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Nursing School

The Newborn
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from class notes...

THE NEWBORN

 

From birth to 4 wks

 

Physiological Assessment:

-Newborn undergoes more profound physiological changes @ this time than at any other time during the life cycle.

-These changes assist the newborn to adapt to life out of the uterus.

 

Respiratory System: most important to sustaining life; prior to birth, O2 needs are met by the placenta-the baby has to estab respiration once the cord is cut

 

3 things that need to happen in the respiratory system:

1)      Initiation of respiration

3 factors involved:

            a. physical factor-the change in pressure from intra to extra-uterine life

            b. sensory factor-cold (most imp), pain, touch, light, sound

            c. chemical factor-all babies go thru this ~ transitory asphyxia- the period of time where O2 levels are decreased-a brief moment-where NO  

                        O2 is getting to baby-until lungs inflate & take over

                        (CO2 increases, O2 decreases, pH decreases)

            Babies with respiratory problems (premies) may need help with this.

2)      Expansion of Alveola-  resistance of lung tissue, thorax, diaphragm & resp muscles because they’ve never used them before

-     lipoprotein which helps this = surfactant - a lipoprotein which when secreted facilitates expansion of lungs by decreasing surface tension & prevents collapse of the alveolar walls

-     enables walls to contract & expand in the func of respiration

-     detected in utero after 28th week

-     babies born early require artifical surfactant after they are born

 

3)      Removal of Lung Fluid

-     by pressure during vaginal delivery when their chest is squeezed in the vaginal canal, they swallow it, it is drained by positioning

-     done by suction in c-section birth

-     **first breath is the most difficult for baby

 

Circulatory System: see fetal circulation notes

-     Total blood volume (TBV) of a newborn = about 300 ml, depends on how the cord is clamped

-     Cord is clamped when it stops pulsating (2-3 min)

-     Babies get 50-100 ml more blood from the cord & store it as iron for 3-5 mos-when their weight will start to double

-     Cord is cut immediately if baby is in distress

-     TBV is also dependent on where the baby is placed - gravity, keep the newborn @ or below the level of the placenta until cord is cut (usually placed on mom’s belly)

-     Some babies can’t handle the extra cord blood & develop jaundice; called Hyperbilirubemia-can’t take the extra bilirubin

*Blood values are higher in this period than any other time in life cycle because they needed it in utero for adequate oxygenation.

Normal levels:  Hct 44-72%, Hgb 14.5-22.5g, RBC 5-7.5 mil, WBC 9000-30,000.   Values start to normalize in about 10 days.

 

Temperature Regulation: babies have difficulty maintaining temp because they have a large surface area (big head & long trunk) related to muscle mass leading to loss of heat from exposure.  Babies only have a thin layer of subq fat & they have an inability to shiver.

            Ways we lose heat:

            Conduction- xfer of heat from warmer object to cooler by direct contact: touch w/cold hands, cold stethoscope, placing on a cold scale

            Convection- xfer from by to surrounding air: cold room, being outside in winter

            Radiation- only indirect contact: cold bassinet, being near a window

            Evaporation- excessive loss- 1st occurs at birth; happens during bathing (quickly dry babies off)

 

            Newborns conserve heat by:

            1. peripheral vasoconstriction (like adults)

            2. assuming the fetal position to decrease body surface area

 

            Ways babies product heat:

            -non-shivering thermogenesis = they have brown fat located between scapula, around neck, behind sternum & in deep layers of kidneys

            -darker in color due to rich blood supply

            -2-6% of total body wt.

            -chemical reaction occurs in the brown fat which brings down the triglycerides into glycerol & fatty acids thereby prod heat which is distributed to other body parts by the blood

            - first appears in wks 26-30 gestation & continues to increase up to 5 wks after birth unless depleted by cold stress

 

 

Cold Stress- stress on the total body system when newborns consistantly lose heat & have to produce & conserve heat.  Causes increase in metabolic rate & calorie consumption (leads to hypoglycemia), also increases O2 requirements (decreases surfactant production)

 

Hypoglycemia- can lead to brain damage/brain cell death & mental retardation because glucose nourishes brain cells

Metabolic acidosis can occur-need to do nursing measures to maintain neutral thermal environment

 

Neurological Assessment:

            -newborns are neither anatomically or physiologically well developed but function well enough to sustain life

            -to know if the baby is developing & functioning, you will test reflexes- reflexes are important indicators of normal development

 

 

Reflexes:

1.      Moro-

2.      Tonic neck-

3.      Rooting- turning head toward mom’s breast

4.      Sucking- touch side of their mouth or lips & they start

5.      Babinski-

 

PHYSICAL ASSESSMENT head to toe

 

Head: - large & size of the total size of the baby

-asymmetrical due to molding of the skull bones during labor

 

-Cephalhematoma- accumulation of blood between the bone & periosteal membrane

bleeding occurs due to pressure during birth or d/t long labor or use of forceps; not apparent at birth  *does not cross suture lines  *no bruising (echymosis) *firm to touch

*resolves in weeks to months on its own w/no treatment

 

-Caput Succedaneum- swelling of soft tissue d/t prolonged & extended pressure on the head

-can result from long labor or suction extraction

-does cross suture lines

-is apparent at birth

-does have bruising, there is no treatment, will resolve itself in days to a week or 2

 

Fontanels:  (soft spots)

            Anterior: larger, closes in 12-18 mos

            Posterior:  closes in 2-3 mos

-fontanels overlap as head goes thru birth canal

-should feel soft & flat

-if depressed or indented, means dehydration

-if bulging, means intracranial pressure

-they allow for brain growth

 

Circumference: The increase in circumference of the head indicates brain growth. Normal range of newborn head circumference is 33-37 cm (2 cm larger than chest)

 

Eyes: - babies can see, like to look at faces, can detect colors, mostly attracted to black & white before 2 months of age; can see 7-8 inches away, like to look @ faces & eyes

-Strabismus- cross-eyed d/t poor muscle control

-Lacrimal (tear) ducts are not fully functional at birth.  No Tears for up to the 2nd month; post-term babies may cry tears

 

Ears: - can hear; pinna (top) of ear should be in direct alignment w/outer canthus of the eye

- ears & kidneys develop at the same time - low-set ears can sometimes indicate renal abnormalities, Down Syndrome…

 

Mouth: - is checked for intact hard/soft, cleft palate

 

Nose: - flat, tip of nose usually has bruise because of trauma during birth

-assess nasal patency by covering 1 nostril at a time (if they cry, they may not be getting enough air due to deviated septum)

 

Thorax: - round chest, check circumference (2 cm less than head)

-breast tissue sometimes swollen as a result of maternal hormone influences, may discharge “witches milk” may last a few weeks -tell parents not to massage or squeeze breast causing an infection called mastitis;

 

Abdomen: - round, protrudes-d/t weak abdominal muscles (stomach flattens at age 2-3 yrs)

-look at umbilical cord- it is clamped, clamp stays on 24 hrs to prevent bleeding, leaving a stump which starts to dry in about 2 hours

-take care of cord with triple dye, then alcohol swab is used during every diaper change, also making sure to keep diaper below the cord

-teach parents to assess the stump for s/s of infection-discharge, odor, swelling, redness

-no immersion in water until the cord falls off

 

Female Genitals: - normal to have swollen, enlarged labia d/t influence of maternal hormones, can be hard to distinguish between labia majora & minora; will also have enlarged clitoris

-smegma sometimes present - white, cheeselike substance between labia, not to be removed

-Pseudomenstruation- discharge sometimes blood tinged, or blood droplets in diaper, no odor; disappears in 2-4 wks, d/t influence of maternal hormones

 

Male Genitals: - check loc of urinary meatus; should be on tip of the glans penis

-Hypospadias- meatus is loc on ventral (underside, below) surface of the glans penis, not on tip

-Epispadias- meatus is on the dorsal surface of the glans penis

-Cryptochidism- failure of testes to descend into scrotal sac; wait 1 yr, then if they haven’t descended, can be done surgically; palpate scrotum to assess this; testes usually descend in utero between weeks 37-40

-Phimosis- where foreskin is small & can’t be pulled back to expose the glans penis, circumcision will correct this problem

-Hydrocele- fluid collection surrounding the testes in the scrotum; you can feel the fluid on palpation

- Circumcision- done for religious, cultural reasons; female partners of uncircumcised men have an increased risk of cervical cancer; done the 2nd day -two types:

- Gomco: use Vaseline to keep diaper from sticking

- Plastibell: do not use Vaseline or plastic bell will fall off before fully healed.

 

 

NOTHING on this website is to take the place of a physician's advice. Everything in this site is meant to be only a helpful tool for me and my nursing student friends.

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