exam 1: the normal neonate (ch 21 & 22) & feeding (ch 23)
voiding
- 1-2 voids/stools daily on days 1 and 2 - 3 voids/stools on day 3 - 6 voids daily minimum on 4 and beyond & minimum of 4 stools daily if breastfed - psuedomenstruation - urate crystals
lactogenesis 2
- 2 to 3 days after birth to 10 days - transitional milk "comes in"
danger signs to teach parents
- abnormal cry (shrill, weak, grunty, excessive) - lethargy, difficult to arouse - twitching or jitteriness - vomiting/diarrhea (2 episodes) - change in feeding patterns - signs of infection: > 101F or < 97F (rectal) - rapid breathing
cord clamping
- timing makes a difference - delayed cord clamping may prevent childhood anemia, increase BP, increase O2 transport, and increase red blood cell flow
less than a score of 7 at the 5 minute scoring, baby also gets a ___________ Apgar score
10 minute
WBC
10,000-30,000 (can be higher than normal like the postpartum mom)
babies should breastfeed q 2-3 hours for ________ mins on each side
10-20
unmodified cow's milk is NOT recommended for infants younger than _________ months
12
Your infant's birth weight is 4250g, he is 3 days old and his weight is now 3725g. What is his percentage of weight loss?
12%
posterior fontanel
- 0.5-1.0 cm - closes by 2-4 months
stork bites
- "telangiectactic nevi" dark red spots on the eyelids, forehead, or nape of the neck, that usually fade in time - concentration of immature RBCs
s/s hypoglycemia
- *jitters, tremors - poor tone - diaphoresis - poor suck - tachycardia/ tachypnea - grunting - cyanosis - low temperature
neutral thermal environment (NTE)
- an environment in which the infant can maintain a stable temp with minimal O2 - if newborn's temp falls below 36.5 place under radiant warmer (**test, not real life) - use probe for safety (tells machine how much heat to do, can't heat up too fast/much) - may also double wrap OR put baby skin to skin with parent (not on hesi...)
danger signs in the newborn
- apnea > 15 seconds - delayed voiding or meconium - central cyanosis, circumoral cyanosis - hypothermia - pallor, skin color changes, jaundice in 1st 24 hours - bleeding → cord or circumcision site
eyes
- assess for inflammation, symmetry, equal in size - gray-blue in light toned skin changes to true color by 6 months - infants with darker skin tone may have dark brown eyes - best vision at 8-12 inches, can see up to 2.5 feet
safe sleeping advice
- back to sleep - if swaddled, arms out** - firm sleep surfaces - no soft objects/bedding - no smoking in the home - consider a pacifier
phenomenal growth
- birth weight DOUBLES in 6 months** - and TRIPLES in one year** - infant energy, protein, vitamins, and mineral requirements during first year of life are higher per pound than at ANY other time of their life
cephalohematoma
- blood under the periosteum - doesn't cross suture lines - risk for jaundice** - notify HCP!!
acrocyanosis
- blueness of the extremities - normal for 12 hours post birth
vernix caseosa
- cheesy substance covering the skin of the fetus - keeps skin supple and protects it
temperature
- don't often see fevers - hypothermia is a far more common s/s of septicemia
caput succedaneum
- edema under the scalp, from excessive and long pushing from mom - crosses suture lines - not necessarily harmful
maternal advantages of breastfeeding
- facilitates post partum weight loss - helps control uterine bleeding, promotes involution - decreases risk of breast cancer and osteoporosis - some protection against conception
vitamin K
- fat soluble - promote blood clotting - not born with it, so risk for brain bleeds* - 0.5-1 mg IM (only vastus lateralis) - prevents BLEEDING in the newborn - given in first hour
long term breastfeeding benefits
- fewer respiratory, GI & ear infections - better jaw and teeth development - stronger immune systems - less leukemia - higher IQ (10 point average) - less type I & II diabetes, heart disease and obesity
the first breath
- fluid-filled to a gaseous environment - triggered by pressure changes, noise, light, chilling, compression of chest, & low oxygen - CRY after birth shows good transition** - transient tachypnea
apical pulse
- high pitched, irregular, murmurs are common with lower sleep, and with hypothermia - take for 1 full minute
oxytocin
- increases in response to nipple stimulation and causes the milk ejection reflex or "let down" - may be a tingling sensation
physiological status of the infant
- limited stomach capacity - immature immune system (located mostly in gut) - limited pancreatic enzymes & bile secretion - kidneys are immature - limited neck/head control
slate grey nevi (mongolian spots)
- look like bruises, butt & hips of darker skinned people - **document at birth because they can be mistaken as bruises and abuse
lactogenesis 3
- mature milk - bluish, thinner
hepatitis B vaccine
- only vaccine given in newborn period - only vastus lateralis
immediate advantages of breastfeeding
- passive immunity - decreases stomach upset, diarrhea, colic - decreases newborn constipation - protection against food allergies - always available, always clean, proper temperature, no contamination - less overfeeding - less SIDS
circumcision care
- petroleum gauze dressing may be applied with each diaper change x 1-2 days - #1 side effect is bleeding, be careful when opening diaper
erythromycin ophthalmic ointment
- prevents ophthalmia neonatorum (blindness - most common cause is from STDs) - prophylactic agent given in first 1-2 hours
during the assessment of a preterm neonate, the nurse determines that the infant is experiencing hypothermia. Which action would the nurse take? select all that apply - rewarm gradually - notify the practitioner - assess for hyperglycemia - remove wet linens - assess for jaundice
- rewarm gradually - remove wet linens - assess for jaundice
anterior fontanel
- should be soft, flat, 4-5 cm - closes by 18 months
prolactin
- stimulates milk production - loss of placenta and infant sucking cause continues elevation
survival instincts present at birth
- sucking, rooting - swallowing, gag - grasp (hands, toes) - moro (startle) - sneeze, cough - yawn, stretching, burp, hiccuping - babinski (stroke from heel toward toes) - crawling - stepping or walking - tonic neck or fencing (when baby is asleep, turn head, baby = on guard position) - trunk incurvature (should flex toward the side stroked)
circumcision
- surgical removal of part of the foreskin of the penis - ⅔ of american newborn males
signs of respiratory distress*
- tachypnea with RR > 60 - flaring nares, grunting - cyanosis (*circumoral - after mouth) - seesaw or paradoxical respirations (chest & belly opposite) - retractions, asymmetry
newborn vital signs
- temp → 97.7-99.5 - respirations → 30-60 breaths/min - apical pulse → 110-160 bpm - blood pressure → full term averages 80/50
feeding recommendations
- the AAP and ADA recommend breastfeeding exclusively for first 6 months - breastfeeding and solids until 1 year and then continue breastfeeding as long as the mother and baby desire - U.S. breastfeeding rates → 83% at birth, 58% at 6 months, 36% at 12 months
the appropriate steps in conducting an infant heel stick include the following: - cool the heal with a commercial ice pack - warm the heel with a commercial heel warmer - choose puncture site on lateral heel that hasn't been used before - wipe away first drop of blood - avoid excessive squeezing of foot
- warm the heel with a commercial heel warmer - choose puncture site on lateral heel that hasn't been used before - wipe away first drop of blood - avoid excessive squeezing of foot
hemoglobin
17-20 (higher to cope with less O2)
meconium
1st stool (about 12 hrs) - progresses from thick, greenish-black, to loose greenish-brown transitional stools to milk stools (from drinking amniotic fluid) - usually passed in 12 hrs, if delay is > 24-48 hrs → bowel obstruction?
Your infant's birth weight is 3258g. He is 1 day old and his weight is now 3126g. What is his percentage of weight loss?
4%
normal glucose
40-80
discard unused formula after ________ _______
48 hours
hematocrit
52-63% (higher to cope with less O2)
weight loss
7% loss typical (up to 10% normal) and regains by 10 days
___________ is higher in babies than adults because we breathe 21% O2 and babies breath less % of O2 than mom
H&H
evaporation
liquid converted to vapor
convection
air flow to cooler areas
milia (60%)
baby acne, unopened sebaceous glands, usually worse before better
lactogenesis 1
begins during pregnancy and continues through early days after birth - colostrum → "liquid gold"
phenylketonuria screening (PKU)
blood from a heel stick collected after 24 hours of breastmilk or formula ingestion - tests for multiple metabolic disorders as well, takes weeks for results - regulated by state laws - recessive disorder of protein metabolism
blood volume
can vary by 25-40% (think of cord clamping, if cord is clamped too early then less blood delivered)
radiation
close, cool solid surfaces
common breastfeeding problems
damaged nipples - fix the latch* engorgement - "wear supportive or tight filling bra"
too little formula can lead to
failure to thrive*
psuedomenstruation
fake period dime size in baby girl diapers, maternal hormones, harmless
if baby is well flexed even if not crying the baby is
fine
breastfed stools
frequent, seedy, and mustard-colored
too much formula can lead to
hypernatremia
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
pale can mean
hypovolemic (bleed somewhere)
LATCH assessment
latch, audible swallowing, type of nipple, comfort, hold
effects of heat loss
leads to depletion of glucose and use of brown fat (only newborns, norepi triggers burning of brown far in neck, scapula, kidneys, etc, blood moves by & picks up heat) this may result in respiratory distress, ketoacidosis, & possible shock
mastitis
milk stasis and bacterial invasion treatment - keep nursing to empty breast - ice packs - no heat - start BF on unaffected side
reflex irritability is a
negative stimuli response
erythema toxic (70%)
normal newborn rash
strabismus
normal x 3-6 months, eyes don't look the same way
vastus lateralis injection
on lateral aspect of thigh
urate crystals
orange dust, sign of dehydration, not ominous sign, shouldn't be after day 4
formula stools
pale yellow to brown, firmer, less frequent
What is the most important thing that parents should know before hospital discharge after childbirth? - results of the infant's cardiac screening - principles of infant feeding (amount and frequency) - how to contact the pediatrician - how to change diapers and dress the infant
principles of infant feeding (amount and frequency)
best time to feed
quiet alert, active alert
transient tachypnea
slow or incomplete removal (c/s or depressed) when fluid in lungs post birth (normal) doesn't go away
Epstein's pearls (60%)
small,white epithelial cysts on babys gums
if baby has no tone at all, __________ won't help, baby needs air
stimulating
__________ or shivering is usually NOT present at birth
sweating
respirations
take for 1 full minute because - periodic breathing → cessation 5-10 sec - apnea → > 15 sec with cyanosis and HR changes & requires further evaluation
thermoregulation
the maintenance of body temperature
reasons that newborns are predisposed to heat loss
thin skin, blood vessels close to surface, lacks subcutaneous* fat
conduction
two objects touching