RNC-LRN cheat sheet

Apgar is scored at 1 and 5 minutes using appearance, pulse, grimace, activity, and respiration; 7-10 is generally reassuring.

Apgar heart rate: >100 bpm = 2 points, <100 bpm = 1 point, absent = 0 points.

Typical term newborn: heart rate 110-160 bpm, respiratory rate 30-60/min, axillary temperature 36.5-37.5 C.

First period of reactivity lasts about 30 minutes after birth; a second period occurs 2-8 hours after birth.

Expected weight loss is up to 7-10% of birth weight by days 3-5, with regain by 10-14 days.

Newborn hemoglobin is about 14-24 g/dL and venous hematocrit 45-65%; polycythemia is venous hematocrit >65%.

Blood glucose screening is indicated for at-risk infants; values below the protocol threshold require feeding or IV dextrose evaluation.

Ductus arteriosus functional closure occurs within 24-72 hours after birth; foramen ovale and ductus venosus close functionally after birth.

Maternal diabetes increases risk of macrosomia, shoulder dystocia, neonatal hypoglycemia, polycythemia, and respiratory distress syndrome.

Preeclampsia is associated with intrauterine growth restriction, preterm birth, placental abruption, and oligohydramnios.

Maternal fever >=38 C plus uterine tenderness or foul fluid suggests chorioamnionitis and increases neonatal sepsis risk.

Group B streptococcus colonization is treated with intrapartum penicillin; rupture of membranes >=18 hours increases neonatal sepsis risk.

Meconium-stained amniotic fluid raises risk of meconium aspiration syndrome; nonvigorous infants need airway assessment.

Fetal heart baseline is 110-160 bpm; moderate variability is 6-25 bpm; accelerations after 32 weeks are >=15 bpm for >=15 seconds.

Late decelerations suggest uteroplacental insufficiency; variable decelerations suggest umbilical cord compression.

Maternal magnesium sulfate can cause neonatal hypotonia, poor feeding, and respiratory depression.

Heat loss occurs by evaporation, conduction, convection, and radiation; a neutral thermal environment minimizes oxygen consumption.

Axillary temperature is checked routinely; hypothermia is <36.5 C and hyperthermia is >37.5 C.

Bathing is performed after temperature is stable; routine cord care keeps the cord clean and dry.

Vitamin K 0.5-1 mg is given intramuscularly once after birth to prevent hemorrhagic disease of the newborn.

Erythromycin 0.5% ophthalmic ointment is applied to both eyes once after birth for gonococcal ophthalmia prophylaxis.

Newborn metabolic screening is collected after 24 hours of age and before discharge; repeat if collected before 24 hours per protocol.

Hearing screening is completed before discharge; circumcision requires consent, vitamin K, and pain control.

Use two patient identifiers before procedures and medications; place infants supine on a firm surface for sleep.

Colostrum volume is small, about 5-10 mL on day 1; newborn stomach capacity is about 5-10 mL on day 1 and 45-60 mL by week 1.

Term infants feed 8-12 times per 24 hours; early cues include rooting, hand-to-mouth movement, and sucking.

Weight loss >10% or fewer than 6 wet diapers by day 5 warrants feeding assessment.

Standard infant formula is 20 kcal/oz; formula should not be diluted or concentrated, and water is not given to newborns.

Exclusively breastfed infants need 400 IU vitamin D daily; formula-fed infants need supplementation if intake is <1 L/day.

Fresh breast milk storage: about 4 hours at room temperature, 4 days in the refrigerator, and 6 months in the freezer.

Paced bottle feeding uses a semi-upright position, horizontal nipple, and pauses to follow infant cues.

Frequent effective feeding supports bilirubin excretion and reduces breastfeeding jaundice.

Jaundice appearing within the first 24 hours is pathologic and requires bilirubin measurement and evaluation for hemolysis or infection.

Phototherapy thresholds use hour-specific bilirubin nomograms; exchange transfusion is reserved for severe hyperbilirubinemia.

Breastfeeding jaundice results from insufficient intake in the first week; breast milk jaundice appears after week 1 and is usually benign.

Hypoglycemia signs include jitteriness, lethargy, poor feeding, apnea, and seizures; confirm with blood glucose and treat per protocol.

Sepsis risk rises with group B streptococcus colonization, maternal fever, and rupture of membranes >=18 hours.

Respiratory distress signs: respiratory rate >60/min, grunting, nasal flaring, retractions, and cyanosis.

Transient tachypnea of the newborn usually resolves within 24-72 hours and is common after cesarean birth.

Bilious emesis in a newborn is a red flag for intestinal obstruction and requires urgent evaluation.

Rooming-in supports breastfeeding, cue-based feeding, bonding, and parental confidence.

Discharge criteria include stable vital signs, adequate feeding, voiding and stooling, completed screening, and planned follow-up.

Term newborns are seen 48-72 hours after discharge; earlier follow-up is needed for jaundice, weight loss, or feeding problems.

Safe sleep: supine, firm surface, no soft bedding, and room-sharing without bed-sharing.

Car seat safety: rear-facing seat, snug five-point harness; preterm infants may need a car seat challenge before discharge.

Teach-back asks families to explain or demonstrate care in their own words to confirm understanding.

Professional interpreters are used for families with limited English proficiency; family-centered care includes parents in rounds and care decisions.

SBAR handoff: Situation, Background, Assessment, Recommendation.

Two patient identifiers, such as name and date of birth, are verified before medications, procedures, or transfusion.

PDSA is a rapid-cycle quality improvement method: Plan, Do, Study, Act.

Incident reporting is nonpunitive; sentinel events trigger root cause analysis.

Handoff includes medications, allergies, lines, pending tests, and recent changes.

Scope of practice is defined by the state nurse practice act and hospital policy.

Just culture separates human error from reckless behavior while maintaining accountability for unsafe choices.

Evidence-based practice uses current clinical guidelines and research rather than tradition alone.