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Maternity > Chapter 17 and 18: Newborn > Flashcards

Chapter 17 and 18: Newborn Flashcards

1
Q

Phases of physiologic transitioning

A
  1. first period of reactivity - approx 30 minutes after birth
  2. period of decreased responsiveness or inactivity (30 min - 2hrs)
  3. second period of reactivity (lasting 2 - 8 hrs)
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2
Q

Normal RR:

A

30 - 60

Over 60 in first 2 hours is ok

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3
Q

Normal newborn breathing characteristics

A 
irregular
shallow
unlabored
short periods of apnea (<15 sec)
symmetrical chest movements
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4
Q

3 cardiovascular adaptations and timing

A
  1. closure of foramen ovale (
    functional: 1-2 hours after birth, permanent: by 6 months)
  2. Closure of ductus arteriosus (functional: w/n first 72 hours, permanent closure 3-4 weeks)
  3. Closure of the ductus venosus
    (closure 1 week after birth)
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5
Q

Infant heart rate after birth

first few minutes:
after:

A

first few minutes: 120-180

after: 120-140

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6
Q

are cardiac murmurs ok?

A

yes

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7
Q

Newborn normal temp range

A

97.9 (36.5) – 99.7 (37.5)

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8
Q

reasons for poor thermoregulation in infants

A 
thin skin (vessels close to surface)
lack of shivering ability
limited energy stores
limited voluntary muscle activity
large SA relative to weight
lack of SQ fat
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9
Q

Primary heat production mechanism of newborn

A

Nonshivering thermogenesis

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10
Q

Cold stress leads to…

A
  • depleted brown fat stores
  • increased oxygen needs
  • respiratory distress
  • increased glucose
  • consumption leading to hypoglycemia
  • metabolic acidosis
  • jaundice, hypoxia
  • decreased surfactant production
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11
Q

When does hepatic system become fully active

A

3 months old

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12
Q

3 types of jaundice based on mechanism of accumulation of bilirubin

A

overproduction
decreased conjugation
impaired excretion

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13
Q

Causes of overproduction bilirubin

A 
blood incompatibility Rh or ABO
drugs
trauma at birth
polycythemia
delayed cord clamping
breast milk jaundice
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14
Q

Decreased bilirubin conjugation

A

physiologic jaundice
hypothyroidism
breast-feeding

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15
Q

Impaired bilirubin excretion causes

A 
biliary obstruction
sepsis
hepatitis
chromosomal abnormality 
drugs
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16
Q

What organ is responsible for bilirubin conjugation

A

liver

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17
Q

When does bilirubin production decline to adult level

A

10-14 days after birth

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18
Q

danger of extremely high bilirubin in the first week of newborn

A

bilirubin encephalopathy

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19
Q

Risk factors for juandice

A
  • Maternal blood group incompatibility
  • Prematurity
  • breast-feeding
  • drugs (diazepam)
  • maternal gestational diabetes
  • infrequent feedings
  • male gender
  • cephalohematoma
  • TORCH infection
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20
Q

TORCH

A 
toxoplasmosis
other viruses
rubella
cytomegalovirus
herpes simplex virus
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21
Q

phsyiologic jaundice timeing

A

24 hr - 3 days

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22
Q

When is phototherapy indicated (bilirubin level)

A

12-15 mg/dl in the first 48 hours

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23
Q

how many kcal/kg/day for first 6 months

A

108 kcal/kg/day

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24
Q

Normal amount of daily voids for newborn

A

6-8

up until day 7 the voids and stools match the day

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25
Q

pink orange material in diaper in first week

A

urate cyrstals - may indicate dehydration

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26
Q

least mature sense at birth

A

vision (limit of 8-10”)

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27
Q

What does serum glucose decline of 40-50 after birth mean?

A

normal

28
Q

Newborn assessment

A
  1. general appearance
  2. head/neck
  3. chest/abd.
  4. hip/genitals/anus
  5. limb/spine/CNS
29
Q

General appearance

A 
muscle tone
LOC
color/size
cry
spine
30
Q

head/neck

A 
head circ
fontanels/sutures/molding
scalp
eyes/ears
nose
mouth
clavicles
neck/jaw
31
Q

chest/abd

A 
shape/symmetry pectus
heart sounds
apex
breath sounds
nipple
ABD
umbilicus
defects
liver hepatomegaly
32
Q

hips/genitals/anus

A

femoral pulse
hip clicks
testes descended/hydrocele/hernia

33
Q

limb/spine/CNS

A 
digits
palmar creases
feet
pulses/perfusion
spine
reflexes (sucking, moro, grasp, babisnkin)
limbs
34
Q

Physical maturity indicators in newborn

A 
skin texture
lanugo
plantar creases
breast tissue
eyes
ears 
genitals
35
Q

Neuromuscular maturity indictors

A 
posture
square window
arm recoil
popliteal angle
scarf sign
heel-to-ear
36
Q

APGAR

A 
appearance (color)
Pulse (HR)
Grimace (reflex irritability)
Activity (muscle tone)
Respiratory effort
37
Q

APGAR HR

A 
0= absent
1= <100
2= >100
38
Q

Normal BP for newborn

A

50-75 / 30-45

39
Q

How frequently are HR and RR assessed

A

1st 2hr: q 30min

after: q 8hrs

40
Q

Classifications by gestation age (3)

A

preterm or premature: <37
term: 38 to 42 weeks gestation
post-term or postdates: born after completion of week >42 gestation

41
Q

Classifications by birth weight????

A

low birth weight: > 2500 g (>5.5 lb)

very low birth weight: > 1500 g (>3.5 lb)

extremely low birth weight: > 1000 g (>2.5 lb)

42
Q

SGA vs AGA vs LGA

A

SGA: < 10th percentile, <5.5lbs
AGA: between 10th and 90th
LGA: >90th, >9lbs

43
Q

Suction newborn order

A
  1. mouth

2. nose

44
Q

where is vitamin k injected

what guage/length

A

vastus lateralis

25G, 5/8 inch

45
Q

Expected length of newborn

A

44 - 55 cm

17 - 22 inches

46
Q

what if newborn loses approximately 10% of their initial birth weight by 4 days?

A

this is normal

-secondary to loss of meconium, extracellular fluid, limited food intake

47
Q

collection ofo serous fluid that crosses suture line

A

caput cucedaneum

48
Q

collection of blood that does not cross fluid line

A

cephalohematoma

49
Q

what are large fontanels?

what do they indicate

A

larger than 6cm in the anterior
larger than 1 cm in the posterior

  • malnutrition
  • hydrocephaly
  • congenital hypothyroidism
  • trisomys
  • bone disoorders
50
Q

telangiectatic nevi

A

stork bites

angel kisses

51
Q

Milia

A

dead skin cells get trapped within small pockets on teh skin’s surface rather than falling off

52
Q

Mongolian spots

A

disappear 3-5 years after birth

53
Q

Erythema toxicum

A

harmless disappears in a few days

54
Q

Nevus flammeus

A

port wine stain

55
Q

Nevus vasculosus

A

overgrowth of capillary blood vessels

56
Q

Factors associated with obstetric brachial plexus paralysis

A

large birth weight
breech delivery
shoulder dystocia

57
Q

normal umbilical cord progression

A

drying within hours
shriveled and black by day 2 or 3
sloughs off by days 7-10

58
Q

When to remove cord clamp

A

24 hours after birth

59
Q

Circumcision care

A

assess for bleeding q30 for 2 hours
soapy water and pat dry
petroluem jelly with every diaper change
fasten diaper loosely

60
Q

breastfeeding benefits mom

A 
decreased postpartum bleeding
more rapid uterine involution
reduced risk of breast cancer, uterine cancer, and ovarian cancer
earlier return to prepregnancy weight
decreased risk of post menopausal oseto
61
Q

breastfeeding benefits baby

A

decreased risk SIDS
decreased risk DM
decreased risk asthma and allergies
analgesic effect

62
Q

LATCH

A 
L - how well infant Latches
A- amount of audible swallowing
T - nipple type
C - level of comfort
H - amount of help mother needs
63
Q

What conditions are screened for in newborn?

A

PKU - must be done 24 hours after feeding
hypothyroidism
Galactosemia
sickle cell

64
Q

Infant hypoglycemia level

A

less than 40 mg/dL in first 72 hours

jitteriness, lethargy, cyanosis, apnea, seizures, highpitched or weak cry, hypothermia, poor feeding

65
Q

risk factors hypoglycemia

A

preterm
SGA
maternal DM
LGA

Maternity (8 decks)

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