CH.13 Nursing Care during Newborn Transition

4. What are 2 findings when checking a newborn's Genitourinary system?

1. The newborn should void within the first 24 hours 2. Genitalia of both sexes may be swollen

Heat is lost through the what 4 processes?

1. Convection 2. Conduction 3. Evaporation 4. Radiation

Define Harlequin sign

- characterized by a clown suit-like appearance of the newborn. The newborn's skin is dark red on one side of the body while the other side of the body is pale. The dark red color is caused by dilation of blood vessels, and the pallor is caused by contraction of blood vessels

Define cephalohematoma

- collection of blood between the periosteum and the skull caused by excessive pressure on the head during birth.

Define Epispadias

- condition in which the opening of the urinary meatus is located abnormally on the dorsal (upper) surface of the glans penis

Define hypospadias

- condition that occurs when the opening to the urethra is on the ventral (under) surface of the glans

What is the expected Chest circumference for newborns?

- 12 to 13 inches - 30.5 to 33 cm

What is the expected Head circumference for newborns?

- 13 to 14 inches - 33 to 33.5 cm

What is the expected length range for newborns?

- 19 to 21 inches - 48 to 53 cm

What is the expected weight range for newborns?

- 5 lb - 8 lb - 8 oz - 13 oz - 2,500 grams - 4,000 grams

FILL IN THE BLANK Newborn hypoglycemia is a blood glucose level less than (........) mg/dL

- 50 mg/dL

What is an immediate assessment that is performed on the Newborn within 1-5 minutes of life?

- An Apgar score

When does Respiratory adaptation occur in newborns?

- As soon as they breath in their first gasp of air, fresh out the womb * when the newborn fills their lungs with air, absorbs remaining fluid in the lungs, and begins oxygen exchange

How does the newborn conserve heat?

- By maintaining a flexed position and producing heat by metabolizing brown fat

What does an Apgar score determine? List the 5 parameters in the Apgar test.

- Determines how well the newborn is transitioning to life outside the womb 1. Respiratory effort 2. Heart rate 3. Muscle tone 4. Reflex irritability 5. Color *A healthy, vigorous newborn has a 5-minute score of 7 or greater.

What is a common symptom of Newborn hypoglycemia?

- Jitteriness * Newborns can be without symptoms or may demonstrate multiple signs

Explain why the newborn has poor thermoregulation?

- Newborns are prone to heat loss through the skin and cannot produce heat through muscle movement and shivering

Vitamin K is given (......) to stimulate appropriate clotting in newborns A. Intramuscularly B. Subcutaneously C. Sub-dermal D. Intravenously

- Not all of the necessary blood coagulation factors are manufactured directly after birth - The gut is sterile SO vitamin K is given (A) intramuscularly to stimulate appropriate clotting

The least disturbing aspects of Newborn examinations are completed first. Which examinations come first? Then next?

- Respiratory rate & heart rate are taken first while the newborn is quiet - Then examination proceeds in a head-to-toe manner and includes physical measurements and inspection of each body part

What are some skin characteristics that are present in Newborns?

- Supple with good turgor - Natural color to it - Many variations are normally present on newborn skin - Acrocyanosis may be present

Explain how Jaundice occurs

- The newborn's immature liver may not be able to handle the heavy load from the breakdown of red blood cells = physiologic jaundice appears

Define thrush

- a fungal infection (caused by Candida albicans) in the oral cavity

Define mottling

- a red and white lacy pattern sometimes seen on the skin of newborns who have fair complexions

Define Apgar

- a scoring tool used as a means of quickly assessing the newborn's transition to extrauterine life based upon evaluation of five parameters: heart rate, respiratory effort, muscle tone, reflex irritability, and color.

Define cold stress

- a serious, potentially life-threatening condition, where exposure to temperatures cooler than normal body temperature results in the newborn using energy to maintain heat

Define simian crease

- a single straight palmar crease; a finding that is associated with Down syndrome

Define brown fat

- a specialized form of heat-producing tissue found only in fetuses and newborns.

Define surfactant

- a substance found in the alveoli of mature fetuses that decreases the surface tension and keeps the alveoli from collapsing after they first expand after birth

Define molding

- a temporary elongation of the fetal skull caused by the bones of the skull overlapping during labor, which reduces the diameter of the head

Define vernix caseosa

- a white, cheese-like substance that covers the body of the fetus and protects the skin during fetal life; consists of sebum and desquamated epithelial cells

Define phimosis

- adherence of the foreskin to the glans penis

Define acrocyanosis

- blue hands and/or feet with a natural color trunk.

Define Caput succedaneum

- edematous swelling of the soft tissues of the scalp caused by prolonged pressure of the occiput against the cervix during labor and delivery. The edema disappears within a few days

Define pseudomenstruation

- false menstruation; a slight red-tinged vaginal discharge in female infants resulting from a decline in the hormonal level after birth compared with the higher concentration in the maternal hormone environment before birth

Define lanugo

- fine downy hair that is present in abundance on the preterm infant and found in thinning patches on the shoulders, arms, and back of the term newborn.

Define hyperbilirubinemia

- high levels of unconjugated bilirubin in the bloodstream - serum levels of 4 to 6 mg/dL and greater

Define physiologic jaundice

- icterus neonatorum; jaundice that occurs in a large number of newborns but has no medical significance; result of the breakdown of fetal red blood cells

Define frontal-occipital circumference (FOC)

- measurement of the widest circumference of the head Ex.: From the occipital prominence around to just above the eyebrows

Define Epstein pearls

- small white cysts found on the midline portion of the hard palate of some newborns

Define smegma

- the cheese-like secretion of the sebaceous glands found under the foreskin, or within the folds of the labia

Define meconium

- the first stool of the newborn, a thick black tarry substance composed of dead cells, mucus, and bile that collects in the rectum of the fetus in utero

Define thermoregulation

- the process by which the body balances heat production with heat loss to maintain adequate body temperature

Define milia

- tiny white papules found on the face of the newborn; common skin manifestation

Each infant is unique, but all infants have similar sleep and activity patterns... List the 6 Sleep/Activity patterns

1. Deep sleep 2. Light sleep 3. Drowsiness 4. Quiet alert state 5. Active alert state 6. Crying

List the 3 fetal shunts that must close so that blood will travel to the lungs for gas exchange and to route blood through the liver.

1. Foramen ovale 2. Ductus arteriosus 3. ductus venosus

1. What are 4 findings when checking a newborn's Head and face?

1. Molding may be present 2. Infant's head should be observed and palpated for the presence of caput or cephalohematoma 3. Newborn is an obligate nose breather 4. Hard and soft palates should be intact

2. What are 5 findings when checking a newborn's Neck and Chest?

1. Neck is short and thick 2. Webbing should not be present 3. Periodic breathing episodes are normal 4. Infant should be examined for a fractured clavicle 5. Swollen breast tissue in the newborn is common in both sexes and is temporary

6. What are 7 findings when checking a newborn's Neuro Status?

1. Rooting 2. Sucking 3. Swallowing 4. Grasping 5. Moro 6. Babinski 7. Tonic neck

5. What are 2 findings when checking a newborn's Back & Extremities?

1. Should be straight and free of hairy tufts, dimples, or tumors 2. There should be equal and full range of motion of all extremities

What 7 general areas should be checked on Newborn?

1. Skin 2. Head and face 3. Neck and Chest 4. Abdomen 5. Genitourinary 6. Back & Extremities 7. Neuro Status

3. What are 4 findings when checking a newborn's abdomen?

1. The abdomen is protuberant 2. The cord should be clamped and drying with three vessels present 3. Bowel sounds should be present 4. Newborn should pass meconium, the first stool, within the first 24 hours

TRUE or FALSE Jaundice is harmless if bilirubin levels do not rise dramatically and if jaundice is present before the newborn is 24 hours old.

FALSE - This condition is harmless if bilirubin levels do not rise dramatically and if jaundice is NOT present before the newborn is 24 hours old.

Define jaundice

a yellow staining of the skin that occurs when a large amount of unconjugated bilirubin is present