Newborn Nursing Care Notes – Assessments, Reflexes, and Intervention

The Neonate (recorded lecture)
Fetus
★​ A FETUS TOTALLY DEPENDENT on his Mother but at the moment of birth transitions to a
NEONATE WHO IS TOTALLY INDEPENDENT


Fetal circulation
★​ Fetal circulatory system uses 3 shunts
○​ Shunt: small passages that direct blood that needs to be oxygenated
○​ Purpose: bypass the lungs and liver
○​ 2 main shunts: Ductus arteriosus and Ductus venosus
■​ Umbilical cord has 1 vein & 2 arteries
○​ Foramen ovale: in the heart, allows the blood to mix in the heart
○​ We look at the newborn to see if theres 2 arteries and a vein, this shows us if there's
appropriate circulation during the fetal development


Blood Circulation After Birth
★​ Umbilical cord is clamped -> baby no longer gets oxygen and nutrients from the mother
★​ 1st breath -> lungs start to expand, alveoli are cleared of fluid
★​ This causes an INC in the baby's BP
○​ Major reduction in the pulmonary pressures = reduced need for the ductus arteriosus
to shunt blood
★​ These changes help the shunt close
★​ These changes raise pressure in the LA of the heart and lower pressure in RA
★​ The shift in pressure stimulates the foramen ovale to close
★​ The closure of the ductus arteriosus, ductus venosus, and foramen ovale completes the change
of fetal circulation to newborn circulation
○​ Shunts = flaps of skin
○​ Initially flop down and close → not solid yet → takes a few weeks to become permanent
changes → will see shifts in the first 24 hours listening with stethoscope
○​ ***names of 3 shunts, where the shunts are, what they bypass, how fetal circulation is
different from newborn circulation***


Transitions
★​ First 24-48 hours, be prepared for this!!!


How do we prepare to assist this transition to extrauterine life
★​ Know the Risk factors (nurse needs to know)
★​ Expected Gestational Age
○​ Important bc younger babies/post date babies = higher risk
★​ Ensure appropriately supplies/equipment
○​ Set up like there is going to be a problem
★​ Thermoregulation: source of heat, Skin to skin, radiant warmer, warmed blankets, etc.

, ○​ We WANT chest to chest, but anticipate if the transition goes wrong, if baby needs CPR
★​ Stimulation: “rough towels”, bulb syringe
○​ Syringe bc lots of fluid in lungs, suction mouth/nose
★​ Positive pressure ventilation (PPV): Neonatal bag and mask attached to O2 source and
manometer
★​ ***Interventions if…..
○​ HR less than 100 bpm = 15 seconds of “PPV”
■​ If baby needs help expanding alveoli/opening lungs
○​ HR less than 60 bpm = CHEST COMPRESSIONS


Gestational age
★​ Preterm: less than 37 weeks
★​ Late preterm: 37-38 weeks
★​ FULL Term: 280 days/40 weeks
★​ Post term: AFTER 41 completed weeks
★​ Size associated with dates
○​ AGA- Average for Gestational Age
○​ SGA –Small for Gestational Age
○​ LGA- Large for Gestational Age


Transition begins
★​ This transition to extrauterine life begins the moment the cord is cut
★​ Babies delivered vaginally benefit from the birth squeeze which helps to push fluid out of the
lungs
○​ C-section babies tend to have more fluid in lungs, more at risk for assistance


APGAR*******
★​ “APGAR SCORE” at 1 and 5 minutes after birth to assess these things…..
★​ Score of 0-3
○​ Severe distress
○​ Needs IMMEDIATE resuscitation
■​ PPV → chest compressions → medications
★​ Score of 4-6
○​ Moderate difficulty
○​ Interventions specific to deficits
■​ Suction, oxygen, drying baby, stimulating baby
★​ Score 7-10
○​ Stable neonate- continue to monitor (HR, temp, keep warm, suction)


Umbilical cord
★​ The umbilical cord contains 2 arteries and 1 vein
★​ The vessels are surrounded by “Wharton’s jelly”