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NM 717 Comps > Module 7 Newborn Flashcards > Flashcards

Module 7 Newborn Flashcards

1
Q

What is a normal RR for a newborn?

A

30-60 breaths/min

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2
Q

Describe normal breathing of a newborn.

A

Diaphragmatic and abdominal breathing
Obligate nasal breathers
No retractions

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3
Q

What is a normal HR for a newborn?

A

100-160 bpm

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4
Q

What is a normal BP for a newborn?

A

Systolic 63 mmHg

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5
Q

What is the normal axillary temp for a newborn?

A

36.5-37.5C
37.7-99F

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6
Q

What is the avg. head and chest circumference of a term newborn?

A

Head: 32-38 cm
Chest: 30-36 cm

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7
Q

How should cord blood be collected?

A

Needle aspiration of 2 samples
One venous and one arterial
Use a tuberculin syringe 25-27 gauge needle.

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8
Q

How can you prevent heat loss from convection?

A

Turn off fans, block draughts

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9
Q

How can you prevent heat loss from conduction?

A

Skin-to-skin or warming bed

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10
Q

How can you prevent heat loss from radiation?

A

Keep baby away from cold windows or use curtains

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11
Q

How can you prevent heat loss from evaporation?

A

Dry skin

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12
Q

When is shivering seen in a newborn?

A

only seen in SEVERE cold stress

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13
Q

Describe nonshivering thermogenesis.

A

utilization of brown fat for heat production (also burns glucose)
it’s the primary purpose of brown fat
the cold stimulus of leaving the mother’s warm body triggers the newborn’s hypothalamus to oxidate stored lipids in brown adipose thereby producing heat (a-Mazing!)

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14
Q

Why do newborns with hypoglycemia or thyroid dysfunction have more cold stress?

A

Newborns with hypoglycemia or thyroid dysfunction can’t efficiently use brown adipose stores

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15
Q

What are the clinical signs of hypothermia in the newborn?

A

low core temp
cold skin, pale skin, pallor, hypotonia, lethargy or irritability, poor feeding or vomiting tachypnea, increased HR
any hypothermic newborn should be evaluated for hypoglycemia

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16
Q

What are risk factors for hypoglycemia?

A

growth restriction
Large for gestational age
PreTerm
Post-term
Newborns who have experienced some form of distress prior to birth
newborns who have experienced some for of distress AFTER birth

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17
Q

What level glucose is expected at 3-4 hours of life?

A

Levels stabilize at about 3-4 hours after birth (at least 40 mg/dL)

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18
Q

What level glucose is expected at 12 hours of life?

A

Stabilize after 12 hours of life to 45mg/dl or greater

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19
Q

What are the signs and symptoms of hypoglycemia?

A

jitteriness, cyanosis, apnea, weak cry, lethargy, limpness, and refusal to feed

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20
Q

What adverse outcomes are associated with hypoglycemia?

A

damage to the occipital area of the brain = seizures
intellectual disability
attention-deficit disorder

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21
Q

What are potential signs of infection in a newborn?

A

Changes in:activity, tone, color, or feeding

LACK OF FEVER does NOT exclude the possibility of infection!!!

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22
Q

What is the main weakness of newborns and what does it make them high risk for?

A

INABILITY TO LOCALIZE INFECTION

SYSTEMIC INFECTION IS A HIGH RISK

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23
Q

What is the primary line of defense in newborns?

A

Innate immunity

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24
Q

What is the difference between IgG and IgM?

A

IgG=Past infection
IgM=current infection (“I’ve got it and I’m miserable”)

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25
Q

Which immunoglobulins do not cross the placenta?

A

IgM and IgA

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26
Q

Which immunoglobulin is associated with breast milk?

A

IgA

Breastmilk contains a significant amount of secretory IgA that protects the infant from microbes in the maternal intestinal tract
IgA - Areola”(the infant gets IgA from breastmilk)

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27
Q

What are the components of APGAR score?

A

Color (Appearance)
HR (Pulse)
Reflex Irritability (Grimace)
Muscle Tone (Activity)
Respiratory Effort (Respirations)

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28
Q

When is cord clamping recommended?

A

3-5M after skin-to-skin is initiated

Appendix 30A p. 1127- Clamp the cord with 2 clamps placed close together near the newborn’s umbilicus after at least 1-3 minutes or when the cord stops pulsating

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29
Q

When performing NRP, what actions should be taken for a HR <100 but >60?

A

HR below 100? PPV
HR still below 100? Ventilation corrective steps/ETT?

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30
Q

When performing NRP, what actions should be taken for a HR <60?

A

HR below 60? intubate/chest compressions & 100% o2
HR still below 60? IV epi

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31
Q

What is the dose of epi that should be given during NRP?

A

The IV dose of epinephrine is 0.02 mg/kg, followed by a normal saline flush.

If umbilical venous access has not yet been obtained, epinephrine may be given by the
endotracheal route in a dose of 0.1 mg/kg.

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32
Q

How often can epi be given in the newborn?

A

dosage interval for epinephrine is every 3 to 5 minutes if the heart rate remains less than 60/min

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33
Q

What is caput succedaneum?

A

edematous collection of serosanguineous and subcutaneous fluid
on the presenting part of the head
poorly defined margins
crosses suture lines (like a baseball CAP)
not markedly tense
Think “not so concerning, we are chilling at a baseball game”

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34
Q

What is a cephalohematoma and a key sign?

A

a collection of blood under the periosteum of one of the cranial bones (usually parietal)
the blood DOES NOT cross the suture line
sometimes occur with skull fractures

35
Q

What is Erb-Duchenne paralysis?

A

generalized loss of movement in the affected arm with an adduction of the lower part of the arm
“waiter’s tip” sign -
-internal rotation of the lower portion of the arm with the finger and wrist flexed
-grasp reflex is intact (can hold a tip!)$$
-Moro reflex is weak on the affected side

cervical roots C5 and C6

36
Q

What is Klumpke’s paralysis?

A

the grasp reflex is absent
infant’s hand is kept in a claw-like posture
roots C8 and T1141

37
Q

How can we prevent hypothermia in the newborn?

A

Prewarm the resus area
Set room temp to 75F
Prewarm blankets/clothing
Place skin-to-skin immediatly
Gently dry the newborn and replace wet blankets
Postpone the bath for 2 hours of a stable temp
Keep the newborn from windows, walls, and doorways
Keep the head covered and body wrapped

38
Q

According to current recommendations, how should a heel stick be performed?

A

heel stick- capillary blood sample
**it is NO LONGER RECOMMENDED TO WARM THE HEEL
avoid puncturing sensitive structures on the back of the heel
automated blood collection device better than manual lancets & squeezing the heel (creates hemolysis)
cleans the heel with antiseptic followed by sterile water then air dry (avoid alcohol)

39
Q

How should the provider respond to a heel stick of 45-50 or lower?

A

**Heel stick glucose value of 45-50 mg/dL or lower should be verified immediately via a venous sample
**Consult the pediatric provider

40
Q

What steps should be followed for a low glucose in the newborn?

A

First step: Verify with venous sample
Second step: (while waiting for labs results) feed the infant)
Third step: repeat glucose test 30 min after feeding

41
Q

When should the pediatrician be consulted for a low glucose?

A

If a glucose below 45 was confirmed

42
Q

What is the recommendation for eye prophylaxis in the newborn?

A

Erythromycin 0.5% ophthalmic ointment per CDC rec

Should be applied within 2 hours of birth

43
Q

How should the provider apply erythromycin?

A

Should be applied within 2 hours of birth
Can delay 30 minutes to promote en face interactions with parents and newborns
place medication on each of the lower conjunctival sacs and spread with gentle massage of the eyelids.
Can wipe away excess ointment after 1 minute
eyes should not be irrigated.

44
Q

Why is vitamin K recommended for all newborns?

A

It promotes clotting and Hemolytic disease of the newborn

Vitamin K is a byproduct of gut bacteria that takes 10-14 days to establish

45
Q

How should the provider respond if a patient requests oral vitamin K?

A

IM vitamin K is the only route approved by the FDA and the oral dose may be subtherapuetic

46
Q

When is the Hep B vaccine recommended for the newborn?

A

Within the first 12 hours of life for all newborns

47
Q

What are the risks for the newborn of a Hep B positive mother if they are not vaccinated?

A

development of chronic hepatitis B
potentially fatal hepatic carcinoma or cirrhosis

48
Q

What should be given to a newborn of a Hep B positive mother?

A

Give hep B vaccine and HBIG immunoglobulin within 12 hours of birth.

49
Q

What is gastroschisis?

A

eviscerated abdominal organs are not covered by a peritoneal membrane sac

50
Q

What is an omphalocele?

A

abdominal organs are external but are covered by peritoneal membrane that protects the intestines from exposure to amniotic fluid and after birth, ambient air

51
Q

How does the CNM/APRN manage gastroschisis and omphalocele?

A

immediate call for pediatric assistance

Followed by:
transport to a tertiary pediatric hospital or unit
place in a radiant warmer in as sterile an environment as possible
sterile, warmed saline is applied to the eviscerated abdominal contents via sterile gauze pads
Torso wrapped in sterile gauze to keep the saline in place
a feeding tube is inserted and any stomach contents are aspirated
acute need for IV fluids

52
Q

What is a meningocele?

A

bony defect of the spinal cord

53
Q

What is a meningomyelocele (spina bifida)

A

the vertebra is defective and the spinal cord and spinal roots are externally located in a meningeal sac
found in the lower spine, lumbar and sacral areas

54
Q

How are neural tube defects in the newborn managed by the CNM/APRN?

A

Immediate pediatric consult

application of a sterile, warm saline dressing
dry sterile overwrap
thermoregulation
fluid maintenance
position infant prone
scrupulously avoid fecal contamination

55
Q

What are the signs and symptoms of a tracheoesophageal fistula and esophageal atresia?

A

excessive salivation- frothy
respiratory distress
swallowing problems
abdominal distension

56
Q

How are tracheoesophageal fistula and esophageal atresia diagnosed?

A

sterile feeding tube introduced to esophagus will not pass more than 10-12 cm

57
Q

How are tracheoesophageal fistula and esophageal atresia treated?

A

position the newborn prone
head elevated
oral feedings withheld
aspiration of the esophageal contents by feeding tube attached to a syringe

58
Q

What are the signs and symptoms of diaphragmatic hernias?

A

decreased left-sided breath sounds
heart sounds on the right side
severe respiratory distress at birth s/t persistent pulmonary hypertension

**usually unilateral on the left

59
Q

How should the CNM/APRN manage a diaphragmatic hernia?

A

Immediate Pediatric care

This is a surgical emergency

60
Q

What newborn screens should be done on all newborns?

A

Screens for MANY conditions

PKU- phenylketonuria is one
Needs to be done after 24 hours of age for accuracy
No test should be included in a state newborn screening program unless treatment exists

61
Q

How should the cord be cared for after brith?

A

Keep it dry

62
Q

What is the current recommendation for bathing a newborn?

A

Delay bath for 6 hours (WHO)
Water alone is as effective as mild soaps

63
Q

Describe newborn hearing testing.

A

Step 1: Otoacoustic emissions
Step 2: Auditory brainstem response

If both are positive-testing will be done by the pediatrician

64
Q

What causes physiologic jaundice?

A

physiologic jaundice is the result of increased production of bilirubin at a time when elimination is delayed

ALL newborns develop rising total bilirubin levels in the first few days after birth

the mean peak of total bilirubin plasma levels is 48-92° after birth (2-3.5 days)
the average value is 7-9 mg/dL

65
Q

How can jaundice be prevented?

A

early and frequent feedings to promote the passage of meconium
all parents should be educated about newborn jaundice

teach to assess the newborn in a well-lighted room by blanching the skin to reveal the underlying color

66
Q

What is the common screening for jaundice?

A

some hospitals screen all newborns with serum total bilirubin at 1 day of age

infants with a level less than 5 mg/dL are not rescreened unless the clinical picture changes

67
Q

When does pathologic jaundice occur? and what is the peak total serum bilirubin?

A

within 24 hours
>13

Concern for:
-cephalohematoma
-ABO blood group or
-RH incompatibility
-polycythemia

68
Q

When does physiologic jaundice occur? And what is the peak total serum bilirubin?

A

days 2-4 after birth
<13

69
Q

When does breast milk jaundice occur? and what is the peak total serum bilirubin?

A

After the 1st week
<10 (mildly elevated)

70
Q

When does breast milk failure jaundice occur? and what is the peak total serum bilirubin?

A

within the 1st week
>13

71
Q

What are the signs and symptoms of pathologic jaundice?

A

vomiting
lethargy
poor feeding
weight loss
hepatosplenomegaly
apnea
temperature instability
tachypnea
dark urine
urine positive for bilirubin
light-colored stools
jaundice that persists for more than 3 weeks

72
Q

What level total serum bilirubin is associated with bilirubin-induced neurologic dysfunction?

A

total bilirubin level higher than 25-30 mg/dL is associated with a risk for bilirubin-induced neurologic dysfunction (BIND).

73
Q

What are the signs and symptoms associated with a ventral septal defect?

A

tachypnea
feeding problems
failure to thrive
a parent may describe troubling symptoms during a PP visit or during calls about breastfeeding
**Cyanosis often is NOT present

Small defect: systolic murmur

74
Q

What is the outcome of a ventral septal defect?

A

oxygenated blood crosses over the opening in the septum and recirculates through the lungs

May lead to congestive heart failure.

75
Q

What are the signs and symptoms of persistent pulmonary hypertension?

A

tachypnea
nasal flaring
intercostal retractions

76
Q

What is the outcome of persistent pulmonary hypertension?

A

pulmonary resistance remains so high that blood flow through the newborn lungs is decreased

the ductus arteriosus and the foramen ovale may stay open to provide right-to-left shunting

77
Q

What weight loss should result in a peds referral?

A

If more than 5-7 % of birth weight lost = refer

78
Q

What weight gain should result in a peds referral?

A

If not gaining between 150 - 200 g per week OR if not PAST birth weight by day 14 = refer

79
Q

When should weight gain begin in the newborn?

A

Weight gain should begin at the end of 1st/beginning of 2nd week

80
Q

How many calories per ounce is human milk?

A

human milk is approximately 19-20 calories/ fluid ounce

81
Q

What is the expected kCal per kg/day intake for a healthy term newborn?

A

usual intake for a healthy term newborn in 100-110 kCal per kg/day

82
Q

When collecting cord blood samples, in what order should the vessels be drawn from?

A

1st: Artery
2nd: Vein

83
Q

Make card of FC 5, 6, & 7

A

NM 717 Comps (31 decks)

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