normal newborn

Question 1

Neonatal Period

Answer 1

From birth to 28 days.
AFTER 38-42 weeks of gestation

for normal newborn

Question 2

Weight

Answer 2

⚫Between 2500 to 4100 grams.
⚫Between 5.5 – 9 Lbs.

Question 3

Head

Answer 3

⚫Between 32-36 cm or 12.5-14 inches

Question 4

Chest

Answer 4

⚫Usually measures 2cm less than head circumference ⚫Between 12-13 inches or 30.5-33 cm
Length
⚫Between 46 – 52 cm or 18-20.5 inches

Question 5

Respiratory System

Answer 5

Infants must obtain oxygen from the environment

Question 6

What causes neonates to take their first breath?

Answer 6

Mechanical

Question 7

Mechanical

Answer 7

⚫Birth process increases thoracic pressure
, fluid pushed out and recoil of chest wall after birth and increases intrathoracic pressure 🡪 passive inspiration of air

Question 8

Chemical

Answer 8

⚫↑ PCO2, ↓ pH and ↓ O2 🡪 chemoreceptors send message to respiratory center in medulla 🡪 diaphragm contracts 🡪 baby breathes

Question 9

Thermal and Sensory
⚫

Answer 9

Thermal – decrease in environmental temperature can stimulate baby to breathe

Question 10

◦Tactile =

Answer 10

Tactile= rubbing the cloth on the baby to clean

Question 11

Circulation

Answer 11

Significant changes occur from fetal circulation 🡪 neonate
Fetus: O2 from mom via umbilical vein

Question 12

⚫Fetal Circulation: (3)

Answer 12

◦Ductus Venous
◦Foramen Ovale
◦Ductus Arteriosus

Question 13

Foramen Ovale

Answer 13

the blood bypasses the pulmonary artery. goes to the left atrium. bc blood doesn’t need to be oxygenated

closes as first breath taken and the pressure in the left atrium exceeds the pressure in the right atrium.

Question 14

Ductus arteriosus

Answer 14

closes as pO2=50 and as a response to decrease in prostaglandin (within 1-2 days after birth; serious problems if doesn’t close)

Question 15

Ductus venosus

.

veins do what…

Answer 15

closes as placenta is delivered.delivers blood to the inferior vena cava

Question 16

Birth weight

Answer 16

A newborn is expected to lose some weight during the first five to seven days of life.
◦5 – 10% weight loss is normal in the first week
◦ Sometime between days 10 and 14 after birth, the infant will return to birth weight.

Question 17

Nutrition/Hydration

Answer 17

The newborn takes in and excretes approximately 600-700 ml of fluids per day.
* The mucous membranes of the mouth is moist and pink; the hard and soft palates are intact.
* The infant is unable to move food from the lips to the pharynx; therefore, placing the nipple well inside the baby’s mouth is necessary.

Question 18

infant stomach capacity

Answer 18

30-90 ml

Question 19

Transitional
Milk stool
Bottle vs Breast

Answer 19

24-48 hrs

Question 20

Thermal Instability d/t:
A. Decreased threshold for temperature variations:
Cold:

Answer 20

Immature heat-generating abilities

Do not shiver ( cant move put hands in pocket) cant sweat

Do not have muscle movement

Question 21

Non-shivering thermogenesis

Answer 21

◦ 1st –Brown fat
&
◦ secondarily through
increased metabolic activity
of brain, heart, and liver

Question 21

Brown Fat

Answer 21

⚫Provides: Non-shivering thermogenesis
◦Brown Adipose Tissue (BAT)
◦Easily metabolized
◦Lasts several weeks
◦Depleted rapidly with cold
stress
◦Lower in premature
infants

Question 22

Infants have Sweat Gland Mechanisms …. T or F

Answer 22

they are present but not functioning

Question 23

fetal position helps to conserve

Answer 23

heat

Question 24

At risk for-- Cold Stress ⚫Quickly depletes ⚫Reponses by neonate: ◦O2 requirements rise =↑ RR (can cause reopening of ( DA) ⚫Reponses by neonate: ◦O2 requirements rise =↑ RR (can cause reopening of DA) ◦Increased use of glucose—for heat maintenance and not for growth ◦Increased BMR -

Answer 24

⚫Quickly depletes brown fat ⚫Reponses by neonate: ◦O2 requirements rise =↑ RR (can cause reopening of ( DA) ⚫Reponses by neonate: ◦O2 requirements rise =↑ RR (can cause reopening of DA) ◦Increased use of glucose—for heat maintenance and not for growth ◦Increased BMR - can lead to metabolic acidosis and ↑ bilirubin levels

Question 25

Nursing Interventions for Cold Stress

Answer 25

⚫Assess respiratory status ⚫Warm newborns slowly– ◦double wrap and cap or ◦Skin to skin contact ⚫Monitor temp q 30min (axillary) ⚫Place under warmer ⚫Check blood glucose ⚫At home – dress as parents dress

Question 26

site for temp

Answer 26

axillary

Question 27

The Golden HourFirst breath

Answer 27

At 1 hour: Vit K (clotting), eye ointment (protect from blindness) , Hep B (optional)

Question 28

The Golden Hour Hat on baby WHY?

Answer 28

1. heat-evaporation 2) Inc heat – radiation 3) Conduction 4) Hypothermia can occur quickly 5) Poor thermoregulation

Question 29

The Golden Hour Hat on baby

Answer 29

1) Dry infant immediately after birth 2) Place under radiant warmer 3) Use warmed items – blankets, etc 4) Assess temp q1h x 4 5) Keep infant capped and wrapped

Question 30

TEMPERATURE: At birth: (° F ) Within 12 hrs: (F) PULSE At birth: Within 12 hours:

Answer 30

TEMPERATURE: At birth: ⚫97.7-99° F / 36.5-37.2° C Within 12 hrs: ⚫97.6° – 98.6° F ⚫36.5°– 37° C ⚫PULSE ⚫PULSE At birth: ⚫110 – 160 Listen for a full minute Murmurs are common – usually gone by 6 months Apical pulse over 4th intercostal space

Question 31

Respirations At birth: ◦Short apnea - ✔Suction ✔Respirations may be irregular ✔Any apnea greater than _____- report ✔ S/S of respiratory distress: After 12 hours:

Answer 31

Respirations At birth: ⚫30 – 60 ◦ irregular ◦ occasional crackles ◦Short apnea - < 15 sec (OWLET) ✔Suction mouth, then nose – newborn gasp ✔Respirations may be irregular ✔Any apnea greater than 20 seconds - report ✔Important that you remember these S/S of respiratory distress: nasal flaring, grunting, intercostal retractions, and a RR> 60. ✔ After 12 hours: ⚫30 – 60 ◦ irregular ◦no crackles

Question 32

WBC & RBC At birth: | average, at birth, after

Answer 32

9000 – 30,000 Average = 20,000 Changes to: 23,000 to 24,000 first day after birth' Decreases to 11,500 At birth: 4 -6.6 million/mm Changes to: 4 million /mm in 2 – 5 days Unnecessary cells begin to

Question 33

HGB HCT At birth: ⚫ Changes to: ⚫ At birth the infant’s blood contains about _______fetal hemoglobin, in order to carry enough O2 for cells to function during labor. At birth: ⚫ Changes to: ⚫

Answer 33

HGB HCT At birth: ⚫15 – 19 Gm Changes to: ⚫12 – 15 GM at one month At birth the infant’s blood contains about 80% fetal hemoglobin, in order to carry enough O2 for cells to function during labor. At birth: ⚫44 – 64% Changes to: ⚫35 – 49%

Question 34

Bilirubin***** Bilirubin is a = At birth: ⚫ Changes to: ⚫Day 0 – 1 = ⚫Day 1 – 2= ⚫Day 2 – 5 =

Answer 34

yellow pigment derived from the hemoglobin released with the breakdown of RBC’s . Extra RBC’s break down causing jaundice. At birth: ⚫< 2 mg/dl Changes to: 2 2 ⚫Day 0 – 1 =< 6 mg ⚫Day 1 – 2=< 8 ⚫Day 2 – 5 =< 12 Extra RBC’s break down causing jaundice. (more later)

Question 35

Glucose At birth: ⚫ ______mg/dl ⚫Avg ______ ⚫Avg= ________ rapidly when Mom’s blood supply stopped ⚫ After 12 hours: ⚫ Essential to keep glucose level _____for neurological functioning ⚫

Answer 35

Glucose At birth: ⚫30 – 60 mg/dl ⚫Avg 40-50 mg/dl ⚫Avg 40-50 mg/dl Drops rapidly when Mom’s blood supply stopped ⚫ After 12 hours: ⚫50 – 70 mg/dl Essential to keep glucose level ↑ for neurological functioning ⚫

Question 36

First Period of Reactivity ⚫Neonatal characteristics: ⚫NURSING INTERVENTIONS

Answer 36

First 30-40 minutes after birth ⚫Neonatal characteristics: alert, hungry, increased RR, mucous, crackles in lungs ⚫NURSING INTERVENTIONS ◦Watch Respirations ◦Keep warm and Dry ◦Breast feed (Bottle feed) ◦Bonding with Mom and Dad ASAP

Question 37

First Period of Sleep / Inactivity ⚫Neonatal Characteristics: ⚫NURSING INTERVENTIONS

Answer 37

First Period of Sleep / Inactivity ⚫30-40 post birth to next 2-4 hours ⚫Neonatal Characteristics: deep sleep, HR, RR and temp decrease ⚫NURSING INTERVENTIONS ◦Skin to skin ◦Radiant warmer to stabilize temp ◦Allow to rest

Question 38

Second Period of Reactivity Neonatal characteristics: awake, NURSING INTERVENTIONS

Answer 38

Second Period of Reactivity Time when baby is stable Neonatal characteristics: awake, hungry, crying, alert to surroundings, gaggy NURSING INTERVENTIONS ◦ Bonding with Mom and Dad ◦ Feed – especially breast feed ◦ Maintain patent airway ◦ Maintain Neutral Thermal Environment

Question 39

active alert

Answer 39

crying

Question 40

APGAR ⚫

Answer 40

⚫Appearance ⚫Pulse ⚫Grimace ⚫Attitude (activity) ⚫Respiration Rapid assessment of the need for resuscitation based on five signs that indicate the physiologic state of the newborn

Question 41

APGAR Scoring ⚫0-3 – ⚫4-6 – ⚫7-10 – Evaluations are made at

Answer 41

APGAR Scoring ⚫0-3 –needs aggressive measures ⚫ ⚫4-6 – needs prompt interventions ⚫7-10 – indicative of good adjustment to extrauterine life 1 and 5 minutes after birth

Question 42

Establish Ventilation and Circulation Action Rationale | first steps once doctor pulls baby out

Answer 42

1) Suction oral cavity 1st ⚫ 2) Suction nasal cavity gently 3) APGAR score at 1 min. 4) Blow by oxygen prn

Question 43

Assess Nutritional Status Diabetic Mom, LGA, SGA, post-dates, pre-term (per protocol) Action

Answer 43

1)Heel stick - At birth and 4 hrs later 2) Early feeding 3) Glucose water prn NEVER 4) Maintain temp

Question 44

Rationale for nutritional status | think about paul blart

Answer 44

1, 2, 3) Glucose levels fall rapidly after birth d/t drop in maternal blood supply. Brain, heart, lungs, liver are dependant on glucose for cell function. Decrease affects LOC, RR, hypothalamus function 4) Hypothermia increases glucose need

Question 45

Ensure Safety and Identification of Infant Action Rationale

Answer 45

1) Name band on baby 2) Baby’s name band on Mom and Dad 3) Compare names and numbers each baby transfer (on unit) 4) Sensor on baby – ankle or umbilicus

Question 46

Encourage Bonding

Answer 46

Action: 1) Baby to Mom ASAP when stable 2) Dad/SO to attend birth when possible 3) Cluster care to decrease interruptions 4) Include all family in teaching 5) Help Mom with personal care and baby care until confident

Question 47

Health teaching for parents- ⚫BATHING – ⚫Gentle ⚫CORD CARE –

Answer 47

⚫BATHING – no tub bath until cord falls off ⚫Gentle wiping of eyes inner to outer canthus ⚫CORD CARE – nothing needed – will dry / deteriorate by self. May get sticky after few days –leave it alone. Fall off ~ 1 week – 10 days ◦Call pediatrician if bloody, redness, pus. diaper underneath belly

Question 48

Circumcision Care

Answer 48

Circumcision Care MAKE SURE THEY VOID FIRST ⚫Depends on device used for circumcision ⚫Monitor for 1st void prior to circ ⚫Tylenol prn ⚫Assess bleeding – Q 15 mins for 1 hour, then Q 2-3 hours/ hosp policy ⚫NO soap or packaged wipes ⚫Glans penis *Normally red during healing

Question 49

Temperature Regulation ⚫TEMPERATURE REGULATION –

Answer 49

Temperature Regulation ⚫TEMPERATURE REGULATION –watch in first 24 hrs especially for signs of COLD STRESS

Question 50

Diapering ◦ Voiding –

Answer 50

6-8 wet diapers/day indicate/ adequate fluid intake; diaper counts.

Question 51

◦ Stools – meconium =  Breastfed:  Bottle Fed:

Answer 51

◦ Stools – meconium -1st 24 hrs  Breastfed: Yellow/seedy/ pasty  Bottle Fed: Greenish/firm

Question 52

Safety - ⚫Asepsis –

Answer 52

Safety - ⚫Asepsis – ◦Erythromycin eye ointment ◦Vitamin K - Phytonadione ◦Cover gown ◦Hand washing ●Scrub before entering nursery ●Parents and visitors before ALL baby contact (home too)

Question 53

Physiologic Needs / Safety

Answer 53

⚫All of the following before D/C ⚫“Back to Sleep”/SIDS = can sleep on their backs, not loose bedding ⚫Car Seat/police & fire station ⚫Shaken Baby Info.

Question 54

Feeding HT parents-schedules; burping… Nutritional Needs ⚫ Newborns eat

Answer 54

Feeding HT parents-schedules; burping G ( MORE IN BOTTLE FEED BC THEY HAVE MORE AIR) Nutritional Needs ⚫ Caloric requirements ⚫ Basal Fluid Requirements of Infant ⚫ Infant Stomach Capacity ⚫ Nutrient Requirement ⚫ Infant Stomach Capacity ⚫ Nutrient Requirement ⚫ Newborns eat q 2-4hrs ATC 2

Question 55

NYS Newborn Screening Screen for approximately

Answer 55

disorders including PKU, CF, Sickle Cell Anemia * Hearing

Question 56

Infant states of consciousness 1. —Deep sleep — 2.Light sleep —3. Drowsy —4. Quiet alert —5. Active alert —6. Crying

Answer 56

Infant states of consciousness Deep sleep= no body movement Light sleep = easily startled — Drowsy= eyes open and close Quiet alert= neonate eyes are open with a bright look —Active alert = fusiness —Crying= crying

Question 57

Day one (stomach eating) Day three One week One month

Question 58

5 s’s

Answer 58

1. swaddle/football hold/ swing/"shhhhh' them= fluid when they was in the womb/pacifier 2. 3. 4. 5.

Question 59

Normal Newborn

Answer 59

* Protruding belly * + Bowel sounds * * 1st nose breathers then Diaphragmatic breathing

Question 60

Chemical Norms vs newborn PO2 PCO2 Ph

Answer 60

20-30. / norm is 50-70 45-50./ norm is 35-45 7.25/ norm 7.35

Question 61

murmur may be heard T or F

Answer 61

especially in the first 24 hrs as shunt are closing. T or F

Question 62

stork bite

Answer 62

hemangiomas

Question 63

cyanosis of hands and feet are normal findings, T or F

Answer 63

T

Question 64

slate gray patches

Question 65

eye prophylaxis

Answer 65

Eye drops or ointment containing an antibiotic medication are placed in a newborn's eyes after birth

Question 66

epstein pearls

Question 67

"briick dust"