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Admission procedures for newbron
- review history
- Charting, L& D, Newborn Record (nurse)
- Initial assessment (nurse)
- Parent-infant interaction (nurse)
- Weight in grams and pounds
- Obtain vitals
- If at risk- hematocrit and bg
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How to maintain neutral thermal enviornment
- dry off and discard wet linens
- provide warmth
- skin to skin
- hat
- radient warmer
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Comprehensive assessment done when
first 4 hours
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When is the ideal time to breast feed?
after delivery because baby is alert
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Early breast feeding is especially important for
infants at risk for hypoglycemia
make sure infant is stable first
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When are formula fed babies usually fed?
by about 5 hours of age
early if at risk for hypoglycemia
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What should baby be dressed in after birth
Recommend to parents to dress infant in one more layer of clothing than adults in a comforable room
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If infants are overheat they are at increased risk for
crib death
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A cold baby can be at risk for
respiratory disress due to increased oxygen use
jaundice
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If newborn temperature drops below 97
place back in radient warmer
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how much to formula fed infants eat and when?
25-35 mL/3 hrs during the first 48 hrs
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Infants are ___________ in the first 24-48 hrs
sleepy
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first void when?
first stool?
- within 24 hrs
- within 48 hours
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weight should be taken when?
how much weight loss normal?
same time, every day
No more than 10%
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Spitting of ________ common in first 48 hrs
clear mucous
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Meconium
- sticky, thick, green
- normal passage in 48 hrs
- breast feeding stools looser than formula
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After 48 hours, breast fed stools vs formula
- formula green seedy
- breast fed yellow seedy
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Danger signs for hydration and nutrition
- failure to pass meconium
- abdominal distention
- bilious vomiting
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Danger signs for Umbilical cord
- bleeding
- drainage ( may be urine )
- Omphalitis
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Omphalitis
- umbilical infection
- redness
- foul smell
- induration
- can be fatal
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What is included on the ID band
- dr name
- dob
- time
- mothers name
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what is the only exercise a newborn gets
crying
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________ must be done before circumcison
vit k
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Advantages of circ
- Easy to care for
- perceived as normal in society
- desire to have infant appear same as father or sibling
- prevent trauma if necessary later in life
- possibly may decrease penile cancer
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After Gomco or Mogan
- Wrap penis in vasaline gauze
- apply vaseline to diaper for first 24 hrs
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after care for plastibell
- keep dry and clean
- no special care
- allow bell to fall off on its own (about a week)
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dont retract foreskin until
3-5 years old for baths
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Infant cannot leave hospital without
- metabolic screening
- state required
- multiple screans
- special training
- must have screen done on full feedings, off iv fluids
- results after 14 days
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Hearing screening is or is not state mandadited
- state mandated
- Can not leave without it
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if hearing screen is abnormal
BAER after discharge
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Critical Congenital Heart disease
- state law
- Must be done prior to discharge
- should be done after 24 hours
- must be off oxygen
- Done using pulse ox
- pass/fail
- if fails, obtain echo
- not necessary if infant had an echo
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SGA
- hypothermia
- hypoglycemia
- delays in growth and development
- polycythemia
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LGA
- hypoglycemia
- poor feeding
- traumatic injury
- jaundice
-
ideal place for assessment
in room, nursery
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1st glance assessment
- skin color
- muscle tone
- behavior state
- remove clothing- radient warmer ideal
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bili must be ______ to see jaundice
>6
-
-
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acrocyanosis is seen in _____________
hands and feet
normal
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harlequin sign
normal- line below midline and one side is pink, one side is pale
abnormal- if line transverse and upper body pink, lower body pale (serious heart disease)
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melanor pustulosis
slightly pigmented stpots when rubbed off
normal
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milia
raise wite spots on the face
no treatment necessary
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mottling
lacy pattern of dilated blood vessels
may be r/t cold, poor perfusion, apnea, sepsis
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blueberry muffin baby
- cytomegalic virus (CMV
- profuse petechia
- jaundice
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bathing trunk nevus
abnormal
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erythema toxicum
firm, yellow/whit papule of pustules
normal
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forcep marks
reddened areas over cheeks, jaws, eyes
disappear within 1-2 days
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port wine stain
associated with sturge-webber syndrome
delayed development and trigeminal nerve damage
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stork bites
pale, pink/red spots found on eyelids, nose, lower occiptial, and nape of neck
normal
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strawberry marks
- hemangioma
- raised, dark red, rough-surfaced birth mark
normal
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mongolian spots
bluish black or gray-blue spots found on back and butt
common in hispanics and blacks
normal
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cafe au lait spots
coffee colored spots
normal
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sucking blisters
blisters on lips, fingers or hands
normal
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collodion baby
epidermis bullosa
skin peels off when touched
BURN PRECATIONS!
abnormal
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Candid diaper rash
scattered leasions on diaper area
takes 1-2 wees to develop
abnormal
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if >6 cafe au lait spots
neurofibromatosis
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herpes lesions
several blisters
not on hands
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Head
- 1/4 size of adult head
- anterior and posterior fontanel
- molding-change in skull shape d/t overlapping sutures
caput-generalized head edema (under scalp)
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subgaleal hemorrhage
mushy at first then feels like a water balloon
- measure head circumferance every 8-12 hours
- serial H&H
abnormal
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cephalohematoma
bleeding b/w cranial bones and periostium
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Cutis aplasia
punched out place in head
associated with trisomy 21
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Epstein pearls
small glistening white specks that feel hard to the touch on hard palate and gums
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choanal atresia
blue at rest and pink white crying
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nose
- fairly flat
- obligat nose breathers
- can smell
- frequent sneezing
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eyes normal
- iris blue
- clear drainage in 1st day
- conjunctival hemmorhages
- sclera= white or bluish
- stabismus common
red light reflex
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Upward slanted palpebral fissures-epicanthal folds indicitave of
down syndrome
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downward slanted palpebral fissues
- aperts syndrome
- associated with cranial bone malformations
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ears should be
same level as eyes
open canal
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crepitus in clavicles meansq
their broken
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torticollis
neck to one side
means damage to sternocladomastoid muscle
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webbed neck
turner syndrome or inbreeding
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normal breathing pattern
30-60 bpm
diaphragmatic
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Chest
- symmetrical
- flexible ribs
- protrusion of lower end of sternum common
- engourged breast common
-
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murmurs common in ____ of all newborns
50%
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Abnormal chest
- retractions
- expiratory grunting
- nasal flaring
- increased AP chest diameter
- Rales/rhonchi (except within first hour of life)
- stridor
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diaphragmatic hernia
life threatening
intubate and OG suction
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Absent s2 sound
heart disease
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Bounding pericardium against chest
heart working overtime
patent ductus arteriosis
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upper and lower extremity pulses not equal
think heart disease
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overall weak pulses
shock
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absent pulses
hypoplastic left heart
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no LE pulses
coartation of aorta
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bounding pulses
patent ductus arteriosis
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Do not palpate what kind of mass
abdominal
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umbilical cord will fall off when
7-10 days
granulated tissue may form (normal)
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if umblicial cord has only one artery
renal anamoly
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where to take pulses
- upper- brachial
- lower- fem or posterior tib
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Liver
1-2 cm below the RCM
-
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normal genitalia girls
- rust, brick colored urine (uric acid crystals)
- vaginal or hymenal tag
- white mucous, blood streaked
- edematous at birth
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Abnormal geitalia girls
- bulging mass
- enlarged clitorus
- labial fusion
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do not circ a boy who has a
hypospadias
- Put sign on chart in red
- Put note on crib
- Explain to mother/father
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Testicular torsion
- twists on spermatic cord
- surgerical emergency
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Hydrocele
sac of fluid, lights up with transiliumination
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Ambiguous genitalia
say sex organs are not fully developed
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polydactyly next to thumb
next to pinky
chromosomal abnormalities
familial. String
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Syndactyly
webbing of fingers/toes
uncommon in fingers
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brachial palsy
partial/complete paralysis of arm
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Erb's palsy
- damage to upper arm
- usually resolves with PT
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single palmer crease
famililal
r/t trisomy 21
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rock bottom feet
- heel round like rocker
- trisomy 18
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Barlow
push legs together and down
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tuft of hair on sacral dimple
- get US for tethered cord
- sinus tract to spinal canal
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jitteriness
movement stops with passive flexion and typically seen with stimulation
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seizures
movement continues despite passive flexion and not caused by stimulation
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habituation
stop responding to repeated stimuli
normal
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neuromuscular
- can turn to voices
- can follow with eyes
- can see 6-12 inches
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Late preterm
34-36.6 weeks
increased long term handicaps- neuro, cerebral palsy, behavioral
increased infant mortality 3x
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