RE

Module 5 High Risk Newborn

Notes

  • VEAL CHOP

    • vARIABLE DECEL

    • eARLY DECEL

    • aCEEL

    • LATE

  • Chop

    • Cord

    • Head

Powerpoint

  • Fetal Cirulation

    • The lungs are fluid filled causing high resistance and is more likely go to the dutus ateerious to aorta

    • When the umbilical cord is cut and 6-8 pulmonary vascular resistances go to nomrla

    • Foramen valley in 3 months it closes

    • Ductus venosus is closed when older

    • Umblincal lan and umbilical ateriole become ligament

  • Know you medication

    • Post birth you can put surfactant into the lungs using ET tube

  • Assessment

    • 30 to 60 per minutes regular

    • Ireggualr is shallow, unlabored, short period fo apnea

  • Neonatal Respiratory Support

    • Suctions

      • Bulb

      • Delee: Deeper suction

    • Poistioning

      • Sniff position: Hvaing head back of baby

    • O2 Adminstration

      • Bag/mask

      • Blow by: Oxygen being delivered on just side of the baby

      • NS

    • Intubation

      • Surfactant administration

  • Immediate newborn period

    • Golden hour to make sure there is skin and skin contact with mom

    • Ensuring proper identification

    • Adminstered medication

      • Arithromizen to prevent ghonnerea

      • Shot of Vitamin k on vatus lateriuls and giving coagulation factors

  • Temperature

    • Risk for hypothermia since there is high body surface to mass ratio and blood vessels

    • They don’t shiver and have brown fat

  • Thermoregulation of the new born

    • Heat loss

      • Evaporation : Body surface moisture evaporates pulling away eheaet

      • Conduction: Heat loss to cooler surfaces touching skin

      • Convection: Heat loss form cool air drafts

      • Radiation: Heat loss to cooler objet not in contact with skin

  • Cold Stess

    • Causes acidosis, hypoglycemia and reopening of fetal circulation

  • Keep mom and baby cold

  • Elimination

    • Stomach capacity of neonate about 5 to 10 mL at birth and increases to 60 mL with int he first weak

    • Infants should be fed on demands

      • Every 2-3 hours

    • Meconium is passed within the first 24 hours and is thick, dark green and tarry

    • By the end of the first week the stool of breastfed infant is yellow and seedy and ispassing 4 to 8 times per day

  • Integumentary

    • Acrocyansosis is normal up to 24 hours after birth

    • Caput is soft swelling at top of heads crosses suture line

      • Is like a huge pimple blood filleded

    • Molding changes in shape of head due to sutures in order to fhit through birth naal

    • Cephalohematoma which is collection of blood in sclap

      • Blood near scalp might be slightly enlarged

    • RBC

  • Jaundice

    • If levels are high then phottherpay will be needed

  • Milia: White paules

  • Erythema toxicum newborn

    • Papules or pustules on the skin and clear in 2 weeks

  • Mongolain Spots/ Congential dermal melanocytosis

    • Blue gray spots on lower back buttocks

    • Pigmenetation. 80% non caucasion and 20% caucasian babies

  • Port wine stain

  • Stawberry Hemagona

  • Natal Teeth

  • Epstein pearls: Whtie papule on palate and gumes

  • Thrush: Yeast infection

  • Lanugo: Hair all over baby

  • Newborn Assessment

    • Apgar assessment done immediately after birth at 1 minutes and 5 minutes and informs clinicians of infants status

      • Score 0-2. ( Higher the better)

        • Categories: Appearanc,e pulse, grimace, activity, respiration

    • Gestational age assessment is the evaluation of an infants physical and neuromuscular

  • Vitals

    • Temp:36.5 - 37.2

    • Pulse 120-160

    • 30 to 60 breaths per minutes

    • BP isn’t done during routine assessment

    • Weight, lengths, heads, chest circumference

      • Symetricals and bareel shap

    • Inspect integumentary

  • Physical Assessment

    • Head: molding and caput is common

    • Eyes and nose are symmetrical and eqya

    • Ears should be alightes with corner eyes to sop of ear

    • Males: Makes sure testes palpable within the scrotum

    • Female genitalia:

  • Reflex

    • Rooting

    • Sucking

    • Babinski

  • Respiratory distress

    • Tachynpea

    • Nasal flare

    • Retraction

      • Collapse of soft tissue

        • Supra

        • Intercostal

        • Substernal

    • Grunting

      • Closure of the glottis

        • Low pitch and deep in the throat

    • See saw breathing

      • Rocking motions of chest and abdomen

    • Head pooping

  • Factors affect fetal growth

    • Maternal nutrition

    • Genetic

    • Placental Function

    • Environmental Factors

  • Birth Weugth Varuation

    • Low birth weight : Infant weighing

      • <2,500 g or 5.5 lb

    • Very low birth weight: Infant weighing <1,500 g or 3 lbs and 5 ozs

  • IUGR: Symmetricla vs Asymmetricla

    • Asymmetrical is better since It doesn’t affect the brain but rather the body

  • SGA

  • LGA

    • Large body, plump, full

    • Proportional increase in body size

    • Poor moto skills

    • Difficulty regualting behavioral states

  • LGA common problem

    • Birth trauma, hypogltcemia, polycythemia, hyperbilirubin, jaundice

  • Acquired disorders

    • Occur at , or soon after birth

    • Problems or condition experienced by the woman during her pregnancy

  • Nursing management for distress syndrome

    • Do anitbbodtics early since they can progressive really fast

  • Muconium aspiration syndrome

  • Necrotiziing Enterocolitis

    • Three patholigc mechanism: Bowel ischemia, bacterial flora an effect of feeding

    • S/S

    • : abdominal distention, tenderness, bloody stools

  • Hyperbilrubinemia

    • Whe jaundice get really bad we are worried about kernicterus

  • Esophageal Atresia Tracheoesophageal Fistula

    • Three C: Choking, coughing and cynsoiss are the classic signs of tracheoesophageal fistula and atresia

  • Omphalocele and fastroschisis

    • Put most sterile gauze

  • Imperforate Anus