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NURS 4500: Final Material > Class 9: Physical Assessment of Newborn > Flashcards

Class 9: Physical Assessment of Newborn Flashcards

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1
Q

what is the method of assessment of temp in the newborn (NB)

A
  • axillary
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2
Q

what is the average finding for temp in NB? normal variation?

A
  • average finding: 37
  • normal variation: 36.5-37.5
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3
Q

what is the method of assessment for HR/pulse

A
  • auscultation
  • palpation
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4
Q

what are the average findings for NB pulse?

A
  • 110-160
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5
Q

what is the normal variation for HR in NB

A
  • 80-100 when asleep
  • up to 180 if actively crying
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6
Q

what is the method of assessment for RR of NB

A
  • observe effort
  • auscultate
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7
Q

what are the average findings of RR in NB

A
  • 30-60 breaths/min
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8
Q

what is normal variation of RR in NB

A
  • short periodic breathing episodes
  • stabilization occurs by day 1-2
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9
Q

what is concerning r/t short periodic breathing episodes in NB

A
  • no apnea >20 sec
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10
Q

by days 1-2, describe RR in NB

A
  • usually then 30-40 breaths/min
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11
Q

how long should RR of NB be assessed?

A
  • for full min due to irregularity
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12
Q

what is the protocol for VS of the NB

A
  • shortly after birth
  • then q1h x3
  • then q8h for up to 24 h after birth
  • then q12h until discharge
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13
Q

describe assessment of BP in NB

A
  • not routinely assessed in healthy newborns
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14
Q

what are the guidelines for physical exam of NB (7)

A
  • provide normothermic & non-stimulating exam area
  • hand hygeine
  • undress only body area to be examined to maintain newborn temp
  • proceed quickly to avoid stressing NB
  • comfort infant throughout
  • involve parents
  • document findings
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15
Q

what findings from the physical assessment of the NB should be communicated to the PCP?

A
  • all normal variations and abnormal findings
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16
Q

ideally, perform NB assessment when NB is… (2)

A
  • quiet
  • alert
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17
Q

describe the order of physical assessment in NB

A
  • perform procedures that require quiet first –> skin color, tone, auscultation, overall condition
  • perform more disturbing procedures last –> temp, testing reflexes
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18
Q

describe antibodies present in the NB, how are they transported?

A
  • born with some antibodies
  • most transported across the placenta from maternal circulation
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19
Q

antibodies transported to NB from placenta & maternal circulation provides microbial protection to the NB for how long?

A
  • 1st 3 months of life
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20
Q

describe the risk of infection in NB

A
  • high risk
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21
Q

what is included in prevention of infection in NB (2)

A
  • good hand hygiene
  • staff should avoid unit if actively infectious
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22
Q

describe the general appearance of NB(2)

A
  • should have general plump appearance
  • flexed posture
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23
Q

what are the normal values of activity/state of alertness in the NB (3)

A
  • sleeping
  • quiet alert
  • active alert
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24
Q

what measurements are done for the NB (3)

A
  • length (measured initially & plotted for gestational age)
  • weight (measured initially & plotted for gestational age)
  • head circumference
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25
describe the method of assessment of weight in NB
- naked w protective liner/pad/towel
26
what are the average findings of weight in newborn? normal variation?
- average: 3400-3500 - normal variation: 2500-4000g
27
describe the method of assessment of length in NB
- top of head to heel
28
what are the average findings of NB length?
- average: 45-55 cm
29
describe the method of assessment of head circumference in NB
- occipitofrontal circumference
30
what are the average findings of head circumference in NB? normal variation?
- average: 33-35 cm - normal variation: 32-36.8
31
what are normal findings of skin assessment in NB (8)
- generally/centrally pink - acrocyanosis common - skin intact, smooth - general plump appearance - vernix caseosa - lanugo hair - warm - some mottling in limbs
32
what is vernix caseosa? what is its function?
- soft cheeselike/whiteish substance on skin - protective function
33
what is lanugo hair
- fine hair over face, shoulders, back
34
describe changes to skin pigmentation after birth
- begins to deepen
35
what are normal variations of skin assessment in NB (7)
- superficial crackling/peeling hands & feet - mottling extremities - mongolian spots - stork bites - erythema toxicum - petechiae - sweat glands
36
superficial cracking/peeling of hands & feet is more common with?
- postterm babies
37
what causes mottling to extremities in NB
- due to instability of newborn circulation
38
what are mongolian spots
- congenital dermal melancytosis - bluish spots common to back & buttocks at birth
39
describe the duration of mongolian spots in NB
- fade over months
40
what are stork bites/nevi/telangiecases
- flat, pink capillary hemangiomas
41
describe blanching of stork bites
- easily blanched
42
describe duration of stork bites in newborn
- most fade in 1st and 2nd years if life
43
what is erythema toxicum
- transient rash - erythematous macules, papules, and small vesicles
44
what is the clinical signif of erythema toxicum? treatment?
- no clinical significance - no treatment required
45
petechiae in the NB are especially present where?
- over presenting part
46
what can occur r/t sweat glands in NB
- milia --> tiny white bumps that most often appear on a newborn’s upper cheeks, nose, chin, or forehead
47
what skin assessment findings have potential for concern?(4)
- bruising - jaundice - central cyanosis - pallor
48
where might bruising occur in the NB (2)
- facial bruising - bruising to head d/t face presentation
49
what may cause bruising to NB (2)
- forceps assisted birth - vacuum extraction
50
jaundice is never normal in NB what PP period
- first 24 h
51
central cyanosis in the NB is...
- abnormal
52
pallor in the NB is...
- abnormal
53
what is assessed r/t head & face of NB (5)
- appearance - shape - size - facial symmetry - moulding
54
describe the presence of moulding in the NB
- may or may not be present
55
describe the size of NB head
~ a fourth of NB body length
56
describe symmetry of the face in NB
- should be symmetrical
57
fontanels and sutures of the NB are impacted by?
- degree of moulding
58
fontanels and sutures of NB should not be... we should be able to..
- should not be bulging or swollen - should be able to palpate suture lines
59
describe the shape & size of anterior fontanel
- diamond shaped - 5cm
60
describe the shape and size of posterior fontanel
- triangular shaped - 3cm
61
the chin of the NB should be ?
- distinct
62
what should be assessed r/t eyes of the NB (4)
- placement - symmetry for size and shape - discharge - presence
63
describe the eyebrows of NB
- should be distinct
64
describe the eyes & space between eyes in NB
- each 1/3 the distance from outer left to outer right canthus
65
describe discharge in eyes of NB
- should be none
66
describe pupils of NB (4)
- present - equal in size - assess reactivity to light - physician or nurse will check red reflex
67
what should be assessed r/t NB ears (4)
- size - placement - cartilage - open auditory canal
68
describe placement of ears in NB
- line drawn thru inner and outer canthi of eyes reaching to top notch of ears (at junction w scalp)
69
describe cartilage of ears in NB
- well formed & firm
70
NB should respond to sounds. this is influenced by?
- state of alertness/activity
71
what is assessed r/t NB nose (4)
- shape - placement - patency (both nares should be patent) - discharge
72
what is assessed r/t mouth of NB (7)
- color - appearance - symmetry - soft & hard palate - tongue - saliva - presence of teeth
73
describe presence of natal teeth in NB
- not usually present - if present, risk for aspiration = usually extracted
74
describe symmetry of lips in NB
- should have symmetrical lip mvmt - no clefts
75
describe tongue of NB (4)
- tongue not protruding - freely movable - symmetrical shape/mvmt - pink
76
what is a normal variation of NB tongue
- tongue tie --> needs to be noted
77
describe the soft & hard palate of NB
- should be intact - no clefts
78
describe uvula of NB
- should be midline
79
describe color and moisture of mouth of NB
- should be moist & pink throughout
80
describe chin of NB
- should be distinct
81
what reflexes r/t mouth should be present in NB? these can be affected by?
- rooting & sucking reflexes - can be affected by state of alertness/hunger
82
what are epstein pearls?
- very small cysts that can appear in a baby's mouth that look like tiny, white bumps
83
where can epstein pearls present in NB (2)
- along soft/hard palate - gums
84
define: caput succedaneum
- generalized edematous areas of scalp
85
caput succedaneum can be accompanied by? what relationship does it have w suture lines
- can be accompanied by ecchymosis - crosses suture lines
86
how long does it take for caput succedaneum to resolve
- 3-4 days
87
describe the risks of caput succedaneum to NB
- normal variation
88
define: cephalhematoma
- collection of blood between a skull bone and its periosteum
89
describe the relationship between cephalhematoma and suture lines
- does not cross suture lines
90
describe the appearance of cephalhematoma when baby crued
- does not pulsate or bulge when baby cries
91
describe onset & duration of cephalhematoma when is it largest?
- onset: several hrs or day after birth - largest on 2nd or 3rd day - duration: fullness esolves in 3-6 weeks
92
cephalhematoma is more common with...
- assisted birth
93
define: subgaleal hemorrhage
- bleeding into subgaleal compartment
94
describe the risk of subgaleal hemorrhage
- most dangerous
95
describe the relationship between subgaleal hemorrhage and suture lines
- crosses suture lines
96
subgaleal hemorrhage is associated with?
- vacuum assisted birth
97
why is subgaleal hemorrhage considered dangerous
- potential space - loosely arranged CT - blood loss in this space can be severe
98
what is vital w subgaleal hemorrhage
- early detection
99
what assists in detected of subgaleal hemorrhage (2)
- serial head circumference measurements for newborns w vacuum assisted birth - assessment of back of neck for edema & masses w vacuum extraction
100
what are potential assessment findings associated w subgaleal hemorrhage (6)
- boggy scalp - pallor - tachycardia - increasing head circumference - forward position in of the NB ears - changes in NB LOC
101
what may be required w subgaleal hemorrhage
- blood transfusion
102
what is assessed r/t NB neck (3)
- freedom of movement (flexion & extension) - flexibility - bruises
103
what should not be present in NB neck (3)
- webbing - masses - bruising
104
bruising of NB neck can potentially be from...
- nuchal cord
105
the head of NB should be ______, trachea should be ____
- head should be midline - trachea should be midline
106
describe the thyroid of the NB
- should not be palpable
107
NB necks are generally ___ with lots of ____
- generally short w lots of skin folds
108
what is assessed r/t NB chest (3)
- shape - appearance - color
109
what shape of the NB chest is normal?
- circular
110
describe the ribs of NB (3)
- should be symmetrical - intact - should have symmetrical mvmt with respirations
111
describe the nipples of NB
are usually: - prominent - well formed - symmetrically placed
112
breast nodule of NB is ~ ___. what is the normal variation? theres the potential for ___?
- ~6mm - normal variation: 3-10 mm - potential for discharge
113
what is prominent w NB chest? what should be intact ?
- tip of sternum can be prominent - clavicles intact with no crepitus
114
crepitus of NB clavicles should be especially assessed with ___
- shoulder dystocia
115
what plays a role in adequate O2 supply of newborn (4)
- clear & maintained airway - effective resps - adequate circulation, perfusion, and cardiac function - adequate thermoregulation, maintain body temp
116
at term, lungs contain approx how much fluid?
- 20mL of fluid/kg
117
in NB transition, what happens to the fluid in the lungs?
- air replaced the fluid - some lung fluid retention can be experienced
118
retention of lung fluid can lead to??
- transient tachypnea of the NB (TTNB)
119
what impact do pulmonary surfactants have on NB lungs?
- reduces surface tension = increases NB lung compliance
120
what impact does decreased surfactant have on NB respiration? this is more common with?
= requires more P for inspiration = tiring - more common w preterm infants
121
NB have immature resp control. what might this cause?
- apneic periods in NB
122
how do newborns tend to breathe?
- tend to nose breathe
123
what kind of breathing is normal with NB
- abdominal breathing is normal = ribs and abdomen move w respirations
124
what is a normal variation of NB respirations
- occassional retractions, especially with crying
125
when should resp be assessed?
- when at rest & with resp effort
126
how are resp assessed in NB? breath sounds?
- count resps for full minutes - auscultate breath sounds
127
NB breath soundes should be ...
- clear and equal bilat - some fine crackles may be heard during initial transition after birth
128
describe mvmt of chest & abdomen during respirations
- chest & abdomen move together w resps
129
what are S&S of NB resp distress (6)
- nasal flaring - intercostal or substernal or subclavicular retractions - stridor - grunting - grasping - apnea lasting 20 sec or longer
130
what are other signs of abnormal NB breathing
- tachypnea/bradypnea - abnormal breath sounds - seesaw or paradoxical resps - central cyanosis or mottling of skin - pulse ox <95%
131
define: transient tachypnea of the NB
- a parenchymal lung disorder characterized by pulmonary edema resulting from delayed resorption & clearance of fetal alveolar fluid
132
what is the most common cause of resp distress in late preterm & term infants
- TTN
133
describe the risk of TTN
- usually benign and self-limiting
134
what is the most common feature of TTN
- tachypnea
135
when does TTn occur?
- during first 1-2 hrs
136
what are signs of TTN (4)
- resp rate up to 100 - intermittent grunting - nasal flaring - mild retractions
137
how long does it take for TTN to resolve?
- within 24 hrs
138
what is included in supportive care for TTN? (2)
- support w feeding - promote neutral thermal enviro
139
what is included in resp support of TTN? Target sats?
- O2 supplementation may be provided to maintain O2 sat between 90-95%
140
TTN is more common after...
- elective c-section d/t no labor process to squeeze fluid out of lungs
141
how long does it take for ductus venosis to convert to ligaments in the NB
- occurs within 2-3 months
142
how long does it take for the ductus arteriosis to functionally close after birth? permanently close?
- functionally = within hours after birth - permanently within 3-4 weeks
143
how can a patent ductus arteriosis be detected?
- auscultated as a heart murmur
144
what leads to functional closure of foramen ovale? when does permanent closure occur?
- increased pulmonary blood flow after birth leads to functional closure - permanent closure within months -- years
145
when does rapid construction of umbilical arteries & veins occur after birth? closure? conversion to ligaments?
- rapid construction within minutes of birth - closed w cord clamping/severing - coverts to ligaments within 2-3 months
146
what is the blood volume of CVS of NB
- 80-100 mL/kg
147
describe the chest wall of NB
- have thin chest wall
148
what should be inspected r/t chest wall of NB
- inspect for visible pulsation in midclavicular line (4th intercostal space)
149
describe assessment of HR of NB
- auscultate apical pulse for full minute for rate --> 4th intercostal space
150
describe auscultation of heart sounds (S1 and S2) in NB
- should be sharp and clear
151
most heart murmurs in infancy are..
- not significant pathologically
152
describe the duration of heart murmurs in NB
- >50% disappear by 6 months
153
assessment of heart murmurs should be done in conjunction with... (4)
overall status - color - appearance - behavior - feeding
154
identification of heart murmurs in NBs should be...
- noted to provider
155
describe HR of NB in first few hours
- irregular heart rate not uncommon
156
what types of pulses are assessed with extremities
- femoral pulses
157
what should be assessed r/t NB abdomen (3)
- umbilical cord - inspect & palpate abdomen - auscultate BS
158
what is assessed r/t umbilical cord of NB (6)
- 2 arteries & 1 vein - clamp --> should not be bleeding - color - should be odorless - dry/drying around base - clear demarcation between cord & skin
159
describe the color of the umbilical cord
- whitish grey color
160
what is a sign of meconium r/t umbilical cord
- greenish color of umbilical cord
161
what should not be present r/t umbilical cord
- no intestinal structures within cord
162
what is the tone and contour of NB abdomen
- round & prominent (like a dome) - soft
163
describe mvmt of NB abdomen
- mvmt w respirations should be noted
164
what may be visible of NB abdomen
- could be a few visible veins on surface
165
when should BS be present in NB
- within minutes after birth
166
describe the presence of bacteria in the GI tract at birth
- lacks bacteria
167
normal intestinal flora supports.. what is this imp for?
- synthesis of vitamin K - vitamin K imp for synthesis of blood coagulation factors
168
within hrs of birth, what occurs r/t NB GI tract
- stool passed contains bacteria
169
when should the first stool of NB be passed?
- within 24-48 hrs
170
define: omphalocele
- herniation of abdominal contents thru the cord opening
171
describe the appearance of female genitalia in NB
- increased pigmentation
172
describe the appearance of clitoris & labia in NB
- can both be edematous
173
describe the appearance of female discharge/spotting in NB
- may occur r/t hormones of pregnancy
174
describe the appearance of female urinary meatus in NB (2)
- below clitoris - can be difficult to see
175
describe the appearance of vagina in NB
- open orifice
176
what may be present in between labia of NB?
- vernix caseosa
177
describe appearance of male genitalia in NB
may have: - increase in size - pigmentation d/t pregnancy hormones
178
describe appearance of penis of NB
- urinary meatus at tip of penis in center
179
if the urinary meatus of the penis is below the center of the penis, what is this called?
- hypospadias
180
describe appearance of male scortum in NB
- rugae
181
describe palpation of testes of NB
- should be descended & palpable on each side
182
when should the NBs first void occur?
- within first 24 hrs , often pee right after birth
183
describe the length of NB arms vs legs
- arms should be longer than legs
184
what should be assessed r/t NB extremities (8)
- general appearance (color, intactness) - general flexion / muscle tone - range of motion - symmetry - hands & fingers - legs & feet - hips - birth injuries ex. shoulder dystocia
185
what should be assessed r/t NB hands & fingers (3)
- count # of fingers - grasp reflex - nails should be present
186
what should be assessed r/t NB legs and feet (6)
- number of toes - nails should be present - feet do not have appraent arches - gluteal folds - grasp/babinski reflex - soles of feet
187
describe the soles of feet of NB (2)
- wrinkles - gestational age assessments
188
describe gluteal folds of legs & feet in NB, what could it mean if they are not?
- should be even - if uneven, could be signs of hip dysplasia
189
what pulses are assessed in the extremities?
- femoral --> should be equal bilaterally
190
define polydactyly
- extra digit
191
define syndactyly
- when digits are infused
192
define oligodactyly
- missing digit
193
polydactyly, syndactyly, and oligodactyly can indicate?
- chromosomal abnormality
194
what are signs of hip dysplasia (4)
- asymmetry of gluteal & thigh folds with shortening of the thigh - limited hip abduction - shortening of the femur - ortolani test w femoral head moving in & out of acetabulum
195
what should be assessed r/t NB back (2)
- shoulders, scapulae, iliac crests --> symmetry - inspect & palpate spine
196
escribe the normal spine of NB (3)
- should appear straight - easily flexed - skin intact
197
describe head control in the NB
- should be able to momentarily raise & support their head/turn to the side in a prone position - gain head control at ~3 months of age
198
what are abnormal findings of the NB back (3)
- pilonidal dimple or tuft of hair - sinus (opening of spinal cord) - mass
199
what is a pilonidal dimple? what can it or a tuft of hair be associated w?
= sacral area of the spine - can be associated w spina bifida or abnormalities of the spine
200
what is assessed r/t NB anus (5)
- should have 1 anus - good sphincter control - inspect & palpate placement - patency - meconium passed?
201
at birth, what is the development of the NB neuromuscular system
- almost completely developed
202
what does the NB brain require? (2)
- glucose for energy - large supply of oxygen
203
what are abnormal signs of the neuromuscular system
- tremors & jitteriness - seizure activity
204
describe normal assessment of the NB neuromuscular system (4)
- generally have normal tone - some resistance to pass mvmt - reflexes - behavior
205
what are the primitive NB reflexes (7)
- sucking & rooting - swallowing - grasp (palmar & plantar) - moro (startle) - stepping or "walking" - crawling - babinski (plantar)
206
presence and then disappearance of primitive reflexes reflect ??
- a mature and intact nervous system and normal brainstem activity
207
describe the palmar grasp reflex
- when placing a finger or stroking the inside of the infant’s palm the hand will close around it…hence grasp it.
208
describe the plantar grasp reflex
- when a finger is placed under the toes, the toes will curl.
209
describe the moro reflex
- This reflex occurs when the infant hears a sudden loud noise or experiences unexpected movement. - Example: when placed in the supine position (with the head supported) and the head is allowed to fall lower than the body this reflex will occur. - Response? the infant will throw out the arms (hence extend them) with the palms up and then move the arms back to the body.
210
describe the rooting reflex
- When the infant’s cheek or side of mouth is stroked, the head will turn towards it and the infant will open its mouth in an attempt to suck. This helps the baby find its food source when feeding
211
describe the sucking reflex
- When something touches the top of the infant’s mouth (specifically the hard palate of the mouth….so the roof of the mouth) the infant will automatically suck - this helps with feeding by allowing the infant to pull food from the source….breast or a bottle
212
describe the babinski reflex
- When the bottom of the foot is stroked from the heel upward along the outward part of the foot, the big toe dorsiflexes (bends back) and the other toes fan or spread out.
213
describe the crawling reflex
- When the infant is placed on the stomach and pressure (such as a hand) is applied to the sole of the foot, the infant will attempt to push against the hand and move the arms and legs in a crawling like motion.
214
describe the stepping reflex
- When holding the infant upright with legs and feet touching a surface, the infant will move the legs like taking steps or walking.
215
what is included in assessment of behavioral characteristics of the NB (2)
- sleep-wake states - responsiveness to enviro, people etc.
216
how much can NBs sleep?
- up to 17 hrs a day, with periods of wakefulness gradually increasing
217
in the early newborn period, newborns fluctuate between?
- sleep and wakefulness states
218
what are the wake states of the NB? (4)
- crying - active alert - quiet alert - drowsy
219
what are the sleep states of the NB (2)
- light sleep - deep sleep
220
what factors may influence behaviors of NBs? (3)
- gestational age (ex. preterm = not as developed) - stimuli - meds
221
describe the development of NB vision (3)
- cannot see far - clearest visualization is close (~17-25 cm), usually distance when feeding - sensitive to light
222
at what age is NB vision the same as adults?
- at 6 months
223
describe the development of NB hearing (2)
- similar to adult when AF clears out of ears - loud sounds elicit strong response in NB
224
describe development of smell of NB
- highly developed
225
describe development of taste in NBs
- can distinguish some different flavors
226
describe development of touch in NBs (2)
- very responsive to touch - imp to be held and touched lots for development
227
what terms describe NB responses to enviro stimuli (6)
- temperament - habituation - consolability - cuddliness - irritability - crying
228
describe habituation of the NB
- protective mechanisms of the NB - ability to respond to and then inhibit responding to discrete stimulus (ex. light, rattle, pinprick etc.) while asleep - avoid overload in terms of stimuli in their enviro , habituated to enviro stimuli
229
what does habituation promote? (2)
- sleep in their home enviro - promote continued learning
230
describe consolability of the NB
-variability in ability to self- console or be consoled
231
what are examples of how the NB can be consoled (3)
- hand-to-mouth mvmts/non-nutritive sucking - being alert to voices, noises, visual stimuli - held/rocked
232
why is cuddliness of NBs important?
- parents gauge their ability to care for the child by child's responses to their actions
233
what cna cause irritability in NBs? (5)
- hunger - wetness - noises - cold - new experiences
234
what is imp to note w irritability in NBs
- some are more irritabile than others
235
what is the language of the newborn?
- crying
236
why is responsivness to crying imp?
- creates trust
237
rying in the NB shouldn't be... (4)
- high pitched - shrill - hoarse - prolonged
238
what vitamin is given to NBs? when?
- vitamin K - within 6 hrs of birth
239
what dose and route of vitamin K is given to newborns weighing greater than 1500g
1mg IM injection
240
vitamin K is typically synthesized by? describe this at birth
- synthesized by intestinal flora - no flora present at birth
241
what is the goal of giving vitamin K to NBs
- reduce risk of bleeding due to vitamin K deficiency
242
describe eye prophylaxis in the NB
- involves erythromycin ointment instilled into eye of newborn to prevent chlamydia or gonorrhea
243
when is eye prophylaxis given to the NB
- within 1st 24 hrs
244
describe the use of eye prophylaxis in the NB
- highly debated, some parents refuse - offerred to all NB
245
do NBs experience pain?
- yes
246
what is included in assessment of pain in the NB (7)
- crying / irritability - grimacing, eye squeeze, brow contraction, open mouth, chin quizer - attempts to withdraw from painful stimulus - changes in HR (increased) - changes in RR (increased, shallow) - skin pallor or flushing/diaphoresis - changes in state, appetite, activity lvl
247
what kind of crying can indicate pain?
- whimpering to high pitched
248
assessment of pain in the newborn depends on..
- state of alertness
249
what is the goal of nonpharmacological mngmt of pain in the NB
- minimize the intensity, duration, and physiological cost of pain - maximize coping
250
what is included in nonpharmacological mnmgt of pain in the newborn (5)
- holding/cuddling/rocking newborn - non-nutritive sucking/pacifier - oral sucrose - skin to skin contact - breast/chest feeding
251
oral sucrose is used for what kind of pain? what route is used?
- admined orally - for relief of pain caused by minor procedures up to 12 months of age
252
pharmacological mngmt of pain in the NB
- usually used w procedures
253
what is included in care for the NB from 2 hrs after birth until discharge (7)
- ongoing monitoring & assessment of newborn - newborn bath & other care - newborn screening - parental education - family bonding --> promote parent-infant interactions - common newborn problems - confidence w newborn feeding
254
what is included in ongoing monitoring & assessment of the NB from the 2hrs after birth until discharge (5)
- VS - feeding - elimination - behavioral characteristics - sleep-wake states
255
describe screening for metabolic, endocrine, and congential disorders in the NB; what is collected? when is this done?
- early detection of certain disorders - blood sample collected --> screens for over 40 disorders - done prior to discharge & at least 24 hrs of age
256
describe hearing screening in NBs
- Universal Newborn Screening Act --> must be offerred to all parents - screening provides info about the pathways from the external ear to the cerebral cortex
257
what is 1 of the most common congential disorders in NBs
- hearing loss
258
what is done for screening for jaundice in NBs
- transcutaneous bilirubin (TcB) at 24hrs of age and q24 hrs or prn (as ordered)
259
what is the importance of pulse ox screening in NBs
- enhances early detection of critical congential heart disease
260
when and why is pulse ox screening done in NBs
- done to determine the ox sat for newborns between 24-26 hrs of age
261
describe how pulse ox screening is done in NBs
- right hand (pre-ductal) and either foot (post ductal) are used for the screening test - monitored for 30 secs, record highest number achieves
262
what pulse ox results are considered normal in the NB
>= 95% in right hand AND <= 3% difference bwteen them
263
what is considered borderline pulse ox screening result in NBs?
90-94% in rigtht hand OR >3% difference between them
264
what is considered an abnormal pulse ox screening result in NBs?
- <90% in right hand or foot
265
what is included in promoting parent-infant interaction w NBs (3)
- encourage responsiveness to infant cues - support parents to identify cues & infant's social capabilities - encourage, validate, and involve the parents
266
when is the NB bath completed
- prior to discharge
267
what are ways to prevent heat loss during the NB bath (5)
- be efficient - dry thorouhgly - temp of room at 24*C - immersion = less heat loss than sponging technique - be prepared, supplies gathered
268
how should the temp of the water w NB baths feels?
- pleasantly warm to the elbow
269
what are imp things to note w newborn baths? (4)
- do not hold under running water - never leave alone - work from clean to dirty - do not use soap on face
270
what determines the technique for umbilical cord care
- hospital protocol
271
what is the recommended care for the umbilical cord
- initial cleaning w water & subsequent cleaning w water - keep clean & dry *there is no difference in dry cord compared w those treated w antiseptics*
272
when is the umbilical cord clamp usually removed? when does the umbilical cord usually fall off?
- clamp removed once stump is dry = 24-36 hrs - umbilical cord falls off at 10-14 days
273
what is included in NB discharge teaching r/t maintaining normal temp
- if comfy for you, comfy for them - if sweating = too hot
274
what is included in NB dc teaching r/t what to do if infant appears to be choking (2)
- back clows -encourage participation in course
275
what is included in NB dc teaching r/t protecting the infant from resp infections & 2nd hand smoke (3)
- encourage to smoke outside - no visitors w cold - hand hygeine imp
276
what is included in NB dc teaching r/t car seat safety (2)
- note expiry date - use federally approved seat
277
what is included in NB dc teaching r/t when to seek help (6)
- weak cry - lethargic - less active - hypotonic - not able to settle - overly fussy
278
what plays a role in reducing the risk of sudden infant death syndrome (6)
- safe place to sleep - smoke-free setting - maintain normal infant temp - breast/chest feeding - sharing a room (not a bad) w parents for first 6 months - safety w night feedings
279
what position should the NB sleep in to prevent SIDS
- lay on back
280
what is included in a safe place to sleep to help prevent SIDS (6)
- alone in approved crib or craddle - flat surface - firm mattress - tight fitting sheets - no pillows, quilts, toys, heavy blankets - only light blanket
281
when do NB immunizations usually begin?
- usually begin at 2 months
282
when does infant follow up with public health occur? primary care provider? if midwifery care?
- public health = usually within few days in the home - PCP = within 2 weeks of discharge in office - midwifery care = will follow NB for 6 weeks

NURS 4500: Final Material (16 decks)

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