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NUR 103A > Maternity 4 - Newborn Care > Flashcards

Maternity 4 - Newborn Care Flashcards

(60 cards)

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1
Q

Transition - After Birth
VS

A

first set VS - then
q30 min for 2 hours
with lungs and heart assessment

Maintain respirations
Thermoregulation
Bonding

Newborn ID - another RN to witness - 4 parts bands applied

weight & measurements

head assessment

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2
Q

Newborn Focused Assessments

A

HR 110-160
RR 30-60
TEMP 97.7-99.0
Sats >90% by 10 MOL
Respiratory -lung sounds, retractions, grunting, flaring

Color - pink, acrocyanosis OK
Head - molding sutures, fontanelles

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3
Q

Newborn Target O2 following delivery by minutes up to 10 min

A

1 min = 60-70%
2 min = 65-70%
3 min = 70-75%
4 min = 75-80%
5 min = 80=85%
10 min = 85-95%

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4
Q

APGAR score
Expected value >7
timing: repeat until reach 8

A

q 5 min until reach 8

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5
Q

Focused Respiratory Assessment

Overall indicator of transition

A

RR 30-60
~cry
~shallow
~irregular
~periodic brief pauses

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6
Q

Signs of Neonatal Respiratory Distress

A

Central cyanosis
tachypnea (RR >60)
Apnea
Grunting
Nasal Flaring
Retractions
Hypotonia (late sign) = floppy baby

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7
Q

Cardiovascular Adaptation

transition from fetal to regular circulation

A
  1. increases in blood oxygen level
  2. shifts in pressure in the heart and lung
  3. closing of the umbilical vessels
  4. closing of the ductus arteriosus, foramen ovale, ductus venosis
    within 24 hours of birth
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8
Q

Focused Cardiac Assessment

A
  1. Apical Sounds on all infants
  2. One full minute
  3. Heart sounds are high pitched, shorter duration, greater intensity
  4. heart murmurs may be present <24 hours after birth - normal finding
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9
Q

Focused Assessment

Head

A
  1. Fontanels - size, fullness w/o bulge sunken in
  2. Sutures - overriding, approximated
  3. Caput Succedaneum - NORMAL
    crosses suture line - edema disappears in a few days
    NORMAL
  4. Cephalhematome -
    NOT NORMAL
    does not cross suture line
    r/t birth trauma
    hemorrhage
    weeks - goes away in months
    contributed to hyperbilirubinemia

which is the break down of RBCs - excrete out in stool

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10
Q

THERMOREGULATION

newborn characteristics leading to heat loss

A

low SUBQ fat
blood vessels close to the surface
large skin surface compared to body mass

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11
Q

THERMOREGULATION

Methods of Heat Loss

A

Evaporation
Conduction
Convection
Radiation

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12
Q

THERMOREGULATION

Evaporation

A

Moisture on skin

dry off with towels - keep skin dry

think of shower - warm when wet, get out and cold

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13
Q

THERMOREGULATION

Conduction

A

Come in contact with cold objects

Scale = lay down blanket first
Cold hands
Cold stethoscope

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14
Q

THERMOREGULATION

Convection

A

Drafts

open doors
AC
people moving about

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15
Q

THERMOREGULATION

Radiation

A

lost by radiation when near cold surfaces - windows, crib, walls

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16
Q

THERMOREGULATION

Heat production Methods

A
  1. increased activity - restless, crying
  2. Flexion - muscle activity
  3. Metabolism, increased
  4. Vasoconstriction, mottling, acrocyanosis
  5. Nonshivering - brown fat breaks down
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17
Q

Risks from cold stress

Increase oxygen and glucose consumption may lead to:

A
  1. increased oxygen need
  2. decreased surfactant production
  3. respiratory distress
  4. return to fetal circulation
  5. hypoglycemia
  6. metabolic acidosis
  7. jaundice
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18
Q

Newborn Pain assessment Scale:

A

NIPS pain > =4

neonatal
infant
pain
scale

Facial Expression
Cry
Breathing
Arms
Legs
ALertness

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19
Q

1 intervention

Painful Baby:

A

Breast Feed Baby

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20
Q

Weight & Measurements

A
  1. following first feed (w/in first hour
  2. weight
  3. length
  4. head circumference
  5. Plot based on gestational age
  6. Glycemic control
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21
Q

Weight & Measurements

Determine % Ranking

A

SGA <10th
AGA
LGA >90th & at risk for hypoglycemia

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22
Q

Blood GLucose Maintenance

Baby uses glucose rapidly

Infants at risk for hypoglycemia include:

A
  1. Preterm & Late preterm
  2. SGA
  3. LGA
  4. Born to Diabetic mothers
  5. Expossed to stressors
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23
Q

Symptoms of Hypoglycemia in Newborn

Some babies may asymptomatic

BS = 40-60

A
  1. jitteriness, tremors
  2. diaphoresis
  3. decreased tone
  4. decreased temp
  5. respiratory distress
  6. tachycardia
  7. irritability
  8. lethargy
  9. poor feeding
  10. seizure or coma
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24
Q

Medications for Baby

A

Eye = Erithromycin ointment
eye prophylaxis
gonorrhea - blindness

VIT K - clotting
Vastus Lateralis
low levels due to sterile gut

HEP B vaccine
Birth - 2 months, 4 months

first dose w/in 12 hours of life

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25
Newborn Assessment: Beyond Transition
Skin - 1. Skin, scalp, body, hair, nails, all for color, texture, birthmarks Acrocyanosis normal for first 24 hours 2. Milia - white pearls on nose - white heads 3. Lanugo - hair 4. Vernix - cheesey substance - rub in 5. Stork Bite
26
Assessment of Infant's Head
1. Symmetry 2. Eyes: ~shape ~size ~placement ~coordinated lid movement ~red reflex 3. EARS: ~shape ~size ~placement 4. LIPS: ~movement ~Color 5. Mouth: ~teeth - not normal ~ability to suck ~hard and soft palate
27
Low set ears are typically associated with...
genetic disorders >24 hours newborn screen - metabolic screen
28
Respiratory Assessment
1. skin color 2. lung sounds 3. Rate, pattern, accessory muscles (NR = 30-60) 4. Symmetry in chest movement 5. Nasal patency mmm mmm = grunting
29
Cardiac Assessment
Heart Rate and Sounds: 1. NM HR 110-160 2. can palpate cord by grasping base at birth (Unreliable in code) 3. PMI at 4th intercostal space, mid-clavicular line 4. listen for 1 minute 5. cap refill <3 seconds 6. Pulses: Brachial and femoral 7. Murmurs in 30% - resolve in 2 days - normal finding
30
Patent Ductus Arteriosus PDA Patent = open
PDA = condition in which the ductus arteriosus does not close Should close by 15 hours of life Ductus arterious is a blood vessel that allows blood to bypass teh baby's lungs before. birth. S/S Respiratory distress = rapid heart rate, murmur = PDA
31
PATENT FORAMEN OVALE Patent = open
Foramen Ovale is small hole in septal wall between right and left atrium. Allows some blood to bypass pulmonary circuit S/S = unlikely to notice may have some cyanosis with straining
32
DUCTUS VENOSUS CLOSURE
it shunts a portion of the umbilical vein blood flow directly to inferior Vena Cava and bypasses the liver Usually closes in 3 days Allows for umbilical catheritazation
33
GI system
includes the umbilical cord inspection = 1 vein 2 arteries (AVA) bowel sounds listen, palpate anus inspection opening sacral dimple - normal or not stools - last BM - should be within 24 hours
34
GI STOOL progression
thick, greenish black meconium to loose, greenish brown transitional stools to milk stools Breastfed stools = frequent, seedy, and mustard colored
35
GI Concerning Conditions
Abdominal distention absent bowel sounds discharge from umbilical site mass
36
GU system Palpate and inspect scrotum, testes, penis, retract foreskin slightly Common Findings:
Common Findings: Swelling Hypospadias (ventral opening) Episadias (Dorsal opening)
37
GU system Palpate and inspect female genitalia Common Findings:
Common Findings: Hymenal Tags Vernix on labia Pseudomenstration
38
GU system Void/Stool
First void should occur within 24 hours - Notify HCP if not Absence of stool or urine for 48 hours abnormality - report
39
Musculoskeletal System Assessment
1. Observe movements 2. inspect for differences in extremity length and size 3. Assess muscle tone and symmetry 4. Gentle passive ROM to assess joint rotation 5. Assess head lag
40
Musculoskeletal System Assessment Further assessment
1. Fractured Clavicle 2. Polydactyl - extra finger 3. Syndactyly 4. Simian Crease
41
Neuro Assessment Reflexes
1. Gag 2. Babinski (toes flare plantar rub heel to pinky toe- across to big toe) (1 year) 3. Moro - startle reflex 4. Palmar grasp 5. Plantar grasp 6. rooting 7. sucking 8. Tonic Neck (head one way - arm and leg extend the way head is turned and looking -- Flexes the other side (back of head side) 9. Stepping Reflex
42
Immune system - Passive
IgC - placenta IgA - milk produce to protect against infection
43
Peri Bottle
Warm water spray Blot front to back
44
24 hour screenings
1. Metabolic 2. Weight 3. Bilirubin level 4. CCHO
45
What is a late sign of hunger?
Crying
46
Breastfeeding helps to
1. involute the uterus 1. promote immune system 2. promote GI system 3. prevent GI infections 4. prevent diabetes 5. decrease childhood obesity
47
Screening prior to discharge?
Hearing if fail - stay another night and follow up with pediatrician possible fluid in ears
48
Hyperbilirubinemia Physiologic Jaundice
AFTER 24 hours hemolysis RBC and immaturity of liver
49
Hyperbilirubinemia Pathologic Jaundice
BEFORE 24 hours Tx = phototherapy Blood type can cause: RH- O+ ABO incompatibility (Kernicterus risk) staining of he brain and brain damage that is irreversible
50
Hyperbilirubinemia Breast Milk Jaundice
Lack of sufficient intake, days 2-4 Increase feeding to reduce bilirubin - excrete out
51
Hyperbilirubinemia Factors that increase
1. hemolysis of excessive RBCs 2. short RBC life 3. Lack of albumin-binding sites 4. liver immaturity 5. preterm and late preterm infants 6. lack of intestinal flora 7. delayed feeding 8. trauma resulting in bruising or cephalhematoma 9. fatty acids from cold stress or asphyxia
52
Hyperbilirubinemia Complications
Kernicterus Brain damage
53
State Mandated Screening
Metabolic screening
54
Metabolic screening for:
PKU Cystic fibrosis Congenital hypothyroidism Other metabolic diseases
55
Metabolic screening performed...
24 hours after birth
56
Critical Congenital Heart Disease in newborns CCHD
Surgical or cath based therapy within first year of life necessary for survival 24-48 hours of age PULSE OX Monitor placed on right hand and either foot no greater than 5% discrepancy with pulse ox readings
57
Discharge Teaching
1. Temp assessment - axillary 2. Bathing - sponge baths until cord falls off 3. no cutting nails - only file them 4. umbilical care 5. Output expectations ~as many days old + 2 stools up to one week 6. Safety (Car seat & Sleeping) - SIDS 7. Purple Crying - nothing soothes them - put down to avoid shaken baby syndrome 8. PP depression 9. infection S/S mom & Baby 10. Circumcision Care - do not retract foreskin
58
Postpartum vaccines for mom
MMR - check for immunity TDAP - 2 years (pertusis)
59
Pain control for baby =
breast feeding
60
s/s hemorrhage mom
low BP high HR

NUR 103A (8 decks)

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