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
