Normal Newborn S

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    Apgar ScoringActivity (muscle tone)0 Limp; no movement; flaccid1 Some flexion of arms and legs2 Active motion

    Pulse (heart rate)0 No heart rate1 Fewer than 100 beats per minute2 At least 100 beats per minute

    Grimace (reflex response)0 No response to airways being suctioned1 Grimace2 Vigorous Cry; cough, or sneeze

    Appearance (color)0 The baby's whole body is completely bluish-gray or pale1 Good color (pink) in body with bluish hands or feet2 Good color all over (completely pink)

    Respiration (breathing)0 Not breathing

    1 Weak cry; may sound like whimpering, slow or irregular breathing2 Good, strong cry; normal rate and effort of breathing

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    Pulmonary System Transition

    First baby must take that first breathe

    Function of respiration switches

    Management

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    Cardiac System Transition

    Closure of the foramen ovale- after cordis clamped

    Closure of the ductus arteriosus

    Closure of the ductus venosus

    Common variations

    Murmurs

    Acrocyanosis

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    Nursing Responsibilities

    Dry and Stimulate- to makebaby cry

    Suction (if needed)

    Assess heart rate

    Weight and identify

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    Newborn Thermoregulation

    Heat production

    Brown adipose tissue

    Heat loss

    Convection

    Radiation

    Evaporation- most common Conduction

    Response to heat

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    Nursing Interventions to

    Prevent Hypothermia

    Dry infant, removewet blankets

    Apply a hat andwarm blankets

    Avoid placing infanton cold surfaces

    Avoid placing infants

    in drafts

    Place under radiantwarmer iftemperature is

    unstable- naked

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    Normal Newborn Vital Signs

    Temperature:

    Axillary: 36.5-37c (97.7-98.6F)

    Rectal:

    36.6-37.2c (97.8-99F) Heart rate:

    Apical: 120-160bpm. Varies withsleeping or crying

    Respiration: 30-60 breaths/min Blood Pressure: 80/40.varies.

    Arm/Thigh- not part of normalv/s for baby

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    Newborn Sleep Cycle

    Sleep states:

    Deep or quiet sleep

    Active (REM)

    Alert states:

    Drowsy

    Wide awake Active awake

    Crying

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    NursingAssessment of the newborn

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    Newborn Appearance

    Head circumference

    3237 cm (12.5-14.5)

    Approx. 2-3 cmlarger than chestcircumference

    Fontanels- Anterior and posterior

    Molding

    Caput succedaneum

    Cephalhematoma

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    Newborn Measurements

    Weight

    2,500 4,000 g

    5 lb 8 oz 8 lb 13 ozAverage: 3405g

    7 lb 8 oz

    Length

    4852 cm (18-22 in)

    Average: 50cm(20in)

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    Newborn Appearance

    Caput succedaneum Cephalhematoma

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    Eyes, Ears, Nose, and Mouth

    AssessmentEyes

    Symmetry in appearance, aligned with the ears. ifbelow indicates down syndrome.

    normal placement

    Ears Without lesions, cysts, nodules

    Sinus tract

    Nose

    Patent nares bilaterally

    Sneezing (common)- this is like a reflex to clearairway. Is normal. Doesn't mean infection or cold.

    Mouth

    Palpate soft and hard palate

    Teeth

    Tongue

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    Abdominal and Back Assessment

    Abdomen

    Round, full, symmetrical, normal bowel sounds

    Two arteries, one vein in cord

    Brachia

    land femora

    lpu

    lses- make sure ispresent & strong

    Hernia- common in African Americans

    Back

    Spine intact- nice straight curve

    Patent anus

    No sacral dimples- can be sign of spinal bifida.Report to doctor.

    Lanugo

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    Genital and Anal Assessment

    Normal finding

    Patent anus

    Stool and urine by 24 hours after birth

    Male Findings:

    Testes palpable in scrotum

    Undescended testes

    Epispadius -pee hole is on the top part of theshaft

    Hypospadius- pee hole is on the bottom part ofthe shaft

    Scrotum pendulous- when is swollen. You see iton breech babies.

    Imperforate anus

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    Genital and Anal Assessment

    Female Finding:

    Labia & clitoris edematous

    Hymenal tag Vaginal discharge- normal

    Pseudomenstruation- spot of

    bleeding from the materna

    lhormone passing through the

    babies system causes this or breastto swell

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    Skin Assessment

    Acrocyanosis

    Vernix caseosa- whitish coat whenborn. Lubricate and protect theirskin in utero.

    Milia- white spots on the nose andface. It will disapear.

    Erythema toxicum (newborn rash).Disappear by itself.

    Mongolian spots

    Birthmarks Telangiectacic nevi (stork bites)

    Nevus flammeus (pork wine stain)

    Nevus vasculosus (strawberry mark)

    Mongolian spot

    Birthmark

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    Neurologic System

    Normal reflexes Blink- reaction to light within 2 hours after birth. Open

    and close the eyes.

    Sucking Rooting- stroke the side of face. They should turn to

    that side. To see if able to find breast.

    Grasp (plantar and palmer)- finger in hand. Clamp.

    Moro when you lift them of the crib a little or through

    startle. Their hand come to a C. Up to 6 months. Babinski- finger through feet. Flare till 2 yr. opposite

    after that.

    Stepping- when u stand them up and move legs like ifthey are stepping

    Tonic neck- head one side and hand goes other way

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    General Nursing Care

    Erythromycin ointment

    Vitamin K prophylaxis (0.51.0 mg)

    First bath

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    Gestational Age Assessment-

    not important

    Dubowitz Tool

    Neuromuscularmaturity

    Posture

    Square window

    Arm recoil

    Popliteal angle

    Scarf sign

    Heel-to-ear

    Physical maturity

    Skin

    Lanugo

    Plantar surface

    Breasts

    Eye and ear Genitalia

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    Newborn Nutrition

    Calorie requirements:

    50 to 55kcal/lb/day or 105-108kcal/kg/day

    Breast Milk

    Colostrum- provides baby with passiveimmunity

    Transitional

    Mature milk

    Fore milk Hind milk

    Frequency

    1 and a half to 3 hours

    Determined by baby cues

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    Newborn Stools

    Meconium- 1rst poop. Passes first 8-24hours. Thick and tarry.

    Transitional- switches to greenish loosestool.

    Breast fed stools- liquid. Seed. Yellowcolor stool.

    Formula fed stools- more formed and

    pasty brown color

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    Newborn Stools

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    Questions

    If newborn temp is 96.5F, what would youdo? You warm up the baby with radiantwarmer, naked. You want it to be at least

    97.5F. Do double wrapping if is slightly loweror put on mother stomach and out blanketsover it. Sign of infection is low temp., babiescant maintain body temp and have to be puton the radiant several times.

    The caput crosses the suture line. Caput isfull of fluids. Heals hours to days.

    Vitamin k given in vastus lateralis and isgiven to prevent bleeding. Promotes clotting

    factor.

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    Baby looses heat to cold window,how is it loosing heat? Radiation.

    Rectal temp done initially tonewborn to check for patency.

    What is the bluish discoloration inthe hand and feet? Acrocyanosis.

    Baby should be placed to sleep onthe back to prevent SID. And havethem turn the head to the side.