Thermoregulation of the NB
- NB do not shiver; maintenance of temp is accomplished by brown fat metabolism
- Premies have less brown fat
- Head is 20% of body surface
Ways heat is lost in the NB?
-Conduction
-Radiation
-Evaporation
-Convection
(pictures on pp slide 5)
Effects of cold stress
-Metabolism increases, increasing the O2 and glucose need
-Rapid resp rate
-Low blood sugar (hypoglycemia)
-Surfactant production decreased, impeding lung
expansion
Heat loss prevention
- Dry NB immediately
- Use warm blankets, radiant warmer, or skin-to-skin with Mom
- Use cap on head
- Most heat lost thru head
- Insure head is dry before applying
Vital statistics
- Weight:
- Length: If abn- neurological probs
Head circumference: if out of range- associated with neuro prbs
Chest circumference: usually smaller than head
Vital signs: temp: 97.7-99.5
pulse: 120-160 (if crying can go up to 180, sleeping can go down to 90)
bradycardia: heart block
Switching from fetal circulation
- Circulation to extremities poor at first
- Incomplete closure of shunts (?Murmur)
- Palpate femorals
- Cap refill
Blood values (To get accurate values warm foot)
- RBCs, H&H elevated due to fetal circulation
- Breakdown of extra RBC = Bili 1-4 OK
- Increased WBC – 15-30,000, 40,000 Stressed
- Blood coagulation
- Decreased vitamin K
GI psychological function
- Stomach holds 60-90cc
- Intestines synthesize Vit K
- Immature liver may lead to decreased glucose and protein, increased bilirubin
NB stool color meaning
- Black = meconeum
- Green = transitional,
- Yellow,seedy
- Meconeum – mucous, vernix, hormones, carbs, bile
- Must have BM – 24-48 hours –listen for bowel sounds
Respiratory psychological function
- Initiated by cold receptors, increase CO2, decrease O2
- In 10 minutes, good volume attained, 10 hours, established
Signs of resp distress
- Flare, grunt, retractions
- Unequal sounds, asymmetrical chest movement
GU psychological function
- Due to void in 24 hours
- Day 1 only 30-60cc
- Output 1-3cc/kg/hr
- Bladder capacity 6-44cc
- 1st void – uric acid crystals
Immune psychological function
- Immature til 2 months
- More at risk for infection
- No immunity to Herpes
Behavioral states
Sleep
-Deep, quiet, REM
Alert
- Drowsy
- Wide awake
- Active awake
- Crying
NB skin color
- Cyanosis
- Yellow
- Pallor
- Gray
- Ruddy
- Green/brown
- Mottled
- Red and sticky
- Harlequin sign
NB birthmarks
- Hemangiomas
- Mongolian spots
NB skin appearance
- Turgor
- Vernix caseosa
- Lanugo
- Desquamation
- Milia
- Erythema toxicum
- Forceps marks
NB Priorities
- Initiating and maintaining respirations
- Extrauterine circulation
- Fluid and electrolyte balance
- Temperature
Care of the NB at birth
- Suction, Dry, Warm, Stimulate*
- Keeping the newborn warm
- Record of first cry
- Eye care
- Vitamin K
- Infection precautions
- Apgar @ 1 and 5 minutes
IM location for NB
Vastus lateralis muscle
What does Apgar score rate?
- respiration, crying
- reflexes, irritability
- pulse, HR
- skin color of body and extremities
- muscle tone
Nursing care: NB
- Initial feeding
- Bathing
- Sleeping pattern
- Diaper area care
- Metabolic screening tests
- Hepatitis B vaccination
- Circumcision
Nursing care: family
Family Readiness - Teachings
- Daily home care
- Sleep patterns
- Crying
- Parental concerns related to breathing
- Health maintenance
- Car safety
Circ care
Watch for bleeding q 15 minutes x 1 hour
-If bleeding occurs –slight pressure
Vasoline dressings on the wound
-Do not use for plastibell circ
Keep clean and dry
-No soap x 5 days
Watch for infection
- Redness swelling
- Normal + red glans with yellow exudate
