Chapter 18The Newborn Flashcards
Exam 3 (205 cards)
1
Q
Adapting to Extrauterine Life:
After the birth, what must the infant begin?
A
After the birth, the infant must begin the transition to extrauterine life.
2
Q
Adapting to Extrauterine Life:
After the birth, the infant must begin the transition to extrauterine life.
How long does transition period last?
A
Transition period lasts 6 to 8 hours.
3
Q
Adapting to Extrauterine Life:
What are the Phases of transition period?
A
The first phase
The second phase
The final phase
4
Q
Adapting to Extrauterine Life:
When does the first phase occur?
A
The first phase of reactivity occurs 1 to 2 hours after birth.
5
Q
Adapting to Extrauterine Life:
How should the infant be in the first phase of reactivity?
A
The infant should be awake and alert.
6
Q
Adapting to Extrauterine Life:
What is the first phase of reactivity the optimal time for?
A
This is an optimal time for initiating breastfeeding and bonding.
7
Q
Adapting to Extrauterine Life:
First phase: What phase of Erikson’s psychosocial development is occurring?
A
Trust v mistrust
8
Q
Adapting to Extrauterine Life:
What is the second phase of transition? How long does it last?
A
The second phase of transition is a time of sleep and may last several hours.
9
Q
Adapting to Extrauterine Life:
What phase are babies transferred to postpartum???
A
Phase 2??
10
Q
Adapting to Extrauterine Life:
What is the final phase of transition?
A
The final phase of transition is the second phase of reactivity
11
Q
Adapting to Extrauterine Life:
When does the final phase of reactivity occur? What occurs at this time?
A
Occurs between 2 and 8 hours after birth. Meconium often passed at this time
12
Q
Adapting to Extrauterine Life:
What are the cues to start breathing?
A
The cues to start breathing are chemical, mechanical, and thermal.
13
Q
Adapting to Extrauterine Life:
What (having to do with cord) stimulates breathing?
A
When the cord is clamped and the placenta cannot provide gas exchange, a mild state of hypoxia is created, which stimulates breathing.
14
Q
Adapting to Extrauterine Life:
What does squeezing through the birth canal do for infants?
A
Squeezing through the birth canal is a mechanical mechanism to expel fluid in the lungs.
15
Q
Adapting to Extrauterine Life:
After birth, what does crying help with?
A
Crying after birth helps absorb fluid in the lungs.
16
Q
Adapting to Extrauterine Life:
How does a neonates environment change from in the womb to outside the womb?
A
At birth, the neonate goes from a warm liquid environment to one that is cool and dry.
17
Q
Adapting to Extrauterine Life:
At birth, the neonate goes from a warm liquid environment to one that is cool and dry.
What does this change in temperature do?
A
This change in temperature is thought to stimulate breathing
18
Q
Adapting to Extrauterine Life:
What should nurses assess?
A
Nurses should assess neonatal respiratory status.
19
Q
Adapting to Extrauterine Life:
Why is skin to skin important after birth?
A
Skin to skin with mom- the mom’s temperature will adapt to what the baby needs and regulate all the baby’s systems.
Has a lot of physiologic factors to it.
20
Q
Adapting to Extrauterine Life:
What are signs of respiratory distress in newborns?
A
Cyanosis
Apnea
Tachypnea
Intercostal or substernal retractions
Nasal flaring
Seesaw breathing
Stridor
Gasping
21
Q
Adapting to Extrauterine Life: What is something normal to see in the newborn in the first 24 hours postpartum?
A
Acrocyanosis
Transient cyanosis
22
Q
Acrocyanosis
A
Blue color of the neonates hands and feet, is normal in the first 24 hour period.
23
Q
Adapting to Extrauterine Life:
Central cyanosis: What indicates this is occurring?
A
Bluing of the lips and the chest; is abnormal
24
Q
Adapting to Extrauterine Life:
Transient cyanosis: When is it common to see this?
A
Transient cyanosis when crying is not uncommon immediately after birth
25
Adapting to Extrauterine Life:
Apnea: What is it?
Cessation of breathing for 20 seconds or more; is concerning.
26
Adapting to Extrauterine Life:
Apnea: When is it considered normal?
Short periods of apnea in the absence of other signs of distress are considered normal
27
Adapting to Extrauterine Life:
Apnea: What does apnea over 20 seconds indicate?
Sepsis
Hypothermia
Hypoglycemia
or another problem
28
Adapting to Extrauterine Life:
What is the normal breaths per minute a neonate takes?
Neonates typically take 30-60 breaths per minute.
29
Adapting to Extrauterine Life:
Tachypnea: What may sustained tachypnea indicate?
Sustained tachypnea is abnormal and may indicate respiratory distress syndrome or fluid in the lungs.
May also indicate infection or cardiac or metabolic illness
30
Adapting to Extrauterine Life:
Intercostal or substernal retractions:
What are retractions?
Retractions are the pulling of the tissue with each breath and indicate reduced pressure inside the lungs, likely because of occlusion of the upper airways
31
Adapting to Extrauterine Life:
Grunting: When would this occur?
Grunting with expiration occur with a partially closed glottis.
32
Adapting to Extrauterine Life:
Grunting: What does partial occlusion of glottis cause?
This partial occlusion increases the pressure within the lungs so more oxyygen can diffuse into the bloodstream.
33
Adapting to Extrauterine Life:
Grunting: How can grunting be recognized?
Grunting may be auscultated with a stethoscope or in more severe cases, heard without assistance
34
Adapting to Extrauterine Life:
Nasal flaring: What does it do?
Nasal flaring expands the airway and reduces airway resistance
35
Adapting to Extrauterine Life:
How is the chest and abdomen in the absence of respiratory distress?
The chest and abdomen rise simultaneously in the absence of respiratory distress.
36
Adapting to Extrauterine Life:
Seesaw breathing: What does it suggest?
Seesaw breathing, like retractions, suggests partial blockage of the airways.
37
Adapting to Extrauterine Life:
Stridor: What is it?
Stridor, which is an abnormal, high-pitched breath sound, is a sign of upper airway obstruction
38
Adapting to Extrauterine Life:
Gasping: What is it a sign of?
Gasping is a sign of upper airway obstruction
39
Adapting to Extrauterine Life:
After birth, what does the first breaths do? What does this result in?
After birth, the first breaths dilate pulmonary vasculature, which results in pulmonary vascular resistance.
40
Adapting to Extrauterine Life:
What does pulmonary vascular resistance cause?
Pulmonary vascular resistance causes increased blood return from the lungs to the left atrium.
41
Adapting to Extrauterine Life:
Pulmonary vascular resistance causes increased blood return from the lungs to the left atrium.
What does this lead to?
With the increased blood flow, the left atrium has a higher pressure than the right atrium, causing closing of the foramen ovale.
42
Adapting to Extrauterine Life
When does the ductus arteriosus close?
The ductus arteriosus closes within a few days or weeks after birth.
43
Adapting to Extrauterine Life
What does the clamping of the umbilical cord do to blood flow?
Clamping of the umbilical cord causes decreased blood flow to the ductus venosus, which will then begin to atrophy.
44
Adapting to Extrauterine Life:
How is an infant's gut? What does the infant lack?
The infant’s gut is sterile and does not have the bacteria needed to make vitamin K, which is used by the body to help blood clot.
45
Adapting to Extrauterine Life
What is given within six hours of birth to newborn? Why?
An injection of vitamin K is administered to prevent a pathological bleed. (helps with clotting)
Given IM
46
Adapting to Extrauterine Life
In NYS, what is it illegal for the parents to refuse?
NYS- it is illegal to deny Vitamin K; it must be reported if parents refuse.
47
Adapting to Extrauterine Life:
What are newborns at high risk for? Why?
Neonates are at risk for hypothermia because they have a high body surface to mass ratio and blood vessels are close to the surface of the skin.
48
Adapting to Extrauterine Life:
What do newborns not do to produce heat?
Neonates typically do not shiver to produce heat.
49
Adapting to Extrauterine Life:
How do infants produce heat?
Infants produce heat by metabolizing brown fat stores.
50
Adapting to Extrauterine Life:
What are the four mechanisms of heat loss in a newborn?
Conduction
Convection
Evaporation
Radiation
51
Adapting to Extrauterine Life:
When does the skin reach adult thickness?
Skin does reach adult thickness until the end of puberty.
52
Adapting to Extrauterine Life:
Neonatal Heat Loss: Evaporation
Heat loss due to evaporation of liquid from the body
53
Adapting to Extrauterine Life:
Neonatal Heat Loss: Evaporation- What is a care consideration?
Dry neonate thoroughly after the birth.
Stabilize their temperature prior to the bath and bathe them in a warm environment
54
Adapting to Extrauterine Life:
Neonatal Heat Loss: Conduction
Transfer of heat by direct contact with a cooler object
55
Adapting to Extrauterine Life:
Neonatal Heat Loss: Conduction- What is a care consideration?
Place infants on prewarmed surfaces or keep them skin to skin with the mother
56
Adapting to Extrauterine Life:
Neonatal Heat Loss: Convection
Heat transfer from the newborn to the surrounding air
57
Adapting to Extrauterine Life:
Neonatal Heat Loss: Convection- What is a care consideration?
Keep the ambient room temperature at least 72 F.
Avoid having air currents from open windows and fans
58
Adapting to Extrauterine Life:
Neonatal Heat Loss: Radiation
Transfer of heat from or to the newborn from or nearby surfaces
59
Adapting to Extrauterine Life:
Neonatal Heat Loss: Radiation- What are care considerations?
Keep the infant away from cool windows and exterior walls
60
Adapting to Extrauterine Life: Nurses should help prevent heat loss by:
(Doing what in the delivery room)
Minimizing air currents in the delivery room (turn off fans, avoid drafts from air conditioning, doors, or windows).
61
Adapting to Extrauterine Life: Nurses should help prevent heat loss by:
What should be done to infant immediately after birth?
Drying the infant immediately after birth.
62
Adapting to Extrauterine Life: Nurses should help prevent heat loss by:
What should be done to infant immediately after birth?- As in where should infant be placed?
Placing the infant skin to skin with the parent under a warmed blanket.
63
Adapting to Extrauterine Life: Nurses should help prevent heat loss by:
What should be done with warmers before use?
Preheating warmers before use.
64
Adapting to Extrauterine Life: Nurses should help prevent heat loss by:
What should you delay? Why?
Delaying giving the infant a bath until the infant’s temperature is stable.
65
Adapting to Extrauterine Life
What is the stomach capacity of the neonate at birth? What does it increase to in a week?
The stomach capacity of the neonate is about 5 to 10 mL at birth and increases to 60 mL within the first week.
66
Adapting to Extrauterine Life
What accommodates infant's stomach volume?
Colostrum and breast milk accommodate infant stomach volume.
67
Adapting to Extrauterine Life
When should infants be fed?
Infants should be fed on demand.
68
Adapting to Extrauterine Life
When is meconium passed? How does it appear?
Meconium is typically passed within the first 24 hours and is thick, dark green, and tarry.
69
Adapting to Extrauterine Life
For breastfed infants:
How should stool be at the end of the first week of life? How often is stool passed?
By the end of the first week, the stool of infants who are breastfed is yellow and seedy and is passed 4 to 8 times per day.
70
Adapting to Extrauterine Life
For formula fed infants, how is stool?
Infants who are formula-fed have more formed stool and it is not passed as frequently.
71
Adapting to Extrauterine Life:
How is a neonates weight in the first few days of life? What should happen within 2 weeks?
Neonates typically lose 5% to 10% of their birth weight within the first 3 to 5 days. Weight should be regained within 2 weeks.
72
Adapting to Extrauterine Life:
How often do infants urinate a day?
Infants urinate 6 to 8 times daily.
73
Adapting to Extrauterine Life:
When should diapers be changed?
Diapers should be changed when wet or dirty to prevent skin breakdown.
74
Adapting to Extrauterine Life
What may be seen in newborn diapers?
Newborn diapers may have uric acid crystals that are red in color and can be alarming.
75
Adapting to Extrauterine Life
What kind of wet diaper pattern should be reported?
Fewer than five wet diapers in 24 hours should be reported to pediatrician.
76
Adapting to Extrauterine Life
What are newborns at risk for (having to do with bilirubin)? What does this mean they should be evaluated by?
Newborns are at risk for jaundice and should be evaluated by transcutaneous or serum evaluation of bilirubin levels.
77
Adapting to Extrauterine Life
What are newborns at risk for (having to do with glucose levels)?
When does treatment being?
Newborns are at risk for hypoglycemia.
Treatment for hypoglycemia generally begins with breast or formula feeding.
78
Adapting to Extrauterine Life
What type of infants should have their sugar checked regularly?
Small for gestational age or large will be sugar checked regularly .
79
Adapting to Extrauterine Life
What is jaundice?
breakdown of rbc.
Bilirubin is the product of rbc breakdown. Stool is how bilirubin is removed from the body.
80
Adapting to Extrauterine Life
What is the first sign of jaundice? How to tell if there is a lot of bilirubin or a little?
Sclera is the first sign of jaundice.
Lower in the body= higher levels of bilirubin
81
Newborn Behaviors:
Brazelton Neonatal Behavioral Assessment Scale Assessment Categories include:
Habituation (sleep protection)
Motor
Self regulation
Stress response
Social interactive capacity
82
Newborn Behaviors:
Brazelton Neonatal Behavioral Assessment Scale Assessment Categories:
Habituation (sleep protection)
the ability to adjust to audio and light stimulation in relation to sleep
83
Newborn Behaviors:
Brazelton Neonatal Behavioral Assessment Scale Assessment Categories:
Motor
The maturity of muscle tone and control
84
Newborn Behaviors:
Brazelton Neonatal Behavioral Assessment Scale Assessment Categories:
Self regulation
The ability to self console and to be consoled when crying
85
Newborn Behaviors:
Brazelton Neonatal Behavioral Assessment Scale Assessment Categories:
Stress response
The newborn's threshold of stimulation in response to stress
86
Newborn Behaviors:
Brazelton Neonatal Behavioral Assessment Scale Assessment Categories:
Social interactive capacity
Alertness and responsiveness to human and other stimuli
87
Newborn Behaviors:
Sleep-Wake States: What are they?
Deep sleep
Light sleep
Drowsy
Quiet alert
Active alert
Crying
88
Newborn Behaviors:
Sleep-Wake States: Deep sleep
Possible startle reflex but no other movement
Regular breathing
No eye movement or change in state due to external stimuli
89
Newborn Behaviors:
Sleep-Wake States: Light sleep
Some body movement
Irregular breathing
Rapid eye movement
Possible change in state due to external stimuli
90
Newborn Behaviors:
Sleep-Wake States: Drowsy
Muscle movement
Irregular breathing
Eyes open and close
External stimuli typically results in change of state
91
Newborn Behaviors:
Sleep-Wake States: Quiet alert
Regular respirations
Eyes open
May focus on stimuli
Optimal time to attempt breastfeeding
92
Newborn Behaviors:
Sleep-Wake States: Active alert
Body movements and possible fussiness
Increased startle reflex and motor activity
Eyes open
Irregular respirations
93
Newborn Behaviors:
Sleep-Wake States: Crying
Intense crying
Difficult to calm
Ample body movement
Breathing irregular
94
Newborn Assessment:
What is included?
Apgar assessment
Gestational age assessment
Physical assessment
Newborn reflexes
95
Newborn Assessment:
Apgar assessment: When is it done? What is it for?
done immediately after birth (at 1 and 5 minutes of age) and informs clinicians of the infant’s status.
96
Newborn Assessment:
Gestational age assessment: When is it done? What is it for?
Evaluation of an infants physical and neuromuscular maturity (typically done within 12 hours of age in infants up to 26 weeks gestation, others within 48 hours).
97
Newborn Assessment APGAR
What does it stand for?
Appearance
Pulse
Grimace
Activity
Respirations
98
Newborn Physical Assessment:
What is included in assessment?
Posture
Pulse
Respirations
Blood pressure
Temperature
Weight, length, head and chest circumference
Chest circumference
99
Newborn Physical Assessment:
Posture:
arms and legs should be flexed and hands fisted.
100
Newborn Physical Assessment:
Pulse
At rest, expect 120- 160 beats per minute, maybe higher is crying or lower if in a deep sleep
101
Newborn Physical Assessment:
Respirations
Expect a rate of 30-60 breaths per minute and irregular
102
Newborn Physical Assessment:
Blood pressure
Not done during routine assessment
103
Newborn Physical Assessment:
Temperature
36.5 C to 37.2 C (97.8F to 99F) taken axillary or temporal
104
Newborn Physical Assessment:
Weight, length, head and chest circumference?
Refer to a graph weight charts for expected findings
105
Newborn Physical Assessment:
Chest circumference?
2 to 3 cm smaller than the head
106
Newborn Physical Assessment:
What else is included?
Chest general assessment
Integumentary
Head
Eyes
Nose
Ears
Mouth
107
Newborn Physical Assessment:
Chest general assessment
Should be symmetrical and barrel-shaped
108
Newborn Physical Assessment:
Integumentary: What are you inspecting for? What are you expecting?
Inspect for color, bruising, birth marks, lanugo, vernix, or rashes.
Expect skin to be centrally pink but may have bluish hands and feet (acrocyanosis).
109
Newborn Physical Assessment:
Head: What is common?
Molding and caput is common
Fontanels may be slightly depressed
110
Newborn Physical Assessment:
Eyes
Should be symmetrical and equal
111
Newborn Physical Assessment:
Nose
Should be midline and patent,
Sneezing is common
112
Newborn Physical Assessment:
Ears
Corners of eyes should align with tops of ears
113
Newborn Physical Assessment:
Mouth
Structures should be symmetric, intact, moist, and pink
Epstein's pearls are common
114
Caput Succedaneum
Swelling under the skin of the scalp that does cross the suture line
115
Cephalohematoma
A collection of blood between the skull and periosteum
Swelling does not cross the suture line
116
Newborn Physical Assessment: How should neck be?
Neck—should be short, thick, and mobile, with no webbing.
117
Newborn Physical Assessment:
How should abdomen be?
When is umbilical clamp removed?
Abdomen—umbilical stump should be white or grey.
The clamp is removed after 24 hours.
Abdomen soft, round, and nondistended.
118
Newborn Physical Assessment:
How should rectum be?
Rectum—passage of meconium occurs within 24 hours.
119
Newborn Physical Assessment:
How should male genitals be?
Male genitals—urinary meatus should be located at the tip of the penis and testes palpable within the scrotum.
120
Newborn Physical Assessment
How should female genitals be? What is normal after birth?
Female genitals—for term infants the labia majora covers the labia minora, clitoris, and introitus.
Pseudomenses (mucus or bloody discharge) is normal after birth but may be concerning to family.
121
Newborn Physical Assessment
How should musculoskeletal be?
Musculoskeletal—arms and legs should be symmetrical and have full range of motion and no clicks with movement.
122
Newborn Reflexes: What are they?
Rooting reflex
Swallowing reflex
Extrusion
Grasp reflex
Moro reflex
Babinski reflex
Stepping reflex
Fencing reflex
123
Newborn Reflexes:
Rooting reflex
—when the mouth or cheek is touched, the infant turns toward the stimulus and opens the mouth.
124
Newborn Reflexes:
Swallowing reflex
—when fed, the neonate coordinates sucking, swallowing, and breathing.
125
Newborn Reflexes:
Extrusion
—when the tip of the tongue is touched, the infant sticks out the tongue.
126
Newborn Reflexes:
Grasp reflex: two types
—Palmer the infant curls fingers around the object placed in the hand;
Plantar—the infant curls toes around the object placed at the base of the toes.
127
Newborn Reflexes:
Moro reflex:
—the infant abducts and extends arms when startled by a loud noise or if experiencing a dropping sensation.
128
Newborn Reflexes:
Babinski reflex:
—when an infant’s foot is stroked along the lateral aspect and then across the ball of the foot, the toes fan outward.
129
Newborn Reflexes:
Stepping reflex
—when held upright by the torso and held so the feet touch a surface, the infant makes a walking motion.
130
Newborn Reflexes:
Fencing reflex
Turning an infant’s head to one side quickly causes the baby to extend the arm and leg on that side and flex the other side.
131
Breastfeeding: What does it do for infant and mother?
Breastfeeding has numerous benefits for the patient and the infant.
132
Breastfeeding:
How long should infants exclusively receive breastmilk or formula?
Infants should only receive breastmilk or formula for the first 6 months of life.
133
Breastfeeding:
Healthy People 2020 goal
Healthy People 2020 goal is to increase exclusive breastfeeding at 6 months from 24.9% to 42.4%, and some breastfeeding for a full year from 35.9% to 54.1% per Healthy People 2030.
134
Breastfeeding:
What is cited as a major reason for lack of breastfeeding success?
Lack of skin-to-skin contact within the first hour after birth and formula supplementation is cited as major reasons for lack of breastfeeding success.
135
Breastfeeding:
Breastfed infants typically feed how many times per day?
Breastfed infants typically feed 8 to 12 times per day.
136
Breastfeeding:
Formula-fed infants typically feed how many times per day?
Formula-fed infants may feed a little less frequently and should always be held with head elevated during a feeding.
137
Slide 23
138
Infant Feeding:
What signs would an infant show that they want to feed?
Feed infant whenever they start rooting, sucking, or smacking.
139
Breastfeeding Positions: What are they?
Cradle
Cross-cradle
Football
Side-lying
140
Infant Feeding
What makes infant breastfeeding successful?
Infant breastfeeding is successful if there is a proper latch.
141
Infant Feeding
What are elements of a good latch?
Upper and lower lips flanged outward
Chin and tip of nose pushed into breast
Wide-open mouth
Full cheeks
Asymmetry of exposed areola
Audible swallowing
142
Infant Feeding
After feeding, an infant how should an infant appear?
After feeding, the infant should appear satiated.
143
Breast Issues Associated with Lactation:
Mastitis
Abscess
Candidal infection
Bloody nipple discharge
Plugged duct
Galactoceleles
144
Slide 26 read
145
Routine Newborn Interventions include:
Vitamin K
Antibiotic eye ointment
Hearing screening
Newborn Screen
Critical congenital heart disease (CCHD) screening
Hepatitis B
Circumcision
146
Routine Newborn Interventions:
What is the antibiotic eye ointment? What is it typically done with? When are they done?
"Eyes and thighs"
Erythromycin
Typically done with Vitamin K shot within 6 hours of birth.
147
Routine Newborn Interventions:
Why is the antibiotic eye ointment given? Typically what diseases does it protect against?
Antibiotic eye ointment erythromycin is given to prevent any infection in the eyes.
Typically is given to protect against chlamydia and gonorrhea
Can protect against other infections that are transmitted during the birth process
148
Routine Newborn Interventions:
When should hearing screening be done? Why?
The hearing screening should be done after 24 hours of life. Because mucus and fluid can affect results?
Do hearing screening as close to discharge as possible
149
Routine Newborn Interventions:
What happens if a newborn fails the hearing test?
If they fail, the test is repeated.
If they fail the test twice, they get swabbed for cytomegalovirus.
150
Routine Newborn Interventions:
Newborn screen: What is it? It is how you get what?
Is the blood test that every infant gets done before they get discharged home.
Heel stick
151
Routine Newborn Interventions:
Newborn screen- heel stick
Blood sample get sent to the state and checked for a variety of diseases
152
Routine Newborn Interventions:
How is Critical Congenital Heart disease screening done? What part of the body is it done?
We check for critical congenital heart disease with oxgyen saturation in the right wrist and contralateral leg. Make sure that it is within a few degrees of each other
153
Routine Newborn Interventions:
How can Hepatitis B be transmitted?
Can be transmitted through the birth process; Has a specific protocal
154
Routine Newborn Interventions:When are mother's screened for Hepatitis B?
Mothers are screened prenatally.
155
Routine Newborn Interventions:
What happens if the mother has hepatitis B?
If mom is hep B, the baby will be bathed right away and they will get the Hepatitis B vaccine and Hepatitis B IV immunoglobulin. The RN should be wearing gloves.
156
Routine Newborn Interventions:
Why else would Hepatitis B protocol be implemented in hospitals for a infant and mother?
We implement this if the mom comes in and we don't have any record of prenatal care
157
Routine Newborn Interventions:
Why is Hepatitis B vaccine offered to all infants?
Giving vaccine can prevent what?
Because the earlier that you start the vaccination process, the better immunity, so it is offered at birth.
Vaccine can prevent transmission
158
Routine Newborn Interventions:
Who preforms circumcision? When?
Performed by the OB prior to hospital discharge
159
Size Matters: What of infant should be measured?
Measure length, HC, weight
160
Size Matters: What is large for gestational age?
Large for Gestational Age > 90th percentile
161
Size Matters:
Large for Gestational Age > 90th percentile: What could this mean?
Big, but may not be mature ( e.g. IDM)
162
Size Matters:
Large for Gestational Age puts infant at risk for what?
At risk for: birth injury, perinatal asphyxia, hypoglycemia
163
Size Matters:
Appropriate for gestational age means what?
10th – 90th percentile
164
Size Matters:
What is small for Gestational age?
Small for Gestational Age <10th percentile
165
Size Matters:
Small for Gestational Age <10th percentile
How are measurements?
Measurements symmetrical
166
Size Matters:
Small for Gestational Age <10th percentile
How are fetal cells?
Decreased number fetal cells
167
Size Matters:
Small for Gestational Age <10th percentile
Decreased number fetal cells- Why would this occur? Why are they small?
Family gene pool (genetics)
Congenital infections
Chromosomal disorders
168
Size Matters:
What are small and large gestational babies at risk for?
Hypoglycemia
169
Size Matters:
What are small for gestational age babies at risk for?
SGA babies at risk for hypoglycemia, polycythemia (a venous hematocrit ≥65%, resulting from hypoxia in utero)
170
Nursing Management: Early Newborn Period: Nursing Interventions
What are nurses doing?
Initial and Ongoing Assessments
General newborn care
Safety
171
Nursing Management: Early Newborn Period: Nursing Interventions
How is safety promoted?
Prevention of abduction
Car safety – back facing in middle of back seat of car
Infection prevention (crowds, visitors, handwashing, COVID precautions)
Sleep promotion - ABC’s of Safe Sleep
172
Characteristics of Newborn Stools: When is meconium typically passed?
What does it look like?
Meconium is typically passed within the first 24-48 hours and is thick, dark green, and tarry.
173
Characteristics of Newborn Stools
What are the stool patterns?
Meconium
Transitional
Mature Milk stool
174
Formula Feeding Considerations:
Why may formula fed be the only option?
A mother may choose not to breast feed.
Mothers who are HIV+ can not breast feed.
175
Formula Feeding Considerations:
What do parents need education on?
Parents need education on Infant formulas (e.g. types, preparation).
176
Formula Feeding Considerations:
What are the formula feeding options?
Ready-to-feed or premixed formulas
Concentrated or powdered formulas
177
Formula Feeding Considerations:
What are the most expensive formula options?
Ready-to-feed or premixed formulas are the most expensive option.
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Formula Feeding Considerations:
What must be done with concentrated or powdered formulas?
What happens if not prepared properly?
Concentrated or powdered formulas must be mixed with water;
too much or too little water can have health consequences for the infant.
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Formula Feeding Considerations:
When reconstituting, what must not be done?
When reconstituting, do not add anything (e.g. cereal) to the bottle besides water.
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Formula Feeding Considerations:
How to warm prepared formula?
Warm the prepared formula in a bowl of warm water. (Never warm milk in microwave)
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Formula Feeding Considerations:
When can solid food be started?
Solid foods for infants are not started until at least 6 months of age.
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Formula Feeding Considerations
How long can prepared formula sit at room temperature?
Do not allow prepared formula to sit at room temperature for longer than 2 hours.
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Formula Feeding Considerations:
How should infants be positioned during feeding?
How should bottle be held?
Always hold infant during feedings. Do not prop the bottle.
Hold the bottle at a 45-degree angle.
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Formula Feeding Considerations:
What do newborns require for feeding?
Newborns require a slow-flow nipple.
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Formula Feeding Considerations:
What should be done during and after feeding?
Burp the infant during and after feeding to avoid vomiting.
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Formula Feeding Considerations:
What should be done with leftover formula?
Discard any formula that is left over in the bottle, because it is not safe.
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Circumcision:
What is it?
What kind of procedure?
Removal of the foreskin of the penis.
An elective surgical procedure
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Circumcision:
What are the medical benefits?
Decreased incidence of urinary tract infections, and
decreased risk of sexually transmitted infection and human papilloma virus.
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Circumcision:
Procedure: When is it done? What is done in preparation for procedure?
Usually done before discharge;
Feeds held up to 1-2 hours before to prevent vomiting and aspiration.
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Circumcision:
What must be done by parents prior to procedure? What else must be done prior to procedure?
A consent form is signed.
The newborn is properly identified.
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Circumcision:
How is infant positioned for procedure?
He is positioned with a plastic restraint.
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Circumcision:
What is done for pain? (pharmacological)
For pain: lidocaine, penile block.
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Circumcision:
What is done for pain?(nonpharmacological)
Other nonpharmacologic methods used: sucrose solution w/ pacifier, swaddling
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Circumcision:
What must the RN do after procedure?
The RN assesses for bleeding and monitors for urine/voiding after the procedure.
Must void prior to DC.
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Circumcision:
DC Teaching: What is applied after procedure? Why?
Petroleum jelly/gauze is applied to the penis tip for first 24 hours to prevent tip from sticking to the diaper.
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Circumcision:
DC Teaching: How is diaper worn after procedure?
The diaper is applied loosely.
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Circumcision:
DC Teaching:
What is a normal occurrence after procedure?
What is not normal that should be reported?
It’s normal for a yellow crust to form over the circumcision site. Parents are told not remove it.
Report fever and signs of drainage with a bad odor or pus.
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Late Preterm & Postterm Infants:
What are Late Preterm infants?
born from 34-0/7 to 36-6/7 weeks are considered late preterm.
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Late Preterm & Postterm Infants:
Where can older LPIs be cared for?
Older LPIs can be cared for on mother/baby units
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Late Preterm & Postterm Infants:
What are late preterm infants have a higher chance for?
Although their size may appear to be term, late preterm infants have higher morbidity and mortality due to immaturity.
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Late Preterm & Postterm Infants:
Late preterm infants are at high risk for:
Hypothermia, Hypoglycemia, Respiratory distress, Jaundice & Feeding difficulties
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Late Preterm & Postterm Infants:
Late preterm infants may have what kind of problems?
Late preterm infants may appear to be feeding appropriately but have difficulties related to the inability to coordinate sucking, swallowing, and breathing.
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Late Preterm & Postterm Infants:
Postterm infants - ?
are born beyond 42 weeks of gestation.
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Late Preterm & Postterm Infants:
Postterm infants: How might they appear? Why?
Postterm infants may be macrosomic or small for gestational age (SGA) because of the aging placenta.
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Late Preterm & Postterm Infants:
Postterm infants: What are complications?
Complications for postterm infants include: Birth injuries, Oligohydramnios, Low Apgar scores, Cerebral palsy, Meconium-stained amniotic fluid
