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Healthy People 2010
- Increase the proportion of mothers who breast-feed their babies during the early postpartum period from a baseline of 64% to 75%
- Increase the proportion of mothers who breast-feed at 6 months from a baseline of 29% to 50%
- Increase the proportion of mothers who breast-feed at 1 year from a baseline of 16% to 25%
- Ensure appropriate newborn bloodspot screening, newborn hearing screening, follow-testing, and referral services.
- Ensure that all newborns are screened at birth for conditions mandated by their state-sponsored newborn screening programs
- Ensure that follow-up diagnostic testing for screening positives is performed within an appropriate time period.
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Newborn assessments
- First one completed in the birthing area
- Second one within 2-4 hours of birth
- Third before discharge
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Signs that might indicate a problem in a newborn assessment.
- nasal flaring
- Chest retractions
- Grunting on exhalation
- labored breathing
- Generalized cyanosis
- Abnormal breath sounds: rhonchi, creackles (rales), wheezing, stridor
- Abnormal respiratory rates (tachypnea, more than 60 breaths/min; bradypnea, less than 25 breaths/min)
- Flaccid body posture
- abnormal heart rates (tachycardia, more than 160 bpm; bradycardia, less than 100 bpm)
- Abnormal newborn size: small or large for gestational age
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Apgar score
- Used to evaluate newborns at 1 min and 5 min after birth
- A- appearance
- P- pulse (heart rate)
- G- grimace (reflex irritability)
- A- activity (muscle tone)
- R- respiratory (respiratory effort)
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When the newborn experiences physiologic depression, the apgar score characteristics disappear in what order?
- 1 the pink coloration is lost
- 2 the respiratory effort
- 3 the tone
- 4 reflex irritability
- 5 heart rate
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What is the expected length of a full term newborn ?
48-53 cm (19-21 inches)
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What is the typical newborn birth weight?
- 2,700 to 4,000 g (6-9 lbs.)
- less than 10% or more than 90% outside of normal range requires further investigation
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Newborns classified by birthweight regardless on gestational age.
- Low birthweight: <2,500g (<5.5 lb)
- Very low birthweight: <1,500g (<3.4 lb)
- Extremely low birthweight: <1,000g (<2.5 lb.)
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How often is HR and RR assessed in the newborn?
Q30 min until stable for 2 hours. Once stable, Q8 hours
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How often is temp assessed in the newborn?
Q30 mins until stable for 2 hours. Then Q8 hours until discharge.
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If blood pressure needs to be assessed what equipment is used and what is the typical range for a newborn?
Oscillometer (Dinamap) and range is 50-75 mm Hg (systolic) and 30-45 mmHg (diastolic).
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Crying, moving, and late clamping of the umbilical cord will increase systolic pressure.
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What tool is used to determine the gestational age of a newborn?
Dubowitz/Ballard or New Ballard Score system
low score of -1 point or -2 points for extreme immaturity to 4 or 5 points for postmaturity
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Physical maturity examination is done how soon after birth?
within the first 2 hours
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The areas assessed on the physical maturity examination include:
- skin texture- sticky to transparent to smooth, peeling and cracking, parchmentlike or leathery with significant cracking and wrinkling.
- Lanugo- soft downy hair on body
- Plantar creases-greater number on creases the greater maturity
- Breast tissue- thickness and size of breast tissue and areola
- Eyes and ears- lids fused or open and ear cartilage and stiffness determine the degree of maturity
- genitals- males, testicular descent and appearance of scrotum (from smooth to rugae covered); females, appearance and size of clitoris and labia (prominant clitoris w/ flat labia suggests prematurity, clitoris covered by labia suggests greater maturity)
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Neuromuscular maturity assessment is completed within 24 hours of birth and includes:
- Posture- greater degree of flexion, greater degree of maturity
- Square window- degree the hands can be flexed towards the wrists, as angle decreases, maturity increases
- Arm recoil-degree of arm flexion and the strength of recoil
- Popliteal angle- extended knees; an angle less than 90 degrees indicates greater maturity
- Scarf sign-elbows movement across chest; an albow that does not reach midline indicates greater maturity
- Heel to ear-can feet be moved to the ears; the lesser the ability, the greater the maturity
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Gestational classifications
- Preterm or premature- born before 37 weeks gestation, regardless of birthweight
- Term - born between 38 and 42 weeks' gestation
- Postterm or Postdates - born after completion of week 42 of gestation
- Postmature - born after 42 and demonstrating signs of placental aging
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Nursing intervention for helping infant transition.
- maintaining airway patency
- ensuring proper identification
- administering prescribed medications
- maintaining thermoregulation
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How soon after birth should a picture be taken of the newborn for safety reasons?
within 2 hours
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