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67 Cards in this Set
- Front
- Back
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normal respiratory rate
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30-60/min
periodic breathing lasting 5-15 seconds periods of apnea are normal- not normal if last longer than 20 seconds give gentle stimulation to baby to breathe |
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l/s ratio
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2:1
LECITHIN SPHINGOMYELIN The lecithin-sphingomyelin ratio is a test of fetal amniotic fluid to assess for fetal lung immaturity. |
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circulatory changes: shunts
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1. FORAMEN OVALE
2. DUCTUS ARTERIOSIS 3. DUCTUS VENOSUS eventually shut off: If they don’t shut off to normal circulation you get persistent fetal circulation -> leads to heart problems |
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normal heart rate for infant
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NORMAL 110-160
APICAL PULSE 1 FULL MINUTE MURMURS |
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normal bp for infant
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average= 72/47
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THERMOGENESIS
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heat production:
newborn has a problem with maintaining normal temperature due to excessive heat loss rather than impaired heat production Heat is produced by: 1. SHIVERING 2. NON-SHIVERING -BROWN FAT |
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brown fat
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brown fat is one of two types of fat or adipose tissue (the other being white adipose tissue) found in mammals.
It is especially abundant in newborns and in hibernating mammals.[1] Its primary function is to generate body heat in animals or newborns that do not shiver. In contrast to white adipocytes (fat cells), which contain a single lipid droplet, brown adipocytes contain numerous smaller droplets and a much higher number of mitochondria, which contain iron and make it brown.[2] Brown fat also contains more capillaries than white fat, since it has a greater need for oxygen than most tissues. |
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sites of brown fat
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MIDSCAPULAR AREA
AROUND NECK AXILLA AROUND TRACHEA ESOPHAGUS ABDOMINAL AORTA KIDNEYS ADRENAL GLAND |
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heat loss: convection
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exposure to cool air currents
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heat loss: radiation
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exposure to cool objects near infant
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heat loss: evaporation
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wet body surface
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heat loss: conduction
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cool surface exposure on infant (cold clothes, towels, stethoscope)
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what can we do to prevent heat loss for infants?
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Only unwrap a little part of the blanket that youre doing the assessment on- never take blanket off completely
Warm up stethoscope |
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cold stress
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EXCESSIVE HEAT LOSS RESULTING IN COMPENSATORY MECHANISMS (INCREASED RESPIRATIONS AND NONSHIVERING THERMOGENESIS) TO MAINTAIN CORE BODY TEMPERATURE
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what is a result of cold stress for infants?
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they increase their metabolic rate, which leads to calories being unavailable for overall energy supporting maintenance, repair, and growth.
The consequences of the increased metabolic rate while listed separately, are all intimately involved. |
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cold stress results in release of...
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Norepinephrine that causes vasoconstriction to reduce heat loss and initiate heat production.
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cold stress increases...
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metabolic rates causing an increase in utilization of glucose stores
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the infant uses what during cold stress?
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anaerobic metabolism to produce heat resulting in lactic acid production and hypoxia.
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end result of cold stress?
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metabolic acidosis, hypoglycemia and eventually, death, if hypothermia continues.
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infant's hypoglycemia during cold stress
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When the infant is cold stressed, the metabolic rate will increase to produce heat.
If the infant's metabolic rate is increased he/she will use up the glycogen stores and their blood glucose much faster predisposing them to hypoglycemic episodes. Remember the body needs glucose to met their energy needs. |
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infant's acidosis during cold stress
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When an infant is cold stressed, brown fat is converted to heat and free fatty acids.
The fatty acids and lactic acid, which are formed during muscular activity by the breakdown of glycogen, are dumped into the bloodstream, causing a lower blood pH metabolic acidosis. Acidosis also causes vasoconstriction of the pulmonary blood vessels, resulting in low oxygen blood levels. |
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infant's hypoxia during cold stress
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Extra oxygen is needed when the infant is cold in order to produce heat.
A cold infant with normal lungs will increase his respiratory rate in order to get extra oxygen. If the cold infant has diseased lungs, he/she may not be able to get enough oxygen to maintain brain and body functions. Both infants may show signs of respiratory distress, such as grunting, retracting, nasal flaring, and tachypnea. An infant doesn't have to be severely cold stressed to develop these consequences. Some infants demonstrate these consequences if their temperature drops only one or two degrees. |
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newborn serum glucose level:
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45-96mg/dl
assess by chemstrip @ 4 hrs. old |
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what to do if serum glucose level is low?
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Feed with PO D5W if glucose level is low (even if Mom is breastfeeding)
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breastfed babies # of stools/day
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Breastfed babies- 6-10 small, semiliquid yellow stools per day by 3rd or 4th day after milk production is established
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formula fed babies # of stools/day
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Formula-fed babies- 1-2 stools per day, more formed, yellow or yellow brown
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urine for babies every day?
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5-8 x day
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bilirubin: conjugated (direct)
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conversion of yellow pigmented fluid into a water soluable pigment.
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bilirubin: unconjugated (indirect)
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breakdown of hemoglobin from RBC’s
Not an excretable form and a potential toxin Total= sum of both= <3mh/dl (normal) |
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physiological: jaundice
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acceleration of destruction of RBC’s impaired conjugation of bilirubin; not pathological, normal variation of newborn
50% of FT and 80% pre-term babies on 2-3 day: 4-6 mg/dl before jaundice occurs |
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pathologic: jaundice
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occurs within first 24 hours,
needs hydration, warmth, monitor for adequate stools, early feedings, phototherapy Can be fixed and its nbd |
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what nursing intervention do you perform when baby is receiving photo therapy for jaundice?
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keep them hydrated- can become dehydrated
Baby must wear mask in bili light so their eyes don’t get hurt |
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bili light (photo therapy)
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a phototherapy tool to treat newborn jaundice (hyperbilirubinemia) which in higher levels causes brain damage (kernicterus), leading to cerebral palsy, auditory neuropathy, gaze abnormalities and dental enamel hypoplasia. The therapy uses a blue light (420-470 nm) that converts bilirubin so that it can be excreted in the urine and feces. Soft eye shields are placed on the baby to protect their eyes from damage that may lead to retinopathy due to the bili lights.
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active acquired immunity
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pregnant woman passes on immunity to fetus by having had the diseases or by immunization
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passive acquired immunity
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IgG antibodies are transferred to fetus in utero, occurs mostly in 3rd trimester, causing pre-term babies to be more prone to infection
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PALLOR
JAUNDICE CYANOSIS ACROCYANOSIS |
Pallor: pale
Cyanosis: can be all over the body or just certain areas; Very cyanotic w mask ready to go on face- never give oxygen to a baby unless absolutely necessary Acrocyanosis: hands and feet;Cause is unknown. In premies its more evident bc of immaturity. If its severe it could be from heart defect. But in normal newborn cause is unknown |
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lanugo
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downey white hair- peach fuzz
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milia
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little white dots – look like little pores
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mongolian spots
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can see on face, shoulders, lower back, upper legs- black spots;
Spots do go away in several weeks- primarily seen in black/mediterranean babies |
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vernix caseosa
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cheesy substance on baby when its first born
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reflex: tonic neck
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if you straighten arm out the opposite arm and leg will be bent
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reflex: grasping
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put your finger in a babies hand they’ll grasp onto it (palmar grasp) if you put finger under toes – toes will curl over them (plantar grasp)
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reflex: moro
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whole body movement in response to stimulus (surprised kitty video)
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reflex: rooting
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newborns natural instinct to breastfeed; searching for nipple; good sign of hunger
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reflex: sucking
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put your finger in newborns mouth and they will suck hard
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reflex: babinski
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toes sprawl out when doing assessment- if its absent in newborn something is wrong- don’t want it in a.hood
Either absent or present (not pos or neg) |
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APGAR:
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Evaluation of newborn after birth. Rate 0-2 for each category. the higher the better.
HR: 0=absent. 1= slow- below 100. 2= above 100. resp effort: 0= absent. 1=slow- irregular. 2=good crying muscle tone: 0=flaccid. 1=some flexion of extremities. 2= active motion reflex irritability: 0=absent. 1=grimace. 2=vigorous cry. color: 0=pale blue. 1=body pink, blue extremities. 2=completely pink. |
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areas of physical assessment?
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VITAL SIGNS
CRY MEASUREMENTS HEAD NECK SKIN FACE CHEST ABDOMEN EXTREMETIES GENITALIA |
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head: molding
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Newborn head molding is an abnormal head shape that results from pressure on the baby's head during childbirth.
Te bones of a newborn baby's skull are soft and flexible, with gaps between the plates of bone. |
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head: CEPHALHEMATOMA
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a hemorrhage of blood between the skull and the periosteum of a newborn baby secondary to rupture of blood vessels crossing the periosteum. Because the swelling is subperiosteal its boundaries are limited by the individual bones, in contrast to a chignon.
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head: CAPUT SUCCEDANEUM
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a neonatal condition involving a serosanguinous, subcutaneous, extraperiosteal fluid collection with poorly defined margins caused by the pressure of the presenting part of the scalp against the dilating cervix (tourniquet effect of the cervix) during delivery.
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male genitalia: HYPOSPADIUS
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a birth defect of the urethra in the male that involves an abnormally placed urinary meatus
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male genitalia: CRYPTORCHIDISM
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the absence of one or both testes from the scrotum. It is the most common birth defect regarding male genitalia.
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male genitalia: HYDROCELE
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notes a pathological accumulation of serous fluid in a body cavity.
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female genitalia: PSEUDOMENSTRUATION
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from moms hormones- normal
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female genitalia: SMEGMA
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white stuff. a combination of exfoliated (shed) epithelial cells, transudated skin oils, and moisture. It occurs in both female and male mammalian genitalia.
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preterm
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37 weeks and less
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term
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38-41 weeks
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post term
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42+ weeks
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viable age
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24 weeks
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SGA- SMALL for GESTATIONAL AGE
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4 lb, 40 week baby
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AGA- APPROPRIATE GESTATIONAL AGE
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7 lb, 38 week baby
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LGA- LARGE GESTATIONAL AGE
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11.5 lb, 38 week baby
6 lb, 32 week baby |
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newborn maturity rating
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More immature: lower numbers
Mature: higher numbers****** (0-5) Neuromuscular maturity Posture Square window: way to look @ maturity Arm recoil Popliteal angle Scarf sign Heel to ear |
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physical maturity aspects: skin, lanugo, plantar surfaces, breast, ear, genitals
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Skin- leathery, cracks, veins visible
Lanugo Plantar surfaces-creases over sole Breast-nodule and areolar area Ear-pinna Male genitals-scrotum, testes, rugae Female genitals- clitoris, labia majora, labia minora |
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immediate care areas
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MAINTAIN CLEAR AIRWAY
THERMOREGULATION VITAMIN K OPHTHALMIC OINTMENT: ghonnerhea INITIATION FIRST FEEDING PARENT-NEWBORN ATTACHMENT |
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ongoing newborn care
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THERMOREGULATION
HYDRATION AND NUTRITION SAFETY CIRCUMCISION PARENT-NEWBORN ATTACHMENT CARE OF BABY NEWBORN SCREENING AND IMMUNIZATION |
