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