Week 2- Physiological Transition and Needs of the Normal Newborn

CH 17, 18, 25 (pg 924-928 & 931 Box 25.2)

What are the big changes the infant will experience from their intrauterine environment to their extra uterine environment?

Intrauterine is a fluid-filled, high pressure system

Extrauterine is air filled low pressure system

what is the major cardiovascular adaptation that takes place for a newborn after birth?

change from placental to pulmonary gas exchange and the switch from fetal to newborn circulation

what is the normal range for hemoglobin in a newborn?

16-18 g/dL

what is the normal range for hematocrit in a newborn?

46-68%

what is the normal range for platelets in a newborn?

150,000-350,000/ microliter

what is the normal range for red blood cells in a newborn?

4.5-7.0 (1,000,000/ microliter)

what is the normal range for white blood cells in a newborn?

10-30,000/mm3

How can nurses help babies take their first breath?

External stimuli ← usually tactile AKA vigorous rubbing

what is the role of surfactant?

surface tension reducing lipoprotein that prevents alveolar collapse

what is considered normal for a newborn respiratory assessment?

30 to 60 breaths per minute; irregular, shallow, unlabored; symmetrical chest movements

Note: apnea is defined as the absence of breathing for longer than 20 seconds (p1452).This is not normal.

What events lead to the maintenance of Respiratory Function?

1. Initiation of respiratory movement- Expansion of lungs, Establishment of functional residual capacity

2. Redistribution of cardiac output to increase pulmonary blood flow

What are the dangerous respiratory signs in an newborn?

1. Apnea

2. Tachypnea

3. Cyanosis

4. Grunting

5. Retractions

6. Nasal flaring

What are the characteristics of newborns that predispose them to heat loss? 9()

1. Thin skin; blood vessels close to the surface

2. Lack of shivering ability

3. limited stores of metabolic substrates (glucose, glycogen, fat)

4. Limited use of voluntary muscle activity

5. Large body surface area relative to body weight

6. Lack of subcutaneous fat

7. little ability to conserve heat by changing posture

8. No ability to adjust own clothing to achieve warmth

9. Infants cannot communicate that they are too cold or too warm

what is the normal temperature range for newborns? What is the normal route for taking a newborns temperature?

97.7-99.5F axillary

what is conduction?

transfer of heat from object to object when the two objects are in direct contact with each other

What is convection?

flow of heat from body surface to cooler surrounding air or to air circulating over a body surface

What is evaporation?

loss of heat when a liquid is converted to a vapor

What is radiation?

loss of body heat to cooler, solid surfaces in close proximity but not in direct contact

What is the most important intervention for cold stress?

PREVENTION! Don’t let baby get cold!

How does bilirubin accumulate in pathological jaundice?

overproduction

How does bilirubin accumulate in physiological jaundice?

decreased conjugation

How does bilirubin accumulate in biliary duct issues?

impaired excretion

how much weight do infants lose in the first few days after birth?

5-10% of body weight

Why are babies susceptible to regurgitation?

stomach nervous control and cardiac sphincter control are immature which causes regurgitation and uncoordinated peristaltic activity

what is meconium?

1st stool; tar-like, sticky, black stool

what does the stool of breast-fed newborns look like?

yellow-gold, loose, stringy to pasty, sour-smelling but less odorous than other kind (almost sweet smelling)

what does the stool of formula-fed newborns look like?

yellow to yellow-green, loose, pasty, or formed, unpleasant odor

how long should it take for an infant to pass their first stool?

within the first 24 hours is ideal but can take up to 48 hours

How many voids should the baby have per day?

6-8

What is natural immunity?

physical barriers, chemical barriers, and resident nonpathologic organisms

what is acquired immunity?

development of circulating immunoglobulins; formation of activated lymphocytes

what is a good source of acquired immunity for newborns?

Breastmilk

What are the main functions of the skin? (3)

1. Protection (harmful agents, physical trauma, water loss)

2. Thermoregulation

3. Fat storage

what is the least developed sense when babies are first born?

vision

What patterns does neurological development take place in?

cephalocaudal and proximal-distal patterns

What occurs during the first period of reactivity?

newborn is alert, moving, may appear hungry

Good time to breast feed and golden hour for skin to skin

when does the first period of reactivity take place?

birth to 30mins to 2hrs after birth

When does the period of decreased responsiveness take place?

30-120 minutes old

what takes place during the period of decreased activity?

Sleep, decreased activity

When does the second period of reactivity take place?

2-8 hrs after birth

What occurs during the second period of reactivity?

newborn awakens and shows an interest in stimuli

Feeding #2 takes place now

what is orientation? (Newborn behavioral response)

Response to stimuli

what is habituation? (Newborn behavioral response)

Ability to process and respond to auditory and visual stimuli; ability to block out external stimuli after the newborn has become used to activity

What are the social behaviors of a newborn?

Cuddling and snuggling

What are the critical adaptations that take place in the transition from fetus to newborn?

1. Initiation of independent respirations

2. Circulatory changes- closure of fetal shunts

3. Thermoregulation and glucose stabilization

4. Establishing feeding, elimination, and physiologic homeostasis

what are the nursing priorities during the newborn transitional phase? (5)

1. ABC’s

2. Temperature regulation

3. Early bonding

4. Feeding

5. Prevention of complications

what are the nursing priorities in the care of a newborn? (3)

1. Establish airway

2. Provide warmth

3. Assess frequently

   1. Respiratory Status

   2. Activity- flexed? Mvmt?

   3. Perfusion

   4. Position/time

how do nurses provide warmth to infants?

1. Drying infant

2. Place on mom’s abdomen/chest “skin to skin”

3. Wrap the baby in a warm blanket

4. Place a cap on the baby’s head

5. If using a radiant warmer, no clothes on infant- decrease barriers

What are some signs that indicate a problem for the infant?

1. Nasal flaring

2. Chest retractions

3. Grunting on exhalation

4. Labored breathing

5. Generalized cyanosis

6. Flaccid body posture

7. Abnormal breath sounds

8. Abnormal respiratory rates

9. Abnormal heart rates- too high = initial compensation; too low = fatigue from efforts to compensate

10. Abnormal newborn size

What does APGAR stand for?

Appearance (color)

Pulse/HR

Grimace (reflex irritability)

Activity (muscle tone)

Respiratory effort

what is the purpose of the APGAR score? (2)

1. standardized, quick method to determine the newborn’s physiologic status

Does not guide resuscitation

2. Allows objective communication amongst providers

What is a normal newborn temperature?

97.7-99.5 degrees F

What is a normal newborn HR?

110-160 bpm

Can increase with crying

Can decrease with sleep

What is a normal newborn RR?

30-60 breaths/min

Can increase with crying

What is a normal newborn BP?

50-75 systolic

30-45 diastolic

what is a preterm or premature gestational age (in weeks)?

prior to 37 weeks gestation exactly

what is a term gestational age (in weeks)?

38-42 weeks gestation

what is a post-term or post-dates gestational age (in weeks)?

after 42 weeks gestation

what is a postmature gestational age (in weeks)?

after week 42 of gestation with signs of placental aging

Often are induced before this point

what is small for gestational age (SGA)?

less than 10th percentile for gestational age or less than 5lb 5oz

what is appropriate for gestational age (AGA)?

About 7.5lbs on average

5lbs 5oz < baby < 9lbs or 90th percentile for gestational age

what is large for gestational age (LGA)?

greater than 9lbs or higher than 90th percentile for gestational age

Often diabetic

What are the priority nursing interventions for the immediate newborn period?

1. Maintaining airway patency

2. Ensuring proper identification

3. Maintaining thermoregulation

4. Administering prescribed medications

   1. Vitamin K

   2. Eye prophylaxis - usually erythromycin

what is vernix caseosa?

Cottage cheese like substance

What is lanugo?

peach fuzz

what is milia?

Newborn acne

What is erythema toxicum?

newborn rash

What are Mongolian spots?

Bruise like spots

What is molding?

”conehead” that occurs as a result of passing through the pelvis

What is caput succedaneum?

Edema in scalp

what is a cephalohematoma?

accumulation of fluid and blood

what is microcephaly?

small headW

What is macrocephaly?

large head

what can bulging fontanelles indicate?

increased ICP

what can sunken fontanelles indicate?

dehydration

what is torticollis?

an abnormality in which the newborn’s head is not midline with the rest of the body

when can bowel sounds first be auscultated in a newborn?

1-2 hr after birth maximum; note: if the infant passed meconium stool in utero bowel sounds can be heard during first assessments directly after birth

What does post-circumcision care entail? (6)

1. Applying Vaseline gauze to prevent adherence to the diaper

2. Assess bleeding q30min for at least 2hr

3. Assess for and document first voiding post-op

4. Pain management

5. Observe for s&s of infection- REEDA

6. Assess for swelling ← risk for urinary obstruction

How is pain management achieved in newborns for circumcisions? ()

1. Swaddling

2. Nursing

3. Emla cream

4. Sucking on oral glucose (ex. Sweetums)

5. Penile nerve block

what is the rooting and sucking reflex?

upon touching or stroking their cheek or the corner of their mouth, the infant turns their head toward the stimulus and opens their mouth, preparing to feed

What is the Moro/startle reflex?

an involuntary reaction in newborns where they suddenly extend their arms and legs, spread their fingers, and then quickly bring their arms and legs back to their body, often accompanied by a cry

what is the tonic neck reflex?

head and arm extends to go in the same direction

what is the fencing reflex?

flexion of opposite arm that occurs during the tonic neck reflex?

What is the palmar reflex?

a newborn's involuntary response to an object in its palm, causing the fingers to close in a grasp

what is the babinski/plantar reflex?

a normal, primitive reflex in infants where the big toe moves upward (dorsiflexion) and the other toes fan out when the sole of the foot is stroked

what is the stepping reflex?

an instinctive response that makes a baby appear to walk when held upright with their feet on a flat surface

what are the Barlow and ortolani maneuvers used for?

Checking for hip problems

what is syndactyly?

2 or more digits that are fused together

Can be fingers or toes

What is polydactyly?

extra digits

what should be done if polydactyly is observed? Outcomes?

Assess for bones!

If present- extra digits must be surgically removed

If not present- digits are sutured around to cut of blood supply and then necrosis takes place and the digit will fall off on its own