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41 Cards in this Set
- Front
- Back
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Fetal Respiratory Adaptation
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- Placenta has been fetal lungs
- Inutero fetal breathing - Surfactant - First inflation of the lungs begins circulatory adaptations. |
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Fetal Circulatory Adatations
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Ductus Venosus:
1) Diverts blood to liver 2) Closes - cord clamping Foramen Ovale 1) Bypasses lungs 2) Closes - inspirations Ductus arteriosus 1) Bypasses lungs 2) Closes - pO2 > 50 mmHg |
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Fetal Nutritional Adaptations
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- The placenta provides all of the fetal nutritional needs
- Glucose - Vitamins/Minerals - Albumin/gamma globulin |
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Apgars: Respiratory Effort
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0 = absent
1 = slow, irregular 2 = Good crying |
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Apgars: Heart rate
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0 = absent
1 = < 100 bpm 2 = > 100 bpm |
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Apgar: Muscle tone
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0 = Flaccid
1 = Some flexion 2 = Active/flexed |
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Apgar: Reflex Irritability
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0 = none
1 = Grimace 2 = Vigorous cry |
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Apgar: Color
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0 = pale blue
1 = body pink, hands/feet blue 2 = entirely pink |
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Newborn Assessment: Vitals
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- Take for a full minute
- HR and RR can be irregular - HR: apical - RR: auscultate and visualize - Temp: axillary |
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Newborn Assessment: head/face
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* Fontanels/sutures
- Ant. is largest (closes in 12-18 mo) - Post. is smaller (closes in 6-8 wks) * Molding: bones changing shape for the head to fit pelvis * Facial symmetry/location of eyes and ears - hard palate should be smooth, arched and firm - feel around gums to make sure they're not deformed and to see if there are teeth |
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Newborn Assessment: birth trauma
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* Caput: generalized edema of the scalp
- normal/common - may see right away - crosses suture lines * Cephalhematoma: bleeding between the periosteum and skull bone - serious - may take a couple of hours to form - Does not cross suture lines |
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Newborn Assessment: neck/spine
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* Webbing: extra skin around the neck that can signify neurological disorders
* Masses/lymph nodes * Clavicle intact: Can be broken during birth - need to be V shaped - feel with 2 fingers for solid "match sticks" - will heal in 2-4 weeks - put arm across chest to act like a natural sling * Spina bifida - usually diagnosed by ultrasound - looking for a pit at the base of the spine |
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Newborn Assessment: chest
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* Lungs
- RR between 30-60 (full minute) - Respiratory movement - Auscultation * Heart - HR between 120-160 (awake) 80-100 (sleeping) (full minute) - PMI - Cold stress an reopen the FO |
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Newborn Assessment: Abdomen
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* Umbilical cord
- clamped well - 3 vessels (2 arteries, 1 vein) - arteries pump deoxygenated blood back to theplacenta - veins take oxygenated blood to the baby - do light palpation to feel for masses - femoral pulses difficult to find. May feel inside pelvic girdle. |
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Newborn Assessment: Genitalia/Anus
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* Female
- Labia need to be of equal size - On a preterm baby one will be larger than the other - Discharge: there can be a pseudomensies * Male -Urethral opening at the tip of the penis -Hypospadius: when urethral opening is not at the tip of the penis Testes: palpable (go from the body down) * Anus - Patent/meconium |
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Newborn Assessment: Extremities
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Anomalies
ROM Trauma Polydactoly: an extra digit |
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Newborn Assessment: Skin
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- Milia: little white dots on the baby's face
- Lanugo: peach fuzz - Erythema toxicum: normal newborn rash that will go away on its own - Mongolian spots: dark spots that need to be documented for future reference - Vernix |
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Newborn Assessment: Neurological reflexes
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* Sucking/rooting: will turn their face in the direction of being touched and open their mouth
* Sucking: need to stick tongue way out * Moro: startle reflex * Palmer grasp: will take a hold of your finger * Stepping: helps nudge themselves closer to their mother's breast * babinski: toes should flare (only do it once) * Trunk incurvation: when baby is held on stomach, run finger up spine and hips should move in app. direction |
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Thermoregulation of the newborn
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* features leading to heat loss
- less insulation - blood vessels are closer to surface - larger surface area to mass - lack shivering mechanism - dependent on caregiver |
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Thermogenesis
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- babies lack shivering mechanism
- if shaking, it's b/c blood sugar is low. - Brown fat supply rapidly diminishes - increased metabolic activity of the brain, heart, and liver - vasoconstriction |
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Complications of Cold Stress
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* Increased RR leads to increased O2 consumption
- survival not growth * Vasoconstriction compromises pulmonary perfusion - Aggravates RDS - May reopen DA * Anaerobic glycolysis occurs - increases acidosis and can lead to metabolic acidosis - happens when not enough O2 present * Fatty acids displace bilirubin from binding - increases serum bilirubin levels |
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4 mechanisms of heat loss
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convection
radiation evaporation conduction |
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Convection
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* Flow of heat from the body to the cooler ambient air
- AIR - keep room 72-74 degrees - Cap to head - Swaddle in blanket |
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Radiation
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* Loss of heat from the obdy surface to the cooler solid surface not in direct contact but in relative proximity
- INDIRECT SURFACE |
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Evaporation
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* loss of heat that occurs when a liquid is converted to a vapor
- WATER - dry each body section right after its been washed |
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conduction
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* Loss of heat from the body surface to a cooler surface in direct contact
- SURFACE - Place baby skin to skin |
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Ophthalmic prophylaxis
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- Protects against Gonorrhea & Chlamydia
- TN state law * Medications used: - Erythromycin - Silver nitrate - Tetracycline |
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Vitamin K
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- 1 mg given to prevent hemorrhagic disease
- created in intestines with help of bacteria - Baby's intestines still sterile so need Vit K Aspirate to ensure no blood return |
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Hepatitis B Vaccine
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- Induces protective antibodies in 95-99% of healthy babies
- Requires informed consent - First of 3 doses |
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Heel stick technique
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Do it on the outside of the heel
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Baby blood glucose
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- taken soon after birth
- repeat if symptomatic - Hypoglycemia < 35 mg/dl * infants at risk: - large babies - babies of diabetic mothers - preterm babies - babies of traumatic births * Tx = feeding baby |
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Baby hematocrit
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45-65%
higher than that of an adult |
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Assessment of newborn pain
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Take into account physical signs of pain
Ex) NIPS, CRIES, PIPP, etc |
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How to know if producing enough milk
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- feeds at least 15 min on one breast every 2-3 hours
- is satisfied and sleeps between feedings - has 6-10 wet diapers a day - has multiple "mustard" BM's a day |
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Helpful breastfeeding tips
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- Infants chest toward mom
- Lips flanges out - mouth wide open - all or most of areola in mouth - if baby latches on in first hour of life, more success |
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Bottle feeding
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1 oz every 3-4 hrs first 24 hrs of life and increase volume over next week to about 3 oz per feeding.
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Newborn stomach size
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Day 1 = 5-7 ml
Day 3 = .75-1 oz Day 7 = 1.5-2 oz |
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Meconium
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- Should pass in 24-48 hrs
- Looks thick black/green tar - If not passed, could be a sign of cystic fibrosis - transitional stool will be mustard colored with curds |
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Hyperbilirubinemia
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- build up of unconjugated BR moves into the extravasculare tissues, skin, sclera and brain tissue
- jaundice will start at the face and work it's way down the body - if it reaches the stomach need to be vigulent - If crosses the BBB can cause irreversible neurological damage |
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Hyperbilirubinemia: infants at risk
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- Higher hct
- Blood incompatibility - Birth trauma - Ethnic groups |
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Hyperbilirubinemia: phototherapy
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- bililights
- fiberoptic blanket - sunlight - eyes and genitals covered - regular feedings - dehydration - photometer level usually starts out at 15 |
