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247 > Module 4A > Flashcards

Module 4A Flashcards

1
Q

what is RAPP

A

Newborn assessment tool
Respiratory
Activity
Perfusion/color
Position/tone

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2
Q

When is the 1st, 2nd and 3rd RAPP assessment performed?

A

1st in birthing area
2nd within 2-4hrs
3rd before discharge

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3
Q

What are some signs that indicate a problem in initial newborn assessment

A

Nasal flaring
Chest retractions
Grunting on exhalation
labored breathing
Generalized cyanosis
Abnormal breath sounds
Abnormal respiratory rates (+60, -25)
Flaccid body posture
Pallor
Apneic episodes
Abnormal HR (+160, -100)
Abnormal size of body

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4
Q

When is APGAR score done?

A

At 1 minute
5 minutes
and again at 10 mins if 5 min score was less than 7pts

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5
Q

What does 1 min and 5 min apgar score tell us?

A

1min - data about newborns initial adaptation to extrauterine life
5 min - Newborns overall CNS

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6
Q

What 5 parameters are assessed with APGAR?

A

A - appearance (color)
P - Pulse
G - grimace (reflex irritability)
A - activity (muscle tone_
R - Respiratory

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7
Q

How does APGAR scoring work?
What does final scores mean?

A

0-2 for each category. 0-absent or poor. 2-normal response
8-10- normal
4-7 moderate difficulty
0-3 Severe distress in adjusting

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8
Q

When a newborn is expierencing physiologic depression what predictable manner do APGAR scoring disappear?

A

Pink color is lost
then respiratory effort
then tone
followed by irritability reflex and finally hR

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9
Q

What is expected lenght for full term newborn

A

17-22in

44-55cm

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10
Q

What are normal newborn weights?

A

Grams - 2500-4000g
(5lb8oz - 8lb14oz)

Anything higher or lower is considered outside normal range

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11
Q

Newborns can lose how much weight by 3-4 days?
when is weightloss usually regained?

A

10%
Regained by 10th day

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12
Q

How are newborn birth weights classified?
Low
Very low
Extremely low

A

Low - >2500g/>5,5;b
Very low- >1500g / 3/5lb
Extremely low- >1000g/>2.5lb

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13
Q

What is HR and RR for immediate newborn
-How often assessed after birth? then after stabilized?

A

HR - 110-160
RR - 30-60
Assessed q 30 until 2 hours post birth then q 8hours

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14
Q

Once born, gestational age is determined by what 2 tests?

A

Ballard gestational age
or Ballard scale

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15
Q

What weeks are gestational age

Preterm
Term
Post-term
Postmature

A

Preterm - before 37 wks
Term- 38-42
Post-term - after wk 42
Postmature - after 42 and signs of placental aging

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16
Q

Newborns can also be classified by weight
SGA - Small for gestational age
AGA - Appropriate for gestational age
LGA - Large for gestational age

A

SGA - Small for gestational age - less than 10th percentile (less than 5.5;b)
AGA - Appropriate for gestational age - between 10th-90th percentile
LGA - Large for gestational age - more than 90th percentile (over 9lb)

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17
Q

What 2 medications are given to immediate newborn

A

Vitamin K
Eye prophylaxis erythromycin or tetracycline ophthalmic ointment

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18
Q

Ophthalmia neonatorum

A

Hyperacute purulent conjunctivitis occuring during first 10 days of life

Contracted by birth with mom with gonorrhea and chlamydia / potentially blinding

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19
Q

What is a typical newborn head circumference

A

32-38cm (13-15in)

*should be 1/4 of newborn length or 1/2 length + 10cm

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20
Q

What could a small infant head indicate

A

Microcephaly caused by rubella, toxoplasmosis, SGA status

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21
Q

What could a enlarged infant head indicate

A

hydrocephalus or increased intracranial pressure

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22
Q

What should infant chest circumference be

A

1-2cm less than head circumference

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23
Q

Acrocyanosis

A

Persistent cyanosis of fingers, hands, toes and feet with mottled blue or red discoloration and coldness

*normal and intermittent

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24
Q

Vernix Caseosa

A

Thick white substance that protects skin of fetus
2-3days post birth

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25
Q

Stork bites

A

Salmon patches - superficial vascular areas found on nape of neck, eyelids, between eyes and upper lip

26
Q

MIlia

A

multiple pearly white or pale yellow unopened sebaceous glands freq found on newborn nose, chin or forehead
Disappear in 2-4wks

27
Q

Epstein pearls

A

When Milia occur in newborns mouth and gums

28
Q

Mongolian spots

A

Benign blue or purple splotches that appear solitary on lower back and but of newborns, may occur on legs and shoulders

29
Q

Erythemia toxicum

A

Benign generalized transient rash that occurs in up to 70% of all newborns during 1st week of life consisting of small papules that resemeble flea bites

30
Q

Harlequin sign

A

Dilation of blood vessels on only one side of body. Appearance of wearing a clown suit. Distinct midline demarcation

-From immature autoregulation of blood flow commonly seen in low birth weight
**last 20 min no intervention needed

31
Q

Nevus flammeus

A

Port wine stain

Commonly appears on newborn face and other body areas

Capillary angioma located below dermis / flat with sharp demarcations and purple red

Permenant assoc with structural malformations, bony/musclur overgrowth, certain cancers

32
Q

Nevus Vasculosus

A

Strawberry mark

Benign capillary hemangioma in dermal or subdermal layers. Raised, dark red and sharply demarcated. Commonly in head

Common in premature infants less than 1500g

33
Q

Microcephaly

A

Head circumference more than two standard deviations below avg or less than 10% of normal parameters for gestational age caused by failure of brain development

34
Q

Conditions assoc with microcephaly

A

Seizures
Developmental delay
Intellectual disability
Hearing loss
problem with vision, movement, balance and feeding

35
Q

Macrocephaly

A

Usually benign that does not require intervention
Head circumference more than 90% of normal, related to hydrpcephalus

36
Q

Large fontanels

A

More than 6cm in anterior and more than 1cm in posterior

Poss assoc with malnurition, hydrocephaly, congential hypothroidism, trisomies 13, 18, 21 and various bone disorders

37
Q

Sucking reflex

A

Elicited by gently stimulating newborns lips by touching them
Normal - open mouth and begin sucking motion

38
Q

Moro reflex
aka Embrace reflex

A

Occurs when neonate is startled

PLace baby on back, support upper body w/o lifting then release newborn suddenly
Normal - throw arms outward and flex knees, then arms return to chest, fingers spread to form a C shape

39
Q

Stepping reflex

A

Holding newborn upright and inclined forward with soles of feet touching a flat surface

Normal - baby should make stepping motion

40
Q

Pseudomenstruation

A

Vag discharge from female baby composed of mucus mixed with blood present during first few weeks of life

No treatment

41
Q

Tonic neck reflex

A

Resembles stance of a fencer

Lie newborn on back, turn babies head to one side, arm which baby is facing whould extend straight with hand partial open. Arm on other side is flexed and fist clentched. Reversing direction on which fetus is turned reverses position

42
Q

Babinski reflex

A

Present at birth, disappears by 1 year
Stroking lateral sole of food from heel across ball of foot. Toes should fan out

**diminished response indicates neurological problem and needs follow up

43
Q

Palmer grasp
Planter grasp

A

Palmer - place a finger on newborns open palm. Babies hand will close around finger, attempting to remove finger will cause baby to tighten grasp

Planter - Place finger just below toes. Toes typically curl over finger

44
Q

Truncal incurvation reflex (galant reflex)

A

Present at birth and disappears in a few day sto 4 wks

Prone position, apply firm pressure and run finger down either side of spine. Caues pelvis flex toward stimulated side. Indicated T2-S1 innervation

Lack of response indiacted neurologic or spinal cord problem

45
Q

Anocutaneous reflex (anal wink)

A

Stim perianal skin close to anus. External sphincter will constrict

Indicated s4-S5 innervations

46
Q

How many urine diapers indicated a hydrated newborn?

A

6-12 a day

47
Q

When does umbilical cord slough off

A

7-10days

48
Q

Is cord bleeding or drainage normal

A

No - bleeding may occur is cord clamp is loose
Drainage is sign of infection, needs immediate treatment

49
Q

Risks of circumcision

A

INfection
Hemorrhage
Skin dehiscence
adhesions
Urethral fistula
Pain

50
Q

Benefits of circumcision

A

UTIs less common
STI less common
Lower rate of penile cancer

51
Q

Preop circumcision prep includes

A

12hrs or older
Received Vit K
Voided normally at least once
Not eaten for last hour
Written consent
Correct ID

52
Q

What is continued care for circumcision

A

Assess for bleeding q 30mins for 2 hours
Docu 1st void
Squeeze soapy water daily and pat dry
Apply petroleum jelly every diaper change

53
Q

Factors assoc with increased hearing loss in newborns

A

Congenital infections (rubella, herpes, toxoplasmosis)
Craniofacial anomalies
Low birth weight
Postnatal infections (Bacterial meningitis)
Head truma
Hyperbilirubinemia
Exposure to ototoxic drugs (aminoglycosides)
Perinatal asphyxia

54
Q

What are caloric needs for newborn?
What are fluid requirments for newborn

A

110-120 cal/kg of body weight
100-150ml/kg daily

55
Q

Breast milk and formula contain how many cal/oz?

A

20cal/oz

56
Q

AAP recommends all infants receive daily supplement of how much vitamin D

A

400iu starting first few days of life to prevent rickets and deficiency

57
Q

What is Soy formula usually given for

A

Infants with Galactosemia
Its corn based

58
Q

What is Hypoallergenic formula usually given for

A

Infants with milk protein allergy
Extensively hydrolyzed
Corn or sucrose source

59
Q

What is nonallergenic formula usually given for

A

INfants with milk protein allergy
Amino acids as a protein source
Corn or sucrose carb source

60
Q

What is antireflux formula usually given for

A

Infants with gastric reflux
Protein source - cows milk
Carb source - lactose thickened with rice starch

61
Q

What are the types of holds for feeding

A

Football - under arm pit
Crosscradling
Across the lap
Side lying

62
Q

What are some readiness cues that a baby is ready for food

A

about 6 months
Consume 32pz daily
Ability to sit up with minimal support and turn head
Reduction of protrusion reflex
Demonstrating interest in food
Ability to open mouth automactically when food approaches

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