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OB-Newborn
| Question | Answer |
|---|---|
| normal axillary temp | 36.5-37.2C (97.7-98.8 degrees F) |
| normal apical heart rate | 120-160 beats/min. (crying increases, sleep decreases rate); during 1st period of reactivity (6-8 hr.) heart rate can be up to 180 beats/min |
| normal respiration rate | 30-60 breaths/min. (crying increases rate, sleep decreases rate); during 1st period of reactivity (6-8 hr.) rate goes up to 80 breaths/min |
| normal B/P | 50-75/30-45 mmHg in arm/leg |
| **this reflex is paired with the rooting reflex; newborn is searching for food; is elicited by gently stimulating the newborn’s lips by touching them; placing a gloved finger in the newborn’s mouth will also elicit this reflex | **sucking reflex |
| **reflex that is seen in normal newborn babies, who automatically turn the face toward the stimulus and make sucking motions with the mouth when the cheek or lip is touched; helps to ensure successful breastfeeding | **rooting reflex |
| **reflex as a response to a sudden loss of support, when the infant feels as if it is falling; involves three distinct components: spreading out the arms (abduction), pulling the arms in (adduction), crying (usually); fingers spread to form a C | **Moro reflex (lost at 4 months) |
| holding the newborn upright and inclined forward with the soles of the feet touching a flat surface, baby should make a stepping motion or walking, alternating flexion and extension with the soles of the feet | stepping reflex |
| have newborn lie on back, turn the baby’s head to one side, arm toward which the baby is facing should extend straight away from body with the hand partially open, whereas the arm on the side away from the face is flexed and the fist is clenched tightly | tonic neck reflex |
| **stroking the lateral sole of the newborn’s foot from the heel toward and across the ball of the foot. The toes should fan out. A diminished response indicates a neurologic problem and needs follow-up | **Babinski reflex |
| **place a finger on the newborn’s open palm, baby’s hand will close around the finger, attempting to remove the finger causes the grip to tighten; grasp should be equal bilaterally; lost around 6 months | **palmar grasp |
| **place a finger just below the newborn’s toes, toes typically curl over the finger; should be equal bilaterally | **plantar grasp |
| skin assessment | normal: smooth, flexible, good skin turgor, well hydrated, warm; deviations/common problems: jaundice, acrocyanosis, milia, Mongolian spots, stork bites (telangiectatic nevi), port wine stain (nevus flammeus), erythema toxicum |
| superficial vascular areas found on nape of neck, on eyelids, and between eyes and upper lip; caused by a concentration of immature blood vessels and are most visible when newborn is crying; considered a normal variant | stork bites (telangiectatic nevi) |
| **multiple pearly-white or pale yellow unopened sebaceous glands frequently found on a newborn’s nose, may also appear on chin and forehead; form from oil glands and disappear on their own within 2 to 4 weeks | **milia |
| milia that occur in a newborn’s mouth and gums; occur in approximately 80% of newborns; as most lesions break spontaneously within the first few weeks of life, no therapy is indicated | Epstein pearls |
| **benign blue or purple splotches that appear solitary on lower back and buttocks of newborns, but may occur as multiple over the legs and shoulders; tend to occur in dark skin ethnicities; caused by concentration of pigmented cells | **Mongolian spots |
| **benign, idiopathic, generalized, transient rash that consists of small papules or pustules on the skin resembling flea bites; often mistaken for staph pustules; common on the face, chest, and back; chief characteristics of rash is its lack of pattern | **erythema toxicum |
| dilation of blood vessels on only one side of the body, giving the newborn the appearance of wearing a clown suit; gives a distinct midline demarcation, which is described as pale on the nondependent side and red on the opposite, dependent side; transient | Harlequin sign |
| commonly appears on newborn’s face; is a capillary angioma located directly below the dermis; flat with sharp demarcations and is purple-red; made up of mature capillaries that are congested and dilated; is permanent and will not fade | port-wine stain (Nevus flammeus) |
| head assessment | normal: varies with age, gender, ethnicity; variations/common problems: microcephaly, macrocephaly, enlarged fontanels |
| a head circumference more than 2 standard deviations below average or less than 10% of normal parameters for gestational age, caused by failure of brain development | microcephaly |
| a head circumference more than 90% of normal, typically related to hydrocephalus; often familial (with autosomal dominant inheritance) and can be either an isolated anomaly or a manifestation of other anomalies (hydrocephalus and skeletal disorders) | macrocephaly |
| elongated shaping of the fetal head to accommodate passage through the birth canal; occurs with a vaginal birth from a vertex position in which elongation of the fetal head occurs with prominence of the occiput and overriding sagittal suture line | molding |
| localized, soft tissue edema of the scalp that can cross the suture lines; resolves in first week of life | caput succedaneum |
| forms between the periosteum and skull with unilateral swelling; does not cross the suture lines; occurs d/t trauma of head (forceps, vacuum extractor) used in delivery | cephalhematoma |
| tissue designed for newborn heat production | brown fat |
| bilirubin staining of skin and sclera | jaundice |
| **permanent neurologic damage from high levels of bilirubin; bilirubin moves from blood stream into brain tissue | **kernicterus |
| slippery substance that reduces surface tension in lung aveoli | surfactant |
| low blood oxygen and high blood or tissue carbon dioxide levels | asphyxia |
| production of heat by use of specialized fat | non-shivering thermogenesis |
| bluish color of hands and feet | acrocyanosis |
| pinkish color discharge on a wet diaper | brick dust stain |
| grating sensation during palpation | crepitus |
| ventral curvature of penis | chordee |
| scrotal skin creases | rugae |
| "crossed" eye appearance | strabismus |
| irritable crying for no obvious reason in an infant | colic |
| using the tongue to push out anything that touches it | extrusion reflex |
| what immunization/meds are given to newborn wiithin first 24-48 hours? | Hep B, Vitamin K, Erythromycin eye ointment |
| measures for low blood glucose in newborn? | feed then recheck level 1/2-hr later |
| damage to blood vessels by oxygen use that may cause blindness | retinopathy |
| inflammatory condition of the intestines; portion of the bowel dies; typically occurs in newborns that are either premature or otherwise unwell; Sx may include poor feeding, bloating, decreased activity, blood in the stool, or vomiting of bile | necrotizing enterocolitis |
| signs exhibited by newborn exposed in utero to maternal substance abuse | neonatal abstinence syndrome |
| pulmonary condition resulting from prolonged use of supplemental oxygen | bronchopulmonary dysplasia |
| major disadvantages the preterm infant has in regulating temperature | none-to-low brown fat, decreased circulation, low birth weight, increased BSA |
| common measures to help preterm infant maintain thermoregulation | incubator, swaddling, cap for head, feeding |
| infection prevention measures for preterm infant | handwashing, limit exposure to sick people, using more sterile (vs clean) procedures, less invasive procedures, changing bedding/clothing frequently |
| reasons why a preterm infant will need IV or gavage feedings | deformities, genetic metabolic disorders, immature reflexes |
| What advantages does breast milk have for the preterm infant? | easily digested, immunity |
| management of infant with high levels of bilirubin | increase feedings, maintain feeding schedule, eye covering, bili light or blanket (infant naked; bili broken down and excreted in urine and stool), monitor with bili thermometer |
| management of infant with meconium at birth | suction, monitor for infection |
| management of preterm infant (28 weeks) with respiratory distress at birth | O2, CPAP, liquid surfactant, trach |
| newborn's immature liver often can't remove bilirubin quickly enough, causing an excess of bilirubin; typically appears on the second or third day of life | physiologic jaundice |
| most serious type of jaundice; occurs within 24-48 hours after birth; baby’s bilirubin level usually rises fast; most likely cause is blood incompatibility or liver disease; prompt medical attention is necessary, blood transfusions may be required | pathologic jaundice |
| how to weigh an infant | place paper, zero scale, place naked infant on scale |
| anterior fontanel closes when? | 8-12 months |
| posterior fontanel closes when? | 6-12 weeks |
| bulb syringe order | mouth first, then nares |
| infant circulation | foramen ovale, ductus arteriosus; can take up to 24-hours to close |
| PKU test | warm compress to promote circulation, heel stick on outer part of heel |
| newborn significantly larger than average, fat around organs, susceptible to hypoglycemia, seen in babies with diabetic mothers | macrosomia |
| Who's gonna kick ass on this test? | You are! You're amazing!!! |
| **high risk newborn nursing interventions: monitor what? | **temperature, food & fluids, and resp. function |
| **high risk newborn nursing intervention: temp | **minimize cold stress, maintain skin temp, continuously monitor temp, prevent rapid warming or cooling, use a cap to prevent heat loss from head |
| **high risk newborn nursing intervention: food & fluids | **monitor for hypoglycemia, assess tolerance of oral or tube feedings, monitor hydration closely, assess for gastric residual/ bowel sounds/ change in stool pattern/ abd girth, monitor weight gain/loss |
| **high risk newborn nursing intervention: resp function | **position for increased O2 (semiprone/side lying), maintain resp tract patency, stimulate-->remind to breathe, monitor O2 therapy, assess resp effort (grunting, nasal flaring, cyanosis, apnea) |
| **signs of jaundice in high risk newborn | **yellowing of skin and sclera, elevated blood bilirubin level (total serum bilirubin level above 5 mg/dL) |
| **signs of correct latch in breastfeeding | **nose is free, most of areola is hidden inside baby's mouth, lips are flanged outward (like a fish), baby's chin is immersed in breast at bottom of areola |
Created by:
nurse savage
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