N1040 Exam 5 newborns

mongolian spots

bluish/blackish areas of pigmentation that appear in the back, buttocks or extremities of dark skinned infants — important to document presence as they are commonly mistaken for bruises

Newborn rash

appears commonly on the chest, abdomen, back/buttocks of the newborn. _____ is harmless, will disappear without treatment

Milia

distended sebaceous glands on nose and cheeks; raised white bumps on the face, nose, and chin; do not attempt to pick/squeeze them; they will clear spontaneoously on their own

Epstein pearls

whitish hardened nodules on the gums or roof of the mouth; cysts that are not unusual but disappear within a few weeks

Natal neeth

RARE occurance

Reflexes that should be present at birth

• palmar grasp

• plantar grasp

• rooting

• sucking

• babinski

• moro or startle

• stepping

• dancing or tonic neck reflex

What senses should be present at birth?

ALL 5 senses

• hearing (assessed prior to discharge)

• sight

• taste

• touch

• smell

What are the initial adjustments of the newborn at birth?

Adjustment to extrauterine life;

• establish/maintain respirations

• adjusting to circulatory changes

• injesting, retaining, and digesting nutrients

• eliminating wastes

• regulating weight

what 2 systems go through the most rapid change after birth for the newborn

• respiratory

• cardiovascular; immediate change from fetal circulation to adult circulators; converts within 60 seconds after birth

Normal BP for newborn

60-80 / 40-45 mm HG

Normal HR for newborn

110-160 bpm

Normal RR for newborn

30-60

Normal temp (axillary) for newborn

97.7 - 98.6 F / 36.5 - 37 C

Best prevention for infection in newborns

• hand hygeine / wearing gloves

• prevent exposure to illness/sickness

• immunizations

S/SX of infeciton in newborns

• temperature instability (increase or decrease)

• glucose instability& metabolic acidosis

• poor sucking

• vomiting/diarrhea

• apnea/resp. distress/ cyanosis/ skin mottling etc..

If the mother is HBsAg POSITIVE what should the infant recieve?

the infant should recieve HepB Immunoglobin within 12 hours after birth in addition to the immunization/vaccine

What is given at birth to assist with blood clotting

Vitamin K

Safety protocols for newborns:

• never leave newborn unattended

• DO NOT remove ID bands

• DO NOT release the newborn to anyone who does not have the matching ID band to the newborn

• Family should know the nurses

• be aware of the infants schedule

• be aware/alert to any suspicious activity by visitors

• car seat safety

• Be aware of shaken baby syndrome

• Know SIDS prevention (back sleeping, no pillows/toys/large blankets in the crib/bed, use pacifiers)

What is the nurses highest priority of care of the newborn

Stabilization (ABCs)

What does APGAR measure?

• respiratory effort

• HR

• Muscle tone

• Reflex irritability

• Color

What are the contraindications for circumcision in newborns?

• still in transition period

• preterm or ill

• family hx of bleeding disorders

• have congenital genitourinary disorder (e.g. espispadias or hypospadias)

post-care for circumcision

• apply patroleum jelly

• comfort newborn

• check site periodically for active bleeding

• crusty yellow exudate indicates

preterm infants are born _____

before 37 weeks

Term infants born at ____

37 - 40 weeks

Post term infants born at _____

42 weeks +

what are the risks of phototherapy ?

Dehydration

S/SX of dehydration in newborns?

• sunken fontanel

• less wet diapers

How is hyperbilirubinemia diagnosed

diagnosed with a bilirubin test

what causes hyperbilirubinemia

delayed cord clamping ; high levels of unconjugated bilirubin in the bloodstream

S/SX of respiratory distress

• nasal flaring

• expiratory grunting

• chest retractions

• mild respirations

weight loss in the newborn; what is allowed?

• preterm babies: 7% weight loss

• term babies: 10% weight loss

what is the first period of reactivity in a newborn

baby is awake/alert for about 30-60 mins after birth; may display nursing/attachment behaviors with random diffuse movement.
ideal time to start bonding with baby

what is the period of reactivity that comes after the 1st period of reactivity?

period of inactivity — deep sleep

what is the second period of reactivity?

awakes from deep sleep, lasting 4-6 hours

what are the stages of grief?

• denial

• anger

• bargaining

• depression

• acceptance

What does the ballard score measure?

assesses 6 physical and 6 neuromuscular signs

when do you perform a gestational age assessment?

2 - 12 hours after birth

how do you prevent cold stress

delay the 1st bath

what is cold stress

non shivering thermogenesis; the depletion of brown fat due to stress

Heat loss routes: Evaporation

the heat loss that occurs when a liquid is converted to vapor

Heat loss routes: Radiation

loss of heat from the body surface to cooler solid surface not in direct contact (indirect) but in relative proximity

Heat loss routes: Conduction

loss of heat from the body surface to cooler surfaces in direct contact

Heat loss routes: convection

flow of heat from the body surface to cooler surfaces in direct contact

what newborns are at risk of hypoglycemia

• LGA’s

• SGA’s

• premature/preterm babies

• ALL stressed infants

S/SX of hypoglycemia in newborns (early signs)

• jitteriness

• poor feeding

• inability to maintain a stable temp

• diaphoresis (sweating)

• lethargy/weakness

• weak or high pitched cry

S/SX of hypoglycemia (late signs)

• Respiratory distress

• apnea

• tremors

• seizure/coma

Premature infant risks include:

• lung immaturity

• gastic immaturity

• retinopathy (possible blindness)

• circulation issues

• intraventricular hemorrage

what are the major metabolic disorders screened for in metabolic screenings?

• PKU

• galactosemia

• endocrine disorders

Are metabolic screenings fixed by diet or medications?

DIET

Caput succedaneum

a collection of serous fluid between the periosteum and the scalp; often crosses the suture line

Cephalohematoma

a collectio of blood between the periosteum and the skull; never crosses the suture lines

types of birth traumas

• macrosomia

• shoulder distocia - often leading clavicle fracture

• fractures to humerus, femor, clavicle, linear/depressed fractures

• palsis

• facial paralysis

• phrenic nerve injury

• intercranial hemorrhage

What is the most common type of paralysis

palsis - erb-duchenne

Physiological jaundice

occuring from a normal function of the body

• occurs in the first 24 hours

• usually 2-3 days after birth

• causes: high RBCs, immature liver, dehydration, birth trauma wtc

Pathological jaundice

a condition caused by a contributing disease or condition

• within the first 24 hours

What is TORCH

• Toxoplasms

• Other

  • hepatitis

  • syphillis

  • varicella

  • herpes zoster

• rubella

• cytomegalovirus

• herpes simplex

Diet for newborns

• ONLY breastmilk or formula for the 1st 6 months

• NO cows milk before 12 months

Meconium aspiration syndrome

condition where the fetus or newborn develops respiratory distress after inhaling meconfium mixed with amniotic fluid

causes chemical pneumonitis

indicates baby is under stressed

What is TTN (transient tachypnea of the newborn)

development of mild respiratory distress

presentation of TTN

• >60 breaths per minute

• mild retrations, nasal flaring, some expiratory grunting

• cyanosis DOES NOT occur

• difficulty feeding

• hypoxemia and decreased CO2 levels

Contributing factors of TTN

• delivery by c/s

• prematurity

• maternal DM

• maternal smoking

A 2 vessel cord indicates:

cardiac anomalies

factors contributing to 2 vessel cords:

• downs, Marfan, turner’s syndrome

• maternal alcoholism

• rubella infection

• DM

• exposure to x-rays

• medications

unbilical cord care

• let cord fall off on its own

• only sponge baths until it fals off

• keep dry and out of diaper

• check cord (AVA - 2 arteries and 1 vein)

RIsk of oxygen therapy and preterm infants

• oxidative stress; brain damage or lung damage if too much is given

• risk of oxygen toxicity