birth to first 28 days of life
_____ Hx is an important part of newborn assessment.
if mom is diabetic, STDs
Physical exam of infant why important?
important b/c one time will get good head to toe physical: ID any probs
When may phys assessment findings be overlooked in newborn?
done before bath may miss something and find after bath
Important components of newborn phys assessment? (4)
- 1. maternal Hx
- 2. phys exam
- 3. interaction & assessment of bonding
- 4. analysis of blood type, Hct, and HgB
Why is interaction and assessment of bonding important?
studies show more likely to be abused if no bonding in hospital
What blood type is important in infants?
Rh and ABO incompatibilities
What can cause newborn to be anemic?
if mom is anemic
take care of the baby well to be a good example
change often role model loving behavior
bathing baby teaching
What is an intervention to help mother bond with baby and be good parent?
allow for rest, sleep when the baby sleeps and get some help from family etc
No rest for mom - risk for?
PP depression and bad parenting
Why do we need to encourage well baby visits?
Head circumference of newborn?
Lenght of newborn
chest circumference of newborn?
Weight of newborn?
5.8lbs to 8lb& 13 oz (2500-4000 g)
RR rate of newborn?
Temp of newborn?
97.7 - 99.1 axillary
Measurement and V/S done on newborn?
- 1. head & chest circumference
- 2. length & weight
- 3. HR
- 4. RR
- 5. axillary temp
What can occur if do rectal temp on newborn?
may not have patent butt - tissue trauma
Head circumference how measure?
What does it mean if head circumference goes up in first 2 days after birth?
measure around largest part
may not be a prob. could be molding
Molding of baby head?
sutures overlap and make head look thin and skinny - day 1 or 2 will get round again and will have a higher head circumference
When do they close?
anterior - 12 - 18 mo
post - 2 to 3 mo
What may they do?
head is made of 5 ind plates - sutures are where bones meet
sutures may overlap - will be normal in 2 days
Wide open suture line indication?
1. could be ICP
2. could be subdural hematoma
2 babies at high risk for subdural hematoma?
Indication of this?
- 1. preemies
- 2. babies with traumtic births
6 components of a head assessments?
- 1. fontanelles
- 2. sutures
- 3. molding
- 4. caput succedaeum
- 5. cephalhematoma
- 6. craniotabes
swelling that is a build up of fluid accumulation b/t bone and skin of the skull that occurs due to pressure against the pelvis of the mother
occurs over the head like a cap and crosses suture lines
bleeding b/t the bony plate & periosteum that does not cross suture lines
When will caput succedaeum resolve/
edema will go away in 1 to 2 days
Cephalhematoma resolves when?
can take weeks
softening of the bone that may be due to lack of Ca in mother's diet
Important consideration with craniotabes?
must be very careful with baby's head until the bone hardens
scary for parents
2 char of a normal fontanel?
soft and flat
What does bulging fontanel indicate?
1. increased ICP & ass. with hydrocephalus
3 ways to describe skull sutures?
What causes molding?
posterior head elongates to fit through mothers cervix and pelvic contours - cone head baby
When will molding resolve?
in a few days
When do caput succedaeum and cephalhematoma occur and resolve?
caput - appears at birth and resolves in a few days
cephalhematoma appears in 24 h and takes months to resolve
What is included in EENT assesment of newborn?
- 1. eyes,
- 2. ears
- 3. nose
- 4. mouth
- 5 neck/clavicles
Common observation in sclera of baby eyes?
conjunctival hemorrhage due to excessive pressure on eyes as coming through the birth canal
When do conjunctival hemorrhages resolve?
3 to 6 weeks
Tear ducts of newborn?
usually don't have them until 3 to 4 mo old b/c lacrimal duct not working yet
Baby eye color?
When true eye color?
will have grey - brown eyes
will not get true eye color until 3 to 12 mo old
Blue sclear indication?
Edema around eyes and eylids in newborn?
can occur normally esp if a lot of trauma
What may be cause of baby eyes red and swollen?
can be caused by ERY eye ung
Cornea that appears larger than usual indication?
can be congenital glaucoma
White pupil in newborn indicatuion?
What does white light reflex indicate?
Slanted eyes indication?
Asian or down syndrome
Strabismus in newborn?
Doll's eye in newborn?
normal in newborn
Cont. drainage watery clear from eye?
can be occluded lacrimal duct and will need Tx
Ears of newborn char?
not fully dev
look normal but really soft
should be even with outer canthus of eye
Low-set ears indication?
possibly down syndrome
look at mom and dad to see if genetic
Where are skin tags usually?
What may the indicate?
usually in area in front of ear
can be clipped off or tied off
can indicate chromosomal abnormalities or kidney probs
Where will a preauricular sinus be located?
in front of the ears
not a prob but parents will notice and ask about it
Hearing tests for newborn babies?
required for all newborns in every state
Way nurse can test newborn hearing?
baby will usually cease crying to listen for sounds
Babies are ____ breathers.
nose - cannot breathe through their mouth
Intervention for congestion/birth fluids in baby?
suction mouth then the nose
one side of nose has no opening
watch for congestion in open side
Way to test baby for conal atresia?
hold the side that is open closed and see if baby can breathe
Normal/good char. of mouth on assessment?
- 1. open easily
- 2. sucking reflex
- 3. frenula membrane may be intact (tongue tied) can correct itself
- 4. check palate
Frunula membrane considerations?
Teach parents that it should correct itself and if it doesn't will need to be clipped
Little white dots on the gumline of the baby?
Epstein pearls - inclusion cysts
How to test for it?
wipe white spot with rag and if it doesn't come off it is yeast
Tx for thrush?
- 1. gentian violet
- 2. griseofulvin
Consideration of gentian violet?
stains everything purple
Is this a problem?
baby born with teeth
usually not a prob unless they are loose - ped will pull them
Nursing consideration for natal teeth?
check for loose teeth
Assessment of neck and clavicles?
- 1. short chubby neck with skin folds
- 2. check for fractured clavicle
- 3. check for Herb's palsy
How to assess for fractured clavicle?
- 1. one arm will be just hanging and other moving around
- 2. may feel crepitus
paralysis of should and arm muscle due to permenant nerve injury during birth
If mother water has been broken more than 24 hours what is baby at risk for?
S/S that it has developed?
if you move/turn baby will let out horrific squeal b/c painful neck
Gonorrhea consideration in newborn?
can cause eye infection and blindness
Redness in inner canthus of one eye but not other can indicate?
lacrimal duct obstruction
Indication of osteogenesis imperfecta in newborn?
Indication of retinoblastoma in newborn?
white light test - pupil
If baby's ear doesn't look normally developed what can this indicate?
congenital problem - chromosomal
Indication of cataracts in newborn?
neck injury during birth that causes shoulders to be offset (one lower)
Head is larger than chest until about ___ years old.
2 years old
head is heaviest part and if get off balance will fall on their head/fall into things that they are looking into like buckets of water
Breasts of newborn?
may be slightly enlarged due to maternal hormones
may have leakage of milk called witches milk
Abd of newborn?
should be round and soft
Sunken abd indication in newborn?
may have no intestines
When should bowel sounds show up in newborn?
about an hour after birth
When may a bath be given to a baby?
Teaching about umbilical cord?
anytime after birth
do not use alcohol on umb and it can be submerged
when cord falls off need to cont to clean area for a few days
Anal/genital of baby boy char?
more mature they are = more rugae on testicles
testicles should be down
2 probs that may occur in newborn testicles?
- 1. may be inguinal canal and not come down
- 2. may be born with no testicles
Consideration if baby has testicles that are not down at birth?
at risk for testicular cancer later in life
If testicles are not down could indicate _____.
What is it?
cryptorchidism - absence of testicles
Urethral opening on dorsal side?
fluid accumulation in scrotal sack around testicles
Way to distinguish b/t hydrocele and hernia?
if have large testicle shine light through it
hydrocele with transilluminate/light up
hernia will not transilluminate
Penis length at term?
cottage cheesy stuff around head of penis esp in males that are uncircumcised
Should foreskin be retracted?
consideration if it is?
put it back or can cause ischemia
Name for foreskin
Epispadius/hypospadius in females?
have a small penis inside vagina with meatus way inside the vagina
surgical removal of foreskin of the penis
Jewish religious requirement for circumcision?
on 8th day of life
When is circumcision contraindicated?
- 1. if have epi or hypospadius
- 2. Hx of bleeding tendency in family
Complications of circumcision?
- 1. bleeding
- 2. infection
- 3. skin dehiscence
- 4. adhesions
- 5. urethral fistula
- 6. pain
How much bleeding is considered hemorrhage for newborn?
Assessments for infection of circumcision?
- 1. redness
- 2. discharge
- 3. odor
- 4. urethra fistula
- 5. pain
Pain management for circumcision?
- 1. DPNB/ring block
- 2. topical anesthetic
- 3. sucrose pacifiers
inject local anesthetic around penile nerve
Topical anesthetic for circumcision?
takes 60-90 minutes to take effect
Sucrose pacifiers for circumcision pain?
EBP shows that sucrose on passy helps with pain management as well as injections
3 different types of instruments used for circumcisions?
- 1. mogen clamp
- 2. gomco/yellen clamp
- 3. plastibell clamp
plastic ring that fits over penis
suture tied around rim of the bell and a circle of prepuce is cut away so the foreskin can be easily retracted and glans exposed
rim remains in place for one week then falls off on its own
Post circumcision nursing care?
- 1. wash site daily, with each soiled diaper with warm water
- 2. apply vaseline if not plastibell
- 3. assess for urine output
- 4. cuddle, paci, console, observe for overstimulation
- 5. parent teaching
- 6. if see edema, drainage, redness, tenderness or inconsolable crying report to health care provider
- 7. apply diaper snug enough to prevent rubbing with movement but not tight encough to cause pain
Nursing consideration if had mogen clamp or gomco clamp?
always use vaseline on incision area with q diaper change
Important nursing consideration with plastybell circumcision?
do not use vaseline - can cause ring to fall off and cause permenant damage
Normal and abnormal assessment findings in circumcision?
- 1. site may be red but should not have strong odor or discharge
- 2. site should not have active bleeding
- 3. a film of yellowish mucus is normal and should not be washed off
Nursing intervention if bleeding of circumcision occurs?
apply pressure and reassess - if still bleeding call physician
When is it OK to use vaseline with plastybell?
after ring comes off
Important consideration after circumcision?
baby should urinate within 6 to 8 h of circumcision
Env for baby in pain?
don't over stimulate
Teaching for parents with circumcision?
teach s/s of infection and when to call the MD
Normal/abnormal bleeding of circumcision?
normal to have a little spotting but not active bleeding
Yellowish exudate around circumcision area?
part of healing process and should not remove
When should parent call MD with plastibell?
if not off w/in 8 days
Female genitalia assessment?
- 1. labia majora and minora cover clitoris?
- 2. hymenal skin tags
- 3. white mucoid discharge
- 4. pseudomenstruation
- 5. rectovaginal fistula
If a female is full term what will vagina look like?
labia major and minora will cover clitoris
preterm will have small labia major and minora
Hymenal skin tags?
skin tag that occurs around hymen of vag that is normal
What is indicated by white vag discharge in baby girl?
normal - due to mom hormones
baby girl will have false period r/t mom's hormones
baby has actually cycled
Stool coming out of vagina?
rectovaginal fistula - opening b/t vagina and rectum
What may a sacral dimple indicate?
HOw to assess for it?
What else may occur along with this?
pull skin folds apart and may have dimple above butt
indication of spina bifida
tuft of black hair esp with spina bifida
sacral dimple not r/t spina bifida that doesn't go all the way to the spine
Barlow and ortalani tests?
screens for hip dysplasia, clicks, and abnormal alignment
hips should be level and creases should be same on both sides
knees to chest then abduct legs with pressure on greater trochanter
checks for hip dysplasia
knee to chest with light pressure
if hip pops out = positive for dysplasia
Stool assessment of newborn?
1. should have meconium in 24 h
black, to dark brown and sticky
What will stool look like if breast fed?
yellowish seedy stool with little odor
formula - offensive odor with green/brown color
Diff b/t breast and formula fed stools?
- 1. less odor in breast fed
- 2. less poopy diapers in breast fed
After second week what change may occur in stools?
will go from every day to 2 to 3 times per week
parents may think baby is constipated: teach that baby may strain b/c doesn't know how to do it and is normal
Does straining indicate constipation?
What may indicate diarrhea in baby?
water ring around the stool in diaper
Meconium must be passed within ___ h or there is a prob
no opening in anus
What to teach parents about how stools will change?
- 1. dark meconium to brown-yellow
- 2. transitional stool - green and loose
- 3. yellow loosely formed
How many wet diaper/day in newborn?
6 to 8
How many stools should a baby have if breast fed?
breast - 3 to 4 stools/day for first 2 weeks
bottle - 2 to 3 stools/day for first 2 weeks
When should a baby void after birth?
12 - 24 h age
Blood ring/pink or samon colored stains around urination in newborn diapers?
urea crystals have formed in urine and urinated out
not a prob
called "brick dust"
Anal patency - when will you know for sure that anus is patent?
when pass meconium
What is a simian crease?
single crease from one side of palm to the other
can be normal
2 s/s that baby has that means baby has down syndrome until proven otherwise?
- 1. simian crease
- 2. low-set ears
webbing of the toes or fingers
What will hands normally be doing in a child?
Can you do hand print for newborn?
hands usually stay clenched
Syndactaly and polydactyly are indicative of what?
can indicate chromosomal disorder
if have bones will have surgical intervention
if don't have bones will tie off and fall off
Unusual spacing b/t toes can indicate?
Fingernails of newborn?
have long nails - need to cover hands
do not trim the nails
educate mom not use fingernail clippers on the nails - can peel off or nail file instead
When should color become normal?
hands and feet
24 to 48 h or may indicate circulatory prob
resp obstruction or cardiac defect
circuforential cyanosis or center of body
Pallor of newborn can indicate what?
anemia r/t Rh incompatibility, blood loss, baby being held up too high before cord cut
Ruddiness of baby?
red - polycythemia, crying,
Color of preterm baby?
ruddy b/c no SQ tissue so see blood
What causes it?
side lying on will be very red and other will be very pale
caused by immature circulatory system
Face only jaundice indicates what bilirubin level?
down to toes?
- face level - ~5 to 7 mg/dL
- mid-abd level - ~15mg/dL
- down to toes ~20mg/dL
At what level should we start seeing jaundice?
at 5 to 7
Where does bilirubin start?
from head and moves down
Complication of bilirubin?
bilirubin crosses BBB and stains brain yellow and causes permenant brain damage
2 types of jaundice?
- 1. physiologic
- 2. pathologic
Physiologic jaundice - when does it occur?
after 24 h
When will pathologic jaundice occur?
will occur at birth and before 24 h
What type of jaundice is more severe?
has a physiologic explanation
EX: when baby is born will have excess blood and when natural hemolyze these -> filter through liver-> stool
if liver not mature enough will build up bilirubin and have jaundice
Something nurse can do to lower the bilirubin level?
feed them as much as possible to get them to poop more
feed at least q 2 h
put baby under bilirubin lights to break down RBC and excrete faster
Stools of baby under bilirubin light?
What is baby at risk for?
will be green and frequent
at risk for skin b/d r/t frequent stools
When can bilirubin get across BBB?
when gets to level of 7 to 10
What babies are at risk for jaundice?
breastfed more than bottle fed babies r/t breakdown product of progesterone from mother
If the baby is breastfed baby what to do about jaundice?
feed more often to increase poo
Tx of jaundice?
- 1. when levels reach about 10 will do phototherapy
- 2. fluids
- 3. feedings
- 4. promote stooling
- 5. exchange blood transfusion
Pathologic jaundice char?
- 1. first 24 h of life
- 2. usually Rh or ABO incompatibility
When will Rh incompatibility be seen?
within 72 h - will get progressively worse
usually need blood transfusion
Appearance of babies with Rh incompatibility?
pallor b/c extremely anemic b/c attacked inutero
Rh incompatibility with direct and indirect coombs risk for what complication?
swelling/edema build up in baby that can be fatal
Direct v/s indirect coombs?
indirect coombs - indirectly see if mom has antibodies for Rh factor
direct coombs - check baby's blood cells for antibodies bound to baby's blood cells
ABO incompatibility prob usually occurs in?
usually mother is O type blood and baby is B
When does Rh and ABO incompatibility usually occur?
with subsequent pregnancies, amniocentesis, chorionic villi sampling, trauma
Tx of Rh incompatibility baby?
same interventions as jaundice
phototherapy and feed a lot
SE of phototherapy?
How often will bilirubin be checked if using phototherapy?
q 12 h or more often
Exchange transfusion for bilirubin?
2 to 10 mL of blood w/d from baby and replace with donar blood that is Oneg
Important nursing consideration if baby needs a blood transfusion?
When should this be checked?
can affect glucose levels
- check glucose levels
- at least an hour after the transfusion
3 factors that inhibit bilirubin conjugation?
- 1. immatur liver - all newborns esp preemies
- 2. dalay in feedings
- 3. delay in stooling
6 normal skin variations in baby?
- nevus simplex - stork bite
- nves flammeus - prot wine stain
- strawberry hemangioma
- mongolian spots
- cafe/ au lait spots
Important consideration if baby has nasal congestion?
babies are nose breathers only
Other name for port wine stain?
will lighten if above bridge of nose and darken if below
dark and big
usually on head
Strawberry hemangioma char?
filled with capillaries
will begin to shrink and will fade usually b/t 6 and 9
will get larger before they start shrinking
problem with parents if able to be seen
Stork bite AKA?
forehead, on neck
usually on the booty, hip, may be on shoulder - and look like bruises
usually in AA, asian, and hispanics
beginning to occur in caucasians due to interracial
Mottling indicates what 3 things may be occurring?
cold stress, hypovolemia, sepsis
Cafe au lait spots?
When are they a problem
LIGHT BROWN AND CREAMY COLORED MACULAR LESION
not a prob unless have 6 or more spots that are greater than 1cm each can suggest neurofibromatosis
What causes it?
When will it go away?
across nose and chin
due to immature sebaceous glands
go away in 2 to 4 weeks
don't pick at it - can cause infection
Vernix caseosa -
cream cheese like covering on infant to protect skin/lubricant
rubs off with bathing
Consideration with vernix and lanugo?
more in prematures
When does lanugo go away?
Where is it usually?
usually gone in 2 weeks
shoulders, back, and upper arms
Erythema neonatorum toxicum?
What causes it?
flea bite rash
erythematous macular spots that will spread, become papules then become pustules
eosinophil reaction to the environment that is usually harmless
only use water on the baby - do not use soap etc at all & watch for s/s of staff infection (fever, not eating well)
Newborn blink and swallowing reflex?
term babies have blink and immature swallowing reflex but will still gag a lot
preterm babies do not have swallowing reflex
Trunk incurvation reflex?
hold baby on stomach and rub babies back up side of spine and baby will curve to the side where you touched
spit out their food
step in place reflex
lift one leg and act like take a step
Plantar and palmar reflex?
palmar is grasp reflex
plantar reflex - toes hold finger
put baby down briskly and baby will flare arms out then will come back with arms and make a C with the hands
stroke foot and toes flare out
Tonic neck reflex?
turn baby's head to a different side and the arm and leg on side head is turned to will be stretched out and opposite side will be flexed
What will baby be screened for before leaving the hospital?
How is this tested?
- 1. PKU
- 2. thyroid/T4
- 3. sickle cell
heel stick then let the blood transfer to a paper without touching the paper to the skin
Important consideration before doing PKU test?
must have ate enough protein to allow PKU to build up
must wait 24 hours before doing
do 2 to 3 days after discharge if not done
What happens with PKU tests?
sent to state and get results at 6 weeks checkup
Important consideration for first bath?
anything in mom's blood is on the baby
1. start from top and work way down - butt last
2. warm water
3. give in incubator or in warm water
4. Make sure soap up well and rinse off well to prevent drying of the skin wash and dry as go
5. front to back on female genitals and don't retract foreskin
Important consideration for after a bath?
monitor temp closely
When should a baby first breastfeed?
in the labor room if possible
hole b/t trachea and esophagus where baby will blow milk bubbles out of mouth
How often should babies eat?
15 to 30cc q 3 to 4 h
How long in carseat?
in carseat until they are 4'9"
Newborn carseat considerations?
preemies may not fit in carseat and can be injured/suffocate if not sitting properly in it
can use rolled up blanket, towel, or diape to support head
may get hot in the summer check metal peices
Best location for newborn in car?
in rear seat facing backward until reaches 21 pounds or is able to sit alone without support
Preemies and small babies consideration?
may need special carseat and need to be fitted in before leave hospital
2 things to do before putting in carseat?
check for hot spots and make sure it is buckled in
How much do babies sleep in first week?
typically 16 to 24 hours for about 4 hours at a time
When will babies start sleeping through the night?
by 4 months most will
Will adding food/cereal help baby sleep longer?
Problem with this?
will not help sleep and will decrease good nutrition and can cause later food allergies
Teaching about when baby is sleeping?
mother should sleep too
When is it OK to put baby on stomach?
when awake and being observed
5 interventions to prevent SIDs?
- 1. on back
- 2. firm matteress
- 3. no loose blankets or pillows & stuffed animals
- 4. no sleeping with baby
- 5. give pacifier when put down to sleep
3 most common causes of bilirubin?
- 1. failure to process bilirubin because of inadequate intake or elimination
- 2. traumatic birth injuries
- 3. breastfeeding jaundice
What can increase risk of SIDs?
smoking in utero and after birth
What 3 things should you assess for with baby's first feeding?
- 1. sucking
- 2. swallowing
- 3. tracheoesophageal fistula
infants born prior to 38th week
appropriate for gest age
Low birth weight?
Very low birth weight?
Extremely low birth weight?
baby weighs less than 2500 g or 5lb 8oz or less at birth regardless of gest. age
Intrauterine growth restriction?
IUGR AKA intrauterine growth retardation
baby has failed to grow normally in utereo
born after 42 weeks gest
Causes/risk factors of IUGR?
- 1. poor nutrion
- 2. cardiac defect in mother
- 3. occurs more in adol
- 4. partial abruptio placentae
- 5. diabetics
- 6. preg induced HTN
- 7. cigs
- 8. congenital prob with baby
- 9. toxoplasmosis or rubella
When can IUGR be detected?
fundal height during assessments prenatal can show LGA and SGA
IUGR baby appearance/char.?
- 1. wasted atrophied muscles
- 2. usually have underdev. liver
- 3. poor skin turgor
- 4. large head r/t to body
- 5. hair will be dull
- 6. abd may be sunken in
- 7. usually have high Hct
- 8. significant and longer lasting acrocyanosis
- 9. decreased glycogen stores
Hypoglycemia in babies?
glucose below 40
2 types of abnormal growth and describe?
symmetric - will grow abnormally in proportion
asymmetric - grow abnormally out of proportion
usually weight will be low and others OK
LGA babies causes/risk factors?
- 1. gest. diabetes
- 2. may have GH prob
- 3. obese mom with too much calories
- 4. transposition of the great vessels
With LGA baby what will assessment of mother show?
higher fundal height than expected
Problem that may occur during L&D of a baby that is LGA?
CPD - cephalopelvic disproportion
more shoulder distocia, clavicle fractures, herb's palsy
Char/risk factors of LGA babies
- 1. usually have immature reflexes
- 2. low Ballard scores for maturity
- 3. bruising and injury
- 4. may have more caput succedeum and cephalohematomas
- 5. hyperbilirubinemia
- 6. hypoglycemia when from gest diabetes mother
Consideration if baby is blue and LGA?
transposition of the great vessels
Consideration if baby is born from gest diabetes mom?
baby has lots of insulin on board
will go straight to ICU b/c blood sugar WILL bottom out within 24 h b/c cut off from mom's high blood sugar
- 1. ruddy
- 2. small
- 3. not much SQ
- 4. no/less creases on feet
- 5. no rugae on boys
- 6. can see clitoris on girls
- 7. head is large
- 8. acrocyanosis
- 9. covered with lanugo and vernix
- 10. fontanels are small
- 11. ear cartiledge immature
- 12. poor/no muscle tone - laying flat
- 13. no sucking reflex and feeding probs
Cause of preemies?
* 80-90% of infant mortality is r/t _____.
Risk factors for preterm birth?
- 1. low socioeconomic status
- 2. lack of prenatal care
- 3. closely spaced pregnancies
- 4. UTI
- 5. preterm rupture of membranes
What can cause preterm rupture of membranes?
Probs with Temp regulation with preemies?
not much SQ or brown fat
no shivering mech (not in newborns either)
exposed more because don't flex
don't move a lot
What should ears do when bent over?
If they don't ?
should return to normal
if stay down can mean not mature or preterm
Nursing consideration with parents of preemies?
will be afraid to touch them b/c they look so fragile
Position of preemie?
limp and extended
Prob with preemie feeding?
have trouble learning to feed, breathe, and swallow at same time and don't want to eat
- 1. airway
- 2. resuscitation
- 3. lung expansion
- 4. positioning
- 5. drug therapy
Resusitation of the newborn?
first hours of life most critical to decrease risk or neuro defects like cerebal palsy
pH of newborn?
most are born acidotic and if they can't breathe -> more acidotic and will turn off production of surfactant
Airway consideration of newborn?
suction mouth then nose
Important thermoregulation intervention of baby just born?
dry the baby well
4 methods of heat loss?
- 1. conduction - transferred to cold surface
- 2. convection - air movement/circulating
- 3. radiation - heat transfers from baby to nearby source of heat (window/heater)
- 4. evaporation - lose body heat thru moisture
Why does baby get cold quickly directly after birth?
evaporation b/c wet
What will occur if baby is not breathing?
If baby has HR of ___ or less must start CPR?
60 or less
If have a baby struggling to stay warm and temp is dropping what will baby do to warm itself?
it starts moving to increase temp and will burn brown fat if it has it
moving will increase need for energy and can cause hypoglycemia -> shock and loss of conciusness -> death
Important consideration if a baby gets cold or decreased BG?
can cause blood flow to go back to intrauterine blood flow and stop surfactant and decrease blood sugar
Lung expansion considerations?
once expanded surfactant keeps them expanded
if need to give O2 give by mask 100% warmed and humidified
listen to both lungs - does baby have 2 lungs
if mother had narcotics with L&D need narcan avail. in case of resp depression
Imp consideration if mother of newborn just born has been using street drugs?
do not give baby narcan for resp depression - can cause withdrawals
Doing chest compressions on baby and have HR less than 60/BP lower than needed what drug may be given?
To correct acidosis of baby what drug may we use?
How is surfactant given to baby?
suction well then admin thru endotracheal tube into baby's airway and dropped down
cannot suction again for an hour after surfactant is placed in airway - make sure suction well before
S/S of a cold baby?
- 1. fussy and moving
- 2. acrocyanosis
- 3. jittery
If a baby is jittery check ___ & ___>
BG and temp
What is incubator used for?
transfer from newborn nursery to NICU
bare skin to bare skin on chest of parent
Babies have tendency to become _____ r/t rapid breathing and may be in radiant heat source.
Urine output/specific gravity of newborn?
no BP no peepee
Hypo/hypervolemia r/t IV fluids?
hypervolemia from too much IV fluids can cause brown hemorrhaging and can cause ductus arteriosus to reopen
Hypovolemia appearance of baby & s/s?
- 1. pallor
- 2. tachypnea
- 3. tachycardia
s/s of hypervolemia?
Consideration with giving baby meds?
give in as little fluids as possible to prevent hypervolemia
Consideration with geting blood from babyt?
must monitor to prevent hypovolemia
Nutrion for preemies?
1. will get NG b/c can't suck, swallow, and breathe and most have no suck reflex
2. best to give breast milk for immunity needed
3. give pacifiers to learn to suck
When will preemie void?
usually in 24 h
What should be documented when resusitation is done?
if void or defacate during
BM in preemies?
may or may not have bowel movement within 48 h
Interventions for parents of preemies?
- 1. Encourage visiting and handling baby
- 2. take pics and send them with parents
- 3. encourage bonding
- 4. watch siblings for RSV
- 5. if infant dies take the equipment off the baby before letting them see it
Sending preemie home?
- 1. look at condition of baby and mother during check ups
- 2. make sure the parents understand dev needs of baby
- 3. carseat fits
- 4. bonding
Preterm baby risks/diagnoses possible?
- 1. risk for infection
- 2. risk for altered nutrition
- 3. hypothermia
- 4. risk for altered bonding r/t equipment and absent from parent for long period
Skin of newborn considerations?
- 1. no adhesive tapes - will rip skin
- 2. disinfectants b/c not much tissue b/t skin and cells - use chlorhexidine
- 3. warm water - no soap
Prob with using alcohol and betadine on preemies?
skin is so thin will leak through
betadine can cause thyroid issues
Risks for preemies?
huge risk for infection
Newborn or preterm that is sick important consideration?
will not get high temp - will get low temp
What causes most infections in newborn?
preterm rupture of membrane
Painful perception in preemies?
they have it
pain threshhold may be permenantly altered r/t so many needle sticks in preemies - will be more sensitive to pain
Non pharm intervention for pain in preemies and newborns?
kangaroo care, swaddling, holding close, sucrose passy before sticks
Closing door on incubator of preemie?
Lights in room with preemie?
keep lights low and quiet
alarms turned down
need inutero env
Postterm babies char?
1. dry skin and leathery appearance (alligator skin)
Risks with postterm babies?
1. risk for meconium aspiration- will stool inutero
2. decreased placental function - decreased nutrition - will start loosing weight
3. injury risk if they are still big when delivered
Monitor large babies for ______!!
Why are postterm babies at risk for hyperbilirubinemia?
will have polycythemia r/t hypoxia r/t decreased placental functioning and RBC will be destroyed after birth to decrease blood volume
resp distress syndrome -lack of surfactant
hyaline membrane disease
baby born with a lot of fluid in lungs and come thru birth canal the fluid is sqeezed out -> blood that has been bypassing lung will now go to the blood -> RDS baby has no surfactant -> alveoli sticks together -> blood starts to shunt again like fetal circulation -> big prob
Most common s/s of RDS?
- 1. nasal flaring
- 2. sternal/subcostal retractions
- 3. tachypnea
- 4. cyanotic
- 5. grunting min to h after develops
Tx of RDS?
- 1. treat with surfactant
- 2. may do O2 admin usually by CPAP
- 3. ventilation
- 4. supportive care
Consideration if baby is on cont. O2?
retinopathy - blindness that can be caused by too much O2
What babies most at risk for RDS?
Supportive care of baby with RDS?
- 1. keep warm
- 2. monitor fluid & glucose
- 3. feed them
What is an LGA baby at risk for?
CPD - cephalopelvic disproportion
If a baby has bruising/injury from birth what is he at risk for?
Transient tachypnea s/s?
- may have RR of 80 to 120X per minute
- along with s/s of resp distress but mostly high rr is imporatnt
s/s of resp are milder than RDS
Transient tachypnea cause?
Who is most at risk?
retained fluid in the lungs during birth
C-section babies that didn't get squeezed
When does transient tachypnea occur?
can occur hours after delivery
will peak in 36 h and gone in 72 h
RDS occurs imm.
Interventions for transient tachypnea?
1. gavage feeding until better
meconium aspiration syndrome - breathe meconium into the airway
Patho of MAS?
suck tarry meconium into airway -> causes alveoli and airway to stick together
Interventions for MAS?
- 1. intrapartum can do amnioinfusion
- 2. at delivery when head first comes out use delee suction device to get as much meconium off perineum as possible
- 3. do not stim baby to cry b/c will suck it down farther - suction first and look down with endotrach light then look at RR ect
If have baby trying to resusitate with meconium aspiration what do first?
- clear the airway of meconium and clean up first
- then CPR
s/s of meconium aspiration?
same as transient tachypnea -> stop producing surfactant -> can lead to cardiac arrest
Mom's that can cause concerning blood incompatibility?
mom's with negetive and O
babies with positive and B
Blood incompatibility pathologic or physiologic jaundice?
Tx of jaundice baby?
- 1. phototherapy
- 2. exchange transfusions
- 3. feed them
- 4. change diaper
- 5. serum bilirubin
- 6. skin tone
Feeding of jaundice baby?
1. feed ASAP
Cover ___ & _____ in a baby undergoing phototherapy for jaundice?
genitals and eyes
Schedule feeding of jaundice baby?
When bilirubin checked?
feed q 2 h and check levels q 12 h
Complications/char of gest diabetes with newborn?
- 1. hypoglycemia r/t baby high insulin r/t mother hyperglycemia
- 2. all organs will be larger except the brain
- 3. baby will be huge if mom diet sucks - will have to take them out early b/c so big
Normal BG of baby?
40 to 60
Why may gest diabetes baby be early?
will get too big
If BG gets low ?
feed the baby then check again based on hospital policy
If baby is getting hypoglycemia key s/s?
s/s of drug use/withdrawal in baby?
- 1. jittery
- 2. disturbed sleep pattern
- 3. want dark and left alone
- 4. frequent sneezing
- 5. convulsion
- 6. most like to be swaddled but not usually held
- 7. most like sucking a pacifier
Drug addict mother and breastfeeding?
if a mom is on drugs do not breastfeed
Nursing responsiblity with drug mom baby?
watch for need to call social services - baby may not go home with mom