ch. 23: physiologic and behavioral adaptations of the newborn Flashcards by Adilene Torquemada

What is the BALLARD ASSESSMENT?

estimation of gestational age by neuromuscular and physical maturity

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Is PERIODIC BREATHING normal in newborns?

yes it is a normal variation of breathing

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What is the NORMAL BREATHS/MIN for newborns?

30 to 60 breaths/min

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When should APNEIC PERIODS be evaluated?

when they last > 20 seconds

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Are MOIST LUNG SOUNDS normal in newborns?

yes it is common, especially in c-section babies

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What is ACROCYANOSIS?

bluish discoloration of HANDS and FEET due to immature circulation

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Is ACROCYANOSIS normal?

It is normal in first 24 hrs of birth

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What are some signs of RESPIRATORY DISTRESS?

nasal flaring, intercostal or subcostal retractions
grunting
RR < 30 or > 60
central cyanosis

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What is CENTRAL CYANOSIS?

a LATE sign of RESPIRATORY DISTRESS
LIPS & MUCOSA are BLUE
signifies HYPOXEMIA

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What is the normal range for FHR?

110 to 160 bpm

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What is the average FHR when SLEEPING?

80 to 100 bpm

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What is the average FHR when CRYING?

up to 180 bpm

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Where is the PMI on newborns?

4th ICS left of the midclavicular line

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What is the normal range for NEWBORN BP?

systolic: 60-80 mmHg

- diastolic: 40-50 mmHg

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What is PERSISTENT TACHYCARDIA (>160 BPM) associated w?

anemia, hypovolemia, hyperthermia, sepsis

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What is PERSISTENT BRADYCARDIA (<100bpm) associated w?

hypoxemia or congenital abnormalities

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What is CONVECTION?

loss of heat from the warm body surface to the COOLER AIR CURRENTS
-keep infant away from open doors, wrap them and place cap on head

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What is RADIATION?

loss of heat when body heat RISES TO COOLER SURFACES and objects NOT IN DIRECT CONTACT w/ body
-keep infant away from cold objects and outside windows

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What is EVAPORATION?

loss of heat when WATER is converted into VAPOR

-dry infant after birth and place skin to skin

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What is CONDUCTION?

loss of heat to cooler surface by DIRECT CONTACT

-place protective covering on scale, prewarm bed

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What are signs of HYPOTHERMIA and COLD STRESS?

pale, mottled, and skin cool to touch
flexed position to conserve heat
increased RR

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What are some INTERVENTIONS for COLD STRESS?

1) cap on head
2) skin to skin w/ warm blanket
3) swaddle
4) radiate warmer (set to 36.5 C)
5) assess VS every 5 min when rewarming until 37 C
6) check hydration and provide fluids
7) monitor q4 hrs
8) obtain heel stick BS

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What are signs of HYPERTHERMIA?

-infant appears FLUSHED, hands and feet WARM to touch, EXTENDED POSITION

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What are some interventions for HYPERTHERMIA?

1) physical assessment
2) maintain neutral thermal environment
3) assess axillary temp

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What is the normal BODY TEMP for newborns?

36.5 to 37.5 C (97.7 to 100 F)

What percentile is LGA?

> 90%

What percentile is AGA?

10-90 %

What percentile is SGA?

< 10%

What could a PILONIDAL DIMPLE OR SINUS mean?

spina bifida

How can you check if an infant has NORMAL TREMORS?

as you touch the body part or place mild restraint, the TREMORS SHOULD CEASE

Why do NORMAL TREMORS OCCUR?

because of slight immaturity

How long do NORMAL TREMORS LAST?

first month

What are SIGNS of HYPOGLYCEMIA?

-lethargy, poor feeding, jitteriness, abnormal cry, hypotonia, temp instability

How do you check for SEIZURE ACTIVITY?

- tremor DOES NOT cease w/ general restraint | - involves ocular and autonomic (apnea, tachycardia, pupil changes, salivation)

What is MOLDING?

overlapping of the cranial bones as the baby comes through the birth canal

What is CAPUT SUCCEDANEUM?

generalized area of EDEMA on the scalp and CROSSES SUTURE LINES -subsides in 3 to 4 days

What is CEPHALOHEMATOMA?

collection of BLOOD btwn the SKULL BONE and its PERIOSTEUM and DOES NOT CROSS SUTURE LINES

What is SUBGALEAL HEMORRHAGE?

- usually from trauma during birthing process such as a vacuum - vessels are broken and BLEEDING happens into subgaleal space

What are SIGNS of SUBGALEAL HEMORRHAGE?

- boggy scalp - pallor - tachycardia - increased head circ - decrease in HCT - increase in bilirubin

What is VERNIX CASEOSIA?

WHITE CHEESY substance that acts as PROTECTION layer on skin and has ANTIMICROBIAL properties -also prevents fluid loss

What is DESQUAMATION?

PEELING of skin

What is NEVI?

- stork bite - small FLAT and PINK areas - on upper eyelids, nose, upper lip, nape of neck - fades in 1 to 2 yrs

What is MILA?

small distended WHITE SEBACEOUS glands on face

What are MONGOLIAN SPOTS?

- BLUISH/BLACKISH areas - usually noted at BACK OF BUTTOCKS - most common in: HISPANICS, ASIAN, AFRICAN AMERICANS

What is ERYTHEMA TOXICUM?

- aka NEWBORN RASH - looks like SMALL FLEA BITES - appears during 224-72 hrs - lasts up to 3 weeks

When should INFANTS VOID?

within 24 hrs

What is MECONIUM?

- first stools passed - black tarry stools composed of amniotic fluid & elements - should pass within 24 hrs

What are some HUNGER CUES?

- random hand to mouth movement | - sucking on fingers

Is it common for newborn FEMALES to have a WHITE MUCOUSY VAGINAL DISCHARGE?

yes its bc of the increased estrogen during pregnancy

Is it normal for GENITALIA to be more pigmented than the rest of the body?

yes

Is it common for BREAST TISSUE to me SWOLLEN?

yes it is caused by HYPERESTROGENISM - subsides in a few days - may also notice thin discharge from nipples (Witch's Milk)

How long does the IRON STORAGE last in newborns?

4 to 6 months

What is the normal GLUCOSE LEVELS for newborns?

50-60 mg/dl

What glucose level is TOO LOW and requires INTERVENTION?

< 40 mg/dl

What is JAUNDICE?

yellowing of skin, sclera, lethargy, irritability | -build-up of bilirubin (from broken down RBCs)

Do newborns have a Vit. K DEFICIENCY?

yes bc of the lack of intestinal bacteria needed to synthesize Vit. K

What is PHYSIOLOGIC JAUNDICE?

- appears AFTER 24 hrs | - NO TREATMENT needed

What is PATHOLOGIC JAUNDICE?

- appears WITHIN 24 hrs | - DANGEROUS bc unconjugated bilirubin will pass the BBB and cause irreversible brain damage and neurologic delays

What is BREASTFEEDING-ASSOCIATED JAUNDICE?

- early onset (2-5 days) | - caused by LACK of effective breastfeeding

What is BREAST MILK JAUNDICE?

- late onset (5-10 days) | - may be due to factors in BREAST MILK that inhibit conjugation or decrease excretion in bilirubin

What ANTIBODY makes up most of the circulating antibodies in newborns?

IgG

At what distance do newborns have the CLEAREST VISION?

8 to 12 inches

What is TEMPERAMENT?

individual characteristics that affect how infant responds to stimuli

What is HABITUATION?

ability to ADAPT to and DECREASE RESPONSE to REPETITIVE STIMULI

What is CONSOLABILITY?

can the newborn console themselves or does the caregiver need to do something like HOLDING or ROCKING?

What is CUDDLINESS?

the degree to which the newborn will RELAX and MOLD to caregiver

What is IRRITABILITY?

sensory threshold | does the child get upset easily?