Module 07: Care of the Newborn Child Flashcards
What pattern does growth and development follow?
(A) It follows a definite and predictable pattern of trends.
(B) All aspects are interrelated.
(C) There are periods of accelerated and decelerated growth rates.
Do all children develop in exactly the same way?
No, while children resemble one another, each child is unique.
What is considered the universal language of children?
PLAY
This is characterized to be the most sensitive indicator of development.
BEHAVIOR
What are the two periods within the infancy stage?
(A) Neonatal (0 to 28 days)
(B) Infancy (29 days to 1 year)
What age group does toddlerhood refer to?
Children aged 1 to 3 years old.
What age range defines preschool stage?
From 3 to 5 years old.
What age range defines school age stage?
From 6 to 12 years old
What age does adolescence occur?
Adolescence occurs between 12 to 18 years of age.
Under respiratory system, what are the stimuli that help initiate respiration among newborns?
(A) Chemical: Low oxygen and high CO2 levels.
(B) Thermal: Sudden drop in environment temperature.
(C) Tactile: Rubbing of the back and soles of the feet.
This involves rubbing the back and soles of the feet, especially during the first 24 hours.
Tactile Stimulation
Why is it important to monitor the newborn’s oxygen and CO2 levels?
To ensure proper respiratory function and oxygenation
Why are a bonnet and blanket used during birth?
To prevent heat loss (hypothermia) due to the sudden drop in environmental temperature (EINC).
Under cardiovascular system, why must the newborn’s lungs expand after birth?
To take over the blood oxygenation function from the placenta.
What happens to the newborn’s peripheral circulation in the first 24 hours?
Peripheral circulation remains sluggish during the first 24 hours after birth.
What is the normal blood volume of a newborn?
80 to 110 ml/kg
What is the normal hemoglobin (Hgb) level for a newborn?
17 to 18 g/100 mL of blood.
What is the normal hematocrit (Hct) range for a newborn?
45% to 50%.
How many red blood cells (RBCs) does a newborn typically have?
6 million cells/mm³.
What is the typical white blood cell (WBC) count in a newborn?
15,000 to 30,000 cells/mm³.
Under the gastrointestinal system, why is vitamin K synthesis absent in newborns at birth?
Because the gastrointestinal tract (GIT) is sterile at birth, and the necessary bacteria for Vitamin K synthesis are absent.
What is a key characteristic of liver function in newborns?
The liver is immature at birth.
How much milk can a newborn’s stomach hold?
About 60 to 90 ml of milk.
Why do newborns have a higher risk of regurgitation?
Due to the immaturity of the cardiac sphincter between the stomach and esophagus.
What digestive enzymes are deficient in newborns?
Pancreatic enzymes such as lipase and amylase.
This is known as the first stool passed after birth.
Meconium is usually passed within the first 24 hours of life.
What is transitional stool, and when is it passed?
Transitional stool is greenish and is passed on the 2nd to 3rd day of life.
How often does a breastfed baby typically pass stool?
A breastfed baby typically passes stool 3-4 times a day.
How often does a formula-fed baby pass stool?
A formula-fed baby usually passes stool 2-3 times a day.
What is the characteristic odor of breastfed baby stools?
Sweet-smelling due to the high lactic acid found in breast milk.
How does the odor of formula-fed baby stools differ?
Formula-fed baby stools tend to have a more offensive odor.
What is the consistency of breastfed baby stools?
Breastfed baby stools have a pasty consistency.
What is the consistency of formula-fed baby stools?
Formula-fed baby stools have a firmer consistency.
What color are breastfed baby stools?
Yellowish to golden.
What color are formula-fed baby stools?
Pale yellow.
When should a newborn void for the first time?
A newborn should void within the first 24 hours after birth. However, they cannot concentrate urine well due to the immaturity of their kidneys.
What is the daily urine output for a newborn in the first 1 to 2 days?
30 to 60 ml daily.
How much urine should a newborn produce by the end of week one?
Total urine volume rises to about 300 ml per day by week one (Male babies should void with enough force to produce a small projected arc.)
How do female newborns typically void?
Female babies produce a steady stream of urine, not just dribbling.
What should be assessed regarding the testes and the urinary meatus of male newborns?
(A) Both testes should be present in the scrotum.
(B) The urinary meatus should be located at the tip of the penis.
What is a common characteristic of female genitalia in newborns?
Female newborns may have a swollen vulva.
What secretion might some female newborns have?
Some may have blood-tinged vaginal mucus secretion.
Why are newborns prone to infections up to 2 months of age?
Because they have difficulty forming antibodies during invading antigens. That is why some immunizations are not given to infants less than 2 months.
What type of antibodies does a newborn receive from the mother?
IgG antibodies, which cross the placenta and provide passive immunity.
This sense is well developed at birth, with the most sensitive areas being the lips, the hands, and the soles of the feet.
Sense of Touch
What effect does gentle touch have on a newborn?
Gentle patting and soothing touch can relax the newborn.
Describe the sense of hearing of the newborn.
(A) Calms down in response to soothing voice.
(B) Newborns startle when they hear loud noises.
Can a newborn recognize their mother’s voice?
Yes, newborns can recognize their mother’s voice almost immediately after birth because they can hear even before birth.
How does a newborn respond to the smell of their mother’s milk?
A newborn recognizes the smell of their mother’s milk and turns toward the mother’s breast.
Describe the sense of vision of the newborn.
(A) A newborn can see as soon as they are born.
(B) They blink and follow strong light.
What type of objects do newborns focus best on?
Newborns focus best on black and white objects at a distance of 9-12 inches.
How does a newborn react to different tastes?
Newborns turn away from bitter tastes and accept the sweet taste of milk.
Under the neuromuscular system. this protects the eyes by causing rapid eyelid closure when an object comes near.
Blink reflex (serves the same purpose as an adult)
Blink reflex is elicited by what?
A shining strong light, such as flashlight into the eye.
Under the neuromuscular system, this helps the newborn find food by turning towards the breast when their cheek is brushed.
Rooting Reflex
When does the rooting reflex disappear?
It disappears at about 6 weeks of life when the baby can focus their eyes steadily.
Under the neuromuscular system, this helps the newborn find food by making a sucking motion when the lips are touched.
Sucking Reflex
When does the sucking reflex begin to diminish?
It begins to diminish at 6 months of age.
Under the neuromuscular system, this reflex prevents swallowing inedible substances by pushing them out when placed on the anterior part of the tongue.
Extrusion Reflex
When does the extrusion reflex disappear?
It fades at around 4 months of age (Hence, parents should be made aware to prevent them from offering solid food before the reflex fades, which could happen early).
Under the neuromuscular system, this reflex is elicited when held in a vertical position with their feet touching a hard solid ground, newborns will take a few quick and alternating steps.
Step-in-Place Reflex
When does the step-in-place reflex disappear?
This reflex disappears by 3 months of age.
How is the placing reflex demonstrated by a newborn?
The newborn makes a few quick lifting leg motions, as if to step onto a table.
Under the neuromuscular system, this reflex is elicited when the newborn grasps the object quickly by closing their fingers around it.
Palmar Grasp Reflex
When does the palmar grasp reflex disappear?
It fades between 6 weeks and 3 months of age, after which the baby begins to grasp objects meaningfully.
Under the neuromuscular system, this reflex occurs when an object touches the sole of a newborn’s foot at the base of the toes, and the toes grasp in the same manner as the fingers.
Plantar Grasp Reflex
When does the plantar grasp reflex disappear?
It disappears usually at 8 to 9 months of age, thus preparing the child for walking.
Under the neuromuscular system, this reflex occurs when the newborn’s head is turned to one side, the arm and the leg on that side extend, while the opposite arm and leg contract.
Tonic Neck Reflex or Fencing Reflex
Where is the Tonic Neck Reflex or Fencing Reflex mainly evident?
It is mainly evident on the arms.
What happens if the newborn’s head is turned to the opposite side?
The newborn may change the extension and contractions of their arms and legs accordingly.
When does the Tonic Neck Reflex or Fencing Reflex disappear?
It disappears usually in the second and third month of life.
Under the neuromuscular system, this reflex is elicited by using a loud noise or by jarring the bassinet.
Moro Reflex or Startle Reflex
How is the Moro Reflex or Startle Reflex elicited?
The most accurate method is holding the newborn in a supine position and allowing the head to drop backward about 1 inch.
What is the Moro reflex’s response in a newborn?
The reflex involves the newborn spreading out their arms as if trying to ward off an attacker and then covering up to protect the body.
When does the Moro reflex disappear?
It is strong for the first 8 weeks of life and fades by the fourth or fifth month.
Under the neuromuscular system, this is elicited when the the sole of the newborn’s foot is stroked in an inverted “J” curve from the heel upward, the newborn fans the toes.
Babinski Reflex
When does the Babinski reflex disappear?
This reflex remains positive (toe fans) until the 3 months of age, after which it is supplanted by the down turning response.
Under the neuromuscular system. this reflex is elicited when pressure is applied to the soles of a newborn lying supine, the newborn pushes back against the same pressure.
Magnet Reflex or Crawling or Bauer Reflex
The magnet or crawling or bauer reflex is usually done to test what?
Spinal Cord Integrity
Under the neuromuscular system, this reflex is elicited when the newborn is lying supine, if one leg is extended and the other sole is irritated by rubbing a sharp object, the the infant raises the other leg and extends it as if to push away the irritation.
Crossed Extension Reflex
What is the newborn’s response when the trunk incurvation reflex is elicited?
When a newborn lies prone and is touched along the paravertebral area, the newborn flexes the trunk and swings the pelvis toward the touch.
This reflex is elicited when a newborn is supported in a prone position by hand. The newborn should demonstrate some muscle tone.
Landau Reflex
What does it indicate if a newborn sags into an inverted “U” position during the Landau reflex?
Sagging into an inverted “U” position indicates extremely poor muscle tone.
This is the method used to assess the newborn’s immediate adjustment to the extrauterine life.
APGAR score
When are APGAR assessments conducted?
APGAR assessments are conducted at 1 minute and 5 minutes after birth, and repeated until the infant’s condition stabilizes.
How is each item in the APGAR score rated?
Each item is given a score of 0, 1, or 2.
What does a score of 0, 1, or 2 represent for heart rate in the APGAR score?
(A) 0: Means absent
(B 1: <100 bpm
(C) 2: >100 bpm
What does a score of 0, 1, or 2 represent for reflex irritability in the APGAR score?
(A) 0: No response
(B) 1: Grimace is present, some motion
(C) 2: Cry and cough
What does a score of 0, 1, or 2 represent for respiratory rate in the APGAR score?
(A) 0: Absent
(B) 1: Slow, irregular, and weak cry
(C) 2: Good lustly cry
What does a score of 0, 1, or 2 represent for muscle tone in the APGAR score?
(A) 0: Flaccid or limp
(B) 1: Minimal flexion or extremities
(C) 2: Active, good flexion
What does a score of 0, 1, or 2 represent for color in the APGAR score?
(A) 0: Pale or cyanotic
(B) 1: Pink body, acrocyanosis
(C) 2: Pink body, pink extremities
What does an APGAR score of 0-3 indicate?
The infant is in serious danger and needs resuscitation.
What does an APGAR score of 4-6 indicate?
The infant must be closely monitored and may need airway clearance and oxygen.
What does an APGAR score of 7-10 indicate
Fetal Well Being
This is used to determine the child’s gestational age by assessing the maturity of the newborn.
Ballard’s score
Who developed the New Ballard Score?
It was developed by Dr. Jeanne L. Ballard.
What is an infant classified as AGA (Appropriate for Gestational Age)?
An infant whose weight falls between the 10th and 90th percentiles on intrauterine growth charts.
What is an infant classified as SGA (Small for Gestational Age)?
An infant whose weight falls below the 10th percentile on intrauterine growth charts.
What is an infant classified as LGA (Large for Gestational Age)?
An infant whose weight falls above the 90th percentile on intrauterine growth charts.
What are the six neuromuscular maturity signs in the New Ballard Score?
(A) Posture
(B) Square window (wrist)
(C) Arm Recoil
(D) Popliteal Angle
(E) Scarf Sign
(F) Heel to Ear
What are the six physical maturity signs in the New Ballard Score?
(A) Skin
(B) Lanugo
(C) Plantar Surface
(D) Breast
(E) Eye and Ear
(F) Male and Female Genitalia
How is the total New Ballard Score interpreted?
The total score from both the neuromuscular and physical maturity sections is used to estimate the newborn’s gestational age in weeks.
It is used to assess a newborn’s birth weight in relation to gestational age, determining if the infant is small-for-gestational age (SGA), appropriate-for-gestational age (AGA), or large-for-gestational age (LGA).
Lubchenco Chart
This evaluates a newborn’s ability to respond to stimuli, demonstrating that newborns are not passive and can react to sounds and visual stimuli, such as widening eyes or turning the head toward the parent’s voice.
Brazelton Neonatal Behavioral Assessment Scale (BNBAS)
What is the normal birth weight for Filipino babies?
Normal birth weight is 2,500g to 3,400g.
How much weight does a newborn typically lose after birth, and when do they regain it?
Newborns lose 5 to 10% of their birth weight in the first few days. Breastfed infants regain their weight in 10 days, while formula-fed infants regain it in 7 days.
What is the average birth length of a newborn?
46 to 54 cm (Obtained from measuring heel to head measurement)
What is the normal head circumference of a newborn?
The normal head circumference is 34 cm to 35 cm, and measurements above 37 cm or below 33 cm should be reported.
Where is the head circumference measured?
Occipitofrontal Area
What is the normal chest circumference?
32 to 33 cm (usually 2cm less than the head circumference.
Where is the chest circumference measured?
At the level of the nipple line
This should be measured at the level of the abdomen, above the umbilical cord. It is almost the same size of the chest and should be less than 2cm from the head circumference.
Abdominal Circumference
What are the normal vital signs for a newborn?
(A) Temperature: 37.2°C
(B) Heart rate: 120-140 bpm (may reach 180 bpm)
(C) Respiratory rate: 30-60 bpm (may reach 80 bpm)
(D) Blood pressure: 80/46 mmHg (up to 100/50 mmHg by the 10th day)
What is the typical posture of a newborn?
Newborns typically have flexion of the head and extremities, resting on the abdomen and chest.
Describe the size of a newborn’s head in proportion to the body.
A newborn’s head is disproportionately large, about 1/4 or 25% of their total body length.
This fontanel is characterized as diamond shape and usually closes at 12 to 18 months.
Anterior Fontanel (Bregma)
Where is the anterior fontanel located?
Between two parietal bones and two frontal bones
This fontanel is characterized as triangle shaped and usually closes about 2 to 3 months.
Posterior Fontanel (lambda)
Where is the posterior fontanel located?
Between two parietal and two occipital bones/
What reflex is present in the eyes of the newborn?
(A) The blink reflex.
(B) The eyelids are often edematous due to the pressure from the birthing process.
(C) It should be symmetrical clear and no discharge.
What causes the crossing of eyes in a newborn?
Eye crossing is due to weak extraocular muscles in newborns.
How should the pinna of the ear be positioned in relation to the eyes?
The tip of the pinna should be aligned with the outer canthus of the eyes (Pinna should be firm and recoils)
This may be associated with down syndrome.
Low-Set Ears
These are known as small white cysts that may be present on each side of the hard palate.
Epstein Pearls
What should be present in the newborn’s mouth and throat?
(A) Swallow and gag reflex.
(B) Nasal Teeth.
(C) Pink and moist gums
(D) Intact soft and hard palate
(E) Uvula in midline
How do you assess a newborn’s hydration status using the skin?
Skin turgor can be assessed by checking the elasticity over the abdomen.
What should be the newborn’s color?
Pink or reddish depending on their racial background.
What should be the texture of the newborn’s skin after birth?
Soft, smooth and velvety
This is known as the peeling of the skin which occurs during the first two weeks of life.
Desquamation
These are tiny white spots that occur on the nose and chin due to the clogging of sebaceous glands.
Milia
This is known as the is a cheese-like, greasy, yellowish substance made up of sebaceous gland secretions and epithelial cells.
Vernix Caseosa
This is known as the yellowish discoloration of the skin, which is definite between 3 to 7 days.
Physiological Jaundice or Ictus Neonotorum
These are are flat red marks caused by localized capillary dilatation, typically found on the upper eyelids, between eyebrows, nose, upper lip, and back of the neck.
Stork Marks
These are are slate-colored patches often found on the buttocks or lower back of newborns, which usually fade during preschool.
Mongolian Spots
This is a transitory mottling of the skin due to exposure to cold.
Cutis Marmorata
This occurs when a newborn lying on their side shows redness on the dependent side and paleness on the upper side.
Harlequin Sign
What is the normal anteroposterior diameter in a newborn’s chest?
The anteroposterior diameter is equal in a newborn’s chest.
What may occur in a newborn’s chest during inspiration?
There may be slight sternal retractions during inspiration.
This refers to the secretion of a milky substance from a newborn’s breasts, which can occur in both male and female infants.
Witch’s Milk
Describe the appearance of the newborn’s abdomen.
Should be cylindrical in shape.
What are the components of a normal umbilical cord?
2 arteries and 1 vein
What happens to the umbilical cord after clamping?
The umbilical stamp is usually moist. The cord becomes yellowish brown and then greenish black, shrinks after 2 and 3 days then falls off 7 to 10 days.
How do a newborn’s extremities typically appear?
Newborn extremities are flexed, with a full range of motion and symmetrical movements. And the fists should be clenched.
How do the soles of a newborn’s feet appear?
The soles of a newborn’s feet have crisscrossed lines covering 2/3 of the foot.
What are common nursing diagnoses for newborns?
(A) Risk for ineffective airway clearance
(B) Risk for ineffective thermoregulation.
(C) Risk for infection and complications.
(D) Risk for enhanced nutrition.
(E) Risk for enhanced parenting.
How should an infant be positioned to help establish and maintain a patent airway?
Position the infant in Trendelenburg or head-down-to-side position.
What is the correct method for using a suction bulb on a newborn?
Use the bulb syringe, decompress it before insertion, and always suction the mouth before the nose.
How can heat loss through convection be minimized in a newborn?
To minimize heat loss through convection, transport neonates in a crib with solid sides to reduce airflow around the infant.
How can heat loss through conduction be minimized in a newborn?
Place the infant on padded, covered surface and provide insulation using clothes and warmed blanket.
This condition is known as an infectious conjunctivitis among newborns.
Ophthalmia neonatorum
What is the eye care protocol for newborns?
(A) Prophylactic treatment for ophthalmia neonatorum
(B) Use Silver nitrate 1%, Erythromycin 0.5%, or Tetracycline 1% ophthalmic ointments
This is known as a method of preventing ophthalmia neonatorum by instilling 1% Silver Nitrate or antibiotic ointment in the newborn’s eyes.
Crede’s Prophylaxis
Why is vitamin K administered to newborns?
Because the newborn’s GIT is sterile and there is a lack of bacteria entailed for Vitamin K synthesis.
Where is vitamin K synthesized?
Intestinal Flora
What is the function of vitamin K?
Catalyzes prothrombin synthesis for blood clotting.
How much Vitamin K should be administered?
Administer 0.5 to 1 mg to prevent hemorrhagic disease
When is Hepatitis B vaccination given to newborns?
(A) 1st dose: Within 12 hours of birth
(B) 2nd dose: At 1 month
(C) 3rd dose: At 2 months
This is known as a great opportunity for general hygiene and observation. In this, the nurse must involve the parent in child care.
Bathing
What are the steps for newborn bathing?
(A) Teach parents to bathe from cleanest to most soiled (cephalocaudal method)
(B) Use water at 37-38°C. Check using elbow to wrist.
How should the umbilical cord be cared for?
(A) Clean from the base to top using betadine and alcohol.
(B) Clamp 1 inch from the base, and cut 1 cm from the clamp.
(C) Fold the diaper below the cord to avoid irritation.
(D) Avoid use of cream, lotions, and oil near cord area
This is used to detect congenital metabolic disorders and helps prevent mental retardation or death if untreated.
Newborn Screening
How should newborn screening be performed?
(A) Heel puncture to obtain 3 drops of blood on special filter paper
(B) Ideally done 48 to 72 hours after birth
What is the nurse’s role in newborn screening?
(A) Educate the parents about its importance.
(B) Obtain blood samples appropriately.
(C) It can be done 24 hours after birth or after feeding has been introduced.
Why is early detection important in newborn screening?
To reduce long term effects and healthcare costs.
What is the purpose of newborn hearing screening?
Detects possible hearing issues early, allowing prompt intervention.
When should breastfeeding be initiated?
Immediately after birth for the infant to suck the colostrum.
What are the formula-feeding guidelines?
(A) Wash hands and equipment well.
(B) Do not alter formula proportions or dilute it.
(C) Discard leftover milk.
(D) Refrigerate unused formula.
This is used to calculate the amount of milk formula.
Rule of Thumb
How is the amount of formula calculated for an infant?
(A) Add 2 or 3 to the infant’s age in months
(B) Example: 3-month-old needs 5-6 oz of formula per feeding
Why is burping important for infants?
Infants swallow air during feeding, which can cause regurgitation, abdominal distention and colic pain.
What are the techniques for burping an infant?
(A) Place baby over your shoulder and pat gently on the back.
(B) Hold baby in sitting position on your lap, lean forward, and support head.
(C) Lay the baby in prone position across your lap and pat the back.
How do you promote parent-infant bonding?
(A) Assess behaviors that initiate emotional bonds,
(B) Prepare older children sensitively for the arrival of a new sibling to minimize jealousy.
What are the nurse’s responsibilities for the newborn’s identification band?
(A) Verify information with birth records.
(B) Ensure that the ID band is securely fastened.
(C) Double-check the newborn’s ID band with the mother before discharge.
What should be recorded in the newborn’s chart?
(A) Time of birth
(B) Whether respiration was aided or spontaneous
(C) APGAR schore 1 and 5 minutes
(D) Eye prophylaxis, Vitamin K Administration
(E) If the infant voided or passed stool
(F) Number of vessels on the umbilical cord
How should the diaper area be cared for?
(A) Teach the mother to prevent diaper dermatitis.
(B) Aerate the area by removing the diaper periodically.
(C) Ammonia in the urine can irritate the infant’s skin.
What can be used to prevent diaper dermatitis?
Use talcum or cornstarch, petroleum jelly, or zinc oxide
What types of activities do newborns prefer?
(A) Animated and auditory objects
(B) Geometric shapes and checkerboard patterns
(C) Contrasting lights and reflective surfaces
Determine the type of stimulation.
(A) Look at the infant’s face.
(B) Hang bright shiny objects 8-10 inches from the infant’s face.
(C) Use mobiles with black and white designs.
Visual Stimulation
Determine the type of stimulation.
(A) Talk to the infant and sing in a soft voice.
(B) Play a music box, tape, or compact disc.
(C) Use a tickling clock nearby.
Auditory Stimulation
Determine the type of stimulation.
(A) Hold, caress, and cuddle the infant.
(B) Keep the infant warm.
(C) Swaddle the infant.
Tactile Stimulation
What are some examples of kinetic stimulation for infants?
(A) Rock the infant and place them in a cradle.
(B) Use strollers for walks.
Kinetic Stimulation
How many hours do newborns typically sleep in a day?
16 HOURS A DAY
What sleeping position is recommended for infants to prevent SIDS?
Position infants on their back instead of on their stomach.
How many hours per day do infants typically cry?
Infants cry an average of 2 hours per day.
What vaccinations should a child receive before their birthday for full immunization?
(A) OPV (Oral Polio Vaccine) - 3 doses
(B) DPT (Diphtheria-Pertussis-Tetanus) - 3 doses
(C) Hepatitis B - 3 doses
(D) BCG (Bacille Calmette-Guerin) - 1 dose
(E) Measles - 1 dose
What health teachings should mothers receive regarding breastfeeding?
(A) Teach how to prevent or relieve breast engorgement.
(B) Provide information on breastfeeding and introducing solid food.
(C) Provide a schedule for immunization.
(D) Give instructions on proper bathing, cord care, and diaper changing.
(E) Schedule a check-up for the mother 1 week after discharge.
