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MIN Exam 1 > Care of the Neonate > Flashcards

Care of the Neonate Flashcards

1
Q

Within minutes after birth…

A

-a newborn has to initiate respirations -adapt a circulatory system to extrauterine oxygenation

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2
Q

Within 24 hours…

A

-neurologic, renal, endocrine, and GI functions must be operating competently for life to be sustained

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3
Q

Fetal breathing starts…

A

11 weeks

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4
Q

Fetal breathing is characterized by…

A

minimal circulation to the pulmonary bed

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5
Q

intrauterine oxygenation occurs via..

A

placenta -no gas exchange in fetal lungs

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6
Q

Fetal lungs are…

A

fluid filled -some reduction in this prior to birth -there is still 100mL of fluid remaining in the respiratory passages at delivery

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7
Q

Intrauterine role of surfactant

A

-promotes lung maturity by overcoming surface tension inside and outside the alveolar sacs in the fetus -surfactant peaks at 35 weeks and remains high

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8
Q

How is blood shunted

A

-shunted away from the pulmonary (right side) circulation via the foramen ovale and ductus arterisus

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9
Q

Extra uterine circulation begins…

A

with the first breath

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10
Q

Respiratory gas exchange in conjunction with marked circulatory changes…

A

must occur immediately for the baby to begin life as a separate being

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11
Q

what 2 changes are needed to maintain life

A

-lungs must expand and allow for pulmonary ventilation -marked increase in pulmonary circulation

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12
Q

Initiation of Respirations

A

-thoracic squeeze decreases fluid further -chest wall recoil-small amount of air in, more fluid out -chemoreceptor response to decrease pO2, pH, and increase in CO2 -cold air means less resp effort -sensory stimuli including tactile, auditory, and visual that stimulate resp effort

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13
Q

What happens after umbilical cord is clamped and respirations are initiated

A
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14
Q

3 Anatomic Shunts that normally close after delivery

A
  1. Foramen Ovale
  2. Ductus Arteriosus
  3. Ductus Venosus
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15
Q

Why do the 3 shunts close after delivery?

A

due to the response to pressure gradient shifts following the first few breaths

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16
Q

What happens to pulmonary blood flow with first few breaths?

A
  • lung fluid has been removed
  • pulmonary vascular resistance decreases and pulmonary blood flow increases
  • sometimes this doesn’t happen right away and the baby develops Transitory Tachypnea of the Newborn (TTN)
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17
Q

Tx for TTN

A
  • support until the lungs clear
  • O2
  • hold PO feeds
  • IVF with expected recovery in 24-72 hours
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18
Q

Initial steps for newborn

A
  • drying
  • warming
  • stimulation
  • positioning
  • clear airway
  • necessary for all newborns
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19
Q

Immediately after delivery, look at…

A
  • general appearance
  • color and cry
  • ease of breathing

first exam begins as nurse is drying, stimulating and wrapping infant or when infant is placed on mothers abdomen after being born

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20
Q

Skin to skin

A

promotes bonding and breastfeeding

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21
Q

Immediate newborn care

A
  • wear gloves
  • maintain airway
    • suction, O2 prn
    • RR: 30-70’s
    • Apgar score
  • Neutral thermal environment
    • warmer, maintain temp of 36.5-37.2 C
  • Safety ID Bands
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22
Q

Convection

A

losses from circulating air

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23
Q

Radiation

A

body heat transferring to nearby objects

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24
Q

Evaporation

A

heat loss when moisture on baby vaporizes into air

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25
Q

Conduction

A

body heat lost when baby in direct contact with cold object

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26
Q

Increase in muscular activity

A

shown by crying and restlessness (increases BMR)

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27
Q

Non-shivering thermogenesis

A

unique to newborns

-uses the infants stores of brown fat

28
Q

brown fat

A

found in the midscapular area, around the neck, axillas, trachea, kidneys, and adrenal glands

29
Q

Cold Stress

A
  • Hypothermia
  1. ↑ O2 consumption (to keep warm) that leads to ↑ RR
  2. Pulmonary vasoconstriction and Peripheral vasoconstriction
  3. ↓ O2 to tissues causing Anaerobic glycolysis OR metabolic acidosis
30
Q

Metabolic acidosis

A

↓O2, ↑ CO2 leading to ↓ pH (acid)

31
Q

Cord Clamping

A
  • keep at level of uterus
  • approx 45 second delay in clamping has benefits
  • place clamp approx 1 inch from abdomen
  • Assess for 2 arteries and 1 vein
  • Remove plastic clamp in about 24 hours and offer save it for parents
32
Q

Apgar Scoring System

A

Taken at 1 minute and 5 minutes

  • 7-10 good condition
  • 4-6 moderately depressed
  • 0-3 severely depressed
33
Q

Normal neonate axillary temp

A

36.5-37.2

34
Q

Normal neonate respirations

A

30-60

35
Q

Normal neonate apical pulse

A

120-160

36
Q

Normal neonate BP

A

not generally done

80-60/45-40

37
Q

Normal neonate weight

A

2500-4000g

38
Q

Normal neonate length

A

46-56cm

39
Q

Normal neonate head circumference

A

32-37cm

40
Q

Immediate care

A
  • vit k injection
  • check cord clamp
  • footprints and ID bands
  • security tag
41
Q

Vitamin K Injection

A

??

42
Q

Protection from hypoglycemia

A
  • closely monitor
    • SGA, LGA, IUGR
    • Stressed infants
    • infants of DM
    • Cold stress
  • symptomatic
  • feed as soon as possible
43
Q

Hypoglycemia Heel Stick Procedure

A
  • blood sugar norm: 45-60
  • blood sugar <45
    • requires feeding
  • blood sugar <20-25
    • requires parenteral glucose
    • warm heel, select size and correct heel location
44
Q

Newborn screening

A
  • Development - orderly and predictable
  • newborn screening
    • Metabolic disorders
    • phenylalanine/phenylketonuria PKU
    • several genetic disorders
  • F/U care home health after d/c home
    • 2 weeks, then 2-4-6-9-12 months
45
Q

SGA

A

small less than 2500

46
Q

LGA

A

large over 4000g

47
Q

IUGR

A

intrauterine growth restriction

48
Q

Vernix Caseosa

A

??

49
Q

Arocyanosis

A

??

50
Q

Erythema Toxicum

A

??

51
Q

Milia

A

??

52
Q

Fontanels

A

Anterior:

Posterior:

53
Q

Molding of head influenced by vaginal birth

A

??

54
Q

Caput succedaneum

A

??

55
Q

Cephalohematoma

A

??

56
Q

Digits/Polydactyly

A

??

57
Q

Palmar Crease - Simian Crease

A

??

58
Q

Male Genitalia Exam

A

Determine meatus location: Hypospadias Epispadias

Warm hand when inspecting scrotum

Palpate testes separately

Assess for hydrocele

59
Q

Female Genitalia Exam

A
  • Examine
    • Labia majora
    • Labia minora
    • clitoris
  • Observe for pseudo-menstration
60
Q

Reflexes

A
  1. Root
  2. Suck
  3. Swallow
  4. Moro
  5. Babinski
61
Q

2 parts to Gestational Age Assessment

A
  1. External physical characteristics
  2. Neurological characteristics
62
Q

Physical Maturity Charcteristics

A
  • resting posture
  • skin
  • lanugo
  • plantar creases
  • breast tissue
  • ear formation and cartilage development
  • evaluation of genitals
63
Q

Early assessment of neonatal distress

A
  • parental teaching
  • observe for:
    • changes in color or activity
    • grunting or sighing sounds
    • rapid breathing
    • chest retractions
    • facial grimacing
64
Q

Non Breastfed Feeding guidelines

A
  • 1st feeding by 5 hours of age, 2nd period of reactivity
  • enfamil, similac, good-start 20 kcal/oz
  • various bottles and nipples available NUK nipple vs. standard and high flow versus normal. DR. brown bottles may help with reduction in gas
  • no honey on pacificer - risk of botulism
65
Q

General Feeding Guidelines

A
  • establish a feeding routine after the first week or so
  • incorporate baby’s cues into feeding routine
  • initially feed q3-4 hours
  • identify signs of intolerance including reflux, emesis, diarrhea
  • burping q 1-2 ounces
  • keep mixed formula in the fridge
  • dilute correctly when using concentrate
66
Q
A

MIN Exam 1 (1 decks)

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