Amie Bedgood RN, MSNFall 2012

What is this?Why is it necessary?When is it formed?

InitiationInitiation ofof BreathingBreathing

Mechanical

Chemical

Thermal

Sensory

Mechanical – chest recoilChemical- respiratory acidosisThermal- decrease in environmental

tempSensory- tactile, auditory, and visual

influences stimulate activation of the first breath

Ductus arteriosus- blood flow from pulmonary artery to aorta

Ductus venosus-blood flow from umbilical vein into the inferior vena cava

Foramen ovale- blood flow from right atrium to left atrium

Ductus arteriosus- closes after birth triggered by pressure changes and pO2

(transient murmurs normal in first 24 hours)

Ductus venosus- closes at clamping of umbilical cord

Foramen ovale- closes at first breath

Increased aortic pressure and decreased venous pressure (clamping of cord)

Systemic pressure and pulmonary artery pressure (expanding of the lungs)

Closure of foramen ovale (atrial pressure

changes) Closure of ductus arteriosus (PO2 triggers constriction of ductus arteriosus) Closure of ductus venosus (clamping of cord)

Contributing factors to neonatal heat loss Size Loss of heat source Loss of glucose supply Metabolic rate

Convection Radiation Evaporation Conduction

How does the NB maintain body temperature?

Basal metabolic rateMuscular activityNon-shivering thermogenesis

(NST)

Why is heat regulation vital to the neonate’s survival?

What nursing interventions assist the neonate to maintain adequate thermoregulation?

Lifespan of neonatal RBC:80-100 days (2/3 lifespan of adult’s RBC)

What factors will effect the newborns blood volume?

Hemoglobin 14-20g/dlHematocrit 48-69%WBC 10,000 – 30,000mm3Glucose 40-60mg/dl first 24 hr

then 50-90mg/dlLow blood sugar 40-45mg/dl requires

treatment

Why is Vitamin K AquaMEPHYTON ®

administered to the newborn?

What is the significance of meconium?

What is the priority nursing intervention regarding GI assessment?

PHYSIOLOGIC JAUNDICE

Differences in life span of RBC

Immaturity of liver No pathology involved

PATHOLOGIC JAUNDICE

Pathology involved Birth trauma Blood type

incompatabilties

Bilirubin levels for a term NB<3mg/dl

Elevated bilirubin levels depend on NB’s age- peak levels reached between day 3 and 5 in the term infant.

Toxic levels approximately – 20mg/dl

Maintain NB’s core temperature

Monitor stool frequency and characteristics

Encourage early feeding

Encourage bowel elimination

Prevent dehydration

What is the normal number of voids in a 24 hour period? For first 48 hours- 1 or 2 daily Following 48 hours- 6 times daily

What is brick-dust staining?

Active acquired immunity- the mother forms antibodies in response to illness or immunization – passed through breast milk

Passive acquired immunity- transfer of immunoglobulins to the fetus in utero (IgG production begins at 20 weeks gestation)

Sleep States: Deep or quiet sleep Active or REM sleep

Alert States: Drowsy Wide awake Active awake Crying

Which of the behavioral states is optimal for maternal-infant bonding?

VisualAuditoryOlfactoryTasteTactile

Sign 0 1 2Heart rate Absent Slow-below

100Above 100

Respiratory effort

Absent Slow- irregular

Good Crying

Muscle tone

Flaccid Some flexion of

extremities

Active motion

Reflex irritability

None Grimace Vigorous cry

Color Pale blue Body pink, blue

extremities

Completely pink

0-3 poor condition

4-6 fair condition

7-10 positive (good condition)

What measures should the nurse take to ensure a patent airway in the NB?

Why is it important to maintain a neutral thermal environment?

What nursing interventions assist to maintain the NB’s core temp? (prevent cold stress)

Pulse

Respirations

Temperature

Blood pressure

WeightLengthFOC

Which measurement is priority for on-going assessment?

Fontanelles Anterior Posterior

Suturelines Frontal Coronal Sagittal Lambdoidal

Molding

Caput succedaneum

Cephalhematoma

EyesEarsMouthWhat is the significance of variations? (nursing interventions)

ColorSizeReaction to light/blinkConjunctival hemorrhagesTransient strabismus or nystagmus

LevelShape/ malformation FlexibilityWhat body system must the nurse

carefully monitor if anomalies occur with the ears?

LipsPalate HydrationReflexesAdditional normal findings:

Epstein’s pearls Precocious teeth Short fernulum of tongue

How many vessels will you find in the umbilical cord? ___ Arteries ___ Veins

What is Wharton’s jelly?

What is the general shapeWhat is the ratio of FOC to

abdominal size?What organs must be assessed in

the abdomen?

UpperHands

LowerHipsFeet

Moro or Startle

Palmer grasp

Rooting

Sucking

Babinski

Plantar grasp

Tonic neck

Stepping

Female Labia Clitoris Vaginal opening

▪ Hymeneal tag▪ Secretions

Anal opening

Male Penis

▪ Penial raphe▪ Urethral meatus

Scrotum-testes Anus

Color and thicknessBirthmarks

Harlequin signJaundice

AcrocyonosisMottling Erythema toxicumVernix caseosaTelangiectatic neviMongolian spots- Why is it important

to carefully document these birth marks?

Neuromuscular and physical maturity

Newborn Maturity Rating & Classification Dubowitz tool Ballard Score

Posture, reflexes, size, skin characteristics and fat distribution

Dubowitz scaleBallard score Neuromuscular maturity- posture, square window (wrist)

arm recoil, popliteal angle, scarf sign, heal to ear maneuver Physical maturity- skin condition, lanugo, plantar surface,

breast buds, earl and genital development.

Administered within 1 to 2 hours of birth

AquaMEPHYTON ®- vitamin K

Erythromycin ointment When is best time to administer?

Footprints

Identification bands Newborn Mother Designated “other”

What factors are involved in the parent’s decision to have their male newborn circumcised?

What assessments/ care must the nurse include after circumcision?

“The American Academy of Pediatrics (AAP) believes that circumcision has potential medical benefits and advantages, as well as risks. The existing scientific evidence is not sufficient to recommend routine circumcision. Therefore, because the procedure is not essential to a child’s current well-being, we recommend that the decision to circumcise is one best made by parents in consultation with their pediatrician, taking into account what is in the best interests of the child, including medical, religious, cultural, and ethnic traditions.

http://www.aap.org/en-us/search/pages/results.aspx?k=stance%20on%20circumcision

Informed consentComfort measuresRisk of ______? Infection preventionParent teaching and discharge

planning

Safety Elimination Genitalia care General Feeding Signs of illness NB behavior Immunization schedule Return appointment schedule