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HEART RATE averages 140 bmn BP 73/55 mmHg PERIPHERAL CIRCULATION acrocyanosis w/n 24H RBC high immediately after birth; falls after 1st wk ABSENCE /NORMAL FLORA INTESTINE vit K Slide 4: RESPIRATORY SYSTEM NORMAL RESPIRATORY RATE Chest and abdomen rise simultaneously. - no SEE-SAW BREATHING LECITHIN & SPINGOMYELIN N/B are obligate nose breathers. Slide 5: Urine present in the bladder at birth, but NB may not void for 1st 12-24 hours. Later pattern is 6-10 voidings/day - indicative of sufficient fluid intake. Urine is pale and straw colored. - initial voidings may leave brick-red spots on diaper (d/t passage of uric acid crystals in urine Infant unable to concentrate urine for the 1st 3 mos RENAL SYSTEM Slide 6: DIGESTIVE SYSTEM Hard palate should be intact, small raised white areas on the palate are normal. EPSTEIN’S PEARLS Newborn can’t move food from lips to pharynx. CIRCUMORAL PALLOR may appear while sucking. capable of digesting simple CHO and simple CHON but fats Immature Cardiac (esophageal) Sphincter Stomach capacity caries= 50-60 ml Feeding patterns Slide 7: FIRST STOOL is MECONIUM. - black, tarry residue from lower intestine. - usually passed within 12- 24 hours after birth. TRANSITIONAL STOOLS - thin, brownish green in color After 3 days MILK STOOLS are usually passed. a. MILK STOOLS for BF-INFANT - Loose and golden yellow b. MILK STOOLS for FORMULA-FED - Formed and pale yellow Slide 8: HEPATIC hgb … unconjugated bilirubin (< 12mg/dl), …conjugated (water-soluble) bilirubin..excreted Slide 9: TEMPERATURE HEAT PRODUCTION a. Metabolism of “BROWN FAT” Axillary temperature: 96. 8 to 99ºF NB can’t shiver as an adult does to release heat. NB’s body temp drops quickly after birth. - cold stress occurs easily. Body stabilizes temp in 8-10 hours if unstressed. Cold stress increases O2 consumption. - may lead to metabolic acidosis and respi distress. Slide 10: IMMUNOLOGIC IgG & Colostrum NB develops own antibodies during 1st 3 mos, but at risk for infection during first 6 weeks. Ability to develop antibodies develops sequentially. Slide 11: NEUROLOGIC / SENSORY SIX STATES OF CONSCIOUSNESS DEEP SLEEP LIGHT SLEEP DROWSY QUIET ALERT ACTIVE ALERT CRYING NEONATAL ASSESSMENT : NEONATAL ASSESSMENT Slide 13: WEIGHT normal= 2500 - 4300 g (5.5 to 9.5 lbs) at term. Initial loss of 5-10% of body weight - normal for the first few days - this should be regained in 1-2 weeks LENGTH Average 45.7-55.9 cm (18-22 in) CHEST CIRCUMFERENCE 30-33 cm (12-13 inches) should be equal to or 2-3 cm < head circumference Slide 14: 25% of the body length; circumference 33-37cm Bones of the skull are not fused Palpable sutures Fontanels Molding …Caput Succedaneum..Cephal Hematoma Masses from birth trauma *Re-measure after several days if significant molding or caput succedaneum present HEAD LAG HEAD Slide 15: EYES EARS NOSE MOUTH NECK Slide 16: CHEST Appears circular since AP and lateral diameters are about equal Respirations appear diaphragmatic Bronchial sounds heard on ausculation Nipples prominent and often edematus Milky secretion (Witch’s milk) common Clavicles need to be palpated to assess for fractures Slide 17: ABDOMEN UMBILICAL CORD 2. GASTROINTESTINAL 3. ANUS Slide 18: Pigmentation increases after birth Skin may be dry. ACROCYANOSIS Small amounts of lanugo and vernix caseosa still seen May develop “NEONATAL RASH” - (ERYTHEMA TOXICUM NEONATORUM) HARLEQUIN SIGN SKIN COLOR Slide 19: Testes descended or in inguinal canal. Rugae cover scrotum. Meatus at tip of penis. BREASTS Nodule of tissue present in breasts. FEMALE GENITALIA Vernix seen between labia Pseudomenstruatrion MALE GENITALIA Slide 20: Predominantly flexed. Occasional transient tremors of mouth & chin. Newborn can turn head from side to side in prone position. Needs head supported when held erect or lifted. LEGS Bowed No click or displacement of head of femur observed when hips flexed and abducted. FEET Flat Soles covered with creases in fully mature infant. MUSCLE TONE Slide 21: BIRTHMARKS Slide 22: TELANGIECTATIC NEVI (STORK BITES) NEVUS FLAMMEUS (PORT-WINE STAIN) NEVUS VASCULOSUS (STRAWBERRY MARK) MONGOLIAN SPOTS REFLEXES PRESENT at BIRTH : REFLEXES PRESENT at BIRTH ROOTING REFLEX : ROOTING REFLEX PALMAR-PLANTAR GRASP REFLEX : PALMAR-PLANTAR GRASP REFLEX Newborn’s fingers curl around the examiner’s fingers and the newborn’s toes curl downward. Palmar response lessens within 3-4 months Plantar response lessens within 8 months DARWINIAN REFLEX : DARWINIAN REFLEX MORO REFLEX : MORO REFLEX BAINSKI REFLEX : BAINSKI REFLEX SLEEPING OR WALKING REFLEX : SLEEPING OR WALKING REFLEX CRAWLING REFLEX : CRAWLING REFLEX Place the newborn on the abdomen The newborn begins making crawling movements with the arm and legs Reflex usually disappears after 6 weeks TONIC NECK/FENCING REFLEX : TONIC NECK/FENCING REFLEX CRY : CRY Loud and vigorous. Heard when infant is hungry, disturbed or uncomfortable. GESTATIONAL AGE ASSESSMENT : GESTATIONAL AGE ASSESSMENT Slide 34: Direct examination of the infant leads to an accurate assessment of maturity. SKIN thickens with gestational age may be dry/peeling if postmature LANUGO disappears as pregnancy progresses SOLE (PLANTAR) CREASES increase with gestational age (both depth & no.) Slide 35: AREOLA OF BREAST at term, 5-10 mm in diameter EAR CARTILAGES Cartilage stiffens, recoil increases, and curvature of pinna increases with advancing gestational age. GENITALIA Female, look for the labia majora to cover the labia minora and clitoris Male, check for descended testicles & scrotal rugae Slide 36: NEUROMUSCULAR ASSESSMENT - best done after 24 hours RESTING POSTURE Relaxed posture (extension) seen in the premature; Flexion increases with maturity SQUARE WINDOW ANGLE Flex hand onto underside of forearm, identify angle at which you feel resistance. Angle decreases with increasing gestational age. Slide 37: ARM RECOIL Flex infant’s arms, extend for 5 sec., then release. Note angle formed as arms recoil. Decreases with increasing gestational age. POPLITEAL ANGLE Place infant on back, extend one leg and measure angle at point of resistance. Angle becomes more acute as gestation progresses. Flex infant’s arms, extend for 5 sec., then release. Note angle formed as arms recoil. Decreases with increasing gestational age. Place infant on back, extend one leg and measure angle at point of resistance. Angle becomes more acute as gestation progresses. Slide 38: SCARF’S SIGN Draw one arm across chest until resistance is felt; note relation of elbow to midline of chest. Resistance increases with advancing gestational age. HEEL TO EAR Attempt to raise foot to ear, noting point at which foot slips from your grasp. Resistance increases with gestational age. INITIAL CARE OF THE NEWBORN : INITIAL CARE OF THE NEWBORN Slide 43: Observe and assist with initiation of respirations Assess Apgar score Note characteristics of cry Monitor for nasal flaring, grunting, retractions and abnormal respirations Obtain vital signs. Observe NB for signs of hypothermia or hyperthermia. ASSESSMENT Slide 44: Suction mouth, then nares with bulb syringe. Dry baby and stimulate crying by rubbing. Maintain temperature stability. Keep newborn with mother to facilitate bonding. Place newborn at mother’s breast if breastfeeding is planned or place on mother’s abdomen. Place newborn in a warmer. Position newborn on the side or abdomen or in modified Trendelenburg position to facilitate drainage of mucus. Ensure proper NB ID Footprint NB & fingerprint mother on ID sheet/ agency’s policies & procedures Place matching ID bracelets on mother & NB NURSING INTERVENTION Slide 45: APGAR SCORING SYSTEM Perform and record Apgar score at 1 min & at 5 mins. If the score is less than 7 at 5 mins., the Apgar score shld be perform at 10 mins. A score of 7-10 indicates a healthy newborn. A score of 3-6 is considered moderately depressed. A score of 0-2 is severely depressed. PRETERM NEWBORN : PRETERM NEWBORN respirations are irregular with periods of apnea body temp. is below normal poor suck and swallow reflexes diminished bowel sounds increased/decreased UO extremities thin w/ minimal creasing on soles & palms extends extremities & does not maintain flexion Lanugo present in wooly patches skin thin, with visible bld. vessels & minimal SQ fat pads skin may appear jaundiced testes undescended in boys labia narrow in girls CLINICAL FINDINGS POSTTERM NEWBORN : CLINICAL FINDINGS Hypoglycemia Parchment-like skin (dry & cracked) w/o lanugo Fingernails long & extended over ends of fingers profuse scalp hair body is long & thin extremities show wasting of fat & muscle meconium-staining may be present on nails & umbilical cord POSTTERM NEWBORN SMALL FOR GESTATIONAL AGE : SMALL FOR GESTATIONAL AGE CLINICAL FINDINGS Fetal distress Lowered or elevated body temperature Hypoglycemia Signs of polycythemia - ruddy appearance - cyanosis - jaundice Signs of infection Signs of aspiration of meconium LARGE FOR GESTATIONAL AGE : LARGE FOR GESTATIONAL AGE CLINICAL FINDINGS Gestational age Birth trauma or injury Respiratory distress Hypoglycemia HYPOGLYCEMIA : HYPOGLYCEMIA Abnormally low level of glucose in the blood (less than 30 mg/dl in the first 72 hours or below 45 mg/dl after the first 3 days of life Normal: 40-60 mg/dl in 1-day-old neonate 50-90 mg/dl in neonate older than 1 day CLINICAL FINDINGS Increased RR Twitching, nervousness, or tremors Unstable temp. Cyanosis NB OF DIABETIC MOTHER : NB OF DIABETIC MOTHER CLINICAL FINDINGS Excessive size and weight Edema or puffiness in the face & cheeks hypocalcemia, hyperbilirubenemia, hypoglycemia Signs of respiratory distress such as: -tachypnea - cyanosis - retractions - grunting - nasal flaring Slide 52: Tachypnea (RR >60 bpm) & increased apical pulse Flaring nares & expiratory grunting Retractions & chin lag Decreased activity level & elevated CO2 level in ABG Metabolic acidosis Decreased breath sounds Apnea Pallor & cyanosis Hypothermia & Poor muscle tone X-rays show atelectasis & high density in alveoli RESPIRATORY DISTRESS SYNDROME (RDS) Slide 53: HYPERBILIRUBINEMIA RENTROLENTAL FIBROPLASIA BRONCHOPULMONARY DYSPLASIA (BPD) - damage to alveolar epithelium of the lungs related to high O2 concentrations and positive ventilation. - may be difficult to wean infant from ventilator, but most recover & have normal x-rays at 6 months to 2 years. NECROTIZING ENTEROCOLITIS SEQUELA OF RDS Slide 54: Monitor for color, RR, degree of effort in breathing. Monitor ABG and O2 sat. levels q2-4H. Assess retinal damage. Position on side or back, w/ neck slightly hyper-extended CPAP or PEEP may be used Encourage as much parental participation in NB care Maintain infant temp @ 97.6’F (36.2’C) NURSING INTERVENTIONS HYPERBILIRUBINEMIA : HYPERBILIRUBINEMIA NURSING INTERVENTIONS Monitor for presence of jaundice. - examine the newborn’s skin color in natural light. - press fingers over bony prominence or tip of nose to press out capillary blood from the tissues - jaundice starts from head, chest abdomen arms & legs then hands and feet Keep newborn well hydrated to maintain bld. volume Facilitate early, frequent feeding. - hasten passage of meconium and encourage excretion of bilirubin Report jaundice to MD any signs of jaundice in the first 24 hours and any abnormal S/S. Prepare for phototherapy & monitor closely during treatment. PHOTOTHERAPY : Expose newborn’s skin as much as possible. Cover genital area & monitor for skin irritation/breakdown. Cover the eyes with eye shields or patches. Measure the quantity of light q8H Monitor skin temp closely. Increase fluids for compensate for water loss. Expect loose green stools & green urine. Monitor the skin color w/ florescent light turned off q4-8H Monitor for BRONZE BABY SYNDROME Reposition q2H Provide stimulation. Monitor for signs of hyperbilirubinemia PHOTOTHERAPY ERYTHROBLASTOSIS FETALIS : ERYTHROBLASTOSIS FETALIS Destruction of RBCs that result from Ag-Ab rxn hemolytic anemia/ hyperbilirubinemia Rh Incompatibility ABO incompatibility RH INCOMPATIBILTY : RH INCOMPATIBILTY In each pregnancy, an Rh(-) mother who carries an Rh (+) fetus receives Rhogam if both the mother and infant is (-) to both direct & indirect Coombs’ test. If mother is has been sensitized: anti-Rh(+) Ab are present - Rhogam is not indicated Rhogam must be injected into unsensitized mother’s system within 72 hours of delivery of Rh(+) infant ABO INCOMPATIBILTY : ABO INCOMPATIBILTY Reaction less severe than Rh incompatibility First born may be affected - mother may have anti-A & anti-B Ab even before pregnancy Fetal RBCs w/ A, B, or AB Ag evoke less severe reaction on part of mother - fewer anti-A, anti-B or anti-AB Ab are produced Observe for hemolysis & jaundice ERYTHROBLASTOSIS FETALIS : NURSING INTERVENTIONS Determine blood type and Rh early in pregnancy. Determine results of direct Coomb’s test early in pregnancy & again at 28 week’s. Determine results of direct Coomb’s test on cord blood. - type & Rh, Hgb, Hct Implement phototherapy/exchange transfusion. ERYTHROBLASTOSIS FETALIS ERYTHROBLASTOSIS FETALIS : NURSING INTERVENTIONS Administer Rh0 (D) immune globulin to the mother during the first 72 hrs. after delivery if the Rh(-) mother delivers an Rh (+) fetus but remains unsensitized Assist with exchange transfusion as prescribed. The baby’s blood is replaced with Rh(-) blood to stop the destruction of the baby’s RBC - the Rh (-) blood is replaced with the baby’s own blood gradually Reassure the mother that the newborn will suffer no untoward effects from the condition ERYTHROBLASTOSIS FETALIS SEPSIS : SEPSIS NURSING INTERVENTIONS Assess for periods of apnea or irregular respirations If apnea is present, stimulate by gently rubbing chest or foot Administer oxygen as prescribed. Monitor vital signs. Maintain warmth in an isolette. Provide isolation as necessary. Assess for fever. Monitor for I&O and obtain daily weight. Monitor for diarrhea. Assess feeding & sucking reflex which may be poor Assess for jaundice Assess for irritability and lethargy. Administer antibiotics as prescribed and monitor for toxicity. TORCH SYNDROME : TORCH SYNDROME TOXOPLASMOSIS : TOXOPLASMOSIS CHARACTERISTICS Protozoan infection Produces no serious effects in the mother Can be transmitted to the fetus Can result in severe physical and development abnormalities Common carriers include cat feces and raw beef RUBELLA : RUBELLA CHARACTERISTICS Systemic viral infection Causes congenital rubella syndrome which includes congenital heart disease, cataracts, growth retardation, and pneumonia if the mother becomes infected within the trimester Deafness and some learning disabilities can occur if the mother becomes infected during the first trimester CYTOMEGALUS : CYTOMEGALUS CHARACTERISTICS A viral infection that persists in the body indefinitely, with periods of reactivation without symptoms Can infect the fetus or infant during delivery or after birth through breastmilk, blood transfusions or contact with infected secretions May cause microcephaly, blindness, deafness, mental and motor retardation. HERPES SIMPLEX : HERPES SIMPLEX CHARACTERISTICS Sexually transmitted disease caused by a virus Periods of reactivation Neonate is commonly infected during delivery by direct contact with lesions in the genital tract Can cause neurological impairment or death. SYPHILIS : SYPHILIS Sexually transmitted disease Congenital syphilis can result in premature delivery, skin lesions, abnormal skeletal development Treponema pallidum, a spirochete, is able to cross the placenta throughout pregnancy and infect the fetus usually after 18 weeks’ gestation Risks include preterm birth, stillbirth, and low birth weight Congenital effects are irreversible and may include CNS damage and hearing loss. SYPHILIS : SYPHILIS CLINICAL FINDINGS Hepatosplenomegaly Joint swelling Palmar rash Anemia Jaundice Snuffles Ascites Pnemonitis CSF changes SYPHILIS : NURSING INTERVENTION Monitor for signs of syphilis Monitor for palmar rash and snuffles Prepare newborn for serological testing if prescribed. Administer antibiotic therapy as prescribed. Use universal (standard) precautions and drainage/ secretion precautions with suspected congenital syphilis Wear gloves when handling neonate until 24 hours of antibiotic therapy has been administered. SYPHILIS THE ADDICTED NEWBORN : THE ADDICTED NEWBORN ADDICTING DRUGS HEROIN Methadone cocaine THE ADDICTED NEWBORN : CLINICAL FINDINGS Irritability, tremors, hyperactivity & hypertonicity Respiratory distress Vomiting High-pitched cry Sneezing Diarrhea Excessive sweating Poor feeding Excessive sucking fists Convulsions THE ADDICTED NEWBORN THE ADDICTED NEWBORN : NURSING INTERVENTIONS Monitor respiratory & cardiac status frequently Monitor temperature & V/S Hold during feeding & when giving care. Initiate seizure precautions (pad side rails) Provide small frequent feedings & allow longer period of feeding. Monitor I&O. Administer IV hydration if prescribed. Protect skin from injury that can be caused by the constant rubbing from hyperactive jitters THE ADDICTED NEWBORN THE ADDICTED NEWBORN : NURSING INTERVENTIONS Swaddle newborn. Place newborn in a quiet room & reduce stimulation. Handle minimally. Administer medications as ordered. - may use Phenobarbital or Paragoric Allow mother to ventilate feelings of anxiety & guilt. Refer mother for treatment of substance abuse. THE ADDICTED NEWBORN FETAL ALCOHOL SYNDROME : FETAL ALCOHOL SYNDROME CLINICAL FINDINGS FACIAL CHANGES Short palpebral fissures Hypoplastic philtrum Short upturned nose Flat midface Thin upper lip Low nasal bridge FETAL ALCOHOL SYNDROME : CLINICAL FINDINGS Abnormal palmar creases Respiratory distress (apnea, cyanosis) Congenital heart disorders Irritability, hypersensitivity to stimuli Tremors Poor feeding Seizures Abnormal palmar creases Respiratory distress (apnea, cyanosis) Congenital heart disorders Irritability, hypersensitivity to stimuli Tremors Poor feeding Seizures FETAL ALCOHOL SYNDROME FETAL ALCOHOL SYNDROME : NURSING INTERVENTIONS Monitor for respiratory distress. Keep resuscitation equipment at the bedside. Monitor for hypoglycemia. Assess suck & swallow reflex. Administer small feedings & burp well. Suction as necessary. Monitor I&O. Monitor weight & head circumference. Decrease environmental stimuli. FETAL ALCOHOL SYNDROME PHENYLKETONURIA(PKU) : PHENYLKETONURIA(PKU) - Done when the infant is about 6 weeks old - test urine with PHENISTIX - Done after infant has ingested CHON for a minimum of 24H Initial screening is done via GUTHRIE TEST SECOND screening PHENYLKETONURIA(PKU) : PHENYLKETONURIA(PKU) CLINICAL FINDINGS Phenylalanine levels greater than 8 mg/dl - are diagnostic of PKU. Newborn appears normal but may be fair with decreased pigmentation. Untreated PKU may result in: - failure to thrive - vomiting - ezcema By about 6 months, signs of brain involvement evident if left untreated. PHENYLKETONURIA(PKU) : PHENYLKETONURIA(PKU) Restrict CHON intake. Substitute a low-phenylalanine formula (Lofenalac) for either mothers’s milk or formula. Provide special food lists for parents. NURSING INTERVENTIONS NECROTIZING ENTEROCOLITIS (NEC) : An ischemic attack to the intestine resulting in thrombosis & infarction of the affected bowel, mucosal ulcerations, pseudomembrane formation, & inflammation. Bacterial action (E.coli or Klebsiella) complicates the process causing SEPSIS. May be precipitated by any event in which blood is shunted away from the intestine to the heart & brain. - Fetal distress - low Apgar score - RDS - prematurity - neonatal shock & asphyxia NECROTIZING ENTEROCOLITIS (NEC) NECROTIZING ENTEROCOLITIS (NEC) : NECROTIZING ENTEROCOLITIS (NEC) Average onset: 4 days NEC more encountered more frequently due to reasons that more severely ill infants are surviving. May ultimately cause bowel perforation. MEDICAL MANAGEMENT Parenteral antibiotics Gastric decompression Correction of acidosis & fluid and electrolyte imbalances Surgical removal of diseased intestine NECROTIZING ENTEROCOLITIS (NEC) : NECROTIZING ENTEROCOLITIS (NEC) CLINICAL FINDINGS History indicating high risk group Findings related to sepsis - temperature instability - apnea, labored respirations - cardiovascular collapse - lethargy or irritability NECROTIZING ENTEROCOLITIS (NEC) : Gastrointestinal symptoms - abdominal distention - vomiting or increased gastric residual - poor feeding - (+) Hematest for stools - X-rays showing air in the bowel wall, adynamic ileus, & bowel wall thickening NECROTIZING ENTEROCOLITIS (NEC) NECROTIZING ENTEROCOLITIS (NEC) : NECROTIZING ENTEROCOLITIS (NEC) NURSING INTERVENTIONS Carefully assess infants at risk for early recognition of symptoms. D/C oral feedings. Insert NGT. Prevent trauma to abdomen by avoiding diapers & planning care for minimal handling. Maintain acid-base balance Administer antibiotics as ordered. Stroke infant’s hands & head and talk to the infant as much as possible. Provide auditory & visual stimulation. Inform parents of progress & support them in expressing their fears & concerns. You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.