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Neonatal Assessment - Part 1 - Coggle Diagram
Neonatal Assessment - Part 1
Neonatal - A newborn infant, or neonate, is a child under 28 days of age. It is a time when changes are very rapid. Many critical events can occur in this period
Preterm is defined as babies born alive before 37 weeks of pregnancy are completed.
Babies' immune systems aren't well-developed, so they don't yet recognise many germs. This can make it easier for babies to get sick with an infection and make it take longer for their bodies to fight it off.
Why do babies get sick and why do they get admitted
Reasons for admissions
Prematurity
Respiratory Distress Syndrome
Infection
Birth asphyxia/ hypoxic-ischaemic encephalopathy
Jaundice
Respiratory distress
Intrauterine growth restriction
Hypoglycemia
Seizures
Congenital heart disease
Congenital anomalies/ Surgical pathologies
Endocrine/Metabolic conditions
Substance abuse and/or safeguarding
Maternal risk factors
Diabetes (Gestational or Insulin-Dependant)
Maternal thyroid problems
Maternal hypertension (HELLP) or Maternal PET
Labour and Delivery
Maternal chorioamnionitis
Placental abruption, placenta praevia
Antepartum haemorrhages
Umbilical cord prolapse
Preterm rupture of membranes or preterm labour
Comman causes of respiratory
Respiratory Distress Syndrome
Sepsis / Pneumonia
Meconium Aspiration Syndrome
Transient Tachypnoea of the Newborn
Persistent Pulmonary Hypertension of the Newborn (PPHN)
The admissions and Golden hour for NICU
Weight, HC
Monitoring of vital signs
Keep warm
Respiratory support
Establishing IV access
Fluid management
Medications (Vitamin K, antibiotics...)
Parental support
The maintenance of the body temp
An initial set of obs
What are the core principles of nursing a sick neonate?
Physical assessment and monitoring
Cardiorespiratory assessment
Neurological assessment
Thermoregulation
Nutritional assessment
Assessment of infection
Assessment of pain/ distress/discomfort
Promoting developmental care
Emotional and psycho-social support of families
What to be included when taking a comphsesive history
When?
Where?
How?
Why? Action Needed?
What challenges could arise in history taking
Newborns may have limited postnatal history
Low-risk pregnancies!
Transitioning physiology
Communication!
Subtle signs/behaviour changes are often important
Parents
The multidisciplinary team includes midwives, paediatricians, S&L therapists, neonate DRs, resp team, OTs, physios, and a cardiac team.
Handovers/Ward rounds
Consistency of care
Attention to detail
The pricniples of a physical assessment in NICU
Weight/Maturity, Colour, Skin integrity
Observe
Behavioural state
Tone and posture
Auscultate
Chest, Heart, Abdomen
Palpate
Opportunistic
Cardiac assessment look at heart rate 100 - 160 beats a minute is normal
Blood pressure systolic 50 - 72 mmHg, Diastolic 25 - 45mmHg the mean can also be 30 - 35mmHg
Golden hour is the period of time staright after the child is born.
Thermoregulation - the maintenance of physiologic core body temperature by balancing heat generation with heat loss.
Normal range 36.5 to 37.2 degrees
For every 1-degree drop in temp the baby's chance of mortality increases by 28%
The mechansim of heat loss
Conduction
Convection
Radiation
Evaporation
The preterm infants
Large surface area: volume ratio
Decreased subcutaneous fat
Decreased brown fat
Immature skin and significant transepidermal water loss
Poor vasoconstrictive mechanisms
Poor metabolic responses to cold stress
Reduced tone/posture= reduced positioning
Jaudice - Jaundice is caused by the build-up of bilirubin in the blood. Bilirubin is a yellow substance produced when red blood cells, which carry oxygen around the body, are broken down.
Risk of Kerniceterus can occur this is bilirubin-induced neurological damage
Assessment - Tone
Posture
Crying
Floppy - bad
Colour
Neurological assessment
Flexed posture
“frogged legged” or hypotonic?
Stiff/Hypertonic
Opisthotonus - spasm of the muscle
Behavioural state
Crying versus irritability
Quiet-awake versus lethargic
Appropriate responses to handling/procedures
Movements
Normal reflexes
“Jittery” versus seizures
Assessment - movement
Jittery
High-frequency tremors
Stop when held
Maybe a normal startle reflex
Excessive or continuous consideration:
Hypoglycaemia, hypocalcaemia, withdrawal (also CAFFEINE!) or sepsis!
Seziures
Repetitive, rhythmic, jerking movements often slow, cycling/boxing
Do not stop when held
May be associated with autonomic instability/physiological symptoms
Can also be subtle- lip smacking, staring/eye deviation, hiccoughs!