1
Q
stages of transition to extrauterine life
A
- first period of reactivity
- period of decreased responsiveness
- second period of reactivity
2
Q
first period of reactivity
A
- lasts up to 30 min after birth
- HR = 160-180 bpm
- RR = 60-80/min
3
Q
period of decreased responsiveness
A
- lasts 60-100 min
- sleepiness and ↓ motor activity
4
Q
second period of reactivity
A
- 2-8 hr after birth
- ↑
- HR
- RR
- muscle tone
- mucus production
- may have meconium
5
Q
meconium
A
- first stool neonate passess within 24-48 hr of birth
- dark black
- sticky
6
Q
changes in fxn of resp system after birth
A
- infant must clear fluid that filled lungs in utero, aided by
- squeezing of chest during labor
- hormonal changes during labor
- alveoli collapsed at birth, must be expanded
- surfactant necessary for expansion
- resp irregular at birth
- RR = 30-60/min
- babies are nose-breathers
7
Q
acrocyanosis
A
- normal bluish discoloration of baby’s extremities
- lasts up to 48 hr
8
Q
CV changes at birth
A
- fetal openings that must close
- foramen ovale
- ductus arteriosus
- ductus venosus
- if not closed, surgical correction needed
- can lead to complications later in life if not fixed
9
Q
foramen ovale (RA-LA)
A
- purpose in utero
- send high-O2
- diverts blood from fluid-filled lungs
- closes soon after birth 2/2
- ↑ pulmonary blood flow from left side of heart
- ↑ pressure in left atrium
- crying can temporarily reverse flow and cause cyanosis
10
Q
ductus arteriosus (aorta-PA)
A
- allows OP from RV to bypass lungs
- closes 24 hr after birth
- permanent closure within 2-3 mo
- can reopen before 2-3 mo because of hypoxia, asphyxia, prolonged crying, and pathological problems
- patent ductus arteriosus: unclosed DA
- “washing-machine” sounding heart murmur
- prostaglandin inhibitors: ibuprofen, indomethacin
- surgery if still not closed
11
Q
ductus venosus (umbilical vein-IVC)
A
- allows blood flow from UV to bypass liver and GI tract
- closes when cord is clamped and converts to ligament by 2-3 mo
12
Q
RA
A
right atrium
13
Q
LA
A
left atrium
14
Q
PA
A
pulmonary artery
15
Q
RV
A
right ventricle
16
Q
LV
A
left ventricle
17
Q
IVC
A
inferior vena cava
18
Q
UV
A
umbilical vein
19
Q
neonate normal VS
A
- HR: 110-160 bpm
- murmur abnormal if accompanied by
- poor feeding
- sweating
- apnea
- cyanosis
- pallor
- murmur abnormal if accompanied by
- BP: 80/40
- MAP = GA
20
Q
MAP
A
mean arterial pressure
21
Q
normal neonate blood volume
A
80-100 mL/kg
22
Q
delayed cord clamping (DCC)
A
- cord clamped 15-45 sec after birth
- benefits
- ↑ circulating blood
- ↑ BP
- ↓ risk for intravascular hemorrhage, necrotizing enterocolitis
- can ↑ polycythemia and hyperbilirubinemia
23
Q
polycythemia
A
excess RBCs
24
Q
hematologic changes at birth
A
- ↑ RBCs
- shorter lifespan, ↓ O2 storage
- possible anemia @ 4-6 mo
- ↑ WBCs
- rapidly ↓ and stabilize
- limited ability to fight certain bacteria
- ↑ risk of infection
25
heat loss
* convection
* body → ambient air
* keep away from drafts, vents, foot traffic (any moving air)
* radiation
* body → cooler nearby surface
* keep away from cold exterior walls, windows
* preheat warmer if using
* evaporation
* body → evaporating moisture
* dry baby well with warm blankets (esp. head)
* remove wet linen
* put warmed hat on baby
* conduction
* body → cooler surface in contact
* skin to skin on mom
* dry with warmed blankets
* warm stethoscope and hands
* warm blanket on scale before weighing
26
neutral thermal environment
balance of maintaining appropriate temperature for infants to avoid cold stress, heat stress, hypothermia, and hyperthermia
27
thermogenesis
* infants' response to cold
* burns brown fat
* babies can't shiver
* limited brown fat stores = risk for cold stress
28
hypothermia in infants
* temp \< 97.7F
* more common than hyperthermia
* →
* vasoconstriction: pale and mottled skin
* ↑ RR to produce heat
* ↓ O2 to brain
* respiratory distress
* hypoglycemia: burning everything to stay warm
29
hyperthermia in infants
* temp \> 99.5F
* cause: environment or sepsis
* sweat glands inadequate
* signs
* flushed skin
* warm hands/feet (overheated)
* cold hands/feet (sepsis)
* extended posture
* → neuro injury, sz, heatstroke, death
30
renal changes at birth
* must record UOP, I/O
* babies lose body weight after birth
* times voided = days old
* check for abd masses
* immediate follow-up for lack of voiding, masses
31
GI changes at birth
* gut flora built in first week
* meconium: first stool, mostly amniotic fluid swallowed in utero; different color, consistency
* as flora build, color → green, brown, yellow
* LES immature → risk for GER
* avoid overfeeding
* burping important
* position with head slightly elevated (controversial in NICU)
32
green emesis
indicates volvulus, twisting of bowel
33
volvulus
* twisting of bowel, usually in sigmoid and ileocecal areas
* predisposing cause: prolapsed mesentery
34
projectile vomiting
pyloric stenosis
35
pyloric stenosis
* constriction or narrowing of the pyloric opening
* nausea, projectile vomiting, dehydration, wt loss, malnutrition
* happens by about 1 mo
* firm, round mass in abd palpated, confirmed by US
* Tx: pyloromyotomy
36
pyloromyotomy
incision of the pyloric sphincter to treat (infantile hypertrophic) pyloric stenosis
37
hepatic changes at birth
* immature infant liver ↑ risk for hyperbilirubinemia
* hyperbilirubinemia = \> 1.5x normal for age, jaundice
38
hyperbilirubinemia
* excess of bilirubin in the blood
* immature liver can't conjugate bilirubin after breakdown of short-lived RBCs
* unbound bilirubin crosses BBB → kernicterus
* monitored if mild-moderate, phototherapy if severe
39
immune system changes at birth
* ↓ circulation Igs
* ↑ infection risk
* sources of Igs
* breastmilk: IgA
* placenta: IgG
* immunity for 3 mo
* ↓ time in utero = ↓ IgG
40
galactosemia
* autosomal recessive disorder
* inability to metabolize galactose r/t congenital absence of one of two enzymes needed to convert galactose to glucose
41
nursing actions directly after delivery
* dry and stimulate
* warm blanket/towel
* replace wet linen with dry
* apply warm hat
* physical assess. and APGAR
* for central cyanosis, dyspnea, lack of vigor
* reposition head
* suction with bulb syringe or neo-yankauer
* supplementary O2
* call for peds
42
APGAR
* done at 1 and 5 min of life
* Appearance
* Pulse
* Grimace
* Activity
* Respirations
43
newborn initial assessment equipment
* sulb syringe: suction mouth, then nose
* stethoscope: heart and lungs
* thermometer
* BP cuff: check for equal in arms and legs
* scale
* tape measure
* cm for charting, inches for parents
* length
* head circumference
* clean gloves
44
neonate initial skin assessment
* color: acrocyanosis normal
* peeling
* birthmarks
* foot/hand creases
45
newborn initial torso assessment
* chest
* RR
* breathing effort, symmetry
* HR/sounds (S1, S2)
* breath sounds
* breast tissue
* abd
* rounded
* umbilical cord: AVA
* palpate for massess
46
newborn initial HEENT assessment
* nose
* patency
* alignment
* head
* palpate fontanels: soft, open
* palpate sutures
* hair: abnormal swirls or patterns (genetic disorders)
* eyes
* hemorrhage
* bruising
* discharge
* abnormal epicanthal folds
* facial symmetry
* eye/ear alignment
* mouth
* color
* moisture
* integrity of hard and soft palates
* sucking/rooting reflex
* frenulum
* distinct chin
* neck: midline with thyroid not palpable
47
newborn initial neuro assessment
* muscle tone
* reflexes
* Moro
* Babinski
* sucking and rooting
* palmar/plantar grasp
48
New Ballard Score
* done in first 24-48 hr of life
* used to assess physical, neuromuscular maturity
49
neonate female genitalia assessment
* integrity
* may be swollen 2/2 hormones from mom's blood
50
neonate male genitalia assessment
* intact foreskin
* palpable testes
* conditions such as hypospadias
51
hypospadias
* misplaced urethra opening
* can cause trouble urinating
52
normal newborn VS
* HR: 110-160/min
* RR: 30-60/min
* BP: 80/40 (MAP = GA)
* temp: 97.7F - 99.5F (36.5C - 37.5C)
53
AGA
appropriate for gestational age
54
LGA
large for gestational age
55
SGA
small for gestational age
56
post-term
42 wks
57
post-mature
* \> 42 wks
* placenta fails: ↓ O2 and nutrients
* ↓ wt
* skin dry and cracked
58
milia
small, raised pearly white spots on nose, chin, or forehead
59
Mongolian spots
areas of blue, brown, gray, or black pigmentation
60
talngiectatic nevi
* stork bites
* flat pink or red marks
* on neck, nose, upper eyelids, forehead
* go away by 2nd year of life
61
nevus flammeus
* port wine stain
* capillary angioma below skin
* red or purple
* usually on face
* does not resolve on its own
* usually only removed if obvious and could cause psychosocial issue
62
erythema toxicum
* newborn rash
* pink
* appears suddenly in 1st 3 wks of life
* anywhere on body
* resolves on its own
63
cephalohematoma
* collection of blood between periosteum and skull bone
* doesn't cross midline
* from birth trauma
64
caput succedaneum
* localized swelling of soft tissue of scalp
* crosses midline
* from birth trauma
65
molding
* normal process
* newborn skull is flexible
* molds to fit birth canal
* gradually regains proper shape
66
subconjunctival and retinal injuries
* caused by ↑ ICP at birth
* benign
* will heal in 10-14 days
* reassure parents
* report if not healing after a couple of wks
67
bruising
* breech presentation: lower extremities
* trauma in difficult birth
68
petechiae
* seen in nuchal cord, trauma from squeezing
* benign of disappear in 48 hr
69
forceps injury
* linear bilateral marks from placement of forceps in assisted birth
* reassure family
* usually heal on their own
70
lacerations
* causes
* scalpel in C/S or episiotomy
* internal fetal monitoring
* usually found on
* scalp
* butt
* thighs
71
newborn normal blood counts
* RBC: 4.8-7.1 x 106
* Hgb: 14-24 g/dL
* Hct: 44-64%
* WBC: 9,000-30,000/mm3
* Plt: 150-300k/mm3
72
normal newborn BG
40-60 mg/dL
73
normal newborn bilirubin
* 24 hr: 2-6 mg/dL
* 48 hr: 6-7 mg/dL
* 3-5 days: 4-6 mg/dL
74
newborn meds and labs at birth
* vitamin K (IM)
* erythromycin (ophthalmic ointment)
* cord blood type and screen
75
newborn meds, labs, and procedures within 24 hr of life
* bathe: leave vernix on for 24 hr
* labs: draw blood via heel stick or venipuncture
* PKU
* glucose
* Hct
* bilirubin
* Hep B vaccine/immune globulin
* hearing screen
* CHD screen
76
PKU
phenylketonuria
77
phenylketonuria
rare inherited disorder that causes an amino acid called phenylalanine to build up in the body
78
CHD
congenital heart dz
79
PKU screen
* tests for 35 congenital dz and disorders
* required by law
* disorders include
* PKU
* cystic fibrosis
* sickle cell dz
* galactosemia
* congenital hypothyroidism
80
circumcision
* ensure consent is signed
* gather supplies
* provider performs procedure, nurse assists
* try to keep newborn calm
* local anesthesia in groin area
* Gomco or Plasti-Bell
* document voiding and teach parents about post-circumsion care
81
types of circumcisions
* Gomco
* metal clamp and bell stabilize foreskin and glans while provider removes foreskin with scalpel
* post-care: apply petroleum jelly to area to keep diaper from sticking; check hourly x12 for bleeding
* Plasti-Bell
* plastic bell placed over glans, separating it from foreskin; string tied tightly over bell and foreskin occludes blood flow; distal part of foreskin dies and falls off with plastic bell as remaining portion heals
* post-care: check frequently for infection or oozing; diaper loosely
* monitor for and report excess bleeding or s/sx of infection
82
criteria for postpartum discharge
* parents can feed and diaper every 3 hr
* parents can tend to baby when something is wrong/changed
* normal physical exam, VS, screenings
* baby fed successfully on regular schedule
* passed urine/stool
* no excess bleeding for circumcision site
* no significant jaundice (follow-up if borderline)
* 48-hr stay for vaginal delivery
* 96-hr stay for C/S w/o complications
83
parent education
* check car seat for recalls
* proper installation/use
* rear-facing in back seat
* breast- or bottle feeding
* temp or signs to bring baby in
* importance of follow-ups
* bathing
* bulb syringe
* diapering
* signs of pain
* CPR
84
bathing education
* sponge bath until cord falls off (10-14 days)
* keep cord clean and dry
* check for redness, oozing, bleeding
* universal precautions
* be aware of temp and thermoregulation
* safety precautions
85
feeding education
* breastfeeding: check for appropriate latch, suck, and expression of breastmilk (EBM)
* bottle feeding
* if mom not producing, can get consent for donor EBM
* check respirations, stress cues, ability to express milk from nipple
* infant is well-fed when
* sleeping after feed
* gaining wt
* 6-8 soiled diapers/day
86
EBM
expression of breastmilk
87
kangaroo care
* skin-to-skin contact with baby, which enhances
* thermoregulation
* breasfeeding
* VS regulation
* ↓ LOS
88
LOS
length of stay
89
contraindications for breastfeeding
* HIV/AIDS
* galactosemia
* active TB
90
calorie content of breastmilk
20 kcal/oz
91
calorie content of formula
20-24 kcal/oz
92
galactosemia
* "galactose in the blood"
* rare, inherited dz in which galactose cannot be broken down, and undigested sugars build up in the blood
* untreated children who do survive usually fail to grow, are mentally retarded, and have cataracts
93
normal newborn caloric intake
110 kcal/kg/day
94
preterm newborn caloric intake
150 kcal/kg/day
