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FINAL - Neonatal Care
Terms in this set (80)
Neonates lungs go from fluid-filled to air-filled; passage through the birth canal helps eliminate ____. Surfacant lowers the pressure needed to keep alveoli open.
Persistent _____ leads to constriction of the pulmonary arteries in neonates.
Signs of resp distress:
retractions (intercostal), grunting, nasal flaring, "humming" sound.
______ physiologic adaptations occurs within seconds of the clamping of the cord. Foraman ovale (b/w right and left atrium) closes.
The ____ ____ connects the pulmonary artery and descending aorta--closes within 15 hours. Vessels that are no longer needed become ligaments.
GI physiological adaptations:
Feeding: coordination of suck, swallow, breath (36-37 weeks)
development of mucosal barrier
Digestion: enzymes minimal, breastmilk is easiest to breakdown
Stools: meconium passed by 24 hours
Newborns stomach is the size of a ___ and holds about 7ml.
Newborns lose about ____% of birth weight by 3-4 days of life and regain by 10-14 days. Babies lose water weight, especially with moms who had a lot of fluid. Breastfed babies lose more weight then bottlefed.
Most babies void immed after birth
6-8 voids/day is typical
Immediate care of a newborn:
-Bulb suction (mouth before nose)-if they don't cry, or for meconium aspiration
dry and remove wet blankets
-skin to skin
-cut and clamp cord
-APGAR at 1 and 5 mins
-Promote early breastfeeding
Bring baby to mom, wait until cord stops pulsating (~2 mins) before you cut it. Helps prevent ______.
The first hour of life is known as the "___ ___" -- uninterrupted contact between mother and baby.
1 and 5 minutes
Grimace (reflex irritability)
Activity (muscle tone)
Respiratory (resp effort)
Score 0, 1, 2 for each based on assessment findings, >8 is appropriate transitioning
____ tells status of how baby is transitioning to life outside uterus. <7 at 5 mins=baby is probably going to NICU to be watched better. Mom and baby must keep band on the whole time they're in NICU!
_____ is often seen in healthy newborns and refers to the peripheral cyanosis around the mouth and the extremities (hands and feet)
Nursing Interventions for Newborn:
Proper ID-4 bracelets, 2 on baby
General assessment and physical exam
General newborn care/parental education
____ is the process of maintaining balance between heat loss and heat production.
Infants are predisposed to heat loss because:
they're born wet, have a large body surface (in relation to how small they are), decreased body fat, thin skin, blood vessels are closer to skin, inability to shiver.
When you sweat or when your skin or clothing gets wet, the evaporation of that liquid (i.e., the change from liquid to vapour form) promotes heat loss, and the natural result is a cooling effect. ____ is the process of air or water flowing by the skin and carrying away body heat.
____ is the transfer of heat from 1 surface to another--cold scale, skin to skin.
____ is loss to cooler surfaces new the body--don't put baby near cold walls.
The risk of ___ ___ is greatest during the immediate transitional period after delivery and is caused by the preterm newborn's immature skin, the high ratio of surface area to birth weight, and the environmental conditions in the delivery room (large temperature gradients between the newborn's body temperature and the ambient temperature of delivery room, air flow through the room, and contact with cold surfaces that lead to significant evaporative, radiant, convective, and conductive heat losses).
Ways to decrease likelihood of cold stress:
swaddle baby, cover head, skin to skin, warmed blankets, mattress, DONT give bath right away.
Baths should be above _____ degrees
Your newborn baby will only really need a bath______ times a week — at first a sponge bath, until his umbilical cord stump heals (about one to four weeks after birth), then a baby tub bath, and eventually a tub bath, when baby can sit up on his own and outgrows the infant tub).
General Assessment includes:
Gestational age assessment
low 100s are okay, usually just means they're over dressed.
lower when sleeping, higher when crying
irregular, short periods of apnea (less then 5 seconds)
Blood pressure rises as the baby grows. The average blood pressure in a newborn is ____. The average blood pressure in a child 1 month through 2 years old is 95/58. It is normal for these numbers to vary.
2500-4000 grams (8.8 lbs)
Preterm/Premature is before ___ weeks
Post term or post dates are:
past 42 weeks
Gestational Age Assessment includes:
stage of maturity
Ways to assess age if you don't know:
Lanugo skin (preterm has lanugo), preterm babies have a lot of vernix, creases on hands and feet. post or term babies-skin will be dry or cracked.
Average size of baby is ___ pounds
Size of baby is broken down into:
Babies who are small for gestational age (SGA) are less then the ___ percentile. Babies who are LGA are greater then ___ percentile--GDM or obese mom
Risk factors for having a SGA infant:
IUGR (can lead to failure to thrive), smoking, HTN, age extremes, lack of prenatal care, placenta abnormalities.
Newborn Physical Exam:
Vernix caseosa-thick, white covering
Acrocyanosis-hands and feet
Mongolion spots- blue/purple spot, nonwhite kids, can last 4 years
Stork bites- red patches on face, eyelids, upper lip, go away in 1 year
Erythema toxicum-newborn rash, blotchy red skin, goes away in 2 weeks.
Anterior fontanelle closes in _____ and posterior closes in ____ weeks. Can use to assess hydration status. Anterior stays open to allow for brain growth.
18 months-2 years
Assessment of newborns head can include:
molding-elongated head, goes away 1 week
____ ____ is localized edema/swelling on scalp-fluid.. caused by pressure from birth process, usually even on both sides. Goes away without treatment in a few days.
_____ is blood, 1 sided usually, feels more firm. Can last for weeks-months.
Chest circumference is measured during physical exam, some other common findings are:
breast buds, discharge (from maternal hormones)
premature babies nipples can be flat and inverted
Abdomen assessment consists of: bowel sounds, umbilical cord-->(AVA)--2 arteries, 1 vein. Common questions:
Is ab soft? Distended?
Assessment of genitalia:
meatus, testes, pseudomenses (decrease in hormones)
males: hypospadias, feel testicles in scrotum (little peas), preterm can be up in groin, scrotum is usually large.
girls: large labia majora, edemidus, whitish d/c--don't wipe
Nueromuscular-alertness, posture, tone (are they awake? lethargic? irritable? hypotonic, normal hypertonic?
Newborn Reflexes to assess:
Rooting-turn toward side you stroke
Grasp-palmar and plantar
Babinksi-stroke bottom of foot, toes flare out
Stepping-put baby and place foot on surface
Tonic neck-"fencing" turn head to 1 side, 1 arm up, 1 down
Hypoglycemia is less than ____.
Risk factors for hypoglycemia:
diabetic mom, IUGR, sepsis, stressed baby, hypothermia, preterm baby
Assessment of hypoglycemia:
may be asymptomatic--
if not: poor feed, jittery, lethargic or hypothermic possible
Interventions for _____: offer feeding immediately, follow up monitoring per protocol (may check prior to feeding).
For babies that can't maintain a high enough sugar, the nurse will hang ____
Meds for newborn:
Phytonadione (vitamin K)-IM
Hep B immunoglobulin-baby whos mom is hep B positive
____ promotes blood clotting because ____ is made in GI tract and baby hasn't made it yet. Takes about ~1 week to make. If mom refuses ___ for baby, they CANNOT be circumcised.
vitamin K (phytonadione)
____ is used to prevent gonorrhea infections of eye in newborn, as well as conjunctivitis. Delay until after initial feed, baby needs to locate nipple and they can't see if eyes are blurry.
erythro ophthalmic ointment
Screening tests for newborns include:
IEM/PKU-blood tests to screen for metabolic diseases
CCHD-pulse ox on R hand and either foor to screen for undiagnosed cardiac issues 95 or >
___ is Newborn screening is a preventive health measure to detect and treat disorders that can result in early mortality or lifelong disability.
IEM-inborn errors of metabolism
The blood sample for ____ screening should be obtained at least 12 hours after the infant's birth. Newborn screening for ___ has largely eliminated mental retardation caused by this disease. If the first phenylalanine test demonstrates positive results, a repeat test should be performed
____ is a type of amino acid metabolism disorder. It is inherited. If you have it, your body can't process part of a protein called phenylalanine (Phe). Phe is in almost all foods. If your Phe level gets too high, it can damage your brain and cause severe intellectual disability
Pulse oximetry newborn screening is a non-invasive test that measures how much oxygen is in the blood and can help to identify babies that may be affected with ____ before they leave the newborn nursery. Have to wait 24 hrs until ductus arteriosus is closed.
CCHD-critical congenital heart disease
Patent ____ is an extra blood vessel found in babies before birth and just after birth. In most babies who have an otherwise normal heart, the PDA will shrink and close on its own in the first few days of life. If it stays open longer, it may cause extra blood to flow to the lungs
ductus arteriosus (PDA)
Hearing screening is done at hospital. If detection occurs before __ months of age it improves outcomes. If baby does not pass, refer to audiologist. C/S babies-wait 24 hours.
Parental Education (of newborns):
SAFETY-SIDs prevention (safe sleep, same room as mom for 1 year, no 2nd or 3rd hand smoke)
Car seat safety- rear facing until 2 and weigh min of 20 lbs-30
Infection prevention-wash hands, immunizations
Bathing should be done no more then ___ ___ ___. test water temp, and have another person with you.
every other day
With ____, baby inevitably suffocates--if baby is re-breathing CO2 they will stop breathing because they lose the drive to breath.
The umbilical cord will fall off in ___ weeks--keep dry.
____ is the surgical removal of the foreskin. Decreased risk of UTIs, penile cancer, and some STIs (including HIV). Mainly geared from parental preference, religion, or culture.
PO ____ Vaseline gauze is applied. MUST provide pain relief. Check for bleeding Q30 for first 2 hours. Must document void.
Education for parents following circumcision:
Vaseline gauze, keep diaper loose, wash with soap and water until heald, don't wipe off exudate. Look for s/s of infection: odorous, bleeding, d/c
It is important following a ____ to provide comfort measures.
Education following circumcision:
apply Vaseline with every diaper change
keep diaper loose to prevent friction
if bleeding occurs--apply light pressure but call MD if not stopped quickly
Granulation tissue will form during healing
Call for swelling, draining, fever, and NOT urination
Pharm management of neonatal pain:
penile nerve block with lido
___ ___ contains two active substances called lidocaine and prilocaine. These belong to a group of medicines called local anaesthetics.___ ___ works by numbing the surface of the skin for a short time. Takes 60 mins to work. Lasts 2-3 hours.
Non pharm management of neonatal pain:
swaddling, non-nutritive sucking, sucrose, skin to skin
The normal HR of a newborn is OVER ____, if the pulse is less hen 100 BPM, you should begin ventilating baby artificially.
Check the babies temp several times during the first few hours of life, normal temp axillary is:
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