Editing Maternal and Newborn Nursing – RN Flashcards (section)

== Newborn ==

;Apgar score components and what the score does not do
:Heart rate, respiratory effort, muscle tone, reflex irritability, and color, each scored 0 to 2 at 1 and 5 minutes. 7 to 10 reassuring, 4 to 6 moderate difficulty, 0 to 3 severe distress. '''The Apgar score does not guide resuscitation'''; resuscitation is initiated based on respirations, heart rate, and tone.

;Normal newborn vital sign ranges
:Heart rate 110 to 160 bpm awake, respirations 30 to 60 and irregular with pauses under 20 seconds, axillary temperature 97.7 to 99.5 degrees F (36.5 to 37.5 degrees C), blood pressure roughly 60 to 80 over 40 to 50.

;Four mechanisms of newborn heat loss with the matching intervention
:'''Evaporation''' (dry the infant, remove wet linens), '''conduction''' (prewarm scales, mattresses, stethoscopes, hands), '''convection''' (avoid drafts, vents, open portholes), '''radiation''' (move the crib away from cold walls and windows).

;The cold stress cascade
:Newborns cannot shiver and rely on nonshivering thermogenesis using brown adipose tissue. Cold raises oxygen consumption and metabolic rate, producing '''hypoglycemia''', then anaerobic metabolism and '''metabolic acidosis''', which causes pulmonary vasoconstriction, worsening respiratory distress, and impaired bilirubin binding.

;Newborn hypoglycemia: at-risk infants and signs
:Risk: large or small for gestational age, preterm or late preterm, infants of diabetic mothers, and any infant with cold stress, sepsis, or asphyxia. Signs are nonspecific: jitteriness, poor feeding, lethargy, hypotonia, weak or high-pitched cry, temperature instability, apnea, cyanosis, seizures. A commonly used treatment threshold is below about 40 to 45 mg/dL. '''Jitteriness gets a glucose check, not reassurance.'''

;Why newborns need vitamin K
:The neonatal gut is sterile at birth and little vitamin K crosses the placenta, so clotting factors II, VII, IX, and X are deficient. Phytonadione is given IM in the vastus lateralis shortly after birth to prevent vitamin K deficiency bleeding.

;Physiologic versus pathologic jaundice
:'''Physiologic''' appears '''after 24 hours''', peaks days 3 to 5, and resolves spontaneously. '''Pathologic''' appears '''within the first 24 hours''', rises rapidly, or persists, and suggests hemolysis (Rh or ABO incompatibility), infection, or metabolic disease. Unconjugated bilirubin crosses the blood-brain barrier and can cause kernicterus.

;Phototherapy nursing care
:Maximize skin exposure, provide eye protection, monitor temperature and hydration, expect loose green stools and possible rash, and '''promote frequent feeding''' (8 to 12 times per 24 hours) because bilirubin is excreted in stool. Water supplementation does not lower bilirubin and is not given.

;Caput succedaneum versus cephalhematoma
:'''Caput''': soft scalp edema, present at birth, '''crosses suture lines''', resolves in days. '''Cephalhematoma''': subperiosteal bleeding, appears hours after birth, '''does not cross suture lines''', resolves over weeks, and '''increases hyperbilirubinemia risk'''.

;Fontanel expectations
:Anterior (diamond) closes at 12 to 18 months; posterior (triangle) closes by about 2 to 3 months. Both should be soft and flat. Bulging suggests increased intracranial pressure; sunken suggests dehydration.

;Newborn findings that must be reported
:Central or circumoral cyanosis, grunting, nasal flaring, retractions, sustained respirations above 60, apnea longer than 20 seconds, temperature instability, jitteriness, '''jaundice in the first 24 hours''', a '''single umbilical artery''' (normal is two arteries and one vein), an asymmetric Moro reflex, and no void within 24 hours or no meconium within 24 to 48 hours.

;Signs of adequate breastfeeding intake
:At least 6 wet diapers per day by about day 4 to 5, 3 or more stools per day in the early weeks, audible swallowing, appropriate weight gain after an expected initial loss of up to 7 to 10 percent regained by 10 to 14 days, and a comfortable deep latch. Nipple pain and cracking usually indicate a shallow latch.

;Engorgement care differs by feeding goal
:'''Breastfeeding''': warmth before feeding to promote letdown, frequent feeding or pumping, cold compresses after feeding for comfort. '''Not breastfeeding''': avoid all nipple stimulation and pumping, wear a supportive bra, and use cold compresses only.

[[Category:Maternal and Newborn Nursing]]
[[Category:Registered Nurse (NCLEX-RN)]]
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