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OB > 2. Newborn > Flashcards

2. Newborn Flashcards

1
Q

What is a neonate?

A

A baby up to 28 days old

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2
Q

Six biologic tasks of the neonate

A

o Establishing and maintaining respiration
o Adjusting to circulatory changes
o Regulating temperature
o Ingesting, retaining and digesting nutrients
o Eliminating waste
o Regulating waste

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3
Q

What are the 3 phases of transition period? What is the total duration?

A
  • 1st period of reactivity
  • Period of decreased responsiveness
  • 2nd period of reactivity

TOTAL TOME: 6-8 hours

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4
Q

1st period of reactivity
• Duration
• What happens? (2)

A
  • Lasts 30 minutes to 2 hours

* Increased HR and RR

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5
Q

Period of decreased responsiveness
• Duration
• What happens? (2)

A
  • Lasts from 2-4 hours

* HR & RR are back to normal

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6
Q

2nd period of reactivity
• Duration
• What happens? (4)

A

• Lasts 10 minutes to several hours

  • Increased HR, RR
  • Increased muscle tone, mucus production (bulb syringe)
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7
Q

Six types of activity for babies:

A
  • Active alert
  • Quiet alert
  • Drowsy
  • Light sleeping
  • Crying
  • Deep sleep
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8
Q

What must the first breath do?

A

Must force the fetal lung fluid into the interstitial spaces around the alveoli so that air can now enter the respiratory tract.

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9
Q

Initiation of breathing (3)

A
  • Pressure (1st breath has the greatest negative pressure compared to subsequent breathing)
  • Temperature (baby has sensors on skin to send impulses to brain to breathe)
  • Chemical (Carotid arteries and the aorta respond to changes in blood chemistry brought on by hypoxia, which occurs with birth)
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10
Q

Vessels in umbilical cord

A

2 Arteries, 1 vein

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11
Q

What will the HCP do if a murmur is heard?

A

4- extremity BP

to ensure that there is no coarctation of the aorta, which would mean that there is higher BP on upper extremities than lower

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12
Q

What happens during the simultaneous CV / Respiratory shift? (5)

A
  • Lung recoil causes a pressure shift
  • Pressure shift causes closure / constriction of DA, DV, FO
  • Circulatory shift
  • Decreased pulmonary pressure
  • Increased perfusion
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13
Q

Four mechanisms of heat loss in the neonate

A
  • Convection
  • Radiation
  • Evaporation
  • Conduction
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14
Q

Convection

A

• Heat loss due to air current or flow or people walking by creating a cool breeze

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15
Q

Radiation

A

• Loss to cooler environment that might be NEAR a cold surface. Like the warmed incubator to the window or cold wall

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16
Q

Evaporation

A

• Can occur during birth or anytime the infant is wet from insensible water loss.

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17
Q

Conduction

A
  • Loss to cooler object in direct contact

* Example: Scale or providers hand actually touching baby

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18
Q

3 mechanisms newborns use to increase body temp

A
  • Increasing BMR
  • Increased muscular activity
  • Non-shivering thermogenesis (NST)
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19
Q

What is Non-Shivering Thermogenesis (NST)?

A

BROWN FAT METABOLISM

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20
Q

When in the lifespan does brown fat metabolism occur?

A
  • Developed at 26-30 weeks gestation

* Continues to 2-5 weeks old

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21
Q

What triggers the body to start metabolizing brown fat when needed?

A

SNS

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22
Q

Burning brown fat requires the use of what?

A
  • Glucose
  • ATP
  • Oxygen
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23
Q

What is the risk of brown fat metabolism?

A

Hypoglycemia

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24
Q

Oxygen consumption in a newborn doubles with…

A

a 2 degree ambient temperature drop

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25
Q

Baby has capacity to suck, swallow, breathe at what age?

A

32 weeks gestation

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26
Q

How big is the baby’s stomach when leaving the hospital?

A

30cc

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27
Q

Characteristics of Meconium

A

Thick, Sticky, Dark (Almost black)
Odorless
First 1-2 days

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28
Q

Characteristics of milk stool

A

SYS: Seedy Yellow Stool. No odor, doesn’t stain clothing.

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29
Q

3 types of baby stools:

A

1) Meconium
2) Transitional Stool
3) Milk stool

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30
Q

How many stools by 34d day of life?

A

1-3 stools per day

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31
Q

When do you want the baby to pass first stool?

A

Within 24 hours of life

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32
Q

Characteristics of normal urine

A

Usually straw colored and odorless

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33
Q

Characteristics of urate crystals

A

Look like brick dust, means baby is dehydrated

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34
Q

Characteristic of pseudomenstruation

A

Normally occurs on the 3rd day after birth 2/2 mom’s drop in hormones

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35
Q

When should urine output be 6-8 voids per day

A

4th day of life

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36
Q

What is acrocyanosis?

When does it resolve?

A
  • Peripheral cyanosis

- Resolves in 24-48 hours

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37
Q

How can you tell the difference between facial brusing and acrocyanosis?

A

If pressed, acrocyanosis will blanch – facial bruising will not blanch.

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38
Q

Mongolian spots

A

Bluish black spots that resemble bruises

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39
Q

Stork bite

A

Little red area sometimes on back of neck

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40
Q

Erythema Toxicum

A

Benign rash of unknown cause in newborn. Transient.

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41
Q

Millia

A

White crystals 1-2 mm in size, 2/2 distended sebacious glands. Over the nose.

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42
Q

Vernix

A

Thick, white substance. Protects skin of fetus.

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43
Q

Lanugo

A
  • In term infant

- Fine hair

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44
Q

Caput Succadaneum
• What is it
• What causes it

A
  • Pitting edema in skull that Crosses the Suture line

* Occurs with vaginal births or vacuum extractions

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45
Q

Cephalohematoma

A
  • Swelling with clear edges that end at the suture line – bleeding is held between the bone and the periosteum
46
Q

Normal newborn temp (F)

A

97-99.5

47
Q

Normal newborn respirations

A

30-60 rpm

48
Q

How often to check respirations

A

ea 30 minutes until infant has been stable for 2 hours after birth (more often if there are abnormalities)

49
Q

Normal newborn heart rate

A

120-160 bpm

50
Q

Normal Newborn BP

A
  • Systolic: 65-95 mm/Hg

* Diastolic: 30-60 mmHg

51
Q

Normal Newborn Length

A

19-21” (48-53cm)

52
Q

Normal newborn head circumfrence

A

13-15” (33-35cm)

53
Q

Normal newborn Chest circumfrence

A

12-13” (30.5-33cm)

54
Q

Normal newborn weight

A

5.3-8.5lbs (2500-4000g)

55
Q

What is the APGAR score?

A

The immediate assessment of a newborn, to assess the transition to extrauterine life. Determines need for resuscitation

Assigned at 1 and 5 minutes (sometimes 10 also)

56
Q

What is administered during initial physical assessment - LDR (2)

A 
Vitamin K
Opthalmic ointment (prophylactic ABX)
57
Q

Term infant

A

37-42 weeks

58
Q

What defines Postmature (Syndrome)

A

> 42 weeks with s&s of placental insufficiency (placenta shuts down at 42 weeks)

59
Q

LGA

A

Large for gestational age.

>4000 or >90th percentile

60
Q

AGA

A

Average for gestational age.

Between 10th and 90th percentile.

61
Q

SGA

A

Small for gestational age.

<10th percentile

62
Q

LBW

A

<2500 g

63
Q

VLBW

A

<1500g

64
Q

IUGR

A

Doesn’t meet expected nroms

65
Q

What does the Apgar score mean?

A
  • 0-3 serious distress
  • 1-4 moderate difficulty
  • 7-10 no difficulty adjusting to extrauterine life
66
Q

5 components of the apgar score

A
  • Heart Rate
  • Respiratory Effort
  • Muscle tone
  • Reflex irritability
  • Color
67
Q

Apgar: Heart Rate
0
1
2

A

0: Absent
1: 100

68
Q

Apgar: Respiratory Effort
0
1
2

A

0 Absent
1 Slow weak cry
2 Good cry

69
Q

Apgar: Muscle tone
0
1
2

A

0 Flaccid
1 Some flexion
2 Well flexed

70
Q

Apgar: Reflex irritability
0
1
2

A

0 No response
1 Grimace
2 Good cry

71
Q

Apgar: Color
0
1
2

A

0 Pale / blue
1 Acrocyanosis
2 Pink / uniform

72
Q

What is the glabellar reflex

A

Tap the forehead, the baby will blink 4-5x

73
Q

Normal babinski response - newborn

A

toes flare with dorsiflexion of big toe

74
Q

New Ballard’s Scale: 3 characteristics
• Age
• How accurate
• When most accurate

A
  • From 20 to 44 weeks
  • Provides accurate information within 2 weeks
  • Most accurate if assessed within 12 hours of birth
75
Q

Four physical / muscular tests for newborns:

A
  • Heel to ear
  • Popliteal angle
  • Scarf sign
  • Square window
76
Q

How to perform the Heel-to-ear test

A

Grasp foot, bring it toward ear. Score is recorded when resistance is felt. (Pre-term infant = foot is closer to ear when resistance)

77
Q

How to perform the popliteal angle test

A

The newborn’s leg is folded against the thigh on the abdomen, and the lower leg is straightened until resistance is met.

Score is 0 if leg can be fully extended, 5 if the angle of the popliteal space is less than 90 degrees.

78
Q

How to perform the scarf sign test

A

Move arm across chest; observe position of elbow when resistance is felt.

(Pre-term infant elbow can move past midline without resistance)

79
Q

How to perform the square window test

A

Flex the wrist and measure the angle.

Pre-term infant wrist ill bend more

80
Q

What is bilirubin?

What is it derived from (2)

A
  • A yellow pigment

* Derived from the hemoglobin release with the breakdown of RBCs and myoglobin in muscle cells

81
Q

When is bilirubin visible

A

In jaundice – unconjugated bilirubin binds to albumin, then can leave the vascular system and permeate other extravascular tissue

82
Q

Two types of jaundice:

A
  • Physiologic

* Pathologic

83
Q

Characteristics of physiologic jaundice

A
  • 50% prevalence

* Onset > 24 hours

84
Q

Onset of pathologic jaundice

A

Onset: within 24 hours of life

85
Q

Possible causes of pathologic jaundice (3)

A
  • Result of ABO disease
  • Result of Rh incompatibility
  • Physiologic hyperbilirumia that is more severe
86
Q

Unconjugated serum bilirubin levels: Physiologic versus pathologic

A

Unconjugated serum bilirubin:
Physiologic: < or = to 12 mg / dL
Pathologic: Peaks >13mg/dL

87
Q

Characteristics of physiologic hyperbilirubinemia that is classified as pathologic

  • Unconjugated serum bilirubin levels
  • Rate of increase
  • 2 concurrent syndromes
A
  • Peaks >13mg/dL
  • Increases >0.5 mg/dL/hr
  • a/w HSM (hepatosplenomegaly) or anemia
88
Q

3 characteristics of kernicterus

A
  • Bilirubin encephalopathy
  • Results in acute symptoms and long term neurologic damage
  • 50% of infants survive
89
Q

Early signs of a cold infant:

A

Crying, restlessness, increased activity

90
Q

What could result from a cold infant (NST, crying)?

A
  • Hypoglycemia

- Acidosis

91
Q

Signs of respiratory distress (5)

A 
o	Nasal Flaring
o	Retractions: 
o	Grunting
o	Altered respiratory Rate
o	Apnea > 20 seconds
92
Q

Where do retractions in babies occur (early)

A

• Babies retract in the lower lungs first, when an older person would be using accessory muscles

93
Q

Sign of respiratory distress in infants: Early / late

A
  • Early: >60 at rest
  • Late: <30 at rest

(RR)

94
Q

Newborn weight loss
• Early
• Later
• When to see a HCP

A

By 3-5 DOL
• 5-10% of birth weight loss

By 14 DOL
• Regain to birth weight

o Any loss over 7-10% of body weight should be evaluated by HCP

95
Q

3 signs of newborn dehydration

A

o Fewer wet diapers (early)
o Sunken fontanel
o Lethargy

96
Q

Most notable sign of hypoglycemia

  • Symptom
  • Blood clucose concentration
A

o “Jittery” infant

o Blood glucose concentration <35 mg / dL

97
Q

Other sx of hypoglycemia (9)

A
  • Irregular respiration / apnea
  • Cyanosis
  • Weak, high-pitched cry
  • Feeding difficulty
  • Hunger
  • Lethargy
  • Twitching
  • Eye rolling
  • Seizures
98
Q

Neonatal sepsis: Definition

A

Infection in blood or tissues. Wide range of symptoms

99
Q

Respiratory sepsis in neonate – sx (6)

A
  • Apnea, tachypnea, grunting, nasal flaring, retractions

* Decreased O2 sat is a late sign

100
Q

CV sepsis in neonate – sx (5)

A

• Bradycardia, tachycardia, hypotension, decreased perfusion, decreased cardiac output

101
Q

CNS sepsis in neonate – sx (5)

A
  • Temperature instability
  • Lethargy
  • Hypotonia
  • Irritability
  • Seizures
102
Q

GI sepsis in neonate – sx (4)

A

• Feeding intolerance, abdominal distention, vomiting, diarrhea

103
Q

Integumentary sepsis in neonate – sx (3)

A

• Jaundice, pallor, petechiae

104
Q

Seven components of postnatal nursing care

A 
o	Suction: Maintain patent airway
o	Apply cord clamp: Check cord
o	Vitamin K and eye ointment
o	ID bands and footprints
o	Wrap in pre-warmed blanket
o	Encourage bonding, initiate breastfeeding
o	APGAR score documented
105
Q

When to contact the HCP after discharge (6)

A
  • Fever (100.4 or higher)
  • Lethargy
  • Decreased appetite
  • Decreased urine / stool
  • Color night right (pale, yellow, blue)
  • Baby “just doesn’t seem well”
106
Q

NB Care instructions at discharge: Urine and stool

A

o Urine: 6-10 wet diapers per day after about 4 days

o Stool: 1-3 per day (more if breastfed)

107
Q

NB Care instructions at discharge: Feeding guidelines

A
  • Breastfeed approximately every 2-3 hours

* Bottlefeeding approximately up to 2 oz every 3-4 hours

108
Q

NB Care instructions at discharge: Expected activity

A
  • 4-5 wakeful periods a day, responds to sounds / voices

* “Back to sleep”

109
Q

NB Care instructions at discharge: Bathing

A

Sponge bath until cord falls off, 2-3x per week or less

110
Q

NB Care instructions at discharge: Cord care (3)

A
  • Keep clean and dry until falls off (2 weeks)
  • Wharton’s jelly
  • Clean with alcohol only if it looks infected
111
Q

NB Care instructions at discharge: Circumcision care (3)

A
  • Wash with warm water only
  • May put Vaseline on diaper or glands
  • Watch for signs and symptoms of infection

OB (15 decks)

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