Chapter 13, 14 and 15: Nursing Care during Newborn Transition, Nursing Care of the Normal Newborn, and Newborn Transition

assessment of the cardiorespiratory status on a newborn (resuscitation)

GOAL- quickly determine the need for resuscitation 1. airway/breathing -respiratory rate= 30-60 breaths/min. Counted 1 full minutes. by auscultation, palpation and observation. -apnea- normal to have apneic spells less than 15 seconds. 2. Breath sounds- may hear crackles 3. Signs of respiratory distress- tachypnea, retractions, flaring nostrils, cyanosis, grunting, chest asymmetry 4. Choanal atresia- obligatory nose breathers, assess by occluding one nostril and listen for breath sounds

thrush

a fungal infection in the oral cavity

simian crease

a single straight palmar crease; an abnormal finding that is associated with down syndrome

brown fat

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

surfactant

a substance found in the lungs of mature fetuses that keeps the alveoli from collapsing after they first expand

kangaroo care

a way to maintain the newborn's temperature and promote early bonding; the nurse dries the newborn quickly, places a diaper or blanket over the genital area and a cap on the head, then places the newborn in skin-to-skin contact with the mother or father and covers them both with blankets

jaundice

a yellow staining of the skin that occurs when a large amount of unconjugated bilirubin is present (serum levels >4 to 6 mg/dL)

phimosis

adherence of the foreskin on the glans penis

fetal shunts

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

thermoneutral environment

an environment in which heat is neither lost nor gained

choanal atresia

baby is an obligatory nose breather- that means that they are only nose breathers. To check: plug up one nose nostril and check if baby is still able to breath

chest circumference on a newborn

usually smaller than the head

What is recommended for proper umbilical cord care?

water.

Milia

white cysts (1-2mm) in size= NOT PIMPLES, DO NOT POP

scarf sign

wrapping arm up and over the front of the body and chest. - arm should not be able to go all the way.

assessment of sleep on a newborn

-15 to 20 hours per day -phases of sleep-wake cycle - first reactive - sleep - second reactive - stability

APGAR scoring

-Activity (muscle tone) -Pulse/heart rate -Grimace (reflex response) -Appearance (skin color) -acrocyanosis -Respiratory effort Score that is given in the delivery room between 1-5 minutes. gives everyone in the room an idea of how the baby is transitioning

Red flags for baby abduction

-every time you get a baby, you need to be taking it back in the open crib - carrying a baby around is a RED FLAG for a baby abduction -Always check for baby's ID and mom and dad's ID and NEVER LEAVE BABY ALONE

assessing vertebral column

-indentation with tuft of hair = spina bifida

When is the most critical period for a new born and why?

-most critical period is the first hour of life. 1. requires breath must force fluid into interstitial spaces 2. Requires negative pressure 3. Initiation of respirations - chemical factors- changes in Po2, Pco2, pH - mechanical factors-compress the chest/birth - sensory factors- light, sound, touch and smell 4. continuation of respirations- cry 5. newborn should be positioned on the back or side to help maintain a patent airway -suction and oxygen Alveoli remain partially open, reduces the amount of pressure needed to take next breath. Cry forces leftover fluid into interstitial spaces. May take several hours so may hear moist lungs initially

stork bite

-nevus simplex/salmon patch/telangiectatic nevus= pink discoloration from dialated capillaries on eyelids, nose, nape of neck, most disappear - see this more on caucasians. -will go away on its own

Formula feeding

-regardless of type, it is important to follow manufacturer's instruction on preparation and storage of formula products -over dilution or under dilution of concentrated liquid or powdered formulas can result in serious illness. - can have mom collect breast milk -breast milk is specific to that baby

Assessing a newborn's abdomen

Abdomen- checking for contents in the peritineum Umbilical cord= 3 vessels, wharton's jelly, if thin may indicate malnourished infant, green-tinge= meconium

assessing a circumcision on a newborn

1. Nursing care -restraint -pain med/soothe -pressure dressing -monitor 1st void 2. Parental teaching -Gomco-vaseline gauze, keep clean/dry/ do not take yellow crust off. -Plastibell-report if bell out of position; bell falls off 5-8 days, keep clean/dry -teach S/S of infection

assessment of the integumentary system on a newborn

1. Skin-fragile -color-pink,tan -vernix caseosa- protects fetal skin in utero and see more in late preterm -lanugo -milia -erythema toxicum -birthmarks -marks from delivery -bathing when temperature stable 2. Breasts -supernumerary -enlarged, discharge 3. Hair and nails -term=soft; preterm; fuzzy -sharp nails, post=long ( use mittens or baby scissors)

discharge planning and parent teaching

1. begins upon admission of the laboring mother 2. areas may include -basic infant care, safety measures, immunizations, return appointments, proper use of a car seat, S/S of problems and who to contact 3. Home care -feedings, furnishings, clothing, skin care

assessment on behavior

1. behavioral -orientation- active alert to environment -Habituation- ignore unpleasant stimuli -self-consoling activities- hand to mouth, watching objects -parent's responses- nurse help to interpret cues

How to promote bonding and attachment

1. bonding: strong emotional tie that forms soon after birth between parents and newborns 2. Attachement: affectionate tie occurring over time with increased interaction 3. Need to learn infant's communication cues, ex; hunger, wet diaper 4. Nursing assessments should include observing for these to occur 5. Nursing interventions - calling the infant by name, holding the infant en face, providing skin-to-skin contact, talking in gentle, high-pitched tones

Breastfeeding

1. choosing whether to breastfeed 2. physiology of lactation -hormonal stimulation -prolactin - oxytoxin 3. composition of milk -foremilk -hindmilk 4. phases of milk production -colostrum -transitional -mature

newborn discharge care education

1. discharge planning for the newborn begins shortly after birth 2. if discharged before 72 hours old, a follow-up visit with the pediatrician is recommended within 2 days of discharge. 3. well baby checks start around 6-8 weeks of age 4. Immunization information may be provided 5. Car seat safety: seat should be in back seat and facing the rear until 2 years of age.

assessing a newborn's head

1. elevate head during palpation of the fontanelle anterior (diamond shaped) (4-6cm) and closes by 18 months. 2. Pressure posterior fontanelle (triangular shaped) (.5-1cm) closes by 2 months (PIC)

administering medications to a newborn

1. eye care (erythromycin) -eye prophylaxis to prevent infection from gonorrhea and chlamydia should be instituted within the first hour after birth 2. Vitamin K (aqua-MEPHYTON)- given to as an IM to stimulate appropriate clotting 3. Hepatitis B (initial vaccine)

nurses responsibility when assessing a newborn

1. facial symmetry- facial nerve trauma 2. neck- able to turn from side to side/webbing 3. Clavicles-broken = crepitus, lump or swelling, unequal movements - treatment: pin arm sleeve to chest to immobolize 4. Extremities- flexed, good tone and vigorous movements, check nerve damage 5. Hands/Feet- Simian line, webbing, extra digits (polydactlyly)/ club foot (move midline and not true club foot)

feeding the infant

1. feed every 3 to 4 hours because formula is digested more slowly than breast milk 2. Do not microwave formula 3. Do not prop bottle 4. Involve partner and family in bottle feeding of infant -many woman desire to warm their infant's formula. This is not necessary.

How to recognize hunger in the newborn

1. hand to mouth movements 2. mouth and tongue movements 3. sucking motions 4. rooting movements 5. clenched fists 6. kicking of legs 7. crying (a late sign)

Circulatory system on newborn

1. has about 300 mL of circulating blood volume 2. Neonatal circulation differs from fetal circulation 3. Dependent upon ducts within the heart to close at certain points in time such as: -foramen ovale -ductus arteriosus -ductus venosus 4. If the ducts fails to close when they are supposed to, the neonate may become cyanotic because the blood bypasses the lungs and does not pick up any oxygen

initial assessment on a newborn for abnormalities

1. head -shape/symmetry -fontanels/sutures -caput succedaneum 2. face 3. neck and clavicles 4. cord 5. extremities 6. hands and feet 7. hips 8. vertebral column 9. measurements -weight -length -head

assessment of the genitourinary system on a newborn

1. kidney- not fully developed at birth -glomeruli are small -renal blood flow is about a third of an adult -unable to handle large shifts in fluid 2. Urine -average number of wet diapers -uric acid crystals- brisk dusk staining; kidney immature 3. Genitalia- size, maturation, and abnormalities -female -male

female genitalia on a preterm newborn

1. may be slightly swollen 2. thin, white or blood-tinged mucus may be discharged from the vagina (psedomensturation) caused by hormonal withdrawal from the mother -cleanse the vulva from the urethra to the anus to prevent fecal matter from entering the urinary meatus, leading to UTI

maternal nutrition

1. mother needs an additional 500 calories over the nonpregnant diet 2. 8-10 glasses of fluids per day 3. some foods eaten by mother may cause a change in the taste of the milk or cause the infant to develop gas (flatus) 4. medications taken by the mother may be secreted in the breast milk -dietary changes might be required if certain substances are found to cause distress in the infant

assessing the gastrointestinal system on a newborn

1. mouth- visualize and palpate -teeth, epstein's pearls, tongue-tied, thrush (yeast infection in the mouth) -hard/soft palate (need to be closed), cleft lip 2. suck- insert gloved finger 3. initial feeding- observe and assist; suck, swallow and breath -latch & position for breastfeed -amount & position for bottle feed, freq, burping 4. Abdomen- soft, round with bowel sounds -hernia, distention, no masses -swollen breast tissue is common 5. stools- type, color, consistency- should look black and tarry (first)

nervous system relexes

1. moves arms and legs vigorously but cannot control them 2. Full-term infants are born with the following reflexes (which help keep them alive) -blinking, sneezing, gagging, sucking, grasping 3. they can also cry, swallow and left their head (slightly) when lying on their abdomen

ballard score (20-44 weeks)

1. neuromuscular -posture, square window, arm recoil, popliteal angle, scarf sign, heel to ear 2. Physical characteristics -skin, lanugo, plantar surface, breasts, eyes and ears, genitals,

Preventing infections on a newborn's umbilical cord

1. newborn's response to inflammation and infection is slow because of the immaturity of the immune system 2. umbilical cord stump primary site of infection if not kept clean 3. Hand hygiene is the primary means of preventing infection and/or its spread

immunoglobulins on a newborn

1. newborns are less effective at fighting off infection. 2. Immunoglobulin G (igG) -crosses the placenta and provides temporary immunity-3 months 3. Immunoglobulin M (IgM) -first immunoglobulin produced when exposed to infection 4. Immunoglobulin A (IgA)-receive some from colostrum and breast milk, provides some resistance to respiratory and gastrointestinal infections, must be produced by the infant at 1 month. *clamping of the umbilical cord- gives the baby temporary immunity

assessing pain on a newborn

1. newborns show behavioral and physiologic responses to painful procedures 2. These responses include crying, grimacing and increased heart and respiratory rates 3. Unrelieved pain can cause exhaustion, irritability, and delay the healing process * Pay attention to behavior, such as crying, sleeplessness, facial expression, and body movements. HR, RR, BP and O2 should also be monitored. PREMATURE BABIES ARE USUALLY THE ONES THAT ARE IN PAIN

What are the phases of the neonate transition to extrauterine life?

1. phase 1: period of reactivity, 0-30 minutes after birth 2. phase 2: decreased responsiveness, 30 minutes to 2 hours after birth 3. phase 3: second period of reactivity, 2 to 8 hours after birth Newborn must rapidly adapt to life outside the womb; they are awake the first couple of hours- best to breast feed and then later on they sleep

assessing the neurological system on a newborn

1. reflexes -presences, strength, symmetry -diminished response in ill/preterm 2. sensory assessment -ears-placement, gestational age, hearing screen, (ear problems may indicate kidney defects- startle reflex- head turn toward sound) -eyes-sclera, iris, slanting, eyelids, ducts, acuity (8-12 inches and should respond to environment) , cross-eyed -STD- gonorrhea causes blindness=antibiotic -Strabismus -sense of smell and taste, no tears (1-3 mo) 3. Other neurologic signs- note: cry pitch -jitteriness (tremors)-check glucose -seizures-hold arm but continue to shake -sensory overload -moving one arm but not the other- could mean baby broke their bone? -Diminished response- could mean down syndrome

male genitalia on a preterm newborn

1. rugae (creases in the scrotum); enlargement of the scrotum= hydrocele, most reabsorb 2. testes descended- block inguinal canal and check scrotum 3. Cryptorchidism- undescended testes- usually descends within a 3 mo or surgery 4. Meatus- underside= hypospadias, upper= epispadias. Correct by surgery so will not circumcise 5. preterm- scrotum is not fully developed

assessing the musculoskeletal system on a newborn

1. skeleton is flexible 2. movements are random and uncoordinated 3. development of muscle control proceeds form head to foot and from the center of the body to the periphery 4. head and neck muscles are the first ones under control- assess how strong baby is. -Head lad should disappear by 6 months

evaluating intake of infant

1. supply and demand philosophy 2. Let-down reflex occurs - a tingling sensation with milk dripping from nipple 3. Infant nurses for 15 minutes per breast 8 to 10 times per day 4. An audible swallow is heard 5. Infant appears relaxed after feeding 6. Infant has 6-8 wet diapers per day. 7. Infant passes several stools per day 8. Breast feels soft after feeding 9. Infant has continued weight gain on growth chart

phase 2: nursing care of the newborn

1. supporting thermoregulation -evaporation -conduction -convection -radiation 2. Observing bowel and urinary function 3. Security measures- ID bands for newborns and parents; release infant to those with identification 4. Assessing the infant -gestational age -evaluation -skin -vernix -hair -ears -breast tissue -genitalia -sole creases 5. Observing for injuries or abnormalities 6. Obtaining vital signs 7. Weighing and measuring length and head circumference 8. Umbilical cord care 9. Screening tests ( must gather baby's blood- checking if a baby has a certain disease that can possibly be helped -PKU -Galactosemia -Bilirubin -Inherited diseases

assessment on a newborn thermoregulation

1. take temperature soon after birth (97.7-99.5 F AX) 2. set warmer controls to regulate the amount of heat produced using a temp probe 3. Reassess every 30 minutes until stable Nurse would reassess baby every 30 minutes until stable - teach parents to use axillary area for temp not the anus TYMPANIC DEVICES are NOT accurate for a newborn

Measurements- record in metric

1. weight- 5lb 8oz to 8lb 13 oz average -weight daily, same time -will lose up to 5-10% of birth weight in 1 week -recover by 2 weeks of age -may be a result of withdrawal from maternal hormones, fluid shifts, and the loss of feces and urine 2. Length= 19-21 inches 3. Head circumference= 13-14 inches -small-microcephaly -large-hydrocephalus 4. Chest circumference= 12-13 inches

lactation consultant

a nurse or layperson who has received special training to assist and support the breast-feeding woman

The nurse is assisting the breast-feeding woman during a feeding session. Which data collection has priority during the feeding session?

A. Observe the position, latching on, and sucking of the newborn B. Observe the woman's visitors and their opinions regarding breast-feeding C. Check the woman's perineal pad for increased lochia flow D. Determine if the woman needs a visit from the lactation consultant A

A woman dressed in hospital scrub attire without a name badge presents to the nursery and says that Mrs. Smith is ready for her baby. She then offers to take the baby back to Mrs. Smith. What response by the nurse is best in this situation.

A. "I don't know you. Are you trying to take a baby?" B. "Leave immediately! I'm calling security." C. "May I see you identification, please?" D. " You must be Mrs. Smith's sister. She said her sister is a nurse." C

A new mother says, "I think something is wrong with my baby. She looks like she is having a menstrual period!" Wha is the nurse's best response?

A. "I don't know. Let me have the charge nurse check the baby." B. "It's nothing to worry about. That's a normal finding." C. "This is a normal occurrence. You may clean her with a damp washcloth, and it will go away in a few days." D. "This means the baby was exposed to an infection during birth. I'll notify the doctor at once!" C

A new mother is not sure if she wants her baby to be circumcised. Which response by the nurse is best?

A. "circumcision is best in order to protect the baby from diseases like cancer." B. " If you do not circumcise your baby, he will always have difficulty maintaining adequate hygiene." C. " It is best not to circumcise your baby because the procedure is very painful" D. "There are pros and cons to circumcision. Let me ask the pediatrician to come and talk to you about the procedure." D

Which of the following should the nurse include in the discharge instructions to the parents of a term newborn male infant (select all that apply)

A. "sponge bathe the infant every other day until the cord falls off." B. " your son will need to be circumcised before being sent home." C. "It is important to bring your son back in a week for his follow up newborn screening lab test." D. "A yellow color to the skin is normal in the first week and ears off. " E. "Only if he turn blue with crying do you need to call 911." F. " Your son will have a hearing test before he is discharged."

Baby boy Alvarez is 5 minutes old. The nurse gathers the following data: the newborn has a heart rate of 110 bpm, a weak cry, and acrocyanosis. His extremities are held in partial flexion, and he grimaces when a catheter is placed in his nose. What Apgar scare does the nurse record?

A. 5- the newborn is having extreme difficulty transitioning B. 5- the newborn is having moderate difficulty transitioning C. 6- the newborn is having moderate difficulty transitioning D. 6- the newborn is vigorous and transitioning with minimal effort C

The delivery room nurse has just brought a 10-lb newborn to the nursery. The nurse monitoring the newborn during the transition period recognize that which of the following parameters will most likely inhibit the newborn's transition?

A. Apgar score B. Blood sugar C.Heart rate D. Temperature B

Which statements are true regarding breast-feeding?(select all that apply)

A. Breast-fed infants are ill less frequently than formula-fed infants B. Previous breast-feeding experiences do not affect how the mother will breast-feed this infant C. The woman with mastitis is unable to breast-feed D. Medications the woman takes can pass to the infant vis the breast milk E. The woman cannot breast-feed until her milk comes in F. The woman will not ovulate while breast-feeding

The newborn has just been delivered. He is placed in skin-to-skin contact with his mother. A blanket covers all of his body except his head. His hair is still wet with amniotic fluid, etc. What is the most likely type of heat loss this baby may experience?

A. Conductive B. Convection C. Evaporative D. Radiating C

During a prenatal visit, an 18 year old gravida 1, para 0 in her 36th week says to the nurse, "I don't know if I should breast-feed or not. Isn't formula just as good for the baby?" On what information should the nurse base her response?

A. The benefits of breast-feeding are equal to those of formula-feeding B. It is ultimately the woman's choice whether she wants to breast-feed or not. C. The immunologic properties in breast milk cannot be duplicated in formula D. The economic status of the woman is an important breast-feeding consideration C

A woman tells the nurse, " I don't need to use any contraception because I plan on breast-feeding exclusively." On which fact should the nurse base her response?

A. Women who exclusively breast-feed do not ovulate B. Ovulation can occur even in the absence of menstruation C. The birth control pill is the best form of contraception because for breast-feeding women. D. Breast-feeding woman should not use contraception because it will decrease their milk supply B

The nurse is preforming a newborn examination on a 12 hour old term female infant. Which of the following finding should be reported to the RN (select all that apply)

A. bluish colored feet B. Swollen labia C. Bluish color around mouth D. Positive Babinski reflex E. Passage of meconium F. Cephalohematoma G. Respiratory rate of 68 during rest H. Presence of milia

The nurse is examining a 1 day old newborn and notices a small amount of white drainage and redness at the base of the umbilical cord. Which of the following is the best response by the nurse?

A. call the doctor immediately to ask for intravenous antibiotics B. Carefully clean the area with a damp wash cloth, and cover it with an absorbent dressing. C. Notify the charge nurse because this finding represents a possible complication D. Show the mother how to clean the area with soap and water. C

A newborn's axillary temperature is 97.4 F. His t-shirt is damp with spit-up milk. His blanket is loosely applied, and several children are in the room running around his crib. The room is comfortably warm, and the bassinet is beside the mother's bed away from the window and doors. What are the most likely mechanisms of heat loss for this newborn?

A. conduction and evaporation B. conduction and radiation C. convection and radiation D. convection and evaporation D

an infant is born by cesarean delivery. In what way is respiratory adaptation more difficult for this infant than the one who is born by vaginal delivery?

A. more fluid is present in the lungs at birth B. surfactant is missing from the lungs C. the respiratory centers in the brain are not stimulated D. there is less sensory stimulation to breathe A

assessing hips

Barlow and ortolani test assesses hip instability= equal abduction knee height= lower leg may indicate hip problem- treating: immobilize leg with harness - hip problem if unequal leg lengths, thigh and gluteal creases should be symmetric -assessing gluteal folds, noting that the folds and creases should be symmetric, if thay are not symmetric that could indicate that the newborn may have a hip problem

pain assessment tools

COMFORT, CRIES, FLACC, PIPP, NIPS, NPASS

mottling

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

apgar

a scoring tool used as an immediate assessment of newborn adaptation and transition to extrauterine life.

ophthalmia neonatorum

a severe eye infection contracted in the birth canal of a woman with gonorrhea or chlamydia

what is the most common bone for a newborn to break during delivery?

The collar bone! - most common bone that usually break during delivery. a nurse will pin the baby's arm and shoulder down so it can heal. usually take 6-8 weeks

lanugo

When baby has hair all over their back - babies of darker color skin get this more. a gestational age assessment -disappears in a week

Wharton's Jelly

a clear gelatinous substance that gives support to the cord and helps prevent compression of the cord, which could impair blood flow to the fetus

benefits and risks to circumcision

benefits -decrease risk of penile cancer, fewer UTI's fewer STI's disadvantages -infection, hemorrhage, unnecessary surgery 1. Infant must be physiologically stable prior to performing circumcision Nurses role- monitor for bleeding, infection and irritation

anterior fontanelle

bigger, diamond shaped (4-6 cm) and closes by 18 months

mongolian spots

birth marks- size, color, location, elevation and texture -bluish gray marks that resemble bruises, usually go away but some continue- does not blanch, so hard to distinguish from bruises (won't change color over time) - see it more often on darker complected babies.

propping the bottle

bonding, aspiration, milk could stay in their mouth and the first teeth could be cavities

hind milk

breast milk that is thicker and whiter. It contains a higher quantity of fat than foremilk and therefore has a higher caloric content than foremilk

foremilk

breast milk that is very watery and thin and may have a bluish tint. This is what the infant receives first during the breast-feeding sessions

caput succedaneum vs. cephalhemt

caput succedaneum- edema from cervix or suction device and CROSSES suture lines-resolves 24-48 hours cephalhemt.- bleeding between the periosteum and skull from birth pressures and DOES NOT CROSS suture lines-resolves 2-3 mon. May increase risk in jaundice (PIC)

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, ad the pallor is caused by contraction of blood vessels

Umbilical cord

checking for 2 ARTERIES and 1 VEIN- looking at the color too! - wharton's jelly- checking if its not super sticky. it it was thin it may indicate that the baby was malnourished!

What pushes the baby to have its first breath

chemical, mechanical, thermal and sensory factors

assessment on a newborn cardiorespiratory status (circulation)

circulation 1. color- cyanotic, pallor, ruddy, acrocyanosis 2. heart sounds- apical - rate= 110-160 bpm and count 1 full min -rhythm- regular - murmurs- septal defect? most temporary 3. brachial and femoral pulses 4. blood pressure - choose cuff and perform on al extremities - 65-95/30-60 mm Hg ( may indicate heart problems if BP difference) 5. Capillary refill- chest, abd, or extremity

cephalohematoma

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

epispadias

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

hypospadias

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

Conduction

conduction occurs when the infant comes in contact with cold objects or surfaces such as a scale, a circumcision restraint board, cold hands, or a stethoscope

Convection

convection occurs when drafts come from open doors, air conditioning, or even air currents created by people moving about.

positions for breastfeeding

cradle hold, football hold, side-lying position rotating position will help prevent problems with blisters on the nipples

acrocyanosis

cyanosis of the hands and feet seen periodically in the newborn

caput succedaneum

edematous swelling of the soft tissues of the scalp caused by prolonged pressure of the occiput

molding

elongation of the fetal skull to accommodate the birth canal

Evaporation

evaporation can occur during birth or bathing from moisture on skin, as a result of wet linens or clothes, and from insensible water loss. -Air-drying of the skin

Newborn lose heat through may different ways:

evaporation, conduction, convection and radiation

cold stress

exposure to temperatures cooler that normal body temperatures so that the newborn must use energy to maintain heat

pseudomenses

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

lanugo

fine, downy hair that covers the skin of the fetus

what are the 4 phases of sleep-wake cycle?

first reactive, sleep, second reactive, stability

meconium

first stools of the newborn

What are the three shunts on a newborn

foramen ovale, ductus arteriosus, ductus venosus

vernix caseosa

greasy, cheese-like substance that protects the skin during fetal life; consists of sebum and desquamated epithelial cells

Radiation

heat is lost by radiation when the infant is near cold surfaces. thus, heat is lost from the infant's body to the sides of the crib or incubator and to the outside walls and windows.

where to get a glucose on a new born

heel stick- draw blood from outside the V to prevent nerve damage

hyperbilirubinemia

high levels of unconjugated bilirubin in the blood stream (serum levels of 4-6 mg/dL and greater)

physiologic jaundics

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

Elevated head

if head is elevated it means that there could be fluid

What would be a red flag when bonding

if mom is looking away from the baby- not being able to bond with baby!

listening to murmurs on newborn

if you can still hear it that means that the shunt probably hasn't closed yet

retraction

if you see the ribs on a newborn

artificial nutrition

infant formula

mastitis

infection of the breast tissue

phase 1; care of the newborn

initial care includes ABC-T Airway-Breathing-Circulation- Temperature 1. maintaining thermoregulation throughout 2. maintaing cardiorespiratory function 3. observing for urination and/or passage of meconium 4. identifying the mother, father and newborn 5. performing a brief assessment for major abnormalities 6. encourage bonding/breast feeding

hydrocephalus

large head- could indicate infection process, problem for system in the brain

central cyanosis

lips, tongue and mucous membranes and trunk0 cyanotic area will blanch vs bruise

plantar surface

looking at bottoms of newborn's feet. if skin is cracked-postterm. if skin looks smooth with barely any cracks- preterm

Ruddy

may indicate polycysthemia (hematocrit value above 65%)= risk for jaundice

frontal-occipital circumference (FOC)

measurements of the widest circumference of the head ( from occipital prominence around to just above the eyebrows)

what are some special breastfeeding situation

multiple births, premature birth, breast surgery, and delayed feedings

post-wine stain

nevus flammeus- permanent, flat, pink to dark red-purple mark. Does not blanch with pressure -nevus vasculosus- strawberry hemangioma- strawberry like with rough palpation, goes away - cafe-au-lait spots are permanent- it brown areas anywhere, harmless unless large and numerous and then may have neural component BRUISES, PETECHIAE, PUNCTURES, FORCEPS MARKS, EXCESSIVE PEELING-POST-TERM

effects on cold stress

newborns cannot adapt to change in temperatures easily. Poor thermoregulation. Non- shivering thermogenesis- burn brown fat and maintains a flexed position to conserve heat sweat glands do not function during neonatal period, so infant is at risk for developing elevated temperature if overdressed or places in overheated environment BABIES DONT SHIVER HAVE A RESERVE OF BROWN FAT- CAN BECOME ACIDOTIC

engorgement

occurs when the milk comes in and the woman's body responds with increasing the blood supply to the breast tissues

lactation

production and secretion of milk from the breast for newborn nourishment

Latch-on essential factors

proper alignment, correct grasp of the areola; proper hand position of the mother on the breast, mother should wash her hands before breastfeeding -attempting to express some colostrum on the nipple prior to breastfeeding will increase the erectness of the nipples

what are the specific patterns of reactivity that can influence the response to stimuli and bonding?

quiet sleep, rapid eye movement (REM) sleep, active alert, quiet sleep, crying, transitional

Types of formula feeding

ready to feed, concentrated liquid, and powdered -educating the family if the bottle is ready to feed or if they need to add water.

Erythema toxicum

reddened rash with white papules or vesicles in the center -occurs on 70% of newborns- benign - usually on the face, back, shoulder, or chest - this rash does not go away on it's own

Babinski reflex

reflex is elicited by stroking the lateral sole of the infant's foot from the heel forward and across the ball of the foot. This causes the toes to flare outward and the big toe to dorsireflex.

sucking reflex

reflex is essential to normal life. When the mouth or palate is touched bu the nipple or a finger, the infant begins to suck. The sucking relex is assessed for it presence and strength. Feeding difficulties may be related to problems in the infant's ability to suck and to coordinate sucking with swallowing and breathing.

rooting reflex

reflex is important and is most often demonstrated when the infant is hungry. When the infant's cheek is touched near the mouth, the head turn toward the side that has been stroked. This response helps the infant find the nipple for feeding.

plantar grasp reflex

reflex is similar to the palmar grasp reflex. when the area below the toes is touched, the infants toes curl over the nurse's finger

stepping reflex

reflex occurs when infants are help upright with their foot touching a solid surface. this lifts one foot and then the other, giving the appearance that they are trying to walk.

palmar grasp reflex

reflex occurs when the infant's palm is touched near the base of the fingers. The hand closes into a tight fist. grasp reflex may be weak or absent if the infant has damage to the nerves of the arms

Tonic neck reflex

reflex refers to the posture assumed by newborns when in a supine position. The infant extends the arm and leg on the side to which the head is turned and flexes the extremities on the other side. Response is sometimes referred to as the "fencing reflex" bc the infant's position is similar of that of a person engaged in fencing match

thermoregulation

regulation of temperature

correctly removing infant from breast

requires mom to "break suction." she can break suction by inserting a finger in the corner of the infants mouth. Infant should never be pulled away from the breast without first breaking suction.

uneven chest

seesaw or paradoxical respirations/ one-sided may indicate pneumothorax

posture

should be lying on their back with knees bent and arms bent- term

microcephaly

small head- could indicate zika virus

Epstein pearls

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

posterior fontanelle

smaller, triangular shaped (.5-1cm), and closes around 2 months

molding and caput succedaneum

soft and spongy with fluid under the scalp. -caused by overriding parietal bones and edema of presenting part against maternal bones/pelvis -molding happens during the birthing process. it goes away nicely usually

moro reflex

startled reflex

circumcision

surgical removal of all or part of the foreskin (prepuce) of the penis

Barlow and Ortolani

test to assess hips instability -checks for equal abduction knee height -bending the knees and listening to any pops = lower leg may indicate hip problems

smegma

the cheese-like secretion of the sebaceous gland found under the foreskin

colostrum

thin, yellowish, milky fluid secreted by the woman's breast during pregnancy or just after delivery (before the secretion of milk)