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OB NUR 359 > Newborn Assessment > Flashcards

Newborn Assessment Flashcards

(62 cards)

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1
Q

How to promote physical well-being of newborn

A

Nursing care - Keep baby warm, wash after 24 hours, swaddle,

Physical assessment - reflexes, vitals

Nutrition - get them breastfeeding or on formula

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2
Q

How to promote and establish a functioning family?

A

we must educate and support both parents and grandparents

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3
Q

What are respiratory changes from fetus to newborn?

A

Respirations initiate

Chemically - surfactant reduces tension to reduce O2 concentration

Thermally - Moist infant is cold from exposed air

Mechanical - think vaginal compression or fetal chest during vaginal delivery

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4
Q

Apgar scoring. Scoring the Activity

A

0 - Absent

1 - Flexed arms and legs

2 - Active and moving around

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5
Q

APGAR - Pulse scoring

A

0 - No pulse

1 - Less than 100 bpm

2 - More than 100 bpm

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6
Q

APGAR Grimace scoring (Reflex)

A

0 - Floppy

1 - Minimal response to stimulation

2 - Prompt to respond

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7
Q

APGAR Appearance scoring

A

0 - Blue/pale

1 - Pink body with acrycyanosis

2 - Pink all over

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8
Q

APGAR - Respiration scoring

A

0 - No breathing

1- Slow & Irregular

2- Vigorous cry

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9
Q

When to assess APGAR

A

1 minute of birth

5 Minutes

Again at 10 min is the first two readings were low

Assess and intervene then reassess after interventions are done

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10
Q

Methods of heat loss - Evaporation

A

Wet surface exposed to air = loses heat

Baby comes out wet and water evaporates so baby loses heat

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11
Q

Conduction

A

Newborn comes into direct contact with object cooler than skin

Warm blankets and stethoscopes before placing on the baby

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12
Q

Convection

A

Heat is transferred to air that surrounds he newborn

Losing heat through airflow - try to decrease airflow in room to maintain babys temperature

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13
Q

Radiation

A

Transfer of heat to colder objects that arents in contact with infant.

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14
Q

What are the effects of cold stress?

A

Increased metabolic rate

Non-shivering thermogenesis-metabolism of brown fat

Vasoconstriction

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15
Q

How does increased metabolic rate in cold stress effect the baby?

A

Increase use of glucose and low production of surfactant hypoglycemia with respiratory distress

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16
Q

How non-shivering thermogenesis metabolism of brown fat effects the baby?

A

Increased production of free fatty acids leading to metabolic acidosis and jaundice

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17
Q

How does vasoconstriction of cold stress effect the baby?

A

Pale mottled skin leading to fetal circulatory patterns

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18
Q

What are kennel and klaus’ theory on bonding?

A

Must bond within the first hour of life or it will effect baby for the next 20 years

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19
Q

How to encourage bonding with parents?

A

En face -babies can see 6-8 in in front of them

Encourage breastfeeding asap after delivery

Skin to skin

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20
Q

Periods of reactivity
First period

A

30-60 Min
Vitals - eyes are the most open
Encourage bonding
APGAR
Radiant warming
Meds - Vit K & arithromycin

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21
Q

What are the periods of reactivity?

A

First period - 30 - 60 min

Sleep phase - 1 to 4 hours

Second period - 4 to 12 hours

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22
Q

What happens in the second period

A

4 to 12 hours after birth

Increased sensitivity to internal and external stimuly

Voiding and meconium

Mucus, apnea, emesis

Most active in this phase

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23
Q

Risk of not giving vit K injection to newborns

A

Neonatal hemorrhaging

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24
Q

Normal weight in pounds and gms for newborns

A

2500-4000gms
5.5 - 8lbs

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25
SGA
less than 10% SGA
26
LGA
More than 90% LGA
27
Normal length of newborn
18-22 inches 48-52cm
28
Head circumfrence
measure above eyebrow 13-14INCHES 32-36CM
29
Chest circumfrence
Measure nipple line 12-13 Inches 30-34 cm
30
Temp of newborns Pulse
97.5-99.5 110-160 bpm Crying - 180 bpm Sleeping -100 bpm
31
Blood pressure of newborns
Only taken with suspected cardiac issues Measure at the thigh Falls around 70/40 as normal
32
Normal Fontanelles Dehydrated ICP
Flat & pulsing Bulging - ICP Sunken - dehydration
33
Molding
Cone head normal Overrided sutures Resolves quickly
34
Caput Succedenum
Crosses suture line like a cap *Cap Swelling* Goes away without treatment
35
Cephalohematoma
Over a particular bone Does not cross suture line Bleeding, blood clot
36
What will we see when cephalohematoma begins to resolve?
Jaundice that starts from head and spreads to the rest of the body
37
Skin of the newborn?
Reddish in color, ruddy and smooth Edema - resolves but causes weight loss as they lose water Turgor- look for dehydration
38
What to look for in the eyes of newborn?
Color and red reflex Subconjunctival hemorrhage from birth trauma Chemical conjunctivities from reaction to eye prophylaxis
39
What to look for with ears in newborns
Eyes and top of ear should line up - if not possible down syndrom or chromosome abnormalities Loud noise = startle reflex Moro reflex - abduct, adduct, cry (Away at 3mos) Flexible pinna with cartilage - it snaps back
40
What to look for in the nose with newborns
They are nose breathers look for patency Normal sneezing and no bridge Problems: Nasal flaring that lasts longer than a few moments after birth Check for retractions & listen to lungs
41
Mouth and throat assessment in newborn
Reflexes: Sucking, Rooting, Gag, Extrusion reflexes Extrusion usually lost at 4-6mos when solids are introduced Place finger in mouth and see if sucking reflex is available check for cleft palate at same time
42
Abdominal assessment of the newborn?
Dome shaped belly Soft on palpation Liver is palpable 2-3cm below right costal margin Bowel sounds 2 hours post delivery
43
When will be first void and meconium of newborn?
Void - within 24 hours Meconium - Within 24-48 hours
44
Female genitalia of the newborn
Edematous at labia and clitoris with vernix between the labia Moms hormones may have the baby spotting within the first week this is normal!
45
Male genitalia of the newborn
Palpable testes - if not palpable may be testicular cancer later in life Rugae should be formed Do not clean Smega Do not retract the foreskin it will not return if you do.
46
Assessment of extremities
Normal posture Equal bilateral movement and tone of all four extremities Flat feet- will develop the arch later All creases should be present Look for simean crease - if coupled with downset ears can be a down syndrome case.
47
Hip dislocation assessment
Use ortolani's maneuver - push knee up and rotate Look for clicking - can also be r/t breech birth If not breech baby check for: -Clicking -Unequal leg length -Asymmetrical skin creases on back of thigh
48
Neuromuscular system assessment of the newborn?
-Maintains flexion -Can hold head erect for few seconds -When prone turns head to side to breath
49
Troubling signs of the neuromuscular assessment?
No movement Jerking Quivering Clonic jerking -Possible Neonatal abstinence syndrome - check urine tox
50
Behavioral assessment
Soothed to cuddles - if cannot be soothed look into NAS Sleeps for at least 16-20 hours a day Brazelton behavioral assessment - test for ADD
51
Additional care of newborn - Bulb suctioning and sleeping
Parent teaching to suction - Bubl suctions - Depress bulb and suction mouth first to avoid aspiration. Back to sleep - Avoid SIDS
52
Additional care of newborn - Circumcision & PKU
Keep clean and dry Monitor newborn voiding wrap with ointment PKU - Must be breast and bottle fed before wait 24-48 hours
53
When to call MD
Fever Blue or color changing Crying incessantly No urination
54
Car seat safety
Rear face seat until 2 years old Front face until 40 pounds Booster up to 7-8 years old
55
Normal skin assessment
Milia - Clogged sebaceous glands Mottling - happens when they're cold Vernix
56
Rashes and marks
Erythema toxicum (Newborn rash) - Starts are trunk and goes away on its own Forceps mark - assess symmetry (Neuro check) Mongolian spots - common in any race by white. Purple ecchymotic skin Goes away in few weeks/months
57
Birthmarks
Port wine stain - more permanent birthmark Stork bite/ Nevi - Normal - goes away in its own, Found on neck/lips If blanches will go away quickly Strawberry hemangioma - Not uncommon and can be found on lower back Cafe au lait Petechiae
58
Reflexes - Babkin reflex
Stimulated by: Press, stroke both palms Mouth opens, eyes close, head tilts forward Disappears: 3 mos
59
Grasping reflex
Stimulated: Place object in palm Holds it tightly Disappears: 4 mos
60
Babinski reflex
Stimulated: Stroke sole of foot Foot twists and toes fan out Disappears: 8 mos
61
Stepping reflex
Stimulated: Hold baby under arms not on floor Stepping motion Disappears: 2 mos
62
Difference between physiologic and pathologic jaundice in the newborn?
Pathological jaundice happens within the first 24 hours Physiological jaundice occurs 2nd or 3rd day. Not associated with hemolytic disease or other pathologies. (6-10mg/dl & resolves in 5-7 days)

OB NUR 359 (4 decks)

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