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Questions and Answers
What physiological condition is indicated by acrocyanosis in newborns?
What physiological condition is indicated by acrocyanosis in newborns?
What risk is associated with the newborn's inability to adapt to temperature changes?
What risk is associated with the newborn's inability to adapt to temperature changes?
Which is a critical aspect of initial assessment for a newborn?
Which is a critical aspect of initial assessment for a newborn?
What is the recommended method for measuring the newborn's temperature if it is abnormal?
What is the recommended method for measuring the newborn's temperature if it is abnormal?
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What temperature indicates a potential concern for a newborn that must be reported?
What temperature indicates a potential concern for a newborn that must be reported?
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What is assessed during the initial assessment of a normal newborn?
What is assessed during the initial assessment of a normal newborn?
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What are the components of the Apgar score?
What are the components of the Apgar score?
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Which reflex typically disappears within 4 to 6 months after birth?
Which reflex typically disappears within 4 to 6 months after birth?
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During which period after birth is the newborn most alert and responsive?
During which period after birth is the newborn most alert and responsive?
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How can a newborn lose heat through conduction?
How can a newborn lose heat through conduction?
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What is non-shivering thermogenesis in newborns primarily due to?
What is non-shivering thermogenesis in newborns primarily due to?
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What complication can hypothermia in newborns lead to?
What complication can hypothermia in newborns lead to?
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Which method is NOT utilized for maintaining a newborn's body temperature?
Which method is NOT utilized for maintaining a newborn's body temperature?
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Study Notes
Chapter 11: The Term Newborn
- The term newborn refers to a baby born at full term
- Objectives for lesson 12.1 include describing newborn assessment, normal reflexes, pain management, physical assessment, and maintaining newborn body temperature
Apgar Score
- Standardized method for evaluating a newborn's condition immediately after delivery
- Assesses heart rate, respiratory effort, muscle tone, reflexes, and color
- Scores are obtained 1 and 5 minutes after birth
Transition Period
- First 6 to 8 hours after birth
- Transition from intrauterine to extrauterine life
- Nurses balance observation/assessment of newborn with needs of the birthing person and family
- First period of reactivity (30-60 minutes): best time for breastfeeding and bonding
- Period of decreased responsiveness (1-3 hours): infant sleeps, less active
- Second period of reactivity (3-8 hours): infant is alert and responsive
Initial Assessment
- Skin-to-skin contact
- Obtaining vital signs
- Gestational age assessment
- Observing for injuries or anomalies
- Weighing and measuring length and head circumference
- Assessing for passage of urine and meconium
Supporting Thermoregulation
- Non-shivering thermogenesis: metabolism to produce heat, beginning at 6 months
- Brown fat appears at 26-28 weeks gestation
- Hypothermia can lead to cold stress and hypoglycemia
- Heat loss through: evaporation (wet skin), conduction (exposure to cold surfaces), convection (exposure to cold air), radiation (loss of heat to cold surfaces)
- Maintaining a stable heat-regulating system is important
Maintaining body Temperature
- Keep head covered
- Keep infant covered at all times
- Prevent drafts to avoid heat loss from convection
- Do not place infant on cold surfaces
General Nursing Care
- Ophthalmic prophylaxis
Vitamin K Prophylaxis
- Essential for blood clotting
Initial Assessment - Gestational Age Assessment
- Skin
- Vernix
- Hair
- Ears
- Breast tissue
- Genitalia
- Sole creases
- Heart rate
- Apical
- Temperature
- Blood pressure
- Measurements (Weight, Length, Head circumference)
- Vital Signs (Respiratory rate)
Obtaining Temperature, Pulse Rate, and Respirations
- Temperature: axillary, skin-to-skin if abnormal
- Pulse and respiratory rates: count for 1 full minute
- Student must report abnormal temperatures, pulse rates, or respirations
- Temperature elevations >37.5°C or <36.5°C
- Pulse rates >160 or <110 beats/min
- Respirations >60 or <30 breaths/min
- Respiratory sounds (noisy, flaring, retraction)
Ongoing Assessment and Care
- Nurse identifies expected findings and variations/deviations from normal
- Report deviations to the healthcare providers
Length and Weight
- Average length: 45 to 55 cm (19 to 21.5 inches)
- Average weight: 2500 to 4000 g (6 to 9 pounds)
- Infants lose 7 to 10% of birth weight in the first 3 to 4 days
Nervous System
- Active movements of arms and legs, but no control
- Head lag for 3-4 months
- Can cry, swallow, and lift head slightly when lying on abdomen
- Reflexes: Suck, grasp (palmer and planter), Moro/startle, rooting, tonic neck, galant, walking
Newborn Reflexes - Video
- Link to YouTube video
Head
- Molding from birth: Swelling of soft tissues of the scalp (caput succedaneum)
- Cephalohematoma: Collection of blood beneath the periosteum of the cranial bone
- Fontanelles (soft spots): Protect the head during birth and allow for brain growth
Eyes & Ears
- Eyes: Best visual acuity 17-20 cm, prefer human faces, follow moving objects. Conjunctival hemorrhage, strabismus.
- Ears: Present at birth, react to sudden sounds, respond to voices, hearing screenings before discharge
Sensory Overload
- Sensory overload occurs from too much detrimental stimulation
- Keep environment quiet and calm, avoid bright lights and alarms
Sleep
- 15 to 20 hours per day
- Various sleep-wake states (deep sleep, light sleep, drowsy, quiet alert, active alert, crying)
Respiratory System
- First breath expands collapsed lungs
- Full expansion may take several days
- Respiratory distress signs: tachypnea/bradypnea, color change (cyanosis), sternal retractions, nasal flaring, grunting
Circulatory System
- Approximately 300 mL of circulating blood volume
- Newborn circulation differs from fetal circulation
- Dependent on ducts closing at certain points (foramen ovale, ductus arteriosus)
Acrocyanosis
- Normal for the first few weeks
Musculoskeletal System
- Flexible skeleton
- Random, uncoordinated movements
- Head and neck muscles develop first
Genitourinary System
- Kidneys not fully developed at birth, glomeruli are small
- Renal blood flow is about a third of adult's
- Reduced ability to handle water load and limited reabsorbing capacity.
- Important for nurse to note first void; newborn has about 6-8 wet diapers per day
Male Genitalia
- Testes descend into scrotum before birth (cryptorchidism)
- Urethral opening on tip of penis.
- Hypospadias (not at tip) and epispadias (at top)
- Smegma
Circumcision
- Surgical removal of foreskin
- Benefits: Decreased risk of penile cancer, fewer UTIs, fewer STIs
- Risks: Pain, infection, hemorrhage
- Nursing role: ensure consent and NPO, pain management
Female Genitalia
- May be slightly swollen
- Thin, white or blood-tinged mucus discharge (pseudomenstruation)
- Cleanse from urethra to anus to prevent fecal matter from entering urinary tract and UTIs
Lesson 12.2 Objectives
- Define skin manifestations: lanugo, vernix caseosa, congenital dermal melanocytosis, milia, acrocyanosis, and desquamation.
- State the cause and appearance of physiological jaundice in the newborn.
- State methods for preventing newborn infections.
- State ways to prevent sudden infant death syndrome (SIDS).
- Review appropriate discharge teaching for newborn care
Integumentary System
- Assess skin turgor
- Normal skin findings may include lanugo, vernix, milia, Epstein pearls, telangiectatic nevi, and congenital dermal melanocytosis.
Jaundice
- Yellow tinge of skin (hyperbilirubinemia), rapid destruction of excess red blood cells
- Normal response
- Kernicterus: extremely high bilirubin levels, seen between 2nd-3rd day, lasts 1 week
- Screening: Healthy newborns > 35 weeks gestation should have hour-specific serum bilirubin levels before discharge
Gastrointestinal System
- Meconium (first stool): Mixture of amniotic fluid and intestinal secretions, passed 8-24 hours after birth
- Stool color and consistency change over time, dependent on feeding
Digestion
- Breastfeeding should start within the first hour.
- Stomach capacity is 30ml and peristalsis is rapid
- Regurgitation is common
- Saliva is not produced fully until 2-3 months
Hypoglycemia
- Blood glucose below 2.6mmol/L after 12 hours of age, indicates hypoglycemia
- May be 2.0 mmol/L immediately after birth
- Place skin-to-skin and encourage breastfeeding immediately after birth
Risk for Newborn Hypoglycemia
- Preterm/post-term infant
- LGA/SGA infant
- Diabetic birthing person
- Newborn stressed due to hypoxia
- Close observation, monitoring blood glucose after feeding and 2 hours later
- Early, frequent feedings are important
Signs and Symptoms of Hypoglycemia in the Newborn
- Jitteriness; Poor muscle tone
- Sweating
- Respiratory difficulty; Low temperature
- Poor suck; High-pitched cry
- Lethargy; Seizure
Preventing Infections
- Newborn's immune system is immature
- Routine precautions, hand hygiene, cleaning/replacing equipment, proper disposal of soiled diapers and linens
Newborn Screening
- Up to 40 conditions screened (depending on province)
- Treatment can prevent significant health problems (PKU, hypothyroidism, galactosemia, sickle cell, thalassemai, etc.)
- Screening done between 24-48 hours after birth
Providing for Security
- Identifying the newborn; wristbands
- Recognition of employees
- Other security measures
Promoting Bonding and Attachment
- Bonding: strong emotional tie between parent and newborn forms soon after birth
- Attachment: affectionate tie occurs over time with increased interaction
- Nursing assessments should observe for these to occur
Nursing Interventions to Aid in Bonding and Attachment
- Teach learning infant communication cues (hunger, diapers)
- Model positive behavior to parents
- Call infant by name
- Encourage skin-to-skin contact
- Talk in gentle high-pitched tones
- Point out unique characteristics
Health Teaching
- Newborn bath, diaper care, umbilical cord care
- Prevention of SIDS
- Clothing
- Siblings
- Car seat safety
Prevention of SIDS
- Sleep in supine position
- Avoid exposure to tobacco smoke
- Sleep in a safe crib, cradle or bassinet
- Avoid pillows, stuffed animals, bumper pads and blankets
- Avoid overheating
- Sleep in same room with parents for 6 months
- Breastfeeding
- Use of pacifiers
Newborn Assessment
- YouTube link to a newborn assessment video
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Description
Test your knowledge on critical aspects of newborn physiology and care. This quiz covers essential topics such as temperature regulation, assessment methods, and reflexes in newborns. Perfect for healthcare professionals and students studying pediatric care.
