Apgar
Initial assessment of newborn's well being immediately after delivery
Apgar Score?
Normal respiration rate for newborns
Describe normal breathing efforts
30-60 respirations per minute
Irregular, shallow, periodic breathing (< 20secs), abdominal breathers, symmetrical chest movement
A new breastfeeding mother calls her pediatrician's office concerned about her 2 week old's stool. She state the stool is yellow in color, stringy and sometimes pasty in texture with a sour smell. You as the triage nurse would inform the patient...
This is a normal stool pattern for breastfed baby. Stools may be yellow to gold in color, loose, stringy, or pasty, and can have a sour smell.
By 1 week, the newborn should have how many voids per day
6 - 8 voids per day
When do the steps of neonatal resuscitation begin
At delivery of the newborn
Apgar scores at done at what time of life?
Points for each category range from ___ - ___
1 minute
5 minutes
10 minutes (If 5min apgar < 7)
Points range from 0 - 2 points
What 4 signs of respiratory distress in newborns
tachypnea/bradypnea, nasal flaring, chest retractions, grunting, labored breathing, abnormal breath sounds, cyanosis, apnea,
3 mechanisms in which jaundice can develop...
1. Overproduction
2. Decreased conjugation
3. Impaired excretion
1. A newborn is predominantly dependent on 3 immunoglobins
2. Which of the 3 make of 80% of all circulating antibodies in newborn
1. IgG (antibodies that comes from mom; only one able to cross placenta to fetus)
IgA (antibodies that comes from breastmilk especially colostrum)
IgM (antibodies that protect against blood borne pathogens)
2. IgG
What are the initial/routine steps of neonatal resuscitation? (Looking for 3 steps)
1. Provide warmth
2. Clear Airway
3. Dry
What does Apgar stand for?
A: Appearance (Color)
P: Pulse rate (Hear rate)
G: Grimace (reflex irritability)
A: Activity (muscle tone)
R. Respiratory (respiratory effort)
Normal Ranges for Newborn
1. Hgb
2. Hct
3. Plt
4. RBCs
5. WBCs
1. 17 - 20g/dl
2. 52%-63%
3. 100,000-300,000
4. 5.1-5.8
5. 10-30,000
Hepatic system in the newborn has 3 responsibilities?
1. Iron storage
2. Carbohydrate metabolism
3. Bilirubin conjugation
1. LGA newborn's is born to gestational diabetic mother at 0300. Mom plans on exclusively breastfeeding. She reports leaking of colostrum prior to delivery. Newborn blood sugar is checked 1 hr after life via heelstick and reads 35mg/dl. What would be your first nursing intervention?
2. Normal blood sugar for newborn in the first 24hrs of life is
1.Assist mom with breastfeeding
2. > 40mg/dl
After completing the initial steps of neonatal resuscitation, you note the heart rate to be 70bpm and weak, irregular respiratory effort. What are your next steps?
Provide PPV and Spo2 monitoring
4 factors that impact a newborn's Apgar score
infection, gestational age, maternal sedation from medications, labor management, neuromuscular disorders, congenital anomalies, physiologic immaturity
Define surfactant and it's purpose/importance in the newborn's respiratory system
Definition: surface tension-reducing lipoprotein found in the newborn's lungs.
Purpose:
- Prevent alveolar collapse at the end of expiration and loss of lung volume by lining the alveoli.
- Decrease surface tension to promote gas exchange
4 risk factors for developing jaundice are...
fetal-maternal blood incompatibility; prematurity; inadequate intake with breastfeeding; TORCH (toxoplasmosis, other viruses, rubella, cytomegalovirus, herpes); maternal gestational diabetes, medications including Pitocin, Diazepam/Valium, Erythromycin
The difference between natural immunity and acquired immunity
Natural immunity is mechanisms that dont require prior exposure to microorganisms. They include physical barrier like intact skin, and mucus membranes
Acquired immunity is the development of circulating antibodies or immunoglobins and formation of lymphocytes to destroy invaders. Acquired immunity does not exist until the invasion of first organism or toxin
Apgar scoring, weight, length, vital signs, determine gestational age based on assessment,
What is the Apgar Score?
8
Explain the cardiac and respiratory transition from fetus to newborn
Newborn transition from fluid filled intrauterine environment to gaseous extrauterine environment
1. Three types of newborn stool
1.Meconium is made up of _______, _______, _____ and ________
1. Meconium, Transition, Milk
2. amniotic fluid, mucosal cells, intestinal secretions, and blood
Neuromuscular: Posture, square window (wrist), arm recoil, popliteal angle, scarf sign, head to ear
Physical: skin, lanugo, plantar surface, breast, eye/ear, genitalia
__________ is a condition in which there is congenital absence of skin, with or without the absence of underlying structures such as bone. It most commonly affects the scalp, but any location of the body can be affected.
Aplasia cutis congenita