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NURS 3800 > 18-Nursing Management Of the Newborn > Flashcards

18-Nursing Management Of the Newborn Flashcards

0
Q

What are some assessment findings during the initial newborn assessment that can indicate a problem

A

Nasal flaring, chest retractions, grunting on exhalation, labored breathing, generalized cyanosis, abnormal breath sounds, abnormal respiratory rates, flaccid body temperature, abnormal heart rates, abnormal newborn size

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1
Q

When are the assessments of a newborn done?

A

Initial assessment completed in birthing area to see if newborn can stay with parents. A second assessment is done within the first 2-4 hours when the newborn is admitted to the nursery or LDR where the parents are

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2
Q

What is the Apgar score

A

Used to evaluate a newborns physical condition at 1 minute and 5 minutes after birth

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3
Q

When would you do an additional Apgar assessment

A

If the 5 minute score is less than 7 you then do one at 10 minutes

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4
Q

What does the Apgar assessment at 1 minute provide

A

Data about the newborns initial adaption to extrauterine life

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5
Q

What does the Apgar assessment at 5 minutes provide

A

A clearer indication of the newborns overall central nervous system status

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6
Q

What are the five parameters assessed with Apgar scoring

A 
A= appearance (color)
P= pulse (heart rate)
G= grimace (reflex irritability)
A= activity (muscle tone)
R= respiratory (respiratory effort)
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7
Q

Each Apgar parameter is assigned a score ranging from ___ to ____

A

0 to 2

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8
Q

What does a score of 0 indicate

A

Absent or poor response

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9
Q

What is the Apgar score where no interventions are needed besides maintaining normal respiratory efforts and thermoregulation

A

8 or higher

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10
Q

Apgar score that indicates moderate difficulty

A

4-7

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11
Q

What Apgar score signifies severe distress in adjusting to extrauterine life

A

0-3

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12
Q

What are some things that influence the Apgar score

A

Infection, congenital anomalies, physiologic immaturity, maternal sedation via medications, labor management, and neuromuscular disorders

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13
Q

What is the predictable manner of characteristics disappearing when a newborn is experiencing physiologic depression

A

First pink coloration is lost, next respiratory effort, and then the tone, followed by reflex irritability and finally heart rate

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14
Q

How is length of a newborn measured

A

Head of newborn to the heel with the newborn unclothed

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15
Q

What position should newborn be in when measuring length

A

Supine position and extend the leg completely when measuring the length

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16
Q

What is expected length range of a full term newborn

A

44-55 cm ( 17-22 inches)

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17
Q

How is the weight of newborns usually read? What is a typical newborn weight?

A

Using a digital scale that reads weight in grams

2,500-4,000 g ( 5 pounds, 8 ounces to 8 pounds, 14 ounces)

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18
Q

Newborns typically lose ____% or their initial birth weight by ____ to ____ days of age

A

10% by 3-4 days of age

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19
Q

What are some of the causes of newborns weight loss

A

Loss of meconium, extracellular fluid, and limited food intake

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20
Q

When is the newborn weight loss usually regained by ?

A

By the 10th day of life

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21
Q

Low birth weight=
Very low birth weight=
Extremely low birth weight=

A

Low birth weight=< 1,000 g (<2.5 lb)

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22
Q

How do you take a heart rate on a newborn? What is a typical heart rate?

A

Apical pulse for 1 full minute

120-160 bpm

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23
Q

When are newborns respirations assessed? How do you assess them?

A

When they are quiet or sleeping. Place a stethoscope on the right side of the chest and count the breaths for 1 full minute to identify any irregularities

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24
Q

Normal newborn respiratory rate

A

30 to 60 breaths/minute with systemic chest movement

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25
Q

How long are respiratory and heart rates assessed

A

Every 30 minutes until stable for 2 hours after birth, then once stable every 8 hours

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26
Q

When is axillary temperature typically assessed?

A

Not immediately after birth but upon arrival to the nursery or in LDR room when initial,newborn assessment is carried out

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27
Q

Normal axillary temperature range

A

97.7* F - 99.5* F

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28
Q

Why are rectal temperatures no longer taken

A

Because of the risk of perforation

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29
Q

How often should you assess temperature

A

Every 30 minutes until it has been stable for 2 hours then every 8 hours until discharge

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30
Q

Is blood pressure normally assessed as part of the normal newborn examination?

A

No it is not. Blood pressure is not normally assessed unless there is a clinical indication or low Apgar score

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31
Q

If blood pressure is assessed what is used?

A

Oscillometer (Dinamap)

32
Q

Typical BP range for newborn

A

50-75 mm Hg (systolic) / 30-45 mmHg (diastolic)

33
Q

What will increases the systolic BP of a newborn

A

Crying, moving, and late clamping of the umbilical cord

34
Q

How do you determine a newborns gestational age? What is gestational age?

A

Assess physical signs and neurologic characteristics. Gestational age is the stage of maturity

35
Q

How is gestational age typically determined?

A

By using a tool such as a Dubowitz/Ballard or New Ballard Score system. This scoring system provides an objective estimate of gestational age by scoring the specific parameters of physical and neuromuscular maturity

36
Q

How does the Dubowitz/Ballard or New Ballard Scoring System work?

A

Points are given for each assessment parameter
With a low score of -1 point or -2 points for extreme immaturity to 4 to 5 points for post maturity. The scores from each section are added to correspond to a specific gestational age in weeks.

37
Q

When is the physical maturity section of the Gestational Age Assessment done?

A

During the first 2 hours of birth

38
Q

Physical maturity Gestational Age Assessment categories

A 
Skin texture
Lanugo
Plantar creases 
Breast tissue 
Eyes and ears
Genitals
39
Q

What is typical skin texture

A

Sticky to transparent to smooth. With varying degrees of peeling and cracking, to parchment-like or leathery with significant cracking and wrinkling

40
Q

What is lanugo? What is normal?

A

Soft downy hair on the newborns body, which is present in preterm babies and usually mostly gone by the time a term baby is born

41
Q

Do preterm newborns have lanugo

A

No

42
Q

What are plantar creases? What is normal?

A

Creases on the soles of the feet. Range from absent to covering the entire foot, depending on maturity (the greater number of creases, the greater the newborns maturity)

43
Q

What will you see with ear cartilage of a more mature newborn

A

Greater amount of stiff ear cartilage

44
Q

When dealing with genitals what determines maturity in males

A

Evidence of testicular descent and appearance of scrotum (which can range from smooth to covered with rugae) determine maturity

45
Q

When dealing with genitals what determines maturity in females

A

Appearance and size of clitoris and labia determine maturity ( a prominent suitor is with a flat labia suggest prematurity, whereas a clitoris covered by labia suggests greater maturity

46
Q

When is the neuromuscular maturity section usually completed

A

Within 24 hours after birth

47
Q

Six activities to determine newborns maturity with neuromuscular maturity section

A 
Posture
Square window
Arm recoil
Popliteal angle
Scarf sign
Heel to ear
48
Q

Born prior to 37 completed weeks gestation, regardless of birth weight

A

Preterm or premature

49
Q

Born between 38 and 42 weeks gestation

A

Term

50
Q

Born after completion of week 42 gestation

A

Post-term or postdates

51
Q

Born after 42 weeks and demonstrating signs of placental aging

A

Postmature

52
Q

Weight less than the 10th percentile on standard growth charts (usually less than 5.5 lbs)

A

Small for gestational age (SGA)

53
Q

Weight between 10th and 90th percentiles

A

Appropriate foe gestational age (AGA)

54
Q

Weight more than the 90th percentile on standard growth charts (usually more than 9 pounds)

A

Large for gestational age (LGA)

55
Q

Nursing interventions with newborn

A

Maintaining airway patency, ensuring proper identification, administering prescribed meds, and maintaining thermoregulation

56
Q

What is done immediately after birth to help maintain airway patency

A

Newborn is suctioned to remove fluids and mucus from the mouth and nose

57
Q

What is newborn typically suctioned with

A

with a bulb syringe

58
Q

What should you do before placing bulb syringe in newborns mouth or nose

A

Compress the bulb

59
Q

What position of newborn facilitates drainage

A

Head down and to the side position

60
Q

Why should you,always keep a bulb syringe near a newborn

A

In case he or she develops sudden choking or blockage in the nose

61
Q

Is vitamin K fat or water soluble

A

Fat-soluble

62
Q

What does vitamin K do

A

Promotes blood clotting by increasing the synthesis of prothrombin by the liver

63
Q

What does a deficiency of vitamin K do

A

Delays clotting and may lead to hemorrhage

64
Q

When is vitamin k produced in newborns?

A

The bowel is sterile so vitamin k is not produced in the intestine until after microorganisms have been introduced, such as the first feeding

65
Q

How long does it take a newborn to produce enough vitamin k to prevent vitamin k deficiency bleeding

A

About a week

66
Q

When should newborns get Vitamin K

A

The AAP recommends that vitamin k be administered to all newborns soon after birth in a single IM dose of 0.5 to 1mg

67
Q

What should happens to a newborns eyes after birth

A

Should relieve a prophylactic agent in their eyes within an hour or two after birth

68
Q

What is the prophylactic agent in newborns eyes preventing

A

Ophthalmia neonatorum, which can cause neonatal blindness

69
Q

When are the head and chest circumference usually equal?

A

By about 1 year of age

70
Q

Persistent cyanosis of fingers, hands, toes, and feet with mottled blue or red discoloration or coldness is called

A

Acrocyanosis

71
Q

When do you see acrocyanosis?

A

During the first few weeks of life in newborns in response to exposure of cold. It is normal and intermittent

72
Q

What is a thick white substance that protects the skin of the fetus

A

Vernix caseosa

73
Q

What are superficial vascular areas found on the nape of the neck, on the eyelids, and between eyes and the upper lip

A

Stork bites

74
Q

What are unopened sebaceous glands frequently found on a newborns nose

A

Milia

75
Q

What are blue or purple splotches that appear on the lower buttocks or newborns

A

Mongolian spots

76
Q

What is erythema toxicum

A

Benign, idiopathic, generalized, transient rash that occurs in up to 70% of all newborns during the first week of life

77
Q

What is the dilation of blood vessels on only one side of the body, giving the newborn the appearance of wearing a clown suit

A

Harlequin sign

NURS 3800 (19 decks)

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