Newborn Lecture PDF

The Newborn  Transition from Intrauterine to Life  Physiologic  Establish and maintain respirations  Adjust from fetal to adult circulation  Temperature regulation  Ingesting, retaining, and digesting nutrients  Waste elim...

The Newborn  Transition from Intrauterine to Life  Physiologic  Establish and maintain respirations  Adjust from fetal to adult circulation  Temperature regulation  Ingesting, retaining, and digesting nutrients  Waste elimination  Regulating weight  Behavioral  Establishing a routine  Processing, storing, and organizing stimuli  Establishing relationships  Establishing and Maintaining Respirations Intrauterine oxygenation Placenta provides gas exchange and is responsible for oxygenation of fetus Fetal lungs are filled with amniotic fluid Decreased blood flow to lungs Extrauterine (at birth) oxygenation First few cries shift fluid out of lungs Lungs expand with air Blood flow increases to lungs Gas exchange and oxygenation now happens in the lungs See Figures 15-2 and 15-3 in text  Adjusting from fetal to infant Circulation Ductus Venosus - by passes liver  Neonatal Circulation 1-3 month  Shunts close and blood is forced to go to - lungs  Normal neonatal circulation begins Change starts immediately after birth American heart  Fetal Circulation association  Shunts blood  Foramen Ovale (opening between atrium) closes 1-2 hrs after birth. , then a month to a year later  Ductus Arteriosus (pulmonary and aorta, carries blood away from lungs) See Figure 15-2: Transition to helps blood bypass longs endomethicin shuts DA after 32 wks > - cardiac problems - neonatal circulation in text "PDA" if does not close - > -  Delivery Room Care assessment - dry , stimulate , I min Swin - APGAR-O birth chest similar - head + : prevent eye  Review maternal records Medications infection ↳ blindnes Erythromycin ophthalmic abx eye ointment Dry, stimulate, and assess :  Phytonadione (Vit K)- IM clotting for (6ms) Factors  Obtain Apgar score (8 2 wks) - Hepatitis B vaccine- IM initial vaccine  Assess VS, weight, and measurements Witk = no no circumcision  Cord care- 3 vessels, clamp  ID bands  Bath is delayed (12-24 hrs)  Skin to skin w/mom-regulate + stimulates VS , breastfeeding BS  Breastfeeding - 2A + 1v - thermoregulation - ID bands Immediate Assessment  ABC (Airway, Breathing, Circulation)  Clear airway -some may need help  Bulb syringe; suction with mucus trap - sides to cheeks  Crying  Coloring to turn pink quick - mouth first then nose' 12-24 his normal (acroganosis) O O - deep suction - Cs baby  APGAR Scoring Score at 0 1 2 ▪ 1 minute ⑨ Heart rate Absent < 100 bpm >100 bpm ▪ 5 minutes : L7 = 10 min score after Respirations Absent Slow, irregular Strong cry Weak cry ▪ 7-10: minimal to no difficulty Muscle tone Limp, flaccid Some flexion Active motion; well flexed ▪ 4-6: moderate difficulty Reflex irritability No response Grimace Cry or pull ▪ 0-3: severe distress reflex activity away from stimuli ↑= better Color Blue or pale Body pink/ Completely extremities pink blue Gestational Age Assessment  Ballard Gestational Age Assessment Chart  Vital Signs ▪ Heart rate, rhythm, and sounds ▪ 110-160 beats per minute ▪ Acrocyanosis Pulses: Brachial & femoral T V ▪ ▪ Blood Pressure-not routine (unless suspect cardiac issue) Only NICU ▪ Respiratory rate, rhythm, sounds ▪ 30-60 breaths per min ▪ Irregular, short periods of apnea (97.7 skin is converted to vapors Dry newborn quickly after a bath. Don’t overexpose during a bath. -no bathing right away  You are caring for a newborn that is 6 hours old. V.S. are 97.4, 122, 36. Which of the following would be a priority for the nurse? A. Assure that all newborn linens are clean and dry. B. Reassess the V.S. in 30 minutes C. Place the newborn skin to skin with mother. O D. Assess the newborns breathing pattern Minimu 97 7.  GI- Ingesting, Retaining, & Digesting Nutrients Day 1 : 5-7 m  Suck →Swallow →Breathe Day 3 : 22-27 mi  Primarily nose breathers 1WK: 45-60 wh 1 Month : 80-150 wh  Capacity of the stomach  Prone to regurgitation  Intestines sterile at birth. Normal bacterial content w/in 1st wk.  Normal bacteria needed for Vit. K - 10 days  Voiding and stooling  Void Uric acid crystals  Document first voiding (within 24 hours)  Pale straw color  May see pink from uric acid crystal  2-6/day; after day 4 = 6-8 - port of first void 1 2 - 3 2 3 24-48 1 Day = - = ,  Stool  Patency of rectum > -  Meconium (passed 24-48 hours)  Transitional (by 3rd day, for 3-4 days) Meconium Lary Transitional  Refer to Table 15-1 Breastfeeding Formula Feeding  10% -may Weight wf. loss  Appropriate for gestational age – AGA  (10-90th %)  Small for gestational age – SGA  (< 10th %) > - hypoglycan  Large for gestational age – LGA  (> 90th %) > - hypoglyceria  Weight loss in the newborn  5-10% of birth weight during 1st 3-5 days  Regain within 10-14 days - hypoglyca While reviewing the chart of a newborn, you note the birthweight to be 4108gms. Today’s weight is 3925gms. What is the percentage of weight lost? O a. 4.45% 83 + 100% b. 4.27% c. 4.66% d. 4%  Newborn Nutrition  Breastfeeding  Determining effective feeding  Position, latch, and duration  Pumping and storing human milk 92/3H  Formula feeding  Timing and amount  Preparation  Hold to feed  Burping See Chapter 16  Blood Sugars (metabolic system)  Transition to balancing the amount of insulin production with glucose availability  Hypoglycemia is 90%) Spectramhealthlakeland.org  Small for gestational age (SGA - normal from Genitourinary mothers hormone  Female  Anatomical features  Swollen labia  Vaginal discharge/pseudo menses  Male  Anatomical features - descended testes  Scrotum may be swollen (hydrocele)  Assess location of testicles  Urination  No urination in 24 hours- Obstruction, polycystic disease or renal failure Reflexes and Periods of Reactivity  Reflexes  Primitive and protective  Absence is cause for concern  Table 15-4, pg 503  Periods of reactivity  First period (up to 30 minutes after birth)  Initiate feeding and bonding  Resting period- sleeps or has decreased motor activity (30 min – 2 hrs)  Second period of reactivity (2 -8 hours after birth)…active alert → quiet states  Neonatal Pain Physiologic and psychologic Changes can include: Vital Signs (rapid/shallow breaths, increased HR) Motor activity, facial expressions Crying and attempts to withdraw from painful stimuli Behavioral Pain response Varies by gestational age Facial grimacing, chin quivering, furrowed brow, tight closed eyes Assessment (Use pain scales like NPASS and NIPS, next slide) Management Nonpharmacologic Pharmacologic F no US e 2 - 7 : Peds mo. yrs Nicu - VSE  Hepatic System- Physiologic Jaundice/Hyperbilirubinemia - after 24 his - least concurred After first 24 hours of life (72-120 hrs) Phototherapy: converts indirect bilirubin to direct (conjugated) bilirubin so it can be excreted Higher RBC mass at birth + shorter Decision to treat – use of nomogram of life span of RBC → increased Hgb bilirubin (next slide) > liver > bilirubin - - breakdow RBC - Reduced ability of newborn liver to conjugate the bilirubin Increased unconjugated (indirect) bilirubin → jaundice - breastfeeding phototherapy Three babies have been admitted to the newborn nursery. Which of the babies should the nurse assess first? A. Baby with respirations of 32, oxygen saturation of 98% B. Baby with an Apgar' of 8/9, weighing 2300gms (5 lbs 1oz) O C. Baby with temperature of 97.9(36.5C), blood glucose of 50 D. Baby with heart rate of 145 bpm, with acrocyanosis  Behavioral Adaptation 1. Establish a regulated rhythm (independent of mom) 2. Process, store, and organize all stimuli 3. Establish a relationship with the caregiver and environment Purposeful behaviors to maintain optimal  Sleep-wake States arousal state:  Influences baby’s responses to stimuli and caregiver Push away with hands and feet (rejecting stimuli) Deep Sleep Light sleep Drowsy Falling asleep or breaking eye contact deep sleep light sleep drowsy by turning head (sensitivity) Fussing or crying (signaling behavior) Help parents interpret newborn cues  Ex: mom tense → baby may demonstrate difficulty feeding alert (quiet alert) eyes open crying (active alert)  Circumcision Care & Teaching Gomco clamp: - 2 + 2 Keep area clean/prevent infection Small Vaseline gauze is applied to penis Change diaper at least q4h; assess site Apply Vaseline to penis to prevent adhering to diaper. needed Wash with warm water (not baby wipes) - more healing Apply Vaseline (if Gomco) PlastiBelll: Apply diaper so does not rub No Vaseline used. - I mainten Glans will be dark red, then becomes covered with yellow exudate in 24 hrs.; lasts 2-3 days; Its rim remains in place for ~1 wk. do not remove! Rim and remaining foreskin come off after Provide comfort measures, Tylenol healing (7-10 days). Teach parents the care Baby usually cries when diaper is changed, Check bleeding (follow unit protocol) and gauze/Vaseline removed/applied. Assess for urination Be sure feeding well so gets fluid. - infection , suching Easy - Risks and benefits of circumcision Benefits Contraindications  Reduce risk of UTI in first year  Preterm infants  Reduce risk of HIV and other STIs  Neonates with genitourinary  Reduce risks of some cancers defect Risks  Neonates at risk for bleeding  Bleeding  Neonates with complications  Infection (ex: RDS)  Adhesions  Pain  Normal Labs and Screenings Blood glucose level as needed Hypoglycemia: