MB4 Newborn Goodman

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mthompson17
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214928
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MB4 Newborn Goodman
Updated:
2013-04-22 10:53:34
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newborn nursing
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newborn nursing
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  1. Neonatal period?
    birth to first 28 days of life
  2. _____ Hx is an important part of newborn assessment.

    EX?
    maternal

    if mom is diabetic, STDs
  3. Physical exam of infant why important?
    important b/c one time will get good head to toe physical:  ID any probs
  4. When may phys assessment findings be overlooked in newborn?
    done before bath may miss something and find after bath
  5. Important components of newborn phys assessment? (4)
    • 1. maternal Hx
    • 2. phys exam
    • 3. interaction & assessment of bonding
    • 4. analysis of blood type, Hct, and HgB
  6. Why is interaction and assessment of bonding important?
    studies show more likely to be abused if no bonding in hospital
  7. What blood type is important in infants?
    Rh and ABO incompatibilities
  8. What can cause newborn to be anemic?

    Tx?
    if mom is anemic

    iron supplements
  9. Role modeling?
    take care of the baby well to be a good example

    change often role model loving behavior

    bathing baby teaching
  10. What is an intervention to help mother bond with baby and be good parent?
    allow for rest, sleep when the baby sleeps and get some help from family etc
  11. No rest for mom - risk for?
    PP depression and bad parenting
  12. Why do we need to encourage well baby visits?
    bonding
  13. Head circumference of newborn?
    32-38cm
  14. Lenght of newborn
    45-55cm
  15. chest circumference of newborn?
    30-36cm
  16. Weight of newborn?
    5.8lbs to 8lb& 13 oz (2500-4000 g)
  17. HR of newborn?
    120-160
  18. RR rate of newborn?
    30-60
  19. Temp of newborn?
    97.7 - 99.1 axillary
  20. Measurement and V/S done on newborn?
    • 1. head & chest circumference
    • 2. length & weight
    • 3. HR
    • 4. RR
    • 5. axillary temp
  21. What can occur if do rectal temp on newborn?
    may not have patent butt - tissue trauma
  22. Head circumference how measure?

    What does it mean if head circumference goes up in first 2 days after birth?
    measure around largest part


    may not be a prob.  could be molding
  23. Molding of baby head?
    sutures overlap and make head look thin and skinny - day 1 or 2 will get round again and will have a higher head circumference
  24. 2 fontanels?

    When do they close?
    anterior - 12 - 18 mo

    post - 2 to 3 mo
  25. Sutures?

    What may they do?
    head is made of 5 ind plates - sutures are where bones meet

    sutures may overlap - will be normal in 2 days
  26. Wide open suture line indication?
    1. could be ICP

    2. could be subdural hematoma
  27. 2 babies at high risk for subdural hematoma?

    Indication of this?
    • 1. preemies
    • 2. babies with traumtic births

    seperated sutures
  28. 6 components of a head assessments?
    • 1. fontanelles
    • 2. sutures
    • 3. molding
    • 4. caput succedaeum
    • 5. cephalhematoma
    • 6. craniotabes
  29. Caput succedaeum?
    swelling that is a build up of fluid accumulation b/t bone and skin of the skull that occurs due to pressure against the pelvis of the mother

    occurs over the head like a cap and crosses suture lines
  30. Cephalhematoma?
    bleeding b/t the bony plate & periosteum that does not cross suture lines
  31. When will caput succedaeum resolve/
    edema will go away in 1 to 2 days
  32. Cephalhematoma resolves when?
    can take weeks
  33. Craniotabes?
    softening of the bone that may be due to lack of Ca in mother's diet
  34. Important consideration with craniotabes?
    must be very careful with baby's head until the bone hardens

    scary for parents
  35. 2 char of a normal fontanel?
    soft and flat
  36. What does bulging fontanel indicate?
    1. increased ICP & ass. with hydrocephalus
  37. 3 ways to describe skull sutures?
    • overriding
    • meeting
    • seperated
  38. What causes molding?
    posterior head elongates to fit through mothers cervix and pelvic contours - cone head baby
  39. When will molding resolve?
    in a few days
  40. When do caput succedaeum and cephalhematoma occur and resolve?
    caput - appears at birth and resolves in a few days

    cephalhematoma appears in 24 h and takes months to resolve
  41. What is included in EENT assesment of newborn?
    • 1. eyes,
    • 2. ears
    • 3. nose
    • 4. mouth
    • 5 neck/clavicles
  42. Common observation in sclera of baby eyes?
    conjunctival hemorrhage due to excessive pressure on eyes as coming through the birth canal
  43. When do conjunctival hemorrhages resolve?
    3 to 6 weeks
  44. Tear ducts of newborn?
    usually don't have them until 3 to 4 mo old b/c lacrimal duct not working yet
  45. Baby eye color?

    When true eye color?
    will have grey - brown eyes

    will not get true eye color until 3 to 12 mo old
  46. Blue sclear indication?
    osteogenesis imperfecta
  47. Edema around eyes and eylids in newborn?
    can occur normally esp if a lot of trauma
  48. What may be cause of baby eyes red and swollen?
    can be caused by ERY eye ung
  49. Cornea that appears larger than usual indication?
    can be congenital glaucoma
  50. White pupil in newborn indicatuion?
    congenital cataracts
  51. What does white light reflex indicate?
    retinoblastoma
  52. Slanted eyes indication?
    Asian or down syndrome
  53. Strabismus in newborn?
    normal
  54. Doll's eye in newborn?
    normal in newborn
  55. Cont. drainage watery clear from eye?
    can be occluded lacrimal duct and will need Tx
  56. Ears of newborn char?
    not fully dev

    look normal but really soft

    should be even with outer canthus of eye
  57. Low-set ears indication?
    possibly down syndrome

    look at mom and dad to see if genetic
  58. Where are skin tags usually?

    Tx?

    What may the indicate?
    usually in area in front of ear

    can be clipped off or tied off

    can indicate chromosomal abnormalities or kidney probs
  59. Where will a preauricular sinus be located?

    Nursing consideration?
    in front of the ears

    not a prob but parents will notice and ask about it
  60. Hearing tests for newborn babies?
    required for all newborns in every state
  61. Way nurse can test newborn hearing?
    baby will usually cease crying to listen for sounds
  62. Babies are ____ breathers.
    nose - cannot breathe through their mouth
  63. Intervention for congestion/birth fluids in baby?
    suction mouth then the nose
  64. Conal atresia?

    Imp consideration?
    one side of nose has no opening

    watch for congestion in open side
  65. Way to test baby for conal atresia?
    hold the side that is open closed and see if baby can breathe
  66. Normal/good char. of mouth on assessment?
    • 1. open easily
    • 2. sucking reflex
    • 3. frenula membrane may be intact  (tongue tied) can correct itself
    • 4. check palate
  67. Frunula membrane considerations?
    Teach parents that it should correct itself and if it doesn't will need to be clipped
  68. Little white dots on the gumline of the baby?
    Epstein pearls - inclusion cysts
  69. Thrush?

    How to test for it?
    candidiasis

    wipe white spot with rag and if it doesn't come off it is yeast
  70. Tx for thrush?
    • 1. gentian violet
    • 2. griseofulvin
  71. Consideration of gentian violet?
    stains everything purple
  72. Natal teeth?

    Is this a problem?
    baby born with teeth

    usually not a prob unless they are loose - ped will pull them
  73. Nursing consideration for natal teeth?
    check for loose teeth
  74. Assessment of neck and clavicles?
    • 1. short chubby neck with skin folds
    • 2. check for fractured clavicle
    • 3. check for Herb's palsy
  75. How to assess for fractured clavicle?
    • 1. one arm will be just hanging and other moving around
    • 2. may feel crepitus
  76. Herb's palsy?
    paralysis of should and arm muscle due to permenant nerve injury during birth
  77. If mother water has been broken more than 24 hours what is baby at risk for?

    S/S that it has developed?
    meningitis

    if you move/turn baby will let out horrific squeal b/c painful neck
  78. Gonorrhea consideration in newborn?
    can cause eye infection and blindness
  79. Redness in inner canthus of one eye but not other can indicate?
    lacrimal duct obstruction
  80. Indication of osteogenesis imperfecta in newborn?
    blue sclera
  81. Indication of retinoblastoma in newborn?
    white light test - pupil
  82. If baby's ear doesn't look normally developed what can this indicate?
    congenital problem - chromosomal
  83. Indication of cataracts in newborn?
    white iris
  84. Torticollis?
    neck injury during birth that causes shoulders to be offset (one lower)
  85. Head is larger than chest until about ___ years old. 

    Important consideration?
    2 years old

    head is heaviest part and if get off balance will fall on their head/fall into things that they are looking into like buckets of water
  86. Breasts of newborn?
    may be slightly enlarged due to maternal hormones

    may have leakage of milk called witches milk
  87. Abd of newborn?
    should  be round and soft
  88. Sunken abd indication in newborn?
    may have no intestines
  89. When should bowel sounds show up in newborn?
    about an hour after birth
  90. When may a bath be given to a baby?

    Teaching about umbilical cord?
    anytime after birth

    do not use alcohol on umb and it can be submerged

    when cord falls off need to cont to clean area for a few days
  91. Anal/genital of baby boy char?
    more mature they are = more rugae on testicles

    testicles should be down
  92. 2 probs that may occur in newborn testicles?
    • 1. may be inguinal canal and not come down
    • 2. may be born with no testicles
  93. Consideration if baby has testicles that are not down at birth?
    at risk for testicular cancer later in life
  94. If testicles are not down could indicate _____.

    What is it?
    cryptorchidism - absence of testicles
  95. Urethral opening on dorsal side?

    Ventral side?
    epispadias

    hypospadias
  96. Hydrocele?
    fluid accumulation in scrotal sack around testicles
  97. Way to distinguish b/t hydrocele and hernia?
    if have large testicle shine light through it

    hydrocele with transilluminate/light up

    hernia will not transilluminate
  98. Penis length at term?
    2cm
  99. Smegma?
    cottage cheesy stuff around head of penis esp in males that are uncircumcised
  100. Should foreskin be retracted?

    consideration if it is?
    no


    put it back or can cause ischemia
  101. Name for foreskin
    prepuce
  102. Epispadius/hypospadius in females?
    have a small penis inside vagina with meatus way inside the vagina
  103. Circumcision?
    surgical removal of foreskin of the penis
  104. Jewish religious requirement for circumcision?
    on 8th day of life
  105. When is circumcision contraindicated?
    • 1. if have epi or hypospadius
    • 2. Hx of bleeding tendency in family
  106. Complications of circumcision?
    • 1. bleeding
    • 2. infection
    • 3. skin dehiscence
    • 4. adhesions
    • 5. urethral fistula
    • 6. pain
  107. How much bleeding is considered hemorrhage for newborn?
    quarter size
  108. Assessments for infection of circumcision?
    • 1. redness
    • 2. discharge
    • 3. odor
    • 4. urethra fistula
    • 5. pain
  109. Pain management for circumcision?
    • 1. DPNB/ring block
    • 2. topical anesthetic
    • 3. sucrose pacifiers
  110. DPNB? 

    AKA?
    inject local anesthetic around penile nerve

    ring block
  111. Topical anesthetic for circumcision?

    problem?
    EMLA cream

    takes 60-90 minutes to take effect
  112. Sucrose pacifiers for circumcision pain?
    EBP shows that sucrose on passy helps with pain management as well as injections
  113. 3 different types of instruments used for circumcisions?
    • 1. mogen clamp
    • 2. gomco/yellen clamp
    • 3. plastibell clamp
  114. Plastibell circumcision?
    plastic ring that fits over penis

    suture tied around rim of the bell and a circle of prepuce is cut away so the foreskin can be easily retracted and glans exposed

    rim remains in place for one week then falls off on its own
  115. Post circumcision nursing care?
    • 1. wash site daily, with each soiled diaper with warm water
    • 2. apply vaseline if not plastibell
    • 3. assess for urine output
    • 4. cuddle, paci, console, observe for overstimulation
    • 5. parent teaching
    • 6. if see edema, drainage, redness, tenderness or inconsolable crying report to health care provider
    • 7. apply diaper snug enough to prevent rubbing with movement but not tight encough to cause pain
  116. Nursing consideration if had mogen clamp or gomco clamp?
    always use vaseline on incision area with q diaper change
  117. Important nursing consideration with plastybell circumcision?
    do not use vaseline - can cause ring to fall off and cause permenant damage
  118. Normal and abnormal assessment findings in circumcision?
    • 1. site may be red but should not have strong odor or discharge
    • 2. site should not have active bleeding
    • 3. a film of yellowish mucus is normal and should not be washed off
  119. Nursing intervention if bleeding of circumcision occurs?
    apply pressure and reassess - if still bleeding call physician
  120. When is it OK to use vaseline with plastybell?
    after ring comes off
  121. Important consideration after circumcision?
    baby should urinate within 6 to 8 h of circumcision

    assess UO
  122. Env for baby in pain?
    don't over stimulate
  123. Teaching for parents with circumcision?
    teach s/s of infection and when to call the MD
  124. Normal/abnormal bleeding of circumcision?
    normal to have a little spotting but not active bleeding
  125. Yellowish exudate around circumcision area?
    part of healing process and should not remove
  126. When should parent call MD with plastibell?
    if not off w/in 8 days
  127. Female genitalia assessment?
    • 1. labia majora and minora cover clitoris?
    • 2. hymenal skin tags
    • 3. white mucoid discharge
    • 4. pseudomenstruation
    • 5. rectovaginal fistula
  128. If a female is full term what will vagina look like?

    preterm?
    labia major and minora will cover clitoris

    preterm will have small labia major and minora
  129. Hymenal skin tags?
    skin tag that occurs around hymen of vag that is normal
  130. What is indicated by white vag discharge in baby girl?
    normal - due to mom hormones
  131. Pseudomenstruation?
    baby girl will have false period r/t mom's hormones

    baby has actually cycled
  132. Stool coming out of vagina?
    rectovaginal fistula - opening b/t vagina and rectum
  133. What may a sacral dimple indicate?

    HOw to assess for it?

    What else may occur along with this?
    pull skin folds apart and may have dimple above butt

    indication of spina bifida

    tuft of black hair esp with spina bifida
  134. False channel?
    sacral dimple not r/t spina bifida that doesn't go all the way to the spine
  135. Barlow and ortalani tests?
    screens for hip dysplasia, clicks, and abnormal alignment

    hips should be level and creases should be same on both sides
  136. Ortalani test?
    knees to chest then abduct legs with pressure on greater trochanter
  137. Barlow test?
    checks for hip dysplasia

    knee to chest with light pressure

    if hip pops out = positive for dysplasia
  138. Stool assessment of newborn?
    1. should have meconium in 24 h
  139. Meconium char?
    black, to dark brown and sticky
  140. What will stool look like if breast fed?

    formula fed?
    yellowish seedy stool with little odor

    formula - offensive odor with green/brown color
  141. Diff b/t breast and formula fed stools?
    • 1. less odor in breast fed
    • 2. less poopy diapers in breast fed
  142. After second week what change may occur in stools?

    Consideration?
    will go from every day to 2 to 3 times per week

    parents may think baby is constipated:  teach that baby may strain b/c doesn't know how to do it and is normal
  143. Does straining indicate constipation?
    no
  144. What may indicate diarrhea in baby?
    water ring around the stool in diaper
  145. Meconium must be passed within ___ h or there is a prob
    48 h
  146. IMperforated anus?
    no opening in anus
  147. What to teach parents about how stools will change?
    • 1. dark meconium to brown-yellow
    • 2. transitional stool - green and loose
    • 3. yellow loosely formed
  148. How many wet diaper/day in newborn?
    6 to 8
  149. How many stools should a baby have if breast fed?

    Bottle fed?
    breast - 3 to 4 stools/day for first 2 weeks

    bottle - 2 to 3 stools/day for first 2 weeks
  150. When should a baby void after birth?
    12 - 24 h age
  151. Blood ring/pink or samon colored stains around urination in newborn diapers?
    urea crystals have formed in urine and urinated out

    not a prob

    called "brick dust"
  152. Anal patency - when will you know for sure that anus is patent?
    when pass meconium
  153. What is a simian crease?  

    indicative of?

    Always?
    single crease from one side of palm to the other

    down syndrome

    can be normal
  154. 2 s/s that baby has that means baby has down syndrome until proven otherwise?
    • 1. simian crease
    • 2. low-set ears
  155. Sundactyly?
    webbing of the toes or fingers
  156. Polydactyly?
    extra digits
  157. What will hands normally be doing in a child?

    Can you do hand print for newborn?
    hands usually stay clenched

    no
  158. Syndactaly and polydactyly are indicative of what?
    can indicate chromosomal disorder
  159. Polydactyly repair?
    if have bones will have surgical intervention

    if don't have bones will tie off and fall off
  160. Unusual spacing b/t toes can indicate?
    chromosomal disorder
  161. Fingernails of newborn?

    Teaching?
    have long nails - need to cover hands

    do not trim the nails

    educate mom not use fingernail clippers on the nails - can peel off or nail file instead
  162. Acrocyanosis?

    When should color become normal?
    hands and feet

    24 to 48 h or may indicate circulatory prob
  163. Central cyanosis?
    resp obstruction or cardiac defect

    circuforential cyanosis or center of body
  164. Pallor of newborn can indicate what?
    anemia r/t Rh incompatibility, blood loss, baby being held up too high before cord cut
  165. Ruddiness of baby?

    Causes?
    red - polycythemia, crying,
  166. Color of preterm baby?

    Why?
    ruddy b/c no SQ tissue so see blood
  167. Harlequin sign?

    What causes it?
    unilateral redness

    side lying on will be very red and other will be very pale

    caused by immature circulatory system
  168. Face only jaundice indicates what bilirubin level?
    mid-abd level?
    down to toes?
    • face level - ~5 to 7 mg/dL
    • mid-abd level - ~15mg/dL
    • down to toes ~20mg/dL
  169. At what level should we start seeing jaundice?
    at 5 to 7
  170. Where does bilirubin start?
    from head and moves down
  171. Complication of bilirubin?
    kernicterus
  172. Kernicterus?
    bilirubin crosses BBB and stains brain yellow and causes permenant brain damage
  173. 2 types of jaundice?
    • 1. physiologic
    • 2. pathologic
  174. Physiologic jaundice - when does it occur?
    after 24 h
  175. When will pathologic jaundice occur?
    will occur at birth and before 24 h
  176. What type of jaundice is more severe?
    pathologic
  177. Physiologic jaundice?
    has a physiologic explanation

    EX:  when baby is born will have excess blood and when natural hemolyze these -> filter through liver-> stool

    if liver not mature enough will build up bilirubin and have jaundice
  178. Something nurse can do to lower the bilirubin level?
    feed them as much as possible to get them to poop more

    feed at least q 2 h

    put baby under bilirubin lights to break down RBC and excrete faster
  179. Stools of baby under bilirubin light?

    What is baby at risk for?
    will be green and frequent

    at risk for skin b/d r/t frequent stools
  180. When can bilirubin get across BBB?
    when gets to level of 7 to 10
  181. What babies are at risk for jaundice?
    breastfed more than bottle fed babies r/t breakdown product of progesterone from mother
  182. If the baby is breastfed baby what to do about jaundice?
    feed more often to increase poo
  183. Tx of jaundice?
    • 1. when levels reach about 10 will do phototherapy
    • 2. fluids
    • 3. feedings
    • 4. promote stooling
    • 5. exchange blood transfusion
  184. Pathologic jaundice char?
    • 1. first 24 h of life
    • 2. usually Rh or ABO incompatibility
  185. When will Rh incompatibility be seen?

    Tx?
    within 72 h  - will get progressively worse

    usually need blood transfusion
  186. Appearance of babies with Rh incompatibility?
    pallor b/c extremely anemic b/c attacked inutero
  187. Rh incompatibility with direct and indirect coombs risk for what complication?
    hydrops fatalis
  188. Hydrops fatalis?
    swelling/edema build up in baby that can be fatal
  189. Direct v/s indirect coombs?
    indirect coombs - indirectly see if mom has antibodies for Rh factor

    direct coombs - check baby's blood cells for antibodies bound to baby's blood cells
  190. ABO incompatibility prob usually occurs in?
    usually mother is O type blood and baby is B
  191. When does Rh and ABO incompatibility usually occur?
    with subsequent pregnancies, amniocentesis, chorionic villi sampling, trauma
  192. Tx of Rh incompatibility baby?
    same interventions as jaundice

    phototherapy and feed a lot
  193. SE of phototherapy?
    green stools
  194. How often will bilirubin be checked if using phototherapy?
    q 12 h or more often
  195. Exchange transfusion for bilirubin?
    2 to 10 mL of blood w/d from baby and replace with donar blood that is Oneg
  196. Important nursing consideration if baby needs a blood transfusion?

    When should this be checked?
    can affect glucose levels

    • check glucose levels
    •  
    • at least an hour after the transfusion
  197. 3 factors that inhibit bilirubin conjugation?
    • 1. immatur liver - all newborns esp preemies
    • 2. dalay in feedings
    • 3. delay in stooling
  198. 6 normal skin variations in baby?
    • nevus simplex - stork bite
    • nves flammeus - prot wine stain
    • strawberry hemangioma
    • mongolian spots
    • mottling
    • cafe/ au lait spots
  199. Important consideration if baby has nasal congestion?
    babies are nose breathers only
  200. Other name for port wine stain?

    Char?
    neves flammeus

    will lighten if above bridge of nose and darken if below

    permenant

    dark and big 

    usually on head
  201. Strawberry hemangioma char?
    filled with capillaries

    will begin to shrink and will fade usually b/t 6 and 9

    will get larger before they start shrinking

    problem with parents if able to be seen
  202. Stork bite AKA?
    nevus simplex

    forehead, on neck
  203. Mongolian spots?
    usually on the booty, hip, may be on shoulder -  and look like bruises

    usually in AA, asian, and hispanics

    beginning to occur in caucasians due to interracial
  204. Mottling indicates what 3 things may be occurring?
    discoloration

    cold stress, hypovolemia, sepsis
  205. Cafe au lait spots?

    When are they a problem
    LIGHT BROWN AND CREAMY COLORED MACULAR LESION

    not a prob unless have 6 or more spots that are greater than 1cm each can suggest neurofibromatosis
  206. Milia?

    What causes it?

    When will it go away?

    Teaching?
    across nose and chin

    due to immature sebaceous glands

    go away in 2 to 4 weeks

    don't pick at it - can cause infection
  207. Vernix caseosa -
    cream cheese like covering on infant to protect skin/lubricant

    rubs off with bathing
  208. Consideration with vernix and lanugo?
    more in prematures
  209. When does lanugo go away?

    Where is it usually?
    usually gone in 2 weeks

    shoulders, back, and upper arms
  210. Erythema neonatorum toxicum?

    AKA?

    What causes it?

    Teaching?
    flea bite rash

    erythematous macular spots that will spread, become papules then become pustules

    eosinophil reaction to the environment that is usually harmless

    only use water on the baby - do not use soap etc at all & watch for s/s of staff infection (fever, not eating well)
  211. Newborn blink and swallowing reflex?

    Preterm?
    term babies have blink and immature swallowing reflex but will still gag a lot

    preterm babies do not have swallowing reflex
  212. Trunk incurvation reflex?
    hold baby on stomach and rub babies back up  side of spine and baby will curve to the side where you touched
  213. Extrusion reflex?
    spit out their food
  214. Walk reflex?

    AKA?
    step in place reflex

    lift one leg and act like take a step
  215. Plantar and palmar reflex?
    palmar is grasp reflex

    plantar reflex - toes hold finger
  216. Moro reflex?
    startle reflex

    put baby down briskly and baby will flare arms out then will come back with arms and make a C with the hands
  217. Babinski reflex?
    stroke foot and toes flare out
  218. Tonic neck reflex?
    fencing reflex

    turn baby's head to a different side and the arm and leg on side head is turned to will be stretched out and opposite side will be flexed
  219. What will baby be screened for before leaving the hospital?

    How is this tested?
    • 1. PKU
    • 2. thyroid/T4
    • 3. sickle cell

    heel stick then let the blood transfer to a paper without touching the paper to the skin
  220. Important consideration before doing PKU test?
    must have ate enough protein to allow PKU to build up

    must wait 24 hours before doing

    do 2 to 3 days after discharge if not done
  221. What happens with PKU tests?
    sent to state and get results at 6 weeks checkup
  222. Important consideration for first bath?

    Bath considerations?
    anything in mom's blood is on the baby

    1. start from top and work way down - butt last

    2. warm water

    3. give in incubator or in warm water

    4. Make sure soap up well and rinse off well to prevent drying of the skin wash and dry as go

    5. front to back on female genitals and don't retract foreskin
  223. Important consideration for after a bath?
    monitor temp closely
  224. When should a baby first breastfeed?
    in the labor room if possible
  225. Tracheoesophageal fistula?
    hole b/t trachea and esophagus where baby will blow milk bubbles out of mouth
  226. How often should babies eat?
    15 to 30cc q 3 to 4 h
  227. How long in carseat?
    in carseat until they are 4'9"
  228. Newborn carseat considerations?
    rear-facing

    preemies may not fit in carseat and can be injured/suffocate if not sitting properly in it

    can use rolled up blanket, towel, or diape to support head

    may get hot in the summer check metal peices
  229. Best location for newborn in car?
    in rear seat facing backward until reaches 21 pounds or is able to sit alone without support
  230. Preemies and small babies consideration?
    may need special carseat and need to be fitted in before leave hospital
  231. 2 things to do before putting in carseat?
    check for hot spots and make sure it is buckled in
  232. How much do babies sleep in first week?
    typically 16 to 24 hours for about 4 hours at a time
  233. When will babies start sleeping through the night?
    by 4 months most will
  234. Will adding food/cereal help baby sleep longer?

    Problem with this?
    will not help sleep and will decrease good nutrition and can cause later food allergies
  235. Teaching about when baby is sleeping?
    mother should sleep too
  236. When is it OK to put baby on stomach?
    when awake and being observed
  237. 5 interventions to prevent SIDs?
    • 1. on back
    • 2. firm matteress
    • 3. no loose blankets or pillows & stuffed animals
    • 4. no sleeping with baby
    • 5. give pacifier when put down to sleep
  238. 3 most common causes of bilirubin?
    • 1. failure to process bilirubin because of inadequate intake or elimination
    • 2. traumatic birth injuries
    • 3. breastfeeding jaundice
  239. What can increase risk of SIDs?
    smoking in utero and after birth
  240. What 3 things should you assess for with baby's first feeding?
    • 1. sucking
    • 2. swallowing
    • 3. tracheoesophageal fistula
  241. Preterm infant?
    infants born prior to 38th week
  242. LGA?
    large for gest age
  243. AGA?
    appropriate for gest age
  244. SGA?
    small for gest age
  245. Low birth weight?

    Very low birth weight?

    Extremely low birth weight?
    baby weighs less than 2500 g or 5lb 8oz or less at birth regardless of gest. age
  246. Intrauterine growth restriction?
    IUGR AKA intrauterine growth retardation

    baby has failed to grow normally in utereo
  247. Post-term infant?
    born after 42 weeks gest
  248. Causes/risk factors of IUGR?
    • 1. poor nutrion
    • 2. cardiac defect in mother
    • 3. occurs more in adol
    • 4. partial abruptio placentae
    • 5. diabetics
    • 6. preg induced HTN
    • 7. cigs
    • 8. congenital prob with baby
    • 9. toxoplasmosis or rubella
  249. When can IUGR be detected?
    fundal height during assessments prenatal can show LGA and SGA
  250. IUGR baby appearance/char.?
    • 1. wasted atrophied muscles
    • 2. usually have underdev. liver
    • 3. poor skin turgor
    • 4. large head r/t to body
    • 5. hair will be dull
    • 6. abd may be sunken in
    • 7. usually have high Hct
    • 8. significant and longer lasting acrocyanosis
    • 9. decreased glycogen stores
    • 10.
  251. Hypoglycemia in babies?
    glucose below 40
  252. 2 types of abnormal growth and describe?
    symmetric - will grow abnormally in proportion

    asymmetric - grow abnormally out of proportion

    usually weight will be low and others OK
  253. LGA babies causes/risk factors?
    • 1. gest. diabetes
    • 2. may have GH prob
    • 3. obese mom with too much calories
    • 4. transposition of the great vessels
  254. With LGA baby what will assessment of mother show?
    higher fundal height than expected
  255. Problem that may occur during L&D of a baby that is LGA?
    CPD - cephalopelvic disproportion

    more shoulder distocia, clavicle fractures, herb's palsy
  256. Char/risk factors of LGA babies
    • 1. usually have immature reflexes
    • 2. low Ballard scores for maturity
    • 3. bruising and injury
    • 4. may have more caput succedeum and cephalohematomas
    • 5. hyperbilirubinemia
    • 6. hypoglycemia when from gest diabetes mother
  257. Consideration if baby is blue and LGA?
    transposition of the great vessels
  258. Consideration if baby is born from gest diabetes mom?
    baby has lots of insulin on board

    will go straight to ICU b/c blood sugar WILL bottom out within 24 h b/c cut off from mom's high blood sugar
  259. Preemie appearance?
    • 1. ruddy
    • 2. small
    • 3. not much SQ
    • 4. no/less creases on feet
    • 5. no rugae on boys
    • 6. can see clitoris on girls
    • 7. head is large
    • 8. acrocyanosis
    • 9. covered with lanugo and vernix
    • 10. fontanels are small
    • 11. ear cartiledge immature
    • 12. poor/no muscle tone - laying flat
    • 13. no sucking reflex and feeding probs
  260. Cause of preemies?
    unknown mostly
  261. * 80-90% of infant mortality is r/t _____.
    premature
  262. Risk factors for preterm birth?
    • 1. low socioeconomic status
    • 2. lack of prenatal care
    • 3. closely spaced pregnancies
    • 4. UTI
    • 5. preterm rupture of membranes
  263. What can cause preterm rupture of membranes?
    smoking
  264. Probs with Temp regulation with preemies?
    not much SQ or brown fat

    no shivering mech (not in newborns either)

    exposed more because don't flex

    don't move a lot
  265. What should ears do when bent over?

    If they don't ?
    should return to normal

    if stay down can mean not mature or preterm
  266. Nursing consideration with parents of preemies?
    will be afraid to touch them b/c they look so fragile
  267. Position of preemie?
    limp and extended
  268. Prob with preemie feeding?
    have trouble learning to feed, breathe, and swallow at same time and don't want to eat
  269. Newborn priorites?
    • 1. airway
    • 2. resuscitation
    • 3. lung expansion
    • 4. positioning
    • 5. drug therapy
  270. Resusitation of the newborn?
    first hours of life most critical to decrease risk or neuro defects like cerebal palsy
  271. pH of newborn?
    most are born acidotic and if they can't breathe -> more acidotic and will turn off production of surfactant
  272. Airway consideration of newborn?
    suction mouth then nose
  273. Important thermoregulation intervention of baby just born?
    dry the baby well
  274. 4 methods of heat loss?
    • 1. conduction - transferred to cold surface
    • 2. convection - air movement/circulating
    • 3. radiation - heat transfers from baby to nearby source of heat (window/heater)
    • 4. evaporation - lose body heat thru moisture
  275. Why does baby get cold quickly directly after birth?
    evaporation b/c wet
  276. What will occur if baby is not breathing?
    heart failure
  277. If baby has HR of ___ or less must start CPR?
    60 or less
  278. If have a baby struggling to stay warm and temp is dropping what will baby do to warm itself?
    it starts moving to increase temp and will burn brown fat if it has it

    moving will increase need for energy and can cause hypoglycemia -> shock and loss of conciusness -> death
  279. Important consideration if a baby gets cold or decreased BG?
    can cause blood flow to go back to intrauterine blood flow and stop surfactant  and decrease blood sugar
  280. Lung expansion considerations?
    once expanded surfactant keeps them expanded

    if need to give O2 give by mask 100% warmed and humidified

    listen to both lungs - does baby have 2 lungs

    if mother had narcotics with L&D need narcan avail. in case of resp depression
  281. Imp consideration if mother of newborn just born has been using street drugs?
    do not give baby narcan for resp depression - can cause withdrawals
  282. Doing chest compressions on baby and have HR less than 60/BP lower than needed what drug may be given?
    EPI
  283. To correct acidosis of baby what drug may we use?
    sodium bicarbonate
  284. How is surfactant given to baby?

    Important consideration?
    suction well then admin thru endotracheal tube into baby's airway and dropped down

    cannot suction again for an hour after surfactant is placed in airway - make sure suction well before
  285. S/S of a cold baby?
    • 1. fussy and moving
    • 2. acrocyanosis
    • 3. jittery
  286. If a baby is jittery check ___ & ___>
    BG and temp
  287. What is incubator used for?
    transfer from newborn nursery to NICU
  288. Kangaroo care?
    bare skin to bare skin on chest of parent
  289. Babies have tendency to become _____ r/t rapid breathing and may be in radiant heat source.
    dehydrated
  290. Urine output/specific gravity of newborn?
    no BP no peepee
  291. Hypo/hypervolemia r/t IV fluids?
    hypervolemia from too much IV fluids can cause brown hemorrhaging and can cause ductus arteriosus to reopen
  292. Hypovolemia appearance of baby & s/s?
    • 1. pallor
    • 2. tachypnea
    • 3. tachycardia
  293. s/s of hypervolemia?
    bulging fontanel
  294. Consideration with giving baby meds?
    give in as little fluids as possible to prevent hypervolemia
  295. Consideration with geting blood from babyt?
    must monitor to prevent hypovolemia
  296. Nutrion for preemies?
    1. will get NG b/c can't suck, swallow, and breathe and most have no suck reflex

    2. best to give breast milk for immunity needed

    3. give pacifiers to learn to suck
  297. When will preemie void?
    usually in 24 h
  298. What should be documented when resusitation is done?
    if void or defacate during
  299. BM in preemies?
    may or may not have bowel movement within 48 h
  300. Interventions for parents of preemies?
    • 1. Encourage visiting and handling baby
    • 2. take pics and send them with parents
    • 3. encourage bonding
    • 4. watch siblings for RSV
    • 5. if infant dies take the equipment off the baby before letting them see it
  301. Sending preemie home?
    • 1. look at condition of baby and mother during check ups
    • 2. make sure the parents understand dev needs of baby
    • 3. carseat fits
    • 4. bonding
  302. Preterm baby risks/diagnoses possible?
    • 1. risk for infection
    • 2. risk for altered nutrition
    • 3. hypothermia
    • 4. risk for altered bonding r/t equipment and absent from parent for long period
  303. Skin of newborn considerations?
    • 1. no adhesive tapes - will rip skin
    • 2. disinfectants b/c not much tissue b/t skin and cells - use chlorhexidine
    • 3. warm water - no soap
  304. Prob with using alcohol and betadine on preemies?
    skin is so thin will leak through

    betadine can cause thyroid issues
  305. Risks for preemies?
    huge risk for infection
  306. Newborn or preterm that is sick important consideration?
    will not get high temp - will get low temp
  307. What causes most infections in newborn?
    preterm rupture of membrane
  308. Painful perception in preemies?
    they have it

    pain threshhold may be permenantly altered r/t so many needle sticks in preemies - will be more sensitive to pain
  309. Non pharm intervention for pain in preemies and newborns?
    kangaroo care, swaddling, holding close, sucrose passy before sticks
  310. Meds for pain?
    tylenol
  311. Closing door on incubator of preemie?
    close softly
  312. Lights in room with preemie?
    keep lights low and quiet

    alarms turned down

    need inutero env
  313. Postterm babies char?
    1. dry skin and leathery appearance (alligator skin)
  314. Risks with postterm babies?
    1. risk for meconium aspiration- will stool inutero

    2. decreased placental function - decreased nutrition - will start loosing weight

    3. injury risk if they are still big when delivered

    4. hypoglycemia

    5. hyperbilirubinemia
  315. Monitor large babies for ______!!
    hypoglycemia
  316. Why are postterm babies at risk for hyperbilirubinemia?
    will have polycythemia r/t hypoxia r/t decreased placental functioning and RBC will be destroyed after birth to decrease blood volume
  317. RDS?

    AKA?
    resp distress syndrome -lack of surfactant

    hyaline membrane disease

    baby born with a lot of fluid in lungs and come thru birth canal the fluid is sqeezed out -> blood that has been bypassing lung will now go to the blood -> RDS baby has no surfactant -> alveoli sticks together -> blood starts to shunt again like fetal circulation -> big prob
  318. Most common s/s of RDS?
    • 1. nasal flaring
    • 2. sternal/subcostal retractions
    • 3. tachypnea
    • 4. cyanotic
    • 5. grunting min to h after develops
  319. Tx of RDS?
    • 1. treat with surfactant
    • 2. may do O2 admin usually by CPAP
    • 3. ventilation
    • 4. supportive care
  320. Consideration if baby is on cont. O2?
    retinopathy - blindness that can be caused by too much O2
  321. What babies most at risk for RDS?
    preemies
  322. Supportive care of baby with RDS?
    • 1. keep warm
    • 2. monitor fluid & glucose
    • 3. feed them
  323. What is an LGA baby at risk for?
    CPD - cephalopelvic disproportion
  324. If a baby has bruising/injury from birth what is he at risk for?
    jaundice
  325. Transient tachypnea s/s?
    • may have RR of 80 to 120X per minute
    • along with s/s of resp distress but mostly high rr is imporatnt

    s/s of resp are milder than RDS
  326. Transient tachypnea cause?

    Who is most at risk?
    retained fluid in the lungs during birth

    C-section babies that didn't get squeezed
  327. When does transient tachypnea occur?
    can occur hours after delivery

    will peak in 36 h and gone in 72 h

    RDS occurs imm.
  328. Interventions for transient tachypnea?
    1. gavage feeding until better
  329. MAS?
    meconium aspiration syndrome - breathe meconium into the airway
  330. Patho of MAS?
    suck tarry meconium into airway -> causes alveoli and airway to stick together
  331. Interventions for MAS?
    • 1. intrapartum can do amnioinfusion
    • 2. at delivery when head first comes out use delee suction device to get as much meconium off perineum as possible
    • 3. do not stim baby to cry b/c will suck it down farther - suction first and look down with endotrach light then look at RR ect
  332. If have baby trying to resusitate with meconium aspiration what do first?
    • clear the airway of meconium and clean up first
    • then CPR
  333. s/s of meconium aspiration?
    same as transient tachypnea -> stop producing surfactant -> can lead to cardiac arrest
  334. Mom's that can cause concerning blood incompatibility?

    Baby?
    mom's with negetive and O

    babies with positive and B
  335. Blood incompatibility pathologic or physiologic jaundice?
    pathologic
  336. Tx of jaundice baby?
    • 1. phototherapy
    • 2. exchange transfusions
    • 3. feed them
    • 4. change diaper
    • 5. serum bilirubin
    • 6. skin tone
  337. Feeding of jaundice baby?
    1. feed ASAP
  338. Cover ___ & _____ in a baby undergoing phototherapy for jaundice?
    genitals and eyes
  339. Schedule feeding of jaundice baby?

    When bilirubin checked?
    feed q 2 h and check levels q 12 h
  340. Complications/char of gest diabetes with newborn?
    • 1. hypoglycemia r/t baby high insulin r/t mother hyperglycemia
    • 2. all organs will be larger except the brain
    • 3. baby will be huge if mom diet sucks - will have to take them out early b/c so big
  341. Normal BG of baby?
    40 to 60
  342. Why may gest diabetes baby be early?
    will get too big
  343. If BG gets low ?
    feed the baby then check again based on hospital policy
  344. If baby is getting hypoglycemia key s/s?

    INtervention?
    jittery

    check BG
  345. s/s of drug use/withdrawal in baby?
    • 1. jittery
    • 2. disturbed sleep pattern
    • 3. want dark and left alone
    • 4. frequent sneezing
    • 5. convulsion
    • 6. most like to be swaddled but not usually held
    • 7. most like sucking a pacifier
  346. Drug addict mother and breastfeeding?
    if a mom is on drugs do not breastfeed
  347. Nursing responsiblity with drug mom baby?
    watch for need to call social services - baby may not go home with mom

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