Define: acrocyanosis
Bluish discoloration of the hand and feet caused by reduced peripheral circulation
Define: caput succedaneum
Area of edema over the presenting part of the fetus or newborn, resulting from pressure against the cervix
Define: cephalohematoma
bleeding between the periosteum and skull from pressure during birth, does not cross suture lines
Define: epispadias
Abnormal placement of the urinary meatus on the dorsal side of penis
Define: erythema toxicum
Benign rash of unknown cause in newborns with blotchy red areas that may have white or yellow papules
Define: hypospadias
Abnormal placement of the urinary meatus on the ventral side of the penis
Define: jaundice
yellow discoloration of the skin and sclera caused by excessive bilirubin in the blood
Define: lanugo
fine, soft hair covering fetus
Define: milia
white cysts, 1 mm in size from distended sebaceous glands
Define: molding
shaping of fetal heading during movement through the birth canal
Define: mongolian spots
bruise like marks that occur mostly in newborns with dark skin tones
Define: nevus flammeus
permanent purple birthmark; port wine stain
Define: nevus vasculosus
rough, red collection of capillaries with a raised surface that disappears with time; strawberry hemangioma
Define: polydactyle
more than 10 digits on hand or feet
Define: pseudomenstruation
vaginal bleeding in the newborn, resulting from withdrawal of placental hormones
Define: syndactyly
webbing between fingers or toes
Define: tachypnea
respiratory rate greater than 60 bpm in newborn after the first hour
Define: vernix caseosa
thick, white substance that protects the skin of the fetus
Define: telangiectatic nevi
often referred to as “stork bites”
Define: Epstein pearls
whitish-yellow cysts. These form on the gums and roof of the mouth in a newborn baby
Define: precocious teeth
teeth that are already present at birth
Define: circumoral cyanosis
blue discoloration around the mouth only. It’s usually seen in infants, especially above the upper lip
Components of newborn assessment:
APGAR score
Appearance Pulse Grimace Activity Respiration's **point system, done within minutes of birth
Components of newborn assessment:
vital signs
Normal limits Temp 97.9-99.5 (36.5-37.5) AXILLARY Pulse 120-160 Respirations 30-60 (count for full min) BP 65-95(s)/30-60(d)
Components of newborn assessment:
Physical assessment
Color: pink or tan with acrocyanosis
Vernix: present in creases
Lanugo: on shoulders, sides of face, forehead, upper back
Turgor: quick recoil
Some cracking or peeling of skin: normal especially on post term
Components of newborn assessment:
Medications
Vitamin K
Erythromycin ointment
Hepatitis B
Components of newborn assessment:
Measurements
Weight: 5lbs 8oz - 8lbs 13oz
Length: 19-21”
Head: 32-38cm
Chest: 30-36cm
Gestational age of the newborn
New Ballard Score
Neuromuscular Maturity
Posture Square window (wrist) Arm recoil Popliteal angle Scarf sign Heel to ear
Components of newborn assessment:
Gestational age
New Ballard Score
Physical Maturity
Skin Lanugo Plantar surface Breast Eye/Ear Genitals
Components of newborn assessment:
Nutritional needs
Calories Breast fed: 85-100 kcal/kg/day Formula: 100-110 kcal/kg/day Breast and formula: 20 kcal/oz Nutrients Carbs, Proteins, Fat
Components of newborn assessment:
NORMAL skin variations
Milia: white dots, “baby acne”
Erythema toxicum: newborn rash
Skin tags
Mongolian spots: on bottom
Components of newborn assessment:
ABNORMAL skin variations
Petechiae: pin point bruising Facial bruising: quick delivery Forceps markings Harlequin color: half red color Mottling: cold stress Jaundice: yellowing of skin Meconium stained cord/skin: infant passes stool
Components of newborn assessment: ABNORMAL skin (birthmarks)
Nevus Flammeous: port wine stain
Nevus Simplex: stork bite, between eyes
Nevus Vasculous: strawberry hemangioma
Cafe au lait spots: tan, irregular shape
Newborn head assessment
Sutures: Sagital and Coronal
Fontanels: anterior, diamond shape, closes 12-18 months. posterior, triangle shape, closes 2-3 months
Newborn abdomen
soft and rounded
bowel sounds within first hour
void within first 12-24 hours
three vessel cord: 1 vein, 2 arteries
Newborn extremities
Upper: two transverse palm creases
Lower: gluteal and thigh creases, no hop ‘clunk’, normal position of feet
**equal and bilateral movement, correct number/formation of fingers/toes,good muscle tone.
Newborn BACK abnormalities
Spina Bifida: failure of one or more vertebrae to close
Meningocele: protrusion of spinal fluid and meninges
Myelomeningocele: protrusion of spinal fluid, meninges and spinal cord
Pilonidal dimple
Newborn reflexes
Moro (startle)
Palmer grasp (fingers curl)
Plantar grasps (toes curl)
Babinski (toes flare with dorsiflexion of the big toe)
Rooting (turns head to side)
Sucking
Tonic neck (turns head to one side while infant is supine)
Stepping (hold infant so feet touch solid surface)
Reactive phase of newborn
- first period
- period of sleep
- second period
First period: begins at birth Infant is wide awake, alert Lots of movement Rooting Decreased temp, increase HR and Resp Period of sleep: Deep sleep or decreased activity Pulse and resp within normal range Second period: Interested in feeding Pass first meconium Pulse and resp increase Increased mucus secretions
Nursing care for Reactive phase
Protect "golden hour" Monitor VS Positioning Observation Maintain temp Assist with breastfeeding
Types of circumcision
Gomco: pulls prepuce over cone shaped device. Needs dressing with petroleum jelly each diaper change for 4-7 days.
PlastiBell: plastic ring over glans, draws prepuce over, ties suture. Falls off 10-14 days
**need consent
Significant newborn problems and associated nursing diagnosis
Hypothermia- ineffective thermoregulation
Prevent heat loss
- convection (drafts/air current)
- conduction (contact with cold objects/surface)
- radiation (placed near cold surfaced, window/exterior wall)
- evaporation (bathing, wet linens, insensible water loss from lungs)
Interventions
- skin to skin
- hat
- warm blanket
- radiant warmer
Significant newborn problems and associated nursing diagnosis
Respiratory distress- Ineffective airway clearance
Signs of distress
- tachypnea
- retractions
- nasal flaring
- cyanosis
- grunting
- seesaw or paradoxical resp
- asymmetry
Interventions
- positioning
- suctioning
- SpO2 monitoring
- supplemental O2 if necessary
Significant newborn problems and associated nursing diagnosis
Hypoglycemia- Risk for
At risk infants: diabetic mother infection birth defects congenital metabolic disorders incompatible blood types distress during labor/delivery poor feeding maternal terbutaline administration (stop contractions)
Significant newborn problems and associated nursing diagnosis
Hypoglycemia- Risk for
Signs of hypoglycemia
Signs: shaking/tremors cyanosis hypothermia poor muscle tone poor feedings lethargy seizures
Significant newborn problems and associated nursing diagnosis
Hypoglycemia- Risk for
Interventions
Interventions: glucose monitoring frequent feedings supplementation dextrose IV fluids
Significant newborn problems and associated nursing diagnosis
hyperbilirubinemia- Risk for hyperbilirubinemia (Jaundice)
Risk factors
Risk factors: rapid RBC hemoysis liver immaturity blood incompatibilities preterm infant poor feedings birth trauma ethnicity/family history
Significant newborn problems and associated nursing diagnosis
hyperbilirubinemia- Risk for hyperbilirubinemia (Jaundice)
Assessment- observation vs measurement
Assessment- observation vs measurement:
plysical assessment
TcB (Transcutaneous bilirubin) and TSB (bilirubin level test)
Physiologic jaundice VS Non-physiologic (pathologic) jaundice
Physiologic jaundice: occurs on the 2nd or 3rd day of life, normal variant
Non-physiologic jaundice: occurs within the first 24 hours, cause for concern
Hyperbilirubinemia interventions
Increased feedings
Phototherapy
Developmental tasks of newborn
- Erikson’s
- Piaget’s
Erikson’s: trust VS mistrust
Piaget’s: sensorimotor stage, schemas of the newborn are shown through reflexes
Breastfed newborn
Assessment
Positioning
Assessment of breast/nipple: Everted Flat Inverted Positioning: Cradle Cross cradle Football hold side lying
Breastfed newborn
Latch
Amount and frequency
Latch: -lips and tongue -breaking the latch Amount/frequency: -offer breast on demand and at least every 2-3 hours -feed on each side until satisfied -audible swallowing should be heard
Formula fed newborn
Stomach size
Teaching
Stomach size: -1/2-1 oz per feeding for the first 1-2 days -2-3 oz per feeding after 2-3 days -gradual increases as the child ages Teaching: -hand washing -preparation -heating (no microwave) -positioning -burping (every 1/2-1 oz) -frequency/amount
Newborn screening
Hearing
Blood draw
Hearing: -hearing impairments -done before discharge -otoacoustic emissions/acoustic brainstem response is measured Blood draw: -inborn errors of metabolism -genetic conditions -phenylketonuria (PKU) -hypothyroidism -galactosemia -hemoglobinopathies (sickle cell/thalassemia)
What is phenylketonuria (PKU)
inborn error of metabolism that results in decreased metabolism of the amino acid phenylalanine. Untreated, PKU can lead to intellectual disability, seizures, behavioral problems, and mental disorders. It may also result in a musty smell and lighter skin.
What is galactosemia
which means “galactose in the blood,” refers to a group of inherited disorders that impair the body’s ability to process and produce energy from a sugar called galactose. When people with galactosemia injest foods or liquids containing galactose, undigested sugars build up in the blood
What is hemoglobinopathies
medical term for a group of blood disorders and diseases that affect red blood cells. These disorders include both sickle cell disease (SCD) and thalassemia.
Describe Seyle’s model
Three stages
Alarm: fight or flight
Resistance: HR, BP and resp elevated
Exhaustion: can no longer compensate