Mod 4 Chapter 18

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Mod 4 Chapter 18
2011-04-23 18:41:32

Nursing Management of the newborn
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  1. Healthy People 2010
    • Increase the proportion of mothers who breast-feed their babies during the early postpartum period from a baseline of 64% to 75%
    • Increase the proportion of mothers who breast-feed at 6 months from a baseline of 29% to 50%
    • Increase the proportion of mothers who breast-feed at 1 year from a baseline of 16% to 25%
    • Ensure appropriate newborn bloodspot screening, newborn hearing screening, follow-testing, and referral services.
    • Ensure that all newborns are screened at birth for conditions mandated by their state-sponsored newborn screening programs
    • Ensure that follow-up diagnostic testing for screening positives is performed within an appropriate time period.
  2. Newborn assessments
    • First one completed in the birthing area
    • Second one within 2-4 hours of birth
    • Third before discharge
  3. Signs that might indicate a problem in a newborn assessment.
    • nasal flaring
    • Chest retractions
    • Grunting on exhalation
    • labored breathing
    • Generalized cyanosis
    • Abnormal breath sounds: rhonchi, creackles (rales), wheezing, stridor
    • Abnormal respiratory rates (tachypnea, more than 60 breaths/min; bradypnea, less than 25 breaths/min)
    • Flaccid body posture
    • abnormal heart rates (tachycardia, more than 160 bpm; bradycardia, less than 100 bpm)
    • Abnormal newborn size: small or large for gestational age
  4. Apgar score
    • Used to evaluate newborns at 1 min and 5 min after birth
    • A- appearance
    • P- pulse (heart rate)
    • G- grimace (reflex irritability)
    • A- activity (muscle tone)
    • R- respiratory (respiratory effort)
  5. When the newborn experiences physiologic depression, the apgar score characteristics disappear in what order?
    • 1 the pink coloration is lost
    • 2 the respiratory effort
    • 3 the tone
    • 4 reflex irritability
    • 5 heart rate
  6. What is the expected length of a full term newborn ?
    48-53 cm (19-21 inches)
  7. What is the typical newborn birth weight?
    • 2,700 to 4,000 g (6-9 lbs.)
    • less than 10% or more than 90% outside of normal range requires further investigation
  8. Newborns classified by birthweight regardless on gestational age.
    • Low birthweight: <2,500g (<5.5 lb)
    • Very low birthweight: <1,500g (<3.4 lb)
    • Extremely low birthweight: <1,000g (<2.5 lb.)
  9. How often is HR and RR assessed in the newborn?
    Q30 min until stable for 2 hours. Once stable, Q8 hours
  10. How often is temp assessed in the newborn?
    Q30 mins until stable for 2 hours. Then Q8 hours until discharge.
  11. If blood pressure needs to be assessed what equipment is used and what is the typical range for a newborn?
    Oscillometer (Dinamap) and range is 50-75 mm Hg (systolic) and 30-45 mmHg (diastolic).
  12. Crying, moving, and late clamping of the umbilical cord will increase systolic pressure.
  13. What tool is used to determine the gestational age of a newborn?
    Dubowitz/Ballard or New Ballard Score system

    low score of -1 point or -2 points for extreme immaturity to 4 or 5 points for postmaturity
  14. Physical maturity examination is done how soon after birth?
    within the first 2 hours
  15. The areas assessed on the physical maturity examination include:
    • skin texture- sticky to transparent to smooth, peeling and cracking, parchmentlike or leathery with significant cracking and wrinkling.
    • Lanugo- soft downy hair on body
    • Plantar creases-greater number on creases the greater maturity
    • Breast tissue- thickness and size of breast tissue and areola
    • Eyes and ears- lids fused or open and ear cartilage and stiffness determine the degree of maturity
    • genitals- males, testicular descent and appearance of scrotum (from smooth to rugae covered); females, appearance and size of clitoris and labia (prominant clitoris w/ flat labia suggests prematurity, clitoris covered by labia suggests greater maturity)
  16. Neuromuscular maturity assessment is completed within 24 hours of birth and includes:
    • Posture- greater degree of flexion, greater degree of maturity
    • Square window- degree the hands can be flexed towards the wrists, as angle decreases, maturity increases
    • Arm recoil-degree of arm flexion and the strength of recoil
    • Popliteal angle- extended knees; an angle less than 90 degrees indicates greater maturity
    • Scarf sign-elbows movement across chest; an albow that does not reach midline indicates greater maturity
    • Heel to ear-can feet be moved to the ears; the lesser the ability, the greater the maturity
  17. Gestational classifications
    • Preterm or premature- born before 37 weeks gestation, regardless of birthweight
    • Term - born between 38 and 42 weeks' gestation
    • Postterm or Postdates - born after completion of week 42 of gestation
    • Postmature - born after 42 and demonstrating signs of placental aging
  18. Nursing intervention for helping infant transition.
    • maintaining airway patency
    • ensuring proper identification
    • administering prescribed medications
    • maintaining thermoregulation
  19. How soon after birth should a picture be taken of the newborn for safety reasons?
    within 2 hours