late sign)-weak tone
within seconds, of cord cutting/ clamping after 1st breath, what are the initiation of changes?
-improves gas exchange and closes fetal shunts
*increased vascular resistance
*decreased pulmonary resistance
*pulmonary blood flow
Thermoregulatory system-neonates respond to cold by?
*increasing metabolic rate and oxygen consumption
*brown adipose tissue (BAT); non-shivering thermogenesis
*premature babies are born w/ less BAT, more susceptible to cold stress
*restlessness, mottling
*keep a neutral thermal environment (NTE) and warm baby
What places newborns at a higher risk for thermoregulation problems
*Higher body-surface area to body-mass ratio
*Limited subcutaneous fat
*Higher metabolic rate
*Limited thermoregulatory abilities
Cold stress-risk factors
*prematurity
*hypoglycemia
*sepsis
*prolonged resuscitation
*neuro/ cardiorespiratory problem
*SGA
Cold Stress- Signs & Symptoms
temp below 36.4C/97.6*F
*cool skin
*lethargy
*pallor
*tachypnea
*grunting
*hypoglycemia
*hypotonia
*jitteriness
*weak suck
Cold stress nurse actions
*set controls to 36.5 C/ 97.7 F
*normal glucose 40-60 mg/dL
-critical values < 30mg/dL
Cold stress fun fact
Baby’s that are cold can lead to respiratory distress and hypoglycemia. Hypoglycemia and Cold Stress are interrelated
Metabolic System
*stored glucose/ fat during gestation for transition from intrauterine to extrauterine
*lower, increase w/in first 12 hours, normal in first 3 hours
Signs & Symptoms of hypoglycemia
*monitor, check glucose level, check before feeds, help breastfeed, early feeds, oral dextrose gel, NICU-IV dextrose
*jitteriness, hypotonia, irritability, apnea, lethargy, temperature instability, poor feeding
Hepatic system-Kernicterus
*Kernicterus is irreversible damage done by elevated bilirubin
*underdeveloped newborn liver= carb metabolism, limited glucose stores, blood clotting deficiency
Indirect bilirubin
*byproduct of RBCs breakdown, needs liver to convert it to a form that may be removed to the body
Hyperbilirubinemia in the first 24-hours
*24 hours-pathological
*after 24-hours physiological-expected
Jaundice Treatment - Phototherapy
*intervention for babies that have elevated bilirubin levels
Newborn GI system-not fully developed until after birth
*bowel sounds absent immediately after birth, commences 1st hour onward
*stimuli, swallowing air, first feed
*stomach emptying, 2-4-hours following a feeding
Babies feed..by days
*day 1, 2-10mls/feed, stomach size large marble
*30-60mls/feed by day 4 of life.
Characteristics of stools
Meconium - 24-48 Hours
Transitional - 3RD day
Breastfed - semi formed, seedy, yellow
Formula-fed - formed, creamy and brown
Diarrhea - loose and green
Kidneys are underdeveloped, which can lead to…
- 5-10% body weight lost by peeing in 1st week
*Over-hydration
*Dehydration
*Electrolyte disorders
*magnesium sulfate= urinary retention, monitor I &O
Immune System
*newborns have more subtle signs of infection
*monitor temperatures & for decompensation
*IgG maternal primary antibodies cross placenta, to fetus via passive immunity
*IgA maternal antibodies do NOT cross placenta and are found in breastmilk
Neonatal Assessment 2 divisions
*1st for hours much closer attention (1st 4 hours)
*After 4 hours onward
First 4 hours assessment
*universal precaution self, teach
*Q 30/min first hour (vital)
*Q 5-15 minutes vitals if neonate is in distress
APGAR score (5 criteria)
*0-10, 1 and 5 minutes, >7 normal,<7 abnormal interventions
*Appearance (color)
*Pulse rate (HR)
*Grimace (reflex irritability)
*Activity (muscle tone)
*respirations (respiratory effort)
A-appearance (color)
*0-blue/pale
*1 blue extremities, pink body
*2-body fully pink
-Face may be bruised, Most infants exhibit acrocyanosis, Initial perfusion to extremities is poor
P-pulse (HR)
*0-absent
*1-<100 BPM
*>100 BPM
*auscultate, palpate umbilical stump for a full 1 minute
G-grimace (reflex irritability)
*0-no stimuli response, flaccid
*1-responds on suction or aggressive stimuli
*2-cry on stimulation, cough, sneeze, or cry
A-activity (muscle tone)
*0-none, limp/flaccid
*1-some flexion of arms and legs
*2-active flexion against resistance/ active motion
R-Respiration (respiratory effort)
*0-absent, no respiratory effort
*1-weak, irregular, slow cry
*2-strong/ vigorous cry
Newborn normal V/S
HR: 110-160/min
RR: 30-60/min
BP: 60-80/40-50
T: 36.5-37.5
Initial Assessment Equipment
Bulb syringe
Stethoscope
Axillary temp
BP cuff (not typical, for anomalies, 4-pint read)
Scale
Tape measure tape
Clean gloves
Ballard score-preterm, term, post-term
*Skin
*PT-Thin, transparent, and red
*T-Smooth, pink with a few wrinkles, and more opaque
*post-term-Dry, parchment-like, and leathery skin with prominent creases and little vernix left, peeling/ cracking
Ballard score-preterm, term, post-term
*lanugo
*preterm-Abundant
*term–not as much as preterm, upper back and shoulders
*post-term-usually absent, small
Ballard score-preterm, term, post-term
*plantar surface
*pre-term-Few or no creases
*term-Creases start appearing on the soles, mainly on the front half of the foot.
*post-term-Full creases covering the entire sole
Ballard score-preterm, term, post-term
*breast tissue
*pre-term-Minimal to no breast tissue development.
*term- small amount of breast tissue (about 5-10mm) palpable
*pos-term-Well-developed breast tissue (about 1-2 cm), often with palpable areola.
Ballard score-preterm, term, post-term
*eyes
*pre-term-Eyes may be fused or only partially open; the iris is gray or blue with no definitive color.
*term-Eyes are open, white sclera, PEARRLA
*post-term-Eyes are widely open, and the iris is darker with more definition of color.
Ballard score-preterm, term, post-term
*ears
*pre-term-soft, little to no cartilage, remain folded when pinched.
*term-symmetrical, no skin tags
*post-term- firm, fully formed cartilage, does not fold easily
Ballard score-preterm, term, post-term
*genitalia
*pre-term-small scrotum/ few rugae, large clitorus/ flat-small labia majora
*term (edematous)- larger scrotum/ some rugae, LM well-developed/ cover clitoris
*pos-term-developed scrotum/deep rugae/ palpable testes, large labia majora/ completely covered labia minora
Neonatal Infant Pain Scale (NIPS)
pain assessment
skin abnormality *5
Slate gray patches (Mongolian spots)
Hemangiomas (vascular abnormality)
Salmon color patch (stork bite)
Nevus Flammeus- do not disappear (port wine stain)
Strawberry hemangioma
Erythema toxicum- newborn rash-normal, goes away in few weeks
difference between caput and cephalohematoma
*caput-crosses suture lines *cephalohematoma-harder, will not cross the suture lines, and is blood, baby is more susceptible to hyperbilirubinemia
Musculoskeletal
*strength symmetrical
*10 fingers/ toe-syndactyl (webbed digits)
*gluteal folds even (hip dislocated)
*spine straight/ gentle C-shape (no dimples, toughs of hair, opening)
*no clicking joints
*neck tenderness/ crepitus-fx?
Musculoskeletal signs of down-syndrome
- one crease in palm, short fingers, wide-gap between big toe and second toe
Neurological
*Moro/ startle reflex-lift baby shoulders, let go, arms stretch, legs flex against trunk, symmetrical
*Galant/tonic neck/ fencers - supine, stroke face, turns head toward side
*rooting-brush side of mouth-turn head towards finger
*sucking reflex- gloved finger in infants mouth, rhythmic/ strong motion
* plantar grasps-hold on
*Babinski-lateral surface, upward, toes fine out. hyperextends
*steeping/ dancing reflex- hold baby, feet barely touching surface, feet move up and down, trying to walk
common behavioral characteristics-first 6-8 hours of life
*1st period-30-40; alert/ responsive/ eager to breastfeeding, *2nd period-deep sleep-30-40 minutes to 2-4 hours if missed feed
*3rd-reactivity; 2-8 hours-alert-calm
4 hours to nursing discharge
*focus-monitor, teaching, signs of distress?,
Routine Newborn Labs/ Diagnostics
*state/ national requirements- PKU
*Critical congenital heart disease(CCHD)-pulse ox-preductal, R-hand, both feet (o2 >95%, not more than 3 % apart)
*Newborn hearing screening
*Otoacoustic emissions (OAEs)
*Auditory brainstem response (ABR)
Labs to know, glucose and WBC
*blood glucose-40-60 mg/dL
*WBC-9,000-30,000
Circumcision-not recommended
*surgical, soon after birth
*methods- Gomco Clamp, Mogen clamp, plausible, local anesthetic, monitor for abnormal signs, infant should be able to void (1 before leaving)
ABCs of sleep
*no smoking around baby/ change clothes
(no crib bumpers, blankets, plush toys
*Alone, back, crib
Notify MD when….
*temp > 37.5 C
*loss in appetite
*sleepy/ less active, not crying (weak)
*signs of diarrhea
*projectile green vomit
*fewer wet diapers
*severe skin rash-unresponsive to tx.
*sunken fontanelles
*circumcision bleeding or any signs of infection
successful breastfeeding
*tugging, pain <10 seconds, good latch (swallowing, spontaneous release, 8 wet diapers/ several stool, birth weight at 2 weeks), no nipple breakdown, notice signs of early nipple, 450-500 extra calories, expressing and storing milk
* fresh pump milk; room temp (4 hours), refrigerator (4 days), side-by-side fridge freezer (6 months), deep freezer (12 months)
*feeding started not finished discard after 2 hours
bottle feeding positives/ disadvantages
*partner can feed, others can perform, freedom, decrease in feeding frequency
*preparation, increased cost, increased infection (no IgA), increased obesity, 50 more protein/ vegetable oils for fat (lacks essential brain development qualities), take in more air
1-3, 4, after days amount of feeding
*2-10 mL at birth
*1/2 ounce to 1 ounce
*2-3 oz-4 days
*up to 32 oz/ day
-head should be higher than trunk (cradle position)
