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The Normal Neonate

QuestionAnswer
Respiratory Adaptations Initiation of breathing: pressure changes, cool temperature, noise, light, other sensations related to birth.
Chemoreceptor's Decrease arterial O2 pressure; increase carbon dioxide pressure; decrease arterial pH.
Normal Respiratory Response of Neonate Respiratory Rate-30-60 breaths/min; short periods of apnea < 15 seconds; respiratory rate varies with activity; periodic breathing.
Respiratory Distress Nasal flaring, intercostal or subcostal retractions, grunting with respirations, suprasternal/subclavicular retractions with stridor or gasping (upper airway obstruction), seesaw or paradoxical respirations, Resp. rate < 30 min or > 60 min at rest.
Causes of Respiratory Distress Hypoglycemia, sepsis, rapid increase in body temp. or low body temp., analgesics given to mother during labor/birth, inadequate clearance of lung fluid.
Cardiovascular Heart Rate Adaptations Range of 80-90 beats/min during sleep; up to 175-180 bpm when crying; 110-160 normal. Apical Pulse for 1 minute, located at 4th intercostal space and to the left of the midclavicular line. Irregular heart not uncommon in first few hours after birth.
Heart Sound Adaptations Higher pitch, shorter duration, greater intensity.
Blood Pressure Adaptations Average Systolic =60-80mm Hg; Average Diastolic=40-50mm Hg; BP not routinely measured; BP may increase or decrease depending on activity.
Blood Volume Adaptations Appox. 80-85 mL/kg (Average 300mL); Volume may increase up to 100mL depending on when cord is clamped.
Average newborn temperature 97.9 - 99.7
Four Types of Heat Loss Convection, Radiation, Evaporation, Conduction. Prevent heat loss with skin-to-skin.
Cold Stress in Neonate Increased respiratory rate, O2/Energy diverted from brain/cardiac function to thermogenesis for survival, PaO2 decreases, pH decreases, Basal metabolic rate increases, metabolic/respiratory acidosis, Hyperbilirubinemia, hypoglycemia.
GI Adaptations Pass Meconium stool within 8-24 hours after birth, Transitional stool usually by 3rd day, Milk stool appears around 4th day, stomach size varies from 30-90mL depending on infant size.
Thermogenesis Adaptation Nonshivering thermogenesis accomplished by brown fat (unique to newborns). The less mature the newborn, the less reserve of essential fat available at birth.
Renal System Adaptations Less able to concentrate urine, 93% void within 24 hours after birth/100% by 48 hours.
Initial Bladder Volume of Newborn 6-44mL, , 6-8 voidings a day indicate adequate hydration.
Pseudomentruation Due to withdrawal of maternal hormones.
Sleep-wake states Deep sleep, light sleep, drowsy, quiet alert, active alert, crying.
Factors that Affect Behavior Gestational Age, Time, Stimuli, Medications
APGAR Scoring Rapid assessment of newborn; based on 5 signs; done at 1 & 5 minutes of life.
5 Signs of APGAR Scoring Heart rate, respiratory rate, muscle tone, reflex irritability-grimace, appearance-color.
Initial Nursing Care of Newborn Put skin-to-skin, warm and dry newborn, assess airway, resp., temp., apply id bracelet, put infant to breast 1/2 hour -1 hour after birth. *Initial physical assessment can be done 1-2 hours after birth either on mother chest or under radiant warmer*
Neurologic Adaptations Can distinguish between sweet & sour, can distinguish mother's milk from others, sensitive to pain, vision is incomplete at birth, reflexes (babinski, moro, finger grasp).
Process of changing bilirubin from a fat-soluble product to a water-solublr product? Conjugation
Rythmic Spontaneous Movements Motor Maturity
Breast Milk is a major Source of which Immunoglobulin? IgA
Vitamin K Prophylaxis Single Injection og 0.5-1.0mg; recommended to be given 1-2 hours after birth; prevention of hemorrhagic disease of the newborn
Eye Prophylaxis Mandatory in the U.S.-precaution against opthalmia neonatorum; tetracyclin or erythromycin; recommended to be given up to one hour after birth.
Central Nervous System Assessment Moving all extremities; symmetric features; movement; moro, sucking, rooting and grasp reflex present; anterior fontanel soft and flat.
Cardiovascular Assessment Heart Auscultation (regular in rate and rhythm); transient acrocyanosis, otherwise pink in color; pulse strong and equal bilaterally; Cap refill less than 3 seconds centrally and in peripheral tissue.
Gastrointestinal Assessment Abdomen soft, no visible distention; auscultate for bowel sounds; cord attached and clamped; anus patent.
Eyes, Ears, Nose and Throat Assessment Eyes clear, palate intact, nares patent (block oneside then the other), ears in place, correct alignment.
Initial Skin Assessment Color-pink or acrocyanosis; skin lesions or abrasions documented; birthmarks documented; caput/molding; other (skin peeling, skin tags, baby tooth).
Newborn Measurments Weight 2500-4000g (average female- 3400g; average male 3500g); length 45-55cm (average 50cm); head circumfrance 32-38cm (average 33-35cm); vital signs once every 30 min for first 2 hours.
Infant Specimens Cord blood, venopuncture, heel stick, urine bag, meconium stool specimen, cord specimen.
Infant Comfort Measures for Painful Procedures Infant Acetaminophen drops-15mg/kg Q4-6hrs; Sucrose 0.24% oral, per hospital protocol; non-nutritive sucking (pacifier, gloved finger); EMLA Cream (topical analgesic, mixture of lidocaine and prilocaine, applied 1 hour before procedure, only >37wks
Circumscision Types Gomco, Mogen, Plastibell (ring drops off in 7-10 days)
Circumscision Care Check for bleeding 1 hour after procedure (follow hospital protocol); apply petroleum gauze, bacitracin w/gauze or other topical agent to sire for 24 hours with each diaper change (follow hospital protocol); assess for infections; monitor first void after
Metabolic Screening DDone after 24 hours of age; NH screens for 31 metabolic disorders (as of July 2010); Results sent to pediatric provider.
Hearing Screening Done prior to discharge; will determine if further testing is required.
Bilirubin Screening Transcutaneous or serum; timing of jaundice or age of newborn significant
Pre/post ductal measurements-pulse oximetry Determine duct dependent cardiac abnormalities
Nursing Diagnosis •Ineffective thermoregulation •Ineffective airway clearance •Ineffective infant feeding pattern •Readiness for enhanced organized infant behavior •Readiness for enhanced family processes •Risk for infection
Family Centered Care •Patients and families considered integral components of the heath care process •Mutual trust •Partnership approach •Sensitivity to patient’s culture and beliefs •Support and respect uniqueness and diversity of families •Empowers patient’s and famili
Family Centered Care: Outcomes •Decreased anxiety •Improved pain management •Shorter recovery times •Enhanced confidence •Improved communication between patient and healthcare team
Mood Disorders: Rubins Framework ØTaking-in phase ØTaking-hold phase ØLetting-Go Phase
Sibling Roles Sibling rivalry is normal,Expect regression,Encourage sibling(s) to participate in decisions,Spend “special time” with the child,Encourage older children to verbalize emotions about the newborn,Arrange for child to come to the hospital to see newborn
Grandparent Role •Support and comfort to the family •Pay attention to older siblings when visiting •Resource for parenting skills •Learn new parenting concepts •Cultural expectations •Willingness to become involved
Created by: nglidden