week 6 Flashcards
convection, radiation, evaporation, or conduction?
The loss of heat as water evaporates from the newborn’s skin.
- Examples: Wet skin after birth, bathing, or diapering.
- Prevention: Drying the newborn immediately after birth, using warmed blankets, and minimizing bath time.
evaporation
Male newborn genitals
-Term or Preterm?
- Small scrotum
- Few rugae (wrinkles)
- Testes are palpable in the inguinal canal
-Term or Preterm?
- Testes are lower in scrotum
- Rugae
Male genitals
-Preterm
- Small scrotum
- Few rugae (wrinkles)
- Testes are palpable in the inguinal canal
-Term
- Testes are lower in scrotum
- Rugae
Should void by ________ hours, if not contact HCP
Stool
- meconium (1st stool) within ______ hours
- after that stool will appear different based on ___________
48 hours
24 hours
breastfeed vs formula feed
Umbilical cord care
- Clamp until _______
- Falls off 7-10 days usually, maybe more
Umbilical cord care
- Clamp until dried
- Falls off 7-10 days usually, maybe more
newborn skin
- __________ – thin, transparent, veins prominent, smooth feet (no creases)
- ___________– opaque, no vernix, creases on feet
- ____________ – dry, peeling
post term, preterm, term
Skin
- Preterm – thin, transparent, veins prominent, smooth feet (no creases)
- Term – opaque, no vernix, creases on feet
- Post term – dry, peeling
Apgar score
are all of these 0, 1, or 2 points?
- Completely pink color
- HR/pulse above 100 bpm
- Vigorous cry with reflex irritability
- Active motion with muscle tone
- Good cry (respiratory effort)
2 points
treatment of transient tachypnea ( when the baby’s lungs retain fluid from the womb, making it difficult to breathe) of the new born
SATA
- chest xray
- oxyhood
- IV fluids
- Tube feed (if RR over 60, aspiration risk)
- ambulation
- chest xray
- oxyhood
- IV fluids
- Tube feed (if RR over 60, aspiration risk)
X- ambulation
Yellow color of skin/sclera due to increased bilirubin levels from RBC breakdown
- Normal levels 4-6
jaundice
Apgar score
are all of these 0, 1, or 2 points?
- Body pink, extremities blue in color
- HR/pulse is slow, under 100
- Grimace with reflex irritability
- Some flexion with muscle tone
- Slow, irregular respiratory effort
1 point (everything in between 0 and 2, not absent but not great either)
Pathological or physiological jaundice?
BAD
- r/t other condition/pathology
- Occurs within the first 24 hours of life
- Treatment - May use phototherapy or blood transfusion
Pathological jaundice = BAD
s/s of hypothermia or hyperthermia?
- bradycardia
- tachycardia
-tachypnea - restless
- irritability
- shallow and irregular respirations
- respiratory distress
- apnea
- hypoxemia
- metabolic acidosis
hypo - bradycardia
hyper - tachycardia
both -tachypnea
hypo - restless
hyper - irritability
hypo - shallow and irregular respirations
hypo - respiratory distress
both - apnea
hypo - hypoxemia
hypo - metabolic acidosis
Nursing interventions & pharmacological treatment: NAS and withdrawal SATA
- Depends on drug withdrawaling from
- Morphine and methadone most common 1st line meds
- Adjunctive use of phenobarbital or clonidine to treat opioid withdrawal
- Buprenorphine – prevents intrauterine fetal seizures and other withdrawal symptoms, mom heroin use
- May require NICU admission
- continued drug use may be encouraged
- Depends on drug withdrawaling from
- Morphine and methadone most common 1st line meds
- Adjunctive use of phenobarbital or clonidine to treat opioid withdrawal
- Buprenorphine – prevents intrauterine fetal seizures and other withdrawal symptoms, mom heroin use
- May require NICU admission
X- continued drug use may be encouraged
Caput succedaneum or Cephalhematoma?
Collection of blood between scalp and skull bone
- Doesn’t cross suture line
- Appears day 1-2
- Disappears weeks - months
Cephalhematoma
Newborn bath
______ hours or more after birth
Newborn bath
6 hours or more after birth
Thermal changes initiating newborn respiration
increase or decrease in environmental temp after birth triggers newborn RR to increase?
Thermal changes
- decrease in environmental temp after birth = newborn RR increase
- avoid prolonged exposure to cold = cold stress/apnea
- When infants experience cold stress, they begin to metabolize ____________ (brown fat or subq fat) stores
- if the baby is not warmed and the cold stress continues, s/s of ___________ (hypo or hyperthermia) appear
When infants experience cold stress, they begin to metabolize brown fat stores, if the baby is not warmed and the cold stress continues, s/s of hypothermia appear
newborn Ear variations
Placement of ears
- Low set
- Consider syndromes such as down syndrome or intellectual disabilities
Ear form and cartilage distribution
- Term or Preterm? – shapeless, flat, no recoil
- Term or Preterm? – cartilage, curving, good recoil
- Preterm – shapeless, flat, no recoil
- Term – cartilage, curving, good recoil
signs of respiratory distress SATA
- nasal flaring
- fever
- intercostal or xiphoid retractions
- expiratory grunting or sighing
- seesaw respirations
signs of respiratory distress
- nasal flaring
X- fever
- intercostal or xiphoid retractions
- expiratory grunting or sighing
- seesaw respirations
Factors influencing the outcome of at-risk neonates
- Birth weight
- Gestational age
- time of delivery
- Intrauterine growth
- Type and length of illness
- Environmental factors
- Maternal factors
- Maternal-neonatal separation
- Birth weight
- Gestational age
X- time of delivery - Intrauterine growth
- Type and length of illness
- Environmental factors
- Maternal factors
- Maternal-neonatal separation
all s/s of hypothermia or hyperthermia?
- tachycardia, tachypnea, apnea
- warm extremities, flushing, perspiration (term babies)
- dehydration
- lethargic, hypotonia
- poor feed
- irritability
- weak cry
hyperthermia
Neonatal resuscitation protocol
should nurse intervene?
- preterm baby, no tone, not breathing or crying
- Labored breathing or persistent cyanosis
- Apnea or gasping, HR <100
- HR <100
- HR <60
yes = intervene (warm, dry, stimulate, position airway, suction)
yes = intervene (position airway, suction, pulse ox, O2 or CPAP)
yes = = intervene (PPV, pulse ox, cardiac monitor)
yes = intervene
yes = intervene (chest compression, O2, epinephrine)
s/s of newborn illness SATA
- Absence of breath for 10 secs
- Inconsolable infant
- Continuous high pitched cry
- Discharge from umbilical cord
- Bleeding from circumcision
X- Absence of breath longer than 20 secs
- Inconsolable infant
- Continuous high pitched cry
- Discharge or bleeding from umbilical cord, circumcision, or any other opening
newborn size
- _____________ = <5.5 lbs
- ______________ = <3.3 lbs
- ______________ = <2.2 lbs
Very low birth weight VLBW, Low birth weight LBW, Extremely low birth weight ELBW
- Low birth weight LBW = <5.5 lbs
- Very low birth weight VLBW = <3.3 lbs
- Extremely low birth weight ELBW = <2.2 lbs
newborn Eye variation
Transient strabismus, Doll’s eye, Subconjunctival hemorrhage
______________– red sclera, resolves itself
_______________– cross eyed, normal up to 4 mos, resolves itself or may be treated later
________________– due to underdeveloped head/eye coordination, normal up to 12 weeks, resolves itself
Eye variation
Subconjunctival hemorrhage – red sclera, resolves itself
Transient strabismus – cross eyed, normal up to 4 mos, resolves itself or may be treated later
Doll’s eye – due to underdeveloped head/eye coordination, normal up to 12 weeks, resolves itself
convection, radiation, evaporation, or conduction?
The loss of heat from a newborn’s body to a cooler solid surface nearby, without direct contact.
- Examples: Cold walls, windows, or equipment.
- Prevention: Placing the newborn away from cold surfaces, and using radiant warmers.
radiation
bulb vs suction catheter after delivery?
- Meconium plugs
- Only used when infant comes out with no tone, pale, limp, no respiratory effort
suction catheter
Modified Finnegan neonatal abstinence score sheet
T/F
- Assessment tool
- Scores severity of withdrawal from opioids
- Monitors and documents infants clinical response to withdrawal
- 21 most frequently observed symptoms
- Each symptom assigned score, all symptoms observed during the scoring interval are added together for the total score
- Scoring is dynamic, not static
all true
T/F
- alveoli are the first to form during development of lungs?
- the younger the baby, the fewer alveoli, the more severe RDS is likely to be?
F - alveoli are the last to form during development of lungs
T - the younger the baby, the fewer alveoli, the more severe RDS is likely to be
Skin variations
- Vernix caseosa –
- Milia –
- Telangiectatic nevi –
- Mongolian spots –
- Nevus flammeus –
- Nevus vasculosus –
- Vernix caseosa – cheesy
- Milia – white bumps on face
- Telangiectatic nevi – stork bites
- Mongolian spots – birth marks, mistaken for bruises
- Nevus flammeus – port wine stain
- Nevus vasculosus – strawberry mark
- overheating from incubators, radiant warmers, or environmental temp
- maternal fever
- maternal epidural anesthesia
- phototherapy lights, sunlight
- excessive swaddling
- infection
- CNS disorders – asphyxia
- Dehydration
can cause ___________
hyperthermia
Clubfoot
- To assess – move foot to midline, resistance = clubfoot
Sole plantar creases
- As gestation progresses, proceeds to heel
- Preterm or Term – creases?
- Preterm or Term – smooth?
- Term – creases
- Preterm – smooth
Preterm/Premature baby d/c
T/F
- Wait until 36-40 weeks gestation
- Look for Factors that predict normal g&d
- Head lag test - When lifted from prone position, babys head should hang below body
- baby is quiet and calm, even when hungry
- Appropriate amount and pattern of weight gain according to growth curves
- Neurologic responses appropriate for corrected age
- Wait until 36-40 weeks gestation
- Look for Factors that predict normal g&d
X- Head lag test - When lifted from prone position, baby should raise head parallel to body
X- Ability to cry vigorously when hungry - Appropriate amount and pattern of weight gain according to growth curves
- Neurologic responses appropriate for corrected age
Common causes of indicated preterm birth SATA
- Fetal disorders
- IUGR
- Polyhydramnios
- oligohydramnios
- Hydrops
- Birth defects
- Multiple gestation
- Twin to twin transfusion syndrome TTTS – rare condition that affects identical twins in the womb where the blood supply of one twin moves to the other shared placenta
- striae
- Fetal disorders
- IUGR
- Polyhydramnios
- oligohydramnios
- Hydrops
- Birth defects
- Multiple gestation
- Twin to twin transfusion syndrome TTTS – rare condition that affects identical twins in the womb where the blood supply of one twin moves to the other shared placenta
X- striae
s/s of newborn illness SATA
- Refusal of 2 feedings in a row
- Drowsy infant, refusing to feed for 8 hours
- Difficulty waking baby
- Cyanosis w/ a feeding
- Cyanosis w/out a feeding
all
new born Respirations
- First 2 hours of life RR is increased – up to ______ breaths/min
- Normal respiratory _____ - _______ breaths/min
Respirations
- First 2 hours of life RR is increased – up to 70 breaths/min
- Normal respiratory 30-60 breaths/min
Nursing care for jaundice
T/F
- Keep baby warm 97.7 F +
- Monitor amount of stools
- Encourage early feedings
- Increase Frequency of feeding 8-12 x in 24 hours – stimulates gut to poop bilirubin out
- phototherapy
- Wear diaper
- Eye protection
- Monitor hydration
- Allow for bonding
all true
newborn Mouth variation
- Assess suck – finger glove in mouth
- Cleft lip and palate – risk for _________, monitor for _____________ and _____________ while feeding
- Precocious teeth
- Epstein’s pearls – harmless cysts, resolves itself
Mouth
- Assess suck – finger glove in mouth
- Cleft lip and palate – risk for aspiration, monitor for respiratory distress and aspiration while feeding
- Precocious teeth
- Epstein’s pearls – harmless cysts, resolves itself
s/s of respiratory distress syndrome, Neonatal abstinence syndrome, or Newborn withdrawal?
- Vigorous, excessive suck
- Vomit
- Poor weight gain
- poor feed – doesn’t eat a good amount, takes longer than 30 mins to feed
- Sensitive gag reflex
- Diarrhea
NAS and Newborn withdrawal s/s
convection, radiation, evaporation, or conduction?
The loss of heat from a newborn’s body to a cooler solid surface through direct contact.
- Examples: Cold examination table, scale, stethoscope or clothing.
- Prevention: Warming equipment before use, using pre-warmed blankets, and avoiding direct contact with cold surfaces.
conduction
consequences of newborn hyperthermia SATA
- Hypotension
- Dehydration
- Seizures
- Apnea
- Hypernatremia
- Respiratory distress
all
- Hypotension and dehydrations (from increased water loss)
- Seizures and apnea (from high core temp)
- Hypernatremia
- Respiratory distress
T/F
Lanugo decreases as gestational age increases?
true
Apgar score
are all of these 0, 1, or 2 points?
- Pale blue color
- Absent HR/pulse
- Absent reflex irritability
- Limp muscle tone
- Absent respiratory effort
0
- Intrauterine growth restriction IUGR = rate of growth doesn’t meet _____________________
- Symmetric or Asymmetric IUGR = weight, length, head circumference all affected
- Symmetric or Asymmetric IUGR = head normal but body is disproportionately small below 10th percentile
- Increased risk of respiratory depression, sepsis, death is associated with symmetric or asymmetric IUGR?
- Intrauterine growth restriction IUGR = rate of growth doesn’t meet expected growth plan
- Symmetric IUGR = weight, length, head circumference all affected
- Asymmetric IUGR = head normal but body is disproportionately small below 10th percentile
- Increase risk of respiratory depression, sepsis, death
which is done Prior to d/c
- Hearing screening
- Vision screening
- Test for PKU (Guthrie blood test) after 24 hours of breast milk or formula feeding
- Hep B
- Hep B immunoglobulin
- Circumcision
- Parent education
- Hearing screening
X- Vision screening - Test for PKU (Guthrie blood test) after 24 hours of breast milk or formula feeding
- Hep B – all babies
- Hep B immunoglobulin – baby’s with positive Hep B moms
- Circumcision
- Petroleum jelly with diaper change
- Parent education
- Swaddle infant
- Back to sleep
- Car seat safety
- Infant CPR
- Routine pediatric appointments
Fontanelles –
- soft and flat =
- sunken =
- bulging =
Fontanelles –
-should be soft and flat
-sunken = dehydrated
- gather more information, ask mom about number of wet diapers and feeding sessions over last 24 hours
-bulging = ICP or crying
- SBAR provider about ICP concern
convection, radiation, evaporation, or conduction?
The loss of heat from a newborn’s body to the surrounding cooler air.
- Examples: Drafts, open windows, or air conditioning.
- Prevention: Keeping the newborn away from drafts, using radiant warmers, and maintaining a warm environment.
convection
T/F
When crying vitals will be slightly low and that is normal?
Pulse ox reading screens for congenital heart disease in newborn?
F - Consider when crying – vitals will be slightly elevated and that is normal
T - Pulse ox reading screens for congenital heart disease in newborn – low O2 levels indicate heart issues
all s/s of hypothermia or hyperthermia?
- Acrocyanosis
- Cool, mottled, pale skin
- Hypoglycemia – they are using blood sugar to warm up
- Transient hyperglycemia
- Bradycardia
- Tachypnea, restlessness, shallow and irregular respirations
- Respiratory distress, apnea, hypoxemia, metabolic acidosis
- Decreased activity, lethargy, hypotonia
- Feeble cry
- poor feed, Decreased weight gain
hypothermia
signs of respiratory distress SATA
- tachypnea RR 76
- RR 22
- RR 40
- Central cyanosis – blue body and/or mouth
- Circumoral cyanosis – blue mouth
signs of respiratory distress
- tachypnea
- RR outside of 30-60 breaths/min normal range
- Central cyanosis – blue body and/or mouth
- Circumoral cyanosis – blue mouth
Newborn vitals
Pulse
- Normally _____-______ (when is best time to assess?)
- Sleep ______
- Vigorous cry __________
- locations to check pulse _________ and ____________
Newborn vitals
Pulse
- Normally 110-160 (at rest, best time to assess)
- Sleep 80
- Vigorous cry 180
- Brachial and femoral pulse
observe umbilical for _________
hernia
Polydactyly, Simian crease, or syndactyly?
Single line in palm – consider down syndrome
Webbing
Extra digits
Simian crease - Single line in palm – consider down syndrome
Webbing – syndactyly
Extra digits – polydactyly
Caput succedaneum or Cephalhematoma?
Soft tissue swelling between scalp and skull bone
- Will cross suture line
- Appears at birth
- Disappears hours – days
Caput succedaneum
which are s/s of hypothermia, hyperthermia or both?
- hypoglycemia
- transient hyperglycemia
- dehydration
- decreased activity
- lethargy
- hypotonia
- poor feed
- weak cry
hypo - hypoglycemia (using BS to warm up)
hypo - transient hyperglycemia
hyper - dehydration
both - lethargy
both - hypotonia
both - poor feed
both - weak cry
Term baby expected appearance T/F
- Creases on soles of feet
- Vernix only in skin creases
- Instant recoil to ears
- Prominent breast bud tissue
- Increased lanugo
- Creases on soles of feet
- Vernix only in skin creases
- Instant recoil to ears
- Prominent breast bud tissue
X - lanugo decreases as fetus matures, term baby would have little to none
which are s/s of hypothermia or hyperthermia or both?
- acrocyanosis
- warm extremities
- flushing
- perspiration (term babies)
- cool, mottled, pale skin
hypo - acrocyanosis
hyper - warm extremities
hyper - flushing
hyper - perspiration (term babies)
hypo - cool, mottled, pale skin
bulb vs suction catheter after delivery?
- Mouth, then nose
- Non meconium substance
bulb suction
Hypoglycemia s/s
-Jittery/tremors/shivering
-Seizures
-Hypothermia
-Breathing problems
-asthma
-Jittery/tremors/shivering - remember baby cant shiver when cold so this would be a sign of something going on
-Seizures
-Hypothermia
-Breathing problems
X-asthma
s/s of respiratory distress syndrome, Neonatal abstinence syndrome, or Newborn withdrawal?
- High pitched cry
- Hyperirritability, difficult to console
- Restlessness
- Increased muscle tone
- Exaggerated reflexes
- Tremors, jerks, shaking
- Seizures
- Sneezing, hiccups, yawning
- Short, unquiet sleep
NAS and Newborn withdrawal s/s
s/s of respiratory distress syndrome, Neonatal abstinence syndrome, or Newborn withdrawal?
- Stuffy nose
- Sneezing, yawning
- Mottled
- Tachypnea – greater than 60 breaths/min
- Fever, Sweating
- Hyperthermia
- Diaper rash
- Facial scratches
- Pressure-point abrasions
NAS and Newborn withdrawal s/s
progressive respiratory distress noted by at least 6 hours of age until 72 hours of age
transient tachypnea of the new born
- Birth injury
- Large baby
- Shoulder dystocia
- Difficult birth
can cause fracture of which bone?
Fractures clavicle
Hep B immunoglobulin or Hep B
______________– all babies
_____________ – baby’s with positive Hep B moms
- Hep B – all babies
- Hep B immunoglobulin – baby’s with positive Hep B moms
Erythromycin
T/F
-Eye prophylaxis to prevent Hep B
-Caused by untreated chlamydia or gonorrhea in mom
-Can cause blindness in babies
-Give to newborns with positive moms
-Within 30 mins of birth
-Applied inner to outer eye
-Placed directly on eye
X - Eye prophylaxis to prevent conjunctivitis
- Caused by untreated chlamydia or gonorrhea in mom
- Can cause blindness in babies
X - Give to all newborns
- Within 30 mins of birth
- Applied inner to outer eye
- Placed directly on eye
Chemical changes initiating newborn respiration
increased or decreased CO2?
and
increased or decreased pH and O2?
triggers baby’s brain respiratory center to do first breath/gasp
increased Pco2 and decreased pH and Po2 = triggers baby’s brain respiratory center to do first breath/gasp
which ways can surfactant development in the alveoli be stimulated SATA
- giving mom betamethasone
- ROM
- oxygen therapy
- warming environment baby is born in
- giving mom betamethasone - steroid
- ROM – a sign to the body to get surfactant production going
X - oxygen therapy
X- warming environment baby is born in
Newborns are at risk for cold/heat loss because of these issues with thermoregulation SATA
- Large surface area-to-body mass ratio
- high subq fat (low brown fat)
- low body water content
- Immature skin leading to evaporated water and heat loss
- Poorly developed metabolic thermal stress (cant shiver)
- Altered skin blood flow (peripheral cyanosis)
Newborns are at risk for cold/heat loss because
- Large surface area-to-body mass ratio
X- Low subq fat (more brown fat)
X- High body water content
- Immature skin leading to evaporated water and heat loss
- Poorly developed metabolic thermal stress (cant shiver)
- Altered skin blood flow (peripheral cyanosis)
heal stick BS is warranted for babies with SATA
- Maternal DM
- LGA
- SGA
- baby is shivering
Bs level should be _____ or higher
heal stick BS is warranted for babies with SATA
- Maternal DM
- LGA
- SGA
- baby is shivering = hypoglycemia s/s
40 or higher
which infant would get a finnegan score SATA
- All infants with maternal history suggesting narcotic/opioid use
- Infants exhibiting s/s of narcotic/opioid withdrawal
- All infants with low socioeconomic parents
- All infants with maternal history suggesting narcotic/opioid use
- Infants exhibiting s/s of narcotic/opioid withdrawal
X- All infants with low socioeconomic parents
when to do finnegan score
-baseline =___ hours after birth
-Continue scoring every 4 hours, before/after each feeding?
-Scores 8 or +
- Score every 2 hours until NAS meds started
- Score every 4 hours or after every feeding while on NAS meds
When to score
- 2 hours after birth for baseline
- Continue scoring every 4 hours, after each feeding
- Scores 8 or +
- Score every 2 hours until NAS meds started
- Score every 4 hours or after every feeding while on NAS meds
Effect of premature birth on g&d
T/F
- The more premature, the more risk for g&d problems
-Preterm babies can still perform the same as full term babies
-Age of all preemies are adjusted when development is evaluated
T- The more premature, the more risk for g&d problems
F- Preterm babies will not perform the same as full term babies
T- Age of all preemies are adjusted when development is evaluated
umbilical cord
___ arteries
___ veins
- 2 arteries
- 1 vein
kangaroo care vs radiant warmer after delivery
- ________________ – option for stable infants
- ________________ – option for c/s infants, unstable infants, infants requiring close assessment
- Kangaroo care – option for stable infants
- Radiant warmer – option for c/s infants, unstable infants, infants requiring close assessment
s/s of newborn illness SATA
- Temp above 100.4 F – axillary
- Temp below 97.7 F – axillary
- Continual rise in temp
- Forceful or frequent vomit
- excessive burping
- Temp above 100.4 F – axillary
- Temp below 97.7 F – axillary
- Continual rise in temp
- Forceful or frequent vomit
X- excessive burping
newborn Back
-Assess spine
-Sacral dimple (pilonidal dimple) - Closed/open indentation or pit at the base of spine
- If ________ must r/o
- Spina bifida occulta
- Tethered cord syndrome
Back
- Assess spine
- Sacral dimple (pilonidal dimple)
- Closed/open indentation or pit at the base of spine
- If open must r/o
- Spina bifida occulta
- Tethered cord syndrome
Hip dislocation - Ortolanis maneuver or Barlows maneuver?
- (dislocation maneuver) – if hip is dislocated, will feel femur move out of acetabulum, brings legs together
- (realignment maneuver) – if hip is dislocated, will hear hip click back into place (positive sign), brings legs apart
Hip dislocation
- Barlows maneuver (dislocation maneuver) – if hip is dislocated, will feel femur move out of acetabulum, brings legs together
- Ortolanis maneuver (realignment maneuver) – if hip is dislocated, will hear hip click back into place (positive sign), brings legs apart
Dubowitz ballard gestational age assessment = Looks at neuromuscular maturity and physical maturity
Lower/Higher score = higher gestational age
Lower/Higher score = lower gestational age
Higher score = higher gestational age
Lower score = lower gestational age
are these signs of readiness to feed?
- Rooting
- Sucking
- Bobbing head
- aware and alert
yes
Cardiopulmonary changes
-Closure of foramen ovale
-Increased systemic vascular resistance and decreased pulmonary vascular resistance
-Closure of ductus venosus
-Closure of ductus arteriosus
__________ = enhances perfusion of body systems
_________ = between atriums
__________ = blood flows from aorta to pulmonary artery
___________ = perfusion of liver
Cardiopulmonary changes
- Increased systemic vascular resistance and decreased pulmonary vascular resistance = enhances perfusion of body systems
- Closure of foramen ovale = between atriums
- Closure of ductus arteriosus = blood flows from aorta to pulmonary artery
- Closure of ductus venosus = perfusion of liver
Moms on methadone or buprenorphine should be encouraged to breastfeed b/c SATA
- it can delay the onset of withdrawal symptoms
- decrease severity of withdrawal symptoms
- decrease need for pharmacological treatment
- it should not be encouraged b/c puts the baby at risk for exposure to teratogenic substance
- it can delay the onset of withdrawal symptoms
- decrease severity of withdrawal symptoms
- decrease need for pharmacological treatment
X- it should not be encouraged b/c puts the baby at risk for exposure to teratogenic substance
resolves, fades, or permanent?
- Vernix caseosa – cheesy
- Milia – white bumps on face
- Telangiectatic nevi – stork bites
- Mongolian spots – birth marks, mistaken for bruises
- Nevus flammeus – port wine stain
- Nevus vasculosus – strawberry mark
- Vernix caseosa – cheesy, wash it off with newborn bath
- Milia – white bumps on face, resolves itself
- Telangiectatic nevi – stork bites, may fade
- Mongolian spots – birth marks, mistaken for bruises, permanent
- Nevus flammeus – port wine stain – permanent
- Nevus vasculosus – strawberry mark – may fade
lanugo vs vernix?
fine, downy hair that covers a fetus’s body
white, cheesy substance that covers a baby’s skin while in the womb
lanugo - fine, downy hair that covers a fetus’s body
vernix - white, cheesy substance that covers a baby’s skin while in the womb
newborn size
- Small for gestational age SGA = below ________ percentile
- Appropriate for gestational age AGA = between ______ and ______ percentile
- Large for gestational age LGA = above ________ percentile
- Small for gestational age SGA = below 10th percentile
- Appropriate for gestational age AGA = between 10th and 90th percentile
- Large for gestational age LGA = above 90th percentile
Nursing interventions & Nonpharmacological treatment: NAS and withdrawal SATA
- Skin to skin
- Swaddle
- Gentle waking
- Quiet, low light, minimal stimulation
- Calm music
- Massage therapy
- Cluster care
- Encourage parental involvement and rooming in
- Moms on methadone or buprenorphine should formula feed
- Finnegan scoring
Nursing interventions
Nonpharmacological treatment
- Skin to skin
- Swaddle
- Gentle waking
- Quiet, low light, minimal stimulation
- Calm music
- Massage therapy
- Cluster care
- Encourage parental involvement and rooming in
X - Moms on methadone or buprenorphine should be encouraged to breastfeed b/c it can delay the onset of and decrease severity of withdrawal symptoms, also decrease need for pharmacological treatment
- Finnegan scoring
- Normal = ___________ breathing – pauses in breathing up to 20 secs
- Abnormal = __________ breathing – pauses in breathing over 20 secs
- Normal = periodic breathing – pauses in breathing up to 20 secs
- Abnormal = apneic breathing – pauses in breathing over 20 secs
Tonic neck
Palmar and plantar grasp
Moro/startle
Rooting
Suck
Babinski
Stepping
these are all
reflexes born with
Skin color
-Completely ________ – desired
-Acrocyanosis – blue hands/feet or body/mouth
-Central cyanosis – blue hands/feet or body/mouth
Skin color
- Completely Pink – desired
- Acrocyanosis – blue hands and/or feet
- Central cyanosis – blue body and/or mouth
should the nurse suggest feeding newborn with hyperthermia frequently to replace fluids?
yes - Breastfeed newborn frequently to replace fluids
newborn Resting posture
- Preterm – extended or flexed?
- Term – extended or flexed?
Resting posture
- Preterm – extended
- Term – flexed (helps preserve heat)
Common causes of indicated preterm birth SATA
- Diabetes
- pain
- Chronic HTN
- Pre-eclampsia
- Abruption
- Previa
- Gallbladder disease
- Diabetes
X- pain - Chronic HTN
- Pre-eclampsia
- Abruption
- Previa
- Gallbladder disease
s/s of newborn illness SATA
- 2 green watery stools in a week
- No wet diapers for 18-24 hours
- Fewer than 6-8 wet diapers per day (after 4 days old)
- Eye drainage
X- 2 consecutive green watery stools
- No wet diapers for 18-24 hours
- Fewer than 6-8 wet diapers per day (after 4 days old)
- Eye drainage
Erb’s palsy or Epstein’s pearls?
- type of brachial plexus injury that occurs most commonly during childbirth.
- The brachial plexus is a network of nerves that controls movement and sensation in the arm and hand.
Erb’s palsy
breast vs formula feed?
- Feed Q 2-3 hours
- Burp in between each breast
- feed Q 3-4 hours
- burp after ½ formula
breast
- Feed Q 2-3 hours
- Burp in between each breast
Formula
- feed Q 3-4 hours
- burp after ½ formula
- Preterm or Term newborns are at greatest risk for cold/heat loss?
- Preterm or Term newborns lack ability to do the flexed posture for preserving heat?
- Preterm or Term newborns have very thin skin with capillaries close to the surface that make them unable to preserve heat?
Preterm newborn – at even greater risk for cold/heat loss because
- Lack of flexed posture for preserving heat
- Very thin skin with capillaries close to the surface
NAS complications SATA
- Respiratory distress
- Jaundice
- Congenital anomalies
- IUGR
- Behavioral abnormality
- Withdrawal
- General complications from preterm birth (if it was necessary for fetal health)
all
Examples of Infants at greatest risk of developing physiological jaundice or pathological jaundice?
- 2 day old infants born at 35 weeks
- 2 day old SGA baby who is having difficulty breastfeeding
- 2 day old baby diagnosed with a cephalhematoma
Examples of Infants at greatest risk of developing physiological jaundice
- 2 day old infants born at 35 weeks = preterm liver
- 2 day old SGA baby who is having difficulty breastfeeding = if they aren’t eating then they’re not pooping, and that’s how they get rid of excess bilirubin
- 2 day old baby diagnosed with a cephalhematoma = collection of blood
Measure length
- Head circumference
- Chest circumference
- Length head to toe
is head or chest circumference bigger in newborn?
- Head circumference bigger than chest circumference
Female newborn genitals
-Preterm/Term?
- Prominent clitoris
- Labia majora small and widely separates
-Preterm/Term?
- Labia majora covers labia minors and clitoris
Female genitals
-Preterm
- Prominent clitoris
- Labia majora small and widely separates
-Term
- Labia majora covers labia minors and clitoris
new born BP
- Goes up or down after birth?
- Cap refill
BP
- Goes down after birth
Gestational age
- – 20 to 36 6/7 weeks
- – 34 to 36 6/7 weeks
- – 37 to 38 6/7
- – 39 to 40 6/7 weeks
- – 41 to 41 6/7 weeks
- – 42 weeks +
Full term, Late preterm, Early term, Late term, Preterm, Post term
Gestational age
- Preterm – 20 to 36 6/7 weeks
- Late preterm – 34 to 36 6/7 weeks
- Early term – 37 to 38 6/7
- Full term – 39 to 40 6/7 weeks
- Late term – 41 to 41 6/7 weeks
- Post term – 42 weeks +
Vitamin K shot
- Newborns lacking vitamin K in gut when born
- Vitamin K = clotting factor
- Risk of thrombosis
- Goes in vastus lateralis
- 90 degree
- Don’t aspirate
- Needle length smaller than 1.5 inches
- Dose 0.5 – 1.0 mL
Vitamin K shot
- Newborns lacking vitamin K in gut when born
- Vitamin K = clotting factor
X - Risk of bleeding/hemorrhage
- Goes in vastus lateralis
- 90 degree
- Don’t aspirate
- Needle length smaller than 1.5 inches
- Dose 0.5 – 1.0 mL
Pathological or physiological jaundice?
- Occurs after the first 24 hours of life
- Treatment – increase feedings 8-12 times/day, may use phototherapy
physiological jaundice
Newborn head
- Larger or smaller than body?
- About 1/4 of body size?
- Contains 6 or 8 bones?
Newborn head
- Larger than body
- About ¼ of body size
- Contains 6 bones
new born Temp
- ______.7 F – _____.5 F
- location?
Temp
- 97.7 F – 99.5 F
- Axillary
which are RDS risk factors SATA
- Preterm infant
- c/s delivery
- maternal DM
- baby has an infection
- baby has hypothermia
- slow vaginal delivery
RDS risk factors
- Preterm infant – surfactant lacking
- c/s delivery – fluid doesn’t get squeezed out
- maternal DM – hyperinsulinemia and hyperglycemia reduce fetal surfactant production
- stress on baby – infection, cold stress, hypothermia
X- slow vaginal delivery
T/F
SmallGA and IUGrowthRestriction infants are at greater risk of death?
true
causes of transient tachypnea of the new born -
SATA
- LGA
- SGA
- Late preterm infants
- Maternal over sedation
- Maternal bleeding
- Prolapsed cord
- Breech birth
- Maternal diabetes
- c/s birth
- LGA
X- SGA - Late preterm infants
- Maternal over sedation
- Maternal bleeding
- Prolapsed cord
- Breech birth
- Maternal diabetes
- c/s birth
newborn under radiant warmer is showing signs of hyperthermia, which would be appropriate treatment options SATA
- Move away from heat
- Undress newborn
- lower room temp
- give newborn bath
- Move away from heat
- Undress newborn
- lower room temp when in incubator
X- give newborn bath
which Periods of reactivity is best for bonding and breastfeeding?
1st period of reactivity
- 30 mins after birth
Sleep phase
- 2-4 hours
2nd period of reactivity
- 4-6 hours
1st period of reactivity
- 30 mins after birth
- Good for bonding and breastfeeding
Babies more prone to having extra fluid still in lungs after delivery:
- Quick vaginal labor
- c/s delivery
- slow vaginal labor
- Quick vaginal labor
- c/s delivery
b/c during vaginal birth process, fetal chest is compressed and squeezes fluid out
Genitalia variations for Male or Female?
-Hypospadias – urethral opening on underside of penis
-Epispadias - urethral opening on topside of penis
-Phimosis – cant retract foreskin
-Hydrocele – swelling in scrotum
-Cryptorchidism – teste(s) fail to descend
-Pseudo menstruation
Hold _______________ if hypospadias/epispadias is a concern
Male
- Hypospadias – urethral opening on underside of penis
- Epispadias - urethral opening on topside of penis
- Phimosis – cant retract foreskin
- Hydrocele – swelling in scrotum
- Cryptorchidism – teste(s) fail to descend
Hold circumcision if hypospadias/epispadias is a concern
Female
- Pseudo menstruation
Encourage breastfeeding in 1st hour to help regulate _______
blood sugar
Caput succedaneum or Cephalhematoma?
Potential results of unresolved _______________
- Jaundice (high bilirubin)
- Anemia
- Hypotension
cephalhematoma - Collection of blood between scalp and skull bone
Mechanical changes initiating newborn respiration
- Fetus knows to decrease production of lung fluid 2-4 days prior to delivery
- Still 80-100 mL of fluid in infant lungs at delivery
- During vaginal birth process, fetal chest is _____________________
- During vaginal birth process, fetal chest is compressed and squeezes fluid out
Treatment for newborn with RDS - SATA
- Oxygen therapy
- CPAP
- Mechanical ventilation
- Surfactant admin
- Thermoregulation in incubator
- massage therapy
- ECMO - Heart/lung machine allows baby’s lungs to rest and heal
- Oxygen therapy
- CPAP
- Mechanical ventilation
- Surfactant admin
- Thermoregulation in incubator
X- massage therapy - ECMO - Heart/lung machine allows baby’s lungs to rest and heal
Sensory changes initiate respirations in newborns SATA
- light
- sounds
- gravity
- touch
ALL
are neonates considered at-risk SATA
- Mom low socioeconomic status
- Limited access to healthcare
- No prenatal care
- Exposure to environmental dangers
- Pre-existing maternal conditions
- Medical conditions r/t pregnancy
- Pregnancy complications
- Average gestational age
- Mom low socioeconomic status
- Limited access to healthcare
- No prenatal care
- Exposure to environmental dangers
- Pre-existing maternal conditions
- Medical conditions r/t pregnancy
- Pregnancy complications
X- Average gestational age
Common causes of indicated preterm birth SATA
- Heart disease
- VTE
- Asthma
- HIV
- active HSV
- convenience
- Obesity
- AMA
- Heart disease
- VTE
- Asthma
- HIV
- active HSV
X- convenience - Obesity
- AMA
- newborn Weight loss
- Term babies lose _______ of birth weight
- Preterm babies lose _______ of birth weight
- Weight gain
- Double birth weight by 6 mos
- Triple birth weight by 12 mos
Measure weight
- Weight loss
- Term babies lose 5%-10% of birth weight
- Preterm babies lose 15% of birth weight
- Weight gain
- Double birth weight by 6 mos
- Triple birth weight by 12 mos
Apgar score
A –
P –
G –
A –
R –
Apgar score taken at _____ min and ___ min
Apgar score
A – appearance (color)
P – pulse (HR)
G – grimace (reflex irritability)
A – activity (muscle tone)
R – respiratory effort
Apgar score taken at 1 and 5 minutes
