Exam 1P - Care of the Newborn Flashcards
Detergent-like lipoproteins detectable by 24-25 weeks
surfactant
what percent of fetal lung fluid is absorbed by the time of birth?
65%
what is the purpose of fetal lung fluid?
helps expand the alveoli and aids in lung development
____ reduces surface tension within the alveoli
surfactant
when do surfactant levels increase?
during labor and immediately after birth
___ can be given in preterm labor to help increase surfactant production
betamethasone
____ can also delay surfactant production
diabetes
when does lung development stop?
once the neonate is out of the uterus
T/F - surfactant can be given exogenously
T
what are the 4 main types of triggers that lead to first newborn respiration
(1) chemical
(2) mechanical
(3) thermal
(4) sensory
chemical triggers for first newborn breath include
(1) decreased pH
(2) increased CO2
(3) chemoreceptors
(4) stimulation of medulla / respiratory center
mechanical triggers for first newborn breath are
(1) chest is compressed during birth
(2) expulsion of fluid
(3) recoil after birth that eases the first breath
thermal trigger for first newborn breath are
skin senses change in environmental temperature - triggers respiratory center
sensory triggers for first newborn breath include
(1) touch
(2) light
(3) sounds
(4) smell
(5) discomfort
when do the CV shunts close for newborns?
shortly after birth
the initiation of respiration leads to ____
the closing of the three shunts because of pressure changes
what are the predisposing factors that lead to heat loss?
(1) thin skin with blood vessels close to the surface
(2) little SQ fat
(3) newborns have 3x more SA to body mass than adults
(4) rate of heat loss is 4x greater than that of adults
what is the protective factor for newborm thermoregulation?
flexed position (reduces the amt of skin surface exposed)
what are the 4 methods of heat loss?
(1) evaporation (wet skin)
(2) conduction
(3) radiation
(4) convection (air)
nursing implications for evaporation
(1) keep infant dry
(2) remove wet diapers
(3) minimize exposure during baths
nursing implications for conduction
(1) put the baby on prewarmed sheet
(2) cover weighing scaled / x-ray with warm blanket
nursing implications for radiation
(1) keep baby cot away from cold walls
(2) cover baby if stable
nursing implications for convection
(1) avoid air current
(2) manage babies inside incubator
(3) organize work to minimize opening portholes
(4) provide warm, humidified O2
neutral thermal environment for an undressed infant should be
89.6-92.3 F
neutral thermal environment for a dressed infant should be
75.2-80.6 F
what are 5 signs of a cold infant?
(1) restlessness
(2) crying
(3) increased flexion and activity
(4) vasoconstriction / acrocyanosis
(5) body metabolism increases
increase in body metabolism can lead to ____
hypoglycemia
what is an early sign of an infant being cold?
acrocyanosis
____ is caused by peripheral vasoconstriction
acrocyanosis
_____ is the primary source of heat production
non-shivering thermogenesis (NST)
the metabolism of brown fat / adipose tissue to produce heat
non-shivering thermogenesis
newborns can increase heat production by ____ using NST
100%
what is the basic rule of thumb for newborn dressing?
one extra layer than what the parent is wearing
____ is not fully activated until after birth
immune system
what is NOT a reliable indicator of infection in the newborn period?
fever
____ is a common indicator of infection
hypothermia
signs of newborn infection are ___
nonspecific
IgG crosses the placenta in the 3rd trimester and provides ___
passive immunity
___ (immunoglobulin) passes the placenta, but not ___ or ____
IgG; NOT IgM or IgA
___ protects against gram negative bacteria; Increases rapidly a few days after birth
IgM
____ protects the GI and respiratory systems; produced after birth
IgA
which type of feeding can lead to temporary GI issues?
formula feeding
gastric emptying is quicker for infants who are ____
breastfed (compared to formula-fed)
_____ can lead to regurgitation
relaxed cardiac sphincter
____ is stimulated when the stomach fills and leads to stooling
gastric colic reflex
all ___ enzymes are deficient until 7 months, except protein and lactose
digestive
____ is deficient until 4-6 months of age
pancreatic amylase
____ is present in breastmilk and produced by saliva until 3 months
amylase
____ helps in fat absorption and is present in breastmilk
lipase
___ and ___ are the major carbohydrates in an infant’s milk diet
protein; lactose
Breastfeeding is encouraged because ____ and ____ are produced and shared in breast milk
lipase; amylase
the 3 important jobs of the newborn liver are
(1) glucose maintenance
(2) conjugation of bilirubin
(3) crucial role in iron storage, metabolism of drugs, and production of coagulation factors
when is glucose stored as glycogen in the fetal liver?
3rd trimester
in order to be excreted bilirubin must be ____ because ____
conjugated; it needs to be water soluble
____ is stored in the fetal liver and spleen in the last months of pregnancy
iron
non-breastfed infants should be given ____-fortified milk
iron
physiologic jaundice is ____
transient hyperbilirubinemia
T/F: Physiologic jaundice is a normal process
T
bilirubin levels peak at ____ mg/dL
5-6
when do bilirubin levels peak?
days 2-4
when do bilirubin levels begin to fall after peak?
days 5-7
when do we get worried about bilirubin levels?
(1) when they reach 10 or higher (double digits)
(2) levels continue to trend upwards
____ is caused by an accelerated destruction of fetal RBCs and increased reabsorption of bilirubin by the liver
physiologic jaundice
____ develops in 13% of breastfed infants by 1 week of age
early-onset breastfeeding jaundice
early-onset breastfeeding jaundice is primarily due to _____
insufficient fluid intake
what is the primary intervention for someone with early-onset breastfeeding jaundice (or risk for)?
help the parent to stimulate milk production and increase infant intake
____ Usually occurs after the first 3-5 days of life and lasts 3 weeks to 3 months
late-onset breastfeeding jaundice
why does late-onset breastfeeding jaundice occur?
substances in the maternal milk may increase absorption of bilirubin from intestine or interfere with conjugation
explain the treatment for late-onset breastfeeding jaundice
(1) close monitoring of total serum bilirubin (TSB) + at least 8-12 feedings/day
(2) if TSB levels rise too high - phototherapy; continue BF
(3) if dangerously high - may order formula feed for 1-3 days
jaundice that is not physiologic or r/t breastfeeding is ____
pathologic jaundice
the key difference between pathologic jaundice and other types is ____
pathologic jaundice typically appears within 24 hours of birth
____ is a result of excessive destruction of RBCs or problems with bilirubin conjugation
pathologic jaundice
some causes of pathologic jaundice can include
(1) sepsis
(2) blood incompatibilities
(3) metabolic d/o
(4) increased hemolysis of RBCs
____ is double-digit bilirubin levels that do not resolve
hyperbilirubinemia
diagnosis of hyperbilirubinemia
(1) physical exam
(2) lab testing - total serum bilirubin (TSB)
___ is used if bilirubin levels are significant
phototherapy
____ is treatment performed in the NICU
exchanged transfusion
why is hemorrhage a risk for newborns?
newborns lack intestinal bacteria to make Vitamin K ->
Vitamin K is needed to make clotting factors ->
Prothrombin levels are low during first few days of life
what is given within 1 hr after birth to activate prothrombin?
Vitamin K
Vitamin K is given ___ (route)
IM
why is meconium formed in utero?
because intestines are not absorbing nutrients yet (still the placenta)
transitional stools characteristics
thin, brown to green
breastfed stools are often described as
yellow, gold, mushy, seedy
formula-fed infant stools are often described as
pale yellow to light brown; pasty
normal breastfed infant has ____ stool per day until 6 weeks of age
3 or more
most babies void within _____ of birth
24 hours
when would we be worried about a baby voiding?
if 2 days pass without a void
the initial bladder volume is ___
6-44 mL of urine
newborn assessment immediately after birht
(1) need for resuscitation, clear airway, dry baby
(2) newborn stability to initiate early attachment
newborn assessment 1-4 hours after birht
(1) adaptation to extrauterine life
(2) determination of gestational age / size
(3) ongoing assessment for high-risk problems
newborn assessment within 24 hours or before discharge
(1) complete physical exam
(2) nutritional status and ability to feed
(3) complete all screenings
“golden hour” refers to ___
when the newborn is most initially alert
nursing interventions during the golden hour include…
(1) initial assessment and APGARs
(2) eye-to-eye and skin-to-skin
(3) first feedings (if stable
(4) vit K injection
(5) erythromycin ointment
newborns may ____ during the second period of reactivity
pass the first meconium
eye prophylaxis given to all newborns is ____
erythromycin 0.5% ophthalmic ointment
____ can blur vision temporarilty
erythromycin
what is the purpose of APGAR?
to evaluate the need for intervention post-birth
timing of APGARs is
1 minute nad 5 minutes post-birth
what is the nursing role for APGARs?
complete APGAR assessment
APGAR scores of ____ require intervention
<7
APGAR score of ___ is critical
0-3
APGAR score of ____ is below normal
4-6
in hours 1-4 after birth, what are the key items for the nurse? (9)
(1) VS q30m
(2) identify infant and initiate security system
(3) ht, wt, length, head circ
(4) gestational size / age
(5) skin color (acrocyanosis)
(6) suck and swallow
(7) reflexes and movement
(8) anomalies
(9) skin-to-skin as much as possible!
SGA is ____ percentile
<10th
LGA is ____ percentile
> 90th
AGA is ____ percentile
10th-90th
why is gestational age important?
can be risk factors for certain conditions
____ exam is used to look at external and neurologic characteristics
Ballard
the two parts of the Ballard exam are
(1) external physical characteristics
(2) neurologic characteristics
when checking newborn head, we are looking at
sutures
when checking newborn neck, we are looking for
webbing, clavicle
when we are assessing newborn fingers and toes, we are assessing
(1) color
(2) clubbing
(3) webbing
