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PA 3 (RESP 315 ) > Mod 3 Basic Neonte Assessment > Flashcards

Mod 3 Basic Neonte Assessment Flashcards

1
Q

What are 4 Pre-birth Questions to ask?

A
  1. Gestational age?
  2. Clear Amniotic Fluid?
  3. Additional Risk factors?
  4. Umbilical Cord Management Plan?
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2
Q

What are the dates for micro-premature and premature?

A

Micropremature < 26 weeks

Preterm = 26-32 weeks

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3
Q

First 28 days of life is considered what gestational age?

A

Neonate

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4
Q

How are adjusted ages determined?

A

Weeks and days.

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5
Q

How is Gestational Age/Estimated Due Date determined?

A
  • Ultrasound (gold standard)
  • Last menstrual period
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6
Q

What is premature rupture of membranes (PROM)?

A

When the water breaks early

  • Most women will go into labor on their own within 24 hours.
  • If the water breaks before the 37th week of pregnancy, it is called preterm premature rupture of membranes (PROM).
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7
Q

What questions to ask immediately after delivery?

A

Rapid Assessment

  1. Term
  2. Tone
  3. Breathing or crying?
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8
Q

When is the Rapid Assessment of the newborns performed?

A

Regardless of delivery, it is done Immediately after delivery

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9
Q

Why is crying after birth important?

A

Crying establishes FRC

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10
Q

What is the Dubowitz/Ballard Score?

A

Scores gestational age after neonate is stable, w/first 24hs of delivery

  • Assists in care plans, especially around time of viability
  • Usually performed on babes < 2000 gs
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11
Q

When does the Vernix Caseosa appear?

A

20-24 wks, disappears week 41-42

(waxy coating on babes)

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12
Q

When does red, gelatinous, fragile skin appear?

A

Around 32 weeks gestation

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13
Q

When does the Lanugo (hair) appear?

A

26 weeks, starts to disappear around 32 weeks

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14
Q

When do foot creases on soles of feet appear?

A

Week 26

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15
Q

When does the Pinna appear?

A

Cartilage of ear is fully formed after 32 weeks

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16
Q

When do reproductive organs appear

A
  • Breasts not obvious < 25 weeks, areola and nips present at full gestation
  • Genitalia not easily recognizable until 27 weeks
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17
Q

What is the Vernix Caseosa?

A

Wax substance in skin of newborn, produced in cells and protects for immunity.

  • Vernix is rough to get off so its usually left on
  • red gelatinous fragile skin
  • gelatinous because the skin has a shin stretch
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18
Q

Why is brown fat important?

A

Helps regulate temperature.

  • if not present, babes should be put into a bag (preffered) to maintain temperatures or wrapped in a blanket (at the min)
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19
Q

What is hypotonia?

A

Decreased tone aka floppy or flaccid

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20
Q

what is hypertonia

A

high tone/rigid

  • manifests in flexor/extensor muscles of extremities.
  • severe cases = neck stiffness and posturing
  • might be cerebral palsy or brain injury.
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21
Q

What are hypotonia and hypertonia indicative of?

A

Neuromuscular injury.

  • Therapeutic hypothermia may be performed on hypertoned babes
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22
Q

What is rooting?

A

when babes look for a nipple. Its a testable milestone where you put a finger near their mouth.

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23
Q

What are expected neurological milestones for a 28 weeks gestational babe?

A
  • Can be awoken from sleep and stay awake for a few mins.
  • Flicker eye movement in response to light
  • active
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24
Q

What are expected neurological milestones for a 38 weeks gestational babe?

A
  • Can self-wake and stay awake/alert for long periods
  • can smile
  • active with good gross motor function
  • responds to stimulation like light and sound
  • cries for food, mom, discomfort
  • can express pain
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25
Q

Why is it normal for babes < 28 weeks to sleep more?

A

They’re still growing (underdeveloped).
- rare to wake them up for procedure and they stay awake.

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26
Q

What is a indicator of strong respiratory effort?

A

Breathing/crying after delivery.

  • if babe is not crying, observe chest for breathing effort
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27
Q

What is primary apnea?

A

When the infant has undergone in-utero stress, it is self limiting and a reversable condition.

  • Usually cord problems
  • lasts a few seconds
  • may require mild to mod stimulation to initiate respiration
  • may be accompanied by mild bradycardia
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28
Q

What is secondary apnea

A

when respirations will not resume spontaneously

  • requires PPV
  • HR may be severely bradycardic
29
Q

If fetal stress in utero has been observed, and the babe is not breathing. what can you assume?

A

secondary apnea

30
Q

How do you identify primary apnea?

A

Fetal heart rate, when babe is stimulated they will breath in response.

  • usually associated with cord problems
31
Q

How do you differentiate primary and secondary apnea?

A

babes w/Secondary apnea don’t have a respiratory response. You will need to take action.

32
Q

What is the most common cause of bradycardias in kids?

A

Ventilation problems

33
Q

What do you run through if HR does not increase?

A

MR SOPA

34
Q

What should you have before compressions start?

A

Artificial airways like ETT

35
Q

What drug can be given to help stimulate babes?

A

Caffeine

36
Q

What are signs of resp. distress in neonates?

A
  • Retractions
  • Grunting
  • Nasal Flaring
  • Increased O2 requirements
  • Cyanosis
  • Tachypnea (RR >60 bpm)
37
Q

What is Grunting a sign of in Neos/infants?

  • Interventions?
A

A sign of resp. distress where peds/babes are trying to create their own PEEP.

  • To maintain FRC in babes
  • Interventions would be CPAP or increase
  • try to prevent alveolar collapse?
38
Q

How long are infants obligate nose breathers?

A

until aprox 4 months of age.

  • small nasal airways = high obstruction risk
39
Q

Why are infants at higher risk of developing hypoxia?

A
  • Higher metabolic rate (double adults)
  • Lung volumes are smaller, less SA (alveoli) for exchange, and muscles tirer faster.
  • Chest wall more compliant (easily collapse) and bc ribs are horizontal, they can’t expand as much.
  • Premature nervous system, Neos easily fall into bradycardias (rate dependent) leading to hypovolemia which easily leads to shock-decreased perfusion
40
Q

What are cardiac factors that would lead infants to be hypoxic?

A

Heart rate and stroke volume

  • LV are underdeveloped and can’t compensate by increasing stroke volume
  • hypovolemia decompensate quicker (due to reduced pumping)
41
Q

What are the 4 conditions of a routine delivery (babe given to mom instead of warmer)

A
  • Infant born at full term gestation
  • Amniotic fluid clear with no evidence of infection
  • crying or normal breathing
  • good muscle tone
42
Q

Why do body temperatures fall rapidly in infants at neutral thermal environments?

A
  • They haven’t developed the ability to regulate temp. (they can’t shiver yet aka ).
  • Haven’t developed brown fat
  • SA to body mass ratio 4x of an adult, but ability to increase heat production in 1/3 of an adult
  • labile temp. from intrautrine to extra uterine
43
Q

What is thermogenesis?

A

Regulating heat by shivering

44
Q

How to infants manage tempature?

A

They produce brown fats to maintain.

  • If brown fat isn’t produced, babes have to be put into a ziplock bag for thermoregulation.
45
Q

Physiological affect if infants can’t regulate heat?

A

Heat loss releases epinephrine

  • Epi release causes hypoglocemia and high lactate bc of elevations in PVR and SVR
46
Q

Target Temperatures in a newborn

A

36.5-37 degrees Celsius

47
Q

What are consequences of cold stress in a newborn?

A

Increased O2 and calory uptake to compensate for heat loss. Resulting in…

  • Depletion of brown fat and glycogen (energy stores)
  • Increase CO2 and lactate
  • Norepi release -> raises PVR and SVR causing metabolic acidosis and hypoglycemia.
48
Q

What should room temperature be for babes in the NICU?

A

23-25 degrees C to maintain NTE. The NICU is hot.

49
Q

How are baby temperatures measured?

A

skin temperature probes

50
Q

What are 4 mechanisms of heat loss?

A
  • Evaporation
  • Convection
  • Radiation
  • Conduction
51
Q

What are 2 mechanisms of heat loss that deal with proximity and not contact?

A

Radiation and conduction.

52
Q

How do you prevent heat loss from conduction?

A

Occurs when body heat is lost to a cooler contact surface so.

  • keep stethoscope under warmer
  • keep babe in warm spots
53
Q

How to prevent heat loss to evaporation?

A

Wrap the baby up in blankets or in a bag

54
Q

What devices are used to regulate temperature?

A

Radiant warmer and close isolette

55
Q

Functions of Radiant Warmer

A

Used for overhead warming
- Body temp can be maintained via servo mode, with skin probe.
- panda

56
Q

Functions of Closed Isolette?

A

Used for low birth weight infants w/temp instability
- maintains a constant body temp by using either a servo controlled skin probe, air temp control device, or air temp probe.
- should be double walled or heat shielded
- Unicorn/giraffee

57
Q

For micropremature infants (<28wks), what should you do instead of dry stimulation?

A
  • Wrap in polyurethane bag to prevent heat loss and reduce risk of IVH.
  • Adjust body position to reduce risk of IVH (germinal matrix is mature and at high risk of bleeds)
  • Look for bulging fontanels (sign of high ICP and potential IVH)
58
Q

How should you adjust body position of premature infants (<28wks) at delivery?
- why would you do it?
- **ask someone why supine is preferred to proning)

A

first 72hrs, supine, neck extended, midline.
- prevents IVH by preventing abrupt changes in cerebral perfusion, prompting neuroprotection.

59
Q

Which mechanism of heat loss associated with heat loss to the surrounding air?

A

Convection

60
Q

Which mechanism of heat loss is associated with heat loss through fluid evaporating from the skin?

A

Evaporation

61
Q

Which mechanism of heat loss is associated with heat loss from an infant to a colder nearby object?

A

Radiation

62
Q

Which mechanism of heat loss is associated with colder object that the infant comes in contact with?

A

Conduction

63
Q

What is the gold standard for determining Gestational Age?

A

Prenatal sonography

64
Q

What are intrapartum risk factors?

A

Factors/conditions that could pose a risk to the mom and babe.

  • maternal health conditions
  • fetal positioning
  • Previous C-sections
  • preterm labor
  • Placenta abruption
  • Meconium stained amniotic fluid
65
Q

Why is epidural pain control not considered a intrapartum risk factor

A

Because its a med intervention used to alleviate pain and discomfort during the intrapartum period rather than a risk factor that poses a potential harm or complication.

  • Helps women manage the discomfort associated with contractions and childbirth.
  • Epidurals are a well-established and effective method for reducing pain and improving the overall birthing experience for many women.
66
Q

Ideal fetal scalp pH is what?

A

anything > 7.25

67
Q

What does the lung bud emerge from?

A

Pharnyx

68
Q

Why could Preterm infants be unable to maintain thermal homeostasis?

A
  • Lack brown fat
  • No ability to shiver
  • High body surface area to body weight area
69
Q
A

PA 3 (RESP 315 ) (13 decks)

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