The normal newborn

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The normal newborn
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2014-10-07 20:45:25
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  1. Physiologic Adaption..first breath
    Baby O2 sat is low as the baby is coming down the canal. we have chemoreceptors in our caratoid- when carotid pick up a low O2 it is going to release catecholamine which will tell u to breath.

    • Baby comes out-
    • -  cut the cord- baby loses O2 from mom
    • - catecholamine release (chemoreceptor in carotid) tells I need to breath
    • - when O2 goes down CO2 goes which will cause the diaphargm to contract
    • - this happens instantaneously
  2. Physiologic adapation--first breathe part 2
    • cutting of the umbillical cord stimulates cold receptors
    • decease PO2 and increase PCO2, incre acidosis (decr PH)
    • release of catecholamine- msg to the respiratory center in medulla, diaphragm contracts
    • first breath- chest compression during birth draws air into the lungs
  3. Physiologic adaption- 3 heart
    • Causes heart changes
    • decrease the resistance from the lungs- normal heart flow
    • O2 sat goes 
    • pressure in the heart is bigger which helps to close that foramen ovale 
    • ductus artereosis closes (could take up to 24 hrs so u may hear a murmur)- one of the things that help close this is decre in prostagladins
  4. Normal Newborn transition (first 4 hrs)
    • Establish an airway
    • - bulb syringe- mouth than nose
    • - stimulate nb- rub back of baby and try to dry baby
    • - right then and there we have to access
    • access cardiopulmonary circulation
    • - Heart rate- apical hr full min
    •    - initially- 120-180
    •    - 100-160 ATI 120-160 ricci
    •    - may increase to 180 if the baby is crying
    • - after the cord is clamped u can palpate the umbilicus for heart rate
  5. Normal newborn transition (bp/respiration)
    • Blood Pressure:
    •  - normal 60-80/40-50 ATI, 50-75/30-45 RICCI- initially we dont do bp right away only when suspected cardiac defect. it depends on hospital

    • Respiratory rate
    • - lusty cry, no cyanosis (if unable to get rate)
    • - resp rate: 1 minute
    • - 30-60
    • - they breath fast
    • - listen on right side bc left side is so loud bc of heart
    • - do it when the baby is quiet
    • now they do an O2 sat at delivery- normal > 95
  6. Normal newborn transition temperature
    • immediately dry newborn completely, cover head with a hat, and place in warm place (skin to skin or warmer)
    • temp
    • normal (axillary)
    • 36.5-37.5 C
    • 97.9-98.9 F ATI

    • 36.5-37.5 C 
    • 97.7-99.5 RICCI

    no rectal because tissue is delicate/perforiate tissue
  7. APGAR
    use this to assess whether or not baby goes to the NICU

    do this at 1 min and 5 min

    • if > 7 ur good
    • if less repeat 

    this is scoring tool to tell us where baby well being is initially

    • five areas- 
    • HR- absent, less 100, greater than 100
    • RR- apneic, slow weak cry slow irregular resp, good strong cry-reg resp
    • Muscle tone- (baby should be flexed tight)- limp-flaccid, some flexion- when u pull and no recoil-limited resistance, tight flexion-good resistance- quick return flexion
    • reflex irrability- (faces)- no response, grimace-frown when irritated, sneeze cough vigorous cry
    • color- cyanotic/pale, pink body acrocyanosis, completely pink
  8. Newborn Body Temperature regulation
    Thermoregulations: is a balance between heat loss and heat production

    Non-shivering Thermogensis- process in which brown fat is oxidized in response to cold exposure

    Predispose to heat loss (hypothermia)

    Overheating (hyperthermia)

    • Cardiopulmonary
    • keep them warm
  9. Four mechanism of heat loss *
    • Conduction- cool surface- take the temp of the baby down (nurse put baby on warm blanket)
    • Convection- fan/AC vent on (
    • Radiation- near a cold surface like near a window
    • Evaporation- wet- you get cool
  10. Thermoregulations red flag nurse alert
    • Hypothermia
    • inability of newborn to maintain a normal temperature 
    • tachyapnea (bc oxidizing brown fat)
    • decrease activity, lethargy, hypotonic
    • decrease glucose (< 40 mg)
    • Preterm is higher at risk (bc less brown fat)
    • result in cold stress

    • Nursing prevention
    • blanket/hat
  11. Cold Stress- can lead too
    • depleted brown fat stores
    • increase oxygen needs
    • respiratory distress (tachyapnea)
    • hypoglycemia (take CBG, feed baby on breast)
    • metabolic acidosis- more resp issue
    • Jaundice
  12. Initial Assessment and Care of the newborn head size
    • Normal head size 32-37cm
    • Symmetrical
    • - assess eyes (sometimes eyes are red document) normal eye has edema, nose (open), mouth, and ears (position at the inner canas), neck
    • - Inspect posture- should be flexed
    • - palpate skull- suture line (cartilage which helps them make their way thru the vagina)
  13. Initial Asses. of newborn Fontanels
    • Posterior and anterior
    • should be flat, soft and open
    • anterior fontnanel (diamond shape in front 4-6cm)- closes at 18-24
    • posterior font. triangle shape 0.5-1cm smaller and hard to feel because of alot of overlapping of the bone

    • Suture lines
    • - flat (approximated), overriding suture
    • (often unless a c-section)

    After they override the mold- cone head
  14. Initial Assessment and Care of the Newborn
    Molding
    • a. significant molding after vaginal birth- cone head
    • b. schematic of bones of skull when molding is present- bones overrride each other
    • c. cartilage between bones- suture
  15. Initial assess 
    abnormal of head
    • Caput succedaneum- edema extensive swelling- often u would see this and it resolves on its own (depends on the extent of it) 2-3 days goes away- more swishy
    • cephlahematoma- you have to monitor- most of this is causes by the pressure in the pelvis

    • Head circumference 
    • Microcephaly- small brain neurotube defect
    • Macrocephaly- too much fluid in the brain (

    • Fontanels
    • a raised (should be flat)- fluid (triangle piece)
    • b. depression- dehydration
    • c. large fontanels, small or closed fontanels
    • b.
  16. Caput succedaneum v cephlahematoma
    Caput- crosses over the suture line- thats the edema in that area (cap on)

    Cephlahematoma- does not cross over the suture line located usually in one area (bluish tinge to it)- baby can be more anemic (body takes longer time to absorb it)
  17. Initial assessment and care of the newborn neck clavicles
    • inspect the nb neck for movement (free movement) and ability to support the head
    • inspect the clavicles which should be straight and intact

    • Red flag abnormal clavicle
    • - no alignment
    • - crepitus
    • - no arm movement
  18. Cardiac assessment
    Initial 120-180

    • Heart rate: Normal 110-160
    • crying baby 180
    • Pulse
    • Bp 60/40
    • Pulse- compare brachial and femoral pulses to rule out coarctation of aorta- symmetrical/bilateral 

    skin color
  19. Cardiac assessment flag red
    • Tachycardia > 160
    • Bradycardia< 100
    •  Heart Murmur
    • mushy sound as the blood goes the atrium and the ventricles 
    • often heard and usually benign
    • if present after the first 12-24 hours of life should be evaluated to rule out a cardiac disorder 
    • beat beat sh beat
    • listen fourth ICS
  20. Respiratory System (lungs)
    Hypoxia- low oxygen

    • Initiation of respirations
    • role of surfactant- helps to open up that alveoli- so they can expand
    • 30-60 breath/min; irregular periods of apnea bc their brains are not mature yet. (< 15 sec it is not abn) shallow, unlabored, symmerical chest movement
    • apnea period- periodic breathing- irregular teach mom that babies do this
    • auscultate breath sounds- normal newborn has slight rales bc they still have amniotic fluid- wheezing is not normal- on both side (bilaterally/symm)
    • assess skin color- blue is never good
  21. Chest
    average chest 30-36 cm (12-14inc-)

    • inspect for size shape and symmetry
    • xiphoid process maybe prominent at birth
    • nipples may be engorged and may secrete white discharge- due to estrogen from the mom
  22. Respirations/chest red flags 
    • Central cyanosis (generalized)
    • tachypnea, bradypnea
    • expiratory grunting (trying to open up alveoli), sternal retractions and nasal flaring, labored breathing
    • chest movement should be symmetric
    • diminished breath sounds, abnormal breath sounds
    • flaccid body posture 
  23. Gestational age
    • preterm/premature
    • - born before 37 weeks gestation, regardless of birthweight

    • Term
    • - born between 38-42 weeks gestation

    • Post term or post date
    • born after completion of 42 weeks gestation

    • Postmature
    • born after completion of 24 weeks and demonstrating sign of placental aging
  24. Ballard score
    This is how u tell how mature the baby is

    • Neuromuscular maturity
    • Physical maturity- is what their skin looks like 
  25. Length and weight
    L- 49.53cm (19-21in)

    W- 6-9lbs

    about the 3-4 day baby loses about 10% of their birth weight- they lose this because they lose fluid
  26. Abdomen
    • Inspect
    • - shape- protrubant but not distended
    • - movement abd breathers
    • umbilical cord- AVA, odorless, no intestinal structures- now bowels coming thru- auscultate bowel sounds
    • palpate abd- gently bc liver is just waking up

    • diastasis rectus- rectus muscle is not attached yet
    • meconum within the first 24 hours
  27. GI system adaption
    • Mucosal barrier
    • they need to eat first then all happens
    • Normal flora in our bellies 
    • colonization is dependent on oral intact
    • dependent on oral intake
    • needed for Vit K- clotting factor
    • stomach capcity
    • - is 39-90mls- emptying 2-4 hours
    • immature gastruc function
    • Deficiency of pancreatic amylase 3-6 months
    • - limited ability to digest complex carbs and fats
    • - this is why breast milk is important
    • meconium- dark black consider sterile sticky odorless 12-24 hrs should pass

    after the initial feeding baby should have green-brown stool (transitional stool)

    • breastfeed- yellow stool with seeds
    • bottle- brown
  28. abdominal red flag
    • absent bowel sounds
    • abd distention
    • one artery in umbilical
    • umbilical hernia
    • bleeding infection, granuloma or umbilicus
    • no meconium stool in 12-24 hrs of birth
  29. Renal system
    • 6-8 voiding/dat consider normal
    • kidneys and nutrition
    • unable to concentrate urine for up to 3 months- 
    • unable to digest proteins and minerals (r/t kidney function)
    • must consume more fluid per unit of body weight than adults 
    • 4-6 weeks for kidney to wake up
    • if u give more protein than needed it puts a strain on the kidneys that why breast milk is best. 
    • check fontanels- keep them hydrated
  30. renal system red flags
    • no voids noted within the first 12-24 hours
    • uric acid crystals (urate)- dark orange dust due to dehydration
    • abnormal U/S indicating hydroneprosis- fluid in their kidneys (followed by kidney specialist)
  31. GU system
    • note initial void and meconium
    • inspect the anus
    •  - for position and patency
    • Male
    • - inspect the penis and scrotum (press down on the testes to see if the decended testes if not they need to go to uro)
    • - palpate for evidence of testes
    • - look to see the position of the penis

    • Female
    • - inspect labia majoria and minora
    • - pseudomenstration (pink vaginal staining from estrogen), uric and crystals, 
    • - vaginal tags (leave alone)
  32. GU red flags
    • ambiguous genitalia- undetermine if the baby is girl or boy
    • imperforated anus- wait until u get a meconium stool so u can determine if it is patent
    • female variation
    •  - labia bulge- inguinal hernia
    •  - rectovaginal fistula- feces present in the vagina
    •   - imperforate hymen

    • Male variation
    • - hypospadias- urethra on ventral surface of the penis
    •  - epispadias- urethra on dorsal side of the penis
    •  - undecended testes (crypotorchidism)
  33. Musculoskeletal
    • back and extremities 
    •  - inspect upper and lower extremities- make sure they are all moving
    •  - assess posture and muscle tone
    •  - Ortolani and Barlow maneuvers to identify development dysplasia of the hip- one leg longer and the other shorter
    •  - number of digits
    •  - 3 palm creases on the hand
    •  - spine intact str8 and flat
  34. Musculoskeletal cont
    • more cartilage than ossified bone- thru year one
    • head is 1/4 of the total length of the baby 
    • the arms are slightly longer than the legs
    • the face appears small in relation to the head
    • cranial size and shape can by distorted by molding 
    • may appear bold legged when ankles are help together
    • no apparent arch to the foot
    • normal frog legged position 
  35. Musculoskeletal red flag
    • Simian crease- crease in hand that goes str8 across indicates down syndrome
    • branchial plexus injury- happens in the pelvic canal which could break- unable to do moro reflex limb is weak
    • Tuft of hair, a pilonidal dimple in the midline (neurotube defect), a cyst or a mass along the spine
    • club foot- turned in foot like a golf club
    • hypotoniia
    • decrease ROM of neck 
    • crepitus
  36. Signs of Development dysplasia pf the hip
    • A. asymmetry of gluteal and thigh folds
    • b. limited hip abduction as seen in flexion
    • c. apparent shortening of femur as indicated by level of the knees in fleion 
    • d. ortolani click (if infant is less than 4 weeks)- not fitting 

    back side of their legs should be equal and symmerical. 
  37. Neurological status
    • Alertness posture and muscle tone
    • symmetrical of face and movement
    • newborn reflexes
    •  - sucking, babiniski sign 
    • mor, stepping
    • tonic neck, rooting
    • palmar grasp, plantar grasp
    • spinal reflexes
    •  - truncal incurvation (galant)
    • - anocutaneous reflex- 
  38. Neurological red flag
    • Branchial plexus injury
    • - decrease grasp on effect side
    • - negative Moro reflex
    • Asymmetry of the face- droop
    • sever neurological damage- not enough o2
    • occur during fetal growth and labor
    • - limited reflexes
    • - difficulty swallowing breathing
    • - hypotonia
    • - seizures
  39. Integumentary system
    check skin turgor 

    • inspect skin- common skin variation
    • - vernix caseosa, stork bite (telangiectatic nevus), milia (bumps on bridge of nose), acrocynanosis, epsteins pearls, mongolian spots (found on black babies bums looks like a bruise), erythemia toxicum (newborn rash**), harelquin sign, nevus flammeus (port wine spot- laser off), nevus vasculosus,
    • lanugo, maybe drying or cracking of skin
  40. Integumentary red flag
    • bruising
    • lesions
    • petechia (pinpoint hemorrhagic areas)
    • Hairy nevi (tuft of hair located posterior midline near spinal column)
    •  may indicate a neural tube defect
    • Pallor 
    • plethora (a deep purplish, red color related to an increase number of circulating RBC
    • jaundice
    • central cyanosis

    pale or really red- not enough blood on board or too much
  41. Care of the newborn- baby a new patient
    • identified prior to family leaving the birthing area- id bands placed on everyone before u leave the room
    • parents/support person needs id band
    • the id band includes name, gender, moms last name, date and time of birth and id number
    • check by two nurses to see if this is the right baby
  42. Vitamin K (aqua- mephyton)
    • babies are deficient in this so all babies get a dose
    • to prevent vit k deficiency bleeding in the newborn (called VKDB or hemolytic disease of the newborn)
    • initiates clotting
    • recommendations
    • - given as soon after birth as possible. First 1-2 hours- soon after birth
    • single dose of 0.5-1mg SC 90 angle 
    • bath infant prior to injection if mother is HIV positive, hepatitis, herpes simplex
  43. Erythromycin
    • Erythromycin 0.5% ophthalmic ointment or tetracycline 1% opthalmic
    • to prevent an infection of the eye- to prevent ophthalmia neonatorum 
    • recommendation
    • mandated by the state to be given as soon as baby is born 
    • prevents infection from neisseria gonorrhea, and chlamydia trachomatis
    • ointment single dose to both eyes
  44. Hepatitis B Vaccine
    immunization against hepatitis B

    • to prevent hepatitis b virus 
    • recommendation
    • soon after birth
    • 0.5ml sc
    • additional dose at 2 months and no later than 24 weeks- 3 doses

    u ask for the mom is this is ok
  45. Initial newborn birth
    • initiate with stabilization of temperature 
    • temp 98.6 or above x2 15-30 mins

    • provide warmth
    • progress from cleanest to dirtiest
    •  - eyes first and face plain water
    •  - proceed with rest of the body
    •  - shampoo hair

    • waiting more than 12 hours
    • place newborn under NTE after bath until temperature returns to 98.6 x 2 15-30 mins apart

    (really cold instead of using NTE they will do skin to skin)
  46. Hematopoietic adaption
    • blood volume
    • blood components 
    • erthrocyctes (RBC)
    • - hemoglobin 17-20
    • - hematocrit
    • - H&H are much higher than ours
    • leukocytes (WBC)- initially higher bc of birth trauma
    • Polycythemia- abnormally high erthrocyctes count bc they lived in a low O2 world
    • - more at risk for getting jaundice bc of the breakdown

    pleura- sometimes if rbc is higher they baby may appear to be bright red too many red cells
  47. Hepatic adaption
    • when in the belly the liver is not functioning bc of the planceta
    • so now it must wake up

    • Iron storage
    • - iron stored in liver the last few months of pregnancy
    • - iron stores are sufficient to last approx 4-6 months

    • Carbohydrate metabolism
    • - liver releases glucos from glycogen stores for the first 24 hours
    • - maintain blood sugar above 40mg/dl
  48. Capillary Blood Sugar (CBG)
    • monitor baby for sign of hypoglycemia
    • - dont get warm
    • - they get jittery

    • Traumatic birth check more frequently
    • DM mom
    • big fatty check cbg (check protocol)

    • identify high risk newborns
    • monitor for hypoglycemia
    • check bs of infants at risk
    • may need iv of dextrose if really bad...put the baby to moms breast- feed them
  49. Physiologic Jaundice of the newborn
    • common- 3rd-4th day of life we have physiological jaundice (normal)- day 1 they cant tolerate a high bilirubin (red flag)
    • cause- increase of bilirubin level (hyperbilirubinemia) resulting from the hemolysis (breakdown) of erythrocytes
    • -if gets too high it can cross the brain blood barrier- causes the brain to be full of bilirubin- brain damage

    • bilirubin- breakdown of red cells
    • Liver- is responsible for converting unconjugated bilirubin to conjugated bilirubin-- converting bilirubin that the nb can excrete 
    •  - fat soluble into water soluble (unconjugated into conjugated)

    Clinical manifestation- yellow skin, mucous membrane, sclera at approx. the 3rd of life
  50. Bilirubin conjugation
    RBC- breakdown by phagocytes- phagocytes attacks hemoglobin which breaks down heme (which turns into iron) and the other globin. unconjugated bilirubin and u need the acid Glucuronic acid to conjugate it and then it is excreted thru feces.

    if u don't have the acid the bilirubin levels will go up. 
  51. Physiological Jaundice
    • assessment
    • assess skin for jaundice by gently pressing with a fingertip on the bridge of the nose, sternum or forehead
    • careful monitoring of intake and output
    • promote and support successful breast feeding
    • know the risk
    •  - previous child with jaundice
    • - moms blood type
    • - mediterrian decent
    • -hematoma

    all depends on the babies age which will determine how much bilirubin they can tolerate
  52. Jaundice - phototherapy
    • when levels are high
    • under heat source for NTEG
    • newborn is naked with diaper and turned every 2 hours
    • closely monitorbody temp and fluid and electrolyte balance
    • feed often to promote stooling
    • observe skin integrity
    • provide eye protection
    • encourage parents to participate in their newborns care
    • the light is like a sun light and this helps to decrease bilirubin
  53. Immune System adaptions
    • before rupture of membranes-
    •  - sterile enviroment (in mom)
    •  - depends on maternal immune system for protection
    • first exposure to organisms
    • transition of the newborn immune system
    •  - colonization of normal bacterial flora 
    • at risk for infection lack of immune- 
  54. Immune system adaption at risk
    • at risk for infection related to
    • - immature defense mechanism
    • - lack of experience and exposure to organism leading to a delayed responnse to bacteria
    • - breakdown of skin and mucous membranes
  55. Immune system adaptions IgG IgA IgM
    • IgG- passive acquired immunity- only immunoglobin that passes thru the placenta. primarily during the 3rd trimester **
    • preterm babies at risk

    IgA passive acquired immunity- colostrum and breast milk*. protects against respiratory and GI diseases **

    IgM- produced in response to blood group antigens, gram negative pathogens and certain maternal viruses 
  56. Nursing assessment
    • order of routine newborn vital signs
    • - respiration- first cause when they wake up they cry- full minute (bc they are periodic)
    • - heart rate (full minute)
    • - temp- axillary
  57. Behavioral patterns of newborns
    • first period of reactivity
    • - birth to 30 minutes after birth
    • - newborn is alert moving and may appear hungry

    • period of sleep or decreased activity
    • - 30 minutes to 120 mins old
    • - period of sleep or decreased activity

    • Second period of reactivity
    • - 2-8 hours
    • - newborn awakens and shows an interest in stimuli
  58. General newborn care
    • everyday
    • complete newborn assessment/shift
    • Vital signs
    •  - every 4-8 hours
    • Bathing and hygeine- initial bath has a protocol (baby should be washed every other day)
    • Monitor daily weights (to check nutritional status)
  59. Gen. newborn care- output
    • Urine characteristic 
    • - light amber in color
    • - soaking 6-12 diapers 
  60. Stool patterns
    • meconium initially
    • transitional after two days
    • - breast feed- mustard colored soft with seedy consistency)
    • - bottled feed- yellow to brown formed stool with pasty consistency 
    • may pass stools 1-10 day
  61. Cord care
    they dont use anything on it but used to use alcohol, antibacterial agent, or triple dye at each diaper change

    cord clamped can be removed after 24hours after delivery

    within 7-10 days it sloughs off and the umbilicus heals

    sponge baths until the cord comes off
  62. Circumcision procedure
    • not as common
    • some cultural
    • individual chose
    • foreskin comes off

    • when gland is showing the initial day it is bright red but should not be bleeding (red flag)
    • initially they put petroleum jelly on it with gauze
    • when the initially dressing comes off u can u put on diaper
    • teach mom to observe for bleeding and infection
  63. Circumcision care
    • AAP pain relieve must be provided
    • assess for bleeding q 30 for the first 2 hours
    • document first void
    • wash with soapy water rinse and pat dry daily
    • apply a small amt of petroleum jelly with each diaper change
    • assess for signs of infection
    • should heal in 7-10 days
  64. Nutrition
    • Breast feeding
    • - adequate latch suck, swallow
    • - feeding 2-3 hours
    • - satisfied between feedings
    • - retain feedings>

    • Bottle feeding
    • - amount for each feeding
    • - satisfied between feeding
    • - feeding q 3-4 hours
    • - retain feeding

    Non nutritive suck- like a pacifier to keep them calm
  65. Nursing management promoting nutrition
    • stomach capacity 30-90ml variable emptying time from 2-4 hours
    • limited ability to digest complex carbs and fats
    • peristalsis is rapid
    • therefore small frequent feedings are needed at first, with amounts progessively increasing with maturity
  66. Nursing management promoting nutrition 2
    • Feeding the NB
    • - assess for adequate suck and swallow
    • assess bowel sounds and check for abdominal distention
    • - newborn should be satisfied, 6-10 wet diaper/day, several stools sleeps well and gains weight
    • - frequency breast/bottle
    •      - measures to decrease air swallowing pg 531
  67. Breast feeding
    • initiated immediately after birth
    • fosters bonding 
    • oxytocin is released causing the uterus to contract and the colostrum (1st milk ur breast make) to be let down
    • Prolactin aids in breast production
  68. Nursing management promoting nutrition 3
    • breast feeding
    • - breast milk contains protein, fats, carbs, water, minerals, vitamins, and enzymes
    •    - colostrum
    •    - transitional milk
    •    - mature milk
    • advantages for mom
    • advantages for newborn
  69. Newborn Metabolic Screening (NBS)
    every baby has a newborn screening down usually on the day of discharge. heel stick

    Genetic disorders and inborn errors of metabolism most common tests are for Phenylkentonuria (PKU)*, hypothyroidism, galactosemia, cystic fibrosis and sickle cell disease

    • PKU- autosomal recessive disorder - u have to be on a low protein diet-u dont have protein to breakdown the PKU- u get these pheno in your urine cause u cant break down
    •  - u need to feed the baby to get protein to see if they could break it down

    • make sure baby has been feed before u do the test for the PKU
    • if PKU levels are high and they are not on a low protein diet could end up with motor retardation

    Galactosemia
  70. Newborn Metabolic Screening 2
    • Should not be done prior to 24 hours after initiation of feedings
    • early detection and initiation of treatment can prevent mental and motor retardation
    • once diagnosis with PKU- u must adhere to phenylanine restricted diet (very low in protein)
  71. Screening hearing/car seat
    • CCHD screening- congential cardiac heart disease- pulse ox on the upper arm and foot (new)
    • Hearing screen- screen prior to discharge, if fluck then give referral
    •  
    • car seat testing 
    • done on all infants less than 37 weeks gestation
    • monitored for periods of apnea and bradycardia while sitting in car seat- bc they dont have strength to hold head up

    can go home in car seat bed
  72. Discharge planning
    • bathing
    • use bulb syringe
    • clothing- approriate 
    • circumcision care/cord care
    • infant crying- determine whats a painful cry and normal cry
    • colic- GI condition GERD
    • diapering- change frequent
    • elimination- breast babies may have a stool with each feedings. bottles babies not so much
    • follow up care- see md in 2 weeks and then 6 weeks (weight checks and for immunization)
  73. discharge planning 2
    • taking temp
    • potential signs of illness
    • safety- car seat rear faces, shaken baby syndrome, sudden infant death (back to sleep)
    • soothing babies
    • swaddling
    • temp- axillary 
    • uncircumcised- clean the area. 

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