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N306-Expanding Family and Community > Week 4-Newborn > Flashcards

Week 4-Newborn Flashcards

Study Guide

1
Q

Newborn Circulatory System; blood flow from umbilical vessels & placenta stops at birth

A

*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

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2
Q

Newborn Heat loss due to evaporation?

A

*moisture/ wet from skin and breathing lungs
-keep warm/ dry

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3
Q

Newborn Heat loss due to convection?

A

*body heat to cool air flow (drafts)
-keep ambient temperature warmer than the baby

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4
Q

Newborn heat loss due to conduction?

A

*body heat to blankets, ets., body heat to a cooler surface in direct contact
-keep all surfaces prewarmed

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5
Q

Newborn heat loss due to radiation?

A

*heat loss to cool object nearby, an a/c unit
-keep baby warm

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6
Q

Chilling S&S (name five)

A

*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

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7
Q

How many hours per day do newborns sleep within the first 2 weeks?

A

*16-20 hours a day

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8
Q

General Characteristics: average length?

A

*48 cm to 53 cm
*19 inches to 21 inches

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9
Q

General Characteristics: weight

A

*term (37-40 weeks): 2,500 to 4,000 grams
*usually 5 to 10% weight loss-1st few days
*regains withing 10-14 days

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10
Q

General Characteristics: head

A

*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?

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11
Q

What can extremes head size indicate?

A

*microcephaly
*hydrocephaly
*intercranial pressure

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12
Q

General Characteristics: umbilical cord

A

*2 arteries and 1 vein
*obtain a blood sample in the delivery room

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13
Q

Lung maturation

A

*lung function after 26th week gestation
*surfactant O.K. at 35th week gestation

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14
Q

Respiratory System: Effort: w/in first minute of birth? (7)

A

*Loud/ lusty crying
*no dyspnea
*no retractions
*respiration rate 30-60/ minute
*diaphragmatic & abdominal muscles used
*nose breather
*mouth= circumoral cyanosis

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15
Q

Describe the ductus venosus (first)

A

*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)

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16
Q

Describe the foramen oval (second)

A

*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

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17
Q

Describe the ductus arteriosus (third)

A

*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

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18
Q

Explain the intrauterine blood flow?

A
  • 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)
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19
Q

Describe fetal circulation

A

*function to carry highly oxygenated blood to vital arteries (heart/ brain), shunting away from lungs/ liver

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20
Q

What acts as the babies lungs during gestation?

A

*lungs are still developing, won’t fully develop until after birth, placenta (babies lungs)

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21
Q

Describe what the one vein and two arteries of the umbilical cord do…

A

*one vein delivers oxygenated blood, two arteries carry waste/ deoxygenated blood away from the baby

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22
Q

What are the routine medications given after birth?

A

*Erythromycin Ophthalmic Ointment (0.5%)
*Vitamin K1 (Phytonadione)
*Hepatitis B Vaccine

-HBIg-neonate exposed to Hep B, think extra protection

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23
Q

Vitamin K1-Phytonadione

A

*why: prevention of hemorrhage/ Vitamin K deficiency bleeding (VKDB)
*when: within 1 hour of birth
*how: IM; 0.5-1 mg

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24
Q

Erythromycin Ophthalmic Ointment (0.5%)

A

*Why: Prophylaxis for gonococcal or chlamydial eye infections (ophthalmia neonatorum)
*When:
*How: 1/4 inch lower eyelid of each eye, first hour of birth

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25
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)
26
neonatal period (birth to 28 DOL)- nursing priorties
*maintaining body heat *maintaining respiratory function *decreasing risk of infection
27
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
28
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
29
Breathing-first change after birth-what three factors initiate breathing?
*mechanical *chemical *sensory
30
Stimuli causing initial breathing- sensory
*temperature changes, sound, light, drying, touch, skin-to-skin contact
31
Stimuli causing initial breathing- chemical
*mild hypoxia and surfactant
32
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%
33
Risk factors for crackles after birth
*C-section or a precipitous delivery (not undergone squeezing that comes with vaginal delivery)
34
Newborn signs of respiratory distress
*central cyanosis *apnea >20 seconds *tachypnea (rapid breathing) *grunting *nostril flares *retractions of chest *hypotonia (late sign)-weak tone
35
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
36
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
37
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
38
Cold stress-risk factors
*prematurity *hypoglycemia *sepsis *prolonged resuscitation *neuro/ cardiorespiratory problem *SGA
39
Cold Stress- Signs & Symptoms
*temp below 36.4*C/97.6*F *cool skin *lethargy *pallor *tachypnea *grunting *hypoglycemia *hypotonia *jitteriness *weak suck
40
Cold stress nurse actions
*set controls to 36.5 C/ 97.7 F *normal glucose 40-60 mg/dL -critical values < 30mg/dL
41
Cold stress fun fact
Baby’s that are cold can lead to respiratory distress and hypoglycemia. Hypoglycemia and Cold Stress are interrelated
42
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
43
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
44
Hepatic system-Kernicterus
*Kernicterus is irreversible damage done by elevated bilirubin  *underdeveloped newborn liver= carb metabolism, limited glucose stores, blood clotting deficiency
45
Indirect bilirubin
*byproduct of RBCs breakdown, needs liver to convert it to a form that may be removed to the body
46
Hyperbilirubinemia in the first 24-hours
*24 hours-pathological *after 24-hours physiological-expected
47
Jaundice Treatment - Phototherapy
*intervention for babies that have elevated bilirubin levels
48
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
49
Babies feed..by days
*day 1, 2-10mls/feed, stomach size large marble *30-60mls/feed by day 4 of life.
50
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
51
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
52
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
53
Neonatal Assessment 2 divisions
*1st for hours much closer attention (1st 4 hours) *After 4 hours onward
54
First 4 hours assessment
*universal precaution self, teach *Q 30/min first hour (vital) *Q 5-15 minutes vitals if neonate is in distress
55
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)
56
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
57
P-pulse (HR)
*0-absent *1-<100 BPM *>100 BPM *auscultate, palpate umbilical stump for a full 1 minute
58
G-grimace (reflex irritability)
*0-no stimuli response, flaccid *1-responds on suction or aggressive stimuli *2-cry on stimulation, cough, sneeze, or cry
59
A-activity (muscle tone)
*0-none, limp/flaccid *1-some flexion of arms and legs *2-active flexion against resistance/ active motion
60
R-Respiration (respiratory effort)
*0-absent, no respiratory effort *1-weak, irregular, slow cry *2-strong/ vigorous cry
61
Newborn normal V/S
HR: 110-160/min RR: 30-60/min BP: 60-80/40-50 T: 36.5-37.5
62
Initial Assessment Equipment
Bulb syringe Stethoscope Axillary temp BP cuff (not typical, for anomalies, 4-pint read) Scale Tape measure tape Clean gloves
63
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
64
Ballard score-preterm, term, post-term *lanugo
*preterm-Abundant *term--not as much as preterm, upper back and shoulders *post-term-usually absent, small
65
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
66
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.
67
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.
68
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
69
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
70
Neonatal Infant Pain Scale (NIPS)
pain assessment
71
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
72
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
73
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?
74
Musculoskeletal signs of down-syndrome
* one crease in palm, short fingers, wide-gap between big toe and second toe
75
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
76
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
77
4 hours to nursing discharge
*focus-monitor, teaching, signs of distress?,
78
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)
79
Labs to know, glucose and WBC
*blood glucose-40-60 mg/dL *WBC-9,000-30,000
80
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)
81
ABCs of sleep
*no smoking around baby/ change clothes (no crib bumpers, blankets, plush toys *Alone, back, crib
82
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
83
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
84
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
85
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)

N306-Expanding Family and Community (4 decks)

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