Neonatal Care PDF

MCN LEC REVIEWER QUIZ, LONG EXAM, FINALS THE NEONATE - NEONATUS means NEWBORN = - if the newborn is NOT increasing NEONATUS -> NEWBORN its score after 20 mins after birth - During...

MCN LEC REVIEWER QUIZ, LONG EXAM, FINALS THE NEONATE - NEONATUS means NEWBORN = - if the newborn is NOT increasing NEONATUS -> NEWBORN its score after 20 mins after birth - During 28 days = “NEWBORN” = handicap condition - After 28 days = “INFANT” - PHYSIOLOGICAL and PROVIDING WARMTH FOR THE PSYCHOLOGICAL CHANGES (Respiration, Circulation, NEWBORN Extrauterine, Renal, Metabolic) - OXYGENATION IS THE MOST IMPORTANT IN THE 1ST HR OF CLASSIFICATION OF THE LIFE - Skin to skin contact reduces NEWBORN crying of the baby - can be a PARAMETER if the baby - kapag umiiyak = may can survive or not nararamdaman - it will be based on the weight and - CRYING CAN INCREASE THE AOG of the baby OXYGEN DEPLETION OF THE LBW = < 2500 mg NEWBORN VLBW = < 1500 mg - the more na umiiyak si baby the ELBW = < 1000 mg more na nawawalan siya ng FULL TERM = 37 wks oxygen (↑crying = ↑oxygen PREMATURE = < 37 wks depletion) ASSESSING FOR RESPIRATION AND CIRCULATION - APGAR SCORING (Active, Pulse, Grimace, Appearance, Respiration) - 5, 10, 15, 20 mins 1ST TO 5 MINUTES OF LIFE - 1st to 5 minutes of life -> AIRWAY NEWBORN’S FIRST BREATH OF LIFE Then air moves to the lungs Then when the air got into the lungs there should be a change of pressure in the lungs If no (hindi umiyak ang bata) then If yes then It will close the fetal connection to the placenta Cyanosis, respiratory can happen Redirect blood flow to the lungs ↓ Blood pumps into the lungs The alveolar oxygen tension will increase The pulmonary arterial dilatation will decreased -> decreases also the pulmonary resistance (which means na tumatanggap lang siya ng oxygen at hindi niya ito inaayawan) Increases blood flow through the pulmonary vessels ESTABLISHING AND MAINTAINING THE NEWBORN’S AIRWAY - the HEAD should slightly be DOWNWARD to promote DRAINAGE of mucus and fluid that is within the airway - IF THE BABY IS DOESN’T BREATHE SPONTANEOUSLY = STIMULATION - Stimulating by RUBBING the BACK GENTLY - Kapa nai-deliver na ang bata = EINC, place a cloth on the mother’s abdomen that will serve as an additional warmth for the baby - Dry the baby thoroughly without removing its vernix caseosa (it will provide heat and protect the baby from microorganisms and other foreign substances) - CHECK for BREATHING and TEMPERATURE - IF the baby’s lips is NOT pink that means it has oxygen depletion BALLARD SCORING - Evaluates the baby’s appearance, skin texture, motor function, and reflexes - Done in the first 2 hours - Gestational age of a newborn can be assessed through (Mother’s menstruation history, prenatal ultrasonography, postnatal maturation examination) - Highest score for each parameter is FIVE - To assess the baby’s neuromuscular system and physical maturity sign - HAVE 6 parameters NEUROMUSCULAR MATURITY SIGN POSTURE  - total body muscle tone =3 SQUARE WINDOW - wrist flexibility and/or resistance to extensor stretching are responsible for the resulting angle of flexion at the wrist =4 =2 ARM RECOIL - The angle of recoil wot which the forearm springs back into flexion is noted  =0 =3 POPLITEAL ANGLE - Tests for the resistance or to the extension of the lower extremities - FRANK BREECH position newborns may interfere with this sign = 24 to 48 if it is in frank breech position SCARF SIGN - Arms can be covered his/her chest - The more the baby can cover its chest the higher the score is = guess this is 3 (nipple line) HEEL TO EAR - Tinitignan dito kung saan aabot ang paa habang ito’y fino-fold =2 PHYSICAL MATURITY SIGN SKIN - Presence of vernix caseosa LANUGO - Amount of lanugo - The back is mostly bald - Depends on the race of the newborn or hormonal balance - Babies that is born from a diabetic mother PLANTAR SURFACE - The lesser the creases the more premature it is, the more the creases the more mature the baby is - LESS CREASES = PREMATURE  - MORE CREASES = MATURE BREAST ASSESSMENT - Note the size of the areola and the presences or absence of stippling - Maternal estrogen can be an effect to the size of the nipple (neonatal gynecomastia) EYE/EAR ASSESSMENT - Extremely immature infants will have its eyelids tightly fused - Fused eyelids may be caused by stress in intrauterine life GENITALS MALE - Testicles, the LEFT is the first that comes down then followed by the RIGHT - Can be seen at the 30 wks gestation - Premature babies sometimes scrotum cannot be seen but eventually can be when the testicles have come down - Undesencded testicles = crypthorchidism (hereditary) - Retractile testes = immobile testes FEMALE - premature infant-prominent clitoris - mature infant-non-prominent clitoris - Normal sa mga newborn ang large labia majora “matambok” - Pseudomenstruation = because of hormones VITAL SIGNS OF THE NEWBORN INFANT A. THERMAL REGULATION SOURCES OF HEAT LOSS: - maintaining a neutral thermal -first 10 to 20 mins newborn may lose environment is one of the key enough heat for the body temperature physiologic challenges to fall by 2-4 degrees - thermal care is central in reducing -continues heat loss will occur if no morbidity and mortality appropriate measures is taken - thermoregulation is the ability to -the GREATEST source of heat loss in balance heat production and heat loss the newborn is EVAPORATION in order to maintain body temp Hypothermia THERMOGENESIS: production of heat -one of the Major Risk Factor within tissues to raise body influencing the neonatal mortality and temperature morbidities - newborn are faster to lose heat 4x than adults Heat loss MECHANISMS OF HEAT PRODUCTION -by convection OF NEWBORN (means of ventilation) → metabolic processes -by conduction → voluntary muscle activity (transfer of heat in objects in contact → peripheral vasoconstriction with the baby) → Non-shivering thermogenesis -by radiation sources of Heat Loss (transfer of heat in objects NOT in contact with the baby) HEAT MAINLY PRODUCE BY -by evaporation METABOLISM OF BROWN FAT (greatest source of heat loss) - A tissue that is color brown that is found many part of the body - It is brown because of the large number of mitochondria of “free energy” - Release that serves as a heat source - Thermal receptors -> hypothalamus -> stimulates the SNS and cause norepinephrine -> release of brown fat  B. NEWBORN RESPIRATIONS - NOSE BREATHERS - sleeps with mouth closed, does not have to interrupt feedings to breathe - irregular rate - usually Abdominal or IF ALL THREE HANDICAP Diaphragmatic in character CONDITIONS IS NOT TREATED… THE - ranges from 40-60 breaths per NEWBORN WILL LEAD TO DEATH minute ADDITIONAL NOTES: - breathing is quiet and shallow - If thermometer is not available easily altered by external stimuli touch and feel the TRUNK and the FEET because the trunk is a - Periods of APNEA less than 15 large body surface of heat seconds is normal - COLD BABY syndrome - Acrocyanosis may occur during 35.5 is too low for the baby check the trunk and the feet periods of crying - Tachypnea that may be related to sepsis, hypothermia, Measuring infant’s temp hypoglycemia -axillary - newborns are deep breathers not -binabaril -rectal (can cause perforate anus) shallow breathers -radiant warmer The Warm Chain FACTORS THAT CAN AFFECT THE - make sure is in 26-28 C TRANSITION IN EXTRAUTERINE - warm resuscitation RESPIRATIONS →switch on warmer 20-30 mins before delivery →prewarm →breast crawl for stable babies - immediate drying - with mother - warm transportation - use of kangaroo mothering care TTN (Transient Tachypnea E. WEIGHT NEWBORN) - Average mature FEMALE is 3.4 - Newborn breathes rapidly than kg usual - Average mature MALE is 3.5 kg - More common in cesarean birth babies > 4.7 kg = MACROSOMIA < 2.5 kg = PRETERM C. PULSE - BREASTFED recaptures birth - 120-140 bpm weight within 10 days - may rise to 160 bpm when infant - FORMULA-FED infant is crying to 100 bpm when infant accomplishes this gain within 7 is sleeping days - 160 bpm = CRYING 5-10% loss of weight in the first 7-10 - 100 bpm = SLEEPING days (normal) - The APICAL pulse the most - boys gain weight faster than girls accurate - murmurs may be heard (normal) F. LENGTH disappear by 6th month - Average birth length of mature - Tachycardia (> 160 bpm) FEMALE is 53 cm - Average birth length of mature - Bradycardia (< 100 bpm) MALE is 54 cm - LOWER limit of normal is 46 cm - Genes can affect D. BLOOD PRESSURE - at birth, 80/46 mmHg - Measurement are taken from the - 10th day rises to 100/50 mmHg top of the head (crown) down - Only measures when it to the bottom of the heel contemplate or it accommodates of problem in the cardiac G. HEAD CIRCUMFERENCE anomaly - 34 to 35 cm - Doppler method - MORE than 37 cm and LESS than 33 cm should be assessed - Measured from the top of the due to the obstruction of the GI forehead (above the eyebrow) tract to the occiput of the head Microcephaly - below 10th percentile of normal for newborns gestational age - Effect of the zika virus Macrocephaly - > 90th percentile - Related to hydrocephalus H. CHEST CIRCUMFERENCE - minus 2 cm to the head circumference - 32 to 33 cm - Measure at the level of the nipples - May not be accurate when the nipple has an edema I. ABDOMINAL CIRCUMFERENCE - minus 2 cm to the head circumference - 32 to 33 cm - Measure at above the level of the umbilicus - NOT measured unless there is a suspicion of abdominal distention PHYSIOLOGICAL CHANGES CARDIOVASCULAR SYSTEM - Neonatal circulation is strongly - fetal circulation to neonatal influenced by the respiratory circulation begins rapidly within system seconds - Once na mag-activate na ang - the clamping of the umbilical lungs, mai-influence and cord and the initiation of the neonatal circulation first breath - Decrease in pulmonary vascular Foramen ovale resistance causes an Increase in - opening between the right atrium pulmonary blood flow and the and the left atrium closes when Increase in systemic vascular the left atrial pressure is higher resistance influences the than the right atrial pressure cardiovascular changes - fossa ovalis when closed Ductus venosus - the Umbilical vein to the Inferior Vena Cava - closes by day 3 of life and becomes a ligament (ligamentum venosum) a ligament to the hepatic vein (a landmark) - Intrauterine life = daanan siya - Failure in closing of ductus papunta sa lungs venosus will results in different - Closes at the age of 6 months to diseases prevent regurgitation of the - blood flow through the umbilical oxygenated and deoxygenated vein stops once the cord is blood clamped - Most of the time is silent, sometimes called Mr. … because  of thinking that it is closed differences occur within the already circulatory system - Peripheral circulation refers to residual cyanosis in hands and Ductus arteriosus feet - connects the pulmonary artery - Peripheral cyanosis is normal with the descending aorta, within 24 hrs after birth closes within 15 hours post birth - This may be apparent for 1 to 2 - CLOSURE occurs when the hours after birth and is due to pulmonary vascular resistance sluggish circulation becomes less than system - blood is shunted to vital organs vascular resistance → left to right immediately after birth shunt → closure of ductus - femoral pulses are checked and arteriosus compared with brachial pulse - Causes the newborn to be - a weak or delayed femoral pulse acrocyanosis, also cause of the suggests aortic coarctation murmur - central cyanosis suggests congenital heart disease, pulmonary disease GI SYSTEM - sterile at birth - 5 hrs after birth bacteria cultured from the intestinal tract - accumulation of bacteria in the GI tract is necessary for digestion and for the synthesis of VK Ductus arteriosus - Gastric capacity for the first few - when the umbilical blood stops days is approximately 40 to 60 flowing at birth, sudden pressure  mL and increases to 90 mL - paler yellow or brownish yellow around day 3 or 4 emits unpleasant odor - Neonates should feed at least every 4 hrs but when in demand Diarrhea stool - Meconium stool begins to form - Loose and green during the 4th gestational month and is the first stool URINARY SYSTEM eliminated by the neonate - newborn should void within 24 hrs - sticky thick black and odorless after birth - first passed within 24 to 48 hrs - only 15ml/single void - Meconium stool is made up of - first void is pink or dusky cells and substances that was release in the digestive tract IMMUNE SYSTEM - with immunologic protection, passive antibodies (immunoglobulin G) from Transitional stool their mother that crossed the placenta - begins around 3rd day and can - Hepa B vaccine administered during continue for 3 or 4 days the first 12 hours after birth - Greenish brown to yellowish - they had a little natural immunity brown against herpes simplex and herpes - Occurs in both breastfed and simplex for type 2 infection formula-fed neonates Breastfeed stool NEUROMUSCULAR SYSTEM Moro reflex - yellow and semi-formed golden - STARTLE REFLEX yellow with a pasty consistency - Gets startled by a loud sound and has a sour odor and sudden movements - An absent moro reflex may Formula feed stool indicate complications from the - stool is drier and more formed baby than breastfed stools - 5-6 months Rooting reflex - About 16 wks after conception (4 - FRONTAL RELEASE REFLEX months) increase motor - Rooting reflex (involuntary) development - “Root” in the direction of the - If absent then there is a cerebral stroking, helps the newborn find palsy if the reflex comes back in the food adulthood then there is a sign of - “kakain na magsusuck na” cortical maturation (ischemic or - 4-6 months (voluntary) hemorrhagic stroke) - Infantile cerebral palsy, Sucking reflex peripheral nerve injury - SUCK AND SWALLOW REFLEX - Finger closing and clinging - When the roof of the mouth is - 6 months old stimulated move his/her tongue to the nipple to suck and milk the Babinski reflex breast - When you stroke the sole of the - Poor sucking reflex = perinatal baby’s foot = baby’s big toe will hypoxia (oxygen depletion) move forward not backward - 4 months old - Fanning of the interdigital toes - Normal from newborn to 2 years Tonic Neck reflex old babies - FENCING REFLEX - If the reflex come back in - About 18 wks after conception (4 adulthood then it is a condition months and 2 wks) (meningitis, brain tumor) - Stroke or tap the side of the baby’s spine Stepping reflex - spinal injury if not seen - WALKING OR DANCING - 5-6 months old REFLEX - Kapag inangat si baby, may Grasping reflex reflex siya na naglalakad - PALMAR REFLEX  - If after 2 months and still present - Black and white book or object they could be a neurological for testing of the vision - If the baby os not responding to problem the colors then the baby might be - 2 months blind or colorblind Hearing Extrusion reflex - A fetus can hear even before - TONGUE-THRUST REFLEX birth - Any substance that is place on the anterior portion of the tongue Taste - A newborn can discriminate taste - 4 months Smell Step (walk-in–place) reflex - Sense of smell is present in newborns as soon as the nose is Placing reflex clear of lung and amniotic fluid Magnet reflex Crossed extension reflex Touch - Reacts to painful stimuli Trunk incurvation reflex Landau reflex - inverted U position Parachute reflex REFLEXES MAY LAST IN ADULTHOOD - BLINKING REFLEX - COUGH REFLEX - GAG REFLEX - SNEEZE REFLEX - YAWN REFLEX - SWALLOWING REFLEX - DEEP TENDON REFLEX THE SENSES The vision - Baby’s eyes are cloudy NEWBORN PHYSICAL ASSESSMENT - Babies respirations = irregularities, periods of apnea - Baby’s mouth = sucking reflex and cleft palate - Baby’s nipple maybe swollen Pallor because of the hormones - result of anemia of the mother - low in iron INTEGUMENTARY - blood incompatibility - newborns have a ruddier complexion - Internal bleeding in their 1st month - Stool observation - Acrocyanosis - hands and feet Physiologic Jaundice - normal findings 24 to 48 hrs of birth - more than 3 days - Central Cyanosis - pathologic jaundice (few hrs of - from face to trunk jaundice) - could reflect from respiratory or - Blood contains excess of cardiac disease bilirubin (yellow pigment in the - Peripheral Cyanosis red blood cell) - peripheral vasoconstriction - Forehead and the nose - baby isn’t mature enough to get SKIN COLORS - Mottled rid of bilirubin in the bloodstream - The liver of the baby is not working then the bilirubin will stack up - Delay of the liver when the baby is out of delivery - Jaundice  - Once the intestinal motility is - are vascular tumors of the skin activated the GI system will - Caused by extra blood vessels work under the skin - Conjugated and Unconjugated - Developed during the neonatal bilirubin period Nursing management: - Clamped capillaries - Early/Frequent breastfeeding - Babies with lighter skin tone Stork Bites (Telangiectasia) Harlequin Sign - found in the nape of the neck, eyelid, between the eyes, and upper lip - Deepen when the neonate cries - benign idiopathic and rapidly - Does not fade, not noticeable autoresolutive skin phenomenon because covered by hair - positional problem - immature hypothalamus Nevus Flammeus - Normal on newborns with - macular purple or dark-red position problems lesions - present at birth BIRTHMARKS - 0.3% of newborns Hemangiomas - Does not disappear - Red balat (Strawberry) Cavernous Hemangioma VERNIX CASEOSA - Rough dark light - Disappear before the child’s 5th - Cheese-like substance that will birthday serve as a lubricant - The more the premature the Moles baby is more the vernix caseosa is - The more the older the baby is the lesser the vernix caseosa is - We do not remove the caseosa for the newborn’s heat, - elevated protection from infection and - can be cancerous if getting microorganism larger - Can occur elsewhere LANUGO Mongolian Spots - The more premature the baby is - Makikita sa trunk site the more the lanugo is present - Normal of mongolian spot for a - The more the aged baby is the newborn lesser the lanugo is - Appears as gray patches - If the baby has more lanugo and - Depends on the race of what not in a race where the lanugo is color of the spot  many then it might be that the ERYTHEMA TOXICUM mother is diabetic DESQUAMATION - called a flea-bite rash - two weeks - newborns reaction to rough - Normal within 24 hrs after birth surfaces - The baby will bitak-bitak of the - Maybe has skin asthma skin - Rough surfaces - Because they are bathed inside the uterus of the mother for CUTIS MARMORATA many many months - Gelatinous in preterm but in term babies their skin is desquamated MILIA - normal reticulated mottling of the skin - trunks and extremities - vascular response to cold - Tuldok-tuldok na puti sa may SKIN TURGOR bandang ilong - pinpoint white papule usually found on a cheek or across the bridge of the nose of every newborn - open sebaceous gland  - grasp a fold of the skin between CAPUT SUCCEDENAUM your thumb and fingers and evaluate if it feels elastic FORCEP MARKS - edema of the scalp that forms on the presenting part of the head - Cephalhematoma CRANIOTABES - rarely used for birth today FONTANELLES - softening of the cranial bones probably caused by pressure of the fetal skull - 2 mastoid SIZE - 2 sphenoid Microcephaly - anterior fontanelle - describes a head that is smaller - posterior fontanelle than expected for age and sex - closes by the end of the second - Macrocephaly month EYES SUTURE MOLDING - assess the position of the eyes - eyes are equal and symmetrical in size and placement  - assess for blink reflex, red light MOUTH reflex, and pupil reaction to light - inspect lips, gums, tongue, palate Subconjunctival hemorrhage on the and mucus membranes sclera - test for rooting, sucking, - related to birth trauma swallowing, and gag reflex - the bleeding is slight, requires no - fusion of the palate treatment - epstein pearl (puti sa - no tear productions (2 months) ngala-ngala) strabismus and nystagmus inspect Variations From Normal - position and shape of the eyes Natal teeth look for - evidence of ptosis or the presence of epicanthic folds - Mas mababa ang pinna sa outer canthus ng mata kapag may down syndrome - can be benign or related to EARS congenital abnormality - position, shape, and drainage - high in calcium of the mother - hearing test Thrush NOSE - shape - opening of the nares Deviations from normal - Large amount of mucus drainage can lead to respiratory distress - a fungal infection, can be - Flat nasal bridge can be seen in contracted down syndrome - Puti-puti sa dila Ellis Van Creveld syndrome Cleft lip and/or palate - passed down from parents to their children through genes - grooves is shortened in people with certain conditions - Hereditary to occur Micrognathia Tongue-Tie (ankyloglossia) - “small jaw” - condition present at birth that - underlying genetic conditions restricts the tongue’s range of motion NECK - may interfere with breast-feeding - lift the chin to assess the neck - might have difficulty sticking out area his or her tongue - the neck is short with skin folds - positive tonic neck reflex/FENCING REFLEX Variations from Normal - webbing indicates genetic disorders - absent tonic neck reflex indicates Lip Philtrum nerve injury  - congenital torticollis caused by - prominence of the xiphoid injury to the sternocleidomastoid process and does not represent muscle an abnormality CHEST AND LUNGS Pigeon chest/Pectus carinatum - shape, symmetry - Palabas - breath sounds - when the cartilage, the bones of - chest barrel-shaped and the sternum symmetrical - breast engorgement is present in both ABDOMEN male and female neonates - Tone, hernia, diastasis recti - clear or milky fluid from nipples - Umbilical cord (2 veins 1 artery) related to maternal hormones - passage of meconium stool within 48 hrs post-birth Variation from Normal pectus excavatum The newborn examination - Observe - Assess - Examine - Note - funnel chest - Assess - Paloob - no functional impairment Prominent xiphoid