week 6 COPY Flashcards
bulb vs suction catheter after delivery?
- Mouth, then nose
- Non meconium substance
bulb suction
bulb vs suction catheter after delivery?
- Meconium plugs
- Only used when infant comes out with no tone, pale, limp, no respiratory effort
suction catheter
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
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)
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
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
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)
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
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
new born Temp
- ______.7 F – _____.5 F
- location?
Temp
- 97.7 F – 99.5 F
- Axillary
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
- 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
new born BP
- Goes up or down after birth?
- Cap refill
BP
- Goes down after birth
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
- 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
Measure length
- Head circumference
- Chest circumference
- Length head to toe
is head or chest circumference bigger in newborn?
- Head circumference bigger than chest circumference
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
newborn Resting posture
- Preterm – extended or flexed?
- Term – extended or flexed?
Resting posture
- Preterm – extended
- Term – flexed (helps preserve heat)
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
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
T/F
Lanugo decreases as gestational age increases?
true
observe umbilical for _________
hernia
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
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
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
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
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
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
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
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
- Birth injury
- Large baby
- Shoulder dystocia
- Difficult birth
can cause fracture of which bone?
Fractures clavicle
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
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
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
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
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
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
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
Caput succedaneum or Cephalhematoma?
Soft tissue swelling between scalp and skull bone
- Will cross suture line
- Appears at birth
- Disappears hours – days
Caput succedaneum
Caput succedaneum or Cephalhematoma?
Potential results of unresolved _______________
- Jaundice (high bilirubin)
- Anemia
- Hypotension
cephalhematoma - Collection of blood between scalp and skull bone
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
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
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
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
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
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
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
