The quiz will primarily cover week 5 pages in the workbook and chapter 12 in the Leafer textbook.
Pay close attention to circumcision care information, specifically a purple box on pages 302 or 303 in chapter 12.
Thermoregulation and Heat Loss
Four Types of Heat Loss:
Evaporation: Drying the baby immediately after birth minimizes heat loss.
Radiation: Avoid placing the baby near air vents, cold walls, windows, or exterior walls.
Convection: Prevent air drafts across the baby's body.
Conduction: Do not place the baby on cold surfaces.
Managing heat loss is crucial for the newborn's ability to breathe and regulate bodily functions.
Remove any wet items from the bassinet.
Newborn Vital Signs
Respiratory Rate: 30-60 breaths per minute (listen for a full minute).
Heart Rate: 110-160 beats per minute.
Temperature: Same as adults.
Report any vital signs that fall below or rise above the normal ranges.
Blood pressure is not routinely taken in healthy newborns, only in preterm infants in the NICU.
Hypoglycemia
Once the umbilical cord is clamped, the baby no longer receives glucose from the placenta.
The baby uses the last of the sugar from the placenta until feeding begins.
Hypoglycemia is defined as a blood glucose level lower than 45dLmg, typically around two hours after birth.
Feeding:
Breastfed babies can be fed immediately after birth (within the first hour).
Formula-fed babies are typically fed 3-4 hours after birth, unless hypoglycemic.
Signs of Hypoglycemia:
Lethargy.
Poor suck.
Jitteriness.
Respiratory difficulty.
High-pitched cry.
Seizures.
Newborn Medications
Administered within the first hour of birth:
Vitamin K: Assists in blood clotting; given via intramuscular injection in the vastus lateralis muscle.
Erythromycin: Broad-spectrum antibiotic ointment applied to the lower inner canthus of both eyes to prevent newborn conjunctivitis caused by potential gonorrhea or chlamydia.
Hepatitis B Vaccine: Recommended first dose given in the hospital.
Assessment for Respiratory Distress
Persistent Cyanosis: While some duskiness is normal initially, the trunk and head should turn pink as the baby breathes. Acrocyanosis (blue hands and feet) is normal for up to 24 hours due to incomplete closure of cardiac shunts.
Signs of Respiratory Distress:
Grunting.
Nasal flaring.
Retractions (sternum retracting towards the spine).
Other Indicators:
Sustained respiratory rate higher than 60 breaths per minute.
Sustained heart rate greater than 160 beats per minute or less than 100 bpm.
Inability to maintain normal temperature.
Neurological Assessment: Newborn Reflexes
Assesses the central nervous system as the baby adjusts to extrauterine life.
Moro Reflex (Startle Reflex):
Elicit by bumping the crib or briefly releasing the baby's arms.
The baby should extend arms and legs and then bring them back into the body.
Absence may indicate neurological abnormalities.
Rooting Reflex:
Stroke the baby's cheek, and the baby should turn towards that side.
Important for breastfeeding.
Palmar Reflex:
The baby will grasp anything placed in the palm of their hand.
Plantar Reflex:
The toes curl down when pressure is applied to the sole of the foot.
Babinski Reflex:
Stroke the baby's foot from the heel up to the big toe, and the toes should flare out.
Present throughout the first year of life.
Sucking Response:
Evaluated to check for weak suck (especially in preterm or near-term babies).
Assesses the frenulum (connective tissue under the tongue) to ensure it is not too far forward, which can affect breastfeeding.
Head Assessment
Molding:
The head's ability to conform to the mother's pelvis during the second stage of labor.
Parietal bones can slide over each other; the nurse may feel a ridge.
Cephalohematoma:
Collection of blood under the scalp, on one side of the head.
Located beneath the periosteum.
Does not cross the suture line.
Caput Succedaneum:
Generalized swelling over the entire head.
Caused by pressure during delivery.
Common in prolonged pushing or when the baby fits tightly in the pelvis.
Fontanelles (Soft Spots):
Anterior Fontanelle:
Located at the front of the head.
Diamond-shaped.
Remains open for 12-18 months to accommodate brain growth.
Used to assess dehydration (sunken) or increased intracranial pressure (bulging).
Posterior Fontanelle:
Located at the back of the head.
Triangular-shaped.
Usually closes within 8-10 weeks.
Skin Changes
Vernix Caseosa:
Thick, yellowish, cold cream-like substance protecting the baby's skin in utero.
More prevalent in preterm babies; found in creases of full-term babies.
Advise parents not to scrub it off; it will come off with gentle bathing.
Milia:
Small white dots on the baby's nose and cheeks.
Plugged sebaceous glands.
Disappear within a couple of weeks.
Mongolian Spots:
Bluish or greenish discolorations on the back and buttocks (may appear elsewhere).
Common in babies of Mediterranean descent, brown or black babies.
Document their presence; they typically fade over time.
Nevi (Strawberry Marks):
Common for white babies and typically found on the forehead or back of the neck
Fades over time.
Feeding the Newborn
Weight Gain: Baby should gain 4-7 ounces per week for the first six months.
Weight Milestones: Birth weight doubles by six months and triples by the end of the first year.
Diapers: Expect 6-8 wet diapers per day (combination of urine and stool).
Sleep: The baby should sleep several hours after feeding, indicating sufficient intake.
Pediatric Visits: Regular weight, length/height, and head circumference measurements.
Avoid force-feeding or overfeeding.
Introduce iron-fortified rice cereal (or appropriate solid food) between 4-6 months to replenish iron stores.
Breastfed babies may lose more weight (5-10% of birth weight) in the first week.
Breastfeeding Moms:
Colostrum is produced in the first few days, followed by transitional milk and then mature milk by 14 days.
Ensure baby feeds for at least 15 minutes on each breast to get hind milk (which has more fat and is more satiating).
Foremilk (initial milk) is not as high in fat.
Formula Feeding
Feed every 3-4 hours; spacing will increase as the baby grows.
Teach proper formula mixing.
Formula digests slower than breast milk.
Do not microwave breast milk or formula due to risk of hot spots and nutrient destruction.
Discharge Instructions
Review basic care and safety measures.
Baby should sleep on their back.
Supervised tummy time is okay.
Immunization schedule and well-baby care appointments.
Car seat safety.
Apgar Scoring
Done at 1 and 5 minutes after birth.
Five components, each scored from 0-2:
Heart Rate
Respiratory Effort
Muscle Tone
Grimace (Reflex Irritability)
Color
The highest possible score is typically 9 due to acrocyanosis.
A low score indicates the need for resuscitation.
Remember by relating to assessing an adult patient: Cardiac (heart rate), Respiratory (respiratory rate), Neuro (muscle tone and grimace)