Normal Newborn Care
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| ____ period is the first few hours of life when the newborn stabilizes respiratory and circulatory function | transition period
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| What is the nursing goal during the transition period | To identify actual or potential problems that may require immediate or emergency attention
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| ____ stimuli - The head and chest moves through the vaginal canal to expel fluid by squeezing | Mechanical Stimuli
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| ____ stimuli is rubbing with a towel, tapping the bottom of the foot, and noisy birthing room | Sensory Stimuli
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| ____ stimuli is the difference in temperature the newborn feels after being inside a warm mother | Thermal Stimuli
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| ____ is made up of lipoprotein in the lungs to keep alveoli from collapsing creating an alveolar surface tension | Surfactant
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| Surfactant is made up of Lecithin/Sphingomyelin, what L/S ratio is needed to create alveolar surface tension | L/S 2:1 (premies born without this ratio can be given an artificial surfactant
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| Antipoxia causes muscles to relax including the anal spincter and expel ____ into the amnionic fluid which changes the viscosity of lung fluid within respiratory tract which causes ____ | mechonium - Hypoxia
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| degree of lung ____ is how well the lungs expand and contract | degree of lung compliance
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| Greater blood volume to the ____ contributes to conversion of fetal circulation to newborn circulation | Lungs
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| Benign physiological ____ come and go and is caused by shunting of blood common in early newborn period | murmers
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| Onset of respiration triggers increased blood flow to the ____ after birth | lungs
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| With increased ____ pressure comes decreased ____ pressure as newborn starts to breath | Increased aortic pressure and Decreased pulmonary pressure
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| Increased ____ pressure cooresponds with decreased venous pressure | increased systemic pressure
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| Within the cardiovascular system, what closes when a newborn is born | closure of foramen ovale (L&R atriums), ductus arteriosus (aortic arch and pulmonary artery) and ductus venosus (to liver)
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| T/F oxygen saturation of newborn's blood is greater than adult's | True
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| The fetus has special iron oxygen hemoglobin that has a greater affinity for ____ | oxygen.
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| ____ resistance is increased in newborn as compared to adult | Airway resistance
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| In a quiet and alert state, the newborn heart rate is ____ beats/min | 120-160
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| Newborn heart rate during deep sleep state is ____ and crying is ____ | 90 deep sleep 180 crying
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| ____ values during the first 12 hours of life vary with birth weight and are not routinely done unless in PICU or NICU | Blood pressure
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| Average mean blood pressure is ____ - ____ mmHg in full-term over 3kg during first 12 hours of life | 50-55 mm/Hg
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| ____% of all murmers in newborns are transient | 90%
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| Newborn respiratory rate ____ - ____ | 30 - 60
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| periodic breathing with short periods of apnea lasting ____ - ____ seconds is normal | 5-15 seconds
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| ____ is when the palms of hands and feet are blue because the cardiovascular system has not caught up yet. | acrocyanosis - being cold makes it more noticable
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| The newborn is an obligatory ____ breather | nose
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| initial respirations are diaphagmatic, shallow, and irregulare in depth but normal in ____ | rhythm - if rhythm was not normal there would be a sea saw breathing where the abdomen and thorasic are in opposition
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| what happens to hematocrit levels in a newborn | rise 1-2g/dL as a result of placental transfusion, low oral fluid intake and diminished extracellular fluid volume, fall as a natural progression over the first 2 months of life
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| ---- is a normal finding because stress of birth stimulates increased production of neutrophils during the first few days of life | leukocytosis
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| Blood volume of term infant is estimated to be ____ mL/kg of body weight | 80mL/kg
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| blood volume varies based on: | delay in cord claming (normal shift of plasma to extravascular spaces), gestational age, and prenatal and or perinatal hemorrhage
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| ____ in newborn is closely related to rate of metabolism and oxygen consumption | thermoregulation
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| Newborns don't ____ for thermoregulation, they break down brown fat | shiver
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| Newborns have decreased ____ and ____ fat | subcutaneous and brown fat
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| Newborn's poor thermal stability primarily due to excesive ____ rathen than impaired heat production | heat loss. blood vessles closer to skin, thin epidermis, decreased subcutaneous and brown fat.
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| example of heat loss by convection | losing heat to air currents with AC and fans
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| example of heat loss by radiation | cold environment, infant placed next to (not on) cold surface areas and window..
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| example of heat loss by evaporation | Bath - turn off fans
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| example of heat loss by conduction | body placed on cold surface like a scale
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| Three ways a newborn can produce heat by thermogenesis-physiologic mechanisms | increased metabolic rate, muscular activity, and nonshivering thermogenesis (convert brown fat to heat energy)
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| Encouraging early breastfeeding and using heated and humidified oxygen are some interventions of minimize ____ stress | cold
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| ___ bilirubin is the conversion of yellow lipid soluble pigment into water-soluble pigment done in the liver. Since the fetus doesn't use thier liver it goes across the placenta and mother does it for them | Conjugated bilirubin (direct) Think lipid to water
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| ____ bilirubin is breakdown product derived from heoglobin, not water soluable, released primarily from destroyed RBC's and crosses the placents | Unconjugated bilirubin (indirect) Think RBC
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| Total serum bilirubin (conjugated and unconjugated) is less than ___ mg/dl shortly after birth | 3mg/dl
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| jaundice is caused by | hyperbilirubinemia
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| Concentration of bilirubin in the blood must exceed ___ mg/dL for the coloration of jaundice to be visible | 2-3mg/dL
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| physiologic jaundice is a ____ bilogic response of newborn after the first 24 hours | normal
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| physiologic jaundice of newborn is caused by: | accelerated destruction of RBC, impaired conjugation of bilirubin, increased bilirubin reasorption from GI, when get cold
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| Theraputic interaction to get rid of jaundice: | encourage early and frequent feeding, sunlight helps,
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| Jaundice in the first 24 hours is never normal, can be caused from: | obstruction of liver, ABO incompatibility
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| ____ jaundice occures in first days of life associated with poor feeding practices | Breastfeeding jaundice, avoid supplementation, access lactation counseling and encourage frequent breastfeeding
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| Coagulation factors (senthesized in liver) activated under influence of ____ | vitamin K
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| Vitamin K is synthesized in ___ | normal flora of the gut, which is missing in the newborn
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| Vitamin K is given prophylactically on day of birth to combat potential ____ | bleeding - prevents hemorrhagic disease of the newborn
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| ____ - ____ weeks gestation, the gastrointestinal system is mature | 36-38
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| intestinal and pancreatic ____ are needed to digest most simple carbohydrates, proteins and fats and are deficient during the first few months of life | enzymes (pancreatic amylace breaks down carbs from saliva)
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| Newborn has trouble digesting ____ and digests and absorbs ____ less efficiently | trouble digesting starches and digests and absorbs fats less efficiently
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| ____ are well digested and absorbed from newborn intestine | proteins
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| Air enters stomach immediately after birth and with bottle feeding more often than breast feeding. so burp baby every ____ oz or ____ with breastfeeding | every 1/2 oz or after each breast
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| newborn's stomach capacity | 50-60 mL
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| regurgitation is due to | immature cardiac sphincter
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| Due to the sucking reflex, a newborn can ____ easily | overfeed
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| term newborn requires approx. ____ cal/kg/day | 120
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| term newborns usually pass mechonium within ____ hours | 8-24
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| ____ is formed in utro from amniotic fluid and its constituents, intestinal secretions and shed mucosal cells | mechonium - thick, tarry black or dark green
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| newborn's kidney's have full complement of functioning nephrons by ____ weeks gestation | 34-36 weeks gestation
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| Newborn's kidney is unable to dispose of water rapidly when necessary due to ____ filtration rate | low compared to adult rate
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| Why are full term newborns less able than adults to concentrate urine | tubules are short and narrow
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| newborn has reduced ability to concentrate urine caused by limited ____ reabsorption of water and limited excretion of solutes | tubular
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| First 2 days postnatally, newborn voids ____ times daily with urine output of ____ mL/day | 6 times with 15mL/day (about 5mL/kg/day)
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| Newborn subsequently voids up to ____ times a day with urine output of ____mL/kg per day | up to 25 times a day with 25mL/kg/day
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| limitations in newborn's ____ response result in failure to recognize, localize, and destroy invasive bacteria | Inflammatory response
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| Because the hypothalmic response to pyrogens is poor, ____ is not a reliable indicator of infection. | Fever - anything over 100 F call pediatricians office
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| newborn immunity period of resistance varies: Immunity against common viral infections may last ____ months and immunity to certain bacteria may last ____ weeks | Viral 4-8 months, certain bacteria 4-8 weeks.
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| Normal newborn produces antibodies in response to ____ | antigen (except IgM antibodies which respond to bacteria and some viruses)
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| Immnizations at 2 months of age is to develope active ____ immunity | active acquired immunity. Active because it is given in a shot
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| Newborn Immunity IgA is from | breastmilk
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| ____ antibodies are produced in resonse to blood group antigens such as gram negative enteric organisms and some viruses in expectant mother | IgM
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| IgM antibodies does not normally cross ____ | placenta
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| IgM antibodies are produced by fetus beginning at ____ weeks gestation | 10-15 weeks gestation
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| elevated levels of IgM at birth may indicate | placental leaks or antigenic stimulation in utero
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| Which antibody is a passive acquired immunity which crosses the placenta and is transferred to fetus in utreo during third trimester | IgG
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| Passive acquired immunity includes ____ that mother passed on in utero that the fetus does not make | antibodies (HIV antibodies)
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| The first period of reactivity is followed by a sleep phase before the second period of reactivity, how long do these periods last? | First period of reactivity lasts 30 minutes, followed by sleep 30-120 minutes then the second period of reactivity lasts 2-8 hours
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| During the first period of reactivity it is good to initiate breastfeeding, why | strong sucking reflex and awake and active
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| During the period of ____ (between the two periods of reactivity), the newborn is difficult to awaken, shows no interest in sucking and bowel sounds become audible, and cardiac and respiratory rates return to baseline values | inactivity to sleep phase
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| The first mechonium stool is frequently passed during the ____ stage because GI tract becomes more active | second period of reactivity
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| during the second period of reactivity, gagging, choking and regurgitating with turning blue are due to | increase production of respiratory and gastric mucus
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| During the second period of reactivity the nurse must be alert for ____ periods | apneic periods, may cause a drop in heart rate
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| During sleep, the newborn has two stages: deep or quiet sleep and ____ | REM Rapid eye movement
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| What are the characteristics of deep or quiet sleep | No eye movement, regular respirations, jerky motions (startles but rapidly suppressed), heart rate 100-120,
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| Characteristics of REM | Irregular respirations, eye movement, sucking motions, minimal activity, smooth nonjerky movements
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| REM (active sleep) and quiet sleep occure in intervals of | 50-60 minutes
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| How much total sleep of the newborn is active REM and how much is quiet sleep | 45-50% active REM, 35-45% quiet, 10% transitional between two
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| Which stage of sleep stimulates highest peaks of growth hormone and growth of neural system | REM. but disturbance of sleep wake cycle result in irregular spikes of GH
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| The alert state has three states, they are: | drowsey or semi dozing, wide awake, active awake
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| What are the manifestations during the drowsy state | eyes can be open or closed, eyelids fluttering, slow regular movements, & mildly startles
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| What is the difference between wide awake and active awake | wide awake - quietly takes in the environment and stimuli. Active awake - Lots of moving, increased stimuli response and crying
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| Which alert state elicits an appropriate response of help from parents | Active awake, child will cry
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| Normal behavioral-sensory capacities of newborn | Self-quieting ability & Habituation (ability to process and respond to stimuli) for example; ability to fixate and follow complex visual stimuli, and newborn perfers human face and bright objects
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| Auditory behavior capacity of normal newborn include: | minimal starter reflex, cardiac rate rises, and respond with definate organized behavior
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| olfactory capacity of norman newborn include | select people by smell, distinguish mother's taste and sugar increases sucking
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| tactile capacity of normal newborn include | sensitive to being touched, cuddled and held & settled newborn is able to interact with environment
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| T/F It is normal for a baby to have jaundice within the first 24 hrs? | FALSE!!!Never Normal to have Jaundice within the 1st 24hrs of birth after 24hrs can have some jaundice but not a lot.
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| What is SBAR and what does each letter mean? | SBAR is what you should have ready when you call the doctor. S-Situation B-Background A-Assesment R-Recommendation
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| Baby boy smith is 16 hours old and looks jaundice. As his nurse what will you do? | Call the doctor Have the following ready when you call drbaby boy smith was born …he is …hrs old…breast feeding well?....jaundice I recommend…
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| Baby boy smith is now 48 hrs old and has yellow scleara and jaundice skin in his face, chest and abdomen. You draw a bilirubin level on him and find it to be 16. Is this a concern to you as the nurse and if so what do you do? | Yes a concern bilirubin should never be above 12. Call doctor or initiate hospital protical if there is one. Keep feeding them frequently to encourage the excretion of bilirubin…
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| Total serum bilirubin is sum of conjugated (direct) and unconjugated (indirect) bilirubin. Is less than ___ shortly after birth. Levels should not be greater than____. | • Total serum bilirubin is sum of conjugated (direct) and unconjugated (indirect) bilirubin. Is less than 3 mg/dl shortly after birth. Levels should not be greater than 12.
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| Levels of 20 or greater are considered kenicterus and may cause permanent _____ damage | Levels of 20 or greater are considered kenicterus and may cause permanent CNS damage
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| Heat Production In Newbornis acchivedby Thermogensis. What is Thermogenesis? Do babies shiver? | NON Shivering Achieved by Thermogenesis-physiologic mechanisms that increase heat production.
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| What are some ways or mechanisms that babies Achieve Thermogenesis-physiologic? | Increased metabolic rateMuscular activityNonshivering Thermogenesis – chemical process which converts brown fat stores into heat energy
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| Baby boy smith is breastfeeding. What will you teach his new parents about voiding and stooling patterns? | Expect stool color; frequency stool & urine 1st day 2-6 times and after 6-8 at least and 5-25; as milk come in what the stool color will look like
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| Baby boy smith is turning blue and gagging parent screaming and freaking out what do you do? | pick up baby; pat baby; suction baby; u can intiate cpr but call for help
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