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66 Cards in this Set
- Front
- Back
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What is the time frame for the neonatal stage?
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Birth to 28 days of life
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Why is this period so important and critical
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because 2/3 of all infant mortality occurs in this period. first 24h most vital
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Adaptation to extrauterine life
Initiation of breathing |
reflex triggered by change in environment
Neurologic reflexes of chemoreceptors arterial PO2 falls Arterial CO2 Rises Arterial pH falls |
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What is surfactant and what is its role?
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a phospholipid that lines the alveoli of the lungs and lowers surface tension.
Prevents alveoli from collapsing |
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What side of the heart has a higher pressure
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the right side has higher pressure because the lungs are non functional inuteros
HIGH PULMONARY VASCULAR RESISTANCE |
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TEMPERATURE REGULATION
balance b/w heat loss and production |
critical to survial
shivering mechanism is nonfunctional NON-SHIVERING THERMOGENESIS-BROWN FAT |
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WAYS IN WHICH BABIES LOSE HEAT
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EVAPORATION-wet diaper, wet hair, insensible water loss
CONDUCTION-warm hands & stethoscope CONVECTION-drafts, AC, air currents RADIATION-keep crib away from windows and outside wall |
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AT WHAT TEMP DO YOU NEED TO TAKE ACTION
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IF axillary temp is less that 97.7
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Behavioral Adaptations
what affects neonate behavior |
Gestational age
time elapsed since labor/delivery time of day last feeding stimuli maternal medication |
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What is the Apgar scoring system used for?
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Evalutes the newborns need for resussitation
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When is the Apgar test performed?
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done twice. 1 minute after birth and 5 min after birth
high correlation between low apgar at 5 min and mortality/morbidity |
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Peramiters of Apgar test
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If score < 4 need VIGOROUS ressusitation ie intubation
B/W 4-6 vigorous stimuli ie O2 B/W 7-10 baby stable |
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ASSESSMENT
Temp |
axillary
normal range 97.7-99 (36.5-37.2) heat loss due to less thermal insulation, surface blood vessals and larger body surface in relation to wt. Heat conservation mechanisms flexed position vasoconstriction |
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ASSESSMENT
Cardiovascular |
heart rate- full min apical
PMI- 4th intercostal space asleep-80-90 awake 90-170 BP: 60-80/40-50 |
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ASSESSMENT
Blood volume |
related to when cord is clamped. if clamped late BV is high, if early BV low
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ASSESSMENT
RESP |
count full min 30-60
apnea <15sec normal chest and abd rise together shallow/irregular nose breathers except when crying |
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When should you never feed a baby
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if resp >60
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ASSESSMENT
Signs of Resp distress |
seesaw resp-chest and abd don't move together
expiratory grunting retractions rate<30 rate>60 nasal flaring |
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ASSESSMENT
Head assessment |
tape above brow
32-36.8cms important for baseline |
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ASSESSMENT
Chest |
tape at nipple line
2cms<head |
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ASSESSMENT
Length |
head to heel
flat surface 45-55cm |
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ASSESSMENT
EYES |
normal:conjuntival hemmorage, symmetry,red light reflex, muscules immature, visual distance 17-20cm, B&W and patterns
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ASSESSMENT
EARS |
well formed
firm cartilage correct placement hearing similar to adult responds to mothers voice all NH babies screened |
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What might low ears indicate
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kidney abnomilie
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NEONATAL REFLEXES
Rooting |
infant turns head toward stimulus and opens mouth
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NEONATAL REFLEXES
Palmar and plantar |
place finger in palm of hand or base of toes, fingers curl around examiners fingers, toes curl downward
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NEONATAL REFLEXES
Tonic neck or fencing |
supine, turn head to one side
with infant facing left side, arem and leg on that side extend:opposite arm and leg flex |
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NEONATAL REFLEXES
MORO |
place infant flat surface make a loud abrupt noise(drop crib as in movie) thumb and index finger form C
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NEONATAL REFLEXES
STEPPING |
infant will simulate walking, altering flexion and extension of feet.
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NEONATAL REFLEXES
Babinski |
on sole of foot, begin at heel, stroke upward and across ball of foot. toes hyperextend with dorsiflexion of big toe
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ASSESSMENT
GI |
able to digest simple carbs/proteins. little fat
stomach hold 30-90ml=freq feeding lwr esophageal sphicter immature=spit up colon sterile=vit k shot as unable to produce vit k without flora |
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ASSESSMENT
Fluid maintence |
100ml/first 10kg/day
50ml/2nd 10kg/day |
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ASSESSMENT
nutritional status |
sleeps between feedings
loses no more than 10% of birth weight good skin tugor voids 6-8x/day 2-3BM |
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ASSESSMENT
Stooling patterns |
merconium-first 24-48h
transitional stool-3rd day milk stool |
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ASSESSMENT
hematopoietic |
RBC-4.8-7.1
Leukocytes-18,000@birth than decreases Platlets-200-300,000 FETAL HEMOGLOBIN-carries 20-50% more O2 than adults Hb Sepsis in neonate see decrease in WBC |
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ASSESSMENT
Renal system |
approx 40ml urine in bladder at birth
6-10x/day normal amt- 15-60mg/kg/day normal to see uric acid crystals in diaper(red) in hosp setting |
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Why are neonates at such high risk for dehydration?
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limited ability to concentrate urine up to three monthes of age
anterior fontenal depressed if dehydrated |
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DEFINE
DESQUAMATION |
Peeling skin
wont see in a preterm baby |
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DEFINE
VERNIX CASEOSA |
A protective sebaceous deposti covering the feus during interauteine life. It is not necessart to remove after delivery
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DEFINE
ACROCYANOSIS |
A BLUE OR PURPLE MOTTLED DISCOLORATION OF THE EXTREMITIES WSP FINGES,TOES AND/OR NOSE. Vasomotor instability.normal and should resolve
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DEFINE
LANUGO HAIR |
Downy hair covering the body.
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DEFINE
Simian line/crease |
when tje two flexion creases appear to fuse and form a single transverse crease. mayindicate downs or other syndromes
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DEFINE
TELANGIECTATIC NEVI |
Storks kiss
Enlarged superficial blood vessels able to blanche |
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DEFINE
MONGOLIAN SPOTS |
a blue or mulberry-colored spot usually in sacral region. usually disappears over months/years
DOCUMENT as it looks like bruise. seen in African Americans and Asians |
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DEFINE
MILIA |
small white sebacious glands
(white heads) |
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DEFINE
ERYTHEMA TOXICUM |
Newborn rash also called baby acne
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ASSESSMENT
Skeletal system |
more cartilage than ossified bone
head is 1/4 of body arms longer than legs cephalocaudal development (head to tail) |
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ASSESSMENT
Extemeties, spine and skin folds |
symetric and equal
fingers and toes are wqual with naild spine is straight and easily flexed no dimpling |
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MOLDING
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the head shapes itself to fit the birth canal. Cranial sutures cross (overidding sutures) Should return to normal in a week
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What is the difference between a CAPUT SUCCEDANEUM and CEPHALHEMATOMA?
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the caput crosses the suture line and the hematoma does not
the hematoma is between the periostum and skull bone |
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what is a subfalea hemorrhage/hematoma?
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dark red blood beneath the falea aponeurotica(dense CT of the scalp) and over the cranium.
common during the birth process may extend to neck(often first sign) |
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What is Ortolani's maneuver
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Tests for hip dyplasia
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ASSESSMENT
Reproductive system |
male-don't retract foreskin, testes descended
female-common to see discharge/blood vernix b/w labia labia majora covers minora and clitoris BREAST swelling may occurs |
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ASSESSMENT
Neuromuscular system |
almost completely developed at birth
rapid growth of brain during infancy growth of cerebellum complete at 1 year Brain rq's glucose/O2 for metabolism transient tremors-normal but should not last beyond 1month |
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SLEEP/WAKE STATES
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SLEEP: deep-unarousable
quiet-arousable sleep 16-18hr/day WAKE: Drowsy Quiet-alert OPTIMUM Active-alert Crying |
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TEMPERMENT
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hereditary
influences behavior have parent adapt not child Easy child, slow to warm up and difficult. difficult it is hard to pick up cues, irregular |
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SELF-QUIETING BEHAVIORS
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withdrawal
oushing away w/hands and feet breaking eye contact turning head falling asleep fussing crying |
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ASSESSMENT
PAIN |
us riley infant pain scale
uses behavior, physiological and autonomic responses, metabolic |
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Pain treatment
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Non-pharmacological- swaddling, pacifier, oral sucrose
pharmacological-topical, local, tylenol, opiods |
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Describe disorganized behavior
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physical and behavioral response to environment. see in pre-term babies, babies born to mothers who drink/drugs, painful procedures.
babies are irritable, fussy, increase/decreased muscle tone, change in reflex, color, VS, baby flaing in crib |
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Some teaching points
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lay baby on R side after feed ing for gastric emptying
warm h2o not pre-packaged wipes Always have bulb syringe in crib erythromycin ointment to prevent gonarhhea conjunctivitis |
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CIRCUMCISION
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REMOVAL OF PREPUCE
irritation may occur no difference if hygiene properly followed may/maynot affect sexual feeling increased risk of UTI if uncircumcised circumcision provides some protection against cancer analegesia should be used |
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CIRCUMCISION CARE for RN
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monitor bleeding q1h for 12hr
monitor voiding gentle pressure for bleeding if uncontrolled intermittent pressure call MD NO PRE-PACKAGED WIPES vasoline to site after diaper change no vasoline if plasiball used |
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CIRCUMCISION teaching points for parents
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check for bleeding
observe for urination keep clean yellow exudate normal change diaper q4 fanfold diaper s/s infection comfort |
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CORD CARE
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clamp removed when cord is dry, approx 24h
keep diaper away from area observe for s/s infection usually falls off 10-14 days |
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IM INJECTIONS
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Vit K for prevention of hemorrhagic disease
HEP B if mom positive give hepititis immuneblobulin w/i 12hours |
