High-risk Newborn

Question 1

preterm characteristics

Answer 1

frail, weak, limp, skin translucent, abundant vernix and lanugo

Question 2

preterm behavior

Answer 2

easily exhausted from noise and routine activities, feeble cry

Question 3

preterm assessment

Answer 3

inadequate respirations, inadequate thermoregulations, fluid and electrolyte imbalance

Question 4

postterm characteristics

Answer 4

skin peeling, vernix sparse, lanugo absent, long fingernails

Question 5

sga causes

Answer 5

anything restricting utero-placental blood flow, smoking, dm, pih, infections

Question 6

sga complications

Answer 6

hypoglycemia, meconium aspiration, hypothermia, polycythemia

Question 7

lga most common cause

Answer 7

maternal diabetes

Question 8

lga infant at risk

Answer 8

birth injuries, hypoglycemia, and polycythemia - macrosomia

Question 9

rds causes

Answer 9

prematurity, c/s, diabetic mother, birth asphyxia

Question 10

rds signs and symptoms

Answer 10

tachypnea, retractions, cyanosis, nasal flaring, grunting, seesaw respirations, and asymmetry

Question 11

silvermann index grade

Answer 11

grade 0 - synchronized; 1 - lag on inspiration; 2 - seesaw

Question 12

rds treatment

Answer 12

mechanical ventilation, iv fluids, correction of acidosis, surfactant replacement therapy

Question 13

decreased amniotic fluid/cord compression

Answer 13

meconium aspiration syndrome

Question 14

mas signs and symptoms

Answer 14

tachypnea, retractions, cyanosis, nasal flaring, and grunting

Question 15

mas treatment

Answer 15

suction at birth, humidified oxygen, ventilation, may need warmed

Question 16

underdeveloped lungs; intubation - grow lungs

Answer 16

bronchopulmonary dysplasia

Question 17

brain dmg that affects the white matter around the ventricle

Answer 17

periventricular leukomalacia

Question 18

signs and symptoms of pvlm

Answer 18

delay in learning, movement development

Question 19

oxygen toxicity - blindness

Answer 19

retrolenthal fibroplasia

Question 20

intestinal tissues die, making a hole - bacteria can leak

Answer 20

necrotizing enterocolitis

Question 21

nec treatment

Answer 21

npo, iv feeding, breastmilk

Question 22

rds steroids

Answer 22

dexamethasone

Question 23

occurs in less than 1% of newborns (1 out of 100), but accounts for up to 30% of deaths in the first few weeks of life.

Answer 23

neonatal sepsis

Question 24

a type of neonatal infection and specifically refers to the presence in a newborn baby of a bacterial blood stream infection (BSI) in th setting of fever.

Answer 24

neonatal sepsis

Question 25

examples of BSI (4).

Answer 25

meningitis pneumonia pyelonephritis gastroenteritis

Question 26

an infection of the membranes that surround the brain and spinal cord.

Answer 26

meningitis

Question 27

inflammation and fluid in your lungs caused by external infections, primarily affecting the small air sacs known as alveoli.

Answer 27

pneumonia

Question 28

inflammation of the kidney.

Answer 28

pyelonephritis

Question 29

also known as infectious diarrhea, is inflammation from an infection in your stomach and intestines.

Answer 29

gastroenteritis

Question 30

refers to sepsis presenting in the first 7 days of life (although some refer to it as thin the first 72 hours of life).

Answer 30

early-onset sepsis

Question 31

refers to presentation of sepsis after 7 days (or 72 hours, depending on the system used).

Answer 31

late-onset sepsis

Question 32

single most common cause of neonatal death in hospital as well as community in developing countries.

Answer 32

neonatal sepsis

Question 33

signs of sepsis are non-specific and include (11):

Answer 33

body temperature changes breathing problems diarrhea hypoglycemia reduced movements and sucking seizures bradycarda swollen belly area vomiting jaundice

Question 34

a study showed that infants _ old meeting the criteria were at low-risk for having serious bacterial illness.

Answer 34

more than or equal to 60 days

Question 35

normal amount of WBC for neonatal sepsis low-risk infants.

Answer 35

5,000-15,000/mm3

Question 36

normal amount of urine wbc for neonatal sepsis low-risk infants.

Answer 36

less than or equal to 10 per high power field

Question 37

normal amount of stool WBC for neonatal sepsis low-risk infants.

Answer 37

less than or equal to 5 per high power field, only in infants with diarrhea.

Question 38

risk for group b streptococcal infection.

Answer 38

preterm premature rupture of membranes (PPROM)

Question 39

what causes neonatal sepsis?

Answer 39

group b streptococcal infection (GBS)

Question 40

screenings done for GBS (2).

Answer 40

vaginal and rectal swabbing treating culture positive women with intrapartum chemoprophylaxis

Question 41

babies born less than or equal to 60 days old are less-likely to have neonatal sepsis if they have the ff. criteria (12).

Answer 41

generally well-appearing previously healthy - full term (at more than or equal to 37 AOG) no perinatal antibiotics no unexplained hyperbilirubinemia that required treatment no antibiotics since discharge no hospitalizations no chronic illness discharged at the same time or before the mother no evidence of skin, soft tissue, bone, joint, or ear infection WBC, urine, and stool WBC count is within range

Question 42

common antibiotic regimen for infants with suspected sepsis are (2):

Answer 42

beta-lactam antibiotic (ampicillin) aminoglycoside (gentamicin)

Question 43

when there is neonatal sepsis, and if anaerobic species are suspected (where necrotizing enterocolitis or intestinal perforation is a concern), what antibiotic is added?

Answer 43

clindamycin

Question 44

treatment for neonatal sepsis (3).

Answer 44

frequently treated with antibiotics empirically until cultures are suffiently proven to be negative (ampicillin, gentamicin, clindamycin) fluid resuscitation supportive care

Question 45

jaundice that occurs within the first 24 hours.

Answer 45

pathologic jaundice

Question 46

in hyperbilirubinemia, the newborn bilirubin level is _ in term and _ in preterm.

Answer 46

more than 12, 10-14

Question 47

hyperbilirubinemia may lead to _.

Answer 47

kernicterus (brain damage)

Question 48

most common cause of hyperbilirubinemia.

Answer 48

blood incompatibility of mother and fetus (Rh or ABO) only occurs with mother negative Rh or O blood

Question 49

breakdown or destruction of RBCs.

Answer 49

hemolysis

Question 50

Rh meaning in blood.

Answer 50

Rhesus factor

Question 51

treatment for hyperbilirubinemia (5).

Answer 51

prevention assess coombs (detect antibodies that attack red blood cells) monitor bilirubin levels phototherapy blood transfusions

Question 52

bilirubin on skin changes into water-soluble excreted in bile and urine.

Answer 52

phototherapy

Question 53

two side effects of phototherapy.

Answer 53

frequent, loose, green stools skin changes

Question 54

during phototherapy, what are two nursing considerations?

Answer 54

patches over eyes wearing only diaper of fiber-optic phototherapy blanket against skin

Question 55

other interventions for hyperbilirubinemia (5).

Answer 55

exchange transfusions (if lights not working) maintain neutral thermal environment provide optimal nutrition - hydrate protect the eyes from retinal damage enhance therapy by exposing as much skin as possible to light, removing all clothing except diaper, turn frequently

Question 56

signs of a macrosomic baby (6).

Answer 56

face round red body obese poor muscle tone irritable tremors

Question 57

if the infants has a diabetic mother, they have a high risk for (4).

Answer 57

trauma during birth congenital anomalies RDS hypocalcemia

Question 58

most frequent symptom of an infant of a diabetic mother (2).

Answer 58

jitteriness tremors

Question 59

treatment for an infant of a diabetic mother (3).

Answer 59

fed gavage IV if needed

Question 60

how frequent does hypoglycemia occur in infants of a diabetic mother?

Answer 60

15-50%

Question 61

if the infants glucose is _, they are considered hypoglycemic.

Answer 61

less than 40-45 mg/dl

Question 62

for infants with diabetic mother, glucose levels should be tested right after birth, and _, then _ until stable.

Answer 62

2hx4, q4hrx6

Question 63

a medical condition in which a part of the intestine folds into the section next to it.

Answer 63

intussusception

Question 64

intussusception typicallt involves the _, and less commonly the _.

Answer 64

small bowel, large bowel

Question 65

which is more affected in intussusception, children or adults? male or females? what is the usual age of occurence.

Answer 65

children males 6-18 months

Question 66

3 risk factors of intussusception.

Answer 66

certain infections diseases like cystic fibrosis intestinal polyps

Question 67

abnormal tissue growth that can develop on th mucous membranes of the intestine.

Answer 67

intestinal polyps

Question 68

how are childrens and adults diagnosed for intussusception?

Answer 68

children - ultrasound adults - ct scan

Question 69

signs and symptoms of intussusception (7).

Answer 69

periodic abdominal pain nausea and vomting (sometimes green in color from bile) abdominal bloating bloody stool in children or those unable to communicate: cry draw their knees up to their chest dyspnea (difficulty or painful breathing) with paroxysms of pain

Question 70

in children, intussusception at the _ accounts for _ of all cases.

Answer 70

ileocecal junction 90%

Question 71

treatment for intussusception (3).

Answer 71

children - enema (if not successful, surgery) dexamethasone adults - surgical removal of the affected bowel section