Module 6 (Exam 1)

Question 1

Acrocyanosis

Answer 1

Dusky coloration of hands and feet

When is it normal?

• Normal during 1st 24 hours after birth
• May also be prompted by cold stress

Question 2

Lanugo

Answer 2

Fine, downy hair found on all parts of the fetus except the palms and soles

Question 3

Vernix caseosa

Answer 3

Protective, cheese-like substance present on fetal skin in utero

Question 4

Neonatal transition

Answer 4

First few hours of life, during which the neonate stablilizes respirator and circulatory function

Question 5

Surfactant

Answer 5

Lipoprotein secreted by alveoli to reduce surface tension of pulmonary fluids and allow the lungs to remain inflated after the first breath (slippery detergent like substance)

Question 6

Periodic Breathing

Answer 6

Neonatal breathing pattern, characterized by pauses lasting 5 to 15 seconds, rarely associated with skin color and/or heart rate changes

Question 7

Apnea

Answer 7

Cessation of breathing lasting more than 20 seconds and accompanied by generalized cyanosis: abnormal in the term neonate

Question 8

Cold Stress

Answer 8

Metabolic response to loss of body heat characterized by increased oxygen needs, hypoglycemia, and metabolic acidosis

Question 9

Brown Adipose Tissue (BAT)

Answer 9

Fat deposits in neonates providing heat-generating ability: found around kidneys, adrenals, neck, between the scapula and behind the sternum

Question 10

Neutral Thermal Environment

Answer 10

Environment in which the infant maintains temperature without physiologic stress

Question 11

Non-Shivering Thermogenesis

Answer 11

Metabolism of brown adipose tissue to maintain temperature

Question 12

Normal Temperture Neonate

Answer 12

36.5-37.5 C

Question 13

Normal Pulse Neonate

Answer 13

120-160 beats/minute

Question 14

Normal Respirations Neonate

Answer 14

30-60 breaths/minute

Question 15

Normal Neonate Cry

Answer 15

Strong, lusty, medium pitch

Question 16

Abnormal Neonate Cry

Answer 16

Shill cry is abnormal and may indicate hypoglycemia or neurologic disorder

Question 17

Nursing responsibilities associated with airway clearance in the neonate

Answer 17

• Secretions in the mouth and nose are assessed and removed with the bulb syringe
• Bulb syringe is kept with neonate at all times

Question 18

Signs of neonatal respiratory distress

Answer 18

1. Grunting
2. Nasal Flaring
3. Retraction of intercostal muscles
4. Tachypnea
5. Cyanosis (central or circumoral)

Question 19

Signs of early idenfication of hypoglycemia in the neonate

Answer 19

1. Jitteriness
2. Temperature instability
3. Poor feeding pattern
4. BG <40 mg/dL

Question 20

Possible reasons for jitteriness in the neonate

Answer 20

1. May indicate hypoglycemia or substance withdrawal
2. Immediate blood glucose check

Question 21

Infant weight

Answer 21

2500 to 4000 grams

Question 22

Infant Head and Chest Circumfrance

Answer 22

~32-37cm (chest)

Head is 2cm greater than chest circumfrance

Question 23

What color will the urine show up with uric acid crystals?

Answer 23

Red (tinged)

Question 24

Moro

Answer 24

Startle reflex

Question 25

Root reflex

Answer 25

infant will move towards finger placed on cheek

Question 26

Babinski

Answer 26

Toes flare out

Question 27

How often should infants breastfeed?

Answer 27

q1/2-3 hours for breastfeeding

q 3-4 hours formula feeding

Question 28

Feeding Cues

Answer 28

1. Alert, seeking behavior
2. Mouthing, rooting, fist-to-mouth
3. Crying is a late sign of hunger

Question 29

When should the initial meconium stool be excreted?

Answer 29

within first 12-24 hours of life…until day 2

Question 30

When should the infant void for the first time?

Answer 30

Within first 12-24 hours of life

Question 31

Discharge void/stool instruction

Answer 31

Minimum 6 voids and 1-2 stools/24 hours after second milk comes in (day 3 or 4)

Question 32

What is the maximum safe weight loss?

Answer 32

10%

Should regain birthweight by 10 days