Newborn Care Flashcards
(39 cards)
Respiratory system of newborn?
The production of lung fluid decreases 2-4 days before labour, 80-100 mL remain in air passage of term newborn so their first breath is an inspiratory gasp (have increased CO2 and decreased pH/O2, want to get rid of fluid in their airway)
Immediately after birth assessment?
Look at ABCs. Then determine term gestations, breathing/crying, and muscle tone (this forms basis for interventions)
What is the APGAR score?
Quick way for HCP to evaluate health of newborns at 1, 5, and sometimes 10 min (if 5min score <7). Stands for appearance, pulse, grimace, activity, respiration. You assign them 0, 1, or 2 (0 being absent and 2 being good).
Specific aspects of APGAR?
HF- absent (0), <100 (1), >100 (2)
Resp- absent (0), slow/irregular (1), good crying, 30-60 breath/min (2)
Muscle tone (appearance)- flaccid/limp (0), some flexion but limited (1), well flexed/good resistance/active movement (2)
Reflex irritability (grimace)- none (0), grimace or frown (1), vigorous cry/cough (2)
Colour- pale/blue (0), body pink/extremities blue (1), completely pink (2)- loose most points here
Cord blood gases?
These tell use how things were going during utero and can indicate if the newborn will have difficulty transitioning. You take a sample from arterial (unoxygenated- how placenta was functioning) and venous (oxygenated- how fetus was doing with O2) cords
Normal newborn VS ranges?
T: 36.5-37.5
HR: 110-160 (can increase when crying)
Resp: 30-60 breath/minute (can increase when crying)
BP: 50-75/30-45
Newborn care after birth?
Assess VS q1hx4, APGAR, assess level of alertness, general toe to head assessment, ensure infant identification, provide bonding opportunities and maintain warmth
S+S of neonatal resp distress?
Tachypnea, cyanosis, grunt/coo (means increased WOB), nasal flaring, retraction/indrawing, and accessory muscle use. Some late signs are poor feeding/apnea
Newborn thermoregulation?
Means maintain normal temperature and have balance between heat production/loss. Newborns are at risk b/c they aren’t able to regulate very well- always bundle/have warmers
What is BAT?
Non shivering thermogenesis in brown adipose tissue, It the primary source of health in hypothermic newborn. It appears at 26-30 weeks old, and increases 2-5 weeks after birth. It will oxidize in response to cold exposure
Heat loss definitions of evaporation, convection, radiation, and conduction?
E- babies wet with amniotic fluid and when it drys it causes heat loss, so dry babies well after birth to avoid this
C- heat from body into cooler air, it circulates over (like wind chill)
R- placing babies near cold objects (like windows), causes them to have heat loss
C- touching baby with something cold (like cold hands or cold stethoscope)
Risk factors for altered thermoregulation?
Premature, first 8-12 hrs after birth, small for gestational age, infants with CNS problems, sepsis, and prolonged resuscitation efforts
Signs of cold stress and what can we do to prevent it?
S+S: vasoconstriction (acrocyanosis, pallor), tachypnea, tachycardia, fussy, irritable, hyper active
Dry quickly after birth (especially their head), use pre-warmed blankets, skin to skin contact, keep away from drafts/AC/windows, have warm items (stethoscopes), and can provide warmer heat from radiant
Hypoglycemia in newborns? and glucose ranges
Low blood glucose, since glucose is the main energy for brain cells, if no glucose=neuro compromise. Newborns will have repeated level of <2.6 mmol/L or single reading of <1.8. Normal glucose for infants is 2.2-6 mmol/L
Infants at risk for hypoglycemia?
Small for gestational age(weight <10th percentile), large for gestational age (weight >90 percentile, hyper insulin), infant of diabetic client, premature (<37 weeks, have decreased glycogen stores), stressed/sick/cold (use their glucose more).
S+S of hypoglycemia and treatment?
S+S: tremors, apathy, cyanosis, convulsions, apnea spells/tachypnea, weak/high pitch cry, lethargy, difficulty feeding, eye rolling, sweat/sudden pallor/cardiac arrest (less common)
Asymptomatic- feeding interventions (increase frequency of BF, supplement with extra breast milk or formula)
Symptomatic or <2 mmol/L- IV infusion of glucose, want to get levels >2.6mmol/L
What is Vitamin K and why is it given?
Given b/c newborns lack intestinal bacterial flora need for Vitamin K production, so it’s given as a booster dose. 1 mg IM within 6 hrs of birth in thigh given. Given to prevent hemorrhagic disease of the newborn
What is erythromycin ointment and why is it given?
Given because there may be bacteria in the birth canal (chlamydia or gonnorhea) that causes ophthalmia neonatorum, so it can prevent this. Give within 1 hr of birth and apply to eyes while open (inner to outer canthus)
When to take VS for newborn?
Q1hx4, q4hx24-48 hrs, and then BID
Cord care?
The cord is clamped/cut at delivery. The remaining stub will have a plastic clamp on it left to air dry. We need to clean cord area/make sure it’s dry under the stub. When it dries, it should fall off within 5-15 days (looks like beef jerky, no smell, no exudate)
Measuring/weighing newborn?
Weigh them within an 1hr and prior to D/C if everything is stable. Weigh OD if they’re <2500g or >10% drop in birth weight (normally after birth they loose weight, but not more than 10%). Birth weight will depend on the gestational age
Bilirubin screen?
Do it around 24 hrs and perform transcutaneous bilirubin first because its less invasive (place machine on skin) then serum bilirubin if its high or low
Intake and output?
Monitor their amount of wet diapers, dirty diapers, and how much they BF/formula
Overall physical assessment?
Colour (pink, acrocyanosis, pale, jaudice), skin (dry, anomalies), tone (flexed, limp-bad, free movement, limbs # of digits, palm creases- should have multiple, one means maybe down syndrome), cord (clamped, moist, dry), fontanelles (flat, soft, sunken/bulging- abnormal, sutures overlapping or gaping)
