Newborn Assessment Flashcards by Hannah McMahon

What does Apgar scoring look at?

A → Appearance (color)
P → Pulse (HR)
G → Grimace (reflex irritability)
A → Activity (tone)
R → Respiratory effort

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Apgar:

What appearance would give babies a score of 2?

Pink all over → most babies are NOT pink all over
Rare right after birth

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Apgar:

What appearance would give babies a score of 1?

Acrocyanosis → baby is pink except for extremities
Very common, normal finding

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Why do we see acrocyanosis in babies right after birth?

Baby shunts the BF to where it is needed most at first

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Apgar:

What appearance would give babies a score of 0?

Blue or pale

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Apgar:

Pulse rate of _____ will give babies a score of 2

> 100 bpm

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Where can we assess HR at 1 min?

Umbilical → since it will still be pulsating

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Apgar:

Pulse rate of ____ will give babies a score of 1

< 100 bpm

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Apgar:

_____ HR will give babies a score of 0

Absent

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Apgar:

What kind of grimace (reflex irritability) will give babies a score of 2?

Vigorous cry, pulls away

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When would we see a baby give a vigorous cry or pull away?

When drying & irritating the baby

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Apgar:

What kind of grimace (reflex irritability) will give babies a score of 1?

A grimace or facial movement

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Apgar:

What kind of grimace (reflex irritability) will give babies a score of 0?

No response to stimulation
Start tapping/ flicking feet before 1 min

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Apgar:

Activity (tone) that gives baby a score of 2?

Active movement

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Apgar:

Activity (tone) that gives baby a score of 1?

Some flexion of extremities
if baby has some tone but no movement

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Apgar:

Activity (tone) that gives baby a score of 0?

Flaccid (limp)

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Apgar:

Respiratory effort that gives baby a score of 2?

Good breathing with crying
Baby who cries & looks upset w/ you is good

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Apgar:

Respiratory effort that gives baby a score of 1?

Weak cry or slow breathing; or grunting cry (having trouble getting started)

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Apgar:

Respiratory effort that gives baby a score of 0?

Apnea

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When do we assess Apgar score?

At 1 min, and then 5 min

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What should be done if Apgar score is ≤ 7?

Repeat assessment every 5 min until stable

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What is considered a good Apgar score?

8 or above

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At 5 min most babies have an Apgar score of ____

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What is the first mechanism of heat loss in a baby & why?

Evaporation → b/c baby comes out wet w/ amniotic fluid

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How do we prevent conduction heat loss?

Skin to skin or warmed blankets on top of baby & mom

When would conduction occur in a baby?

If they are placed on a cold surface; they transfer their heat

How do babies radiate heat loss?

If baby is naked they will radiate heat to room temp

What should we always have prepared for when the baby is warm?

Hat

How should babies be dressed?

Always in one more layer of clothing than adults

How do radiant warmers work?

They only warm the outside of things **baby should only be in a diaper**

List 2 ways to prevent convection heat loss

1) Keep baby away from drafty areas (doors/ fans) 2) Perform baths away from draft areas

Where should the radiant warmer be placed to prevent convection?

Away from the door

What can low temp = ?

Low glucose & increase risk for respiratory distress

What will happen if baby has to use a lot of its brown fat to keep warm?

Will have less reserve to maintain glucose

When will we see babies using a lot of brown fat to keep warm? **Hint: 3**

1) Preemies 2) Large babies 3) Babies born to diabetic mothers

What could happen to the baby if their sugars go low?

They can go into respiratory distress or lose brain cells

What is important to check before the baby is born?

The warmer!! → check heat source → check the O2 for proper flow → suction (set btwn 80-120) → supplies (stethoscope; laryngoscope; meconium aspirator)

What should we try to do before the cord is clamped?

Get skin-to-skin contact

How does delayed cord clamping help the baby? **Hint: 3**

1) Increases blood volume ~33% 2) Increases iron stores for up to 6 mos → lowers incidence of anemia 3) Increases O2 to vital organs

How long do we delay cord clamping for?

At least 30 seconds up to 5 min

When would delayed cord clamping be contraindicated?

If neonate needs immediate resuscitation

Delayed cord clamping can be good for what kind of babies?

Preemies → like giving a little blood transfusion

How do we dry & gently stimulate the infant after delivery?

Gently rub the baby dry with a warmed blanket while on mom's chest/ abdomen

What does drying & gently stimulating the baby help with? **Hint: 3**

1) Prevents heat loss via evaporation 2) Stimulates baby's first breath 3) Promotes lust cry to clear airway

If secretions are blocking the airway what should we do as the nurse? **Hint: 3**

1) Bulb suction → side of mouth & nose 2) Mechanical suction 3) Carefully assess babies w/ meconium stained fluid

What would indicate apnea or ineffective breathing?

Baby gasping for breath or grunting cry

How do we intervene on a baby who is not breathing or ineffectively breathing?

Ventilate with bag-valve mask

List 6 signs of respiratory distress in a newborn

1) Nasal flaring 2) Grunting 3) Tachypnea 4) Substernal retractions 5) SeeSaw respirations 6) Cyanosis (late sign)

Why do we see grunting?

Natures CPAP → baby is trying to force more air down deep

How would we classify a baby as being tachypniec?

1) Respirations > 60 rpm 2) Trying to take in faster breaths to compensate for not getting enough O2

What do we see with substernal retractions?

Pulling at the rib cage → baby is NOT gasping for breath

What do we see if baby is experiencing SeeSaw respirations?

Pulling at the chest that goes down to the abdomen

How should babies breathe normally?

Belly breathers

Milia

**Normal finding; go away on own** Result of exposure to mom's hormones & the baby's being sensitive

Stork bites

**Totally normal** Usually on eyelids & the nape of the neck

When are mongolian spots usually seen?

**See in most babies of color** Usually disappear somewhere in preschool age

What is Caput Succedaneum?

Swelling or fluid under the skin; diffuse swelling does NOT have a border

What does Vitamin K help with & where is it synthesized?

Helps blood clot normally; Synthesized in our guts

Why should babies receive Phytonadione (Vit. K) shot?

Their gut is sterile so they do NOT make vit K & we do not know when it will start

How much vit. K is administered and how do we prepare the syringe?

NEVER more than 0.5 mL → draw up with filter needle to avoid glass getting into syringe

What should we teach parents if they refuse vit. K shot for their baby?

Advise against circumcision in male infants!!

Why is Erythromycin ophthalmic ointment considered standard of care for NB?

Helps prevent neonatal conjunctivitis & gonococcal infection

How do we administer Erythromycin ophthalmic ointment?

Pull lower lid down & put very thin ribbon of ointment

What is the first vaccine series given to babies?

Hepatitis B vaccine

How & when is hepatitis B vaccine given?

1) 0.5 mL injection into vastus lateralis 2) Given at birth, 1-2 mos, 6-18 mos

What are NB metabolic screenings used to test for?

PKU (Phenylketonuria) & other disorders

Where should heelsticks be performed on a NB?

On the outside of the heel

How do we check bilirubin in NB?

Heel stick & plot on graph → bilitool: plots levels of bilirubin & helps let you know whether there's a need to intervene

Why do we perform hearing screenings on babies?

To test how the baby responds to sounds

Why do we wait 24 hrs to perform critical congenital heart defect screening?

To give PDA and PFO time to close

How do we perform a critical congenital heart defect screening?

1) Pulse ox on right hand: preductal circulation that goes before PDA → want btwn 95-100% 2) Pulse ox on either foor → want no more than a 3 point difference **Both values should be > 95%**

Newborn Assessment Flashcards

(71 cards)