amie bedgood rn, msn fall 2012. what is this? why is it necessary? when is it formed?
TRANSCRIPT
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