Ch 21 & 22: The Normal Neonate - Assessment & Care
What should a newborn's legs be assessed for?
-Length -Assess for abduction & adduction
How do FORMULA stools display?
-Less frequent -Pale yellow to brown -Firmer
What is the average measurement of the chest of a newborn?
12-14 inches
When is a newborn APGAR scored?
-1 minute after birth -5 minutes after birth
What is the normal apical pulse for a newborn?
-110-160 BPM -High pitches, irregular, murmurs are common
What is meconium?
-1st Stool Thick/Greenish-Black --> Loose/Greenish-Brown transitional stools to milk stools
What is vernix caseosa?
-A white thick CHEESY material that protects the skin, made of epithelial cells and the secretions of glands (neck, pit, groin) -The more preterm, the more caseosa
What are DANGER signs to teach parents?
-Abnormal cry (chill, week, grungy, excessive) -Lethargy/difficult to arouse -Twitching or jitteriness -Vomiting/Diarrhea (*2 episodes*) -Change in feeding patterns -Signs of infection: > 101F or < 97F (rectal) -Tachypnea
What is urate crystals?
-After 4 days should not occur -Orange dust
What is Ortolani maneuver?
-Anterior reduction with abduction -Assess for hip dislocation
What are DANGER signs displayed by the newborn?
-Apnea > 15 seconds -Delayed voiding or meconium -Central & Circumoral cyanosis -Hypothermia -Pallor, skin color changes -Jaundice in 1ST 24 HRS -Bleeding: cord or circumcision site
What should a newborn's back be assessed for?
-Assess for dimpling -Spinal column intactness
What should a newborn's eyes be assessed for?
-Assess for inflammation, symmetry, equal in size -Edema -Transient strabismus -Conjunctivitis
What should a newborn's hands be assessed for?
-Assess for palmar creases -# of digits
What should a newborn's hips be assessed for?
-Assess gluteal folds for hip dislocation (especially if kid is breech) -Perform Ortolani Maneuver
What distance is a newborn's best vision?
-Best at 8-12 inches -Can see up to 2.5 feet
What is Cephalohematoma?
-Blood under the periosteum -**Does NOT cross suture lines** - localized -Risk for Jaundice -Could be from forceps -Blood that needs to be reabsorbed -Notify MD!! to measure
What are the benefits of delayed cord clamping?
-Childhood ANEMIA -Increase BP -O2 transport -Increase RBC flow
What are some newborn behavior states?
-Deep or quiet sleep state -Light or active sleep state -Drowsy -Quiet alert -Active alert -Crying
What are the possible effects of heat loss in a newborn?
-Depletion of glucose -Use of brown fat -Respiratory distress -Ketoacidosis -Possible shock
What is Caput Succedanium?
-EDEMA under the scalp (from pushing during labor for so long) -**CROSSES SUTURE LINE** -Superficial, will go away
Why is Vitamin K given to infants?
-Fat soluble, promotes blood clotting -0.5 - 1 mg IM prevents bleeding in the newborn -Given in 1ST HOUR
How do BREASTFED stools display?
-Frequent -Seedy -Mustard color*
What is the normal BP for a neonate?
-Full term: averages 80/50 -SBP: 60-80 -DBP: 40-50
What are the cardiovascular changes of the infant after birth?
-Functional closure of ductus venosus, ductus arteriosus, and foramen ovale -Permanent closure may take several weeks (murmurs) -Oxygenated and deoxygenated blood are now SEPARATE
All Newborn Lab Values
-Hemoglobin 17 - 20 g/dL -Hematocrit 52 - 63% -Platelets 100,000 - 300, 000 /uL -RBC 5.1 - 5.8 (1,000, 000/uL) -WBC 10 - 30,000/mm3 -Blood Volume - can vary by 25 - 40%
How soon is meconium passed after birth typically?
-In 12 Hours -If delay, > 24-48 hours consider bowel obstruction
What are the S/S of hypoglycemia?
-JITTERINESS, tremors -Poor tone -Diaphoresis -Poor suck -Tachypnea -Grunting -Cyanosis -Low temp
What should a newborn's extremities be assessed for?
-Movement -Range of motion -Count # of digits
What are components of safe sleeping advice?
-On back to sleep -If swaddled, ARMS OUT -Firm sleep surfaces -NO soft objects/bedding around body -No smoking in the home -Consider a pacifier
How is a newborn's first breath triggered?
-Pressure changes -Noise -Light -Chilling -Compression of the chest -Low O2
Why is Erythromycin given to newborns?
-Prevents ophthalmia neonatorum (blindness) -Prophylactic agent given in the FIRST 1-2 HOURS (may be delayed to promote bonding since can blur baby's vision)
How can heat loss be avoided in newborns?
-Remove wet linens -Keep babies warm (especially during resuscitation at birth)
What is transient tachypnea of a newborn (TTN)?
-Resp distress due to retained amniotic fluid in the lungs, which resolves with oxygen administration -Slow or incomplete fluid removal from lungs
What can hypothermia indicate in a newborn?
-Sepsis -Hypoglycemia
What nursing interventions could be done when a baby has a low temp?
-Skin to skin -Radiant warmer -Clothes -Take temp an hour later
When can a neonates's HR decrease?
-Sleep -Hypothermia
What are Epstein Pearls?
-Small white cysts found on the hard palate of newborns -Disappears within a few weeks
What are fontanels?
-Soft spots in the skull where the sutures of the head meet -Anterior fontanel: Closes by 18 months -Posterior fontanel: closes by 2-4 months
What are some teaching tips for parents with a newborn?
-Stress infant feeding!!! -Encourage rooming-in to practice caring for newborn (especially important for adolescents)
What are survival reflexes that are present at birth?
-Sucking, rooting -Swallowing, gagging -Grasp: Hands, Toes -Startle -Moro -Sneeze, cough -Yawn, stretching, burp, hiccup -Babinski -Crawling -Stepping, or walking -Tonic neck or fencing -Trunk incurvature -Sweating or shivering usually NOT present at birth
What are signs of respiratory distress in a neonate?
-Tachypnea: RR > 66 BPM -Flaring nares -Cyanosis -*GRUNTING* (usually expiratory/subtle) -Seesaw or PARADOXICAL respirations -Asymmetry
Why are newborns predisposed to heat loss?
-Thin skin -Lacks subQ fat -Blood vessels close to the surface
What are common skin variations in newborns?
-Vernix Caseosa (cheesy) -Stork Bites -Mongolian spots -Milia & Epstein's Pearls -Erythema toxicum
What are infant meds?
-Vitamin K -Hepatitis B shot -Erythromycin
Cardiac sphincter and nervous control of the stomach is...
....IMMATURE - this leading to common reflux of gastric contents (frequent burping can help)
Newborns who have phenylketonuria (PKU) need...
....catered milk since they are NOT able to METABOLIZE formula or breastmilk
Infants with darker skin tone may have...
....dark brown eyes
Every baby loses weight until...
....mom's milk comes in (7-8% loss typical, regains by 10 days)
If there is an episode of APNEA > 15 seconds with cyanosis and HR changes...
....the newborn requires evaluation
CRYING after birth shows a...
...GOOD transition into new gaseous environment
Brown fat metabolism leads to...
...Warming of babies (Want the burning of brown fat to be the last resort because we want to conserve the brown fat)
When neonates are hypothermic, they will lose their inclination to...
...feed
Newborns are predisposed to...
...heat loss
If the APGAR score taken at 5 minutes is <7, then...
...take a 10 minute APGAR
How often should an infant void on Day 1 and Day 2?
1-2 voids daily on Day 1 and Day 2
What are the 4 WAYS that heat is lost in the neonate? **
1.) Evaporation 2.) Convection 3.) Radiation 4.) Conduction
What is the average head circumference of a newborn?
13-15 inches
What is normal Hgb level in newborn?
17-20 g/dL (greater than adult norm)
What is the average length of a newborn?
19-21 inches
What is the common range of weight for a newborn?
2700 - 4000 g (6-9 lbs)
How often should an infant void on Day 3?
3 voids on Day 3
What is the average weight of a newborn?
3,400 g (7.5 lbs)
What is the normal respiration rate for newborns?
30-60 BPM
What is full term?
37-42 weeks
What is the normal temperature for a newborn? **
97.7 - 99.5 (36.5 - 37.5)
What is the normal glucose level for a neonate?
40-80 md/dL
What is normal Hct level in newborn?
52-63% (greater than adult norm)
How long does it take for gray-blue eyes in light tones skin newborns to change to true color?
6 months
How often should an infant void on Day 4 and beyond?
6 voids daily on Day 4 and beyond
What does APGAR stand for?
A: Appearance P: Pulse G: Grimace A: Activity R: Respiratory (Best: 10, Worst: 0)
What is convection?
Air flow to cooler areas
What is a neutral thermal environment (NTE)?
An environment in which the infant can maintain a stable TEMP with MINIMAL O2 needed
What is the AGA?
Average for gestational age (Weight between 10th and 90th percentile)
The appropriate steps in conducting an infant heel stick include the following (all that apply): A.) Cool the heel with a commercial ice pack B.) Warm the heel with a commercial heel warmer C.) Choose a puncture site on the lateral heel that has not been used before. D.) Wipe away the first drop of blood E.) Avoid excessive squeezing of the foot
B & D
What are Mongolian Spots?
Benign bruise on butt or hips
What is the biggest risk to assess for post-circumcision?
Bleeding
How is phenylketonuria (PKU) screening done?
Blood from a heel stick collected 24 hours of breast milk or formula ingestion
What does a new born crying indicate?
Breathing, a breathing in of air pushes fluid out of lungs
Which types of babies are more likely to experience TTN?
C/S or depressed
Newborns experience PERIODIC BREATHING. How is this displayed?
Cessation 5-10 seconds (is why you need to take the full minute for respirations)
What is radiation?
Close, cool solid surfaces
What should a newborn's feet be assessed for?
Club foot (inversion)
How is a newborn's first breath described?
Fluid filled to a GASEOUS environment
A small-for-gestational-age (SGA) newborn who has just been admitted to the nursery has a high-pitched cry, appears jittery, and exhibits irregular respirations. Which complication would the nurse suspect? Hypovolemia Hypoglycemia Hypercalcemia Hypothyroidism
Hypoglycemia
What is the SGA/IUGR?
Small for gestational age/Intra-uterine growth restriction (Weight less than the 10th percentile)
What temperature indicates that the newborn should be placed under the warmer?
If newborn's temperature falls below 97.7 (36.5) ...May also put in skin to skin w/ parent or double wrap newborn
What is phenylketonuria (PKU)?
Individuals with PKU are unable to break down phenylalanine. If PKU is no diagnosed at birth it can lead to possible brain damage and intellectual impairment. However if a baby is diagnosed early and put on a special diet that doesn't contain phenylalanine it will grow and develop normally. It is therefore used to try and explain the difference between genotype and phenotype (RECESSIVE DISORDER OF PROTEIN METABOLISM)
What is the LGA?
Large for gestational age (Weight > 90th percentile)
What is evaporation?
Liquid to vapor
What is milia?
Neonatal whiteheads on malar area
Why are preemies more susceptible to heat loss?
Only full term babies have brown fat
Why is Hepatitis B given to a newborn?
Only vaccine given during newborn period
What is post-term?
Over 42 weeks
What care is done after a circumcision?
Petroleum gauze dressing may be applied with each diaper change x 1-2 day
What should be used for safety while the neonate is under the warmer?
Probe
What are stork bites?
Red mark on baby FOREHEAD/BACK OF NECK
What is a circumcision?
Surgical removal of part of the foreskin of the penis
What should a newborn's face be assessed for?
Symmetry
What is thermoregulation?
The maintenance of body temperature
What is conduction?
Two objects touching
What is a pseudo-menstruation?
Uterine bleeding, or blood-tinged vaginal discharge, that resembles menstruation but is not associated with the typical endometrial changes thereof.
What muscle is Vitamin K given IM to newborns?
Vastus Lateralis
Why can you not use WBC count to gauge whether mom/baby has an infection postpartum?
WBC levels will be high nevertheless
How do you wash an infant's bottom when changing them?
Wash with plain water and use diaper cream with ZINC OXIDE if needed
How do we expect the baby's lungs to sound after the first few hours of birth?
Wet
How do you calculate the percentage of a newborn's weight loss?
Your infant's birth weight is 4250 grams. He is 3 days of age and his weight is now 3725 grams. What is his percentage of weight loss? Answer: 12% Step 1: 4250 - 3725 = 525 Step 2: 525 divided by 4250 = 0.123 Step 3: 0.123 * 100 = 12.3%
What is pre-term?
less than 37 weeks
What is Erythema Toxicum?
newborn rash