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First few hours of life are essential to support changes of the respiratory and cardiac system. Immediate needs: airway, breathing, circulation, and warmth. Airway Breathing: physical, chemical, thermal, and sensory factors Circulation
Neonatal Transition
Infant heated on warmer until normal temperature is established and maintained: At birth, infant moves from 98.6 F within mother to 70 F room temp., wet w amniotic fluid, compounding heat loss Check temp on admission, and every one half hour until stable Sponge bathe only after general condition and temp are stable
Warmth
Full term: general flexion Premature: Slightly hypotonic Jitteriness: low blood sugar, maternal chemical use Flaccid: premature, difficult delivery, ill newborn
Muscle Tone
Resps 30-60, normally irregular Temp- maintain 98-99 F (37 C) Apical heart rate 110-140 at rest BP: Assessed electronically, in range of 80/50
Vital Signs
Pass a feeding tube through both nostrils to check patency Aspirate stomach contents and remove the tube Insert tube into rectum and check patency (or check 1st temp rectally) Start demand feedings after gavage tubes have been passed. Notify physician if infant has not urinate by 24 hours or not stooled by 48 hors of age PKU and T-4 screening Glucoscan as ordered Suction PRN O2 to correct cyanosis, notify physician immedidiatly State bilirubins obtained for jaundiced baby: normal physiologic newborn jaundice, fetabl RBC destruction in response to air breathing, liver too immature to handle workload, bilirubin waste builds up resulting in jaundice, subsides as liver converts bilirubin to excretable form
Standard Newborn Care
Weight- average at term 7-7 1/2 lbs. Length- average 20 inches (50 cm) Chest circumference- 1/2 inch (1 1/4 cm) less than head circumference--measure at nipple line, lift up to remove tape to avoid paper cuts Head circumference- 13 1/2-14 1/2 inchs (34-36 cm) after molding resolved: measure across brow and around widest part of back of head-- lift up to remove tape to avoid paper cuts
Measurements
Vitamin K- to prevent hemorrhagic disorders: aqua mephyton 1.0 mg IM (vastus lateralis muscle) on admission to the nursery Hepatitis B vaccination- within the first 12 hours Eye prophylaxis- to prevent ophthalmia neonatorum: llotycin ophthalmic ointment, 0.5-1 cm. in length instilled in each conjuctival sac Umbilical cord care- to prevent infection: cord care w alcohol w each diaper change, fold diaper under cord stump, until cord drops off, sponge bathe only.
Prophylactic Care
Blueness of hands and feet Result of immature circulation A normal finding for first few days
Acrocyanosis
Downy hair covering body Excessive in premature Absent in post term
Lanugo
Small white distended sebaceous glands on infants face Normal finding Resolve spontaneously.
Milia
White creamy coating protective of skin in utero Heavy in premature Absent in post term
Vermix Caseosa
Generalized swelling, subsides in hours to several days
Caput (Head assessment)
Does not cross suture lines, may appear 3-4 days after birth, absorbs in weeks-months
Cephalhematoma (head assessment)
Normally flat Bulge when crying
Fontanels (head assessment)
Observe appearance and spacing, usually no tears, uncoordinated eye movements, can focus and follow brief moments
Eyes
Note shape, placement, presence of external canal
Ears
Obligate nose breathers. Check patency by passing feeding tube
Nose
Short and straight Moves head freely from side to side from flexion to extension
Neck
Shape: almost circular, observe symmetry of movement w resps Nipples: milky secretion may be evident- normal response due to influence of maternal hormones
Chest
Abdomen: rounded, abdominal resps Umbilical stump: bluish- white, 3 vessels (2 arteries, 1 vein), promote drying
Abdomen
Meconium w in first 24-48 hours: clack, sticky substance. Followed by transitional, then normal, infant stool (Loose, seedy, yellow the norm in breast fed)
Stools
Urates may result in pink staining of urine Normal finding
Frequent Voidings
May have traces of bloody vaginal discharge: result of maternal hormonal influence, normal finding, resolves spontaneously.
Female infant
Elective procedure Post-op: observe for bleeding and voiding Two methods: Gomco (Vaseline gauze reapplied w diaper change) Plasti-bell (Cleanse w water as needed, bell will drop off without intervention)
Circumcision
Infant's weight above 90th percentile
Large for gestational age (LGA)
Weight falls between 90th and 10th percentile
Appropriate for gestational age (AGA)
Weight falls below 10th percentile
Small for gestational age (SGA)
Transmission may occur through placenta, maternal blood, secretions during birth, through breast milk At birth, infant typically has no symptoms All infants of HIV positive mothers should be presumed to be HIV positive Breastfeeding not recommended
Infant of HIV positive mother
When umbilical cord is cut, newborn experience withdrawal Complications: withdrawal, resp distress, jaundice, behavior problems, congenital anomalies, growth retardation Infants of alcohol dependent mothers may be affected by FAS
Infant of substance-abusing mother
Inborn error of metabolism Infant cannot digest amino acid phenlylalanine Test at least 24 hours after initial feeding Infant w PKU needs diet low in phenylalanine or severe mental retardation may occur
Phenylketonuria (PKU)
Most often found in pre-term infants Symptoms: tachypnea, retractions, grunting, crackles, pallor, cyanosis, hypothermia, edema, flaccid muscle tone, GI shutdown, jaundice, and acidosis First 96 hours are critical to recovery Treatment: surfactant, supportive care
Respiratory distress syndrome
Sudden, periodic attack of abdominal pain, cramping; usually end by 3 months Infant cries for several hours and draws the legs up to the abdomen Usually occurs at the same time of day Treatment: medications and exploration of ways to comfort the infant
Colic
May occur separately or together Infants w cleft palate are at risk for aspiration, feeding difficulties, and resp infections. Treat to close defects, maintain nutrition, prevent complications, and foster normal growth and development.
Cleft lip/palate
Failure of the esophagus to develop as a continuous passage and/or an unnatural connection between esophagus and the trachea Prognosis is usually good w surgery
Esophageal atresia w tracheoesophageal fistula
Foot has clublike appearance w entire foot inverted, apparent at birth Treatment includes manipulation and casting of the foot and possible surgery
Congenital Talipes Equinovarus (Club Foot)
Dysplasia: refers to a variety of conditions wherein the femoral head and the acetabulum are improperly aligned. Limited abduction, asymmetry of the gluteal and thigh fat folds, and telescopinf of the thigh (Assessment sign- Ortolani's click) Treatment: casting, bracing, possible surgery
Developmental dysplasia of the hip
Neural tube defect wherein incomplete closure of vertebrae and neural tube results in a opening through which meninges and spinal cord may protrude Surgery is required to close the defect (may be preformed in utero)
Spina Bifida
Results when the balance between the rate of cerebrospinal fluid formation and absorption is disturbed Abnormally large head at birth, bulging anterior fontanels, and eyes appear to pushed downward Surgical insertion of a shunt is required.
Hydrocephalus
Results from damage to the motor centers of the brain Symptoms: Vary in severity but include motor disorders, seizures, impaired vision, difficulty swallowing and speaking Multidisciplinary team treatment to assist child in developing maximum potential
Cerebral Palsy
Urethral opening is on ventral surface of penis Urethral opening is on upper surface of penis Surgically corrected during 1st year of life.
Hypospadias/Epispadias
Palpable, round, non tender mass in scrotum Most close by 1 y/o without intervention Surgery may be required
Hydrocele
Failure of the testicles to descend into scrotal sac Most descend spontaneously by 1 year of age Surgery may be required: preserves fertility, linked to increased risk for testicular cancer
Cryptorchidism
Chromosomal anomaly resulting in a degree of mental retardation Characteristics: almost shaped eyes, depressed nasal bride, protruding tongue, low set ears, short broad neck, transverse palmar crease, broad short hands w stubby fingers, and protruding abdomen.
Down Syndrome
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