Week 6 Nursing Care of the Healthy Newborn Flashcards
Neonatal period is the first _____ days of life
28 days of life
Cord clamping initiates the following:
Occlusion of the umbilical vessels
Occlusion and thrombosis of ductus venosus
Increase in systematic pressure to maintain blood flow to the heart
Clamping of the umbilical cord eliminates what as the reservoir for blood
The placenta
Onset of respirations causes rise in PO2 in the lungs and a decrease in what?
Pulmonary Vascular resistance
This then increases pulmonary blood flow and increases pressure in the left atrium
After the left atrium what happens to the pressure?
Decreases pressure in the right atrium of the heart, then causes the foramen ovale to close
Closes within minutes after birth secondary to a decreased pulmonary vascular resistance and increased left heart pressure
With an increase in oxygen levels after the first breath, an increase in what occurs?
Systematic Vascular resistance occurs
When systematic vascular resistance occurs this decreases ?
Vena Cava return which reduces blood flow in the umbilical vein- constricts and becomes a ligament with functional closing.
Closure of the ductus venosus causes an increase in pressure where?
In the aorta
Force closure of the ductus arteriosus within 10-15 hours after birth
Birth occurs and then what happens with lung ventilation
Increase blood flow to the lungs
Decrease pulmonary vascular resistance
Increase venous return to the LA
When the umbilical cord is cut, then what happens?
Increase lower systematic resistance
Decrease venous return to the RA
Closure of ductus venosus
Pressure increased in LA or RA? Closes?
LA and closes foramen ovale
Bi directional blood flow through the DA and causes what?
DA constriction and closure
Increases stroke volume of the LV
True
In pulmonary atresia how is the blood flow?
Reversed blood flow direction from aorta to pulmonary trunk
RV is hypoplastic- Very small
Lung ventilation in pulmonary atresia includes
Small increase blood flow to the lungs
Decrease pulmonary vascular resistance
Small increase venous return to the LA
Umbilical cord cut in pulmonary atresia
Increase lower systematic resistance
Decreases venous return to the RA
Closure of the ductus venous
Pressure higher in LA or RA in pulmonary atresia
RA
Foramen Ovale open
Unidirectional blood flow through the DA in
Pulmonary Atresia
DA can not close
The first initiates the inflation of the
Lungs
Decrease pulmonary pressure by DILATION of pulmonary vessels
Increase in blood flow through pulmonary vasculature causes constriction of the DA when PO2 > 50mm Hg
Increase in blood flow to the left heart from constriction of the DA
Closure of the FO due to increase in pressure in the left atrium
What are functional closures?
Closure of fetal structures
DA, FO are functional closures
How can FO and DA reopen?
Apnea or conditions resulting in hypoxia
Crying
Cold stress
Hematologic norms for neonates
Normal range is 80-110 ml/ kg
20% less volume, but 20% more RBC mass when compared with adult
Hct is 48-72%
Most body fluids after birth are?
Extracellular
- More puffy and swollen
- Also why baby lose so much weight in 1-2 days
Blood constituents RBC is
Shorter life than adult RBC
80% fetal Hgb, falls 50% by 5 weeks
Hgb norm 17-19
Term neonate has enough iron to maintain Hgb production for
6 months then require diet with additional iron
HR is
120-160 BPM
Slow when sleeping
Increase in moving or crying
Deviations rechecked in 15-30 min
Systolic murmurs and sinus arrhythmia are not uncommon
True
Average BP is
78/42 not routinely assessed
Skin color may be an indicator of cardiac anomaly
Production of lung fluid diminishes how many days before labor?
2-4 days
How much lung fluid remains in the passageway of a full term newborn?
80- 100 ml
During birth what happens to the fetal chest?
Compressed and squeezes fluid
C section infants lack the what?
Squeeze
May have wetter lungs after delivery
Breathing is initially stimulated by?
Pressure changes, temperature changes, chemoreceptor stimulation from hypoxia and stimulation of skin
1st breath occurs in 1st minute
Initial breath requires large amount of ?
Negative intrathoracic pressure
Will see them pull in initially- Seeing ribs
Half of initially inspired air remain in alveoli, which means?
Less negative pressure required in each subsequent breath
- Never fully empty alveoli keeps them puffy
Respiratory Characteristics of Neonate
Normally irregular and shallow - periodic breathing
30-60 RR
Obligated nose breathers- Not nose suction a lot
Simultaneous chest movement, exaggerated diaphragmatic activity
Requires adequate surfactant production to maintain inflation of alveoli and adequate respiratory status
Requires adequate surfactant production to maintain inflation of alveoli and adequate respiratory status
If preterm
- Assess resp. status and ensure alveoli open
- Artificial surfactant to help keep open alveoli open up there own system catches up
What is given to increase development of surfactant before baby is born and given during labor?
Betamethasone
Chest circumference norms is 30-33 cm
Decrease rate of glomerular flow and limited secretion of solutes
Limited tubular reabsorption
Limited ability to concentrate urine
Neonate Renal System Characteristics
How many % void after 24 hours and how many 48 hours?
93%- 24 hr
100%- 48 hr
Initial bladder volume is how much in urine?
6-44 ml
How many voids per day is considered in normal?
6-8 voids
What happens if newborn does not void within 24 hours?
Nurse should assess adequacy of fluid intake
Bladder distention
Restlessness
Symptoms of pain
Term infant should have coordinated what?
Suck- swallow reflex
What sphincter is relaxed in neonate?
Cardiac
Slower emptying time
Initial size of stomach is
Gumball or marble
After 24-36 hr stretches to size of
Ping pong ball
After 3-4 days becomes the size of the a
Chicken Egg
HCI levels in neonate are?
Decreased
More preterm the lower they are
Newborn can digest what?
Simple Carbs and Protein
Less able to digest complex carbs and fats due to limited amylase and lipase
When is meconium formed?
In utero after 28-29 weeks usually
When should newborns pass meconium?
Within 24 hours
Frequency of bowel movements varies
What color are transitional stools?
Thin, brownish stool seen in 3-6 days
3-6 stools per day is common
What color are breast feeding stools?
Loose golden color may pass stool with each feeding
What color is bottle feeding stool?
Firm, pale yellow with sour odor
Generally pass 1-2 day irritating to skin.
Normal poop color can be
Greenish tan
Can signal of teething or baby getting over stomach bug.
Fussy and gassy? Sign of cow’s milk allergy
Dark green stool can be indicator of?
Iron in baby formula
No concern
If stool is bright green and frothy
Too much foremilk and not enough fatty hindmilk
Bright yellow stool is indicator of?
Medications or food eaten by mom
Mustard yellow is normal stool color
True
Solid foods can result in what color of stool?
Orange
Also medications
Does not indicate problems usually
Red color stool Okay?
Yes tiny specs okay
May be red from swallowing blood from nipples
May be certain foods
BLOODY or BRIGHT red may indicate infection, allergy, GI injury or other medical reason
Black stools of newborn may indicate?
Not adequate nutrition or not digesting properly
Older baby could be due to iron in diet
Iron supplement may indicate GI bleeding
Gray color stool may be indicator of?
What your child may eat
May be liver or gallbladder problem
Chalky white poop can be sign of what organ not working properly?
Liver
Healthy stools of a new born should be ?
Yellow seedy and runny
Darker and thicker
Transition of stools go from what to what
Meconium- transitional- Milk stool
Breast fed newborns stool is
Yellow gold, loose, stringy to pasty, sour smelling
Formula fed newborns stool is
Yellow, yellow green, loose, pasty, or formed, unpleasant odor
Newborn liver is slightly less_______ than adult liver
Active
May have difficulty conjugating bilirubin
What plays crucial role in iron storage?
The liver
Carb metabolism- Development of enzymes and coagulation
Why do we give Vitamin K?
Prevents bleeding
Not a vaccine
Mom must sign if refuses
Head bleeds can cause what?
Developmental disabilities
Other brain issues
Death
The liver function of a newborn is
Immature
What is the liver responsible for?
Detoxifying medications
Storing iron in utero
Where does bilirubin conjugation occur?
Liver
Passed out in digestive tract
and urinary tract
Bilirubin is the by product of?
Destruction of RBCs
Unconjugated Hg
bilirubin is bound to
Albumin and is transferred to liver- bound to intracellular proteins
Which enzyme leads to unconjugated bilirubin attached to glucuronic acid
UDGPT
Leads to conjugated bilirubin
Where is conjugated bilirubin excreted?
Common bile ducts into duodenum
In the intestine bacteria transforms conjugate bilirubin into
Urobilinogen
Stercobilinogen
- Excreted as stone in the stool
Bilirubin can or can not change back?
Can be changed back to unconjugated Bilirubin
How does it get unconjugated?
High beta- glucuronidase activity
Delayed colonization of intestinal tract
Physiologic jaundice occurs % in term and % in preterm
50% Term
80% Preterm
What causes physiologic jaundice?
Caused by accelerated destruction of fetal RBCs and increased reabsorption of bilirubin by the liver
Physiological jaundice occurs within 24 hours or more
True
Pathological Jaundice is less than
24 hours
What may cause increase amount of bilirubin in the liver?
Forceps or vacuum extraction can create more bilirubin to be handled by liver especially if bad bruising
Cephalhematoma
Increased blood volume from delayed cord clamping with faster RBC destruction leads to increased bilirubin in blood
Newborn does not take in calories or feed enough can lead to impaired
Conjugation of bilirubin
Mothers that are breastfeeding can cause increase in?
Bili Levels
Later called breastfeeding jaundice
Enzyme in breastmilk that slows the process
Why is there defect in bilirubin excretion because of?
Decreased GI motility
Leads to decreased oxygen tom the liver
Increased Bilirubin reabsorption leads to reduced
Bowel motility
Intestinal obstruction
Delayed passage of meconium
This may lead to increased circulation of bilirubin in enterohepatic pathway and results in higher bilirubin levels
Pathological jaundice results from ?
Rapid and excessive buildup of bilirubin
Generally due to to what for pathological jaundice?
ABO
Rh incompatibility
Infection or trauma
When does pathological jaundice usually occur?
24 hours of life
Levels become high very fast
Pathological jaundice may not respond well to what?
Phototherapy- particular cases in isoimmunization from Rh incompatibility or ABO incompatibility requiring exchange transfusion
Delayed or ineffective treatment of pathological jaundice may lead to?
Kernicterus
Bilirubin induced neurologic toxicity
Phototherapy protocols should include
Cover eyes and genitals
Hydration
Vitals
Labs
Bonding
If baby stays and mom goes home
Neonate immune system is fully developed?
False
Not until after birth fully activated
Newborn has poor hypothalamic response to pyrogens
What is not reliable indicator of infection for neonate?
Infection
Breastfed newborn may have what from mother?
Passive immunity
When do newborns begin to produce IgA
4 weeks intestinal mucosa
Last 4 weeks of passive immunity
During 3rd trimester
Preterm infant more susceptible to infection
Normal edema under the scalp from pressure of labor
Will resolve in a day or two
Does cross suture line
Caput
Blood in between scalp and periosteum
Takes several weeks to resolve
Does not cross suture line
May pre dispose to jaundice
Cephalhematoma
Male reproductive for infant should be
Testes descended
Scrotum edematous
Hypo/ Epispadias
Female reproductive for infant
Labia edematous
Majora covers minora if less may be preterm
Ovaries contain all primitive ovum
May have pseudo menstruation from maternal hormones
Name head deviations of skeletal system
Moulding
Head is 1/4th of body
Hydrocephaly, microcephaly, Anencephaly
Excessive cooling may lead to
Cold stress
Profound depression of cold stress
Thermal Stimuli
Significant decrease in environmental temperature after birth
Stimulates skin nerve endings
Newborn responds to rhythmic respiration that are irregular more sawtooth in formation
What occurs when skin receptors perceive a drop in environmental temperature
Non shivering thermogenesis
Newborn shivers metabolic doubles
Increase in muscle activity
What is the primary source of heat in hypothermic newborns
Brown fat
Found along scapula and kidneys
Very dense circulatory system and heats infant quickly
Appears 26 to 30 weeks
Increases until 2-5 weeks after birth
Once you use it it is gone
Nonshivering thermogenesis
Cold
Noreepi released from symp. nerve endings
Brown fat metabolism
Heat production
Transfer of heat between two objects with direct contact
Conduction
Flow of heat from body surface to cooler surrounding air or air circulating body surface
Convection
Removed from incubator
Loss of heat when a liquid is converted to a vapor
Evaporation
Loss of body heat to cooler solid surfaces in close proximity but not direct contact
Radiation
Nursing care of neonate includes
Fetal to neonatal transition
Treat problems
Provide teaching
Interaction
Adequate nutrition
Initial screening for neonates
Apgars
Physical Exam
Eyes and thighs
Admission to mother baby care
Report from L and D
Review Hx and Prenatal
Review Intrapartal
Assessment
APGAR
A apperance
P pulse
G grimace
A activiy
R respiratory
Prior to 37 weeks is
Preterm
38-42 weeks is
Term
Post-term or post dates
After 42 weeks
Post mature is
After 42 weeks with signs of placental aging
Size For Gestational Age includes
SGA
AGA
LGA
8x/24
Infant initiated
Small Stomach capacity
8-12 diapers
Feeding cues
Breast Feeding
Every 3-4 hours
Less feeding cues
Burp after 15-30 ml
Suck in more air
No juices and waters
Bottle Feeding
LATCH stands for
Latch
Audible swallowing
Type of nipple
Comfort
Hold and positioning
Name selected screenings for newborns
PKU
CHD
Hearing Universal Screening
Safety Measures includes
Check bands
Back to sleep
No bottle propping
Thermoregulation
Parent teaching
Immunizations
Dismissal care includes
Teaching
Labs
Follow up care
Danger signs
Environment
Dangers signs indicating a problems include
Nasal flaring and chest retractions
Grunting on exhalation, labored breathing
Generalized cyanosis, flaccid posture
Abnormal breath sounds and rates
Abnormal HR and newborn size
Labor contractions with cervical changes prior 36.6 weeks
Preterm Labor
PROM
Premature rupture of membranes prior to onset of labor at any gestational age
PPROM
Rupture of membranes prior to 36.6 weeks
Born between 24-36 weeks and 6 days
Preterm infant
Appearance depends on gestational age
Complications of preterm infant includes
RDS MAS
hypothermia
Hypoglycemia
NEC
CNS Trauma
Cold Stress can lead to
Metabolic Acidosis
Newborns of drug addicted mothers include
NAS
Eat Seep and Console
If nonpharmacological measures not work for Eat sleep and console assessment what do we do?
Start morphine 0.05 mg/ kg dose every 3 hr
Increase by 0.01
Fetal demise is
Fetal intrauterine death after 20 weeks gestation
Causes vary
- Cord accident
- Trauma
- Placental abruption
Neonatal Death
Infant death after delivery of a 20 week or greater gestational age
Causes include
Prematurity
Congenital abnormality
Injury
infection
