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N104 > Neonate > Flashcards

Neonate Flashcards

1
Q

What are the 5 circulatory structures that are involved with the fetus?

A

Ductus arteriosus

foramen ovale

ductus venosus

umbilical vein (one)

umbilical arteries (2)

umbilical cord

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2
Q

What is the ductus arteriosus?

A

connects the pulmonary artery to the descending aorta to allow blood most of the blood to bypass the lungs

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3
Q

What is the ductus venosus?

A

it is a shunt that allows most oxygenated blood to bypass the liver

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4
Q

What is the average length of the neonate?

A

50 cm

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5
Q

What is the average weight of the neonate?

A

3.5kg

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6
Q

What is the average circumference of the neonate head?

A

35 cm

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7
Q

what is the average length of the umbilical cord?

A

50cm

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8
Q

What is the normal rate of breathing and what happens to the rate when crying and sleeping?

A

30-60 bpm

increase with crying
decrease with sleep

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9
Q

What are the three factors opposing the first breath?

A

1) alveolar surface tension - need adequate surfactant
2) viscosity of lung fluid within the respiratory tract
3) degree of lung compliance

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10
Q

Why is the first breath the hardest?

A

normally, alveolar sacs always have some level of air

the first breath is difficult because the sacs start with 0 air and therefore have a greater resistance to breathing

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11
Q

What is the expected HR at birth?

A

120-160 bpm

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12
Q

Why do nurses dry the baby right after delivery?

A
  • tactile stimulation

- temperature control

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13
Q

What are some factors that attribute to heat regulation/loss in newborns?

A
  • dec subcutaneous fat and thin epidermis (preterm have very thin skin)
  • blood vessels lie close to skin
  • posture is important (normal curled up conserves heat, preterm sunbathers lose heat)
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14
Q

babies lose ____ times the amount of heat as the grown adult.

A

4

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15
Q

What are the 4 ways babies can lose heat. Which are the two main ones after drying?

A

Convection (currents)

Radiation

Evaporation

Conduction (contact with surfaces)

radiation and convection are the main ones after the baby is dry

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16
Q

How does the baby respond to cool environments?

A

1) inc metabolic rate
2) inc muscle activity
3) chemical thermogenesis (NST)

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17
Q

What is non-shivering thermogenesis (NST)?

A

a heat generating process unique to newborns

metabolizes store of brown fat for heat

  • appears about 26-30 wks
  • around neck, axilla’s, trachea, esophagus, abdominal aorta, kidneys, and adrenal glands
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18
Q

How is temperature taken in the newborn? What is the average value?

A

axilla

36.5-37.2 C

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19
Q

Explain the apgar score

A 
HR
0 = absent
1 = slow  one min
1 = irregular and slow
2 = good breathing and norm crying

Muscle tone
0 = limp and flaccid
1 = weak, inactive, slight flexion
2 = strong, active motion

Body color
0 = blue and pale
1 = body pink, extremities blue
2 = entire body pink

Reflex irritability
0 = no response
1 = grimace
2 = coughing, sneezing, and crying

20
Q

describe the initial physiological assessment

A

symmetry of body

Head (symmetry, fontanels, suture lines for molding, presence of hair)

FACE

  • open eyelids, for presence of eyes. sclera white or red (whites of eyes)
  • nose presence and open nares
  • mouth; gums with no teeth, moist, pink, tongue, alignment, feel palate

SKIN
- lanugo (body hair), stork bites, milia (blocked glands on nose), Mongolian spots

NECK
- no webbing or masses

BODY
- chest symmetry, auscultate lungs, HR, assess breasts, abdominal sounds, examine umbilical cord

EXTREMITIES

  • proper number of fingers/toes
  • color

GENITALS

female: majora bigger than minora
male: have two testes, look for a formed urethra

CHECK SPINE - run finger along to make sure vertebrae are connected, check back dimple

MEASURE circumference and length

assess temp

21
Q

How is iron stored in the newborn?

A

full-term babies have enough iron stored in their body for the first 5 months of life

after that, supplements and food need to be given that contain iron (can’t have too much)

22
Q

What is bilirubin?

A

by-product of RBC breakdown

23
Q

explain the process of getting rid of bilirubin

A

unconjugated (indirect) until it can bind with albumin in the blood stream

then becomes conjugated (direct) bilirubin

conjugated bilirubin is then excreted in the stool

24
Q

What is physiological jaundice?

A

caused by destruction of fetal RBCs and the inability to conjugate the inc bilirubin

appears 2-3 days after birth

need to educate parents

25
Q

what are the three types of stool?

A

Meconium - the first stool; thick, tarry black or dark green (8-24 hrs)

Transitional - thin brown to green (48-72 hrs)

Breastfed - pale yellow, liquid, and frequent to begin with (once every 5-7 days))

26
Q

Describe urinary function in newborns.

A

93% void in first 24 hrs

  • pink stains may appear in male diapers - caused by urates
  • blood in female diapers - pseudomenstration
27
Q

What are the 6 basic reflexes of the newborn?

A

1) suckling
2) grasping
3) stepping/walking (hold them up on surface)
4) moro (startle
5) rooting
6) babinski

28
Q

What is the moro (startle) reflex? how do you test this?

A

lift shoulders off table and let go, arms should spread as if startled

29
Q

What is the rooting reflex?

A

touch nipple to baby’s cheek, baby should turn towards the nipple

30
Q

What is the Babinski reflex?

A

take finger and run down sole of feet, toes should flare then go down

31
Q

How do babies behave when they are first born?

A

wide awake and looking around everywhere

32
Q

What are the two states of babies?

A

Sleep states

  • deep or quite sleep
  • active rapid eye movement (eyes may be open)

Alert state

  • drowsy/semi-dozing
  • wide awake
  • active awake
  • crying
33
Q

What are the 14 signs of distress in newborns?

A
  • increased resp rate (normal is 30-60)
  • sternal retractions
  • nasal flaring
  • grunting
  • excessive mucus
  • facial grimacing
  • cyanosis
  • abdominal distention/mass
  • vomiting of bile stained material
  • absence of meconium within 24 hrs
  • absence of urine within 24 hrs
  • jaundice within 24 hrs
  • temp instability
  • jitteriness or low blood glucose
34
Q

How do temperature changes in babies in response to sickness differ from older humans?

A

tend to go hypo rather than hyper

35
Q

do babies shiver?

A

no, they are chemoregulated so shivering is a sign of distress

36
Q

When is blood screening done in newborns? why?

A

done 24 hrs after birth

wait 24 hrs to allow for normal protein lvls in the blood

37
Q

Define acrocyanosis.

A

persistent cyanosis in the extremities (esp. hands and feet)

38
Q

Define erythema toxicum.

A

a common skin rash that clears and is not harmful in newborns

39
Q

Define milia.

A

clogging of glands esp common on the nose

40
Q

define vernix caseosa

A

white residue found on the surface of the skin in newborn babies after birth

most comes off after cleaning

41
Q

define Mongolian spots

A

blue birth mark on the skin

usually goes away by age 5 and almost always by puberty

42
Q

define nevus flammeus

A

(stork bites)
capillary malformation that results in a red birth mark. usually temporary

25-50% of newborns

43
Q

define nevus vasculosus

A

swelling or growth of capillaries in dermal and subdermal layers that resolves itself

44
Q

what is the foramen ovale?

A

it is a shunt that connects right and left ventricles (helps avoid pulmonary circulation)

45
Q

when is an apgar scoring conducted? what is a normal value?

A

1 and 5 mins after birth

7 and up is normal, anything lower requires medical intervention

N104 (10 decks)

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