what is the most critical extrauterine adjustment for the newborn?
the most critical extrauterine adjustment as air inflates the lungs with the first
... [Show More] breath - establishment if respiratory function
happens with the Cutting of the umbilical cord
Physiologic response of newborn -Circulatory changes occur with the expulsion of the placenta and the cutting of the umbilical cord as a newborn begins breathing independently.
what shunts close?
The three shunts functionally close during a newborns transition to extrauterine life with the flow of oxygenated blood in the lungs and readjustment of atrial blood pressure in the heart.
1. ductus arterious
2. ductus venous
3. formmen ovale
What is an Apgar score? when it it done?
System of scoring an infant's physical condition at 1 and 5 minutes after birth.
This allows the nurse to rapidly assess extrauterine adaption and intervene with appropriate nursing actions
APGAR scoring
A = appearance
2 = completely pink
1= pink body, blue hands and feet
0 = blue, pale
P = pulse
2 = > 100
1 = < 100
0 = absent
G = grimance/reflex irritbaility
2= cry
1 = grimance
0 = none
A = activity (muscle tone)
2 = well flexed
1 = some flexion
0 = flaccid
R = respiratory
2= good gry
1 = slow, weak cry
0 = absent
0-3 = severe distress
7-10 = min or no difficulty adjusting
what kind of temp taking do we do for newborns?
axillary
rectal temp are avoided bc they can injury the delicate rectal mucosa, may be done to evaluate anal abnormalities
how is the length of a baby measured?
head?
chest?
abdomen?
in cm from crown to heel of foot
head = greatest diametes from occiput to frontal
chest = beginning at nipple line
abdomen - above the U
what can meconium staining indicate
fetal hypoxia
abdomen should be....
what are you inspecting the umbilical cord for?
rounded abdomen and umbilical cord with one vein and two arteries
expected weight range
5.5-8.8 lbs
expected length range
45-55 cm (18-22 in)
Expected head circumference
32-36.8 cm (12.6-14.5 in)
Expected chest circumference
30-33 cm (12-13 in)
what is the new ballard scale?
provides an estimation of gestational age and baseline to assess growth and development
done in first 48 hrs
determines whether a baby is mature or premature
2 parts:
1. neuro muscular
2. physical maturity assessment
Neuromuscular
1. posture
-should be well flexed = mature
-more flaccid or extended = premature
2. square window
-assesses the wrist flexability
-should be able to bend wrist down = mature
-if not able = premature
3. arm recoil
-passively extended and then is spontaneous returns to flexion = mature
4. poplietal angle
-degree of the angle to which the newborns knees can extend
-if cant extend more than 90 degrees = mature
-if can go all the way up to the face = premature
5. scarf sign
-crossing the arm over the chest
-if meeting resistance = mature
-if you can take it all the way across = premature
6. heel to ear
-how fare the heel can reach their ears
-meet resistance and can't get past 90 degree = mature
-can go all the way up = premature
Physical maturity assessment (2nd new ballards scale)
1. skin texture
-premature = stick, transparent
-mature - will thicken
-postmature = leathery, wrinkled, cracked
2. lanugo
-mature = will have very little, mostly bald
-premature = a bunch
-very premature = no languo
3. plantar surface creases
-mature = see creases across entire sole
-premature = smooth, no creases
4. breast tissue
-premature = areola will not be perceptible
-mature - full areola, 5-10 mm bud
5. eye and ears
-really premature= eyes fused shot; will stay bent
-mature = open eyes; ear will recoil back
6. genital
-boy premature: scrotoum will be flat and smooth
-boy mature: pendulous testicles , rugue
-girl premature: promient clitoris, flat labia
-girl mature: majoria labia will cover labia minora and clitoris
appropriate for gestational age AGA
weight is between 10th and 90th percentile
small for gestational age SGA
weight is less than the 10th percentile
large for gestational age LGA
weight is greater than 90th percentile
low birth weight LBW
weight of 2500g (5.5 lbs) or less at birth
term
birth between the beginning of week 37 and prior to the end of 42 weeks
preterm or premature
born prior to the completion of 37 weeks of gestation
postterm (postdate)
born after the completion of 42 weeks of gestation
vital sign sequence
respiration, heart rate, blood pressure, temperature
respiratory rate
between 30-60 breaths/min, short periods of apnea (<15sec)
if > 15 sec = evaluate
normal heart rate
110-160/min, fluctuate depending on activity, assess apical pulse for full minute, document any murmurs
blood pressure
60-80mmHg systolic and 40-50mmHg diastolic
normal temperature range
97.7 - 99.5 F axillary
at risk for hypothermia/hyperthermia, if newborn becomes chilled oxygen demands increase and acidosis can occur
in full term babies ____________ can occur few days after birth
desquamation (peeling)
Normal findings in terms of physical assessment of a newborn
1. milia
2. mongolian spots
3. telangiectatic nevi
4. nevus flammeus
5. erythema toxicum
milia
small raised white spots on nose, chin, and forehead may be present, disappear spontaneously
tell parents not to squeeze
mongolian spots
bluish purple spots of pigmentation, commonly on shoulders, back, and buttocks, frequent on dark skin,
document location and presence
telangiectatic nevi
when will they go away?
(stork bites)
flat pink/red marks, easily blanch, found on back of neck, nose upper eyelids, middle of forehead,
usually fade by second year of life
nevus flammeus
capillary angioma
purple/red size/shape varies
commonly seen on face,
does not blanch/disappear
(port wine stain) [Show Less]