Mod 6 Flashcards
A 38 week infant is born via spontaneous vaginal delivery. The infant gives a lusty cry after delivery. The most important reason why it is important to have a strong cry after birth is to:
A) burn surfactant the infant has so lung expansion can take place
B) convert to a fluid filled extra uterine environment
C) apply the breathing movements the infant practiced in utero
D initiate respirations and convert to extra uterine air filled environment
D) initiate respirations and convert to extra uterine air filled environment
The obstetrician delivers a term neonate. The baby has a lusty cry and good muscle tone, is placed on the mothers abdomen, and has a good 30 second heart rate. The next thing the doctor would do is:
A) suction the baby until secretions are clear
B) administer oxygen by face mask until cyanosis clears
C) perform APGAR scoring
D) Cut the umbilical cord and put on a cord clip
D) Cut the umbilical cord and put on a cord clip…(this is correct according to the teacher)
True or false when you dry a baby, you are not only keeping it warm but also stimulating it to breathe?
True
What is involved in the initial care and assessment of a newborn?
It is performed immediately after birth, resuscitation is performed if needed, and if not then routine care and an Apgar is performed
What is the gestational age assessment of a newborn and when is it performed?
It is performed at 1 to 4 hours after birth and it involves newborn maturity rating scale and classification, Ballard score system. It rates neuromuscular and physical maturity
Who in and what time frame performs the complete physical assessment of a newborn?
It is performed by the nurse at 2 to 4 hours and then every eight hours. This performed by the doctor within 24 hours and At discharged
What regulates immediate newborn care after delivery?
Neonatal Resuscitation program guidelines, (NRP)
What three factors determine your plan of care in the immediate newborn assessment?
Respiratory effort/airway - breathing or crying?
good muscle tone - flexed posture, moving?
Gestational age - term?
In the initial care of a newborn USS that the baby is term, is breathing and crying, and has flexed posture and is moving what do you do next?
Move on and Perform routine care because you answered yes to all three factors of initial care of the newborn
In the initial care of a newborn assessment, the baby is not term, is breathing and crying, but is not moving, what should you do?
Resuscitation may be needed, start with warming, drying, stimulating, and clearing the airway if needed.
What does the acronym SADA provide guidelines for?
It provides a way to remember the steps needed, not necessarily the order of steps, of the initial care of a newborn
What does S stand for in the SADA acronym?
Skin to skin, warming
What does The first a stand for in the SADA acronym?
Airway
What does D stand for in the SADA acronym?
Dry
What does the second a stand for in the SADA acronym?
APGAR
What are two forms of warming for newborns?
Skin to skin contact with mother, this accounts for 90% of babies
Radiant warmers this accounts for 10% of babies
In order to perform skin to skin contact what parameters must the child meet?
They must have usual findings a delivery, be term, good crying and breathing, good muscle tone
Should you use a bulb syringe routinely on a infant?
No only if it is absolutely necessary
When clearing the airway of an infant do you clear the mouth or the nose first? Why?
You clear the mouth first and then the nose. Because when you section the nose it simulates the baby to gasp
Does the Apgar score dictate resuscitation in newborns?
No
What three things are done in the first five minutes of a newborn is life?
- At birth the airway is established the infant is dried and warmed
- At 30 seconds of life a heart rate is taken if it is greater than 100 continue with drying and warming if it is less than 100 in addition to drying and warming add PPV (positive pressure ventilation) until the one minute apgar
- at 60 seconds of life the Apgar is performed
A 36 week baby is born vaginally, clear fluid. It is floppy, pale, and at apneic. What would you do initially to resuscitate the infant? A) Place skin to skin B) give oxygen by Blow by C) stimulate and dry D) give epinephrine
C) stimulate and dry
List the correct order of the following:
HR
APGAR
Dry Baby
Dry baby, HR, APGAR
A 40 week old baby is born via C-section and makes no effort to breathe. Which finding will indicate that you give oxygen during the first minute of life?
A) HR 90
B) APGAR 3
Heart rate is 90
What is the sacred hour?
Skin to skin contact that forms a bond with the mother try to minimize interruptions during this time
Eyes and thighs are done within what time frame?
Within one hour
What does erythromycin applied to the babies eyes prevent infection from?
Gonorrhea or chlamydia infection from the mother
How much and why and where is vitamin K given to an infant?
0.5 to 1 mg given in the thigh (vastus lateralus) it is a blood clotting factor that infants cannot produce until one week old
What are four activities that are done after birth?
- Place ID security bands
- Measurements (weight, length, head circumference, Chest circumference)
- assessment
- bathe (head/hair only at LLUMC within 12 hr, if infection bathe within 4)
If the baby is born to a mother with infection how soon does it need to be bathed?
Within four hours
When do you clamp The umbilical cord?
After 1 to 2 minutes
How many arteries and veins are in the umbilical cord?
Two arteries one vein
When is the cord unclamped?
At 24 hours of life as long as the cord is dry
If at 24 hours the cord is still moist what should you do?
Wait until dry up to 48 hours
How often is the infant Weighed?
Daily
Where are O2 saturation’s monitored on the infant?
Right hand and either foot
How do you monitor for jaundice in the infant?
At first transcutaneous, if it is high then you move onto a total and direct bilirubin blood draw
What does the APGAR score do?
Evaluate physiologic status of newborn and transition to extrauterine life.
When is the APGAR score taken?
1 and 5 min
What does the APGAR score rate?
Respirations - crying Pulse -heart rate Reflexes - irritability Muscle tone Skin color of the baby and its extremities
What does the first A stand for in APGAR?
A -appearance
What does the P stand for in APGAR?
P - pulse
What does the G stand for in APGAR?
G - grimace (reflux irritability)
What does the second A stand for in APGAR?
A - activity (muscle tone)
What does the R stand for in APGAR?
R - respirations
A score of 2 in the heart rate category of the APGAR scale indicates what?
That the hr is above 100 bpm
A score of 1 in the heart rate category of the APGAR scale indicates what?
Hr is bellow 100 bpm
A score of 0 in the heart rate category of the APGAR scale indicates what?
The pulse is absent
What does a score of 2 in the respiratory effort category of the the APGAR scale indicate?
Good, crying
What does a score of 1 in the respiratory effort category of the the APGAR scale indicate?
Weak, irregular, gasping
What does a score of 0 in the respiratory effort category of the the APGAR scale indicate?
Absent
What does a score of 2 in the muscle tone category of the the APGAR scale indicate?
Well flexed, or active movements of extremities
What does a score of 1 in the muscle tone category of the the APGAR scale indicate?
Some flexion of arms and legs
What does a score of 0 in the muscle tone category of the the APGAR scale indicate?
Flaccid
What does a score of 2 in the reflex/irritability category of the the APGAR scale indicate?
Good cry
What does a score of 1 in the reflex/irritability category of the the APGAR scale indicate?
Grimace or weak cry
What does a score of 0 in the reflex/irritability category of the the APGAR scale indicate?
No response
What does a score of 2 in the color category of the the APGAR scale indicate?
Pink all over
What does a score of 1 in the color category of the the APGAR scale indicate?
Body pink, hands and feet blue
What does a score of 0 in the color category of the the APGAR scale indicate?
Blue all over, or pale
What is a normal APGAR score, and what does it indicate?
8-10 normal and good transition, routine care
What does a APGAR score of 4-7 indicate?
Moderate difficulty with transition, need for stimulation and may need ppv.
If a 5 min APGAR score is ___ or ___ recheck at ___ ?
7
less
10 min (q5 min up to 20 min)
An APGAR score of 0-3 indicates what?
Severe distress, need for resuscitation
An APGAR score at 5 minutes after birth helps to evaluate what?
Adequacy of transition to extrauterine life
Name 3 signs of respiratory distress in the infant.
Cyanosis Retractions Nasal flaring Grunting Increased respiratory rate Asymmetrical chest rise and fall
True or false lung rales on auscultation can be normal during the first few hours of newborn transition.
True especially for the c section baby that was not squeezed through the birth canal
How much larger is the head circumference than the chest circumstance?
2-3 cm larger
What is normal when assessing fontanels?
Flat, soft
What is the significance of circumoral cyanosis if the baby is not active?
The baby needs to be stimulated to breathe more effectively
What is the significance of circumoral cyanosis in the crying and active baby?
There may be a cardiac cv abnormality the md needs to be notified.
What assessment findings would an infant with a clavicle fracture exhibit, and which infants are most at risk?
Upon palpation there is a bump, swelling, grunting. Larger babies are kore at risk
What is Meconium and when is it usually noted?
The first BM of the baby and it is usually within 24 hours
What is pseudomenstration?
White/red discharge in female diaper from maternal hormones.
What is caput succedaneum?
Collection of serous fluid (crosses the suture line)
What is cephalhematoma?
Collection of blood (does not cross the suture line)
What is moulding?
Elongated shape of the infants head due to overlapping cranial bones caused by passing through the birth canal in vertex position. Usually resolves in one week.
How is the ear height of an infant assessed?
Draw imaginary line from middle of eye to ear. Ear should be crossed with this line.
What is transient steabismus?
Due to poor neuromuscular control (cross-eyed). Usually disappears within 3-6 mo
What is acrocyanosis?
Persistent cyanosis of extremities during normal transition, or intermittently in response to cold Dude the first few weeks of life.
What is developmental dysplasia of the hip?
The asymmetry of gluteal and thigh fat folds.
What is Barlow maneuver?
Grasping the babies thigh and adducting (placing together) with general downward pressure. Feel for dislocation as the femoral head slips out of the acetabulum.
What is ortolani’s maneuver?
Grasping the infants thighs and putting genial downward pressure on the hip and then rotating inward. If the hip dislocates, this maneuver will force the femoral head back in and will make a notable clunk when it hits the acetabular rim.
What is the normal temp of the newborn?
97.7 - 99.5
What is the normal hr of the infant?
120 - 160 bpm
What are the normal respirations of the infant?
30 - 60 per min
What is the normal systolic bp of the newborn?
50-70
What is the normal diastolic bp of the infant?
30-45
What is the normal head circumference of the infant?
32-37 cm
What is the normal chest circumference of the infant?
30-35cm
