Newborn Adaptations
Normal heart rate
What is 110-160
Signs/ symptoms of PPD
What is:
- manifests over 2-3 months
- depressed mood
- loss of interest in activities
- feeling guilty or incompetent as a parent
- sleep disturbances
- appetite changes
- possible suicidal thoughts
- mental health professional should evaluate client
- Tx: psychotherapy, cognitive behavioral therapy, antidepressants
What is:
Tachypnea
Nasal flaring
Grunting
Retractions
Increased respiratory effort
Central cyanosis
Hypoxia
Decreased cap refill
Crackles
Causes of Hyperbilirubemia
ABO Incompatibility
RH incompatibility
Trauma (from birth)
Inadequate feeding
Result of newborn immature liver function
Stages of lochia, in order
What is: Rubra, serosa, alba
Expected respiratory rate
What is 30-60
Plastic-bell circumcision care / general circ care instructions
For Plastic-bell... What is:
- Allow the plastic ring to fall off by itself in about 5 to 8 days.
- We actually *dont* want or need to use petroleum jelly with this technique
General circ care... What is:
- Petroleum jelly
- healing process: redness at first, then small amount of exudate and scab
- 7-10 days to heal
- loose diaper
- avoid soap or wipes in reduce risk of irritation
- we should never see active bleeding; hold pressure and call provider if this is noticed
What are nursing interventions for MAS (meconium aspiration syndrome?)
clear the airway
mouth-then-nose suctioning
stimulation, resuscitation as needed
provide respiratory support
Newborn signs/symptoms of hypoglycemia
What is:
Jitters
Lethargy
Poor sucking reflex
Weak cry
Hypotonia
Seizures
Coma
Respiratory distress
Cyanosis
Expected bloodwork changes in the postpartum period
- slight decrease in H&H (hemoglobin 11-16, hematocrit 33-47)
- increased WBC (25,000)
- decreased insulin/ glucose
- fibrinogen/ clotting factors remain slightly elevates
- expected hemodilution
- immediate PP diuresis and diaphoresis contributes to decreased blood volume
Nursing measures to promote thermoregulation
What is:
Immediate drying after birth
Skin-to-skin contact with parent
Swaddling in warm blankets
Monitoring for temperature drops, especially within the first 20 minutes
Instructions for effective breastfeeding/ proper latch
What is:
lips around the nipple with most of the areola near the lower lip.
abdomen should be flat against the mother's body
wide mouth (the size of a large yawn).
Put the newborn’s chin under the breast (or, nipple on top of nose), and wait for the newborn to latch the nipple.
Bring the newborn to the nipple (not the nipple to the newborn).
newborn’s nose should be free.
There should be no pain.
Nursing considerations for spina bifida
What is:
- prone position
- moist sterile covering over sac
- no diapers to reduce risk of infection
- maintain sterility
- surgery within 24-72 hours
- assess for hydrocephalus, ICP, musculoskeletal impairments
Clinical manifestations of a newborn born to a mother with substance use
What is:
Mottled skin
Excessive crying or high-pitched cry
Irritability
Hyperactive reflexes
Hypertonia
Tachypnea
Sleep problems
Inability to self regulate
Feeding issues
Seizures
Involution of the uterus process
What is:
- During the involution process: oxytocin is released due to the separation and expulsion of the placenta, the contraction of the uterus continues, and in response to breastfeeding, further reducing the size of the uterus.
- 12 hours postpartum the fundus rises to at or below the umbilicus.
- The uterus decreases in size by about 1 cm per day
- should no longer be palpable by the end of 2 weeks postpartum
- expected findings: Fundus should be firm, nontender, globular, and located between symphysis pubis and umbilicus.
3 Newborn medications and purpose of them:
What is:
- Vitamin K (prevents excessive bleeding in a newborn due to lack of clotting factors from an immature liver)
- erythromycin ointment (protects against eye infections)
- Hep B (start of 3 dose series for immunity against Hep B)
Topics for newborn discharge teaching
What is:
- safe sleep
- car seat safety
- bath safety and hygiene guidelines
- umbilical cord care
- circ. care
definition of PKU & important education for parents regarding this newborn test
What is:
PKU testing is one component of the universal newborn screening offered to all newborns the U.S., which screens for up to 50 disorders.
Heel stick performed between 24-48 hrs of life
Nursing interventions for phototherapy
What is:
The nurse places the newborn under lights, undresses them down to only a diaper, and provides protection for their eyes.
Perform frequent skin assessments for jaundice or skin breakdown in the diaper area, which can be caused by frequent loose stools that are common when bilirubin is excreted via stooling.
Check blood work to see if bilirubin numbers are decreasing! That is the best way to know if the phototherapy is working
TcB and Bilirubin levels are obtained routinely to monitor the newborn’s response to treatment.
Immunizations in Postpartum & reason for each of them:
What is:
- Rubella, Varicella (due to lack of immunity; live vaccines must be given outside of pregnancy; varicella given in 2 doses- in MBU and 4-8 weeks later)
-TDaP (protection for newborn against pertussis)
-RH Immunoglobulin: RH negative mothers receive to prevent antibody formation against their fetus's RH positive blood
Pain scale used for newborns
What is NIPS?
3 Stages of Maternal Role Attainment (and their definitions)
What is:
Stage 1. Taking In: the mom focuses on meeting her own needs and is reflecting on her birth experience (lasts about 48 hrs)
Stage 2. Taking Hold: the mom begins to focus on the newborn's needs as well as to recover from the birth
Stage 3. Letting Go: the mom is able to integrate their former selves into their new role as a parent
Purpose of corticosteroid for surfactant production
Corticosteroids, like betamethasone, are administered to accelerate maturation of the lungs and the production of surfactant.
Administered antenatally (2 doses, 24 hours apart)
Or could be administered to the newborn in NICU
Nursing interventions for newborn hypoglycemia:
What is:
Heel stick blood glucose - confirm hypoglycemia and decide treatment plan based on blood glucose result.
Early and frequent feeding to maintain blood glucose at 45 mg/dL or greater prior to feeding.
Oral glucose if prescribed
Pulse oximetry
Thermoregulation
2 nursing interventions for a boddy uterus:
What is:
- fundal massage
- emptying bladder