Ch 24 Nsg care of the newborn

StudyBlue printing of Ch 24 Nsg care of the newborn html, body, div, span, applet, object, iframe, h1, h2, h3, h4, h5, h6, p, blockquote, pre, a, abbr, acronym, address, big, cite, code, del, dfn, em, font, img, ins, kbd, q, s, samp, small, strike, strong, sub, sup, tt, var, b, u, i, center, fieldset, form, label, legend, table, caption, tbody, tfoot, thead, tr, th, td { margin: 0; padding: 0; border: 0; outline: 0; font-size: 100%; background: transparent; } body { line-height: 1; } blockquote, q { quotes: none; } blockquote:before, blockquote:after, q:before, q:after { content: ''; content: none; } /* remember to define focus styles! */ :focus { outline: 0; } /* remember to highlight inserts somehow! */ ins { text-decoration: none; } del { text-decoration: line-through; } /* tables still need 'cellspacing="0"' in the markup */ table { border-collapse: collapse; border-spacing: 0; } /* end RESET */ .header { min-width:800px; } .logo { padding:6px 20px 2px 20px; margin:0; font-size:25px; font-weight:bold; color:#808285; position:relative; border-bottom: 1px solid #c5c5c5; } .logo-blue { color:#70adc4; } .logo-desc { font-weight:normal; font-size:19px; color:#cccccc; margin-top:50px; position:absolute; display: none; } .back-button { position:absolute; top:20px; right:20px; font-size:13px; line-height:25px; color:rgb(0,175,225); font-weight:normal; } .back-button a { color:rgb(0,175,225); } .instructions { padding:0; margin:0; width:100%; position:relative; color:rgb(100,100,100); } .step-holder { border-left:1px solid #ededed; margin-left:20px; } .steps { padding:15px 0; float:left; width:24%; border-right:1px solid #ededed; text-align:center; } .steps-01 { } .steps-02 { } .steps-03 { } .steps-04 { } .label { padding:5px 10px; } .print-button { } .print-button a { background-color:rgb(0,175,225); color:white; line-height: 19px; padding:9px 8px 5px 30px; font-size:14px; text-decoration:none; background-image: url(images/printer.png); background-repeat: no-repeat; background-position: 7px 50%; -moz-border-radius: 5px; -webkit-border-radius: 5px; } .print-button a:hover { background-color:black; } .theNote .content { width: 8.0in !important; margin: 5px auto; padding:20px; background-color:white; } .theNote .header { border-bottom: 1px dashed #C8C8C8; font-size: 17px; padding: 0 0 10px; line-height: 19px; color: #00ADE1; min-width:500px; } .theNote .body { font-size: 14px; line-height: 19px; padding: 10px 0; } .theNote{ padding:6px 0; clear:both; background-color: rgb(200,200,200); } .theNote h3{ color: rgb(100,100,100); } .theNote h1, .theNote h3{ background-color:white; padding:2px 20px; width:8.0in !important; margin: 0 auto; font-size: 15px; } .theNote h1{ padding-top: 10px; font-size: 15px; } .theNote h1:first-child{ font-size: 20px; } .theNote h3 { font-size: 14px; font-weight: normal; } #options { border: 3px double #ccc; padding: 5px 12px; margin: 10px 50px 10px 20px; float: left; } #info { border-top: 1px solid #ccc; padding-top: 5px; font-style: italic; } li { margin: 5px 10px 5px 25px; } ul li { list-style: disc; } ol li { list-style: decimal; } img { border: 0; } table { clear: both; width: 100%; border: 1px solid #c5c5c5; border-width: 1px 0; margin: 0; page-break-after: always; } table#page { page-break-after: auto; } td { text-align: center; font-size: 12px; border-bottom: 1px dashed #c5c5c5; height: 1.75in; width: 50%; padding-left: 15px; } .leftside { border-right: 1px solid #cccccc; padding: 0 15px 0 0; } .bottom td { border-bottom: none; } .clearfix { clear:both; line-height:1px; height:1px; } img { max-width:80%; max-height:150px; margin:20px; } @media print {.header { display: none; } .content .header{ display:inherit; } table { border: 1px dashed #bbb; border-width: 1px 0; } .theNote{ background-color:white; } } Ch 24 Chapter 24: Nursing Care of the Newborn – Approx. 10 questions · Apgar score: 0-10, HR, Resp effort, Muscle tone, Reflex irritability, Color. 0-3 severe distress, 4-6 moderate difficulty, 7-10 minimal to no difficulty transitioning. 1 min and 5 min. 10 min if others were low. · appropriate for gestational age (AGA): if weight/growth is btw 10 and 90 th percentiles. · Circumcision: removal of foreskin of penis, gomco clamp or plastibell. · Nursing care during circumcision and immediately after: pain management, restrain, NPO for 2-3 prior. After: wear gloves, comfort/cuddle, check q15-30 for frist hr, then q4-6h, gentle pressure if bleeding, change diaper q4h, talk to parents. Cleanse gently w water and use petr jelly so it odesnt stick to diaper · hypoglycemia: for newborn, less than 40, normal is 50-60 w/i several hrs of birth, 3rd day of life 60-70 normal. treat by feeding, Risk in late preterm or GD. S/S: jitteriness, lethargy, poor feeding, hypotonia, hypothermia, resp distress, apnea, seizures. · late preterm: 34-36 weeks · postmature: after 42 weeks and showing signs of placental insufficiency · postterm (postdate): after 42 weeks · preterm/premature: before 37 weeks, regardless of weight · term: 37-42 weeks · Hypothermia: prevent cold stress, swaddle, keep dry, skin to skin, assess axillary temp. frequently. perform initial procedures under radiant warmer, baby naked. · Initial assessment & Apgar scoring (Table 24-1, Box 24-2). · Recognize normal exam findings & normal variations (pp. 556-565) · “Normal” position of the NB: general flexion? · Normal Vital Sign ranges: HR btw 120-160/min,(page 556) down to 80 when sleeping and up to 180 when crying. Temp 37* or 98.6, normal variation 36.5-37.2(F: 97.7-98.9) · Normal blood glucose levels-above 40. · Procedures o Suction of mouth & nose – correct procedure p. 570: w/bulb: mouth first, compress bulb and stick in one side of mouth not center, one nostril at a time, show parents. Mechanical: set to less than 80, lubricate catheterin sterile water, insert, carefully suction intermittently and rotate, withdraw. Stop when sounds clear. o Eye prophylaxis – see medication guide p. 572: erythromycin used in all babies, causes vision to blue for 1-2 hours, so it can wait until after initial parent-baby interaction, but within 1-2 hours of birth, clean vernix from eyes, spread ointment from inner to outer canthus to lower conjunctival sac, can wipe excess after 1 min. o Vitamin K - see medication guide p. 573 and technique for IM injections (Fig 24-16): promotes clotting factor formation, give w/i 2 hrs. alcohol pad, dry one minute, grasp muscle, insert at 90 angle, release muscle, aspirate for no blood, inject slowly, massage w dry gauze square, observe for bleeding. o Hepatitis B Vaccine—medication guide p.583: gives immunization, also given at 1 and 6 months, get parental consent, also give HBIG if mom is HB positive. AE: rash, fever, swelling, pain · Classification by age & birth weight : SGA, AGA, LGA… · CRIES pain scale (Table 24-4): crying, requires oxygen, increased VS, expression, sleeplessness. Assesses pain 0-10, 4 or more is significant · Most common problems in the newborn including: o Physical injuries related to the birth process: bruising, lacerations, petechaie(ok if not covering whole body and go away after 2d), usually resolve themselves in several days, keep HCP informed, monitor for jaundice. o Physiologic jaundice: monitor. risk: GA less than 38wks, breastfeeding, sibling hx, jaundice appears before discharge o Phototherapy nursing interventions (pp. 584-5): unclothed infant, eye mask, lights 45-50 cm away, check eyes during breaks, closely monitor UO, billi blanket sometimes used · Be familiar with Discharge Teaching: tell normal and abnormal findings, safety, feeding, bathing, holding, rashes, clothing, cord care, follow up care, quieting, developmental milestones. stump can easily become infected. dont use baby powder. lay on back to sleep.