maternal newborn mod 4 pt 2

1st period reactivity

birth- 30min, HR increases 162-180, hen decreases, spontaneous startles, crying =, head movement

period of drecreased responsiveness (2nd pr.)

30-100 min lasts 60-100 min, pink, shallow/rapid breathing, up to 60/min, sleeps, decreaed motor actibty

2nd period of reactivity

2-8 hours after birth lasts 10min-several hour, tachycardia, tahcypnea, passes meconium, increased muscle tone, skin=color chnages, incfreased muscous

resp system

30-60 breaths per minute, shallow/irregular breatsh, periods of apnea normal but greater than 20 secs= abnormal), nose breather (surfactant= lines alveloi, essential for lung expansion)

resp distress signs

nasal flaring, intercoastal/subcostal retractions, grunting, persistent tahcypnea, color changes, central cyanosis (blue lips), acrocyanosis (blue limbs= normal for first 24hours)

cardiovascular system

pressure in right atrium decreases, left increases, lungs expand, pulmonary blood flow increases, functional closure of foramen ovale, cardiac output nealry nealry doubles, increase blood flow to lungs, heart, kidneys, gi tract, norm heart rate 120-160 (apical impulse= 4th intercoastal space left of midclavicular line)

after cord clamping

umbilical arteries, umbilical vein, oluctus venous, functinally close and become ligaments oiver 2-3 months

delayed cord clamping

is recommended 30-60 secs unless medically advised not to

persistent tachycardia associated with

anemia, hyporvolemia, hypothermia, sepsis,

vitamin k

injection is routine to help prevnt bleeding bc clotting factors are decreased

Thermoregualation

blanket, cap, avoid drafts (convection), bassinet away from windows/cold surfaces (radiation), dry newbron immediately, limit bath time (evaporation), pre-warm surfaces, radiant warmer (conduction) (evaportaion most signifcant cause of heat loss during first few days)

non sivering thermogenesis

generates heat though: increase metabolic activity, primary brown fat, cold stress cause: increase oxygen consumption, increase energy use, energy away from brain/heart function and growth, brown fat stores can become rapidly depucted

hyperhtermia

greater than 99.5, sepsis or decreased heat loss

renal/fluid balance

first few days: 15-16ml , after day 4: 6-8 voids daily, urine should be pale straw colored, day 1-2: 60-80ml of fluid, day 3-7: 100-150ml, day 8-30: 120-180ml

stool progres

meconium: 1st stool, green-black, thick/tarry/sticky, shpuld pss within 12-24 hours, transitional: usually by day 3, green-brown →yellow brown, thinner, less sticky, Milk stool: by day 4. by day 5-1month: 6-8 wet diapers/day, 3 stools /day

Hepatic sys

glucose=initially drops from fetal 70-90 to 50-60 during first 30-90 minutes (hypo signs: jittery, lethargy, poor feeding, seizure) (treatment= fedding)

juandice/hyperbilirubin

bilirubin= from RBC breakdown, yellow skin= bilirubim will be 6/7, manage= feeding (1-2hrs after birth, at least every 8hrs-12hrs), colostrum acts as laxative→ eliminates bilirubin

phototherapy for jaundice

goal: decrease bilirubin, light chnages the form of bilirubin→ eliminated by urine or stool, begins to decrease within 4-6 hrs, may decrease 30-40% within 24hrs (exchnage transfusion if phototherpay not effective)

immune system

at risk for infection, newbron with infection may not have a fever (hypothermia), s/s: hypothermia, temp instability, lethargy, irriatbaility, poor fedding, vomitting/diarrhea, decreased reflexes, pallor/mottled skin, apnea

integumenatry sys

vernix caseosa→ white cottage chesse coating, helps with thermoregulation hydration, etc., no baths within 24hrs, dont agressively wash off

normal skin findings

acrocyanosis, lanugo, milia (small whjite galnds on face), desquamation(blue/balck pigmenation on back/butt, DOCUMENT), nevus/salmon patch/stork bite/angel kiss(red patch from superficial defect occurs in 80% of newborns)

reproductive system

female: mom decrease estrogen= vag discharge. slight bloody show= pseudomenstruation= normal, vernix may be present between labia= do not remove, Male: hypospadias: urethral opening on ventral surface= do NOT circumsize, epispadias: urethral opening on dorsal surface= no circumcision, undesceded tstes: cryptorchidism, in preterm infnats, often descent without interventions Both: breast tissue enlargemtn and thin nipple dischateg= do not squeeze

skeletal system/brain injurt

caput succedaneum: scalp edema, crosses suture lines, disappears in 3-4 days, cephalohematoma: blood between skll and periosteum, does NOT cross suture line, occur with vaccum delivery, subgaleal hemorrhage: bleeding in subgakeal space, associated with traction/shearing forces, and with difficult operative birth/vacuum extraction

extremeties/hip assessment

oligodactyly=missing digits, polydactyly: extra digits, syndactyly: fused digits (developemnt of dysplsia of hip= common with breech) (signs: unequal knee levels, positive ortolani, positive barlow)

neuromuskular sys

jitterness=normal, seizure= continuous with attempts to stop and resistence, eye deviation, staring, apnea, tachycardia, pupil chnages, increase salvation

newborn reflexes

rooting, sucking, palmar grasp, plantar grasp, tonic neck/fencing, moro, stepping/ waling, crawling, babinski

physiological/autonomic regulation (behavirola org)

HR, RR, tmep

motor reg (behavirola org)

cpntrols random movement, improves tone, decreases excessive activity

state regulate (behaviorl org)

cpntrols.modulates consciusness

attention/social intercation (behaviorl org)

attends to visual/auditory stimuli, stays alert, social intercation

Brazelton neonatal behaviroal assess scale

interactive exam, assesses infant repsonse in 28 areas organized in clusters

newborn sensory capabilities

vision: pupils react to light, blink reflex, corneal reflex, accomadation cannot be assessed at birth, can see object 50cm away, hearing: hear/differentiate sound, turn toward sound, routine hearing screen befroe discharge, smell: highly developed, can detect moms smell by day 5, tatse: can distunguish taste, prefers sweet, touch: sensitive face, mouth, hands, soles of feet

Newborn VS

Temp- axillary- 97.7-99.5 (36.5-37.5), RR- 30-60, HR- 120-160

Measurements

weight: 2700-4000g (6-9 lbs), head circumfirance: 32-36cm, legth: 46-56cm (18-22in), Ballard score: estimate gestational age, assess infant as young as 20 weeks, initail assessment recom within first 48 hours

Habituation

decreased response to repeated/constant stimulus

consolability

ability to be consoled

cuddliness

response to being held/cuddled

irritability

how easily infant becomes upset

crying

communication of hunger, discomfort, pain, attention needs, fussiness

If newborn is term and stable (immediate care)

dry, stimulate, immediate skin-skin, remove wet linens, warm blankets, apply cap, assess resp effort, HR, oxygenation

if newborn is preterm or unstable (immediate care)

assess/intervene under warmer, stablize before skin-skin, may require NICU transfer

initail assessment after birth

physcial assessment and APGAR

AGA (classifcation by size/gest age)

Appropriate for gestational age, birth weight 10th-90th percentile

SGA (classifcation by size/gest age)

small for gestational age, birth weight <10 percentile, suggest restricted intrauterine growth

LGA (classifcation by size/gest age)

large for gestational age, suggests accelerated intrauterine growth

Early term

37 weeks through 38 weeks, increased risk for→ hypogylcemia, respiratory distress, transient tachypnea, NICU admission

Late preterm

34-36 weeks increased risk→ respiratory distress, temperature instability, hypogylcemia, apnea, feeding difficulties, hyperbilirubinemia,

Post term

>42 weeks, increased risk→ fetal/neonatal mortality, placental insufficiency, macrosomia, meconium aspiration, fetal distress

common newborn birth injuries

retinal hemorrhage, subconjuctival hemorrhage, erythema, ecchymosis, petechiae, abrasions, lacerations, edema, forceps bruising, vacuum bruising

subconjunctival retinal hemorrhage

from increased pressure during birth, usually clears in around 7-8 days

forceps can cause

can produce linear marks on both sides of face

breech can cause

bruising/swelling may occur over butt/genitalia

c section can cause

accidental superficial lacerations can occur

hypoglycemia

lower than normal limit (70-90) around 40-45 (healthy newborn may drop as low as 30 during first 1-2 hours, then mobilize fatty acids/ketones), signs: jitterness, poor fedding, abnormal cry, hypotonia, temp instability/hypothermia, respiratory distress, apnea, seizures (stable well appearing newborn- ealry frequent oral feedings are suggested)

Heel stick

used for many blood tests, detects genetics diseases early, includes screening for: genetic/endocrine/metabolic/disorders, PKU, hearing, critical congenital heart disease, warm the foot

prevent abduction (infant sfatey)

parents should: identify anyone removing the baby, know facility identification systems, security systems may include bracelets, alarms, badges, cameras, etc.

prevent falls (infant sfatey)

newborn falls can cause : head injury, skull fractures, risk factors: maternal opioids, maternal exhaustion/lightheadedness, c section, breastfeeding, falls commonly occur: early morning, 2n/3rd postpartum night

Circumcision methods

gomco clamp, mogen clamp, plastibell

Gomco/mogen clamp (circumcision)

foreskin surgically removed, petroleum gauze dressing initially, parents apply petroleum with diaper changes for 7-10 days

Plastibell (circumcision)

plastic bell remains approxiamelty 5-7 dyas, falls off after healing, petroleum not applied after plastibell

with crcumcisions report any

bleeding, infection, decreased urine output

Circumcision importnat

hypospadias/epispadias→ NO circumcision; urology refferal

neonatal pain can cause changes in

HR, BP, intracranial pressure, respiratory rate, tidal volume, oxygen saturation, vegal tone

behavioral signs of pain

crying/voca