Postpartum Baby

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Created by
Carolyn Leavitt

Cards (72)

  • Neonatal period

    From birth - 28 days
  • Transition to Extrauterine Life
    • Biological/physiologic adaptations: Each system undergoes change; all systems must be working well at the end of the neonatal period
  • Respiratory System Adaptation

    1. Respiratory pattern: Rate 30 - 60 breaths per minute
    2. Irregular, shallow with periods of apnea (<15 sec)
    3. Nose breathers
    4. Assess respiratory rate for one full minute
    5. Lung expansion/surfactant necessary for normal lung function
  • Cardiovascular System Adaptation

    1. Fetal circulation ceases with the first breath
    2. Closure of foramen ovale
    3. Closure of ductus arteriosus
    4. Umbilical cord has 2 arteries and 1 vein
    5. Heart rate: 120 - 160 healthy term newborn (average 140), may be 80 - 120 when asleep, greater than 160 if crying
    6. Obtain apical pulse for one minute
    7. Blood Pressure typically not obtained
  • Thermogenic Adaptation

    1. Balance between heat loss and heat production
    2. Newborn axillary temp ranges between 97.7 to 98.9F or 36.5 to 37.2C
    3. Rectal temperatures are contraindicated
    4. Types of Heat Loss: Convection, Conduction, Evaporation, Radiation
  • Nursing interventions to keep newborn warm or from losing heat
    • Warm surface, skin to skin, swaddle, hat, etc.
  • Cold stress

    Excessive heat loss leads to cold stress, which if not reversed can: Deplete brown fat stores, Increase oxygen needs → respiratory distress, Lead to hypoglycemia, Lead to hypoxia
  • Renal System Adaptation
    1. Immature until about 3 months of age
    2. Majority of newborns void soon after birth (normal is within 24 hrs)
    3. 6 - 8 voids/day average; indicates adequate fluid intake
  • Gastrointestinal System Adaptation

    1. Immature until about 2 - 3 yrs
    2. Capacity to swallow, digest, metabolize, absorb food
    3. GI bacteria colonized within 24 hours of age
    4. Vitamin K given prophylactically to protect from bleeding difficulties
    5. Stomach capacity 30 - 90 ml by end of first week
    6. 5 - 7 ml for first feeding
    7. Normally, newborns lose 5 - 10% of birthweight due to insufficient caloric intake, shifting of intracellular fluid and insensible water loss
  • Bowel Elimination
    1. Newborn's first stool is meconium - thick, black, tarry. Usually passes within the first 24 hours of life
    2. Transitional stool develops next (greenish, less sticky), followed by milk stools
    3. Newborns that are fed early pass stools sooner, which helps to prevent high levels of bilirubin
  • Meconium

    Newborn's first stool
  • Hepatic System Adaptation
    1. Liver responsible for carbohydrate metabolism, iron storage, conjugation of bilirubin, and blood coagulation
    2. Newborn has iron stores sufficient to last 4 - 6 months
    3. Carbohydrate metabolism reserves are low, places NB at risk for hypoglycemia
    4. Normal blood glucose level > 40 mg/dL
    5. Conjugation of bilirubin (breakdown of red blood cells) enhanced by liver enzymes. Increased bilirubin levels lead to jaundice; occurs in >50% of all newborns
  • Unconjugated bilirubin
    Fat soluble, bound to circulating albumin
  • Conjugated bilirubin
    Water soluble, excreted in urine and stool
  • Serum concentration of unconjugated bilirubin not to exceed 12mg/dL
  • Immune System
    • Protected by passive immunity for first 3 months
    • At birth infants are somewhat immuno-compromised
    • Colostrum and breast milk provide IgA, the second most abundant immunoglobulin
  • Skeletal System
    • Rapid development during first year
    • Assess base of spine for closed dimple
    • Assess for hip dysplasia using Ortolani's maneuver
  • Newborn Appearance
    • Cone-Shaped Head-molding (over riding sutures)
    • Enlarged genitals
    • Breast buds on both sexes (inverted nipples also common)
    • Vernix
    • Birth Marks: Telangiectatic Nevi-Stork bites, Mongolian Spot
    • Skin: Erythema, Toxicum -Newborn rash, Milia, Strawberry mark, Port wine stain
    • Mouth: Epstein's pearls
  • Neuromuscular/Neurologic System
    • Any infant that is difficult to awaken-call MD
    • Behavioral Characteristics: States of consciousness/sleep-wake states (Deep sleep, Light sleep, Drowsy, Quiet alert, Active alert, Crying)
    • Other factors influencing behavior: Gestational age, Time since birth and time of day, Stimuli
  • Sensory Behaviors

    • Vision: Clearest visual distance is 8 to 12 inches, Sensitive to light; open eyes if room darkened, Attracted to black and white patterns; can detect color by 2 months of age, Respond to movement; will track their parents' eyes
    • Hearing: Respond with calmness to mother's voice, singing, heartbeat, Hearing screening performed on all infants prior to D/C
    • Smell: BF infants able to smell breast milk and can differentiate their mother from other lactating women
    • Taste: Able to distinguish between sweet & sour by 72 hr old
    • Touch: Well developed; reflexes elicited; sensitive to pain
  • Newborn Reflexes
    • Moro or startle – present at birth; absent by 6 mo
    • Grasp--lessens by 3-4 mo
    • Tonic neck or "fencing"
    • Sucking, rooting, swallowing
    • Babinski – disappears after 1 yr of age
    • Stepping – present for 3-4 wks
    • Glabellar
    • Trunk Incurvation
  • APGAR

    A = appearance (color), P = pulse (heart rate), G = grimace (reflex irritability), A = activity (muscle tone), R = respiratory (respiratory effort)
  • APGAR Ratings
    • 7 to 10 is within normal limits
    • 4 to 6 is moderately distressed
    • 0 to 3 is severely distressed
  • Physical Assessment of the Newborn
    • Imperative that we maintain temp stability – keep baby warm!
    • Observe, then complete least disruptive assessments, progressing to most disruptive
    • General appearance: Flexed posture, Coordinated movements, Count extremities, fingers, toes, Overall color of skin
    • Head: Molding, Fontanelles
    • Eyes/Ears/Mouth: Equal pupils, ear location, palate, reflexes (rooting and sucking), Epstein's pearls
    • Chest: Auscultate apical heart rate for one minute, Auscultate respirations for one minute—look, listen, feel
    • Clavicles
    • Breasts
    • Abdomen: bowel sounds, number of vessels in cord (2 arteries, one vein)
    • Brachial pulses
    • Skin: Blanching on torso and thighs/knees, Lanugo (fine downy hair), Jaundice, Erythema Toxicum, Nevi variations, Acrocyanosis, Milia, Vernix
    • Genitalia: Edema of labia, scrotum, Descended testes
    • Back and Anus: Dimple at base of spine, Hip Dislocation, Ortolani's maneuver, Femoral Pulses
  • Caput

    Swelling of the scalp
  • Cephalohematoma

    Bleeding under the scalp
  • Vital Signs
    • Temperature Axillary 36.5C to 37.2C
    • Respirations 30 – 60
    • Apical pulse 120 – 160
  • Baseline Measurements
    • Length
    • Weight (average baby is 8lbs 4 oz)
    • Head circumference – OFC (occipitofrontal circumference)
  • Newborn Procedures
    1. Weighing & Measuring
    2. Eye prophylaxis
    3. Vitamin K prophylaxis
    4. Umbilical cord care
    5. Promote parent – infant bonding
  • Eye prophylaxis
    Antibiotic Ointment: Routine procedure to protect newborn from eye infections and blindness caused by vaginal bacteria. The ointment is safe and does not cause burning or irritation. Erythromycin 0.5% opth oint. Administer within 1-2 hrs after birth.
  • Vitamin K prophylaxis
    Aquamephyton - Vitamin K Shot. Administered to help newborn's blood clot. Administer within 1-2 hrs after birth.
  • Care of stable NB from 2 hours after birth until d/c
    1. Routine newborn care
    2. Protective environment basic to NB care
    3. Assessment: Ballard scale to assess neuromuscular and physical maturity, Classification by gestational age and birth weight (LGA, AGA, SGA)
  • Genetic Screening
    PKU, Galactosemia, Sickle cell, Hypothyroidism, Cystic fibrosis, Maple syrup urine disease. Screen for 12+ disorders. Heel Prick.
  • Circumcision
    Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. Circumcised, Uncircumcised.
  • Circumcision Procedures

    1. Plastibell: Falls off in 5-7 days
    2. Gomco clamp
    3. Vaseline with diaper changes
    4. Yellow exudate is normal healing. Instruct parents not to remove it.
    5. Patient teaching: watch for bleeding, watch for first void, prevent infection
  • Neonatal Pain
    • Assessment (NIPS) Neonatal Infant Pain Scale
    • Management: Nonpharmacologic - swaddling, non-nutritive sucking, Pharmacologic - xylocaine, concentrated sucrose solution administered with pacifier (toot sweet)
  • Discharge planning and teaching
    1. Temperature; signs of illness
    2. When to call physician
    3. Safety
    4. Positioning and holding
    5. SIDS prevention
    6. Clothing
    7. Nonnutritive sucking
    8. Cord care, skin care
    9. Infant follow-up
  • Screening
    • PKU
    • Galactosemia
    • Sickle cell
    • Hypothyroidism
    • Cystic fibrosis
    • Maple syrup urine disease
    • Screen for 12+ disorders
    • Heel Prick
  • Newborn Procedures

    • Circumcision
    • Plastibell
    • Gomco clamp
    • Vaseline with diaper changes
  • The American Academy of Pediatrics: 'Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision.'