Health and Illness IV: Lifespan - Exam 1 Review: Care of the Healthy Newborn

how does fetal oxygenation occur

transplacental gas exchange- at birth must establish lung function

what causes spontaneous initiation of breathing at birth

-chemical

-mechanical

-thermal

-sensory

chemical factors of spontaneous initiation of breathing at birth

clamping of cord decreases prostaglandins to increase respirations; surfactant released as lungs expand

mechanical factors of spontaneous initiation of breathing at birth

compression of chest wall during birth

thermal factors of spontaneous initiation of breathing at birth

lower temp stimulates respiration

sensory factors of spontaneous initiation of breathing at birth

touch of MD/CNM/mother; bulb syringe, drying, lights

breathing in newborn

mostly abdominal- chest and abdomen rise and move with respiration

-lung sounds are loud and lclear

respiratory rate in newborn

30-60 per min

what can breathing be after birth

shallow and irregular with periodic pauses/apnea

when do CV changes occur after birth

with first breath

-lungs inflate and decrease pulmonary resistance

-causes functional closure of foramen ovale (permanent closure in 1st few months)

-ductus arteriosus closes at birth (permanently in 3-4 weeks)

HR for newborn

120-160; can be irregular for 1st few hours

-listen for full minute

HR for sleeping newborn

100

HR for crying newborn

180

heart sounds in newborn

higher pitch, shorter duration, S1>S2

murmurs in newborns

-transient murmurs common in 1st few hours (usually form PDA)

-check for other signs of CV dysfunction

s/s of CV dysfunction in newborn

-tachycardia

-bradycardia

-pallor

-cyanosis

-pulse ox reading

normal color of newborn

acrocyanosis is normal in 1st 24 hours

abnormal color of newborns

central cyanosis (lips and mucous membranes)

BP for newborns

-routine BP not recommended

-if done, do a 2-4 extremity with doppler to note variation

-normal is based on fetal weight and age

normal BP in 7-8 oz term newborn

60-80/40-50

what is thermoregulation

maintenance of balance between heat loss and heat production

thermoregulation for neonates

-have to adapt to lower external temp compared to in utero

-less adipose and SQ fat; blood vessels much close to skin surface (difficult adjusting to temp)

neonatal response to cold

-increased muscle activity

-cannot generate heat by shivering

(thus use unique process of "brown fat" metabolism

increased muscle activity in response to cold

crying, acrocyanosis, increased activity

what is brown fat

unique adipose tissue found in neonates

-located in axilla, kidneys, and thoracic column

-lesser amounts in preterm

what does brown fat do

-heat produced by metabolism of brown fat can increase heat production by 100%

why do neonates need to use brown fat for thermoregulation

because they cannot generate heat by shivering

what is brown fat (and thermoregulation) rapidly depleted by

cold stress

cold stress in neonate

-Increased respiratory rate and oxygen consumption

-Oxygen consumption diverted from brain & cardiac fx

-Result if no intervention is metabolic acidosis & hypoglycemia

when does the first void occur after birth

24 hours- expect one void on first day

when does voiding increase

with increased intake

voiding amount on 5th day after birth

6-8 wet diapers/day

normal urine color for newborn

pale yellow/straw colored

-odorless

pseudomenstruation

may cause red/pink stained diaper

-vaginal bleeding in newborn girls from removal of placental hormones

uric acid crystals in newborn

may see pink urine in diaper

-dehydration

mouth in newborn

normally pink and moist if well-hydrated

what is sublingual frenulum

tongue-tied

sucking as a newborn

mature at 34+ weeks

-assess

what does coordination of suck-swallow-breath improve with

time/practice

is emesis common in newborn

yes initiatelly

-don't overfeed!

stomach size of newoborn

small (7-15 ml/day), increases with age

-more relaxed cardiac and pyloric sphincters

meconium

first stool

-thick, tarry green/black

-by 24 hours of life

what is transitional stool

2-3 day

green/brown

-less sticky

what is milk stool

3-4th day

-yellow/gold and soft in breastfed infant

-pale yellow/light brown and odorous in formula fed infant

meconium photo

milk stool photo

stool types

maternal factors that affect newborn behavior

-labor/birth

-pain meds

-pathology

-bonding

newborn factors that affect newborn behavior

-pain

-physiologic factors

-meds

-bonding

-individual personality

-sleep-wake cycles

-sense

nursing interventions for neonatal behavior

-teach parents to respond to their infants

-teach sleep-wake cycles, waking, calming, and personality and uniqueness of individual infant

physical assessment of newborn

-Maintain temperature

-Undress only as needed - work quickly!

-Assessment requiring quiet first (cardiac, respiratory, bowel sounds)

-Invasive tasks last (temperature, reflexes)

max apgar score

10

apgar score components

-color

-respirations

-reflex irritability

-HR

-muscle tone

apgar score chart

neonatal resuscitation

-initiated right after birth PRN

-nurses and RTs present at birth usually certified

normal temp of newborn

97.7-99.6

normal weight of newborn

2500 - 4000 g or 5 1/2 lb - 8 1/2 lb.

normal length of newborn

45-55 cm (18-22 in)

normal head circumference of newborn

33-35 cm (largest point)

normal chest circumference of newborn

30-33 cm (nipple line)

colors of newborn

pink, tan, jaundiced, cyanosis, circumoral cyanosis, pallor, ruddy, acrocyanosis (normal in the first 24 hours)

acrocyanosis photo

lesions or rashes of newborns

Erythema toxicum (newborn rash); bruising, milia, blisters, petechiae, melanosis

birthmarks of newborns

Mongolian spots (75-80% newborns of color), telangiectatic nevi ("stork bite marks"), hyperpigmentation, hemangiomas; skin tags

hydration of newborns

vernix (white/cheesy), lanugo (soft hair), dry skin, turgor

telangiectatic nevi (stork bite marks)

erythema toxicum (newborn rash)

vernix

mongolian spots

size and shape of head assessment

note molding, skull shape

trauma head assessment

-palpate for caput or cephalohematoma

-bruising or lacerations on face or head

suture lines assessment

palpate for overlaping

fontanels assessment

palpate anterior and posterior for bulging (increased ICP) or depression

-should be flat

mouth assessment

-rooting

-sucking

-tongue

-epstein's pearls

-teeth

-frenulum

-palpate

nose assessment

-obligate nose breathers

-sound

-mucous

-abnormal shape/placement

molding assessment

-shaping of the fetal head by overlapping of skull bones

-resolves within a few days

-creates smaller fontanels

what do fontanels allow for

molding

normal fontanels

flat

bulging fontanels

ICP

depressed fontanels

dehydration

location of fontanels

-Larger anterior (2-5cm)

-Smaller posterior (1-2cm)

how large is the newborn head

1/4 of body length

eyes assessment

-Placement, discharge, sclera color, redness

-Can focus, fix & track

-Lids may be edematous

-Lacrimal glands non-functional for 2 - 3 months

-"Pseudostraubismus"

ears assessment

-Abnormal placement, deformities, cartilage

-Newborn Hearing screen mandatory - (1 in 1000 have hearing loss)

what are retractions and nasal flaring

ABNORMAL

-first sign of respiratory distress

-retractions can be substernal or intercostal

retractions

breath sounds assessment

should be clear and vesicular A/P/L bilaterally

adventitious sounds

-coarse

-rales/rhonchi

-stridor

pulses assessment

femoral and brachial pulses should be equal and strong

what are the pulse ox screen/SHINE test

screening for critical congenital cardiac disease that are mandatory in WI

abdomen assessment

-Inspect cord - 3 vessel, drying, healing, discharge, odor

-Abdominal tone - rounded and protuberant but no distention in normal neonate

-Bowel sounds - active in all 4 quadrants within 1st hour

-Stools - assess frequency, color, consistency

what are the newborn reflexes

-sucking

-rooting

-swallowing

-moro

-palmar grasp

-tonic neck (fencing)

-stepping

-babinski

what is the sucking reflex

turn to suck when mouth/lip touched

what is the rooting reflex

turn to open mouth and search for food with touch of lip/mouth/cheek

swallowing reflex

swallows food

moro reflex

startle; abduction and extension of arms, fingers fan out and form a C

palmar grasp

curls fingers around object in palm

tonic neck (fencing)

arm/leg extend on one side/flex on other

stepping reflex

simulated walking

positive babinski reflex

sole of foot stroked; toes fan out