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199 Cards in this Set

  • Front
  • Back
Acrocyanosis
Bluish discoloration of the hands and feet caused by reduced peripheral circulation.
Asphyxia
Insufficient oxygen and excess carbon dioxide in the blood and tissues.
Bilirubin
Unusable component of hemolyzed (broken down) erythrocytes.
Brown fat (or brown adipose tissue)
Highly vascular specialized fat found in the newborn that provides more heat than other fat when metabolized.
Café au lait spots
Light brown birthmarks.
Caput succedaneum
Area of edema over the presenting part of the fetus or newborn, resulting from pressure against the cervix. Often called simply “caput.”
Cephalhematoma
Bleeding between the periosteum and skull from pressure during birth; does not cross suture lines.
Choanal atresia
Abnormality of the nasal septum that obstructs one or both nasal passages.
Chordee
Ventral curvature of the penis.
Craniosynostosis
Premature closure of the sutures of the infant's head.
Cryptorchidism
Failure of one or both testes to descend into the scrotum.
Epispadias
Abnormal placement of the urinary meatus on the dorsal side of the penis.
Erythema toxicum
Benign rash of unknown cause in newborns, with blotchy red areas that may have white or yellow papules or vesicles in the center.
Fetal lung fluid
Fluid that fills the fetal lungs, expanding the alveoli and promoting lung development.
First period of reactivity
Period beginning at birth in which newborns are active and alert. It ends when the infant first falls asleep.
Hyperbilirubinemia
Excessive amount of bilirubin in the blood.
Hypospadias
Abnormal placement of the urinary meatus on the ventral side of the penis.
Jaundice
Yellow discoloration of the skin and sclera caused by excessive bilirubin in the blood; also called icterus.
Lanugo
Fine, soft hair covering the fetus.
Milia
White cysts, 1 to 2 mm in size, from distended sebaceous glands.
Molding
Shaping of the fetal head during movement through the birth canal.
Mongolian spots
Bruiselike marks that occur mostly in newborns with dark skin tones.
Neutral thermal environment
Environment in which body temperature is maintained without an increase in metabolic rate or oxygen use.
Nevus simplex (salmon patch, stork bites, telangiectatic nevi)
Flat, pink areas on the nape of the neck, forehead, or eyelids resulting from dilation of the capillaries.
Nevus flammeus
Permanent purple birthmark; also called port-wine stain.
Nevus vasculosus
Rough, red collection of capillaries with a raised surface that disappears with time. Also called strawberry hemangioma.
Nonshivering thermogenesis
Process of heat production, without shivering, by oxidation of brown fat.
Periodic breathing
Cessation of breathing lasting 5 to 10 seconds followed by 10 to 15 seconds of rapid respirations without changes in color or heart rate.
Point of maximum impulse
Area of the chest in which the heart sounds are loudest when auscultated.
Polycythemia
Abnormally high number of erythrocytes.
Polydactyly
More than 10 digits on the hands or feet.
Pseudomenstruation
Vaginal bleeding in the newborn, resulting from withdrawal of placental hormones.
Second period of reactivity
Period after the first sleep following birth when the newborn may have an elevated pulse and respiratory rate and excessive mucus.
Strabismus
A turning inward (“crossing”) or outward of the eyes caused by poor tone in the muscles that control eye movement.
Surfactant
Combination of lipoproteins produced by the lungs of the mature fetus to reduce surface tension in the alveoli, thus promoting lung expansion after birth.
Syndactyly
Webbing between fingers or toes.
Tachypnea
Respiratory rate greater than 60 breaths per minute in the newborn after the first hour of life.
Thermogenesis
Heat production.
Thermoregulation
Maintenance of body temperature.
Vernix caseosa
Thick, white substance that protects the skin of the fetus.
When does the fetus begin producing fluid? What does the fluid do?
During the later ½ of the pregnancy, the fetal lungs produce fluid. This fluid expands the lungs, filling the air spaces.
When does the production of fluid stop?
The production of lung fluid then begins to diminish 2 to 4 days before labor begins
How much fluid is in the full term newborns lungs?
~80 to 100 mL remain in the passageway of a full-term newborn
How does the fluid get out?
During the birth process*, the fetal chest is compressed and squeezes out the fluid.
How does fluid get out when a baby is delivered C-section?
The uterus incision is small, but the baby will have more fluid in lungs. They may have to be intubated and suctioned.
What is the biggest risk with premature birth?
Respiratory distress.
What intervention needs to happen with premature birth
Give steroids to the mom 24-48 before birth to try and accelerate lung maturity. Give an amniotic infusion to try to keep the baby in. This is not effective after 34 weeks.
What should you do if three hours after birth you hear moist lung sounds
Just continue to monitor. It is normal for lung sounds to be moist up to 24 hours after birth.
What is the first breath called?
The first breath is the inspiratory gasp
What is the first breath triggered by?
An increase in PCO2 and decrease in pH and PO2 levels
What do the changes in PCO2, pH, and P02 trigger?
Trigger the aortic and carotid chemoreceptors and the brain's respiratory center. Which causes the diaphragm to contract.
How much of a decrease in the environmental temperature occurs after birth?
The fetus' temp goes from 37C(98.6F) to 21-23.9C (70-75 F).
When does thermal stimuli begin?
The cold stimulates the skin nerve endings
What is the response of the newborn to the cold?
The newborn begins to respond with a rhythmic respiration
What can excessive cooling lead to?
Excessive cooling may led to a profound depression of cold stress-- which is respiratory distress.
How does the newborn compensate for extreme cold?
The newborn has to use compensatory mechanisms to maintain core temp: flexion and activity increases metabolism which increases respiration. Glucose need is increased. Norepinephrine stimulates nonshivering thermogenesis which is the metabolism of brown fat.
What can the cold stress lead to?
Can lead to respiratory distress syndrome (RDS)
What newborns are more at risk for cold stress?
Preterm and small for gestational age (SGA) are at increased risk due to decreased adipose tissue and brown fat stores
What risks may the preterm or SGA infant have with cold stress?
hypoxemia, hypoglycemia, metabolic acidosis
What does non-shivering thermogenesis do?
They use up their fat stores to stay warm. They can become hypoglycemic so you want to put them in the warmer and get them up to 97.8 degrees and then feed them.
Can develop hypoxemia as well. If respirations are greater than 60, put a pulse ox on, if pulse ox is less than 90 then give O2.
If a baby has a respiratory rate of 55 what interventions should you do
Continue to monitor. Normal is 30-60.
If the baby is cyanotic what is your first intervention?
Put on a pulse ox. If above 90% don't administer O2.
How does the newborn lose heat?
Evaporation (example: wet with amniotic fluid)
Conduction (example: direct contact with cold stethoscopes)
Convection (example: transfer of heat to cool air)
Radiation (example: transfer of heat to cooler objects)
What does the initiation of respiration stimulate?
Stimulates cardiovascular system
Causes increased oxygenated pulmonary blood flow
Systemic blood flow then increases, and the foramen ovale closes (fossa ovalis)
Shortly after, the patent ductus arteriosis (PDA) begins to close
This leads to a decrease in pulmonary vascular resistance – which allows for complete vascular flow to the lungs
Greater blood volume to the lungs converts fetal to newborn circulation
Normal heart rate:
120-160/min (up to 180 with crying, 100 if sleeping)
How long should you take the apical pulse rate?
Apical pulse x 1 minute upon admission. Make sure it's regular.
What do you assess when auscultating the heart?
Assess for murmurs- 90% are transient, because of the closure of passages.
Blood pressure:
Marcia-80-60/40-45 mm/Hg Book 65-95/30-60 mm/Hg
Capillary refill:
-<2-3 seconds
What is the blood volume of a term infant?
The blood volume of a term infant is estimated to be ~ 80 mL/kg of their body weight
What does the infants blood volume vary with?
The amount of placental transfusion received during expulsion of placenta, if cord is unclamped for few minutes, blood volume of infant can increase 61%
Blood volume and Gestational age?
Preterm infants have a greater blood volume per kg than term infants.
What can Prenatal and perinatal hemorrhage cause?
Hemorrhage can decrease the hematocrit level and can cause hypovolemia.
How is the newborn liver different from the adult liver?
It is slightly less active than the adult liver
What difficulties to newborns have because of less liver activity?
The newborn may have difficulty conjugating bilirubin.
What is responsible for the coagulation fators?
The liver
Babies of diabetic moms develop polycythemia. What does this do?
They don't need all those red blood cells and so they start to destruct, the immature liver can’t handle all those cells and the baby will deveiop jaundice.
What are other causes of jaundice?
bruising at birth from suction cup, the bruise blood cells destruct. BlueBerry baby (baby blast out fast) face is all bruised.
What does the liver store?
The liver plays a crucial role in iron storage
What metabolic functions does the newborn liver have?
Coagulation
Carbohydrate metabolism (enzymes)/maintenance of glucose.
Is physiologic jaundice considered a normal physiologic process? When does it occur?
Yes, it is a normal physiologic process. It occurs after the first 24 hours.
What is the etiology of physiologic jaundice?
Caused by the accelerated destruction of RBCs and increased resorption by liver.
What are the Signs of physiologic jaundice?
Note yellowing skin & sclera
The nurse assesses for jaundice at least every 8 to 12 hours and is particularly watchful with infants with increased risk factors. Jaundice is identified by pressing the infant's skin over a firm surface, such as the end of the nose or the sternum. As the skin blanches, the yellow color can be seen. Jaundice begins at the head and moves down the body and the areas of the body involved should be documented.
What is the most common cause of jaundice?
Rh or ABO incompatibility.
What is the treatment for jaundice?
Increase supplementation of formula to promote elimination in bowel. Frequent feeds and monitoring stooling.
Phototherapy
What are some Potential Complications of physiologic jaundice?
Hyperbilirubinemia-- Kernicterus-
Kernicterus
toxic levels of billirubin in brain-- brain damage.
Where is Meconium formed?
It is formed in utero
When does the newborn pass their first stool and what is it called?
Newborn passes meconium within 48 hours
What does Meconium look like?
dark green –black & thick
When should they pass meconium?
Within 48 hours.
What does Transitional stool look like and when is it passed?
thin brown to green ~ 2 days later
What do Breastfed stools look like?
are pale yellow to pasty green
When do newborns first void?
95% of newborns should void by 24 hours after birth and 100% by 48 hours after birth
What is the initial bladder volume?
The initial bladder volume is 6 to 44 mL of urine
What should the nurse do if the newborn doesn't void within 48 hours?
If a newborn does not void within 48 hours, the nurse should assess the adequacy of fluid intake, bladder distention, restlessness, and symptoms of pain
How long does the process of passive immunity last?
4 weeks--month.
When is passive immunity acquired?
Passive acquired immunity occurs during third trimester
The preterm may not have acquired immunity, what risks do they face?
Preterm infant may be more susceptible to infection
Why shouldn't we assume that because they don’t have temperature, they don’t have an infection.
Because their immune system is immature, and won't always respond with an increase in temp.
What is another way to get passive immunity from mother?
Breastfed newborn may have passive immunity from the mother
When do newborns begin to produce secretory IgA?
Newborns begin to produce secretory IgA in the intestinal mucosa at 4 wks gestation.
BUT: IgA does not cross placenta and the IMMUNOGLOBIN is not produced by infant until 2 wks of age.
IgG
IgM
IgM helps protect against gram-negative bacteria. Production increases rapidly a few days after birth as the infant is
exposed to antigens in the environment. IgM reaches adult levels at 1 year of age (Buckley, 2007). If IgM is found in
larger-than-normal amounts in the neonate, exposure to infection in utero is probable because IgM does not cross the
placenta.
IgA
IgA also does not cross the placenta and must be produced by the infant. Because IgA is important in protection of
the gastrointestinal and respiratory systems, newborns are particularly susceptible to infections of those systems. The
immunoglobulin is produced beginning about 2 weeks of age. Secretory IgA is included in colostrum and breast milk. Therefore breastfed infants may receive protection that formula-fed infants do not.
What are the two components of gestational age assessment?
The external physical characteristics and the neurologic characteristics
What conditions or diseases may impact gestational age assessment?
Maternal conditions, such as preeclampsia, diabetes, and maternal analgesics and anesthesia may impact certain components of the gestational assessment. e.g. Things to consider mom with HTN may have 4 lb baby but be born full term. Diabetic mom may have a 35
weeker that is 8 lbs but born immature. Mom may have had pain meds and baby is floppy, that causes cns
depression but doesn’t mean neurological impaired r/t gestational age. If mom has been on Magnesium
Sulfate then baby may have cns depression not r/t gestational age.
When should the newborn be assessed?
Observable characteristics of the newborn should be evaluated while not disturbing baby in the first 24 hours.
What to we look at?
1. We look at babies skin, how much vernix, the more vernix on baby the more preterm. The less vernix, the more term. Full term newborn will have a little crease under their arm, neck, or in groin. A 35 weeker may
have vernix covering face. Baby oil will get vernix off.
2. The more hair they have the less term. Hispanic babies may be full term and have lots of hair on
forehead and shoulders.
3. Look at creases. The more creases, the deeper the creases the more full term. The less creases, the less
term. Preterm may have creases only on the upper 1/3, lower 2/3 flat hands.
4. Look at breast tissues
5. Ear coils, less coils means less term, preterm baby may have flat ears.
6. Genitals:
• female, more term: labia majora covers the minora and clitoris. Less term: the labia minora is more
prominent and may have prominent clitoris.
• Male, more term: more rugae on scrotum, check testes. Less term: testes may not have been
descended. Check both sides.
Baby may have some things look normal and other
What are signs of term vs. preterm for babies who are male or female on the genitalia assessment?
Male
Full term: more rugae on the sac
Less term: less rugae on scrotal sac.
Foreskin shouldseparate and the meatus should be central, testes should be distended
Females
Full term: the labia majora covers the minora and clitoris, hymenal tissue sticking up, sometimes babies have
pseudomenstration rusty staining on diaper d/t excess estrogen from mom
Less term: the labia minora more prominent.
How is temperature of newborn assessed?
Assessed by performing the axillary skin method, or continuous skin probe (radiant warmer) Rectal route is used for 1st temp (36.6-37.2C/ 97.8-99F) The axillary temperature is the preferred method after (36.4-37.2 C/ 97.5-99F)
What does Temperature instability indicate?
infection
Newborn Weight range:
2500 to 4000 g (5 lb, 8 oz to 8 lb 13 oz), weight dependent on maternal size and age
Newborn Length range:
46 to 56 cm (18 to 22 in)
Newborn Head circumference range:
32 to 37 cm (12.5 to 14.5 in) - approximately 2 cm larger than chest circumference
What is asymmetry of head d/t?
Molding, Chephalhematoma, and Caput Succedaneum,
When should you do an accu check?
Accucheck:
Mom has diabetes
5 lb 8 oz or less
8.13 oz 4000 grams or greater
What is Molding? what is it caused by?
Molding refers to changes in the shape of the head from overriding of cranial bones at the sutures. -caused by overriding sutures
What is Cephalhematoma?
Cephalhematoma is a collection of blood resulting from ruptured blood vessels. A cephalhematoma has clear edges that end at the suture lines. It does not cross the suture lines, unlike a caput succedaneum, because the bleeding is held between the bone and its covering, the periosteum. A cephalhematoma reabsorbs slowly and may take 6 to 8 weeks before it is completely resolved. Because of the breakdown of the red blood cells within the hematoma, affected infants are at greater risk for jaundice.
What is Caput Succedaneum?What are the causes?
localized, soft edematous swelling
A caput succedaneum often appears over the vertex of the newborn's head as a result of pressure against the mother's cervix that causes localized edema. The edematous area crosses suture lines, is soft, and varies in size. It resolves quickly and disappears within 12 hours to several days after birth. Caput also may occur when a vacuum extractor is used to assist birth and corresponds to the area where the extractor was placed on the skull. The amount of edema and presence of bruising are assessed.
What information does the nurse include in assessment findings for delivery?
the prenatal, labor, and birthing data
If mom got narcotics what do you assess the baby for?
Respiratory depression.
What information should be included in the newborn assessment?
gestational, behavioral, and physical assessments of newborn
When is the newborn assessment performed?
It is done in first 1 to 4 hours after birth
Head is usually a couple cm greater than chest. If difference is more than 3 cm...
then reassess for micro or macro cephaly.
When is BP monitored in the newborn?
Monitor BP in cases of distress, premature birth, and anomaly
What emergent problem should be watched for?
Evaluate for the newborn for cold stress
When monitoring cold stess, when should the physician be notified?
Notify the physician of an elevation or drop in the core temperature
What correlates with sleep wake cycle?
Identify sleep-wake state and correlate with the respiration pattern
What kind of distress needs to be continuously evaluated?
Evaluate for signs of respiratory distress
What should be included in the cardiac assessment?
Assess the heart rate & rhythm - evaluate murmur: location, timing, and duration
What should the nurse look for when assessing the chest?
Examine appearance and size of chest, Note if there is funnel chest, barrel chest, unequal chest expansion Breasts are flat with symmetric nipples - note lack of breast tissue or discharge
What is included in the respiratory assessment?
Assess and maintain airway, Assess breath sounds and respiratory efforts - evaluate color for pallor or cyanosis
What is included in the abdominal assessment?
Abdomen usually appears large in relation to the pelvis, Note an increase or decrease in peristalsis Note protrusion of umbilicus-ie hernia Note any discharge or oozing from cord Note appearance and amount of vessels
What pulses should be included in the newborn assessment?
Femoral pulses and Brachial pulses
What do you examine the extremities for?
Examine extremities for gross deformities Note position and condition of extremities and trunk Examine for symmetry and strength of movements
When should you examine extremities more closely?
Examine more closely when infant is reluctant to move an extremity –Note if there is brachial palsy or Erb-Duchenne paralysis Suspect injury at birth Check for developmental dysplasia of the hip (Ortolani manuever)
What should the back be assessed for?
Examine the back for associations with any neural tube defects
How much of a head lag should be noted?
Note head lag of less than 45 degrees
What should be included in the head assessment?
Assess ability to hold head erect briefly
What reflexes are assessed?
Moro, palmar grasp, babinski reflexes
Why are the reflexes assessed?
Reflexes characterize an Immature central nervous system (CNS) of newborn is characterized
What are the purposes of the newborn reflexes?
Some reflexes are protective, some aid in feeding, others stimulate interaction
What are the protective reflexes?
Protective reflexes are blinking, yawning, coughing, sneezing, drawing back from pain
What do the rooting and sucking reflexes assists with?
Rooting and sucking reflexes assist with feeding
When should the the family's need for teaching assessed?
During the physical and behavioral assessment, identify the family's need for teaching
Who is important to include in the care of infant?
Involve family early in care of infant
What Processes establish uniqueness and allays concerns?
Teaching Feeding cues
Alert state
Cord care
Sleeping Length and course of labor
Type of delivery
Conditions at delivery
Any medications given during labor
Infections during pregnancy
Estimated date of birth (EDB)
Prenatal lab results
How is output assessed on newborn?
weigh diapers.
1mg=1ml
What is normal input and output?
Intake: 40–60 mL/kg/day

Normal output for newborn is:
What is the only immunoglobin that crosses the placenta?
IgG.
provides the fetus with passive temporary immunity to bacteria, bacterial toxins, and viruses to which the mother has immunity. Preterm infants have less IgG because transfer is greatest during the third trimester. The full-term infant has IgG levels near those of the mother.
Although the fetus begins to make IgG at 20 weeks of gestation, production at significant levels is delayed until after 6 months of age. The passive immunity from the mother gradually disappears over the first 6 to 8 months of life .
What does IgM protect against? When is it produced?
What does if IgM is found in larger than normal amounts in infant?
IgM protects against gram-negative bacteria.
Production increases rapidly a few days after birth as the infant is exposed to antigens in the environment. IgM reaches adult levels at 1 year of age.
If IgM is found in larger-than-normal amounts in the neonate, exposure to infection in utero is probable because IgM does not cross the placenta.
When is Nonphysiologic or abnormal jaundice seen?
In the first 24 hours.
Why is nonphysiologic jaundice a concern?
It is a concern because it may cause acute bilirubin encephalopathy, the acute manifestation of bilirubin toxicity that occurs in the first weeks after birth. This may lead to kernicterus, the chronic and permanent result of bilirubin toxicity
What is the most common cause of nonphysiologic jaundice?
The most common cause of nonphysiologic jaundice is hemolytic disease of the newborn from incompatibility between the blood of the mother and that of the fetus. The best known cause is Rh incompatibility, in which the Rh-negative mother forms antibodies when Rh-positive blood from the fetus enters her circulation
What does excessive destruction of erythrocytes cause?
Excessive hemolysis causes erythroblastosis fetalis.
Infants with erythroblastosis fetalis are anemic from destruction of red blood cells. Severely affected infants may develop hydrops fetalis, a severe anemia that results in heart failure and generalized edema
Who is affected?
The woman's first Rh-positive child is usually unaffected because antibodies are formed after the birth of the infant. Subsequent Rh-positive fetuses may be affected, however, unless the mother receives RhoGAM to prevent antibody formation after the birth of each Rh-positive infant.
What are the indications for RhoGam?
Administered to Rh-negative women who have been exposed to Rh-positive blood by:

• Delivering an Rh-positive infant

• Aborting an Rh-positive fetus

• Having chorionic villus sampling, amniocentesis, or intraabdominal trauma while carrying an Rh-positive fetus

• Accidental transfusion of Rh-positive blood to an Rh-negative woman
When is RhoGam given?
• At 28 weeks of pregnancy and within 72 hours of delivery

• Within 72 hours following the termination of a pregnancy of 13 weeks or more of gestation
Intervention for Risk for Ineffective Thermoregulation related to immature compensation for changes in environmental temperature.
-place the infant on the mother's abdomen to provide warmth from skin-to-skin contact or under the radiant warmer to counteract the cool temperature of the delivery room
Dry the wet infant quickly with warm towels to prevent heat loss by evaporation.
Remove towels or blankets as soon as they become wet, and replace them with dry, warmed linens. Cover the infant's head with a cap when the infant is not under a radiant warmer. Do not use a hat when the infant is under the warmer because it prevents transfer of heat to the infant's head.
Bathe quickly
Interventions for Cold stress:
Feed!
BUT WARM FIRST! DO NOT FEED COLD BABY!
Why is Vitamin K given?
COAGULATION!
The newborn lacks the intestinal bacteria flora for the production of vitamin K. Prothombin levels are low during the first few days of life.
IM in left vastus lateralis.
What is needed to give Hep B?
Consent form
What newborn screen is given in every state?
Hearing
Why is erythromycin ointment given to newborns?
Protect eyes from chlamydia and gonorrhea.
What if mom is positive for Hep B?
Infant receives both vaccine and HBIG.
What prevents contamination of maternal and fetal blood when giving hep B?
the newborn must be bathed before injections or heel sticks are done.
What are the signs of respiratory distress?
Tachypnea, a respiratory rate of more than 60 breaths per minute, is the most common sign of respiratory distress.
Retractions
Nasal flaring
Cyanosis
Grunting
See Saw respiration
Asymmetry
What is intervention if infant is has signs of respiratory distress?
Put pulse ox on
If >90, monitor
If <90 put mask near face at 2L
What factors stimulate first Breath?
Mechanical
Thermal
Chemical
Sensory
What are the mechanical stimuli that initiates breathing?
During a vaginal birth the fetal chest is compressed by the narrow birth canal. A small amount of the fetal lung fluid is forced out of the lungs into the upper air passages and expelled during birth.
What are the Thermal stimuli that initiates breathing?
The temperature change that occurs with birth also stimulates the initiation of respirations. Sensors in the skin respond to this sudden change in temperature by sending impulses that stimulate the respiratory center and breathing.
What are the chemical stimuli that initiates breathing?
Chemoreceptors in the carotid arteries and the aorta respond to changes in blood chemistry brought about by the hypoxia that occurs with normal birth. The decrease in blood oxygen level (PO2) and pH and the increase in blood carbon dioxide (PCO2) cause stimulation of the respiratory center in the medulla. A forceful contraction of the diaphragm results, causing air to enter the lungs. However, stimulation of the respiratory center and breathing do not occur if prolonged hypoxia causes central nervous system depression.
What are the sensory stimuli that initiates breathing?
Tactile stimuli that occur during birth stimulate skin sensors. Nurses hold, dry, and wrap infants in blankets or place them skin to skin with the mother, providing further stimulation to skin sensors. The stimulation of the sound, light, smell, and pain at delivery also may aid in initiating respirations.
When is most of the fluid in the lungs absorbed?
Although most fluid is absorbed within a few hours, complete absorption may take as long as 24 hours. Therefore the lungs may sound moist when first auscultated but become clear a short time later.
How often are vital signs taken on neonate?
Every 30 minutes for 2 hours.
When is assessing infant for low glucose, what is assessed prior to accucheck?
Temperature.
What is required before heel stick?
Bath and heel warmer
What is intervention if glucose is less than 40-45?
Feed formula, 30ml (2 oz)
Reassess glucose 30-40 minutes after.
What other assessments should be performed for low glucose baby?
Bilirubin/Jaundice
hearing
voiding and stooling
What infants are at risk for hypoglycemia?
Preterm/SGA
Macrosomia/LGA
Asphyxia or infection
Cold babies.
What signs are assessed for hypoglycemia?
Signs of Hypoglycemia
• Jitteriness, tremors
• Poor muscle tone
• Tachypnea
• Grunting
• Cyanosis
• Apnea
• Diaphoresis
• Low temperature
• Poor suck
• High-pitched cry
• Lethargy
• Irritability
• Seizures, coma
• No symptoms (some infants may be asymptomatic)
What are complications to watch for in infant with hypoglycemia?
Infants who do not have enough glucose may experience a drop in temperature that could lead to respiratory distress as oxygen is used for nonshivering thermogenesis.
How often is assessment of newborn skin for jaundice done?
Every 8 to 12 hours.
What tests are done for suspected jaundice?
transcutaneous(TcB) or serum bilirubin (TSB) tests
Hyperbilirubinemia
Excessive amount of bilirubin in the blood.
Jaundice
Yellow discoloration of the skin and sclera caused by excessive bilirubin in the blood.
Ophthalmia neonatorum
Severe conjunctivitis in the newborn often caused by gonorrhea or chlamydia infection in the mother. May cause blindness.
Plagiocephaly
Flattening or asymmetry of the head
Prepuce
Fold of skin covering the glans penis; foreskin; may be removed by circumcision.
Thermoregulation
Maintenance of body temperature.
What APGAR score is of concern?
Less than 7.
What do you suction first?
mouth then nose.
What are the normal glucose levels?
In the term infant, blood glucose levels should be 40 to 60 mg/dL at 1 day and 50 to 90 mg/dL thereafter.
Is it normal to be born with jaundice?
No.
Hypospadias
Abnormal placement of the urinary meatus on the ventral side of the penis.
Epispadias
Abnormal placement of the urinary meatus on the dorsal side of the penis.
What is habituation?
Infants gradually stop responding to continued unpleasant stimuli. This gradual habituation allows them to ignore the stimuli and save energy for physiologic needs. Newborns may go into a dull, drowsy state or fall into a deep sleep. Those who seem unresponsive in a bright, noisy nursery may be in a state of habituation. The preterm infant or one with damage to the central nervous system may not be able to habituate.
What test is performed on all babies and is state required?
All babies get hearing screen and metabolic disorder screen.
If baby is hypoglycemic you should
Feed small amount-- under 40 ml, and let them digest.