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Normal Newborn

Marlene Meador RN, MSN, CNE. Normal Newborn. Surfactant-. What is this? Why is it necessary? When is it formed?. Respiratory Changes. Mechanical. Chemical. Initiation of Breathing. Thermal. Sensory. Factors in Initial Respiration . Mechanical – chest recoil

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Normal Newborn

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  1. Marlene Meador RN, MSN, CNE Normal Newborn

  2. Surfactant- • What is this? • Why is it necessary? • When is it formed?

  3. Respiratory Changes Mechanical Chemical Initiation of Breathing Thermal Sensory

  4. Factors in Initial Respiration • Mechanical – chest recoil • Chemical- respiratory acidosis • Thermal- decrease in environmental temp • Sensory- tactile, auditory, and visual influences stimulate activation of the first breath

  5. Fetal Circulation (p246-247) 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

  6. Neonatal Circulation 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

  7. Cardiovascular/Cardiopulmonary Adaptations • 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)

  8. Thermoregulation

  9. Thermoregulation • Contributing factors to neonatal heat loss • Size • Loss of heat source • Loss of glucose supply • Metabolic rate

  10. Temperature Regulation • Convection • Radiation • Evaporation • Conduction How does the NB maintain body temperature?

  11. Neonatal methods of producing heat • Basal metabolic rate • Muscular activity • Non-shivering thermogenesis (NST) Why is heat regulation vital to the neonate’s survival?

  12. What nursing interventions assist the neonate to maintain adequate thermoregulation? • Drying • Swaddling (blankets) • Cap • Skin to skin contact (cuddling)

  13. Hematopoietic System Lifespan of neonatal RBC: 80-100 days (2/3 lifespan of adult’s RBC) Factors effecting blood volume: Delayed cord clamping Shift of plasma to extra-vascular spaces Gestational age Prenatal or postnatal hemorrhage

  14. Neonatal Lab Values (p498) • Hemoglobin 14-20g/dl • Hematocrit 48-69% • WBC 10,000 – 30,000mm3 • Glucose 40-60mg/dl first 24 hr then 50-90mg/dl • Low blood sugar 40-45mg/dl requires treatment

  15. Clinical judgment: Why is Vitamin K AquaMEPHYTON ® administered to the newborn?

  16. GI Function: • What is the significance of meconium? • What is the priority nursing intervention regarding GI assessment? Presence of bowel sounds and patency of the anus

  17. Hepatic Function • What is the function of the liver in the neonate? • What is physiologic jaundice? • What is the difference between conjugated and unconjugated bilirubin? • What is the long-term consequence of elevated bilirubin levels?

  18. Normal Lab Values • 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

  19. Nursing Interventions: to decrease physiologic jaundice • Maintain NB’s core temperature • Monitor stool frequency and characteristics • Encourage early feeding • Encourage bowel elimination • Prevent dehydration

  20. Urinary System of the NB • 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?

  21. Immunologic Adaptations: • 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)

  22. Behavioral States of the NBp. 665 & 872 CHART • Sleep States: • Deep or quiet sleep • Active or REM sleep • Alert States: • Drowsy • Wide awake • Active awake • Crying

  23. Critical thinking… • Which of the behavioral states is optimal for maternal-infant bonding?

  24. Senses in the Neonate: • Visual • Auditory • Olfactory • Taste • Tactile

  25. Apgar Scoring

  26. Apgar Score: assigned at 1 & 5 minutes.A score below 8 may require resuscitative efforts.

  27. Quick review! • 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)

  28. Assessment of the Neonate

  29. Vital Signs: • Pulse • Respirations • Temperature • Blood pressure

  30. Average size for term • Weight • Length • FOC • Which measurement is priority for on-going assessment?

  31. Assessment of NB skull/scalp • Fontanelles • Anterior • Posterior • Suturelines • Frontal • Coronal • Sagittal • Lambdoidal

  32. Assessing the Head: • Molding • Caput succedaneum • Cephalhematoma

  33. Assessing the Face: • Eyes • Ears • Mouth What is the significance of variations? (nursing interventions)

  34. Assessment of the NB’s Eyes: • Color • Size • Reaction to light/blink • Conjunctival hemorrhages • Transient strabismus or nystagmus

  35. Assessment of the NB’s ears: • Level • Shape/ malformation • Flexibility • What body system must the nurse carefully monitor if anomalies occur with the ears?

  36. Assessment of the NB’s mouth: • Lips • Palate • Hydration • Reflexes • Additional normal findings: • Epstein’s pearls • Precocious teeth • Short fernulum of tongue

  37. Why is it important to assess the umbilical stump? • How many vessels will you find in the umbilical cord? • ___ Arteries • ___ Veins • What is Wharton’s jelly? (p. 246)

  38. Assessment of the Abdomen • What is the general shape • What is the ratio of FOC to abdominal size? • What organs must be assessed in the abdomen?

  39. Extremities: • Upper • Hands • Lower • Hips • Feet

  40. Moro or Startle Palmer grasp Rooting Sucking Babinski Plantar grasp Tonic neck Neurological Assessment/ Reflexes

  41. Female Labia Clitoris Vaginal opening Hymeneal tag Secretions Anal opening Male Penis Penial raphe Urethral meatus Scrotum-testes Anus Assessing the genitalia of the NB:

  42. Skin Assessment: • Color and thickness • Birthmarks (telangiectatic nevi, flammeus, Mongolian) • Harlequin sign • Jaundice

  43. Assessment of NB skin • Acrocyonosis • Mottling • Erythema toxicum • Vernix caseosa • Telangiectatic nevi • Mongolian spots- Why is it important to carefully document these birth marks?

  44. Gestational Age: • Neuromuscular and physical maturity • Newborn Maturity Rating & Classification (P. 525) • Dubowitz tool • Ballard Score

  45. Gestational Age Assessment • Posture, reflexes, size, skin characteristics and fat distribution (pages 526-530) • Dubowitz scale • Ballard 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.

  46. Neonatal Medications • Administered within 1 to 2 hours of birth • AquaMEPHYTON ®- vitamin K • Erythromycin ointment • When is best time to administer?

  47. Newborn Identification • Footprints • Identification bands • Newborn • Mother • Designated “other”

  48. What would you include in a transfer of care report for the neonate to the transition nursery?

  49. What would you include in a transfer of care report for the neonate to the transition nursery? • Apgar scores • Resuscitative efforts • Time of birth, weight and length • Labor analgesia or anesthetic • L&D history • Maternal history

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