Final Review Flashcards
Fetal Circulation
Clamping the umbilical cord after birth eliminates the placenta as a reservoir for blood.
Onset of respirations causes a rise in PO2 in the lungs and a decrease in pulmonary vascular resistance, which…
Increases pulmonary blood flow and increases pressure in the left atrium, which…
Decreases pressure in the right atrium of the heart, which causes closure of the foramen ovale (closes within minutes after birth secondary to a decreased pulmonary vascular resistance and increased left heart pressure).
With an increase in oxygen levels after the first breath, an increase in systemic vascular resistance occurs, which…
Decreases vena cava return, which reduces blood flow in the umbilical vein (constricts, becomes a ligament with functional closing).
Closure of the ductus venosus (becomes a ligament) causes an increase in pressure in the aorta, which forces closure of the ductus arteriosus within 10 to 15 hours after birth.
More insulin in the infant
Less surfactant (lubrication in the lungs)
Infant Respirations
30 to 60 breaths per minute; irregular,
shallow, unlabored; short periods of apnea (<15 seconds); symmetrical chest movements
T/F
A respiratory rate of 44 breaths per minute
would be considered a normal finding in a
newborn.
TRUE
Retractions
Chest muscles pull in around the bones
Grunting
snoring/
apnea
pauses in breathing 15-20 secs
cyanosis
blue skin color lips/chest/stomach
oxygen level too low
Jaundice
Yellow skin. Bilirubin build-up in the blood/
Heat Loss
- Thin skin; blood vessels close to the surface
- Lack of shivering ability; limited stores of metabolic
substrates (glucose, glycogen, fat) - Limited use of voluntary muscle activity
- Large body surface area relative to body weight
- Lack of subcutaneous fat; little ability to conserve heat by changing posture
- No ability to adjust own clothing or blankets to achieve warmth
- Infants cannot communicate that they are too cold or too warm
Conduction
transfer of heat from object to object
when the two objects are in direct contact with each other
Convection
flow of heat from body surface to cooler
surrounding air or to air circulating over a body surface
Evaporation
loss of heat when a liquid is converted
to a vapor
Radiation
loss of body heat to cooler, solid surfaces
in close proximity but not in direct contact
Thermoregulation
Balance btwn heat production and heat loss
- Heat production: primarily through nonshivering thermogenesis
- Heat loss via four mechanisms leading to cold stress
weight gain calories
To gain weight the newborn requires an intake of 108 kcal/kg/day from birth to 6 months of age
Newborns usually lose 10% of the body weight due to burning brown fat
Infant Stool
Meconium: first 24 hours dark green/black/tarry
- Breast-fed newborns: yellow-gold, loose, stringy to pasty, sour-smelling
- Formula-fed newborns: yellow, yellow-green, loose, pasty, or formed, unpleasant odor
T/F
When assessing the stools of a 1-week-old newborn who is being breast-fed, which would the nurse expect to find?
Yellow gold loose stool
Natural Immunity
physical barriers, chemical
barriers, and resident nonpathologic organisms
Acquired Immunity
Development of circulating immunoglobulins; formation of activated lymphocytes
- Absent until after first invasion by foreign
organism or toxin
- Newborn primarily dependent on three
immunoglobulins: IgG, IgA, and IgM
IgG
major immunoglobulin and the most abundant, making up about 80% of all circulating antibodies
ONLY immunoglobulin the crosses the PLACENTA (starting 20-22 wks)
IgA
is the second most abundant immunoglobulin in the serum.
This immunoglobulin is believed to protect mucous membranes from viruses and bacteria. IgA is predominantly found in the gastrointestinal and respiratory tracts, tears, saliva, COLOSTRUM, and BREAST MILK
IgM
found in blood and lymph fluid and is the first immunoglobulin to respond to infection.
You have to GET SICK
T/F
A nurse is assessing the sensory capabilities of a newborn. Which is the least mature sense at birth?
Vision
Neurological development
cephalocaudal and proximal–
distal patterns
5 Senses
- Hearing—well developed at birth, responds to noise by turning to sound
- Taste—ability to distinguish between sweet and sour by 72 hours old
- Smell—ability to distinguish between mother’s breast milk and breast milk from others
- Touch—sensitivity to pain, responds to tactile stimuli
- Vision—incomplete at birth; maturation is dependent on nutrition and visual stimulation.
Assess Newborn Reflexes
(how the nerve reflexes are developing and functioning)
- Reflex Names
- Get a response
- Time they should disappear
GRASP Reflex: palmer grab your finger (4-6 mths age)
PLANTAR grab: toes toes grab your finger (9 mths -1yr)
MORO Reflex: loud noise or unexpected movement throwing out arms 6 months
ROOTING reflex: infant turns head when cheek is stroked 4 months
SUCKING reflex: touch top palate infant sucks. 4 months age
BABINSKI reflex: bottom foot stroke heal to toes. toes fan or spread out 1 year age
CRAWLING reflex: place on stomach and apply pressure on the sole of foot. infant will push out. (weeks to months)
STEP reflex: hold infant upright with legs and feet touching a surface. Infant will try to walk 3-4 months
TONIC NECK reflex (fencing reflex): infant head is turns to one side, the leg will extend other 4 months
Behavior patterns
FIRST period of reactivity
o Birth to 30 minutes to 2 hours after birth
o Newborn is alert, moving, may appear hungry
Period of decreased responsiveness
o 30 to 120 minutes old
o Period of sleep or decreased activity
SECOND period of reactivity
o 2 to 8 hours
o Newborn awakens and shows an interest in stimuli
T/F
During the first period of reactivity, a newborn is quite sleepy.
False
Orientation
response to stimuli
Habituation
ability to process and respond to
auditory and visual stimuli; ability to block out external stimuli after newborn has become used to activity
Motor Maturity
ability to control movements
Self-quieting ability
Consolability
Social Behaviors
cuddling and snuggling
Infant HR
intrauterine: 110-160
Extrauterine: 120-160
can go to 180 if crying
APGAR SCORE
Scale of 1-10 (7-9 is normal, no one gets a 10)
1 min of life: transition to extrauterine Life
5 mins of life is overall CNS status
10 min is done with a 6 and below.
A = appearance (color)
P = pulse (heart rate)
G = grimace (reflex irritability)
A = activity (muscle tone)
R = respiratory (respiratory effort) respiration, each of which is given a score of 0, 1, or 2.
What can affect APGAR scores: Infection, prematurity, mothers age, congenital abnormalities, physiologic immaturity, neuromuscular disorders, cns depressant close to delivery
Temp
97.7-99.5 F
Blood Pressure
50-75 systolic
30-45 diastolic
normally not taken unless in NICU
Neuromuscular Maturity and Physical Assessment
FIGURE 18.3
Page 586
Ballard Score
based on the neonate’s physical and neuromuscular maturity
prior to 37 weeks’ gestation
Preterm or premature
37 to 42 weeks’ gestation
Term
after week 42 gestation
Post term or postdate
after week 42 gestation/placental aging
post mature
SGA
small for gestational age
- lower 10th percentile
AGA
appropriate for gestational age
LGA
large for gestational age
- upper 10th percentile
T/F
Arm recoil is one measure of assessing a newborn’s physical maturity.
False
Vitamin K
Assist with clotting. helps prevent brain bleeds.
Eye Prophylaxis
medication percaution chlamydia/gonorrhea’s or ANY infection or bacteria in the birth canal. Left untreated can lead to blindness.
Anthropometric Measurements
length, weight,
head circumference, chest circumference (usually 2-3 cm less than head circumference)
Newborn physical assesment
- Prenatal History
- physical exam: measurements, vitals, skin,
- Neurological exam
Skin
- Vernix caseosa: white creamy film after the birth. wipe off
- Stork bites or salmon patches: om forehead, nape of the neck or eyelids. clears by itself
- Milia: little white heads. clears by itself. (Epstein pearl is milia in the mouth)
- Mongolian spots: looks like bruises
- Erythema toxicum: newborn rash clears in a couple of weeks
- Harlequin sign: pooling of blood when laying on one side. looks red half face.
- Nevus flammeus: Port wine stain. permanent
- Nevus vasculosus: Strawberry mark normally goes away by age 3.
Caput succedaneum
soft tissue injury. head can indent if you touch it. caput crosses the suture like
Cephalhematoma
does not crosses the suture line. hard collection of blood.
TTN transiet tachypnea of newborn
an infant does not have a full explosion of amniotic fluid from the lungs.
try to suction them deeper.
Galactocemia
lactose intolerant. enzyme to break down lactoce. doesnt wrk
Infant frequency of feeding
every 2-3 hours
Measures to decrease air swallowing
breast-feeding: solid latch
Storage of Milk
sealed and chilled: within 24 hr
disregard milk refrigerated for 24 hrs
use frozen expressed milk within 3 months
discard any unused milk
do not refreeze breast milk
dethaw in warm water
only make what they baby is going to drink.
LATCH Method
L: How well infant latches onto the breast
A: Amount of audible swallowing
T: Nipple type
C: Level of comfort
H: Amount of help mother needs
An infant typically requires how many calories per kilogram per day during the first 3 months?
110
SGA newborn assessment
Small for gestational age
- Head disproportionately large compared to rest of body
- Wasted appearance of extremities; loose dry skin
- Reduced subcutaneous fat stores
- Decreased amount of breast tissue
- Scaphoid abdomen (sunken appearance)
- Wide skull sutures
- Poor muscle tone over buttocks and cheeks
- Thin umbilical cord
T/F
The majority of small-for-gestational-age
newborns experience IUGR (intrauterine growth restriction)
False
T/F
An LGA newborn has a wasted appearance.
False
Post term Newborn
- Inability of placenta to provide adequate oxygen and nutrients to fetus after 42 weeks
- Nursing assessment: typical characteristics
- Dry, cracked, wrinkled skin; possibly meconium stained
- Long, thin extremities; long nails; creases cover entire soles of feet
- Wide-eyed, alert expression
- Abundant hair on scalp
Thin umbilical cord
Limited vernix and lanugo
When assessing a preterm newborn, which would the nurse expect to find?
Fewer palmar creases
T/F
Neonatal asphyxia commonly resolves within 72 hours after birth.
False
Neonatal asphyxia requires immediate
resuscitation measures; transient tachypnea of the newborn typically resolves by 72 hours of age
S/S necrotizing enterocolitis
Signs and symptoms: abdominal distention and tenderness, bloody stools, feeding intolerance
(bilious vomiting), sepsis, lethargy, apnea,
shock
Which finding would the nurse expect to assess in a newborn with necrotizing enterocolitis?
Abnormal distention
A newborn with necrotizing enterocolitis would
exhibit abdominal distention and tenderness
with bloody stools, bilious vomiting, feeding intolerance, lethargy, sepsis, apnea, and shock.
Seizures are not associated with NEC
How to treat meconium aspiration syndrome
- Antibiotics to treat infection.
- Breathing machine to keep the lungs inflated.
- Use of a warmer to maintain body temperature.
- Tapping on the chest to loosen secretions.
Albumin
is given before an exchange transfusion
T/F
The underlying problem associated with
meconium aspiration syndrome in utero involves hypoxic stress.
True
Meconium may be passed in utero secondary to hypoxic stress.
T/F
Neonatal asphyxia commonly resolves within 72 hours after birth
False
Neonatal asphyxia requires immediate
resuscitation measures; transient tachypnea of the newborn typically resolves by 72 hours of age
Which finding would the nurse expect to assess in a newborn with necrotizing enterocolitis?
Abnormal Distension
A newborn with necrotizing enterocolitis would exhibit abdominal distention and tenderness with bloody stools, bilious vomiting, feeding intolerance, lethargy, sepsis, apnea, and shock. Seizures are not associated with NEC
Intrauterine congenital causative organism
- Cytomegalovirus
- Rubella
- Toxoplasmosis
- Syphilis
Early Onset infections
- Prolonged rupture of membranes
- Urinary tract infections
- Preterm labor
- Prolonged or difficult labor
- Maternal fever
- Colonization with group B streptococci
- Maternal infections
Decreased pulmonary blood flow
Tetralogy of Fallot (TOF)
Tricuspid atresia
Mild to severe oxygen desaturation, polycythemia, murmur, hypoxemia, dyspnea, increased cardiac workload, and marked exercise
MIXED DEFECTS
Transposition of the great arteries
Total anomalous pulmonary venous connection
Truncus arteriosus
Hypoplastic left heart syndrome
Defects involving mixed (desaturated or saturated) blood
Decreased cardiac output, CHF, ruddiness, dusky or gray color, dyspnea
3 types of spina bifida
Prevent this by folic acid
Myelomeningocele is the most severe and most common. It has nerves inside.
All viruses that can cause
- toxoplasmosis
-herpes - PKU
- Radiation exposure
Omphalocele
Hernia of abdominal contents into a closed pouch
gastroschisis
abdominal contents are out and in the open.
Esophageal Atresia and
Tracheoesophageal Fistula
Nursing assessment
- Hydramnios
- Copious frothy bubbles of mucus and drooling; abdominal distention
- Coughing, choking, and cyanosis
Hypospadias and
epispadias
location of the urethera.
Hypo is below, epi is above
