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Physio OB Midterm > New Born Care > Flashcards

New Born Care Flashcards

1
Q

Initiation of breathing

Factors that influence the first breath

A

Physical examination
Oxygen deprivation and carbondioxide accumulation
Thoracic compression

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2
Q

Initiation of breathing

After the delivery, the residual alveolar fluid is cleared through the

A

Pulmonary circulation and

Pulmonary lymphatics

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3
Q

Initiation of breathing

Delay in fluid removal from alveoli cause

A

Transient Tachypnea of the new born

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4
Q

Initiation of breathing

With the fall in pulmonary arterial blood pressure

A

Ductus Areteriosus normally closes

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5
Q

Initiation of breathing

Required to bring about the initial entry of air into the fluid-filled alveoli.

A

High negative intrathoracic pressures

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6
Q

Initiation of breathing

Normally, from the first breath after birth

A

More residual air accumulates in the lung

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7
Q

Initiation of breathing

Respiration is similar to those of the adult

A

5th breath

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8
Q

Initiation of breathing

Surfactant synthesized by

A

Type 2 pneumocytes

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9
Q

Initiation of breathing

Insufficient surfactant common in

A

Preterm infants leads to RDS

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10
Q

Care in the delivery room

Reverse the effects of opioids

A

Naloxone

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11
Q

Care in the delivery room

Percent of newborn require some degree of active resuscitation to stimulate breathing

A

10%

1% require extensive resuscitation

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12
Q

Care in the delivery room

Newborn delivered at home and those delivered in hospital

A

Two to three fold risk of death

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13
Q

Care in the delivery room

A fall in heart rate
Loss of neuromascular tone

A

Primary apnea

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14
Q

Care in the delivery room

Primary apnea treatment

A

Simple stimulation

Exposure to oxygen

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15
Q

Care in the delivery room

Primary apnea. If persist it continue to develop

A

Deep gasping respiration followed by

Secondary apnea

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16
Q

Care in the delivery room

A further decline in heart rate
Falling blood pressure
Loss of neuromascular tone
Deep gasping respiration

A

Secondary apnea

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17
Q

Care in the delivery room

Secondary apnea will not respond to

A

Stimulation,

Death follows unless ventilation assisted

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18
Q

Care in the delivery room

The vigorous newborn is first placed in a

A

Warm environment
Airway cleared
Infant dried

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19
Q

Care in the delivery room

Non beneficial and harmful

A

Routine gastric aspiration

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20
Q

Care in the delivery room

For clear or Meconium stained fluid is not beneficial, even if the newborn is depressed

A

Bulb suctioning

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21
Q

Care in the delivery room

Breath
Cray

A

Few seconds

Half a minute

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22
Q

Assessment at 30 seconds of life

These should prompt administration of positive pressure ventilation with room air

A

Heart rate is

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23
Q

Assessment at 30 seconds of life

Assisted ventilation rates of ________ are commonly employed

A

30-60bpm

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24
Q

Assessment at 30 seconds of life

Percent of oxygen saturation is monitored by

A

Pulse oximetry

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25
Q

Assessment at 30 seconds of life

Adequate ventilation is indicated by

A

Improved heart rate

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26
Q

Assessment at 60 seconds of life

HR remains

A

Ventilation is inadequate
Head position should be checked
Secretions cleared
Inflation pressure increased

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27
Q

If HR persist below 100 bpm beyond 60 seconds

A

Tracheal intubation is considered

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28
Q

If bag and mask ventilation is ineffective or prolonged

A

Tracheal intubation

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29
Q

Other indication of tracheal intubation

A

Chest compression

Tracheal administration of epinephrine

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30
Q

Tracheal intubation

Special circumstances such as

A

Extremely low birthweight

Congenital diaphragmatic hernia

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31
Q

Tracheal intubation

Sizes

A

0 for a preterm infant

1 for a term neonat

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32
Q

Tracheal intubation
Procedure

Laryngoscopes with a straight blade is introduced at the side of the mouth and then directed posteriorly at the

A

Oropharynx

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33
Q

Tracheal intubation

Procedure 2nd step

Moved gently to

A

Vallecula

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34
Q

Tracheal intubation

Space between the base of the tongue and epiglottis

A

Vallecula

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35
Q

Tracheal intubation

Tube size

A
  1. 5-4 mm term

2. 5 mm

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36
Q

Tracheal intubation
To ensure that the tube is positioned in the trachea and not the esophagus

Observation for

A

Symmetrical chest wall motion

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37
Q

Tracheal intubation
To ensure that the tube is positioned in the trachea and not the esophagus

Auscultation for

A

Equal breath sounds

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38
Q

Tracheal intubation
To ensure that the tube is positioned in the trachea and not the esophagus

No longer recommended

A

Trachea suctioning

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39
Q

Tracheal intubation
To ensure that the tube is positioned in the trachea and not the esophagus

Puffs of air are delivered into the tube at

A

1-2 seconds interval

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40
Q

Tracheal intubation
To ensure that the tube is positioned in the trachea and not the esophagus

Pressure

A

Term- 30-40cm H2O

Preterm 20-25cm H2O

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41
Q

If heart rate is remains

A

Chest compression

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42
Q

Chest compression

Delivered on the

A

Lower third of the sternum

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43
Q

Chest compression

Compression ventilation ratio

A

3:1

90comprssion
30 breaths

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44
Q

Chest compression

3:1 ratio

To achieve approximately

A

120 events/min

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45
Q

Chest compression

3:1 ratio

Heart rate reassess every

A

30 secs

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46
Q

Chest compression

3:1 ratio

Chest compression are continued until the spontaneous heart rate is

A

Atleast 60bpm

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47
Q

Indicated when heart rate remains

A

IV administered epinephrine

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48
Q

Epinephrine and volume expansion

Epinephrine May be given through

A

Endotracheal tube

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49
Q

Epinephrine and volume expansion

Epinephrine

If venous access has not been established

A

IV dose is 0.01-0.03mg/kg

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50
Q

Epinephrine and volume expansion

Epinephrine

If given through the tracheal tube

A

Dose is 0.05-0.1mg/kg

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51
Q

Epinephrine and volume expansion

Volume expansion

A

Crystalloid (NSS/LR)

Packed red cells

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52
Q

Discontinuation of resuscitation if without heartbeat for

A

10 minutes

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53
Q

Memorize

A

APGAR score

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54
Q

APGAR

The total score is determined in all neonates at

A

1 and 5 minutes after delivery

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55
Q

APGAR

If depressed infants the score may be calculated at

A

5 minutes interval until a 20 minute APGAR

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56
Q

APGAR

Score reflects the need for immediate resuscitation

A

1 minute

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57
Q

APGAR

Measures effectiveness of resuscitative efforts and also has significance for neonatal survival

A

5 minute score

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58
Q

APGAR

Death in 1:5000

A

7-10 score

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59
Q

APGAR

Death in 1:4000

A

5 min
Or
3 or less score

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60
Q

Umbilical cord blood Acid Base studies

Used for acid base studies to assess the metabolic status of the neonate

A

Blood from umbilical vessels

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61
Q

Umbilical cord blood Acid Base studies

How many segments of cord

A

10-20 cm

62
Q

Umbilical cord blood Acid Base studies

Can alter both PcO2 and pH

A

Delays of 20-30 seconds of clamping

63
Q

Umbilical cord blood Acid Base studies

Arterial blood is drawn using

A

1-2 ml syringe containing lyophilized heparin

1-2 ml syringe containing heparin solution

64
Q

Umbilical cord blood Acid Base studies

Can be analyzed as late as 60 hours after delivery

A

Birth acid- base status

65
Q

Fetal acid base physiology

Fetus produce both

A

Carbonic acid

Organic acid

66
Q

Fetal acid base physiology

Carbonic acid is formed by

A

Oxidative metabolism of CO2

67
Q

Fetal acid base physiology

Carbonic acid accumulates
No increase in organic acids

A

Respiratory acidemia

68
Q

Fetal acid base physiology

Primary organic acid

A

Lactic acid

Beta HydroxyButyric acid

69
Q

Fetal acid base physiology

Increase organic acid result to

A

Anaerobic glycolysis

70
Q

Fetal acid base physiology

Organic acid accumulate
Without increase in carbonic acid

A

Metabolic acidemia

71
Q

Fetal acid base physiology

With metabolic acidemia it is decrease because it is used to buffer the organic acid

A

HCO3 or bicarbonate

72
Q

Fetal acid base physiology

Increase H2CO3
Increase organic acid
Decrease HCO3

A

Mixed respiratory-metabolic acidemia

73
Q

Fetal acid base physiology

One principal cause of fatal acidemia is

A

Decrease in utero placental perfusion

74
Q

Fetal acid base physiology

Decrease HCO3

A

Base deificit

75
Q

Fetal acid base physiology

Increase HCO3

A

Base excess

76
Q

Fetal acid base physiology

Large base deficit and a low HCO3

A

Mixed respiratory-metabolic acidemia

77
Q

Clinical significance of acidemia

Lower limit of normal pH ranges from

A

7.04-7.102

78
Q

Clinical significance of acidemia

NB with pH

A 
3% neonatal encephalopathy
8% neonatal death
13% seizures
14% intubation
39% ICU admission
79
Q

Respiratory acidemia

Acute interruption in placental gas exchange is accompanied by subsequent

A

CO2 retention and respiratory acidemia

80
Q

Respiratory acidemia

The most common antecedent factor

A

Transient umbilical cord compression

81
Q

Metabolic acidemia

Base deficit >12 mmol/L

A

Fetal acidosis

82
Q

Metabolic acidemia

Base deficit >16 mmol/Lq

A

Severe fetal acidosis

83
Q

Metabolic acidemia

Defined using umbilical cord blood gas cut offs that were

A

2 standard deviations below the mean

84
Q

Metabolic acidemia

Base deificit > 12mmol/L
Ph

A

Cerebral palsy

85
Q

Metabolic acidemia

Associated with a high rate of

A

Multi organ dysfunction

86
Q

Provide the most objective evidence of the fetal metabolic status at birth

A

Umbilical cord acid base blood determination

87
Q

Metabolic acidemia

Neurological impairment

A

Hypoxic ischemic encephalopathy

88
Q

Metabolic acidemia

Acid base status may be more closely linked to long term neurological outcome

A

Very low birth weight infants

89
Q

Metabolic acidemia

Risk of neonatal death is 3200 fold greater among infants with metabolic acidemia

A

Term neonates

90
Q

Preventive care

Gonococcal infection

A

Opthalmia neonatorum

91
Q

Preventive care

Gonococcal infection

Opthalmia neonatorum most common causes

A

Gonococcal

Chlamydia

92
Q

Preventive care

Gonococcal infection

Opthalmia neonatorum

Blindness was previously common in children who develop

A

Neisseria gonorrhea

93
Q

Preventive care

Gonococcal infection

A 1% opthalmic solution of silver nitrate
Mandatory for all neonates

A

Credes prophylaxis

94
Q

Preventive care

Gonococcal infection

Credes prophylaxis

Opthalmic ointment used

A

1% silver nitrate
0.5 % erythromycin
1% tetracycline

95
Q

Preventive care

Gonococcal infection

Conjuctivitis in a neonate born to a mother with untreated gonorrhea

A

Presumptive gonococcal opthalmia

96
Q

Presumptive gonococcal opthalmia

Treatment

A

Single dose of ceftriaxone
100 mg/kg
IM or IV

97
Q

Eye infection prophylaxis

Chlamydial infection

12-25 % of babies will develop conjunctivitis for up to

A

20 weeks

98
Q

Eye infection prophylaxis

Chlamydial infection

Ointments

A

2.5 % povidone iodine
1% silver nitrate
0.5% erythromycin

99
Q

Eye infection prophylaxis

Chlamydial infection

Treatment

A

Oral Azithromycin for 5 days

Oral erythromycin for 14 days

100
Q

If the mother is seropositive for hepatitis B surface antigen

A

The neonate should immunized with

Hepatitis B immune globulin

101
Q

To prevent hemorrhagic disease of the new born

A

Vitamin k
Within 1 hour
0.5mg IM

102
Q

New born screening

A 
Congenital hypothyroidism 
Congenital adrenal hyperplasia
Galactosemia
G6PD deficiency
Phenylketonuria
103
Q

Neonates who are either small or large for gestational age are at increased risk for

A

Hypoglycemia
Polycythemia

Measures blood glucose and hematocrit

104
Q

Care of the skin and umbilical cord

Any remaining vernix is readily absorb and disappears within

A

24hours

105
Q

Care of the skin and umbilical cord

Should be postponed until the neonates temperature is stabilized

A

First bath

106
Q

Care of the skin and umbilical cord

Should be observed in the immediate care of the cord

A

Aseptic precautions

107
Q

Care of the skin and umbilical cord

Umbilical cord begins to lose water from ______ shortly after birth

A

Whartons jelly

108
Q

Care of the skin and umbilical cord

Within 24 hours the cord stump loses its characteristic _____________, __________ and soon become dry and black

A

Bluish white

Moist appearance

109
Q

Care of the skin and umbilical cord

Separation usually takes place within the

A

First 2 weeks

3-45 days

110
Q

Care of the skin and umbilical cord

Dry quickly when exposed to

A

Air

111
Q

Care of the skin and umbilical cord

Applied to the cord is superior to soap and water care in preventing colonization and exudate formation

A

Triple dye

112
Q

Care of the skin and umbilical cord

Cleaning the cord stump with __________ reduce severe omphalitis by 75% compared with soap

A

4% chorhexidine

113
Q

Care of the skin and umbilical cord

Superior to dry cord

A

0.1%

114
Q

Care of the skin and umbilical cord

Most likely offending organism are

A

SA
EC
Group B S

115
Q

Feeding and weight loss

Breast feeding is preferred until

A

6months

116
Q

Feeding and weight loss

Begin BF in the

A

Delivery room

117
Q

Feeding and weight loss

Term newborn thrive best when fed

A

8-12 times daily for 15 minutes

118
Q

Feeding and weight loss

Require feedings at shorter intervals

A

Preterm or

Growth restricted newborns

119
Q

Feeding and weight loss

Most neonates actually receive little nutriment for the

A

First 3-4 days of life

120
Q

Feeding and weight loss

Lose relatively more weight and regain their birthweight more slowly

A

Preterm

121
Q

Feeding and weight loss

Birthweight of term infants regain by the end of the

A

10th day

122
Q

Feeding and weight loss

Weight gain increases by about _______ for the first few months

A

25g/day

123
Q

Feeding and weight loss

Birth weight double

A

5months

124
Q

Feeding and weight loss

Birth weight triples

A

End of the 1st year

125
Q

Stools and urine

For the first 2-3 days after birth

A

Soft, brownish green Meconium

The color results from bile pigment

126
Q

Stools and urine

During fetal life

A

Intestinal of content is sterile

But bacteria quickly colonize the bowel

127
Q

Stools and urine

Seen in 90% of newborn
Within the first 24-36 hours

A

Meconium stooling

128
Q

Stools and urine

Newborn first void shortly

A

After birth

But may not until 2nd day

129
Q

Stools and urine

Indicates patency of the gastrointestinal and urinary tracts

A

Meconium and urine passage

130
Q

Stools and urine

Congenital defect

A

Imperforate anus

Urethral valve

131
Q

Stools and urine

After the third or fourth day, as a result of milk ingestion, Meconium is replaced by

A

Light yellow homogenous feces

132
Q

Icterus neonatorum

At birth, normal bilirubin level is at

A

1.8-2.8mg/DL

133
Q

Icterus neonatorum

2nd-5th day of life

A

Physiological jaundice

134
Q

Icterus neonatorum

3rd-4th day
Bilirubin level

A

> 5mg/dl

135
Q

Icterus neonatorum

Bilirubin is bound to glucoronic acid
Bilirubin is excreted in bile

A

Mature liver

136
Q

Icterus neonatorum

Less bilirubin, less excreted in bile

A

Immature liver

137
Q

Icterus neonatorum

Less bilirubin excreted in bile
Increase erythrocyte destruction

A

Transient hyper bilirubinemia

138
Q

Icterus neonatorum

Treatment

A

Early sunlight exposure

Phototherapy (bilirubin converted to water soluble stereoisomers)

139
Q

Newborn male circumcision

Prevention of

A

Phimosis -constriction of orifice
Para phimosis- retraction of phimosis
Balanoposthitis- inflame glans penis

140
Q

Newborn male circumcision

Decreases the incidence of

A

Penile cancer
Cervical cancer
Transfusion of STD

141
Q

Newborn male circumcision

Contraindications

A

Hypospadias
Bleeding disorders
Genital anomalies

142
Q

Newborn male circumcision

Must before males are subjected to circumcision

A

Growth in penile length

143
Q

Anesthesia for circumcision

A

Dorsal penile nerve block

Ring block

144
Q

Anesthesia for circumcision

Ring block

A

1% lidocaine(mx dose 1ml)

180degree

145
Q

Anesthesia for circumcision

No vasoactive compounds such as

A

Epinephrine

146
Q

This model of maternity care place newborns in their mother rooms instead of central nurseries

A

Rooming in

147
Q

Rooming in

A

Foster early mother child realtionships

148
Q

Mother fully ambulatory

A

24 hours

149
Q

Most newborn discharged within

A

48hours

150
Q

Average lenght of hospital days

A

2-3 days

151
Q

Usual cause of re admission

A

Dehydration
Jaundice
Brain damage
Icterus neonatorum

152
Q

Initiation of breathing

Indicate active perfusion

A

Breathe

Cry

Physio OB Midterm (6 decks)

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