What is the focus of nursing care in the newborn? How can this be done?
to protect and support the newborn;
maintaining body/ thermoregulation
maintaining respiratory function
decrease risk for infection
assist parents in providing appropriate nutrition and hydration
assist parents in learning care of infant
At birth lungs are filled with amniotic fluid; how much is forced out during birth? what happens to the remainder of the fluid? most fluid is absorbed withing how many hours? How many hours until all fluid absorbed?
30 mL is forced out at birth
The remainder is absorbed through pulmonary circulation and lymphatic system
Most is absorbed within two hours
Completely absorbed within 12-24 hours
What causes the initiation of respiration?
Mechanical stimuli: theory that labor process is primarily responsible for initial movement of fluids out of lungs
Chemical stimuli: transitory asphyxia d/t cessation of placental gas exchange
decreased PO2(mild hypoxia)
increased PCO2 (hypercapnea)
Stimulation of respiratory center in medulla
stimulation of respirations
Thermal Stimulation: Drop in environmental temperature
Normal newborn loses how much the amount of heat as an adult? There is a need for balance between heat lost to environment and heat production. Heat production requires what two things? What is the relationship with subQ fat and heat loss? What position decreases heat loss? poor thermoregulation is due to what primarily?
newborn loses 4x amt of heat
Heat production requires both Oxygen use and increased metabolic rate(glucose consumption)
The lesser the amount of Sub Q fate = increased heat loss
The flexed position decreases heat loss
poor thermo is due to heat loss rather than poor production
What are the two major routes of heat loss?
inner core to body surface
body surface to environment
How does the newborn respond to cold?
increases metabolic rate
increases muscle activity
peripheral vascular resistance
metabolism of brown adipose fat (BAT)
Why is a neutral thermal environment important?
Maintains body temperature with minimal metabolic changes and oxygen consumption
decreases possible complications
What is the process of thermoregulation in the newborn?
non-shivering thermogensis; unique heat production of newborns; they use stored brown adipose fat to produce heat; the do not shiver
When does BAT appear? How long does it grow for? Where is it located?
BAT appears @ 26-30 weeks
continues to grow until 2-5 weeks after birth unless it used early due to premature birth
Body heat loss when fluid evaporates off infants skin; via expired air when breathing
What is radiation? Nursing interventions?
Body heat transferred to cooler surfaces and objects not in direct contact with infant;
What is conduction? Nursing interventions?
body heat transferred to cooler surfaces and objects that are in direst contact with infant.
What is cold stress? Nursing actions?
excessive heat loss--> hypothermia --> increase in O2 consumption, depletion of glucose and a decrease in surfactant which --> respiratory stress
What is considered hemoconcentrated in newborns?
Hemoglobin 14-20gm/dL and hematocrit 43-63%
What does blood volume depend on?
Age: term infant has ~ 80ml/kg; total amount of blood in infant after birth influenced by amount of placental transfusion after birth
Cord clamping: increases amount of blood in infant if delayed until pulsing stops
Milking of cord: increases amount of blood in infant
Neonatal height: infant held below level of placenta after birth can increase amount of blood in infant
Metabolic system. There is a large amount of glucose stored by fetus before birth. When does glucose drop? stabilize?
glucose levels drop within first hour of life
glucose levels stabilize by 2-3 hours after birth
What is the optimal range for glucose? What is considered hypoglycemia?
optimal range: 70-100 mg/dL
How much of the abdomen does the liver occupy in the newborn? What are the functions of the liver?
liver occupies 40% of abdominal cavity.
Functions include: x
amino acid and lipid metabolism
synthesis of plasma proteins
conjugation of bilirubin
phagocytosis by Kupffer cells (macrophages)
storgae of fat-soluble vitamins
The liver metabolizes carbs; what does it do with glucose?
converts excess glucose to glycogen; storage of glycogen is 2x that of an adult; converts glycogen to glucose when blood glucose levels are low
Liver stores fat soluable vitamins such as?
For how long is pancreatic amylase lacking? what does it do? When is GI system mature? Why are proteins easier to digest than fats? Why can anoxia cause meconium in amniotic fluid?
1st few months
GI system is mature @ 36-38 weeks
Proteins are easier digested than fats due to poor activity of pancreatic lipase
anoxia stimulates peristalsis
What is the stomach capacity initially? By day 7? When can Bowel sounds be heard? how many calories a day does a newborn need to gain weight? What % of weight loss in first few days is considered normal?
by day 5: 60mL
(cardiac sphincter is immature)
Bowel sounds: 30-60 minutes
in order to gain weight: 120/kcal/kg/day
Weight loss: of 5-10% is considered normal in first few days of life
What is the GFR in newborns? Why is it matter? What are the newborns at risk for due to GFR? When do most infants void by? What is pseudomenstruation and what causes it?
GFR in newborns: decreased
Decreased GFR: newborn is less able to concentrate urine put him at risk for over hydration, dehydration and electrolyte imbalance
Infants usually void by: 24 hours
Pseudomenstruation: Bloody vaginal discharge of newborn caused by withdrawal of maternal hormones
How do babies receive IgG? IgA? IgM?
IgG: Passive immunity; largest group which passes easily through placenta
IgA: does not cross placenta; newborns produce after 4 weeks of age; colostrum is high in igA
IgM: Active immunity; produced by fetus in response to antigen; elevated levels at birth may indicate exposure to an intrauterine infection
What are the implications to consider with immunologic adaption of the newborn?
signs and symptoms may be subtle
poor hypothalmic response to infection; therefore fever is not a reliable indicator
hypothermia may actually indicate infection
neurologic/sensory adaption. When is eye movement present? Growth is_________ which means what? What objects can the infant see? What colors does the infant prefer? What reflexes are present? What kind of movements of the extremities are seen?
Eye movements are present: at birth
Growth is: cephalocaudal
The infant is able to see: close objects
the infant prefers: black and white as well as human faces
The reflexes that are present: moro/startle, grasping, rooting, babinski, sucking, tonic neck
Movements: are purposeless, uncooridnated bilateral movements of extremities
newborn senses. How far can the infant see? Can the infant her? feel pain? taste? Smell?
Vision: 10-12 inches (orientation alert infant able to follow and fixate on complex visual stimuli)
Hearing: able to hear
Touch: feels pain
Taste: able to differentiate taste by 1-2 days of life
Smell: can pick out own mom by 1 week
What is lanugo? vernix caseosa? mongolian spots? milia? stork bites? Port-wine? Strawberry marks? Erythema toxicum?
Lanugo: dawny hair
Vernix: whitish substance to protect skin
mongolian spots: bluish discoloration on buttocks (usually present in african americans)
Strawberry marks: capillary hemangioma; raises, dark red rough surface; grows rapidly, reaching full size by 1-3 months and then begins to shrink and resolve spont
erythema toxicum: Appear suddenly; 24-48 hours of age; no treatment needed
Head. molding from delivery process. What is caput succedaneum? What is a Cephalhematoma? What is the function of the fontanels? How big is the head?
Caput succ: swelling of soft tissue of the scalp
Cephalhematoma: a collection of blood beneath the periosteum of the cranial bone; does not cross suture line
Fontanels: protect head during delivery and allow for further brain growth
The head: is 1/5 pf the infants height
The facial features are small
What is the tool used to determine gestational age? What is it based on?
Ballard scale; based on physical and neuromuscular characteristics
What is a circumcision? What is used for pain? What are the advantages to doing one? disadvantages? What is a gomco clamp? plastibell clamp? Mogen clamp?
It is the removal of the foreskin of penis.
Sucrose and a local anesthetic can be used for pain relief
Advantages: possible prevention of cancer, fewer UTIs; fewer STDs
Disadvantages: infection; hemorrage
Gomco: a clamp used for the procedure; penis is wrapped with gauze; observe for bleeding, infection and trauma
plastibell: foreskin is tied over a fitted plastic ring; rim falls off in 5-8 days
mogen: used by trained rabbi
What are the aspects of newborn care?
initiation of feeding: breast asap
parent infant bonding
What is the newborn discharge teaching?
car seat safety
What types are screening are state mandated?
screening for disorders that have therapy that can prevent many if not all of the disabilities that would result if let untreated;
Which screenings are required in PA?
Congenital Adrenal Hyperplasia: defect in an enzyme that lead to dehydration, shock and death