Nursing Care Of The Newborn

Front 1

Neonatal period

Back 1

0-28 days
There are certain things that newborns have to do to adapt to extrauterine life

Front 2

Respiratory adaptations

Back 2

Initiation of respirations: things done to stimulate babies to breathe
1. Chemical Stimuli: chemical asphyxia due to decreased blood through the placenta & cutting of cord; this stimulates the medulla to have the baby to take a breath.

2. Mechanical Stimuli: vaginal wall compresses chest & lungs of baby and squeezes out 30-50% of fluid; remainder of fluid is pushed down to the bottom of lungs and reabsorbed by body.
C-section babies: once the lungs expand, the surfactant keeps the lungs open but it takes them longer to get rid of the mucus.

3. Thermal Stimuli: occurs when the baby is delivered; with stimulation of the skin receptors; sends a message to the medulla for the baby to breathe.

Front 3

Normal resp of newborn

Back 3

30-60 breaths/min

if crying, can be as high as 80

Front 4

Cardiovascular adaptations

Back 4

Once the baby is delivered, the shifts in pressure cause the following to close & fetal circulation is no more; regular circulation takes over.
May hear a murmur upon initial assessment, usually just a transient murmur.
The following close upon delivery because of shift in pressure: Foramen Ovale, Ductus Arteriosus, Ductus Venosus.

Front 5

Cardiac characteristics

Back 5

120-160blm = normal
Always assess apical pulse on newborns, listen over all the valves

BPs not done on newborns unless specifically requested by MD; if requested, do on all four limbs.

Front 6

Avg blood volume for newborn

Back 6

80 ml/kg

Front 7

Hematopoietic adaptations

Back 7

At birth, NB has more RBCs & higher Hgb/Hct than adults.

RBCs in NB have shorter life span than adults which is what causes jaundice.

WBCs normally rise w/i 1st 12 hrs & then start dropping. Elevated WBC count in baby is not always indicative of infection; often septic babies have decreased WBC count.

Platelets will often decrease if infection is present. Babies have clotting factors but lack Vit K to release those factors (K made in GI tract which is sterile at birth until shot of K is given after birth)

Front 8

Normal Hct in NB

Back 8

48-69% (40-42% in adults)

anything > 65% from a central site indicates polycythemia (excessive RBCs)

Front 9

Polycythemia

Back 9

puts babies at an increased risk for jaundice and damage to brain & other organs as a result of blood stasis.
Need to monitor closely for jaundice; can build up in brain & other organs.

Front 10

Temperature regulation

Back 10

necessary for baby to survive

Front 11

Thermoregulation

Back 11

ability of the neonate to producce heat and maintain a normal body temperature (mom does it for him in utero)

RED FLAG if baby cannot maintain body temp (sepsis)

Front 12

reasons that neonates are predisposed to heat loss

Back 12

limited subQ fat
thin skin, vessels close to surface
large body surface (3x more than adults)
flexed position of full-term reduces amt of skin surface exposed

Front 13

Mechanisms of heat loss

Back 13

evaporation - babies wet when delivered, if not wiped off quickly, evaporates & takes heat with it
conduction - if laid on cold bed, heat taken
convection - body exposed to air
radiation - baby is laid close to windows

Front 14

Baby's optimal environment

Back 14

89.6-93.2 degrees in environment

97.5-99 degrees skin temp

Front 15

nonshivering thermogenesis

Back 15

(babies do not shiver)
increases metabolic rate

consumes calories & O2

metabolism of their stores of brown fat (usually present on chest, abdomen, & upper middle back; preemies have very little, if any, brown fat)

Front 16

effects of cold stress

Back 16

O2 deprivation
rapid depletion of stored glycogen (converted to glucose for heat)
go into metabolic acidosis
decrease in blood glucose (hypoglycemia)
respiratory distress
**if baby has to use their brown fat to maintain heat, it can throw the baby into a state of metabolic acidosis & death can occur.

Front 17

Hyperthermia

Back 17

baby gets too hot
elevated temp b/c of possible sepsis at delivery
metabolic rate rises
increased need for O2 & glucose

Front 18

Hepatic adaptations

Back 18

liver is working, but immature

Blood Glucose Maintenance:
*glucose stored in fetal liver as glycogen in last 4-8 wks before delivery
*Glycogen converted to glucose for use
*Glucose rapidly used to maintain temp which depletes store quickly
*Glucose levels s/b 40-60
*40-45=hypoglycemic

Front 19

Bilirubin (hepatic adaptations)

Back 19

Is released when RBCs are broken down
Bilirubin is released in unconjugated form which is also known as indirect bilirubin.
*Indirect bilirubin - is fat soluble & bound to circulating albumin, body cannot get rid of it b/c its fat soluble (must be water soluble), so it must go to liver to be converted; however the liver is immature & may not be able to convert it. If unable to convert, can lead to jaundice

Front 20

Physiological Jaundice

Back 20

usually occurs a couple of days after delivery; could be b/c of traumatic/hard delivery.
Monitor baby (best place to check is by pressing end of nose)

Front 21

Pathological Jaundice

Back 21

occurs w/i the 1st 24 hours after delivery.
Rh incompatibility
ABO incompatibility
Phototherapy is the best treatment; helps liver break inconjugated bilirubin to conjugated form.

Front 22

Phototherapy

Back 22

monitor hydration status
protect eyes
monitor temp

Front 23

Blood coagulation

Back 23

PT & coagulation factors produced by liver, activated by Vit K

Front 24

Iron storage

Back 24

Fe stored in liver during last weeks of PG.

Front 25

GI adaptations - Stomach

Back 25

holds 50-60ml (a little less than 2 oz) initially
*gastric emptying may be delayed, unless breastfeeding b/c gastric emptying is rapid after ingestion of human milk
*Gastrocolic reflex - when stomach fills, signals peristalsis which comes in waves & is painful for baby.
*relaxed cardiac sphincter b/t esophagus & stomach which causes tendency to spit up.

Front 26

GI adaptations - intestines

Back 26

long in comparison to adults

sterile at birth, need food to produce the normal flora

Front 27

transitional stools

Back 27

looser consistency than meconium, greenish

Front 28

milk stools

Back 28

depends on milk; formula is yellowy; breastfed is looser consistency

Front 29

Urinary adaptations

Back 29

immature kidney function

voiding occurs 12-24 hrs after birth - need to make sure to document first void.

lower tolerance for total fluid volume changes

bladder can hold 6-44ml

Front 30

immunity adaptations

Back 30

immature
risk for infection
HANDWASHING!

Front 31

Immunoglobulins

Back 31

IgG - crosses placenta; fights against bacteria/viruses

IgM - does not cross placenta; produced after birth; fights against Gram Neg bacteria

IgA - does not cross placenta; not produced until 6-12 wks after birth; protects against GI & URIs.

Front 32

Periods of Reactivity

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1st period of reactivity: Birth - 30 minutes. Baby is active, lots of eye contact, looking around, resp rate as high as 80 & heart rate as high as 180 b/c so active.

Period of Inactivity: 2-4 hours after) quiet, not much activity, deep sleep possible. Heart & resp rates drop.

2nd period of Reactivity: 4-6 hours. had a nap, ready for more. Wants to eat, first meconium often happens here. Heart/resp rate may increase again.

Front 33

Quiet sleep

Back 33

eyes closed, no mvmt under eyes

Front 34

Active sleep

Back 34

eyes closed & moving, resps usually irregular & are easily startled

Front 35

Post delivery assessments

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L&D Hx & notes
Apgar scoring
Gest age assess
observe for anomalies
ID process
Measurement/VS
Prophylactic meds
initial bath

Front 36

Gestational age assessment

Back 36

Physical:
>skin (preterm is thin, post-term is dry/cracked)
>foot creases - do not show up until 32 wks, start forming from top down
>lanugo
>size of breast tissue
>rugae on scrotum
>labia majora covers minora
>ear cartilage (if pulled forward does ear pop back or lay there)
>eyes

Neurological
>posture - when laid down
>square window (wrist) - push down on fingers, full term will lay flat, preterm will meet resistance
>scarf sign - where elbow is in relation to midline when pulled across chest
>arm recoil - fold arms & hold down at side; when released should return to original position; if preemie, will not.
>Popliteal Angle - keep hips on bed & extend leg, measure angle behind knee
>heel to ear - preemies legs will go all the way to ears.

Front 37

Newborn Norms

Back 37

HR = 120-160
Resp = 30-60
BP = 60-80/40-45
Temp = 97.5-99
Weight = 5lb 8oz - 8lb 13oz (2500-4000 grams)
length = 18-22" (48-53cm)
H/C = 32-37cm
Chest Circum = 32.5cm (usually 1-2cm < H/C

Front 38

Signs of resp distress in NB

Back 38

tachycardia
retractions
nasal flaring
cyanosis
grunting
see-saw resps
decreased O2 sat
asymmetry