Care of the Newborn

Question 1

Initial Care of the Newborn

Answer 1

• Observe or assist with initiation of respirations, assess Apgar score, note characteristics of cry, monitor for abnormal respirations (such as seesaw), assess for central cyanosis and acronyanosis, obtain VS, observe for signs of hypothermia, assess for gross anomalies.
• Suction the mouth first and then the nares if needed with a bulb syringe. Dry the new born and stimulate crying by rubbing the back. Maintain temperature stability, wrap the newborn in blankets and place a stockinette cap on the newborn’s head.
• Keep the newborn with the mother to facilitate bonding, place the newborn at the mother’s breast if breast-feeding is planned, or place on the mother’s chest for skin-to-skin.
• Place the newborn in a radiant warmer. Ensure the newborn’s proper identification (footprint the newborn and fingerprint the mother on the identification sheet. Place matching bracelets on the mother and newborn.

Question 2

Apgar Scoring System

Answer 2

Assess each of 5 items and add points
- HR: 0 absent; 1 <100bpm; 2 >100bpm.
- RR and effort: 0 absent; 1 slow/irregular/weak; 2 good rate and effort, vigorous cry.
- Muscle tone: 0 flaccid/limp; 1 minimal flexion of extremities; 2 good flexion, active motion.
- Reflex irritability: 0 no response; 1 minimal response to suction or to gentle slap on soles; 2 responds promptly with a cry or active movement.
- Skin color: 0 pallor or cyanosis; 1 body skin color normal, extremities blue; 2 body and extremity skin color normal.
Apgar Score Interventions:
8-10: no intervention required except to support newborn’s spontaneous efforts.
4-7: stimulate; rub newborn’s back; adm oxygen; rescore at specific intervals.
0-3: newborn requires full resuscitation; rescore at specific intervals.
**Apgar score is routinely assessed at 1 min and 5 min after birth, and may be repeated later if the score remains low.

Question 3

Initial Physical Examination: General Guidelines

Answer 3

• keep the newborn warm during the examination.
• begin with general observations, and then perform assessments that are least disturbing to the newborn first.
• initiate nursing interventions for abnormal findings and document findings.
• the Ballard Scale may be used for gestational age assessment (scores are assigned to physical and neurological criteria).
• the phases of newborn instability occur during the first 6-8h after birth and are known as the transition period between intrauterine and extrauterine existence.

Question 4

Initial Physical Examination: Vital Signs

Answer 4

• HR: resting 110-160 bpm; sleeping 90-110 bpm; crying up to 180 bpm. Auscultate at the 4th intercostal space for 1 min to detect abnormalities.
• RR: 30-60 rpm, assess 1 min.
• Assess HR and RR first while sleeping.
• Axillary temperature: 97.7 to 100.3F (36.5 to 37.9C).
• BP: usually not done unless a cardiac issue is suspected. 80-90/40-50 mmHg.

Question 5

Initial Physical Examination: Body Measurements

Answer 5

• length: 45-55cm (18-22in)
• weight 2500-4000g (5.5-8.75lb)
• head circ: 33-35cm (13.2-14in)

Question 6

Initial Physical Examination: Head

Answer 6

• should be 1/4 of the body length.
• bones of the skull are not fused.
• sutures (connective tissue between the bones) are palpable and may be overlapping because of head molding but should not be widened.
• fontanels are unossified membranous tissue at the junction of the sutures.
• molding is asymmetry of the head resulting from pressure in the birth canal; disappears in about 72h.
  = Anterior fontanel: soft, flat, diamond-shaped; 3-4cm wide x 2-3cm long. Closes between 12-18m.
  = Posterior fontanel: triangular; 0.5-1cm wide; located between occipital and parietal bones. Closes between birth and 2-3m.

Question 7

Initial Physical Examination: Masses from birth trauma

Answer 7

• caput succedaneum is edema of the soft tissue over bone (crosses over suture line); it subsides within a few days.
• cephalhematoma is swelling caused by bleeding into an area between the bone and its periosteum (does not cross over suture line); it usually is absorbed within 6 weeks with no treatment.

Question 8

Initial Physical Examination: Head Lag

Answer 8

• common when pulling the newborn to a sitting position.

- when prone, the newborn should be able to lift the head slightly and turn the head from side to side.

Question 9

Initial Physical Examination: Eyes

Answer 9

• symmetrical and clear.
• pupils equal, round, react to light and accommodation.
• blink reflex present.
• eyes cross because of weak extraocular muscles.
• ability to track and fixate momentarily.
• red reflex present.
• eyelids often edematous as a result of pressure during the birth process and effects of eye medication.

Question 10

Initial Physical Examination: Ears

Answer 10

• symmetrical, firm cartilage with recoil.
• top of pinna on or above line drawn from outer canthus of eye.
• low-set ears associated with Down syndrome, renal anomalies, or other genetic or chromosomal syndromes.

Question 11

Initial Physical Examination: Nose

Answer 11

• flat, broad, in center of face.
• obligatory nose breathing.
• occasional sneezing to remove obstructions.
• nares are patent and should not flare.

Question 12

Initial Physical Examination: Mouth

Answer 12

• pink, moist gums.
• soft and hard palates intact.
• epstein’s pearls (small white cysts) may be present on hard palate.
• uvula midline.
• freely moving tongue, symmetrical, has short frenulum.
• sucking and crying movements symmetrical.
• able to swallow.
• root and gag reflexes present.

Question 13

Initial Physical Examination: Neck

Answer 13

• short and thick.
• head held in midline.
• trachea midline.
• good range of motion and ability to flex and extend.
• assess for torticollis (head inclined to 1 side as a result of contraction of muscle on that side).

Question 14

Initial Physical Examination: Chest

Answer 14

• circular appearance because of anteroposterior and lateral diameters are about equal (approx 30-33cm) at birth.
• diaphragmatic respirations (chest and abdomen should rise and fall in synchrony.
• bronchial sounds heard on auscultation.
• nipples prominent and often edematous; milky secretion common.
• breast tissue present
• clavicles need to be palpated to assess for fractures.

Question 15

Initial Physical Examination: Skin

Answer 15

• pinkish red, brown, or yellow.
• vernix caseosa (may be absent after 42 weeks).
• lanugo might be seen (especially back).
• milia (small white sebaceous glands) appear on forehead, nose, and chin.
• dry, peeling skin, increased in postmature newborns.
• cyanosis may be noted with hypothermia, infection, and hypoglycemia and with cardiac, respiratory, or neurological abnormalities.
• acrocyanosis (peripheral) is normal in the first few hours after birth and may be noted for the next 7-10 days.
• assess for ecchymosis and petechiae resulting from trauma.
• assess skin turgor over the abdomen to determine hydration status.
• observe for forceps marks.
• Harlequin sign: deep pink or red color develops over 1 side of newborn’s body while the other side remains pale or of normal color. May indicate shunting of blood that occurs with a cardiac problem or may be sepsis.

Question 16

Initial Physical Examination: Umbilical Cord

Answer 16

• should have 3 vessels (2 arteries and 1 vein); if fewer notify PHCP.
• while 2 vessel cord may present no problems or concerns, there is a higher correlation to intrauterine growth restriction and genetic or chromosomal problems.
• small, thin cord may be associated with poor fetal growth.
• assess for intact cord and ensure that the cord clamp is secured.
• cord should be clamped for at least the first 24h and can be removed when the cord is dried and occluded and is no longer bleeding.
• not any bleeding or drainage from the cord.
• cleansing of the cord needs to be done and if signs of infection, ATB is prescribed.

Question 17

Initial Physical Examination: Gastrointestinal

Answer 17

• monitor cord for meconium staining and assess for umbilical hernia.
• assess for abdominal depression associated with diaphragmatic hernia.
• assess for abdominal distension associated with obstruction, mass, or sepsis.
• monitor bowel sounds (present within the first hour after birth).

Question 18

Initial Physical Examination: Anus

Answer 18

• ensure that the anal opening is present.

- first stool meconium should pass within first 24h.

Question 19

Initial Physical Examination: Female Genitals

Answer 19

• labia may be swollen; clitoris may be enlarged.
• smegma may be present (thick, white mucus discharge).
• pseudomenstruation, caused by the withdrawal of the maternal hormone estrogen, is possible.
• hymen tag may be visible.
• first voiding should occur within 24h.

Question 20

Initial Physical Examination: Male Genitals

Answer 20

• prepuce (foreskin) covers glans penis.
• scrotum may be edematous.
• verify meatus at tip of penis.
• testes are descended but may retract with cold.
• assess for hernia or hydrocele.
• first voiding should occur within 24h.

Question 21

Initial Physical Examination: Spine

Answer 21

• straight, posture flexed.
• supportive of head momentarily when prone.
• chin flexed on upper chest.
• well-coordinated, sporadic movements
• a degree of hypotonicity or hypertonicity may indicate CNS damage.
• assess for hair tufts and dimples along the spine column (may be indicative of a possible opening).

Question 22

Initial Physical Examination: Extremities

Answer 22

• flexed, full range of motion, symmetrical movements.
• fists clenched, 10 fingers and toes, all separate.
• legs bowed, major gluteal folds even.
• creases on soles of feet.
• assess for fractures or dislocations (hip).
• pulses palpable (radial, brachial, femoral)
• assist PHCP to assess for developmental dysplasia of the hip (when thighs are rotated outward, no clicks should be heard).

Question 23

Body Systems Assessment and Interventions: Cardiovascular System

Answer 23

• keep the NB warm.
• measure the apical HR for 1 min.
• listen for murmurs, assess oxygen saturation.
• palpate pulses.
• assess for cyanosis, blanch the skin on the trunk and extremities to assess circulation.
• observe for cardiac distress when the NB is feeding.

Question 24

Body Systems Assessment and Interventions: Respiratory System

Answer 24

• suction the airway as necessary: use a bulb syringe for upper airway and a french catheter for deeper suctioning.
• observe for respiratory distress and hypoxemia
• adm oxygen if necessary

Question 25

Body Systems Assessment and Interventions: Hepatic System

Answer 25

• normal or physiological jaundice appears after the first 24h in full-term NB and after 48h in premature NB (occurring before this time may indicate early hemolysis of red blood cells and must be reported to PHCP.
• physiological jaundice peaks on about the 5th day of life.
• feed early to stimulate intestinal activity and to keep the bilirubin level low.
• prevent chilling because hypothermia can cause acidosis that interferes with bilirubin conjugate and excretion.
• liver stores the iron passed from the mother for 5-6m.
• glycogen storage occurs in the liver.
• the NB is at risk for hemorrhagic disorders; coagulation factors synthesized in the liver depend on vitamin K, which is not synthesized until intestinal bacteria are present.
• handle the NB carefully and monitor for any bruising or bleeding episodes.
• watch for meconium stool and subsequent stools.
• adm IM (vastus lateralis) dose of phytonadione to the NB as prescribed to prevent hemorrhagic disorders.
• assess NB hemoglobin and blood glucose levels.

Question 26

Body Systems Assessment and Interventions: Renal System

Answer 26

• immature kidneys are unable to concentrate urine.
• a weight loss of 5-10% during the first week of life occurs as a result of water loss and limited intake; birth weight should be regained by 10 to 14 days after birth.
• weight the NB daily.
• monitor intake and output (weight diapers if necessary; 1g = 1ml of urine).
• assess for signs of dehydration.

Question 27

Body Systems Assessment and Interventions: Immune System

Answer 27

• NB receives passive immunity via the placenta (IgG).
• NB receives passive immunity from colostrum (IgA).
• Elevations in IgM indicate infection in utero.
• use aseptic technique and standard precautions when caring for the newborn.
• ensure meticulous handwashing.
• observe any cracks or openings in the skin.
• adm eye med within 1h after birth to prevent ophthalmia neonatorum.

Question 28

Body Systems Assessment and Interventions: Cord Care

Answer 28

• Teach the mother, keep the cord clean and dry; alcohol wipes may be prescribed only of becomes soiled.
• Keep the diaper from covering (fold below).
• Assess for odor, edema, or discharge.
• NB is typically washed via a sponge bath until the cord falls off (within 7-10 days).

Question 29

Body Systems Assessment and Interventions: Circumcision Care

Answer 29

• apply petroleum jelly gauze to the penis except when a PlastiBell is used.
• remove petroleum jelly gauze, if applied, after the first voiding following circumcision.
• observe for edema, infection, or bleeding.
• teach the mother how to care.
• clean the penis after each voiding by squeezing warm water over the penis.
• a milky covering over the glans penis is normal and should not be disrupted.
• monitor for urinary retention (needs to void within 24h).

Question 30

Body Systems Assessment and Interventions: Metabolic System and GI System

Answer 30

• NB are able to digest simple carbohydrates but are unable to digest fats because of the lack of lipase.
• proteins may be broken down only partially, so they may serve as antigens and provoke an allergic reaction.
• NB has a small stomach capacity (less than 10ml at birth, increasing to about 90ml by day 10), with rapid intestinal peristalsis (bowel emptying time is 2.5 to 3h).
• breast-feeding usually can begin immediately after birth; bottle-fed may be initially offered no more than 30ml of formula.
• observe feeding reflexes,such as rooting, sucking, and swallowing.
• assist the mother: breast-feeding should be done every2-3h, and formula feeding (minimal of 30ml by day 3) should be done every 3-4h.
• burp the NB during and after feeding.
• assess for regurgitation or vomiting.
• position the NB on the right side after feeding (however, not recommended for sleep because makes it easy to roll to prone).
• observe normal stool and the passage of meconium.
• perform a NB screening test as prescribed before discharge after sufficient protein intake occurs. NB should be on formula or breast-feeding for 24h before screening.

Question 31

Body Systems Assessment and Interventions: Neurological System

Answer 31

• Myelinization of nerve fibers is incomplete, so primitive reflexes are present.
• fontanels are open to allow brain growth.
• measure and graph the head circumference in relation to chest circumference and length.
• assess the NB’s movements, noting symmetry, posture, and abnormal movements.
• observe for jitteriness, marked tremors, and seizures.
• test the NB’s reflexes.
• assess for lethargy and pitch cry.

Question 32

Body Systems Assessment and Interventions: Thermal Regulatory System

Answer 32

• prevent cold stress.
• NB do not shiver to produce heat and have brown fat deposits, which produce heat.
• prevent heat loss resulting from:
  = evaporation by keeping the NB dry and well wrapped with a blanket.
  = radiation by keeping the NB away from cold objects and outside walls.
  = convection by shielding the NB from drafts.
  = conduction by performing all treatments on a warm, padded surface.
• keep the room temperature warm.
• take the NB’s axillary temperature every hour for the first 4 hours of life, every 4 hours for the remainder of the 24h, and then every shift.

Question 33

Reflexes: Sucking and rooting

Answer 33

• touch the NB’s lip, cheek, or corner of the mouth with a nipple, NB turns the head toward the nipple, opens the mouth, takes hold of the nipple, and sucks.
• the rooting reflex usually disappears after 3 to 4 months, but may persist for 1 year.

Question 34

Reflexes: Swallowing

Answer 34

• occurs spontaneously after sucking and obtaining fluids.

- NB swallows in coordination with sucking without gagging, coughing, or vomiting.

Question 35

Reflexes: tonic neck or fencing

Answer 35

• while the NB is falling asleep or sleeping, gently and quickly turn the head to 1 side.
• as the NB faces the left side, the left arm and leg extend outward while the right arm and leg flex.
• same and opposite when facing the right side.
• response usually disappears within 3 to 4m.

Question 36

Reflexes: Palmar- plantar Grasp

Answer 36

• place finger in the palm of the NB and then place a finger at the base of the toes.
• NB’s fingers curl around the examiner’s fingers, and the toes curl downward.
• palmar response lessens withing 3 to 4m.
• plantar response lessens within 8m.

Question 37

Reflexes: Moro

Answer 37

• hold the NB in a semi-sitting position and then allow the head and trunk to fall backward to at least a 30 degree angle.
• NB assumes sharp extension and abduction of the arms with the thumbs and forefingers in a “C” position; this is followed by flexion and adduction to an embrace position (legs follow a similar pattern).
• present at birth and is absent by 6m if neurological maturation is not delayed.
• a body jerk motion may be the response between 8-18 weeks.

Question 38

Reflexes: Startle

Answer 38

• response is best elicited if the NB is at least 24h old.
• examiner makes a loud noise or claps hands to elicit the response.
• NB arms adduct while the elbows flex, hands stay clenched.
• reflex should disappear within 4m.

Question 39

Reflexes: Pull-to-sit response

Answer 39

• pull the NB up by the wrist while the NB is in the supine position.
• head lags until the NB is in an upright position, and then the head is level with the chest and shoulders momentarily before falling forward.
• head then lifts for a few minutes.
• the response depends on the NB general muscle tone and condition and on maturity level.

Question 40

Reflexes: Babinski’s sign (plantar reflex)

Answer 40

• beginning at the heel of the foot, use a finger to stroke gently upward along the lateral aspect of the sole, and then move the finger along the ball of the foot.
• NB’s toes hyperextend while the big toe dorsiflexes.
• disappears after the NB is 1 year old.
• absence of this reflex indicates the need for neurological examination.

Question 41

Reflexes: Stepping or walking

Answer 41

• hold the NB in a vertical position, allowing 1 foot to touch a table surface, NB simulates walking, alternately flexing and extending the feet.
• usually present for 3 to 4m.

Question 42

Reflexes: Crawling

Answer 42

• place the NB on the abdomen, NB begins to make crawling movements with the arms and legs.
• reflex usually disappears after about 6 weeks.

Question 43

Parent Teaching: Formula feeding

Answer 43

teach sterilization techniques if the water supply is located in areas where purification process is questionable.

• remind the mother not to heat the bottle of formula in a microwave.
• inform the mother that the formula is a sufficient diet for the first 4 to 6m.
• assess the mother’s ability to burp the NB.

Question 44

Parent Teaching: Breast-feeding

Answer 44

• assess the NB ability to attach to the mother’s breast and suck.
• teach the mother how to pump and how to store breast milk properly.
• inform the mother that breast milk is a sufficient diet for the first 4 to 6m.

Question 45

Parent Teaching: Bathing

Answer 45

• bathe the NB in a warm room before feeding.
• have all the equipment for bathing available.
• use a mild soap (not on the face).
• proceed from the cleanest area to the dirtiest.
• clean eyes from the inner canthus outward.
• special care should be taken to clean under the folds of the neck, underarms, groin, and genitals.
• make bath time enjoyable for the NB and the mother.

Question 46

Parent Teaching: Clothing

Answer 46

• assess diaper and clothing needs for the NB
• instruct the mother that the NB’s head should be covered in cold weather to prevent heat loss.
• instruct to layer the NB’s clothing in cooler weather.
• to be comfortable, the NB should be dressed in 1 more layer of clothing than what the parents are wearing.

Question 47

Parent Teaching: uncircumcised NB

Answer 47

• inform the mother that the foreskin and glans are 2 similar layers of cells that separate from each other and that the separation process normally is complete by 3 years of age, although the layers can remain adhered until puberty.
• instruct the mother not to pull back the foreskin, but to allow natural separation to occur.
• inform the mother that as the process of separation occurs, sloughed cells build up between the layers of the foreskin and the glans, and that when retraction occurs, daily gentle washing of the glans with soap and water is sufficient to maintain adequate cleanliness.

Question 48

Parent Teaching: Stimulation

Answer 48

Providing stimulation to the NB such as touching, cuddling, or talking is an important intervention.

Question 49

Preterm newborn: assessment and intervention

Answer 49

• infant born between 20-37 weeks.
• respirations are irregular with periods of apnea, body temp is bellow normal, poor suck and swallow reflexes, bowel sounds are diminished, urinary output is increased or decreased, extremities are thin, with minimal creasing on soles and palms. NB extends extremities and does not maintain flexion, lanugo is present in woolly patches, skin is thin with visible vessels and minimal subcutaneous fat pads, skin may appear jaundiced. Tests are undescended in boys and labia majora are narrow in girls.
• monitor VS every 2-4h, maintain airway and cardiopulmonary functions. Adm oxygen and humidification as prescribed. Monitor intake and output and electrolyte balance, daily weight, and maintain the NB in a warming device. Avoid exposure to infections.

Question 50

Post-term Newborn: assessment and intervention

Answer 50

• born after 42 weeks.
• hypoglycemia, parchment-like skin (dry and cracked) without lanugo, long fingernails, profuse scalp hair, long and thin body, wasting of fat and muscle in extremities, meconium staining possibly present on nails and umbilical cord.
• provide normal NB care, maintain temp, monitor for hypoglycemia and meconium aspiration.

Question 51

Small for Gestational Age: assessment and intervention

Answer 51

• bellow the 10% on the intrauterine growth curve.
• fetal distress, decreased or elevated body temp, physical abnormalities, hypoglycemia, signs of polycythemia (ruddy appearance, cyanosis, jaundice), signs of infection or aspiration of meconium.
• maintain airway, cardiopulmonary function and body temp. Observe for signs of respiratory distress, monitor for infection and hypoglycemia. Initiate early feedings and monitor for signs of aspiration.

Question 52

Large for Gestational Age: assessment and intervention

Answer 52

• above the 90% on the intrauterine growth curve.
• birth trauma or injury, respiratory distress, hypoglycemia.
• monitor VS, hypoglycemia, signs of infections and respiratory distress. Initiate early feedings.

Question 53

Respiratory Distress Syndrome: assessment and intervention

Answer 53

• serious lung disorder caused by immaturity and inability to produce surfactant, resulting in hypoxia and acidosis.
• respiratory distress, pallor and cyanosis, hypothermia, poor muscle tone.
• monitor color, RR, degree and effort of breathing, arterial blood gases and oxygen saturation levels. Maintain airway and CP function. Support respirations and ensure that oxygen is adm at the lowest possible concentration necessary and as prescribed.
  Position the NB on the side or back with the neck slightly extended, adm respiratory therapy (percussion and vibration) as prescribed; use padded small plastic cup or small oxygen mask for percussion; use padded electric toothbrush for vibration.
  Provide nutrition, support bonding, prepare parents for short-term or long-term oxygen dependency. Encourage the mother to pump the breasts for future breast-feeding and parental participation in care.
• any premature NB who required oxygen support should be scheduled for an eye examination before discharge to assess for retinal damage.

Question 54

Meconium Aspiration Syndrome: assessment and intervention

Answer 54

• occurs in term or post-term NB, exact etiology is unknown, but the release of meconium into the amniotic fluid is thought to be related to a stressful fetal event initiating a biochemical chain of events. Aspiration can occur in utero or with the first breath.
• respiratory distress is present at birth, NB nails, skin, and umbilical cord may be stained in a yellow-green color.
• if delivered in an active, crying state with no evidence of respiratory distress, no intervention is necessary.
• if delivered inactive and lack of cry, endotracheal suctioning is performed. If exhibits lack of respiratory effort and low HR, additional interventions will be needed.
• NB with severe meconium aspiration may benefit from extracorporeal membrane oxygenation.

Question 55

Bronchopulmonary Dysplasia: assessment and intervention

Answer 55

• chronic pulmonary condition affects NB who have experienced respiratory failure or have been oxygen-dependent for more than 28 days. X-ray findings are abnormal, indicating areas of overinflation and atelectasis.
• tachypnea, tachycardia, retractions, nasal flaring, labored breathing, crackles and decreased air movement, occasional expiratory wheezing.
• monitor airway and CP function, provide oxygen therapy. Fluid restriction may be prescribed, meds include surfactant at birth, brochodilators, and possibly diuretics and corticosteroids.

Question 56

Transient Tachypnea of the NB: assessment and intervention

Answer 56

• respiratory condition thar results from incomplete reabsorption of fetal lung fluid in full-term NB. Usually disappears within 24-48h.
• tachypnea, expiratory grunting, retractions, nasal flaring, fluid breath sounds per auscultation, cyanosis.
• provide supportive care and oxygen adm.

Question 57

Intraventricular Hemorrhage

Answer 57

• bleeding within the ventricles of the brain
• risk factors: prematurity, respiratory distress syndrome, trauma, and asphyxia.
• diminished or absent moro reflex, lethargy, apnea, poor feeding, high-pitched shrill cry, seizure activity.
• provide supportive treatment.

Question 58

Retinopathy of Prematurity

Answer 58

• vascular disorder involving gradual replacement of retina by fibrous tissue and blood vessels.
• primarily caused prematurity and use of supplemental oxygen (>30 days).
• leukocoria (white tissue on the retrolental space), vitreous hemorrhage, strabismus, cataracts (check for red reflex).
• intervention: laser photocoagulation surgery.

Question 59

Necrotizing Enterocolitis (NEC)

Answer 59

• acute inflammatory disease of the GI tract, usually occurs 4-10 days after birth, and is most frequently seen in preterm NB.
• increased abdominal girth, decreased or absent bowel sounds, bowel loop distension, vomiting, bile-stained emesis, abd tenderness, occult blood in stool.
• prevention: withhold feedings for 24-48h from NB believed to have suffered birth asphyxia. Use of probiotics with enteral feedings and breast milk has shown evidence of prevention. Adm of corticosteroids to the mother prior to birth to promote early gut closure and maturation of the gut mucosa.
• Interventions: hold oral feedings, insert oral gastric tube to decompress abd. Adm IV ATB, fluids to correct imbalances. Surgery if indicated.

Question 60

Hyperbilirubinemia

Answer 60

• elevated serum bilirubin level, evaluation is indicated when levels are greater 12mg/dL in a term NB.
• therapy is aimed at preventing kernicterus, which results in permanent neurological damage resulting from the deposition of bilirubin in the brain cells.
• jaundice, elevated bilirubin level, enlarged liver, poor muscle tone, lethargy, poor sucking reflex.
• monitor for jaundice, keep NB hydrated, facilitate early feedings, prepare for phototherapy.

Question 61

Phototherapy

Answer 61

• use of light to reduce serum bilirubin level.
• adverse effects include eye damage, dehydration, or sensory deprivation.
• follow specific instructions and expose as much of the NB’s skin as possible.
• cover the genital area and monitor for irritation or breakdown of skin.
• cover the eyes and ensure the eyelids are closed.
• remove the shields or patches at least once per shift (during the feeding time) to inspect the eyes for infection or irritation and allow eye contact and bonding.
• measure the lamp energy output to ensure efficacy.
• monitor skin temp closely, increase fluids to compensate for water loss, expect loose green stools.
• monitor skin color every 4-8h with the fluorescent light turned off. Monitor for bronze baby syndrome, a grayish brown discoloration.
• reposition every 2h, provide stimulation.
• after treatment continue to monitor for signs of hyperbilirubinemia, because rebound elevations can occur after the therapy is done.
• turn off the phototherapy lights before drawing blood (to prevent the breakdown of bilirubin in the blood specimen).

Question 62

Erythroblastosis Fetalis

Answer 62

• the destruction of red blood cells that results from an antigen-antibody reaction. Characterized by hemolytic anemia or hyperbilirubinemia.
• exchange of fetal and maternal blood occurs primarily when the placenta separates at birth. Antibodies are harmless to the mother but attach to the erythrocytes in the fetus and causes hemolysis.
• sensitization is rare with the first pregnancy and ABO incompatibility is usually less severe.
• anemia, jaundice that develops rapidly after birth and before 24h, edema.
• adm RhoD immuno globulin to the mother during the first 72h after birth. Assist with exchange transfusion after birth or intrauterine transfusion as prescribed.
• the NB’s blood is replaced with Rh- blood to stop destruction of the red blood cells.

Question 63

Sysphilis

Answer 63

• cogenital sysphilis can result in premature birth, skin lesions, and abnormal skeletal development.
• able to cross the placenta, usually after 18 weeks, and infect fetus.
• risks: preterm birth, stillbirth, and low birth weight.
• effects are irreversible and may include CNS damage and hearing loss.
• hepatosplenomegaly, joint swelling, palmar rash and lesions, anemia, jaundice, snuffles, ascites, penumonitis, cerebrospinal fluid changes.
• monitor, adm ATB as prescribed, use standard precautions and drainage and secretion (contact) precautions. Wear gloves when handling the NB until ATB therapy has been adm for 24h.

Question 64

Addicted Newborn

Answer 64

• a NB can be passively addicted to drugs that have passed through the placenta.
• assessment findings and withdrawal times may vary depending on the specific addicting drug.
• irritability, tremors, hyperactivity, hypertonicity, respiratory distress, vomiting, high-pitched cry, sneezing, fever, diarrhea, excessive sweating, poor feeding, extreme sucking of fists, seizures.
• monitor, provide frequent feeding, maintain quite environment to reduce stimulation,initiate seizure precautions.

Question 65

Fetal Alcohol Spectrum Disorders (FASDs)

Answer 65

• a group of conditions caused by maternal alcohol use during pregnancy.
• cause cognitive and physical delays, facial changes, abnormal palmar creases, respiratory distress, congenital heart disorders, irritability and hypersensitivity to stimuli, tremors, poor feeding, seizures.

Question 66

Newborn of Diabetic Mother

Answer 66

• Hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, hypocalcemia, birth trauma, and congenital anomalies may be present.
• excessive size and weight as a result of excess fat and glycogen in the tissues.
• edema or puffiness in the face and cheeks.

Question 67

Hypoglycemia

Answer 67

< 45mg/dL (normal is 45-60 in a 1 day old NB and 50-90 after 1 day).

Question 68

Hypothyroidism

Answer 68

• decrease in the production of thyroid hormone.
• protruding or thick tongue, dull look, swollen face, decreased muscle tone, abnormal lab results.
• focus on thyroid replacement.

Question 69

CPR for infants ( <1y)

Answer 69

• location of the pulse check is brachial.
• compression technique is to use 2 fingers for a single rescuer and to use a 2 thumb-encircling technique for 2 rescuers.
• compression depth is approx 1.5in or 4cm.
• compression ventilation ratio for 1 rescuer is 30:2 and for 2 rescuers 15:2
• the emergency response system should be activated if the arrest is not witnessed and the rescuer is alone after providing 2 min of CPR. After 2 min the sinlge rescuer can activate the emergency response and get an AED.
• the emergency response system should be activated and the AED should be retrieved before beginning CPR if the arrest is sudden and witnessed.