Nursing care of Newborns- ATI ch. 24 – Flashcards
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how often are V/S checked on admission/birth?
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every 30 min X 2, every 1 hr X 2, then every 8 hrs.
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what metabolic screening is mandatory for all NB? how soon should it be done?
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PKU screening, the newborn must have received formula or breast milk for at least 24 hrs.
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why is it required to test for PKU?
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PKU is a defect in protein metabolism, there is an accumulation of amino acid phenylalanine resulting in mental retardation. Treatment should be done in the first 2 months of life to prevent retardation.
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how should you suction the NB to clear the airway?
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suction mouth first, then nasal passage with a bulb syringe to remove excess mucus in the respiratory tract. NB is able to clear most secretions in air passages by the cough reflex.
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how many identifiers should be applied to the NB immediately after birth to prevent NB to be given to the wrong parents, switched or abducted?
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two identifiers, one on the ankle and one on the wrist, plus footprints and mothers thumbprints are taken.
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why is it so important to maintain a normal core temperature or thermoregulation in NB?
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to prevent chilled (cold stress) which can lead to increase O2 demands and rapidly use up brown fat reserves that helps keep NB warm.
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What are the four mechanisms on how heat loss can occur?
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conduction, convection, evaporation, and radiation.
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how is heat loss through conduction?
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loss of body heat through direct contact w/ cooler surface. Place NB directly on mothers warm abdomen while he/she is covered in a warm blanket.
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how is heat loss through convection?
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loss of body heat by the flow of heat form the body surface to cooler environmental air (A/C vent, fan). Any procedure where the NB is uncovered it should be done under the radiant heat source.
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how is heat loss through evaporation?
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loss of heat as surface liquid is converted to vapor prevent by gently drying the NB with a dry/sterile blanket immediately after delivery. When thermoregulation is unstable postpone initial bath until skin tempt is 97.7 F.
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how is heat loss through radiation?
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loss of heat from the body surface to cooler solid surface that is close to, but NOT in direct contact (windows, or air conditioners).
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how many hours of sleep do NB get?
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approx. 17 hrs a day, an average of 4 hrs at a time.
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how should the NB sleep?
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Supine, safe sleep to decrease incidence of SIDS.
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how often should NB void? urine and stool?
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void urine within 24 hrs of birth, then 6-10 times after 4 days of life. Stools passed within first 24 hrs after birth, then 3-4 times a day depending on feeding method.
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how does a stool of NB who is breastfed appear? and bottle-fed stool?
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yellow and seedy for breastfed NB and lighter in color and looser with formula fed NB.
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how should a diaper be changed? how often and what cab be applied?
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keep perineal area dry and clean, ammonia in urine is irritating to the skin and can cause diaper rash. After each diaper change cleanse with water and with mild soap. Diaper wipes w/ alcohol should be avoided. Pat dry, apply triple antibiotic ointment, petroluem jelly, or zinc oxide, depending on facility protocol.
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What ointment is administered to the NB? what is it for? what does it prevent
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ointment is mandatory used to prevent ophthalmia neonatorum infections that can be transmitted through the birth canal caused by Neisseria gonorrhoeae or Chlamydia trachomatis putting NB at risk for blindness
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When and how should erythromycin be applied?
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Erythromycin or tetracycline. Single dose unit to avoid contamination. Apply 1-2 cm ribbon on the lower conjuctival sac of each eye, starting from inner canthus moving outward. Application may be delayed for 1 hr after birth to facilitate baby-friendly activities.
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Why is Vitamin K administered, how, how much?
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Vitamin K is administered to prevent hemorrhagic disorders. Vitamin K is NOT produced in the GI tract until around 8 days of life. Vitamin is produced once formula/breast milk is introduced into the gut of the NB. Administer 0.5-1 mg IM into Vastus Lateralis within 1 hr after birth.
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Why is Hep immunication administered, how much, when, what is it for?
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Provides protection against Hepatitis B. Recommended to be given to all NB, but informed consent must be obtained. For healthy mothers the recommended dosage schedule is at birth, 1 month, and 6 months. If mom is infected with Hep B, vaccine is given within 12 hrs of birth, then at 1 month, 2 months, and 12 months. Do not give Vit K and Hep B on the same thigh.
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To prevent infection and promote drying of umbilical cord stump what nursing considerations are taken?
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Assess for edema, erythema, and drainage w/ each diaper change. Cord care may include applying triple dye or cleansing with neutral pH cleanser and sterile water. Keep cord clean and dry to prevent infections. Do not submerge infant in water, do so until cord has fallen off.
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What can cold stress lead to?
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hypoxia, acidosis, hypoglycemia, NB w/ respiratory distress are at higher risk for hypothermia.
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what are some manifestations of cold stress in NB
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Cyanotic trunk, depressed respirations
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when should hypoglycemia be assessed?
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in the first few hours of life, if mom is healthy.
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What NB are at higher risk for hypoglycemia?
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NB born to mothers who have DM, are small/large for gestation age, are less than 37 wks gestation or greater than 42 weeks gestation. Blood glucose on these NB should be assessed within 2 hrs of life.
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what are some S/S of hypoglycemia in NB?
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jitteriness, twitching, a weak, high pitched cry, irregular respiratory effort, cyanosis, lethargy, eye rolling seizures, and blood glucose less than 40 mg/dL by heel stick.
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Nursing actions for hypoglycemia in a NB?
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give formula immediately, or have mother breastfeed to elevate blood glucose. Brian damage can result if brain cells are depleted of glucose.
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How much does a NB loss/gain weight after birth? when does he regain it and how much?
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Loss of 5% to 10% immediately after birth (regain 10 to 14 days after birth). Gain of 110 to 200 g/week for the first 3 months.
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how much fluid intake does a NB need per day?
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100 to 140 mL/kg/24hrs. NB does not need additional water added the breast milk or formula has sufficient.
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how much caloric intake does a NB need for the first 3 months? then from 3 to 6 months?
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First 3 months: 110 kcal/kg/day From 3 to 6 months: 100 kcal/kg/day
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How much caloric intake does breast milk or breast formula provide per oz.?
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both breastmilk and formula provide 20 kcal/oz.
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what two minerals do breast milk and formula lack of?
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iron and flouride
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How should iron be added to NB diet, while breastfeeding or bottle fed?
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Iron is low in all forms of milk, but it is better absorbed in breast milk. After 6months all NB need to be fed iron-fortified cereals and other foods rich in iron. NB who are formula fed should receive iron-fortified formula until 12 months of age.
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For how long are mothers encouraged to breastfeeding their NB?
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For the first 12 months of life.
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how can flouride be added to NB diet?
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Flouride levels are low in breastmilk and formulas. A flouride supplement should be given to NB who are NOT receiving flouridated water after 6 months of age.
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when should solids be introduced? why at this age?
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until 6 months of age, if introduced too early/before 6 months of age puts the infant at risk for developing food allergies.
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how often should mothers breastfeed their NB? day and night? until what age is breastfeeding recommended?
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Breastfeeding is exclusively recommended for first 6 months of age. Breastfeed every 2-3 hrs. Wake up NB to feed at least q 3 hrs/ day and q 4hrs/ night. Feed on demand may be followed
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what is the first milk secreted called? when does it start? how long does it last ? why is it so good for baby?
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Colostrum, secreted during postpartum days 1 to 3 days. Contains IgA that provides passive immunity to NB.
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benefits of breastfeeding?
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Reduces risk of infections by providing IgA antibodies. Promotes rapid brain growth due to large amounts of lactose. Provides protein and nitrogen for neurological cell building. Contains electrolytes and minerals. Breast milk is easy to digest. Inexpensive. Reduces incidence of SIDS, allergies, obesity, and promotes mother-infant bonding.
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Intervention/teachings for the mother to promote successfull breastfeeding?
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place NB skin-to-skin right after birth, or within 30 mins. Explain to wash her hands, get comfortable, have caffeine-free, nonalcoholic fluids to drink. Explain let-down reflex caused by stimulation of nipple releasing oxytocin causing let-down of milk. Reassure uterine cramps occur during breastfeeding due to the Oxycontin and are normal, they promote uterine involution.
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how can you show a mother the proper latch-on position?
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tell her to support breast w/one hand w/thumb on top and four fingers underneath. Initiate the rooting reflex by tickling lower lip w/nipple so NB can open his mouth, then gently pull NB towards nipple w/ his mouth covering nipple and part of the areola.
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how do you know if NB is latched on correctly?
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His nose, cheeks, and chin will be touching her breast.
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what are the four basic breastfeeding position?
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football, cradle/ modified cradle, across the lap, and side lying.
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how long should breastfeeding last? and what signs can you teach mom that feeding is complete? how to safely remove NB from breast?
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15 to 20 min/ per breast. When feeding is complete NB slows suckling, breast softened, or NB fell asleep. To remove NB from breast insert finder in the side of the NB mouth to break suction, then remove NB, this will prevent nipple trauma.
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how do teach a mother to burp? how should she begin her next breastfeeding?
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As she alternates breast, burp NB over the shoulder, or in an upright position with his chin supported, then gently pat his back to elicit a burp. Begin next feeding on the breast she last stopped feeding from.
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what are some signs you can teach mom's that will indicate their NB is receiving adequate milk/formula supply?
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gaining weight, voiding 6 to 8 diapers/day, and contentedness btw feedings.
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how do breastfeeding stools look like?
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loose, pale or yellow.
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What herbal products can increase breast milk production?
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fenugreek, or metoclopramide (Reglan)
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what are some teaching you can do regarding storage of breast milk?
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Mom can still provide breastmilk during separation periods(work, school) by pumping breast milk into bottle or freezer bags. At room tempt for up to 8hrs, refrigerated in sterile bottles for use within 8 days, freezed in two/door fridge for up to 6 months, deep freezer for 12 months.
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what teachings can you do regarding thawing the milk ?
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place milk in the refrigerator for 24hrs best way to preserve nutrients, or place bottle under running lukewarm water, rotate bottle but don't shake it when thawing in this matter.
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why should you NOT thaw milk in the microwave?
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destroys immune factors and lysozymes in the milk. also leads to development of hot spots in the milk due to uneven heating, which can burn the NB. Do not refreeze thawed milk, and discard used portions of breast milk.
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how often is formula fed to NB?
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every 3 to 4 hrs, wash lids, and bottles with hot soapy water, Mix concetrated formula w/ tap water but if tap water is questionable boil it first. Check flow of bottle nipple ensure its not too fast or slow.
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how should parents hold NB when feeding bottle?
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cradle NB in a semi-upright position, held close and at a 45 degree angle.
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what other teaching can you do to prevent swalling of air, cavities, bacterial contamination? how often should you burp NB?
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Keep nipple filled to prevent swallowing of air, Always hold the bottle never prop, to prevent cavities. Discard any unused formula to prevent bacterial contamination in the bottle. Place NB on his back after feedings.
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What signs can teach parents so they can tell their newborn is being adequately fed by them?
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Gaining weight, bowel movements (yellow, soft and formed) after every feeding, and after a couple of weeks bowel movements decrease to 1 to 2/day; voiding 6 to 8 times/day, and satisfaction btw feedings.
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When should you advice Mother's to feed their NB? what feedings cues to look for?
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Rather than waiting for NB to cry due to hunger, look out for hunger cues such as hand-to-mouth or hand-to-hand movements, sucking motions, rooting, or mouthing and feed NB.
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tips for waking up a sleepy baby to feed him/her?
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unwrap baby, change diaper, hold upright or turn him/her side to side, talk to NB, massage/rub back, hand and feet or apply a cool cloth on NB face.
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Tips for calming a fussy baby to feed him/her?
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swaddle NB, hold close, move, and rock him gently. Reduce stimuli, and place skin to skin.
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What is failure to thrive? where does the percentile fall in the growth chart?
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Failure to thrive is slow weight gain, NB weight falls below 5% percentile on the growth chart.
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what interventions are needed for a failure to thrive NB who is breastfeed?
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evaluate proper position, and latch on. Massage breast during feeding, determine feeding patterns, and length. If NB is spitting up, he may have an allergy to dairy products. Determine if mom is eating dairy products. Lastly eliminate dairy from her diet, and instruct her to consume other food sources high in calcium or calcium supplements.
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what interventions are needed for a failure to thrive NB who is formula fed?
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Evaluate how much and how often the NB is been fed. If NB is spitting up or vomiting he may have an allergy or intolerance to cow milk-based formula and may require a soy-based formula.
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how many wet diapers and stool dipers?
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6-8 wet, and 3-4 stool
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What cord care consists of? prevent infection? when is clamp removed? how is the NB bathed?
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Before discharge, cord clamp is removed. Prevent infection by keeping cord dry, and keep the top of the diaper folded underneath it. sponge baths until cord falls off (occurs 10-14days) after birth.
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what are characteristics of a cord infection?
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cord infection can result if the cord is not kept clean and dry. Monitor for moist, red, foul odor or purulent drainage in the cord. Notify provider right away.
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Why may be a reason why a circumcision may be contraindicated?
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hypospadias (ventral side), epispadias (dorsum side), or history of bleeding disorders.
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Plastibell for circumcision? procedure? care after? post procedure assessment?
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Anethesia is required. nonpharmacologic (swaddling, nonnutritive sucking,) oral sucrose, acetaminophen. After 5-7 days plastibell drops off, leaving a clean, healed excision. No petroleum needed for plastibell. After procedure look for bleeding every 15 mins for first hour then every hour for 12 hrs, and assess for first voiding.
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what is ambiguous genitalia?
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when NB has both female and male genitalia.
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what parent teaching (preprocedure) is done for a circumcision?
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Make sure you have a signed inform consent from parents. Explain NB will not be able to be bottle fed for up to 4hrs prior procedure to prevent vomiting and aspiration. For breastfed NB mom may nurse up until procedure. Explain to parents NB will be restrained on a special board during procedure.
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What are important postprocedure parent teaching for NB circumcision?
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Teach parents to keep area clean, change diaper q 4 hrs, clean penis w/ warm water. With clamp present apply petroleum jelly w/ each diaper change for at least 24 hrs to keep diaper from adhering to penis. Avoid wrapping penis too tight (circulation). Tub baths are NOT given until circumcision is healed which takes couple of weeks. Notify provider immediately if redness, discharge, swelling, strong odor, tenderness, decrease in urination is present or excessive crying. Tell parents a film of yellowish mucus may form over penis by day 2, Do Not wash it off. Do not use towelettes as they contain alcohol. NB may be fussy, and sleep for several hrs after procedure, provide comfort for 24 to 48 hrs, include tylenol.
