OB ch 15 PowerPoint

Who is the first professional to physically examine and initiate care of newborn?

The nurse

Apgar scale

Provides a quick method of assessing the newborn to determine if any emergency interventions are needed

• if possible conduct the observation portion of the assessment before touching the newborn. There should observe, infant position, sleep, or cycle, skin, color, respiratory pattern.

• Vital signs

• Measurements: length, head and chest circumference

Acrocyanosis

• Bluish color of hands and feet due to immature peripheral circulation

• first 24 to 48 hours after birth

peteciae

Tiny pinpoint bruises from delivery. Scalp, forehead, cheeks.

skin turgor

Indicates adequate hydration. Gently pinched skin on thigh or chest.

Creases on hands and soles of feet if absent

Could indicate a motor defect

Lanugo

fine downy hair

vernix caseosa

White protective coating on skin

strawberry hemangioma

newly formed capillaries in dermal and subdermal layers of skin. Usually no medical intervention requires unless larger than 5 cm. Gradually fades away over a few years.

nevus flammeus

Port wine stain; dilated skin capillaries. Frequent on face.; red to purple color. Will not fade on its own.

nervus simplex

Stork bite, angel kiss. No treatment required, usually fades by 18 months.

Melanocytic nevi

Moe, uncommon in newborn. Hair may be present. Hairy Nevis noted along the base of the spine could indicate a spinal bifida congenital spine abnormality. Report any nevi noted.

erythema toxicum neonatorum

newborn rash; macules, papules, or vesicles on body

• Rarely last less than seven days

Acne neonatorum

Clogged hair follicles

Milia

Occluded sebaceous gland, look like tiny, white papule. Nose, chin, cheeks, forehead.

Dermal melanosis

• mongolian spot; trapped melanocytes

• common finding in infants of darker skin. Located on the back or buttocks. Can be mistaken for a bruise.

Cyanosis could be caused by

Cardiovascular or respiratory problems Report !!!!!!!

Thin skin with abundant lanugo could indicate

Prematurity Report !!!!!

Meconium staining may be caused by

Hypoxia in the uterus before birth Report !!!!!!

Poor skin turgor may be caused by

Dehydration Report !!!!!!

pallor could be caused by

Anemia or hypothermia Report !!!!!

Head assessment

• Note appearance, shape, circumference, suture lines

• overridden sutures are normal findings that result from molding and resolve spontaneously. The molding or "cone head" appearance resolves within 3 to 5 days after birth.

Cephalohematoma

Swelling on head, does not cross suture line - will resolve over days or weeks as the blood is reabsorbed

caput succedaneum

Swelling of scale - crosses the suture line - decreases over a few days

Fontanel

Saw spot, fibrous membrane that lies between bones of cranium

anterior fontanel

Closes by 18 months of age

posterior fontanel

Closes by two months of age

Eye assessment

• examine for symmetry

• Document and report the following abnormal findings

• Yellow or red sclera

• any exudate noted in the eyes

• Drooping and eyelids

Ear assessment

• Note: Size shape, and location

• abnormal findings:

• Any abnormal anatomical, newborns lack of response too loud noises

Abnormal nose, assessment findings that you must report

• Obstructed nasal passages

• Discharged that is not clear

• Anatomical abnormalities

• Nasal flaring

Abnormal mouth assessment findings that you must report

• Mucus membranes that are not pink

• Excessive bubbly saliva

• Absent suck reflex

• A hole in the palate

Gynecomastia

Breast enlargement from maternal hormones

Abnormal chest assessment findings that you should report

• Any normalities in the placement or size of the nipples

• Any variation in Chess size from the norm, either two large or too small

• Any purulent or bloody discharge from the nipples

Periodic breathing

Breathing pattern is irregular and can pause breathing for 5 to 15 seconds

What kind of breathing will the infant have the first 24 hours?

Wet sounds, such as crackles

Retractions

Skin pulling around ribs and sternum with difficult inhalation

Apnea

Cessation of breathing > 20 seconds

Bluish nailbeds

Indicates decrease oxygenation

Respiratory rate

30-60 bpm

Heart sounds

Normally fast right. Use a pediatric stuffless scope.

• assess peripheral pulses for quality and equality. Should match apical pulse.

Capillary refill

3 seconds

Bowel sounds

Osculate before palpate. Should hear 1-2 hrs of birth.

Umbilical stump

Should be white and gelatinous. Three vessels, two arteries and a vein.

pseudomenstruation

Mucus and blood changed vaginal discharge.

• May be present for a few days until the level of maternal hormones in the newborn decreases

Inspect male penis

Midline and straight, urethral opening in midline. The scrotum will be large and loose with dark appearance because of maternal hormones. Testes usually descend in third trimester.

Urinary output

Should urinate within 24 hours of birth

Ambiguous genitalia

May have under developed external genitals, or may have both male and female characteristics. These observations should be reported to the HCP immediately.

Immature at birth

Jerking, twitching is normal

• tremors are not a normal finding

A high-pitched cry can indicate

Increase in intracranial pressure

Resting posture

• Flexed with good muscle tone

• Limbs should be inspected for symmetry, weapon, range of motion, length, and number of digits

• hips, assess for dysplasia

• one leg may appear shorter than the other, and the thigh and butt top folds do not match

• spinal cord and back for curvature and asymmetry

Neonatal Infant Pain Scale (NIPS)

used for Infants < 1 year

Medication's for the newborn

Vitamin K, Erythromycin ointment, Hepatitis B vaccine

Estimate gestational age

Ballard's tool

Ballard's tool

The scores from the neuromuscular activity assessment and physical maturity assessment, or combined to classify the newborn as pre-term, term, or post term

Bath

• Removes blood and body fluids

• Sponge, bathing, small tub, bathing, large tub, or immersion, bathing, swaddling immersion, bathing

Newborn screening

Conducted for genetic, metabolic, endocrine disorders, infectious diseases, hearing loss, and congenital heart disease

Phenylketonuria (PKU)

The first screening test developed for newborns, and even though the modern blood test screams for 26 to 40 different disorders, it is still commonly referred to this name

Techniques to obtain blood specimen

• primary tested by blood samples obtain from a heel stick at least 24 hours after the first feed him

• samples are placed on a special filter paper and sent to the State lab

Congenital heart defect screening

• 24 hour or older infant

• Uses pulse oximetry probes

Noninvasive hearing screen

• Easy to perform in the newborn nursery

• Scored as a pass or a fail

• If the infant does not pass the first time, most hospitals, repeat the one final test before discharge.

• the HCP must be notified of the infant failed the hearing screen on the 2nd attempt

Discharge teaching for newborn care

• Focus on safety when teaching parents

• Use of the bulb syringe

• car seat safety

• trimming nails

• Diaper rash

• Unbilical cord care

• circumcision

• clothing

• Swaddling

• Sponge bath

• Skin care

• Education on follow up after discharge

Breast-fed babies feeding times

2-2 1/2 hrs

Bottle fed Feeding times

3-3 1/2 hrs

Positioning and Holding

Cradle hold, Football hold

Clothing

Hypoallergenic detergents

Hypoallergenic detergents; Don't overdress - one layer more of clothing than parent. Cap on head.

Swaddling

Wrapping the baby to provide security and warmth. It is recommended to discontinue when the baby is around two months old.