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Pediatrics I, exam 1 > Eval of Neonate and Infant > Flashcards

Eval of Neonate and Infant Flashcards

1
Q

During what time period is a baby a Neonate

A

first 28 days of life

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2
Q

When is a child considered an infant

A

29 days to 12 months

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3
Q

when is a baby considered a preemie

A

birth prior to 37 weeks

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4
Q

The APGAR score is taken at what time increments after birth

A

1 minute and 5 minutes

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5
Q

Name the 5 components of the APGAR scoring system. What is the range for the total APGAR score

A
  • Activity (muscle tone)
  • Pulse
  • Grimace (reflex irritability)
  • Appearance (skin color)
  • Respiration
  • 0-10
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6
Q

give the 3 catagories for Activity (muscle tone) of APGAR score

A
  • Absent = 0
  • Arms and legs flexed = 1
  • active movement = 2
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7
Q

give the 3 categories for pulse section of APGAR score

A
  • absent =0
  • below 100 bpm = 1
  • above 100 bpm = 2
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8
Q

give the 3 categories for grimace (reflex irritability) aspect of APGAR score

A
  • Flaccid = 0
  • some flexion of extremities = 1
  • active motion (sneeze; cough; pull away) = 2
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9
Q

Give the 3 categories of the Appearance aspect of the APGAR score

A
  • blue, pale = 0
  • body pink; extremities blue = 1
  • completely pink = 2
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10
Q

give the 3 categories of the Respiration aspect of the APGAR score

A
  • absent = 0
  • slow, irregular = 1
  • vigorous cry = 2
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11
Q

at the ONE minute APGAR score, what numbers require immediate resuscitation

A

<4

*scores of 5-7: some nervous system depression

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12
Q

what APGAR scores are considered normal at both the one minute and five minute tests

A

8-10

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13
Q

at the FIVE minute APGAR test, what score indicates a high risk for CNS/organ system dysfunction

A

0-7

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14
Q

The Ballard scoring system is used for what

A

estimate gestational age to within 2 weeks

  • assessment of neuromuscular and physical maturity
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15
Q

birth weight classification: what is considered normal

A

greater than or equal to 2500 g (5.5 lbs)

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16
Q

in a premature baby, which of these three groups are at an increased risk for mortality: SGA, AGA, LGA (small, average, large for gestational age)?

A

Mortality is highest for SGA and LGA

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17
Q

What are some questions you want to ask a mother who gave birth during the child’s first visit

A
  • family hx
  • chronic illness
  • medications used during pregnancy
  • tobacco, etoh, drug use
  • previous pregnancy outcomes
  • maternal age (<16; >35)
  • pregnancy related complications
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18
Q

what are some questions you want to ask mom about the delivery

A
  • duration of rupture of membranes (ROM)
  • fetal presentation/distress
  • maternal fever
  • meconium stained amniotic fluid
  • type of delivery
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19
Q

What 4 preventative treatments are done to neonate at the hospital

A
  1. prophylactic erythromycin ointment
  2. vitamin K - prevent vit k deficient bleeding
  3. hepatitis B vaccine
  4. newborn screen (heel stick; pulse ox; hearing screen)
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20
Q

what drug is given to neonates after birth to prevent gonococcal ophthalmia (cause blindness)

A

prophylactic erythromycin ointment

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21
Q

what is the recommended position for neonates to sleep to prevent SIDS

A

“back to bed”

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22
Q

When is the newborn screening, heel stick, performed

A
  1. 24-48 hrs old
  2. first doctor’s visit or between 5-10 days of age, whichever comes first
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23
Q

What are the two electrophysiologic techniques that are used to test for hearing in neonates

A
  • auditory brainstem responses (ABR)
  • Otoacoustic emissions (OAE)
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24
Q

breastfeeding is the recommended primary source of nutrition for infants up to how many months/years

A

up to 6 months of age

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25
Q

breastfeeding offers child protection against infection via the passage of what immunoglobin

A

IgA

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26
Q

Name the 3 phases of breast milk

A
  1. colostrum
  2. transitional milk
  3. mature milk: higher in fat

* milk comes in 3 days post-partum

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27
Q

how often should breastfed infants be fed

A
  • 8-12 times/24 hrs (every 2-3 hrs) for 10-15 minutes/breast
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28
Q

formula should contain what compound

A

iron

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29
Q

How many wet diapers should be expected within the first 24 hours? By day 5?

A
  1. at least 1 wet diaper in the first 24 hours
  2. by day 5: 6-8 wet diapers/day of light yellow urine
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30
Q

For the first 24-48 hours after birth, what type of stool should be expected? By day 5, what color stools should be expected?

A
  • first 24-48 hrs: meconium: thick, very dark
  • by day 5: 3-4 yellow, seedy stools a day
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31
Q

Insurance is REQUIRED to cover how much hospital time for vaginal deliveries and cesarean deliveries?

A
  • vaginal: 48 hrs
  • cesarean: 96 hrs
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32
Q

If mother and baby are discharged prior to 48 hours of hospitalization, when is the well child visit recommended? If discharged after 48 hours?

A
  1. < 48: well visit is recommended 48 hrs of discharge
  2. > 48: well visit is recommended within 3-5 days of discharge
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33
Q

what is a normal pulse and respiratory rate for infants

A
  • pulse: 120-160 beats/min
  • RR: 30-60 breaths/min
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34
Q

What 3 main measurements are taken for infants

A
  • head circumference
  • Length
  • Weight
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35
Q

fine hair that covers newborn

A

Lanugo

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36
Q

what is the name of this condition? What is caused by? when does it go away?

A

Milia

  • developing sebaceous glands
  • disappears over several weeks
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37
Q

scattered vesicles on an erythematous base located on the face and trunk. Name condition. What is it caused by? Treatment?

A
  • Miliaria Rubra
  • obstruction of sweat glands
  • disappears spontaneously within weeks
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38
Q

erythematous macules with central pinpoint vesicles “flea bites” that are scattered diffusely and usually appears on days 2-3 of life. Name condition. Treamtent?

A
  • erythema toxicum
  • disappears within 1 week of birth
39
Q

small vesiculopustules on a brown macular base that is more common in black infants. Name condition. When does this condition go away?

A
  • pustular melanosis
  • can last several months
40
Q

bluish discoloration that commonly appears shortly after birth on the hands and feet. Note: PINK mucous membranes

A

Acrocyanosis

41
Q

If lips, oral mucosa/tongue, and trunk are blueish in color, what is this called? What condition is associated with these findings?

A
  • central cyanosis
  • cyanotic congenital heart disease
42
Q

benign birthmark located on the eyelid

A

eyelid patch

43
Q

benign birthmark seen on posterior neck

A

stork bite

44
Q

Visible jaundice AFTER 24 hrs of age signifies what?

A

physiologic jaundice

  • common: 65% of all newborns
45
Q

Visible jaundice within 24 hrs of birth suggests what condition

A

hemolytic disease, biliary, or liver disease (non-physiologic jaundice)

46
Q

levels of total biliruben above 20 mg/dl are concerning because?

A
  • accumulates in brain -> kernicterus
  • neurotoxic: can cause death
  • premature babies are at a higher risk
47
Q

treatment for neonatal jaundice

A

phototherapy

48
Q

jaundice that starts After 2 weeks: physiologic or pathologic?

A

pathologic

* check for ABO or Rh incompatibility

49
Q

on a neonatal, infant exam, what are you palpating for on the head

A
  • sutures: seperate the bones from one another: feel like ridges
  • fontanelles: where the major sutures intersect: “soft spots”
50
Q

What are the normal measurements for the anterior and posterior fontanelles at birth

A
  • anterior: 4-6 cm
  • posterior: 1-2 cm
51
Q

when do the anterior and posterior fontanelles close

A
  • anterior: closes between 4-26 months (90% between 7-19 months)
  • posterior: closes at 2 months
52
Q

congenital hypothyroidism can have what clinical sign affecting the fontanelles

A

larger posterior fontanelle

53
Q

Depressed anterior fontanelle can signify what condition

A

dehydration

54
Q

early closure of cranial sutures and fontanelles is called

A

craniosynostosis

55
Q

trauma at birth (associated with foreceps or vacuum delivery) can cause a subperiosteal hemorrhage in neonates. What is this condition referred to as? Treatment?

A

cephalohematoma

  • spontaneously resolves within 3 weeks
56
Q

flat spot on a babies head caused by pressure on the head before or after birth. May see unleveling of ears

A

positional plagiocephaly

57
Q

condition in which head circumference is <2 standard deviations below the mean for age and sex

A

microcephaly

58
Q

condition in which head circumference is >2 standard deviations above the mean for age and sex

A
59
Q

What would you consider if you saw a neonate with nystagmus immediately following birth? If that nystagmus was persistent?

A
  1. common immediately following birth
  2. persistence may indicate poor vision or CNS disease
60
Q

what would you consider if you saw a child with intermittent stabismus within the first few months of life?

A

normal

61
Q

When should a neonate/infant be able to fixate on an object

A

1 month

62
Q

what is the condition when you see a white pupillary reflex on ophthalmoscopic exam? What condition could this represent?

A
  • leukocoria
  • retinoblastoma
63
Q

what main reflex are you looking for with ophthalmoscopic exam of neonate?

A

bilat red light reflex

64
Q

How would you test for hearing in a neonate

A

acoustic blink reflex: snap your finger about 12 inches from the infants ear and see if patient blinks

65
Q

what is choanal atresia

A

congenital disorder in which back of nasal is blocked usually by abnormal bony or soft tissue

66
Q

small, white, benign inclusion cysts commonly seen on gums and palate on neonates

A

Epithelial (Epstein) pearls

67
Q

yeast/fungal infection that can seen on oral mucosa in neonates

A

oral candidiasis (thrush)

68
Q

what is torticollis

A

position/injury to the sternocleidomastoid, formed from “position of comfort” for a baby that was constrained in utero; may be a precipitating factor for plagiocephaly

69
Q

What are 4 things you want to include in your physical exam of the neck of a neonate?

A
  1. palpate lymph nodes
  2. assess for masses
  3. evaluate for torticollis
  4. evaluate for clavicular fx
70
Q

How long do you count respirations for in a neonate?

A

1 full minute

71
Q

When assessing a neonates breathing, what are some things that are abnormal

A
  • nasal flaring, grunting, retractions, audible wheezing or stridor
72
Q

should you refer a neonate if you find sinus dysrhythmia that is associated with respiration ?

A

no, this is a normal finding

73
Q

if you detect a murmur in a neonate, what are some other things you should look for?

A
  • assess for noncardiac signs and symptoms: poor feeding, tachypnea, hepatomegaly *functional (benign) heart murmurs are common; you want to make sure the child does not have congestive heart failure
74
Q

when inspecting the umbilical cord in a neonate, what are you assessing for

A
  • there are 2 arteries and 1 vein present
  • evaluate for redness and swelling
75
Q

if you detect an umbilical hernia in a neonate, what should you tell the parents

A

most disappear by 1 year

76
Q

what is the name for a infection of the umbilical stump

A

omphalitis

77
Q

when does the umbilical cord usually fall off

A
  • cord dries up and falls off within 2 weeks
78
Q

what is the vaginal introitus? What should you be on the look out for when examing this area?

A
  • vaginal opening
  • imperforate hymen: hymen without an opening which completely obstructs the vagina
  • white/blood-tinged discharge - normal
79
Q

congenital condition in which the opening of the urethra is on the underside of the penis

A

hypospadias

80
Q

Name the condition of undescended testicle (s). What will you tell parents regarding treatment

A
  • cryptorchidism
  • 2/3 of cases, testes descend by 1 year, after that surgery is necessary
81
Q

what is a way to test that swelling of the scrotum is due to hydrocele

A

transillumination

82
Q

what is the condition of webbed fingers

A

syndactyly

83
Q

what is the galeazzi test testing for? how do you perform it?

A
  • dysplasia of hip
  • place the feet together and note any differences in knee heights
  • unequal knee heights = + sign
84
Q

what is the Barlow test testing for? How do you perform the test

A
  • hip dysplasia
  • stablize one leg with one hand, with the other hand, place the thumb medially over the lesser trochanter and index finger laterally over greater trochanter
  • flex and adduct the hip while applying a posterior force
  • a palpable clunk or sensation of movement is felt as the femoral head exits the acetabulum posteriorly: + sign
85
Q

what is the ortolani test testing for? How is it performed?

A
  • tests for presence of a posteriorly dislocated hip
  • open up hips, place index fingers over the greater trochanter of each hip, thumbs over lesser trochanters
  • abduct hip (one at a time)
  • positive if you feel a “clunk” as the femoral head enters the acetabulum
86
Q

what does the babinski response test for? What is the response? When is this response normal

A
  • deep tendon reflex
  • dorsiflexion of big toe and fanning of other toes
  • normal until age of 2 months
87
Q

how can you assess CN V is a neonate. When is this response present?

A

rooting, sucking reflex

  • stroke perioral skin at the corners of mouth; mouth will open and baby will turn head toward the stimulated side and suck
  • birth to 3-4 months
88
Q

How can you assess CN VIII in a neonate

A

acoustic blink reflex

89
Q

How can you assess the moro reflex (startle reflex)? At what age is this reflex present

A
  • hold baby supine, supporting the head, back, and legs
  • abruptly lower the entire body about 2 feet
  • the arms ABDuct and extend; hands open; and legs flex
  • birth to 4 months
90
Q

what is the palmar grasp reflex? At what age is the reflex present

A
  • place fingers into the baby’s hand and press against the palmar surface
  • the baby will flex all fingers to grasp your finger
  • birth to 3-4 months
91
Q

What is the plantar grasp reflex? At what age is this reflex present

A
  • touch the sole at the base of toes
  • toes curl
  • birth to 6-8 months
92
Q

What is the asymmetric tonic neck reflex? At what age is it present

A
  • with baby supine, turn head to one side, holding jaw over shoulder
  • arms/legs on side to which head is turned extend while the opposite arms and legs flex
  • birth to 2 months
93
Q

what is the positive support reflex. At what age is it present

A
  • hold baby around the trunk and lower until feet touch a flat surface
  • hips, knees and ankles extend, the baby stands up, partially bearing weight, sags after 20-30 seconds
  • birth or 2 months to 6 months

Pediatrics I, exam 1 (4 decks)

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