18-Nursing Management Of the Newborn Flashcards Preview

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Flashcards in 18-Nursing Management Of the Newborn Deck (78):
0

When are the assessments of a newborn done?

Initial assessment completed in birthing area to see if newborn can stay with parents. A second assessment is done within the first 2-4 hours when the newborn is admitted to the nursery or LDR where the parents are

1

What are some assessment findings during the initial newborn assessment that can indicate a problem

Nasal flaring, chest retractions, grunting on exhalation, labored breathing, generalized cyanosis, abnormal breath sounds, abnormal respiratory rates, flaccid body temperature, abnormal heart rates, abnormal newborn size

2

What is the Apgar score

Used to evaluate a newborns physical condition at 1 minute and 5 minutes after birth

3

When would you do an additional Apgar assessment

If the 5 minute score is less than 7 you then do one at 10 minutes

4

What does the Apgar assessment at 1 minute provide

Data about the newborns initial adaption to extrauterine life

5

What does the Apgar assessment at 5 minutes provide

A clearer indication of the newborns overall central nervous system status

6

What are the five parameters assessed with Apgar scoring

A= appearance (color)
P= pulse (heart rate)
G= grimace (reflex irritability)
A= activity (muscle tone)
R= respiratory (respiratory effort)

7

Each Apgar parameter is assigned a score ranging from ___ to ____

0 to 2

8

What does a score of 0 indicate

Absent or poor response

9

What is the Apgar score where no interventions are needed besides maintaining normal respiratory efforts and thermoregulation

8 or higher

10

Apgar score that indicates moderate difficulty

4-7

11

What Apgar score signifies severe distress in adjusting to extrauterine life

0-3

12

What are some things that influence the Apgar score

Infection, congenital anomalies, physiologic immaturity, maternal sedation via medications, labor management, and neuromuscular disorders

13

What is the predictable manner of characteristics disappearing when a newborn is experiencing physiologic depression

First pink coloration is lost, next respiratory effort, and then the tone, followed by reflex irritability and finally heart rate

14

How is length of a newborn measured

Head of newborn to the heel with the newborn unclothed

15

What position should newborn be in when measuring length

Supine position and extend the leg completely when measuring the length

16

What is expected length range of a full term newborn

44-55 cm ( 17-22 inches)

17

How is the weight of newborns usually read? What is a typical newborn weight?

Using a digital scale that reads weight in grams
2,500-4,000 g ( 5 pounds, 8 ounces to 8 pounds, 14 ounces)

18

Newborns typically lose ____% or their initial birth weight by ____ to ____ days of age

10% by 3-4 days of age

19

What are some of the causes of newborns weight loss

Loss of meconium, extracellular fluid, and limited food intake

20

When is the newborn weight loss usually regained by ?

By the 10th day of life

21

Low birth weight=
Very low birth weight=
Extremely low birth weight=

Low birth weight=< 1,000 g (<2.5 lb)

22

How do you take a heart rate on a newborn? What is a typical heart rate?

Apical pulse for 1 full minute
120-160 bpm

23

When are newborns respirations assessed? How do you assess them?

When they are quiet or sleeping. Place a stethoscope on the right side of the chest and count the breaths for 1 full minute to identify any irregularities

24

Normal newborn respiratory rate

30 to 60 breaths/minute with systemic chest movement

25

How long are respiratory and heart rates assessed

Every 30 minutes until stable for 2 hours after birth, then once stable every 8 hours

26

When is axillary temperature typically assessed?

Not immediately after birth but upon arrival to the nursery or in LDR room when initial,newborn assessment is carried out

27

Normal axillary temperature range

97.7* F - 99.5* F

28

Why are rectal temperatures no longer taken

Because of the risk of perforation

29

How often should you assess temperature

Every 30 minutes until it has been stable for 2 hours then every 8 hours until discharge

30

Is blood pressure normally assessed as part of the normal newborn examination?

No it is not. Blood pressure is not normally assessed unless there is a clinical indication or low Apgar score

31

If blood pressure is assessed what is used?

Oscillometer (Dinamap)

32

Typical BP range for newborn

50-75 mm Hg (systolic) / 30-45 mmHg (diastolic)

33

What will increases the systolic BP of a newborn

Crying, moving, and late clamping of the umbilical cord

34

How do you determine a newborns gestational age? What is gestational age?

Assess physical signs and neurologic characteristics. Gestational age is the stage of maturity

35

How is gestational age typically determined?

By using a tool such as a Dubowitz/Ballard or New Ballard Score system. This scoring system provides an objective estimate of gestational age by scoring the specific parameters of physical and neuromuscular maturity

36

How does the Dubowitz/Ballard or New Ballard Scoring System work?

Points are given for each assessment parameter
With a low score of -1 point or -2 points for extreme immaturity to 4 to 5 points for post maturity. The scores from each section are added to correspond to a specific gestational age in weeks.

37

When is the physical maturity section of the Gestational Age Assessment done?

During the first 2 hours of birth

38

Physical maturity Gestational Age Assessment categories

Skin texture
Lanugo
Plantar creases
Breast tissue
Eyes and ears
Genitals

39

What is typical skin texture

Sticky to transparent to smooth. With varying degrees of peeling and cracking, to parchment-like or leathery with significant cracking and wrinkling

40

What is lanugo? What is normal?

Soft downy hair on the newborns body, which is present in preterm babies and usually mostly gone by the time a term baby is born

41

Do preterm newborns have lanugo

No

42

What are plantar creases? What is normal?

Creases on the soles of the feet. Range from absent to covering the entire foot, depending on maturity (the greater number of creases, the greater the newborns maturity)

43

What will you see with ear cartilage of a more mature newborn

Greater amount of stiff ear cartilage

44

When dealing with genitals what determines maturity in males

Evidence of testicular descent and appearance of scrotum (which can range from smooth to covered with rugae) determine maturity

45

When dealing with genitals what determines maturity in females

Appearance and size of clitoris and labia determine maturity ( a prominent suitor is with a flat labia suggest prematurity, whereas a clitoris covered by labia suggests greater maturity

46

When is the neuromuscular maturity section usually completed

Within 24 hours after birth

47

Six activities to determine newborns maturity with neuromuscular maturity section

Posture
Square window
Arm recoil
Popliteal angle
Scarf sign
Heel to ear

48

Born prior to 37 completed weeks gestation, regardless of birth weight

Preterm or premature

49

Born between 38 and 42 weeks gestation

Term

50

Born after completion of week 42 gestation

Post-term or postdates

51

Born after 42 weeks and demonstrating signs of placental aging

Postmature

52

Weight less than the 10th percentile on standard growth charts (usually less than 5.5 lbs)

Small for gestational age (SGA)

53

Weight between 10th and 90th percentiles

Appropriate foe gestational age (AGA)

54

Weight more than the 90th percentile on standard growth charts (usually more than 9 pounds)

Large for gestational age (LGA)

55

Nursing interventions with newborn

Maintaining airway patency, ensuring proper identification, administering prescribed meds, and maintaining thermoregulation

56

What is done immediately after birth to help maintain airway patency

Newborn is suctioned to remove fluids and mucus from the mouth and nose

57

What is newborn typically suctioned with

with a bulb syringe

58

What should you do before placing bulb syringe in newborns mouth or nose

Compress the bulb

59

What position of newborn facilitates drainage

Head down and to the side position

60

Why should you,always keep a bulb syringe near a newborn

In case he or she develops sudden choking or blockage in the nose

61

Is vitamin K fat or water soluble

Fat-soluble

62

What does vitamin K do

Promotes blood clotting by increasing the synthesis of prothrombin by the liver

63

What does a deficiency of vitamin K do

Delays clotting and may lead to hemorrhage

64

When is vitamin k produced in newborns?

The bowel is sterile so vitamin k is not produced in the intestine until after microorganisms have been introduced, such as the first feeding

65

How long does it take a newborn to produce enough vitamin k to prevent vitamin k deficiency bleeding

About a week

66

When should newborns get Vitamin K

The AAP recommends that vitamin k be administered to all newborns soon after birth in a single IM dose of 0.5 to 1mg

67

What should happens to a newborns eyes after birth

Should relieve a prophylactic agent in their eyes within an hour or two after birth

68

What is the prophylactic agent in newborns eyes preventing

Ophthalmia neonatorum, which can cause neonatal blindness

69

When are the head and chest circumference usually equal?

By about 1 year of age

70

Persistent cyanosis of fingers, hands, toes, and feet with mottled blue or red discoloration or coldness is called

Acrocyanosis

71

When do you see acrocyanosis?

During the first few weeks of life in newborns in response to exposure of cold. It is normal and intermittent

72

What is a thick white substance that protects the skin of the fetus

Vernix caseosa

73

What are superficial vascular areas found on the nape of the neck, on the eyelids, and between eyes and the upper lip

Stork bites

74

What are unopened sebaceous glands frequently found on a newborns nose

Milia

75

What are blue or purple splotches that appear on the lower buttocks or newborns

Mongolian spots

76

What is erythema toxicum

Benign, idiopathic, generalized, transient rash that occurs in up to 70% of all newborns during the first week of life

77

What is the dilation of blood vessels on only one side of the body, giving the newborn the appearance of wearing a clown suit

Harlequin sign