Week 4 - NURS 306
IgM
- Blood - produced by first maturing immune system of infants - produced first during an infection (igG production follows) - part of ABO blood group
hepatic system of the neonate - functions of the liver
- Carbohydrate metabolism - Amino acid metabolism - Lipid metabolism - Synthesis of plasma proteins - Blood coagulation - Conjugation of bilirubin - Phagocytosis by Kupffer cells (Macrophages) - Storage of fat-soluble vitamins A, D, E, K, and iron - Detoxification
respiratory system in neonates
- Change is initiated by compression of the thorax, which forces amniotic fluid from the lungs - Lung expansion - Increase in alveolar oxygen concentration - Vasodilation of the pulmonary vessels - Surfactant assists with the establishment of functional residual capacity which helps keep open the alveolar sacs partially open at the end of exhalation, decreasing the amount of pressure and energy required on inspiration - TLDR: First breath -> Increased oxygen tension (PaO2) and decreased arterial pH -> dilation of pulmonary arteries -> decreased pulmonary vascular resistance -> increase blood flow through pulmonary vessels -> increase oxygen and carbon dioxide exchange within the lungs
preparation of a neonatal assessment
- Check record and birth record: - Maternal malnutrition prior to and/or during pregnancy. - Maternal age younger than 16 or older than 35 - Chronic maternal illnesses like diabetes and hypertension - Hypertensive disorders of pregnancy - Labor and birth before 38 weeks' gestation - Labor longer than 24 hours. - Operative delivery with a vacuum extractor or forceps - Medications during labor that affect the central nervous system (CNS), such as magnesium sulfate and analgesia/anesthesia - Prolonged rupture of membranes (longer than 24 hours) - Meconium-stained amniotic fluid - Placental abnormalities Apgar score 7 or below at 5 minutes
LGA
large for gestational age - weight is greater than the 90th percentile
scale with protective cover in place
scale should be at 0; weight should include pounds, ounces, and grams
neurological of the neonate
- Flexed position - Rapid recoil of extremities to the flexed positions - Positive newborn reflexes
blood pressure cuff
electronic method. blood pressure can be done in all four extremities if evaluating the newborn for cardiac problems
hydrocephalus
excessive cerebral fluid within the brain cavity surrounding the brain if the head circumference is greater or equal to 4 cm larger than the chest circumference
Colic
excessive, inconsolable crying by a young infant for no apparent reason - common for an increase in crying until it gradually decreases after - symptoms of colic: - infant flexes/curls legs when crying - infant has difficulty/discomfort with bowel movements - infant is more irritable after feeding- infant is more irritable when placed in a crib - infant appears in pain- infant requires frequent cuddling - infant suddenly changes from happy to crying
neonatal period
first 28 days of life
abnormal response of plantar grasp
weak or absent may indicate possible spinal cord injury
clean gloves
worn for all physical assessments until discharge
hypospadias
abnormal congenital opening of the male urethra on the undersurface of the penis
Day 2 Diapers
2 Wet - 3 Stools - Meconium
Day 4 Diapers
3 Stools - Yellow, soft, and watery
chest circumference of the neonate
30 - 33 cm (12-13 in) or 2-3 less than head circumference
expected head circumference of the neonate
32-36.8 cm (12.6 - 14.5 in) - head should be 2-3 cm larger than chest circumference - anterior fontanel should be palpable and approximately 5 cm on average and diamond shaped. Posterior fontanel is smaller and triangle shaped. - Bulging fontanels at rest could indicate increased intracranial pressure, infection, or hemorrhage - sutures should be palpable, separated, and can be overlapping (molding), a normal occurrence resulting from head compression from labor
expected temperature of the neonate
36.5 - 37.2 celcius (97.7 - 99 farenheit) axillary
expected length of the neonate
45-55 cm (18-22 in)
Day 5 - 1 Month Diapers
6 Wet - 3 Stools - Breastfed or formula fed stool
transitional stool
Begins around the third day and can continue for 3-4 days. The stool transitions from black to greenish brown, to greenish yellow. This phase of stool characteristics occurs in both breastfed and formula-fed neonates.
meconium
Begins to form during the fourth gestational month and is the first stool eliminated by the neonate. It is sticky, thick, black, and odorless. First passed within 24-48 hours
formula-fed stool
Drier and more formed than breastfed stools. It is a paler yellow or brownish yellow and has an unpleasant odor
intrauterine growth restriction (IUGR)
Growth rate does not meet expected norms
acrocyanosis
Hands or/and feet are blue Response to cold enviornment or immature peripheral circulation
deviated temperature of the neonate
Hypothermia or hyperthermia related to infection, enviornmental extremes, and/or neurological disorders
disadvantages of formula feeding
Need for increased time to prepare formula. Increased cost compared to breastfeeding. Increased risk of infection due to lack of antibodies that are naturally present in human milk. Increased risk of childhood obesity & insulin-dependent diabetes.
expected tonic neck response
Neonate assumes a "fencing" position with arms and legs extended in the direction in which the head was turned
Gestational Age Assessment
Performed within 2 to 12 hr of birth Newborn Measurements and New Ballard Scale Gestational age estimation and baseline to assess growth and development. *Neonatal morbidity and mortality are related to gestational age and birth weight.
microcephaly
abnormally small head - if head circumference is less than or equal to 32 cm
advantages of formula feeding
Provides a pleasurable child caring experience for partner; either parent can feed baby. Provides woman opportunity to leave infant with others while she goes out or returns to work. Decreases frequency of feedings because digestion of formula is slower that that of breast milk.
Skin Care for Neonates
Skin of a term neonate is soft, smooth, slightly transparent, and has less pigmentation than that of an older child
abnormal startle response
Slow response when sleeping, possible deafness, possible neurological deficit
SGA
Small for gestational age [below 10th percentile]
expected repsonse of sucking
Sucking motion occurs
mogan clamp
The foreskin is freed from the glans by blunt dissection, but no dorsal slit is made. A dorsal hemostat is placed, and traction is applied to bring the foreskin forward. Placement of the Mogen clamp follows the angle of the corona to avoid removing excess skin ventrally and to obtain a superior cosmetic result. The clamp crushes the foreskin along a line that is 1 mm wide, and the foreskin is excised distal to the clamp. After removal of the clamp, the glans is liberated by pulling the crush line apart. The procedure usually takes three to four minutes and is virtually bloodless.
first period of reactivity
The newborn is alert, exhibits exploring activity, makes sucking sounds, and has a rapid heart rate and respiratory rate. Heart rate can be as high as 160 to 180/min, but will stabilize at a baseline of 100 to 120/min during a period that lasts 30 min after birth.
AGA
appropriate for gestational age - weight is between 10th and 90th percentile
term
birth beginning of week 37-42
postmature
born after completion of 42 weeks of gestation with evidence of placental insufficiency
postterm (postdate)
born after the completion of 42 weeks of gestation
preterm or premature
born prior to 37 weeks of gestation
ballard maturational score (bms)
calculated by assessing the physical and neuromuscular maturity of the neonate
abnormal response of stepping or dancing
diminished response may indicate hypotonia
IgG
in blood and extracellular fluids - crosses the placenta to provide passive immunity to newborns - provides long-term immunity after recovery or a vaccine
diarrheal stool
loose and green
LBW
low birth weight - weight of 2,500 g or less at birth
tape measure in centimeters
measure from crown to heel of foot for length. Measure head circumference at greatest diameter. measure circumference beginning at the nipple line, and abdominal circumference above the umbilicus
New Ballard Score
newborn maturity rating score used to assess neuromuscular and physical maturity - each individual assessment parament displays at least six ranges of development along a continuum - each range of development within an assessment is assigned a number value from -1 - 5. The totals are added to give maturity a rating in weeks gestation (a score of 35 indicates 38 weeks of gestation)
cross-cradle position
newborn's head is supported by the woman's hand, and newborn's back is against the woman's forearm - abdomen is facing or touching the moms for good head control
Brown Fat
nonshivering thermogenesis is a highly dense and vascular adipose tissue that neonates have. It is located in the neck, thorax, axillary, intrascapular areas, and around the adrenal glands and kidneys. - BAT promotes: An increase in metabolism Heat production through intense lipid metabolic metabolism of BAT Heat transfer to the peripheral system
neuromuscular maturity
posture, square window, arm recoil, popliteal angle, scarf sign, heel to ear
second period of reactivity
the newborn reawakens, becomes responsive again, and often gags and chokes on mucus that has accumulated in the mouth. this period usually occurs 2-8 hours after birth and can last 10 min to several hours
Period of relative inactivity
the newborn will become quiet and begin to rest and sleep. the heart rate and respirations will decrease, and this period will last from 60 - 100 min after birth
let-down reflex
the reflex that forces milk to the front of the breast when the infant begins to nurse
Stage 2 of Human Milk
transitional milk - Lasts 3-10 days - milk will gradually change with decreasing levels of protein and increase of fat, carbs, and calories
deviated female genitourinary of the neonate
- Prominent clitoris and small labia minor are often present in preterm neonates - Ambiguous genitalia; may require genetic testing to determine sex - No urination in 24 hours may indicate a possible urinary tract obstruction, polycystic disease, or renal failure
cephalohematoma
- Hematoma formation between the periosteum and skull with unilateral swelling - It appears within a few hours of birth and can increase in size over the next few days - It has a well-defined outline It does not cross suture lines - Related to trauma to the head due to prolonged labor, forceps delivery, or use of vacuum extractor - Can contribute to jaundice due to the large amounts of red blood cells being hemolyzed Resolves within 3 months
risks for circumcision
- Hemorrhage - Infection - Adhesions - Pain
how to elicit moro
- present at birth; disappears by 6 months - Jar the crib or hold the baby in a semi-sitting position and let the head slightly drop back
how to elicit rooting
- present at birth; disappears within 3-6 months Brush the side of a cheek near the corner of the mouth
deviated length of the neonate
- Molding may interfere with accurate assessment of length - Neonates whose length is <45 cm should be further assessed for causes such as intrauterine growth restriction or prematurity
how to start tonic neck
- present between birth and 6 weeks; disappears by 4-6 months the neonate in a supine position, turn the head to the side so that the chin is over the shoulder
Active humoral immunity
- Acquired immunity from vaccination - Natural Immunity from exposure to antigens, after which the individual produces antibodies
mongolian spots
- Flat, bluish discolored area on the lower back and/or buttock. Seen more often in African American, Asian, Hispanic, and Native American infants - Resolves on own and document size and location
Deviations of the neonate
- Fontanels that are firm and bulging and not related to crying are a possible indicated of increased intracranial pressure - Depressed fontanels are a possible indication of dehydration - Bruising and laceration at the site of the fetal scalp electrode or vacuum extractor - Presence of caput succedaneum and/or cephalohematoma
Gastrointestinal system of neonates
- Gastric capacity for the first few days is 5-10 mL and increases to 60 mL by day 7. - Stomach-emptying time is usually 2-4 hours, requiring the neonate to feed at that interval. Neonates may appear uninterested in feeding during the first few days. - Breast fed neonates tend to have more stools per day than formula-fed
expected pulse of the neonate
- 110-160 bpm - Rate increases to 180 bpm with crying and decreases to 90 when asleep - Murmurs may be heard; most are not pathological and disappear by 6 months
expected weight of the neonate
- 2,500 - 4,000g (5.5 - 8.8 lb) - Weight loss of 5-10% of birth weight during the first week is normal due to water loss through urine, stools, and lungs, and an increase in metabolic rate. It is also related to limited fluid intake. - The neonate will return to birth weight within 10 days
respirations of the neonate
- 30-60 breaths per minute - Slightly irregular - Diaphragmatic and abdominal breathing - Rate increases when crying and decreases when sleeping
Composition of human milk
- 6% proteins - 42% carbohydrates - 52% fats - cholesterol for brain development - vitamins and minerals from the placenta
circumoral cyanosis
- A benign localized transient cyanosis around the mouth - Observed during the transitional period. If persists, may be due to a cardiac anomaly
mottling
- A benign transient pattern of pink and white blotches on skin - Response to cold enviornment
caput succedaneum
- A localized soft tissue edema of the scalp - It feels "spongy" and can cross suture lines - Results from prolonged pressure of the head against the maternal cervix during labor - Resolves within the first week of life - usually resolves within 3-4 days does not require treatment this is an expected finding that can be palpated as a soft edematous mass and can cross over the suture line
Thermoregulatory System in Neonates
- A neutral thermal enviornment (NTE) is needed to support the infant during this transition. NTE is an enviornment that maintains body temperature with minimal metabolic changes and/or oxygen consumption. NTE decreases possible complications related to the delayed response to environmental temperature changes. - normal is 36.5-37.5 with 37 Celsius average - The neonate responds to cold by: - An increase in metabolic rate - An increase in muscle activity - Peripheral vascular constriction - Metabolism of Brown Fat
vernix caseosa
- A protective substance secreted from sebaceous glands that covered the fetus during pregnancy. Looks like a whitish, cheesy substance. - May be noted in auxiliary areas and genital areas of full-term neonates - Full-term neonates usually have none or small amounts of vernix
erythema toxicum
- A rash with red macules and papules (whitish to yellowish-white papule in center surrounded by reddened skin) that appear in different areas of the body, usually the trunk area - Can appear within 24 hours of birth and up to 2 weeks - Benign and will disappear
abnormal response of moro
- A slow response might occur with preterm infants or sleepy neonates - An asymmetrical response may be related to temporary or permanent birth injury to clavicle, humerus, or brachial plexus
deviated eyes of the neonate
- Absent red light reflex indicated cataracts - Unequal pupil reactions indicate neurological trauma - Blue sclera is a possible indication of osteogenesis imperfecta
pain management for circumcision
- Administer acetaminophen 1 hour prior to procedure - Applying topical anesthetic cream prior to procedure - Positioning newborn in a semi-recumbent position on a padded surface with arms swaddled - Administering a 24% sucrose or breast milk orally 2 minutes before penile manipulation or offering pacifier for non-nutritive sucking is sucrose or breast milk contraindicated - Administering oral acetaminophen for at least 24 hours postprocedural - Instructing parents in infant pain assessment and management, and in care of circumcision
Circulatory System Changes of the Neonate - Foramen Ovale
- An opening between the right atrium and the left atrium, closes when the left atrial pressure is higher than the right atrial pressure. - Significant neonatal hypoxia can cause a reopening of the foramen ovale. This closure occurs when: Increased paO2 -> decreased pulmonary pressure -> increased pulmonary blood flow -> increased pressure in left atrium -> closure of foramen ovale
musculoskeletal of the neonate
- Arms are symmetrical in length and equal in strength - Legs are the same - 10 fingers and toes - Full range of motion of all extremities - No clicks at joints - Equal gluteal folds - C curve of spine with no dimpling
deviated abdomen of the neonate
- Asymmetrical abdomen indicates a possible mass - Hernias or diastasis recti are more common in African American neonates and usually resolve on their own within the first year - One umbilical artery and vein is associated with heart or kidney malformation - Failure to pass meconium stool is often associated with imperforated anus or meconium ileus
signs and symptoms of cold stress
- Axillary temperature at or below 36.5 Celsius or 97.7 Fahrenheit - Cool skin - Lethargy - Pallor - Tachypnea - Grunting - Hypoglycemia - Hypotonia - Jitteriness - Weak Suck
chest/lungs of the neonate
- Chest is barrel-shaped and symmetrical - Breast engorgement is present in both male and female neonates related to the influence of maternal hormones and resolves within a few weeks - Clear or milky fluid from nipples related to maternal hormones - Lung sounds are clear and equal - Scattered crackles may be detected during the first few hours after birth. This is due to retained amniotic fluid, which will be absorbed through the lymphatics - breast nodules should be 3-10 mm - nipples should be prominent, well formed, and symmetrical - retractions should be absent - clavicles should be intact - respirations are primarily diaphragmatic
Newborn Screening Tests
- Consist of a blood and hearing test and some with heart defect screenings - Blood test screens for: infection, genetic diseases, and inherited and metabolic disorders and is performed on all babies born in the U.S. - The ideal blood collection should be 2-5 days of age, which provides time for the neonate to ingest breast milk or formula - Heel Stick - Warm the neonate's foot for 10 minutes by wrapping in a warm, moist washcloth to circulate the area - Don gloves and with the nondominant hand, hold the neonate's foot in a dorsiflexed position. The nurse or technician should have a firm grasp of the foot, but the foot should not be squeezed - Clean the heel with alcohol Puncture the skin in the lateral or medial aspect of the heel to decrease the risk of nerve damage - Wipe off the first few drops of blood - Allow large drops to form and fall of testing material - Clean area and place a small dressing over it
factors negatively affecting thermoregulation
- Decrease subcutaneous fat - Large body surface - Decreased BAT in preterm neonates ] Loss of body head from evaporation, conduction, convection, and/or radiation
Factors negatively influencing transition of the respiratory system
- Decreased surfactant levels related to immature lungs - Persistent hypoxemia and acidosis that leads to constriction of the pulmonary arteries
deviated cardiac of the neonate
- Dextrocardia: Heart on right side of chest - Displaced PMI from cardiomegaly Persistent murmurs indicated - persistent fetal circulation or congenital heart defects
nursing actions of cold stress
- Dry thoroughly immediately after birth to decrease evaporation - Remove wet blankets from the neonate's direct enviornment to decrease loss due to radiation, evaporation, and conduction - Place a stocking cap on the head to decrease heat loss due to radiation and convection - Skin-to-skin with a warm blanket over mother an neonate decreases heat loss due to radiation and conduction - Use prewarmed blankets and clothing to decrease heart loss due to conduction - Swaddle in warm blankets and clothing to decrease heat loss due to convection and radiation - Prewarm radiant warmers and heat shield to decrease heat loss due to conduction - Delay initial bath until the neonate's temperature is stable to decrease heat loss due to evaporation - Place neonate away from air vents to decrease heat loss due to convection - Place away from outside walls and windows to decrease hat loss from convection radiation - Maintain an NTE to decrease heat loss due to convection and radiation
Newborn Hearing Screening
- Early detection of hearing loss provides parents the opportunity to seek interventions to foster language development. - Test must be conducted in a quiet room. - Vernix, blood, and amniotic fluid can interfere with screening - Neonates who fail can be rescreened in one month and diagnostic testing is recommended for those who fail the second time.
molding
- Elongation of the fetal head as it adapts to the birth canal - Resolves within one week
eyes of the neonate
- Eyes are equal and symmetrical in size and placement - The neonate is able to follow objects within 8-12 inches of the visual field - Edema may be present due to pressure during labor or birth and/or reaction to eye prophylaxes - The iris is blue-gray or brown - The sclera is white or bluish white - Subconjunctival hemorrhages related to birth trauma - Pupils are equally reactive to lgiht - Positive red light reflex and blink reflex - No tear production (tear production at 2 months) - Strabismus and nystagmus related to immature muscle control - each eye from the inner to outer canthus and the space between the eyes should equal one-third the distance across both eyes to rule out chromosomal abnormalities like Down syndrome - eyes are usually blue or gray following birth - lacrimal glands are immature, with minimal or no tears - subconjunctival hemorrhages can result from pressure during birth - pupillary and red reflex are present - eyeball movements will demonstrate random, jerky movements
lanugo
- Fine, downy hair that develops after 16 weeks' gestation - The amount of lanugo decreases as the fetus ages - Often seen on the neonate's back, shoulders, and forehead
Immunizations for Neonates
- Hepatitis B should be given as it inflames the liver. They should all be vaccinated before hospital discharge. - Neonates who have been or possibly have been exposed to hepatitis B during birth be given both the Hepatitis B vaccine and immune globin within 12 hours of birth - Second dose of hepatitis B vaccine is given 1-2 months of ae and third is given 6-18 months. - Draw the mediation up with a 25-gauge 5/8 needle - Undo the diaper and identify the vastus lateralis - Insert at 90-deree angle and slowly inject medication to decrease discomfort Withdraw and rub site for absorption
Higher risks for thermoregulatory system
- Higher body-to-surface-area-to-body-mass ratio - Higher metabolic rate - Limited and immature thermoregulatory abilities
consequences of cold stress
- Hypoglycemia - Metabolic Acidosis - Decreased Surfactant Production - Respiratory distress that can lead to death - Hypoxemia - Increased indirect bilirubin - Delayed transition from fetal to neonatal circulation - Weight Loss
deviated genitourinary of the male neonate
- Hypospadias: Urethral opening is on the ventral surface of the penis - Epispadias: The urethral opening is on the dorsal side of the pens - Undescended Testes: Testes not palpated on the scrotum - Hydrocele: Enlarged scrotum due to excess fluid - No urination in 24 hours may indicate possible urinary tract obstruction, polycystic disease, or renal failure - Ambiguous genitalia may require genetic testing to determine sex
deviated neurological of the neonate
- Hypotonia: Floppy, limb extremities indicate possible nerve injury related to birth, depression of CNS related received during labor, prematurity, or spinal cord injury - Hypertonia: Tightly flexed arms and stiffly extended legs with quivering indicate possible drug withdrawal Paralysis indicates possible birth trauma or spinal injury - Tremors are possibly due to hypoglycemia, drug withdrawal, cold stress
natal teeth
- Immature caps of enamel and dentin with poorly developed roots - Usually only one or two teeth are present - Usually benign, but can be associated with congenital defects - Natal teeth are often loose and need to be removed to decrease the risk of aspiration
Neonates are at risk for infections related to
- Immature defense mechanism - Lack of experience with and exposure to organisms, which leads to a delayed response to antigens - Breakdown of skin and mucous membranes, which provides a portal of entry for bacteria
Metabolic System of Neonates
- Immediately after birth, the neonate becomes independent of the mother's metabolism and must balance the amount of insulin production with glucose availability. - Glucose values normally decrease about 1 hour post birth, and then values rise and stabilize by 2-3 hours post-birth. Optimal range for plasma glucose is 70-100 mg/dL - During intrauterine life, neonates of diabetic mothers produce high levels of insulin in response to the high levels of circulating maternal glucose. The neonate's insulin level remains higher than normal, leading to hypoglycemia.
deviated rectum of the neonate
- Imperforated anus requires immediate surgery - Anal fissures or fistulas
IgD
- In B lymphocytes - receptors on B lymphocytes
promoting parent-infant bonding nursing actions
- Initiate skin-to-skin with a warm blanket - Point out and explain expected neonatal characteristics such as molding, milia, and lanugo - Provide alone time for the couple and their neonate by organizing care that allows for uninterrupted time - Delay administration of eye ointment until parents have the opportunity to hold the neonate as once applied, there is less likely the neonate will open their eyes. - Provide cultural care as needed.
parent education for circumcision
- Instruct parents to watch for bleeding and sins of infection and to note when their child voids - Inform parents that the gauze will fall off on its own and they should not pull it off. Pulling the gauze off can interfere with the healing process - Instruct parents to fasten diapers loosely to promote comfort by decreasing pressure on the surgical site.
deviated skin of the neonate
- Jaundice within the first 24 hours is pathological - Pallor occurs with anemia, hypothermia, shock, or sepsis - Greenish/yellowish vernix indicates passage of the meconium during pregnancy and/or labor - Persistent ecchymosis or petechiae occurs with thrombocytopenia, sepsis, or congenital infection Abundant lanugo is often seen in preterm neonates - Thin and translucent skin, and increased amounts of vernix caseosa are common in preterm neonates - Nails are longer in neonates >40 weeks gestation - Pilonidal dimple: a small pit or sinus in the sacral area at top of crease between the buttocks; the sinus can become infected later in life.
signs and symptoms of hypoglycemia
- Jitteriness - Hypotonia - Irritability - Apnea - Lethargy - Temperature Instability
female genitourinary of the neonate
- Labia majora covers labial minora and clitoris - Labia majora and minora may be edematous - Blood-tinged discharge related to abrupt decrease of maternal hormones or pseudomenstruation - Whitish vaginal discharge in response to maternal hormones - Neonate urinates within 24 hours - Urinary meatus is midline and uninterrupted stream is noted on voiding
deviated nose of the neonate
- Large amounts of mucus drainage can lead to respiratory distress - A flat nasal bridge is seen with Down syndrome - Nasal flaring is a sign of respiratory distress
mouth of the neonate
- Lips, gums, tongue, palate, and mucous membranes are pink and intact - Reflexes are positive - Epstein's pearls are present - assess for palate closure and strength of sucking - lip movements should be symmetrical - saliva should be scant. excessive saliva can indicate a tracheoesophageal fistula - tongue should move freely, be symmetrical in shape, and not protrude (down's syndrome) - soft and hard palate should be intact - gray-white patches on the tongue and gums can indicate thrush
deviated ears of the neonate
- Low-set ears are associated with genetic disorders such as Down's Syndrome - Absent startle reflex is associated with possible hearing loss
abnormal sucking response
- May not respond if recently fed - Prematurity or neurological defects may cause weak or absent response
head of the neonate
- Molding present - Fontanels are open, soft, intact, and slightly depressed. They may bulge with crying - The anterior fontanel is diamond shaped approximately 2.5-4 cm (closes by 18 months of age) - The posterior fontanel is a triangle shape approximately 0.-1 cm (closes between 2 and 4 months) - Can be difficult to palpate due to excessive molding - There are overriding sutures when there is increased molding
nursing actions of hypoglycemia
- Monitor for S/S - Assess blood glucose level with a monitor - Assist the woman to either breastfeed or formula feed her infant. IV infusion of a dextrose solution or buccal 40% dextrose gel is used when hypoglycemia persists - Maintain NTE to decrease cold stress
deviated mouth of the neonate
- Natal teeth, which can be benign correlated to congenital abnormalities - Thrush, a fungal infection, can be contracted during birth by white patches - Thin philtrum may be indicative of fetal alcohol syndrome - Cleft lip/palate which is a congenital abnormality in which the lip and/or palate does not fuse
passive immunity
- Natural passive immunity is the placental transmission of antibodies from the mother to the fetus. This provides protection for the neonate during the first few months of life from the pathogens to which the mother has been exposed - Artificial passive immunity is gamma globulin, which provides immediate protection for a short.
intraoperative care for circumcision
- Neonate position and secured on a specially designed plastic board, often referred to as a circumcision board. The board is padded to promote comfort and reduce loss - An ear bulb is placed near the neonate to use in case of vomiting or increased mucus - The penis is cleansed, and a sterile drape specially designed for circumcision is placed over the trunk. - A sucrose-dipped pacifier is offered during the nerve block and procedure for pain management - The physician administers a penile nerve block - The physician applies a Gomco clamp, Mogen clamp, or Plastibell - Physician removes foreskin with a scalpel - Petroleum-impregnated gauze is wrapped around the end of the penis to promote comfort by reducing the amount of irritation caused by friction of the diaper
Risks for hypoglycemia
- Neonates of diabetic mothers - Neonates weighing more than 4,000g or large for gestational age - Post-term neonates - Preterm neonates = Small-for-gestational-age neonates - Hypothermia - Neonatal infection - Respiratory distress - Neonatal resuscitation - Birth Trauma
blood pressure of the neonate
- Not routine but mostly done in NICU - Expected: 60-80/40-50 mm Hg
harlequin sign
- One side of body is pink and the other side is white - Related to vasomotor instability
cardiac of the neonate
- PMI at third or fourth intercostal space - S1 and S2 are present - Normal rhythm with variation from respiratory changes - Murmurs in 30% of neonates which disappear within 2 days of birth - Peripheral pulses equal - Femoral pulse difficult to palpate
deviated chest/lungs of the neonate
- Pectus excavatum (funnel chest) is a congenital abnormality - Pectus carinatum (pigeon chest) can obstruct respirations - Chest retractions are a sign of respiratory distress - Persistent crackles, wheezes, stridor, grunting, paradoxical breathing, decreased breathe sounds, and/or prolonged periods of apnea (>15-20 seconds) are sins of respiratory distress - Decreased or absent breathe sounds are often related to meconium aspiration or pneumothorax - 30 to 60 is normal
postoperative care for circumcision
- Penis is assess every 1 minutes for the first hour for signs of bleeding, then 2-3 hours according to policy - Talk to physician is bleeding spots larger than a size of a quarter - Acetaminophen PO is administered every 4-6 hours - Voidings are assessed and documented. The neonate should void within 24 hours after the procedure
deviated respirations of the neonate
- Periods of apnea > 15 seconds - Tachypnea may be related to sepsis, hypothermia,. Hypoglycemia, or respiratory distress syndrome - Respiration <30 maty be related to maternal analgesia and/or anesthesia durin labor
actions for signs and symptoms of cold stress
- Place on stocking cap - Skin-to-skin contact with mom with a warm blanket and reassess temperature - Swaddle in warm blankets and reassess which is usually 30 minutes until stable - Place the naked neonate under a preheated warmer - Attach the servo-controlled probe on the neonate's abdomen or other body surface that is closest to the radiant source. It is recommended not to place probe over BAT areas, but there are too few research studies to view this as evidenced-based practice - Increase the temperature by 1 degree Celsius (1.8 Fahrenheit) until 36.5 Celsius (97.8 Fahrenheit) - Monitor neonates temperature, respiratory rate, and heart rate every 5 minutes when rewarming - Assess and adjust the neonate's fluid requirement; fluids may need to be increased to compensate for insatiable water loss - Monitor temperature as per institution - Obtain a heel-stick to assess for hypoglycemia (under 40 mg/dL) and treat for hypoglycemia based on level
deviated musculoskeletal of the neonate
- Polydactly: Extra digits may indicate a genetic disorder - Syndactylyl: Webbed digits may indicate a genetic disorder - Unequal gluteal folds and/or positive Barlow and Ortolani maneuvers are associated with congenital hip dislocation - Decreased range of motion and/or muscle tone indicates possible birth injury, neurological disorder, or prematurity. Swelling, crepitus and/or neck tenderness indicates possible broken clavicle, which can occur during the birthing process in neonates with large shoulders - Simian creases, short fingers, wide space between big toe and second toe are common with Down syndrome
risk factors of cold stress
- Prematurity - Small for gestational age - Hypoglycemia - Prolonged resuscitation efforts - Sepsis - Neurological, endocrine, or cardiorespiratory problems
Causes of potential threats to skin integrity
- Pressure exerted on the presenting part of the fetus during the labor and birthing process from maternal structures such as the pelvis, causing edema and hematomas Abrasions, bruising, and edema of the skin related to use of vacuum extractors, forceps, and internal fetal monitoring Exposure to bacteria from the maternal genital tract Use of adhesives Drying out and flaking of the skin, a natural process that occurs during the first few weeks of life Diaper dermatitis
contraindications of circumcision
- Preterm neonates - Neonates with a genitourinary defect - Neonates at risk for bleeding problems - Neonates with compromising disorders such as respiratory distress syndrome
abdomen of the neonate
- Soft, round, protuberant, and symmetrical - Bowel sounds are present but may be hypoactive for the first few days - Passage of meconium within 48 hours postbirth - The cord is opaque or whitish blue with two arteries and one vein with Wharton's jelly - The cord becomes dry and darker within 24 hours postbirth and detaches within 2 weeks - umbilical cord should be odorless and exhibit no intestinal structures - abdomen should be round, dome-shaped, and nondistended - bowel sounds should be present within a few minutes following birth
expected response of moro
- Symmetrical abduction and extension of arms and legs, and legs flex up against trunk - The neonate makes a "C" shape with thumb and index finger
deviated pulse of the neonate
- Tachypnea (> 160 bpm) indicates possible sepsis, respiratory distress, congenital heart abnormality - Bradycardia (< 100 bpm) indicates possible sepsis, increased intracranial pressure, or hypoxemia
Danger signs of Neonates
- Tachypnea (greater than 60) - Retractions of chest wall - Grunting - Nasal flaring - Abdominal distension - Failure to pass meconium within 48 hours - Failure to void within 24 hours - Convulsions - Lethargy - Jaundice within first 24 hours of birth - Abnormal temperature, either high or low - Persistent hypoglycemia - Jitteriness - Persistent temperature instability
Circulatory System Changes of the Neonate
- The decrease in pulmonary vascular resistance causes an increase in pulmonary blood flow, and the increase the systemic vascular resistance influences the cardiovascular changes
neck of the neonate
- The neck is short with skin folds - Positive tonic neck reflex
expected response of rooting
- The neonate turns the head towards the direction of the stimulus and opens the mouth. - Instruct mothers who are lactating to touch the corner of the neonate's mouth with a nipple and the infant will turn toward the nipple for feeding
nose of the neonate
- The nose may be flattened or bruised related to the birth process - Nares should be patent - Small amount of mucus - Neonates primarily breathe through their noses - nose should be midline, flat, and broad with lack of a bridge - some mucus with no drainage - newborns are obligated nose breathers and do not develop the response of opening the mouth with a nasal obstruction until 3 weeks after birth - a nasal blockage can result in flaring of the nares, cyanosis, or asphyxia
lymphocytes
- The number of T cells within the neonate's system is comparable to that in adults, but functional abilities are decreased - The functional abilities of B-cells are also hyporesponsive
genitourinary of the male neonate
- The urinary meatus is at the tip of the penis - The scrotum is large, pendulous, and edematous with rugae (ridges/creases) present - Both testes are palpated in the scrotum - The neonate urinates within 24 hours
ears of the neonate
- Top of pinna is aligned with external canthus of the eye - Pinna without deformities, well formed and flexible - The neonate responds to noises with positive startle signs - Hearing becomes more acute as Eustachian tubes clear - Neonates respond more readily to high-pitched vocal sounds - when examining the placement of the ears, draw an imaginary line through the inner to the outer canthus of the newborn's ear, where the eat meets the scalp - ears that are lowset can indicate a chromosome abnormality, like down syndrome or a kidney disorder
preoperative care of circumsision
- Verify the neonate has voided - Neonate shouldn't eat 2-3 hours before the procedure to decrease the risk of vomiting and aspiration during - Acetaminophen is administered 1 hour before procedure per the physician's order for pain management
integumentary/skin of the neonate
- Warm with acrocyanosis - Milia are present on the bridge of the nose and chin - Lanugo is present on the back, shoulders, and forehead, which decreases with advancing gestation - Peeling or cracking noted on infants >40 weeks of gestation - Mongolian Spots - Hemangiomas such as salmon colored patches (stork bites), nevus flammeus (port-wine stain( and strawberry hemangiomas are developmental vascular abnormalities - Stroke bites are found at the nape of the neck, on the eyelid, between the eyes, or on the upper lip. They deepen in color when the neonate cries. They disappear within the first year of life - Nevus flammeus are purple to red colored flat areas that can be located on various portions of the body that don't disappear - Strawberry hemangiomas are raised bright red lesions that develop during the neonatal period. They spontaneously resolve durin early childhood - Erythema toxicum, newborn rash
deviated neck of the neonate
- Webbing is a possible indication of genetic disorders - Absent tonic neck reflex is an indication of nerve injury
deviated weight of the neonate
- Weight above the 90th percentile is common in neonates of diabetic mothers - Weight below the 10th percentile is due to prematurity, intrauterine growth restriction, malnutrition during pregnancy
milia
- White papules on the face; more frequently seen on the bridge of the nose and chin - Exposed sebaceous glands that resolves without treatment - Parents might mistake these for whiteheads - Inform parents to leave them alone and let them resolve on own
epstein's pearls
- White, pearl-like epithelial cysts on gum margins and palate - Benign and usually disappears within a few weeks
jaundice
- Yellow coloring of the skin - First appears on the face and extends to the trunk and eventually the entire body - Best assessed in natural lighting - When jaundice is suspected, the nurse can apply gentle pressure to the skin over a firm surface such as nose, forehead, or sternum. The skin blanches to a yellowish hue
abnormal response of palmar grasp
- absent of weak response indicates a possible CNS defect; or nerve and muscle injury
abnormal response of the babinski reflex
- absent or weak may indicate a possible neurological defect
Contraindications for breastfeeding
- active and untreated TB - those receiving diagnostic or therapeutic radioactive isotopes - antimetabolites or chemotherapeutic agents - herpes simplex lesions on a breast - HIV positive - street drugs - infants with galactosemia
bathing
- best done before a feeding to decrease emesis - 90-100 degrees and keep it to 5-10 minutes - support the infant's head and neck with the parent's forearm - do not leave infant unattended in the bathwater - start from the cleanest area (eyes) and end with the dirtiest (buttocks) - cleanse eyes from inner to outer aspects using a clean corner of the washcloth per eye to reduce the risk of transfer of infection from one eye to another - wash hair and massage the scalp - lift the chin to clean neck folds, where milk often collects - clean female genitals by washing from front to back to decrease risk of cystitis
breast engorgement
- caused by an increase in the vascular and the lymphatic systems within the breast and milk accumulation - breasts are hard, swollen, red, and painful/tender - breasts feel warm to touch - throbbing sensation - elevated temperature - infant may have difficulty latching due to engorgement
immunoglobins
- classified as IgG, IgA, IgM, IgD, and IgE - Maternal IgGs are the primary antibodies that cross the placenta and enter the fetal system to provide passive immunity - The maternal transfer of IgG antibodies protects the neonate from bacterial and viral infections for which the mom has developed antibodies for like rubella, tetanus, and diphtheria
cord care
- diaper placed below the cord to facilitate drying of the cord - if the cord becomes dirty, clean it with plain water and dry it with a clean, absorbent cloth - parents should contact the health care provider if there is bleeding around cord site, foul-smelling drainage redness in the surrounding skin, or fever
treatment of mastitis
- empty the affected breast, antibiotic therapy, analgesia, rest, adequate nutrition, and hydration - continue to breastfeed or pump her breasts as per the physicians or midwife - apply moist heat to affected breast before feeding- document
elimination
- explain newborns pass several stools per day - should have at least six wet diapers per day once breastfeeding or bottle feeding has been established - new borns may have a pink stain due to urates which is normal - urates persisting in more than two diapers suggest dehydration and weight loss. Report continued urates - blood may occur on the diaper of female newborns related to a withdrawal of maternal hormones or pseudomenstruation - instruct parents to notify the health care provider if the infant becomes constipated. Constipation can be a sign of inadequate intake and needs to be evaluated by the health care provider
treatment for breastfeeding women for engorgement
- frequent feedings to empty the breast and to prevent milk stasis - warm compresses to the breast and breast massage to facilitate the flow of milk prior to feeding - express milk by breast pump or manually if infant is unable to nurse (preterm infant) - ice packs after feedings - analgesics for pain management - wear a supportive bra
methods for soothing colicky infants
- hold the infant and sway from side to side or walk around with the infant - give the infant a pacifier - swaddle the infant - place the infant (abdomen down) over the knees and gently rub or pat the back - place in a baby bouncer- place the infant in a car seat and take him or her for a ride in the car - place the infant in a car seat and put on top of a running clothes dryer. Do not leave the infant unattended on the dryer - place on stroller and go for a walk
expected response of the babinski reflex
- hyperextension and fanning of the toes
IgA
- in external secretions (tears, saliva, etc) - present in breast milk to provide passive immunity for breastfed infants - found in secretions of all mucous membranes
football hold position
- is used for breast feeding and is where you tuck your baby under your arm like you would hold a football
mastitis
- occurs 3-4 weeks postbirth - may be caused by bacterial entry through cracks in the nipples and is associated with milk stasis, engorgement, long intervals between feedings, stress, and fatigue - fever, chills, malaise, flulike symptoms, unilateral breast pain, and redness and tenderness in the infected area
IgE
- on mast cells or basophils - important to allergic reactions (mast cells release histamine)
non-nutritive sucking
- pacifiers should not be used to delay feedings or substitute for parental attention - pacifiers should not be used with breastfeeding infants until 1 month of age. This provides time needed for infants to establish breastfeeding - pacifiers have been linked to shorter breastfeeding duration - the mouth motions that a newborn uses when breastfeeding, referred to as suckling, are different from the mouth motions (sucking) used with bottle feeding or use of pacifier - the shield between the nipple and ring should be made of firm plastic with ventilation holes and have a diameter of at least 1.5 inches - warm, soapy water for washing
neuromuscular maturity for a New Ballard Score
- posture ranging from fully extended to fully flexed (0 to 4) - square window formation with the neonate's wrist (-1 to 4) - arm recoil, where the neonate's arm is passively extended and spontaneously returns to flexion (0 to 4) - popliteal angle, which is the degree of the angle which the newborn's knees can extend (-1 to 5) - Scarf sign, which is crossing the neonate's arm over the chest (-1 to 4) - Heel to ear, which is how far the neonate's heels reach to their ears (-1 to 4)
how to elicit palmar grasp
- present at birth and disappears at 3-4 months - the examiner places a finger in the palm of the neonate's hand
babinski reflex how to elicit
- present at birth and disappears at one year - stroke the lateral surface of the sole in an upward motion
how to elicit startle
- present at birth, disappears by 4 months Make a loud sound near the neonate
how to elicit sucking
- present at birth; disappears 10-12 months - Place a gloved finger or nipple of a bottle in the neonate's mouth
stepping or dancing reflex how to elicit
- present at birth; disappears at -4 weeks - hold the neonate upright with feet touching a flat surface
how to elicit plantar grasp
- present at birth; disappears at 3-4 months - place a thumb firmly against the ball of the infant's foot
diapering
- recommended to change the diapers every 1-3 hours during the day and at least once at night - gather supplies (clean diaper, clothing, wet washcloth)before placing the infant on a flat surface such as a changing table - unfasten diaper and lower the front of the diaper - lift the infant's bottom using an ankle hold and fold the soiled diaper under the bottom - use water or diaper wipes to clean genital and rectal areas - lift the bottom of the infant with use of an ankle hold, remove the soiled diaper, and then place a clean diaper under the infant - fasten both sides of the diaper so there is a snug fit - dress the newborn - dispose dirty diaper and wash
physical maturity for a New Ballard Score
- skin texture, ranging from sticky and transparent, to leathery, cracked, and wrinkled (-1 to 5) - lanugo presence and amount, ranging from none, sparse, abundant, thinning, bald, or mostly bald (-1 to 4) - plantar surface creases, ranging from less than 40 mm to creases over the entire sole (-1 to 4) - breast tissue amount, ranging from imperceptible, to full areola with a 5-10 mm bud (-1 to 4) - eyes and ears for amount of eye opening and ear cartilage present (-1 to 4) - genitalia development, ranging from flat smooth scrotum to pendulous testes with deep rugae for males (-1 to 4), and prominent clitoris with flat labia to the labia majora covering the labia minora and clitoris for females (-1 to 4)
expected response of palmar grasp
- the neonate grasps fingers tightly. if the neonate grasps the examiner's fingers with both hands, he or she can be pulled to a sitting position
expected response to stepping or dancing
- the neonate steps up and down in place
effective breast feeding
- the woman feels physically and emotionally comfortable when feeding her newborn - the newborn properly latches on, as indicated by no nipple pain or trauma - the newborn suckles and the woman can hear and/or see swallowing, which indicates the transfer of milk - the newborn spontaneously releases his or her grip on the breast when satiated - the newborn is drowsy and arms and legs are relaxed at the end of the feeding session - there are at least eight wet diaper and several stools per day once breast milk has come in and breastfeeding is established - newborn recovers his or her birth weight by 2 weeks of age
expected response of plantar grasp
- toes flex slightly down in a grasping motion
to decrease risk of infection and bleeding for nipple tissue
- use proper technique for latching on and releasing suction - apply warm compress to the nipples before feeding to enhance the let-down reflex - express colostrum or milk and rub it in the nipple and the end of the feeding session - change positions when feeding to reduce pressure areas - begin feeding on the less sore breast - wash breasts with water only
axillary thermometer
- used to monitor temp and prevent hypothermia - rectal temps are avoided because they can injure the delicate rectal mucosa, an initial rectal temp can be obtained to evaluate for anal abnormalities
manual expression of milk
- wash hands - massage each quadrant of the breast - place her thumb and forefinger so they form the letter C, with the thumb at the 12 o'clock position and the forefinger at the 6 o'clock position - push the thumb and finger toward the chest wall - lean over and direct the spray of milk into a clean container - repeat - occasionally massage distal part of the breast - reposition the thumb and forefinger to the 3 and 9 o'clock positions and repeat above sequence
prevention and treatment for nonbreastfeeding women for engorgement
- wear a supportive bra - avoid stimulating the breast - ice packs - analgesics for pain managements - subsides within 48-72 hours
Circulatory System Changes of the Neonate - Ductus Arteriosus
- which connects the pulmonary artery with the descending aorta, usually closes within 15 hours post-birth. It will remain open when the lungs fail to expand or when PaO2 levels drop. Closure occurs when: The pulmonary vascular resistance -> left to right shunt -> closure of ductus arteriosus
Circulatory System Changes of the Neonate - Ductus Venosus
- which connects the umbilical vein to the inferior vena cava, closes by day three of life and becomes a ligament. Blood flow through the umbilical vein stops once the cord is clamped
lying-down position
- woman lies on bed or sofa in a comfortable position. Pillows are used to provide proper support of her head and neck. Newborn lies next to her side so head is facing nipple
Nursing Actions to Skin Care
-Assess skin once per shift and the perineal area at each diaper change. Intact and healthy skin is a first-line of defense for infection - Decrease risk of diaper dermatitis by changing diapers and cleaning the perineal area with water every 1-3 hours. Apply barrier products containing petrolatum and/or zinc oxide at each diaper change for infants at risk for dermatitis. Apply antifungal creams if infection is present - Use adhesives that cause the least amount of trauma. Slowly and gently remove adhesives using moist gauze - Apply emollients to dry and flaking skin every 12 hours as needed
abnormal response of rooting
-May not respond if recently fed - Prematurity or neurological defects may cause weak or absent response
gomco clamp
-this method of circumcision uses a clamp that is placed around the cone and foreskin and is tightened to provide enough pressure to crush the blood vessels. -remove foreskin after 3-5 minutes
Day 1 Diapers
1 Wet - 1 Stool - Meconium
Stage 1 of Human Milk
Colostrum - Lasts for 2-3 days - present starting second trimester - thick, yellowish breast fluid - high levels of protein and low levels of fat, carbs, and calories - high levels of G and A immunoglobins - acts as a laxative and assist in passage of meconium - needs to feed more frequently due to small amounts
cradle position
Cradle baby in arm closest to breast used - Align ear, shoulder & hip - Opposite hand to support breast
Day 3 Diapers
6 Wet - 3 Stools - Transitional
ovulation when breastfeeding
6 months
breast milk in a deep freezer
6-12 months
ovulation when not breastfeeding
7-9 weeks after birth - menses resumes 12 weeks
breast milk at room temperature
77 for 6-8 hours
plastibell
A device that is fitted over the glans, a suture is tied around the bell's rim, the excess prepuce is cut away and the plastic rim remains in place until it falls off in approximately 5 to 7 days. No petroleum jelly or dressing is used with the plastibell device.
Automated Auditory Brain Stem Response (AABR)
A painless test conducted when the neonate is asleep or lying still. Disposable electrodes are placed high on the neonate's forehead, on the mastoid, and on the nape of the neck. This screening test assesses electrical activity of the cochlea, auditory nerve, and brain stem in response to sound. A referral to a hearing specialist is recommended for neonates who do not have a positive response to the sound stimuli.
Otoacoustic Emissions (OAE)
A painless test that is conducted when the neonate is asleep or lying still. A tiny, flexible ear phone is inserted and records responses of the outer hair cells of the cochlea to clicking sounds coming from the probe's microphone. A referral is made to a hearing specialist when there is no recorded response from the cochlear hair cells
Dubowitz neurological exam
A standardized tool that assess 33 responses in four areas: - Habituation (the response to repetitive light and sound stimuli) - Movement and muscle tone - Reflexes - Neurobehavioral items
cold stress
Excessive loss of heat that results in increased respirations and non-shivering thermogenesis to maintain core body temperature
Deviated posture of the neonate
Extension of extremities often related to prematurity; effects of medications given to mother during labor such as magnesium sulfate and analgesics/anesthesia; birth injuries; hypothermia; or hypoglycemia
Expected posture of the neonate
Extremities are flexed
rectum of the neonate
Anus is patent and stool is passed within 24 hours - present, patent, and not covered by a membrane -
promoting parent-infant bonding
Assessment and monitoring of vital signs can be performed in the parent's arms when the neonate is full term, the Apgar score is 8 or higher, and there are no signs of fetal distress at labor or birth.
convection
Loss of heat from the neonate's warm body surface to cooler air currents, such as air conditioners or oxygen masks
evaporation
Loss of heat that occurs when water on the neonate's skin is converted to vapor, like bathing or directly after birth
Stage 3 of Human Milk
Mature Milk - Mostly water (80%) - 2L of water a day when breastfeeding - Increase of 500 calories- 20% solid - contains 22-23 calories per ounce - foremilk is milk produced and stored between feedings and released at the beginning of the feeding session - hind milk is the milk produced during the feeding session and released at the end with high fat content
Immune System and neonates
Neonates are first exposed to organisms from the maternal genital tract during the birthing process. The maternal genital tract may contain Group B streptococcus and E. Coli, which can result in sepsis.
abnormal response of tonic neck
Response after 6 months may indicate cerebral palsy
expected response of startle
Same as moro response
radiation
Transfer of heat from the neonate to cooler objects that are not in direct contact with the neonate, such as cold walls of the isolette or cold equipment near the neonate.
conduction
Transfer of heat to a cooler surface by direct skin contact, such as cold hands of caregivers or cold equipment
stethoscope with a pediatric head
Used to evaluate heart rate, breath sounds, and bowel sounds. - head is placed on the fourth or fifth intercostal space at the left midclavicular line over the apex of the newborn's heart. Heart murmurs are documented and reported
breast-fed stool
Yellow and semi-formed. Later it becomes a golden yellow with a pasty consistency and has a sour odor
bulb syringe
self-contained, soft rubber and manual pump designed to create pressure to deliver fluid as it passes through one-way valves located within the bulb. It is used only to deliver fluids; it cannot be used for aspiration.