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NURS 501 > Exam 4 - Neonatal Assessment and Hospital Discharge (sync) > Flashcards

Exam 4 - Neonatal Assessment and Hospital Discharge (sync) Flashcards

1
Q

Why do we give eye prophylaxis to newborns? Within how many hours are drops given?

A

Tetracycline or erythromycin drops given to prevent chlamydia or gonorrhea conjunctivitis that can be transmitted via birth canal

Given within first hour of life

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2
Q

Does vitamin K cross the placenta?

A

No, not readily available in breastmilk/formula

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3
Q

How long is one shot of vitamin K good for?

A

Single injection provides enough vitamin K to last until the newborn gets sufficient amounts from solid foods (around 6 months of age)

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4
Q

When should a newborn receive their first shot of hep B?

A

Within first 24 hours

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5
Q

What are the guidelines for hep B vaccine if the infant is born to a hep B NEG mother? What if the infant is <2000 g?

A

Administer to infants weighing >2000 g in first 24 hours

If <2000 g, administer at 1 month or at hospital discharge

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6
Q

What are the guidelines for hep B vaccine if the infant is born to a hep B POS mother?

A

Administer hep B vaccine within first 24 hours regardless of weight AND give hep B immunoglobulin

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7
Q

What five screenings should be done before the newborn can be discharged?

A
  • Glucose screen
  • Jaundice screen
  • Hearing screen
  • Newborn metabolic screen
  • Congenital heart disease screen
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8
Q

How would the provider perform a newborn metabolic disorder screening?

A

Simple heel stick between 24-48 hours after birth

Air dry for 4 hours then sent to states lab

  • Takes 10-14 days for results
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9
Q

What factors can influence newborn metabolic disorder results?

A
  • Samples obtained too early
  • On antibiotics
  • Blood transfusion
  • Stress or sick infant (CAH)
  • Failure to wipe away first drop of blood
  • Not enough feeding
  • Inadequate sample
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10
Q

Under what conditions will the provider institute immediate treatment for based on newborn metabolid disorder screening results?

A
  • Galactosemia
  • Maple syrup urine disease (MSUD)

No treatment for any other positive results until further testing confirms diagnosis

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11
Q

Do glucose levels increase or decrease withint the first hour after birth? What are currently guidelines for intervention based on glucose levels?

A

Levels DROP within first hour

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12
Q

What maternal situations would cause the provider to monitor glucose levels closely?

A
  • Gestational diabetes –> increased insulin levels at birth
  • Preeclampsia/HTN
  • Previous macrosomic infant
  • Substance abuse
  • Exposure to medications (tocolytics, glucose)
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13
Q

What neonate situations would cause the provider to monitor glucose levels closely?

A
  • Prematurity/IUGR
  • HIE event
  • Sepsis
  • Congenital cardiac, endocrine, inborn errors of metabolism disorders
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14
Q

Signs and symptoms of hypoglycemia in neonate

A
  • Irritability
  • Tremors
  • Lethargy
  • Changes in LOC
  • Seizures
  • Hypotonia
  • Feeding difficulty
  • Respiratory distress
  • High pitched cry
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15
Q

At what point are newborns screened for hyperbilirubinemia?

A

Prior to hospital discharge

  • If discharged sooner than 72 hours, done in primary care
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16
Q

Hearing screening: otoacoustic emission test (OAE)

A

Measures sound waves produced in inner ear

  • Soft probe placed in ear canal
  • Series of soft “clicking” sounds sent via computer and probe
  • Measures echo of sound back
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17
Q

Hearing screening: automated auditory brainstem response (AABR)

A

Measures how the acoustic nerve and brain respond to sound

  • Tones played through headphones
  • Electrodes measure brains response to sound
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18
Q

What is the goal of a newborn hearing screening?

A

Screen by 1 month

Identify deficit by 3 months

Be receiving services and/or treatment by 6 months of age

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19
Q

What is the pattern of bloodflow in the fetus prior to birth?

A
  • From the placenta, oxygenated blood travels through umbilical vein to IVC
    • Bypasses the liver (ductus venosus)
  • From IVC, oxygenated blood enters R atrium + mixes with deoxygenated blood
    • Passes through foramen ovale to L atrium
  • L atrium to L ventricle –> goes to aorta and upper body
  • Upper body to SVC –> returns to R atrium + mixes with oxygenated blood
  • R atrium to R ventricle
  • Blood goes to lower body via ductus arteriosus
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20
Q

How does blood flow change at birth for the neonate?

A

First breath and air entering the alveoli triggers a drop in SVR –> rapid increase in perfusion of lungs d/t increased pressure of L ventricle

  • At same time, cord clamping occurs –> vasoconstriction and rise in SVR
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21
Q

What three events must occur to cause increased systemic vascular resistance and decreased pulmonary vascular resistance?

A
  • Increased pressure in L atrium
  • Increased PO2
  • Decreasing levels of prostaglandins
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22
Q

Although the three major fetal shunts close with the newborns first breath, what causes the ductus arteriosus to open?

A

Can remain open

  • Most commonly in premature neonates or neonates with other cardiac anomalies
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23
Q

Can the foramen ovale reopen at any time?

A

Yes, until 6 months of age before cells seal shunt closed

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24
Q

Are murmurs common in newborns?

A

Yes, newborn is still transitioning while at hospital

However, some cardiac anomalies won’t become evident until transition is complete and the newborn is home

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25
Q

What five topics/assessments should be completed by the provider prior to newborn discharge?

A
  • Stable vital signs
    • Temp - 36.5-37.4 C
    • RR <60
    • No signs of distress
    • HR 70-100 bpm
  • Established feedings - 2+ feedings
  • Established elimination pattern - at least 1 void and 1 stool
  • Screening and therapies completed
  • Parent education completed
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26
Q

What is the APGAR screen?

A

Tool used as a rapid and standardized method of assessing the clinical status of a newborn immediately after birth

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27
Q

At what time intervals is a APGAR screen completed?

A

Conducted at 1 and 5 minutes after birth

  • Continue at 5 minute intervals for first 20 minutes if score is under 7
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28
Q

What does the acronym APGAR stand for (what does it test for)?

A
  • A - appearance (color)
  • P - pulse (HR)
  • G - grimace (reflex irritability/response)
  • A - activity (muscle tone)
  • R - respiration (breathing ability)
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29
Q

What are the ranges of scores for APGAR?

A
  • Critically low - 0-3
  • Below normal - 4-6
  • Normal - 7-10
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30
Q

What are limitations associated with APGAR scores?

A
  • Influenced by maternal sedation/anesthesia, congenital conditions, gestational age, trauma
  • Subjectivity of score by clinician
  • Cannot be used to predict morbidity or mortality of neonate
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31
Q

Which vessel (umbilical vein or artery) carries oxygenated blood? Deoxygenated blood?

A

Umbilical vein = oxygenated blood (from placenta to fetus)

Umbilical artery = deoxygenated blood (from fetus to placenta)

32
Q

Normal newborn vital signs

A
  • Temperature - 97.7 - 99.0 F
  • HR - 80-180 bpm
  • RR - 30-60
  • BP - not routinely done in primary care unless there is concern
  • Pain - FLACC
33
Q

When should the WHO growth chart be used versus the CDC growth chart (at what ages)?

A

WHO growth chart - birth to 2 years old

  • Correct for prematurity through 2 years of age

CDC growth chart - 2-18 years old

34
Q

What is the average head circumference of a newborn?

A

12-15 inches (32-38 cm)

35
Q

What is the average weight and length of a newborn?

A

Weight (full term): 5 lb 8 oz - 8 lb 13 oz

Length: 18-22 inches (45-54 cm)

36
Q

What are the four components of a newborn cardiac exam?

A
  • Auscultate all five areas: aortic, pulmonic, Erb’s, tricuspid, mitral + axilla, right sternal border, and back
    • Listen for normal S1, S2
    • Rule out murmurs or prescence of S3, S4
  • Palpate for heaves/lifts/thrills
  • Assess perfusion - skin color, temperature
  • Pulses - symmetry, quality, presence
37
Q

What is the most common innocent heart murmur in neworns?

A

Still’s murmur - vibratory, musical in nature

  • Heard along left sternal border
  • Louder when supine
38
Q

What would be signs of a pathologic murmur (red flags)?

A
  • Holocystolic
  • Diastolic
  • Grade 3+
  • Harsh
39
Q

What would a PDA murmur sound like?

A

Continuous, machine-like murmur

  • Heard at upper left sternal border
40
Q

What would a ASD murmur sound like?

A

Grade 2 or 3 systolic ejection murmur

  • Heard at upper left sternal border
  • Split S2
41
Q

What would a VSD murmur sound like?

A

Harsh holosystolic

  • Heard at lower left sternal border
  • Can sometimes palpate a thrill
42
Q

What should be assessed during a newborn respiratory assessment?

A
  • Observe rise/fall of chest
  • Inspect AP ratio - should be 1:1
  • Count respirations for full minute
  • Observe for signs of distress
    • Nasal flaring
    • Retractions or use of accessory muscles
    • Grunting/noisy breathing
  • Auscultate lung sounds
43
Q

When observing the newborns skin, what conditions would be considered normal findings?

A
  • Acrocyanosis vs mottling
  • Erythema toxicum
  • Milia
  • Neonatal acne
  • “Birth marks” - nevus simplex, mongolian spots, port wine stain
44
Q

What two common skin findings would require further investigation depending on size, location, and overall number?

A
  • Hemangioma
  • Cafe au lait spots
45
Q

What two skin conditions would raise concern and require immediate referral for workup?

A
  • Petechiae
  • Vesicular rash
46
Q

If petechiae are present, where would it normally present? When does it resolve? What is it associated with?

A
  • Normal on presenting parts –> won’t develop new sites
  • Resolves within 24-48 hours
  • Can be associated with infections
    • Rule out sepsis and TORCH infections
47
Q

How do vesicular rashes present on a newborn? What would treatment be? What organisms cause this?

A
  • HSV and varicella can present with clustered vesicles a few days after birth
  • Treatment: IV acyclovir
  • Causative organisms: staph, strep
48
Q

What can cause microcephaly?

A
  • CNS malformation
  • Infection
  • Genetic syndrome
49
Q

What can cause macrocephaly?

A
  • CNS disorder
    • Brain tumor
    • Hydrocephalus
  • Hereditary
50
Q

What are characteristics of caput succedaneum (scalp edema)?

A
  • Crosses suture lines
  • Usually pitting
  • Resolves in 48 hours
51
Q

What are characteristics of cephalohematoma (subperiosteal hemorrhage)?

A
  • Due to injury of blood vessels during delivery (e.g. forceps, vacuum)
  • Does NOT cross suture lines
  • Can get worse before it gets better
    • Takes about 3-4 months to reabsorb
52
Q

What two conditions would having a cephalohematoma put the newborn at risk for?

A
  • Jaundice
  • Sepsis
53
Q

What is the most important finding that should be noted during the newborn eye exam?

A

Red reflex - light should project on both eyes simultaneously

  • Symmetry without opacities or light/dark spots
  • Rule out corneal lesions/cataracts
  • Having a light spot can indicate retinoblastoma
    • Refer out
54
Q

Are infants obligate mouth or nose breathers?

A

Nose breathers - assess for any blockage because that would put the infant in respiratory distress (e.g. choanal atresia)

55
Q

When does the infants umbilical cord normally fall off?

A

Falls off in 7-10 days

56
Q

Do inguinal hernias require treatment if present in the newborn?

A

Requires surgical repair

57
Q

Do hydroceles require treatment if present on exam?

A

Due to fluid in inguinal canal - transilluminates

  • Resolves within first 1-2 years
58
Q

What should the provider do if they palpate bilateral undescended testes, micropenis, or bifid scrotum in the newborn?

A

Requires prompt evaluation for ambiguous genitalia

59
Q

What is cryptorchidism? What does this put the newborn at risk for? Does it resolve on its own?

A

Failure of tests to descend

  • Associated with increased risk of testicular cancers and reduced fertility
  • Should descend by 3-6 months
  • Consider orchiopexy if not descended by 1 year old
60
Q

What are the anatomical differences in female genitalia between term and preterm infants?

A

Term infants - prominent labia majora

Preterm infants - prominent labia minora and clitoris

61
Q

Is discharge or blood normal in the newborn?

A

Small amounts of white discharge or blood within the first 3-4 days is normal

  • Due to maternal estrogen withdrawal
62
Q

While assessing for the patecy of the hymen in infants, would anatomical conditions would cause the provider to refer out for prompt evaluation?

A

Fused labia or clitoromegaly

  • Needs prompt evaluation for ambiguous genitalia
63
Q

When considering the neck of a newborn, what condition is a common musculoskeletal finding? What are potential complications with this condition?

A

Torticollis

  • Due to birth trauma of sternocleidomastoid
  • Requires referral to PT - can lead to plagiocephaly and ear misalignment
64
Q

What test could the provider use to detect clavicle fractures?

A

Moro reflex - reaction will be non symmetric

65
Q

What is the difference between the barlow and ortolani test?

A

Barlow - “dislocate”

  • ADDuction and forward motion towards the bed

Ortolani - “relocate”

  • Move hips outward to ABduction
66
Q

When the provider is observing a baby crying, what cranial nerves are being assessed?

A
  • CN VII (facial)
  • CN IX (glossopharyngeal)
  • CN X (vagus)
67
Q

When the provider is observing a baby feeding, what cranial nerves are being assessed?

A
  • CN V (trigeminal)
  • CN VII (facial)
  • CN IX (glossopharyngeal)
  • CN X (vagus)
68
Q

When the provider is observing a babies eye movements, what cranial nerves are being assessed?

A
  • CN III (oculomotor)
  • CN IV (trochlear)
  • CN VI (abducens)

Assessed by vestibulo-ocular reflex (doll’s eyes maneuver) - when the head is turned, there is conjugate eye movement in the opposite direction

69
Q

When the provider is observing a babies response to light AND sound, what cranial nerves are being assessed?

A
  • Response to light - CN II (optic)
  • Sound - CN VIII (vestibulocochlear)
70
Q

When is the moro reflex present?

A

2-4 months

71
Q

When is the sucking reflex present?

A

2-3 months

72
Q

When is the rooting reflex present?

A

By 4 months

73
Q

When is the stepping reflex present?

A

4 months

74
Q

When is the tonic neck reflex present?

A

By 6 months

75
Q

When is the grasping reflex present?

A

5-6 months

76
Q

How does the babinski reflex differ between adults and infants?

A

The babinski reflex occurs after the sole of the foot has been firmly stroked –> big toe will move upward or toward the top surface of the foot

77
Q

What is the normal schedule of well child visits?

A
  • 3-5 days
  • 1 month
  • 2 months
  • 4 months
  • 6 months
  • 9 months
  • 12 months
  • 15 months
  • 18 months
  • 24 months
  • 30 months
  • 3 years
  • 4 yeasrs
  • Once every year thereafter

NURS 501 (66 decks)

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