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Newborn Care Flashcards

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1
Q

What is the age range of the neonatal period ?

A

birth to 28 days

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2
Q

What are some adjustments newborns go through in extra-uterine life ?

A
  • establish respirations
  • adjust to circulatory changes
  • regulate temperature
  • ingest, retain and digest nutrients
  • eliminate waste
  • regulate weight
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2
Q

What is the major difference in a newborns circulatory flow after birth ?

A
  • in the uterus= left to right flow
  • outside mom= right to left flow
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2
Q

Why is vaginal delivery important when related to the liquid in the baby’s lungs ?

A

compression of the newborn chest during vaginal delivery helps squeeze fluid out of chest and draw air into the lungs
- not as effective with C/S and premature delivieries

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2
Q

When does the newborn’s lungs start to exchange gases ?

A

right after the umbilical cord is cut
- this causes the placenta to no longer work as the lungs

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2
Q

What does clamping of the cord cause for prostaglandin levels ?

A

causes a decrease which can inhibit respirations

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2
Q

What sensory stimuli’s helps establish respirations ?

A
  • handling of infant by person doing delivery
  • suctioning of mouth and nose
  • drying by nurse
  • pain associated with birth
  • lights, sounds, and smells
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2
Q

Why is surfactant important for newborns ?

A

surfactant is released when the lungs expand after birth
- lines the alveoli and respiratory passages

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2
Q

Why is the function of surfactant ?

A

prevents alveolar collapse and lowers surface tension which increases lung compliance

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3
Q

What is a sign of a baby not having adequate surfactant levels ?

A

at the end of exhalation, the baby will make a “grunt” sound
- this them popping back open those alveoli

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3
Q

What are the 3 signs of respiratory distress ?

A
  • nasal faring
  • grunting
  • retracting
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3
Q

Why is nasal flaring a sign of respiratory distress ?

A

they are increasing the surface area of their nose to get more air into their lungs
- early sign of distress

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3
Q

When doing the respiratory assessment, what do we look for ?

A
  • 30-60 breaths per min
  • listen for a full min since they are irregular breathers
  • when auscultating for lung sounds make sure that their abdomen matches with the air sounds
  • may have short pauses of < 15 secs (periodic breathing) which is normal
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4
Q

What is meconium ?

A

first bowel movement of newborn
- ASPIRATION RISK
- black, tarry, sticky
- should be passed within 24 hrs

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5
Q

What are some expected findings of the CVPV assessment ?

A
  • fast HR (120-160) and even faster when crying
  • irregular S1 and S2
  • may hear little of a murmur and swooshing (is normal but monitor if they are compensating well for this)
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6
Q

When does the ductus arteriosus close ?

A
  • functionally= 24 hours
  • permanently= 3-4 wks
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7
Q

What causes the functional closure of the foramen ovale ?

A

increased pressure in L atrium caused by 1st breath

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8
Q

How do we regulate their temp ?

A
  • dry quickly after birth
  • place cap on head
  • delay 1st bath (unless mom has known pathogen like Hep B or a STD)
  • skin to skin contact (kangaroo care)
  • radiant warmer (last resort)
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9
Q

Why are they vulnerable to heat loss ?

A

large surface area, only thin layer of fat and unable to shiver to produce heat
- first 12 hours they are the most vulnerable to heat loss

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10
Q

What is the feeding schedule for breastfeeding or formula ?

A
  • Breast: 2-3 hrs
  • Formula: 3-4 hrs
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11
Q

What are infants at risk for is they are born before 32 weeks in relation to surfactant ?

A

they do not have adequate surfactant levels

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12
Q

What is their stomach capacity ?

A

30 mL (size of marble)

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13
Q

What is the urine schedule ?

A
  • voids 2-6x in first 24-48 hrs
  • 6-8x per day after
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14
Q

When is urine formed in utero ?

A

4th month

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15
When is the bacteria establish and when are bowel sounds heard after birth ?
- bacteria in gut in first week - bowel sounds heard shortly after birth
16
What does the feces of a breastfed baby look like ?
yellow seedy stool w/ each feed
17
What does the feces of a formula baby look like ?
soft brown - 1-2x day
18
What does weight looks like after birth ?
- typical loss of 5-10% of birth weight in first 3-5 days of life - should regain by 14 days
19
Why do baby's look all puffed up after birth ?
they are very fluid heavy and that's why they look all puffed up - its a survival instinct because it protects from potential dehydration
20
What is the temp range ?
97.7-99.5 F - if they have a physiological problem their temp will do down instead of up - temp decreasing is more significant
21
What is the RR, HR, and BP ?
- RR: 30-60 - HR: 110-160 - B/P: 60-80/40-50 (mean arterial BP should correspond with weeks gestation)
22
What is an APGAR score ?
systematic method for assessing infant's condition and transition to extra-uterine life at birth - used at birth to ensure infants are observed for need of resuscitative care
23
What are the different APGAR scores ?
- 0-3: severe distress - 4-6: moderate difficulty - done at 60 secs and repeated at 5 mins of life - doesn't predict neurological outcomes
24
What should the Babinski reflex look like ?
positive Babinski - toes flare out
25
What is Jaundice ?
yellowish discoloration of the skin and other organs caused by high levels of bilirubin - phototherapy may be needed
26
What is physiological jaundice ?
self-limited caused by immature liver and enzyme system - 3-4 days after birth - in 60% of neonates - may resolve on its own - baby can compensate and resolve - cephalocaudal progression
27
What is pathologic jaundice ?
caused by hemolytic disease, RH/incompatibility, prematurity - seen within 24 hrs of birth
28
When performing phototherapy for jaundice what are steps we should take ?
- protect the eyes - max skin exposure - monitor heat loss, fluid balance status - blankets or lights
29
Which babies are at risk for hypoglycemia ?
- preterm - low birth weight - small/large for gestational age - infants of mom with diabetes - distress during birth
30
What is hypoglycemia in babies ?
may occur in first few hours of life - early and regular feeding will prevent this - treat per hospital protocol
31
How is their immune system ?
- immunosuppressed (defenses not well developed) - term infants have acquired natural immunity through maternal antibodies which were transferred in last 3 months of pregnancy - colostrum and breastmilk provide needed antibodies
32
What are some immediate nursing care ?
- assess respiratory status - suction mouth and nose with bulb syringe - maintain adequate 02 supply - dry and stimulate infant - maintain temp (skin to skin, under warmers, hat & blankets - assess temp (axillary) - place ID bands - footprint baby and mom's fingerprints - obtain measurements & vitals
33
What are some baseline measurement and vital signs taken ?
1. obtain vital signs 2. obtain body measurements - weight, head circumference (OFC), chest circumference, length, gestational age using Ballard tool 3 physical assessment
34
What is Caput Succedaneum ?
lump or bump on head shortly after birth - more superficial - goes across multiple plates and sutures
35
What is Cephalohematoma ?
deeper injury than just a surface level tissue injury - contained to one plate of the skull
36
What is Acrycyanosis ?
the extremities are not perfusing enough because of the blood flow first goes to the core and the head - extremities/limbs look slightly bluish
37
What is Molding ?
elongated head - baby took a long time in the birth canal - just have to wait it out because it will be reversed naturally
38
What is milia ?
normal plugged up skin cells - look like small pimples - the less you do the better - don't apply oils or creams or anything
39
What is mottling ?
white and red appearance of the skin - happens when baby is very cold and "freezing"
40
What is a Mongolian spot ?
type of birth mark on baby's - is on the sacrum or buttock and looks like a bruise
41
What is Erythema Toxicum ?
a common rash found on newborns
42
What is the Erythromycin Ophthalmic Ointment used for ?
eye prophylaxis to prevent ophthalmia neonatorum(eye infection) - due to gonorrhea or chlamydia - put ribbon of medicine in eye from inner to outer canthus - administer 1-2 hours of birth
43
When is the Hep B vaccine administered ?
IM at birth then 1-2 months and 6 months - must obtain parental consent
44
Why is the Vitamin K vaccine important ?
prevents hemorrhagic disease - within 2 hrs of birth - bacteria necessary to synthesize Vit. K not present for 1 week (no intestinal flora yet)
45
When, how and why do we perform the hearing test ?
- When: 24-48 hrs before they leave the hospital - important because they are already learning about their environment and speech
46
When and how do we perform the genetic, endocrine, and metabolic screening ?
- When: they have to have eaten something before because they have to be metabolizing something to know if its functioning properly - How: blood test
47
When do we perform the congenital heart disease screening ?
within 24 hrs
48
What do we educate the family on ?
- needs of newborn can be overwhelming to families - education should occur throughout the hospital day and not all at once - be aware of any specific cultural needs when planning education - encourage early bonding with parents (skin to skin contact)
49
What is some bathing education ?
- no more than every other day - daily cleansing of perineum and face - wash hair 1-2x per week
50
What is some umbilical cord care ?
- clean cord with warm water and a washcloth with baths or if soiled with urine or stool - let cord air day (keep outside of diaper) - clamp is removed once the stump is dry & baby is ready for discharge (24-48 hrs after birth)
51
When does the umbilical cord usually fall off ?
10-14 days
52
What is some circumcision care ?
- assess for bleeding every 15-30 mins the first hour, then hourly for the next 4-6 hours - avoid baby wipes (cleanse with water only) - apply vaseline with every diaper change (don't want penis sticking to diaper)
53
What are the sleep needs ?
sleep correlates with rate of growth - 80% at birth - 12 hrs at 12 months - sensitivity to sleep cycles so develop rituals - not firm "schedule" because they won't keep it consistent
54
What is Sudden Infant Death Syndrome (SIDS) ?
- 3rd leading cause of death -unknown cause - nurse role is family coping/grief
55
What are some risk factors to SIDS ?
- prone sleeping - exposure to tobacco smoke - soft sleeping surfaces - hyperthermia - bed sharing - lack of breast-feeding - SIDS sibling - preterm
56
What are some recommendations for safe sleep ?
- sleep alone, on their back in a crib - offer pacifier - breastfeed - firm sleeping surface
57
What is some motor vehicle safety ?
car seats - rear-facing safety seat for up tp 2-3 years of age - always in the back seat heat stroke - dangerous temps occur in 15 to 30 mins if left unattended nurse implications - teach safety and provide resources

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