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Grcc PN135 Newborn
GRCC PN 135 OB Newborn
| Question | Answer |
|---|---|
| Milia | Normal first few days of life...little white dots NB has on nose and cheek. These are fluid dilled sebaceous glands, appear like white heads |
| lanuga | Peach fuzz on the NB |
| Icterus neonatrum | Yellow NB. Jaundice NB due to increased level of bilirubin @ birth. Generally goes away after the 3rd day postbirth- liver hasn't fully developed. NB is placed underneath heat lamp |
| Hyperbilirubin | May be an indication of RH incompatibility |
| Vernix caseosa | Cheesy stuff on NB skin...keeps baby's skin lubricated and repels. |
| Acrocyanosis | Blue hands and feet. Circulation hasn't kicked in yet . Should turn pink in 2 to 3 days |
| Meconium | First stool, sticky green poop. Can lube rear with ad ointment so poop slides out easily. |
| Mongolian spots | Looks like bruises (people of color only) |
| Cephal hematoma | Bruises on top of head, doesn't cross suture lines, takes six weeks to go away, caused by trauma from vacuum, triceps, or difficult delivery. |
| Caput Succedenum | Fluid filled may be due to vaccum extraction; this does cross suture lines. |
| IUGR | Interauterine growth retardation caused by smoking, cocaine,or compromised placenta. Also, gestation date could be wrong |
| APGAR Score | Assess 1 min and then 5 min after birth. If Apgar score is less then 7, then additional scores should be assessed q 5 minutes up to 20 minutes |
| What does APGAR Score assess? | Respiratory Rate, Heart rate, muscle tone, reflex activity, color |
| Apgar scoring system | 0-3 is severe stress, 4-6 is moderate distress, 7-10 is no distress. |
| NB heart rate | 120-160 |
| MI Screen test | Blood test to ID digestive disorders. There are about 18 disorders that MI screen for currently. Done in 24 to 36 hours. |
| AGA | Appropriate for gestation age |
| SGA | Small for gestation age |
| LGA | Large for gestation age |
| Neonatal period | Is from birth through the first 28 days of life. |
| Normal physical characteristics of the NB | Average wt is 6 to 9 pounds Average lenght is 18-22 inches |
| Skin of a newborn | Vemix covers the body. It is a cream cheese like substance that keeps body lubricated. Skin should be pink, but is okay if it turns yellow on third day after birth |
| Disquamination | Peeling of skin within 2-4 wks after birth. |
| Post term NB skin | Skin may be peeling; can give lotion/vaseline; doesn't need to be treated because it will eventually go away. |
| NB head | Circumfrence is between 12-14 inches. |
| NB molding | Fontanel and parietal sutures overlap so that baby can get passed birth canal. |
| Cephlahematoma | a bruise that doesn't cross suture lines. |
| NB Head | is asymetrical, can be molded, but return to normal shape within one week. |
| Gene appearance ; Eyes | Baby born with blue eyes..will change to it's permanent color within 6 months after birth. |
| NB eyes | May mimic mom; focus best 8 to 12 inches away. |
| Gene appearance and function of mouth | Tongue is smooth; should be able to suck and swallow; gums may have tooth ridges (rare) |
| Senses: touch | Lips are most sensitive |
| Senses: Smell | Can smell and can percieve odor; can detect moms smell |
| Senses: taste | Distinguish between sweet and sour |
| Senses: hearing | Can respond to hi-pitch noise better. hearing test are given at the hospital. |
| Reflexes: Moro | Startle them; extension to flexion; tonic neck ; extends arm and leg where head goes. |
| Normal NB bp | 70/40 |
| Normal NB pulse | 120-160 |
| Normal Resp | 30-60 (40-60) |
| What type of breathers are NB | Abdominal breathers; obligate nose breathers. |
| Can new borns cough? | No, they can't cough until they are one year of age. They can sneeze |
| Voiding | Urine is not concentrated (typically light yellow) |
| Eructation | Burp |
| Regurgitation | Vomit |
| NB Genitalia | Edemetis- particularly if baby was breech |
| Boys genitalia assessment goals | Assess scrotum for two testes and understand that it is normal for penile erection happen frequently. |
| Females labia | Labia is enlarged; vaginal white mucous is tinges with blood. |
| Is psuedomenstration normal for NB? What is it? | It is vaginal white mucous tinged with blood due to immeadiate withdrawal of hormones - while in mama, they got a ton of hormones from mama |
| What happens to female nb breasts | Breasts enlarge related to hormones |
| Normal findings on nb | birth marks and fontanels (anterior/posterior) |
| T or F. It is not unusual to hear heart murmur from NB? | True. It is normal to hear heart murmurs. Hard to detect. |
| Vessels on cord | 2 arteries and one vein. Arteries take blood away from baby, veins bring back oxygenated blood to the baby. |
| Single artery on the cord | Occurs more in caucasion; high risk of diabetes |
| Would a skin tac or other anomolies be a "red flag" for other serious conditions? | yes, for example, doctors have foudn that Skin tac may mean NB has a kidney problem. |
| How long do you check for heart rate. | You need to check it for one full minute and the results should be between 120 to 160. |
| Explain how Vit K is absorbed in the body and it's function. | Vit K is synthesized by the flora in our stomach and helps prevent coagulation. |
| Why do docs inject vit k into a new born and when does this need to happen? | New borns are not born with flora in their stomach lining and therefore can's absorb vit k. Until this is present, Vit K is injected within one hour after birth to help with coagulation process. |
| What is the focus of nursing care of a newborn the first hours of life? | Maintain body heat, maintain respiratory function, decrease risk for infections. |
| New born reflexes | Moro; startle; tonic neck; rooting' sucking; palmer grasp; plantar grasp; babinski; stepping or dancing. |
| Moro | symmetrical abduction and extension fo arms and legs and legs flex up against trunk. |
| Startled | same as moro response |
| Tonic neck | the neonate assumes a fencing position with arms and legs extended in the direction in which the head was turned. |
| Rooting | The neonate turns his head toward the direction of the stimulus and opens his mouth. |
| Sucking | Present at birth; sucking motion occurs |
| palmer grasp | The neonate grasp fingers tightly; if the neonate grasps the examiner's fingers with both hands; the neonate can be pulled to a sitting position. |
| Plantar grasp | Toes flex tightly down in a grasping motion. |
| Babinski | Hyperextension and fanning of toes |
| Stepping or dancing | As you hold the neonate upright, it steps up and down in place. |
| Renal system for NB | Urinate within first 24 hours of life, poop within 36 hours of life. |
| How many diapers should a NB go though per day? | 6 to 10 wet diapers/day. If there are less than this may mean dehydration. |
| What color is NB urine? | Rusty pink due to uric crystals. |
| When does kidney reach full maturity? | it reaches full maturity by the time the baby is one year old. |
| Respiratory | 30 -60 breaths/min; they are obligate nose breathers |
| What are two factors that negatively affect transition extrauterine respirations? | Decreased surfactant levels related to immature lungs; presistent hypoxemia and acidosis that lead to constriction of the pulmonary arteries. |
| What are signs of respiratory distress? | cyanosis, apnea, tacypnea, retractions of the chest wall, grunting, flaring of nostrils, hypotonia. |
| Explain the Thermoregulatory system | The hypothalamus is immature and throws them into cold stress which leads to metabolic acidosis. The temp should be no less than 36.4c |
| Normal temp for nb | No less than 36.4c. If it is below, then you need to notify rn or physician asap. |
| When should the temp stabilize? | between 8 to 12 hours after birth |
| What is the difference between axillary and rectal temps? | Axillary is 1 degree lower than rectal. checking rectal temps are against policy at some hospitals. |
| Cold stress | excessive heat loss leading to hypothermia and body's compensatory mechanism in regulating body heat eventually leading to respiratory distress if goes untreated. |
| Risk factors for cold stress | Prematurity, small for gestational age, hypoglycemia, prolonged resuscitation efforts, sepsis, neurological , endocrine, or cardiorespiratory problems. |
| Signs and symptoms of cold stress | Axiliary temp is below 36.4c, cool skin, lethargy, pallor, tacypnea, grunting, hypoglycemia, hypotonia, jitterness, weak suck |
| why do NB have trouble holding in heat? | Blood vessels are closer to the surface;body surface is larger than weight; immature vaso motor systems; non-shivering themogenesis. |
| Preventing cold stress | swaddle, keep nb dry, place stocking cap on head, skin to skin contact with mama. Monitor temp q 5 minutes |
| List new born care | clear mucous; apply cord clamp; conserve body heat; ID mom and baby before leaving delivery room; get bath when baby is warm enough; administer meds (Vit K, Hep B, erythromyacin to eyes) |
| Which preventative meds are optional? | Hep B and erythromyacin. |
| Where do you inject vit k? | You inject 0.5 cc into vastus lateralis. |
| What does daily care of NB involve? | Give face and fanny care; don't put baby in basin; assess temp; assess skin; assess pulse and respirations; fontanels |
| Why don't you want to wash baby in a basin? | its best to wait till cord and/or circumcision are healed |
| Precousious teeth | Tooth ridges in gums. |
| What is normal wt loss for baby? Andy why? | normal to lose 10 percent after birth due to accumalted fluid loss; BM and lack of appetite. |
| Breast feeding babies | Breast feed babies are more intelligent; doesn't smell or stain where formula does (it is a natural laxative, contains IgBa) |
| Appearance of first stool for breast feeding nb | I its called maconium and is yellow and seedy |
| Appearance of first stool for bottle feed nb | Darker stools, usually a dark green color. |
| Status of bottle fed babies | They are doing fine and it is okay to keep it at room temp. Be sure to throw away formula after use. |
| Circumcision care | use 2x4 gauze and petroleum jelly; depending on facility- this procedure can be done by PA or doc. Epinephrine is used to stop bleeding; Worldwide, Israel ranks number 1 for this procedure, US is number 2. Hispanics don't typically do this. |
| What is given to stop bleeding for circumcision care? | Give epinephrine to stop bleeding and DO NOT PICK clot if one forms. |
| Parent education for discharge r/t cord | Betadine is applied on the cord in hospital, and it doesn't need to be done again. Keep it dry and let it fall off on its own. |
Created by:
Wends1984
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