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OB > Module 5 Exam > Flashcards

Module 5 Exam Flashcards

1
Q

What do apgar scores measure?

A
  • performed immediately after birth
  • evaluates the condition of the newborn and how well he/she is adjusting to extra-uterine life
  • done at 1 & 5 minutes of life
  • should improve over time.
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2
Q

What are the 5 assessment factors for APGAR scoring?

A
  1. heart rate (most important)
  2. respiration
  3. muscle tone
  4. reflex irritability
  5. skin color (acrocyanosis)
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3
Q

How is an APGAR score assigned?

A

Each factor is assigned a score of 0-2 for a total score of 0-10.

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4
Q

How does a nurse interpret if an APGAR score is acceptable?

A
  • initial score at 1 min.
  • score of 7-10 = newborn in good condition, bulb suctioning, “blow-by” O2
  • score of 4-6 = need for stimulation
  • score of 3 or less = resuscitation may be needed
  • *a score of <3 at 5 min correlates with increased neonatal mortality
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5
Q

What is the acronym APGAR

A 
Appearance (skin color)
Pulse (pulse rate)
Grimace (reflex irritability)
Activity (muscle tone)
Respiration (breathing)
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6
Q

Apgar Scoring System

A
  • HR: Absent 0, 100 bpm 2
  • RR: Absent 0, slow; irregular 1, good breathing w/ cry 2
  • Muscle tone: Flaccid 0, some flexion of extremities 1, active movement of extremities 2
  • Reflex response: Absent 0, grimace; noticeable facial movement 1, vigorous cry; cough; sneezes; pulls away when touched 2
  • Skin color: Pale or blue 0, pink body, blue extrem. 1, pink body and extremities 2
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7
Q

Describe the cardiopulmonary and cardiovascular adaptations that occur as the newborn transitions to extra-uterine life:

A
  • onset of respiration triggers the necessary cardiovascular changes. As air enters the lungs, PO2 rises in the alveoli. Pulmonary arteries relax
  • decrease in pulmonary vascular resistance…had been increased during fetal life to move blood through ductus arteriosus
  • increase in pulmonary blood flow…normal flow established by 24 hours after birth
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8
Q

5 major areas of change in the cardiopulmonary adaptation:

A
  1. increased aortic pressure & decreased venous pressure.
    - clamping of umb. cord increases aortic pressure
    - blood return from IVC decreases
    - contributes to decreased RA pressure
  2. increased systemic pressure, decreased PA pressure
    - loss of placental low resistance circ. = inc. system. pres.
    - inc. blood PO2 dilates pulmonary blood vessels
    - decreased PA resistance
    * ***marks the transition from fetal to neonatal circulation
  3. closure of the foramen ovale
    - in utero RA pressure is greater. After birth, inc. pulmonary flow causes inc. in LA pressure. Functionally closed w/in a few hours.
  4. closure of ductus arteriosus
    - inc. in sys. pressure & dec. in pulmonary pressure reverse blood flow through ductus arteriosus. Increase in PO2 triggers it to constrict. Functionally closed w/in 10-15 hours of birth.
  5. closure of the ductus venosus
    - inc. pressure from clamping the umbilical cord triggers. Forces perfusion through the liver. Fibrosis w/in 2 months.
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9
Q

What is normal length for newborn?

A

average is 50 cm (20in)

range is 48-52 cm (18-22in)

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10
Q

What is normal head circumference for newborn?

A

average is 33-35 cm (13-14 in)
range: 32-37 cm (12.5-14.5 in)
newborn head is 1/4 size of body and approx. 2 cm larger than chest circumference

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11
Q

What is normal chest circumference for newborn?

A

average is 32 cm (12.5 in)
range: 30-35 cm (12-14 in)
normal chest is cylindrical & symmetrical

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12
Q

What is normal weight for a newborn?

A

average is 7 lbs 8 oz (3504 g)
range is 5lb 8oz to 8lb 13oz (2500-4000g)
5-10% weightloss for term newborns and up to 15% for preterm newborns is expected

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13
Q

What is normal heart rate for newborn?

A

110-160 bpm

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14
Q

What is normal RR for newborn?

A

30-60 breaths/min

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15
Q

What is normal temp for newborn?

A

Monitor q 30 min x 2 hrs then q 8 hrs

  • preferred route is axillary
  • range 97.5-99 F (36.4-37.2C)
  • high temp = dehydration
  • low temp = infection
  • sudden drop in temp r/t heat loss mechanisms after birth, stabilized in 8 to 12 hours.
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16
Q

Describe how a newborn regulates their temperature.

A

Factors that affect establishment of thermal stability of the newborn are:

  1. less SQ fat and a thin epidermis
  2. blood vessels closer to the skin
  3. flexed posture decreases surface area l/t decreased heat loss
    * *newborns require higher environmental temperatures to maintain normal temperatures than do adults**
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17
Q

What is NST?

A
  • Non-shivering thermogenesis; skin receptors perceive decreased temp
  • stimulate SNS to use brown adipose fat (BAT) to provide heat
  • major sources of heat production:
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18
Q

Convection

A

loss of heat from warm body surface to cooler air currents

Ex: AC in rooms, unwarmed O2 by mask, removal of infant from warmth source to perform tasks

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19
Q

Radiation

A

loss of heat from heated body surface to cooler surfaces/objects not in direct contact with the body
Ex: walls of the room or radiant warmer, ice for blood gases

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20
Q

Evaporation

A

loss of heat when water is converted to vapor.
Ex: wet from amniotic fluid & bathing
**accounts for 25% of heat loss immediately after delivery…KEEP BABY DRY

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21
Q

Conduction

A

loss of heat to a cooler surface by direct contact.

Ex: chilled hands, cold scales, cool stethoscopes

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22
Q

Describe the process of conjugation

A

change of bilirubin into excretable form that occurs within the liver.

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23
Q

Differentiate conjugated (direct) vs unconjugated (indirect) bilirubin.

A
  • conjugated (direct) bilirubin - excretable
  • unconjugated (indirect) bilirubin - NOT excretable & potential toxin
  • Total bilirubin is the sum of conjugated and unconjugated bilirubin
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24
Q

Differentiate physiologic vs pathologic jaundice

A
  • *PHYSIOLOGIC is a normal newborn response caused by:
  • accelerated destruction of RBCs (NB RBC lives 60-80 days)
  • impaired conjugation of bilirubin
  • increased bilirubin reabsorption from the intestinal tract
  • physiologic jaundice is common
  • shortened RBC lifespan, slower uptake by the liver, lack of intestinal bacteria, poorly established hydration from breastfeeding
  • characteristic yellow coloration results from increased levels of unconjugated bilirubin
  • occurs in 60% of term and 80% of preterm NBs
  • evidenced after first 24 hours of life
  • *PATHOLOGIC is jaundice evidenced in first 24 hours of life, or past 7 days of age. Bilirubin levels rise faster & higher than in physiologic jaundice
  • Risk factors: Rh - mom & Rh + baby, bruising from birth trauma, poor breastfeeding, preterm
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25
Q

Differentiate between breastfeeding vs breast milk jaundice.

A

BREASTFEEDING occurs in 1st days of life, associated w/ poor feedings (not abnormal milk composition), r/t inadequate intake & dehydration (encourage feeing q 2-3 hrs)
BREAST MILK: bilirubin rises after 1st week of life, r/t milk composition, breast milk that contains increased fatty acids that compete with bilirubin binding sites or inhibit conjugation, promotes reabsorption of bilirubin by intestines.
**temporary cessation of breastfeeding recommended if levels become too high.

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26
Q

What are some risk factors for jaundice?

A
  • Inability of bilirubin to bind to albumin (asphyxia, some meds (indomethacin), hypothermia, hypoglycemia
  • prematurity (less avail. albumin)
  • birth trauma, breastfeeding
  • ABO incompatibility (O mom, A/B fetus)
  • Rh incompatibility ( - mom, + fetus)
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27
Q

What are complications of jaundice?

A 
-hemolytic disease of the newborn (HDN)
     ABO incompatibility
     Rh incompatibility
-Kernicterus
      Depositing of unconjugated (indirect) bilirubin in the basal ganglia of the brain
       R/T untreated byperbilirubinemia
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28
Q

How is jaundice treated?

A
  • prenatal screen for Rh/ABO incompatibility (RhoGAM)
  • screening at 24 hrs of life & discharge (TCB then serum)
  • Coomb’s testing (indirect - Rh+ antibodies from fetus in mom’s blood) (direct - maternal antibodies in fetal blood)
  • frequent feedings
  • phototherapy
  • exchange transfusion (withdrawal & replacement of newborns blood with donor blood)
  • *Lights: position change, hydrate, protect eyes!!**
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29
Q

Physiologic jaundice

A
  • after 1st 24 hrs of life
  • during the first week of life, bilirubin should not exceed 13 mg/dl
  • bilirubin levels peak at 3 to 5 days in term infants
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30
Q

Breastfeeding jaundice

A
  • bili levels rise after the first 24 hours of age
  • peaks on 3rd or 4th day of life and declines through first month to normal levels
  • incidence can be decreased by increasing number of feeding episodes to 8 to 12 in 24 hrs.
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31
Q

Breast milk jaundice

A
  • bili levels begin to rise after the first week of life when mature breast milk comes in
  • peak of 5 to 10 mg/dl is reached at 2 to 3 weeks of age
  • it may be necessary to interrupt breastfeeding for a short period when bili reaches 20 mg/dl
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32
Q

Why is regurgitation common in the newborn?

A

immature cardiac sphincter

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33
Q

What can be done to decrease the occurrence of regurgitation?

A

avoid over-feeding and burp often.

34
Q

What is the acceptable weight loss in the newborn during the first few days of life?

A

5-10%

35
Q

First period of reactivity

A

birth - 30 min, awake and active

optimal time to initiate breastfeeding/parent-infant bonding

36
Q

Inactive to sleep phase

A

30 min to 2-4 hrs
no interest in sucking
difficult to awaken

37
Q

second period of reactivity

A

lasts 4-6 hours
hr & rr increased
respiratory & gastric mucus may increase
increased risk for gagging & choking

38
Q

Why are Vit K (Aquamethyton ) and Erythromycin (Ilocycin) given to newborns?

A

Vit K: prevent hemorrhage.

E-mycin: prevent infections of the eye from birth (Neisseria gonorrhea)

39
Q

Why are newborns more likely to be hypothermic in response to pyrogens than hyperthermic?

A

Poor hypothalamic response to pyrogens.

Hypothermia is a more reliable indicator of infection in the newborn.

40
Q

Which immunoglobulin is passed during the 3rd trimester and which is passed in colostrum?

A

Passive acquired immunity.
Mom passes her IgG antibodies to fetus in utero
Pass through placenta in 3rd trimester

41
Q

Briefly describe how the nurses assess gestational age based on posture:

A

approx. 31 wks: infant exhibits beginning of flexion of the thigh. Note the extension of the upper extremities.
approx. 35 wks: infant exhibits stronger flexion of the arms, hips and thighs.
Full-term: infant exhibits hypertonic flexion of all extremities

42
Q

Briefly describe how the nurses assess gestational age based on skin & lanugo

A

Preterm: skin appears thin & transparent
Near term: skin appears opaque, inc. SQ tissue
-Vernix dec. as gest. age inc., especially post-term
-Lanugo dec. as gest. age inc., greatest 28-20 wks.

43
Q

Briefly describe how the nurses assess gestational age based on plantar surfaces

A

sole creases begin at top (anterior) portion of foot and as gestation progresses, proceeds to heel.

44
Q

Briefly describe how the nurses assess gestational age based on breast tissue

A

as gestation progresses, breast bud tissue & areola enlarge. Term gestation: 0.5 - 1 cm ( 5-10 mm)

45
Q

Briefly describe how the nurses assess gestational age based on ear form & cartilage

A

Pinna is folded toward the face and released. If the auricle stays in the position in which it is pressed or returns slowly to its original position, it usually means the gestation age is less than 38 weeks.
<34 wks: ear is shapeless and flat
36 wks: some cartilage & incurving of upper pinna. Pinna springs back slowly when folded
Term: Pinna is firm & springs back quickly from folding

46
Q

Briefly describe how the nurses assess gestational age based on male genetalia

A

Preterm: testes are not within the scrotum. Scrotal surface has few rugae
< 36 wks: few rugae on scrotum, testes palpable in inguinal canal
36-38 wks: testes are in upper scrotum & rugae more pronounced
Term: testes in lower scrotum fully descended & rugae covers whole scrotal sac

47
Q

Briefly describe how the nurses assess gestational age based on female gentalia

A

30-32 wks: clitoris is prominent & labia majora are small/separated
36-40 wks: labia majora cover clitoris
> 40 wks: labia majora cover labia minora & clitoris

48
Q

Describe when parents need to call the dr and what they need to know

A
  • temp over 100.4 axillary or below 97.8
  • continual rise in temp
  • more than one episode of forceful vomiting or frequent vomiting over a 6-hour period
  • refusal of 2 feedings in a row
  • lethargy, difficulty to wake
  • cyanosis
  • absence of breathing longer than 20 seconds
  • inconsolable or high-pitched cry
  • discharge or bleeding from umbilical cord, circumcision, or any opening.
  • 2 consecutive green, water stools, or black stools, or inc. frequency of stools
  • no wet diaper for 18 to 24 hours or fewer than 6-8 per day after 4 days of age
  • development of eye drainage
49
Q

How often should a baby breastfeed?

A

8-12 times a day, every 3-4 hours

50
Q

How often should a baby bottle feed?

A

6-8 times a day, every 3-4 hours

51
Q

Describe the nurses role in circumcisions

A
  • observe for abnormal bleeding, infection (apply pressure)
  • observe for first void
  • apply pet. jelly w/ each diaper change (gauze)
  • heals in 7 to 10 days
  • plastibell; no pet. jelly, falls off/remove by day 8
52
Q

what is acrocyanosis?

A

bluish discoloration of hands & feet. nailbeds are poor indicator of oxygenation.

53
Q

When is it normal to see acrocyanosis?

A

Up to 24 hours after birth.

54
Q

Milia

A
  • exposed sebaceous glands.
  • Disappear within a few months.
  • Raised white spots on the face (nose).
55
Q

Vernix caseosa

A
  • whitish, cheese-like substance that protects skin in utero

- decreases in term/post-term infants

56
Q

Erythema toxicum

A
  • newborn rash
  • lesions in the area surrounding a hair follicle
  • firm and vary in size
  • may be white/pale w/ reddened base
  • peak in 24 to 48 hrs
  • disappear w/in a few days
57
Q

Mongolian spot

A
  • bluish/black/gray pigmented areas on dorsal area & buttocks
  • common in Asian, Hispanic, AA
  • gradually fade after 2 years of life
58
Q

Telangiectatic vevi

A
  • Stork bites
  • pale pink/red spots
  • common on eyelids, nose, lower occipital bone/nape of neck
  • common w/ light complexions
  • no clinical significance
  • fade by 2nd year of life
59
Q

Nevus flammeus

A
  • port-wine stain
  • directly below epidermis
  • non-elevated & sharply demarcated
  • red/purple coloration (does not blanch)
  • size/shape varies; common on face
  • does not grow in size & does not fade over time
60
Q

Nevus vasculosus

A
  • strawberry mark
  • involves dermal & subdermal layers
  • raised & clearly delineated
  • red in color & rough surfaced
  • commonly found on the head
  • grows rapidly, will disappear
61
Q

Cephalohematoma

A

-collection of blood between crania bone and periostal membrane
-does not cross suture lines
-appears between first and second day
=disappears after 2 - 3 weeks or may take months

62
Q

Caput Succedaneum

A
  • collection of fluid, edematous swelling of the scalp
  • crosses suture lines
  • present at birth or shortly thereafter
  • reabsorbed within 12 hours or a few days after birth
63
Q

Describe what a nurse might find upon assessment of the NB eyes

A

Assess: size, equality of pupils, reaction to light, blink reflex, edema/inflammation

  • eyelids are often edematous r/t pressure from birth
  • eye color established by 3 mos (may change in 1st yr)
  • often tearless cry r/t lacrimal immaturity until 2 mos old
64
Q

Dolls eyes

A

-present for about 10 days. -
newborn head position changes w/ eyes moving to opposite direction
-r/t underdeveloped head-eye coordination

65
Q

Subconjunctival hemorrhage

A
  • appears in about 10% of NB r/t vascular tension from birth

- will resolve on its own

66
Q

Transient strabismus

A

r/t poor neuromuscular control of eye muscles.

67
Q

Describe what a nurse would find upon assessment of NB cry and respirations

A
  • nose breather for first few months
  • nose is patent if infant can breathe w/ mouth closed
  • smell intact if turn toward milk/formula
  • respirations CTA, diaphragmatic, shallow & irregular
  • S/S resp. distress: flaring, retractions, grunting/sighing, tachypnea
68
Q

Are brief periods of apnea normal?

A

Yes. may have brief periods w/out color/HR changes

Last less than 10-15 seconds

69
Q

Tonic neck/Fencer position

A

head vs extremities

lasts to about 3 months

70
Q

Stepping

A

most pronounced at birth and is lost about 4-8 wks

71
Q

Moro

A

Present until about 6 months

“startle reflex”

72
Q

Sucking

A

disappears about 12 months

73
Q

Hormonal control of breastfeeding during pregnancy

A
  • increased estrogen stimulates breast duct development

- increased progesterone promotes development of lobules/alveoli

74
Q

Breastfeeding hormonal control after deliver of placenta

A
  • progesterone decreases and triggers breast milk production
  • prolactin is stimulated from the anterior pituitary to stimulate the milk-secreting cells in the alveoli to produce milk
75
Q

Differentiate foremilk vs hindmilk

A
  • foremilk: milk that flows at the beginning of a feeding. Milk that has tricked between feedings to fill the lactiferous ducts. high protein/low fat
  • Hindmilk: milk that flows during the “let down”; after about 2 minutes; high in fat & calories
76
Q

Differentiate SGA vs IUGR

A

SGA: infants that are < 10 percentile for birth weight. May be preterm, term, or post-term. Constitutionally small.
IUGR: advanced gestation w/ limited growth. Often grows normally until 38 wks. Pathologically small.

77
Q

What are some complications of IDM babies?

A
  • immature physiologic functions
  • congenital birth defects (kidney, heart, GI & NTD)
  • hypoglycemia
  • hypocalcemia
  • birth trauma (hyperbilirubinemia)
  • polycythemia
  • RDS
78
Q

Define hypoglycemia in the newborn

A

Plasma glucose concentration of less than 40 mg/dl

79
Q

Which infants are at risk for hypoglycemia?

A
  • IDM
  • SGA
  • smaller twin
  • pre-eclampsia mother
  • male infants
  • preterm AGA infants
80
Q

S/S of hypoglycemia in an infant

A 
lethargy
apathy
limpness
poor feedings
pallor/cyanosis
hypothermia
apnea
RDS
tremors/seizures
weak/high-pitched cry
****Adequate caloric intake is important
81
Q

Define preterm, late preterm, early term, full term, late term, post term

A 
preterm: < 37 wks
late preterm: 34-36 6/7
early term: 37 -38 6/7
Full term: 90 - 40 6/7
Late term: 41 - 41 6/7
Post term: > 42
82
Q

What is postmaturity syndrome?

A
  • infant born after 42 wks gestation and displays signs of post-maturity syndrome r/t aging placenta.
  • Manifestations: dry, cracking skin, no vernix/lanugo, SQ wasting, loose skin, body long/thin, long fingernails, meconium staining
  • Complications: hypoglycemia, meconium aspiration, polycythemia, congenital anomalies, seizure activity, cold stress

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