Family Exam 3

Newborn respiratory system normal

Nose and abdominal breathers, apnea <20 seconds, acrocyanosis

Newborn respiratory distress

nasal flaring, retractions, grunting, stridor, RR 30< or >60, central cyanosis, transient tachypnea

Newborn Shunts

Ductus arteriosus: closes in 24 hours
Foramen ovale: functionally closes in a few days; fully closes in 3 months
Ductus venosus: turns into ligament in 2-3 months

Newborn Cardiac Distress

HR >160, bradycardia, alterations in BP, central cyanosis, unequal/absent/bounding pulse

Cold Newborn Compensation

Flexion, brown fat metabolism, respiratory distress, acidosis, hypoglycemia

Tx: 1 more layer than comfortable for adults

Newborn GI System

Underdeveloped intestional flora=unable to synthesize adequate Vitamin K and folate

Stomach capacity of day 1 is ~10 mL, by day 3 capacity is ~30 mL

Newborn Renal System

Want 1st void in 1st 24 hours, want 2-6 voids in 1st 2 days, urine may have “brick dust” appearance d/t uric acid crystals

Newborn Hepatic System

Poor glucose regulation (eat q 3-4 hrs), extra unconjugated bilirubin can cause pathologic jaundice and brain damage

Newborn Reproductive Abnormalities

All babies have swelling of breast tissue

Male: hypospadias (urethra opening is lower), hydrocele (fluid in scrotum), undescended testes, inguinal hernia

Newborn Skeletal System Abnormalities

Skin: pilonidal dimple (dimple on spine near butt, may suggest spina bifida), nevus pilosis (mole w/hair)

Skeletal: fractered clavicle (normal), hip dysplasia, club foot, xtra fingers+toes

Head: caput (edema of scalp), cephalhematoma (blood on one side of suture lines), subgleal hemorrhage (bleeding all over scalp)

Newborn Integumentary System

Vernix caseosa (cheesy layer over skin, wait 24 hrs before first bath),

Newborn Integumentary System Problems

petechia (hypoxia injury), erythema toxicum (rash, normal, clears in 2 weeks), nevus simplex (birth mark, fades in 2 years)

Newborn Neuromuscular System

Moro (startled reflex), Rooting, sucking, swallowing, tonic neck (neck turn causes arm on same side to extend), grasp, Babinskis, crawling, stepping

APGAR Score

0-3: severe, do compressions

4-6: moderate; suction, oxygen, stimulate

7-10: normal

Newborn Transitions

Stage 1(30 mins): HR 160-180, alert, wanting to feed

Stage 2(60-90 mins): RR rapid and shallow, sleepy

Second Peiod Reactivity (few mins-few hours): tachycardia and tachypnea, increase in muscle tone, increase in mucus, meconium is passed (needs to be within first 48 hours)

Nursing Care

Eye prophylaxisis, Vit K injection, Hep B vaccine, universal newborn screening (heel stick), hearing screen, conNegenital heart disease screen

Circumcision Teaching

Need Vit K injection to perform, may help prevent UTIs/STIs/cancer, provide some pain relief

Gestational Age Ranges

Premie: <37

Late premie: 37-38

Term: 40

Post-term: 41+