EXAM #4 Flashcards
What four factors influence the initiation of the first breath?
-Chemical
-Sensory
-Thermal
-Mechanical
What chemical factors help with the first breath?
-Hypercarbia (too much CO2 in the blood)
-Acidosis (O2 is low)
-Hypoxia (baby has to be when born)
-Increased CO2 prompts medulla to initate breathing
What can prolonged asphyxia cause in newborn?
CNS mediated respiratory depression
How do healthcare workers know what the pH of the newborn’s blood?
ABG drawn from the umbilical cord immediately after birth
What are signs of respiratory disress in a newborn?
-Grunting
-Nasal flaring
-Sternal retractions
Normal newborns will have periods of apnea lasting…
10 to 20 seconds
What sensory factors help with the first breath?
-Visual and auditory stimulation also help initiate cry
-Increased stimulation of the neonate during the birthing and drying process helps to initate a cry
What Thermal factors help with the first breath?
-Drastic change in temperature from 98 to 70-75 degrees prompts the newborn to cry
-Sensors in the skin respond to the drastic temp change, sending signals to the brain to initate respirations
How can cold stress be prevented?
Dry newborn and place baby in a radiant warmer or skin-to-skin
What Mechanical factors help with the first breath?
-Removing fluid from the lungs and replacing it with air on the first breath
-Fetal chest compression/ thoracic squeeze from the vaginal birth increased intrathoracic pressure helps push fluids out of the lungs
-Recoil of the chest wall after delivery of the trunk creates negative intrathoracic pressure
What 5 changes occur to the cardiovascular system after placental expulsion?
-Increased aortic pressure & decreased venous pressure
-Increased systemtic pressure and decreased pulmonary pressure
-Closure of the foramn ovale, ductus arteriosus, and venosus
What is the neutral thermal environment?
The range of temperature in which the newborn’s body temp can be maintained with minimal metabolic demands and oxygen consumption
What happens to the newborn when they experience cold stress?
Anerobic glycolysis
-Transforms glucose to lactate
-Will turn to lactic acid leading to a state of metabolic acidosis
-Only effective for 10 seconds to 2 min
-Breaksdown brown fat
Evaporation heat loss: Def & intervention
-Loss of heat when fluids cover the body are air-dried and converted into vapor
-Dry baby & keep them warm and covered
Conduction heat loss: Def & interventions
-Loss of heat to a cooler surface via direct skin contact
-Minimize, radiant warmer, blankets, covering scales, skin-to skin
Convection heat loss: Def & interventions
-Loss of heat from the warm body surface to the cooler air currants
-Avoid fans and drafts
Radiation heat loss: def & interventions
-Heat loss occurs when there is a transfer of heat between objects that are not in direct contact with each other.
-Prewarmed radiant warmer, avoid placement of cribs near walls or cold windows
What hematopoietic adaptations occur?
-Volume is determined by the timing of the cord clamping
-Helps enhance pulmonary perfusion
-Extra blood Increases risk for jaundice due to breakdown of the RBC leads to increase in bilirubin. Babies cannot easiy rid of bili quickly
What hepatic adaptations occur?
-Liver stores glucose for the use after birth
-Glucose provides ready energy source for brain and other vital organs
-1st 3 hours
-Can be depleated after a stressful event
What is acrocyanosis?
An expected finding at birth that shows oxygenated blood is shunted to the central area of the body and vital organs
-Only extremities are blue/purple or pale which is not true cyanosis
What are factors that affect the blood glucose of a newborn?
-Small or large for gestational age
-Mothers with DM
-Post-term or intra uterine growth restricted (insufficient placental nourishment
What are signs of hypoglycemia in a newborn?
-Irrtability/fussy
-Jittteriness/tremors
-Lethargy
-Cold
When is the best time to feed and bond with an infant during the behavioral states?
Quiet alert
What are GI/GU adaptations for a newborn?
-Size of neonate’s
stomach
* 6 ml at birth to 90 ml by end
of first week
* First meconium stool within 8-24 hours after birth
* Can pass 1-10 meconium stools within 24 hours
* No stool within first 72 hours may indicate bowel obstruction
* Initial bladder capacity
between 6ml-44ml
* Normally void between 2 and 6 times in a 24-hour period
* May pass glucose and protein in urine as kidneys learn to
concentrate urine
* Urate crystals (pink or red in color) may pass in urine causing urine to look pink (ends after 24 hours)
Where is passive immunity acquired?
From mother to baby through IgG from placenta
IgA from milk
What does apgar stand for?
Appearance, Pulse, Grimace, activity, respiration
What is a normal apgar score?
> or equal to 7
When is apgar conducted?
1 min & 5 min
What medications are given at birth?
-Eye prophylaxis: Erththromycin ointment for STIs
-Vitamin K: IM Vastus lateralis. 1 dose for clotting
-Hep B vaccine: IM Vastus lateralis in 3 doses. 1st one 1 hour after delivery. Signed consent needed if refused
Ballard scoring
Used to determine gestational age
Dubowitz exam
he method used at our institution to determine the baby’s gestational age. This examination evaluates both physical characteristics and neurological characteristic
How is weight recorded?
On a warm scale and in grams
How is length measured?
-In cm
-Crown to heal is the recumbent length
How is head circumference measured?
-Place tape measure
immediately above
eyebrows and pinna of
the ear and wrap around
the occipital prominence
at the back of the head
-Measure three times and
record the largest finding
How is chest circumference measured?
-Place measurement tape on
nipple line and wrap around
entire thoracic area
-Head and chest may be
equal during first few days of
life
How is abdominal circumference measured?
-Place tape above umbilicus and circle infants’ body
-Abdomen should be
same size as chest
What is included in the integumentary system for a newborn?
*Assess skin color visually first
*Always wear gloves during skin assessment to protect yourself from any infection processes
*Assess for any lesions, bruising or rashes
* Nevi
* Port Wine Spots
* Mongolian Spots
* Vernix
* Erythema toxicum
* Milia
* lanugo
*Sclera and conjunctiva
*Eye/Ear alignment
*Check head for size and shape of fontanels
*Check head for caput, molding, cephalohematoma
*Epstein pearls/natal teeth
*Cleft lip and palate
What is a nevi (stork bite) & when will it go away?
- Birth Mark
- On back of neck or forehead
- Usually disappears by 2 years old
- Gets more red when baby cries
Does a port wine stain (nevus flammeus) blanch or disappear?
No
What is a mongolian spot and when will it go away?
- Appear gray, dark blue,
or purple - Back & buttocks,
shoulders, wrists,
forearms, ankles - Usually disappear by 2
yrs old - More often seen in
infants whose ethnic
background include
African American,
Mediterranean, Latin
American, Asian, or
African
Why do babies have vernix caseosa?
To protect their skin
What is erythema toxicum?
-How long will it last and what is the tx?
- Normal newborn rash
- Transient rash
- May start on face and
spread to rest of body - Persists up to one month
- No treatment needed
What is milia?
- Small white papule or
sebaceous cysts - Disappear spontaneously
What is lanugo?
Fine, downy hair on back, shoulders, head
* Preterm -more lanugo present
* Post term -skin is tough, leathery, cracked, peeling skin
What is a normal ear/eye alignment supposed to look like?
- Look for symmetry, noting
placement of the eyes, nose, lips, mouth & ears
A. Normal ear
B. Low set ear
C. Slanted low-set ear
(chromosomal abnormalities)
What should the fontanels not look like and will require emergency intervention?
-Bulging fontanelle in absence of crying can indicate increased intracranial pressure
What is caput succedaneum?
- Generalized tissue swelling
that will go away - Edema that crosses suture
lines
What is a cephalohematoma?
- Does not cross the suture line
- Can predispose newborn to jaundice
What shape is the anterior and posterior fontanelles?
A-diamond
P-Triangle
What are natal teeth?
Natal teeth are usually loose and will need to be pulled to eliminate choking hazard
What are epstein pearls?
-Will disappear within a few weeks (normal finding)
* Whitish hardened nodules on the gums or roof of the mouth
What interventions are used to treat club feet?
- Stretching
- Casting
- Surgery
What is hypospadias & the tx?
- Urethra on ventral side of penis
- DO NOT CIRCUMCISE
- Surgery to repair
What are the type of circumcisions?
- Yellen/Gomco -protects head of penis
- Mogan -credit card
- Plastibell -plastic ring & string lef
What is needed in preparation of a circumcision?
Sterile, lidocaine, oral sucrose,
consent needed, radiant warmer
Care for circumcision:
Q30min x 2hrs, check for
bleeding/infection, petroleum
ointment (NOT for plastibell), UOP by 8 hrs
What are some risks for an uncircumcised penis?
UTI, cancer, STIs
What should be included in the discharge teaching for a newborn?
▪Discharge Tests: Blood Pressure, PKU, O2 Sats
▪Bathing
▪Feeding: Breast & Bottle Feeding
▪Safety
▪Child Care
▪Follow-up Care
What complications can happen a newborn that is small for gestational age?
-Cold stress
-Pain
-Hypoglycemia
-Polycythemia
What complications can happen a newborn that is large for gestational age?
-Transient
Tachypnea of the
Newborn
-Hypoglycemia
-Hypocalcemia
-Hypomagnesemia
-Birth Injuries
What are signs and symptoms of cold stress?
- Lethargy
- Bradycardia
- Respiratory distress
- Poor feeding
- Cold pale or bluish skin
What are s/s of pain in a newborn?
- Tachycardia
- Increased blood pressure
- Shallow respirations
- Pallor
- Flushing
- Diaphoresis
What are complications of pre-mature newborns?
RDS, Apnea, Bronchopulmonary Dysplasia, Jaundice, Anemia, NEC, GERD, Retinopathy (from hyper oxygenation), Intraventricular Hemorrhage
Necrotizing enterocolitis: Def and interventions
-Immature gut
-Do not give formula
-If suspected, stop feedings and report to PCP
-Antibiotics and complete rest
What are complications for a post-term newborn?
Persistent Pulmonary Hypertension, Meconium Aspiration Syndrome
What is physiological jaundice? Solution?
Appears after 24 hours
-Total bili rises by less than 5mg per day, gradual
-Bili is not extreted in the stool
-Serum stays at 15mg or lower
-Feed the baby so they poop
What is pathological jaundice? Solution?
Appears within first 24 hours of age
-Increased of >5mg per day
-Serum is > 15mg
-Is persistent, 14+ days
-Stool is clay/white colored and urine will stain clothes
-TX: light therapy and feeding
What can a serum bilirubin of over 15mg cause (in pathological jaundice) ?
Toxicity
-Kernicterus: Increase in bili circulating in the body and goes to the brain leading to neurological/ development disorders/issues
What are s/s of Jaundice?
Slight yellowish tint on the skin
Yellow stains on the whites of the eye
Yellow discoloration becomes more pronounced when you press on the
skin
Aversion to feeding or unusually low appetite
Increased drowsiness
Restlessness
More irritable than usual
Dark, yellow urine
Light-colored or pale stools
Arching of the back
A high-pitched cry
What should be monitored when the baby is undergoing bilirubin light therapy (phototherapy)?
-Adequacy of hydration (urine
output) and nutrition (weight
gain). Assess diapers (count and COACH), cap refill, s/s of dehydration)
-Temperature continuous. Not on chest or areas of discoloration bc yellowing starts at the head and works its way down
-Clinical improvement in jaundice
-TSB or SBR levels (total serum
bilirubin or serum bilirubin)
-Potential signs of bilirubin
encephalopathy
-Cover eyes at all times and keep a diaper on
-Keep all other skin exposed for proper tx
What should Phenylketonuria PKU avoid?
Phenylalanine Free Diet for
Life
What should galactosemia avoid?
Galactose-Free Diet for Life
What should a patient with Maple Syrup Urine Disease
(Branched-Chain Ketoaciduria) have in their diet?
Low Protein Diet and Thiamine Supplements for life
What are s/s of congenital hypothyroidism?
Lethargy, Poor Feeding,
Constipation, Prolonged
Jaundice, Hoarse Cry,
Hypotonia, Slow Reflexes,
Delayed Growth and
Neurodevelopment
How is congenital hypothyroidism dx?
Newborn Screening, Elevated TSH, Low T3/T4
What medication is given for congenital hypothyroidism?
Levothyroxine
What is anencephaly? How can it be prevented?
-Lack of skull & brain tissue formation
-Pre-pregnancy folic acid intake of 400mcg/day
What is an encephalocele? Nursing care?
-Area where the skull did not fully form and there is blood tissue and fluids in a sack.
-Cover defect with warm sterile gauze to prevent infection until surgical intervention
What is microcephaly?
Nursing care?
-Small skull and brain growth is stunned due to lack of space
- No treatment; supportive on-going care
What is congenital diaphragmatic hernia (CDH)?
Hernia of the diaphragm that normally seperates the lungs from the bowels
-Bowels are in/near the lungs & can hear bowel sounds in the chest
What are the nursing interventions in priority order for congenital diaphragmatic hernia?
-Protect airway
-NG tube insertion for decompression
-Surgical repair
What is gastroschisis?
Bowels are exposed
Nursing interventions for gastroschisis:
▪Sterile moist gauze and wrap in plastic
▪Fluid replacement at 1.5 times the normal
▪TPN, NO ORAL feedings
▪Prevention of infection (priority)
▪Pain management
What is the prevention & tx plan for herpes simplex?
▪Prevention: No vaginal
delivery with active lesions
▪Treatment: Acyclovir
What are the s/s of neonatal sepsis?
Subtle signs, behavioral
changes, hypothermia, lethargy, hypoglycemia, poor feeding, apnea, bradycardia
What are the s/s of neonatal abstinenence syndrome?
Irritability, tremors,
wakefulness, uncoordinated feeding patterns, loose stools,
yawning, hiccups, poor weight gain, hypertonia, seizures, exaggerated rooting reflex, vomiting, tachypnea, apnea,
sneezing, stuffy nose, profuse sweating
Essentially withdrawal
TPN benefits
Promotes positive nitrogen
balance, energy, and infant growth
When can babt start breast/bottle feedings?
Begins at 32 weeks… if baby
stable
High calorie formula (preterm
formula
When should surfactant therapy be done?
-1st 2-6 hours of life in baby more than 1000g
-Continued
mechanical ventilation after
administration helps the
medication to be spread
throughout the lung tissue.
- DO NOT SUCTION NEWBORN AFTER SURFACTANT IS PLACED
IN TUBE
What is the criteria for the baby to be discharged?
Eating/tolerating full feedings
Maintaining own temperature
Consistently gaining weight
No apnea, bradycardia or
desaturation events for 5 to 7
days
What should be included in discharge planning?
-Nutrition
-Condition Based
-Follow-up Care
-Safety
-CPR
