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What four factors are thought to stimulate a baby's first breath?
- 1. Passage through the birth canal fosters removal of fluid from lungs + throat, chest recoil = taking in of air, air expulsion = ^ pressure within the chest = alveoli open
- 2. Chemical stimuli = ^ pco2 & decrease in O2 triggers resp center
- 3. Thermal Stimuli = decrease in enviornment temp = skin stimulation = rhythmic breathing
- 4. Sensory stimuli = Tactile (thorough drying), auditory & visual
What are 4 anatomic and physiologic changes that occur in the cardio sys. during tansition from fetal to neonatal circulation?
- ^ in aortic preasure decrease in venous pressure from the loss of the placenta
- ^ systemic pressure decrease pulmonary artery pressure from decreased pulmonary circulatory resistance & vasodilation
- closure of ducts venous and formen ovale
- closure of the ductus arterious which ^ blood flow in pulmonary vascular sys
Physiologic Jaundice appears when and why?
appears on the 2nd or 3rd day due to the breakdown of RBCs and the liver's decreased ability to excrete billirubin in the blood and fatty tissue under the skin, usually gone by the 10th or 14th day
Pathologic Jaundice appears when and why?
- within the 1st 24hrs of life most commonly associated with
- blood type or group incompatability
- hepatic or metabolic abnormalities
what is the normal respiratory rate for a new born?
30-60 breaths per min
what is the normal hear rate of a new born?
What order does the new born's senses proceed?
A new born is placed on a cool plastic sclae and her temp drops why?
because of conduction
What time period is most appropriate for the RN to initiate breastfeeding?
The 1st period of reactivity
A primary RN intervention in the 2nd period of reactivity would be to?
auscultate the abd. for the presence of bowl sounds
What is a normal temp for a new born?
97.5-99 deg. F
What is a normal bp for a new born?
What is a normal weight for a new born?
7 lbs 8oz or 3405 g
Usual weight loss the first 3-4 days of life for a full term NB?
Why does the NB commonly exhibit a physiologic weight loss?
This is due to sm. fluid intake, increased vol. of meconium stooling, fluid shifts, ^ urination
A NB's head circ. is 34 cm and chest circ. is 32 cm, what RN action would be appropriate?
Measure the occipitofrontal circ. daily
Normal length of NB?
50cm range 45-55 cm
The mother of a NB ?s the RN about the rash on the neck and chest of her 24hr old NB, the lesions are discrete, 2mm, white papules on a pink base. What term would the RN use to define this finding?
Which statement best defines a cephalhematoma?
Subperiosteal hemorrhage from a traumatic birth
Signs of Respiratory distress in a NB are?
- Nasal flaring
- Intercostal or xiphoid retractions
- expiratory grunting/sighing
- seesaw respirations
An RN notices when the bassinette is bumped the NB extends his arms with fingers forming a C shape, how would the RN document this finding?
As Moro reflex
The RN tests the NB's Babinski reflex by doing what?
Stroking the lateral aspect of the sole from the heel upward and across the ball of the foot
Identify protective reflexes found in all normal NBs
Yawn, blink, cough/sneeze, gag, withdrawal from painful stimuli
Why are the NB's hands + feet norm. cold?
B/c of decreased peripheral circulation = acrocyanosis
Setting sun eyes
Head Circumfrence < 90% on growth chart
- Assess presence of hydrocephalus, measure & plot occipital/frontal baseline measurements, then measure head circumfrence once a day
- Check fontanelle for bulging & sutures for widening
- Assisst with head ultrasound & transillumination
- Maintain skin integrity; change position freq.
- Use sheepskin pillow under head
- Watch for S&S of infecction
- Provide nutrition, may need special nipple
- Burp freq
- clean cleft with sterile water
- support parental coping/assisst with grief of loss of idealized baby
- encourage veralization of feelings aboutNB's defect
- provide role model in interacting with NB
- Prevent aspiration/infection
- place prone or in side lying position
- suction nasopharyngeal cavity
- Feed in ^right position w/head and chest tilted slightly back may need special nipple
- Clean mouth w/water after feedings
- Provide support to parents
- Encourage verbalization of frustrations/disappointments
- Praise parental efforts
- Teach parents ways to decrease URI
- Encourage promt treatment for URI
Vitamin K is given to the NB why?
Due to low levels of Vitamin K which create a blood coagulation deficiency. 1mg is given IM
Which site is most appropriate when administering Vitamin K?
Prophylactic eye ointments are used in the NB's eyes to prevent?
Opthalmic neonatorum caused by Neisseria gonorrhoeae
Two common ointments used are?
erythromycin & tetracycline
Central Hematocrit of 68% what needs done?
this is polycythemia fluids need to be increased
Hemoglobin of 12.5 g/dL
this anemia and RN should observe for resp. distress
Bilirubin of 15 mg/dL
Jaundice RN should assess need for phototherapy
Heel stick glucose <45mg%
Hypoglycemia RN should observe for jitteryness, temp instability and initiate early feeding (breast or glucose H2O)
When ascultating the chest of a preterm infant the RN hears crackles & a continous systolic murmur with clicks at the base of the heart The RN should suspect prescense of?
A patent ductus arteriosus
If an infant experiences an apneic episode the 1st RN activity should be?
apply gentle tactile stimulation