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