1. Amie Bedgood RN, MSN Fall 2012

3.  What is this?  Why is it necessary?  When is it formed?

4. Initiation of of Breathing Breathing Mechanical Chemical Thermal Sensory

5.  Mechanical – chest recoil  Chemical- respiratory acidosis  Thermal- decrease in environmental temp  Sensory- tactile, auditory, and visual influences stimulate activation of the first breath

6. Ductus arteriosus- blood flow from pulmonary artery to aorta Ductus venosus-blood flow from umbilical vein into the inferior vena cava Foramen ovale- blood flow from right atrium to left atrium

7. Ductus arteriosus- closes after birth triggered by pressure changes and pO 2 (transient murmurs normal in first 24 hours) Ductus venosus- closes at clamping of umbilical cord Foramen ovale- closes at first breath

8.  Increased aortic pressure and decreased venous pressure (clamping of cord)  Systemic pressure and pulmonary artery pressure (expanding of the lungs)  Closure of foramen ovale (atrial pressure changes)  Closure of ductus arteriosus (PO2 triggers constriction of ductus arteriosus)  Closure of ductus venosus (clamping of cord)

10.  Contributing factors to neonatal heat loss  Size  Loss of heat source  Loss of glucose supply  Metabolic rate

11.  Convection  Radiation  Evaporation  Conduction How does the NB maintain body temperature?

12.  Basal metabolic rate  Muscular activity  Non-shivering thermogenesis (NST) Why is heat regulation vital to the neonate’s survival?

13.  What nursing interventions assist the neonate to maintain adequate thermoregulation?

14.  Lifespan of neonatal RBC: 80-100 days (2/3 lifespan of adult’s RBC)  What factors will effect the newborns blood volume?

15.  Hemoglobin 14-20g/dl  Hematocrit 48-69%  WBC 10,000 – 30,000mm3  Glucose 40-60mg/dl first 24 hr  then 50-90mg/dl  Low blood sugar 40-45mg/dl requires treatment

16. Why is Vitamin K AquaMEPHYTON ® administered to the newborn?

17.  What is the significance of meconium?  What is the priority nursing intervention regarding GI assessment?

18. PHYSIOLOGIC JAUNDICE  Differences in life span of RBC  Immaturity of liver  No pathology involved PATHOLOGIC JAUNDICE  Pathology involved  Birth trauma  Blood type incompatabilties

19.  Bilirubin levels for a term NB<3mg/dl  Elevated bilirubin levels depend on NB’s age- peak levels reached between day 3 and 5 in the term infant.  Toxic levels approximately – 20mg/dl

21.  Maintain NB’s core temperature  Monitor stool frequency and characteristics  Encourage early feeding  Encourage bowel elimination  Prevent dehydration

22.  What is the normal number of voids in a 24 hour period?  For first 48 hours- 1 or 2 daily  Following 48 hours- 6 times daily  What is brick-dust staining?

23.  Active acquired immunity- the mother forms antibodies in response to illness or immunization – passed through breast milk  Passive acquired immunity- transfer of immunoglobulins to the fetus in utero (IgG production begins at 20 weeks gestation)

24.  Sleep States:  Deep or quiet sleep  Active or REM sleep  Alert States:  Drowsy  Wide awake  Active awake  Crying

25.  Which of the behavioral states is optimal for maternal-infant bonding?

26.  Visual  Auditory  Olfactory  Taste  Tactile

27. Sign012 Heart rateAbsent Slow-below 100 Above 100 Respiratory effort Absent Slow- irregular Good Crying Muscle toneFlaccid Some flexion of extremities Active motion Reflex irritability None Grimace Vigorous cry ColorPale blue Body pink, blue extremities Completely pink

28. 0-3 poor condition 4-6 fair condition 7-10 positive (good condition)

29.  What measures should the nurse take to ensure a patent airway in the NB?  Why is it important to maintain a neutral thermal environment?  What nursing interventions assist to maintain the NB’s core temp? (prevent cold stress)

31.  Pulse  Respirations  Temperature  Blood pressure

32.  Weight  Length  FOC  Which measurement is priority for on-going assessment?

33.  Fontanelles  Anterior  Posterior  Suturelines  Frontal  Coronal  Sagittal  Lambdoidal

34.  Molding  Caput succedaneum  Cephalhematoma

35.  Eyes  Ears  Mouth What is the significance of variations? (nursing interventions)

36.  Color  Size  Reaction to light/blink  Conjunctival hemorrhages  Transient strabismus or nystagmus

37.  Level  Shape/ malformation  Flexibility  What body system must the nurse carefully monitor if anomalies occur with the ears?

38.  Lips  Palate  Hydration  Reflexes  Additional normal findings:  Epstein’s pearls  Precocious teeth  Short fernulum of tongue

39.  How many vessels will you find in the umbilical cord?  ___ Arteries  ___ Veins  What is Wharton’s jelly?

40.  What is the general shape  What is the ratio of FOC to abdominal size?  What organs must be assessed in the abdomen?

41.  Upper  Hands  Lower  Hips  Feet

42.  Moro or Startle  Palmer grasp  Rooting  Sucking  Babinski  Plantar grasp  Tonic neck  Stepping

43.  Female  Labia  Clitoris  Vaginal opening ▪ Hymeneal tag ▪ Secretions  Anal opening  Male  Penis ▪ Penial raphe ▪ Urethral meatus  Scrotum-testes  Anus

44.  Color and thickness  Birthmarks  Harlequin sign  Jaundice

45.  Acrocyonosis  Mottling  Erythema toxicum  Vernix caseosa  Telangiectatic nevi  Mongolian spots- Why is it important to carefully document these birth marks?

46.  Neuromuscular and physical maturity  Newborn Maturity Rating & Classification  Dubowitz tool  Ballard Score

47.  Posture, reflexes, size, skin characteristics and fat distribution  Dubowitz scale  Ballard score  Neuromuscular maturity- posture, square window (wrist) arm recoil, popliteal angle, scarf sign, heal to ear maneuver  Physical maturity- skin condition, lanugo, plantar surface, breast buds, earl and genital development.

49.  Administered within 1 to 2 hours of birth  AquaMEPHYTON ®- vitamin K  Erythromycin ointment  When is best time to administer?

50.  Footprints  Identification bands  Newborn  Mother  Designated “other”

52.  What factors are involved in the parent’s decision to have their male newborn circumcised?  What assessments/ care must the nurse include after circumcision?

53.  “The American Academy of Pediatrics (AAP) believes that circumcision has potential medical benefits and advantages, as well as risks. The existing scientific evidence is not sufficient to recommend routine circumcision. Therefore, because the procedure is not essential to a child’s current well-being, we recommend that the decision to circumcise is one best made by parents in consultation with their pediatrician, taking into account what is in the best interests of the child, including medical, religious, cultural, and ethnic traditions. circumcisiondecision http://www.aap.org/en-us/search/pages/results.aspx?k=stance%20on%20circumcision

54.  Informed consent  Comfort measures  Risk of ______?  Infection prevention  Parent teaching and discharge planning

55.  Safety  Elimination  Genitalia care  General  Feeding  Signs of illness  NB behavior  Immunization schedule  Return appointment schedule