Newborn Flashcards
Review APGAR, fontanels, birthmarks, normal and abnormal findings, jaundice, reflexes, and complications.
1
Q
What is an APGAR assessment?
A
It is done on the newborn at 1 minute and 5 minutes after birth to assess for immediate complications.
It is done more often if there are complications.
2
Q
What is the highest and best score a newborn can get for an APGAR score?
A
10
Many newborns get a 9 due to cyanotic feet or hands.
3
Q
What are the 5 categories of an APGAR assessment?
A
- Appearance/skin color
- Pulse
- Grimace/response to stimulation
- Activity/muscle tone
- Respiration effort
4
Q
What is the possible score for each APGAR category?
A
The newborn can be assigned a 0, 1 or 2 for each category of APGAR.
- 0 is the worst score
- 2 is the best score
5
Q
What is the scoring for APGAR Activity/muscle tone?
A
- 0 = flaccid/limp
- 1 = minimal flexion
- 2 = good flexion/active (sneezes or coughs)
6
Q
What is the scoring for APGAR Pulse?
A
- 0 = absent
- 1 = < 100 beats/minute
- 2 = >100 beats/minute
7
Q
What is the scoring for APGAR Grimace/response to stimulation?
A
- 0 = absent
- 1 = grimace to suction or slap on soles of feet
- 2 = responds promptly with cry or active movement
8
Q
What is the scoring for APGAR Appearance/skin color?
A
- 0 = pallor or cyanosis (blue color)
- 1 = cyanotic extremities
- 2 = all normal color / pink
9
Q
What is the scoring for APGAR Respiration effort?
A
- 0 = absent
- 1 = slow and weak
- 2 = vigorous cry and respirations between 30 - 60
10
Q
What are the 3 interventions immediately following the birth of a newborn?
A
- suction mouth and nares with a bulb syringe
- dry the newborn and stimulate crying by rubbing the back
- put baby under a warmer or skin-to-skin contact with woman
11
Q
How is cold stress avoided in a newborn?
A
- dry infant immediately
- place skin-to-skin contact on mom
- put hat on baby
If client is not available, wrap baby in blankets and place in warmer.
12
Q
What is a normal heart rate for a newborn?
A
120 - 160
- if sleeping: down to 80 beats/minute
- if crying: up to 180 beats/minute
13
Q
What are normal respirations for a newborn?
A
30 - 60 breaths/minute
Irregular breathing is common.
14
Q
What is a normal temperature for a newborn?
A
96.8oF - 99oF
(37oC - 37.2oC)
15
Q
Where is the anterior fontanel of a newborn located?
A
On the top of the head.
16
Q
Where is the posterior fontanel of a newborn located?
A
On the back of the head.
17
Q
When does the anterior fontanel close on a newborn?
A
Between 12 and 18 months of age.
18
Q
When does the posterior fontanel close on a newborn?
A
Between birth and 3 months.
19
Q
What is caput succedaneum?
A
Edema of soft tissue over bone on the newborn’s head.
It crosses the suture line and subsides within a few days.
20
Q
What is cephalhematoma?
A
Swelling on the head caused by bleeding.
It does not cross the suture line. It is usually absorbed by 6 months and doesn’t need treatment.
21
Q
What is thrush?
A
A fungal infection in the newborn’s mouth. It looks like white, patchy areas in the mouth.
It may clear up in a few days. If it doesn’t, oral antifungal medicine will be given.
22
Q
What is vernix caseosa?
A
A normal finding of a cheesy-white looking substance covering a newborn’s skin.
It’s a protective cover over the skin from amniotic fluid.
23
Q
What does a stork bite birthmark look like?
A
A red patch.
24
Q
What does a port-wine stain birthmark look like?
A
A dark red patch.
25
What does a **strawberry birthmark** (or **hemangioma**) look like?
A dark red patch.
26
What does a **mongolian spot birthmark** look like?
Purple-blue patches usually on the sacrum.
27
What is **lanugo**?
Fine body hair on a newborn.
## Footnote
It is found on term infants (39 weeks and later) and helps to hold vernis caseosa on the skin which protects it from amniotic fluid.
28
How many **vessels** should the **umbilical cord** have and what are they?
**3 vessels:**
* 2 arteries
* 1 vein
29
What should be **assessed** after circumcision?
Bleeding and urinary retention.
30
What is the **first stool** of a newborn?
**Meconium**: it is black and tarry.
31
When should the **first stool pass (meconium)**?
Within 24 hours of being born.
32
What do the baby's **first stools** look like after the meconium has passed?
**Yellow and look like there are small seeds** in it.
33
What is **physiological jaundice**?
An **increase in bilirubin that causes yellowing of the skin**. It is caused by an immature liver.
## Footnote
**It occurs after 24 hours** and is a mild and common condition.
34
What is **pathological jaundice**?
| (Immediate complication)
An **increase in bilirubin and yellowing of the skin.** It is caused by a hemolytic disease such as Rh incompatibility or liver disease.
## Footnote
**It occurs before 24 hours** and is a serious life-threatening condition.
35
What is the **pathophysiology of jaundice** in a newborn?
Jaundice is from an **increase of bilirubin in the blood**. Bilirubin is a waste product of **red** blood cells and is a **yellow** color. The liver is unable to get rid of the bilirubin.
36
# Lab value:
**bilirubin** in a newborn born at term (not premature)
\< 12 mg/dL (180 mcmol/)
37
What **complication** can occur if jaundice is not treated?
Brain damage.
## Footnote
High levels of bilirubin can enter the newborn's brain and cause toxicity.
38
What are the **interventions** for jaundice in a newborn?
1. **frequent feedings** - to flush bilirubin out
2. **phototherapy** - light makes it easier for liver to break down and remove bilirubin
3. **vitamin K injection** - to prevent bleeding disorders from an immature liver
39
In how many days after birth should the **birth weight be regained** by the newborn?
10 - 14 days after birth.
40
Do **newborns shiver** when they are cold?
No.
## Footnote
Newborns do NOT shiver when they are cold.
41
How do **newborns keep warm**?
Newborns have **brown fat deposits** that keep them warm. They also should be wrapped in a blanket with a hat on.
## Footnote
Put baby under a radiant warmer if needs to be kept warm.
42
What is the **sucking (rooting) reflex**?
An automatic response by the newborn when they **turn their face toward the stimulus and make a sucking or rooting motion with the mouth** when the cheek or lip is touched.
## Footnote
The rooting reflex helps to ensure successful breastfeeding.
43
What is the **swallowing reflex**?
An automatic response by the newborn to **swallow without gagging or coughing**.
44
What is the **tonic neck (fencing) reflex**?
An automatic response by the newborn when the **arm is extended and the face points in that direction**.
## Footnote
Reflex goes away at about 4 months old.
45
What is the **palmar grasp reflex**?
An automatic response by the newborn when an object is placed in the infant's hand and they **involuntary grasp it tightly**.
## Footnote
Reflex goes away between 3 - 6 months old.
46
What is the **moro (startle) reflex**?
An automatic response by the newborn when the **arms go out to the sides if they feel like they are falling**.
## Footnote
Reflex goes away at about 2 months.
47
What is the **babinski reflex**?
An automatic response by the newborn when the sole of the foot is firmly stroked. The **big toe then moves upward or toward the top surface of the foot. The other toes fan out.**
## Footnote
It should disappear at about 1 year.
48
What is the parent teaching on how to **bathe a newborn**?
1. keep room warm - *cold rooms cause too much oxygen demand*
2. use a mild soap
3. clean from the cleanest spot to the dirtiest spot last
4. clean eyes from inner to outer area
5. dress in layers and put a hat on baby
## Footnote
Do not submerge umbilical cord under water.
49
How should an **uncircumcised** baby be cleaned?
* there is no special cleaning
* never pull on foreskin or underneath foreskin
* clean with mild soap and water
50
What are the safety measures for a newborn in a hospital to **prevent infant abduction**?
* ID bracelet is applied to both mom and baby
* every person caring for baby must have ID on
* baby is wheeled in a bassinet when leaving the room, never carried by staff
51
What is the gestational age for a **preterm newborn**?
\< 37 weeks
52
What is the gestational age for a **post-term baby**?
\> 42 weeks
53
What is the **most common complication** of a post-term newborn?
Hypoglycemia.
## Footnote
Infant does not have enough stored glucose at birth.
54
What can **cause** respiratory distress syndrome in an infant?
| (Immediate complication)
The newborn **unable to produce enough surfactant**. It can occur in preterm infants.
## Footnote
Surfactant helps open up the lungs to breathe better.
55
# Medications:
Respiratory distress syndrome in an infant
Give surfactant through the ET tube.
56
# Describe:
Meconium aspiration syndrome
| (Immediate complication)
When **meconium gets into the lungs** and causes respiratory distress and/or pneumonia.
57
# Interventions:
Meconium aspiration syndrome
* oxygen
* antibiotics
* ventilator if severe
58
# Describe:
Erythroblastosis fetalis
When the **red blood cells get destroyed** due to an Rh incompatibility.
59
# Treatment:
Erythroblastosis fetalis
Give **Rh-negative blood** infusions to the infant.
60
# Describe:
**Addicted newborn** and **fetal alcohol spectrum disorders**
When the infant is born **addicted to alcohol or other substances**.
## Footnote
The infant is highly irritated and has an increase in metabolism.
61
# Interventions:
**Addicted newborn** and **fetal alcohol spectrum disorders**
* wrap baby snuggly
* seizure precautions
* reduce stimulation
* let mom express guilt and encourage treatment for mom
62
What are the **priority assessments** of a newborn from a diabetic mother?
* assess for respiratory distress
* assess blood sugar
## Footnote
Increased insulin from mother can cause delayed production of surfactant, which is needed for lung development
63
# Lab value:
Blood glucose in a one day old infant
40 - 60 mg/dL (2.3 mmol/L)
64
# Interventions:
Hypoglycemic newborn
* feed baby
* give glucose if needed
65
What are the **steps** for CPR on an infant?
| (Immediate complication)
1. check for pulse with brachial artery
2. use 2 fingers or 2 thumbs for chest compressions
3. go down 1 1/2 inches (2 cm) for compressions
* 1 rescuer: 30 compressions then 2 breaths
* 2 rescuers: 15 compressions and then 2 breaths
## Footnote
Click [HERE](http://www.youtube.com/watch?v=I3pvuYMcPg4) for an instructional video on infant CPR and Choking.
66
What are the **steps** for a choking infant?
| (Immediate complication)
1. hold infant face down with head lower than feet
2. support head and jaw
3. give 5 back slaps
4. then put baby face up and give 5 chest thrusts
5. repeat until obstruction clears
## Footnote
Click [HERE](http://www.youtube.com/watch?v=I3pvuYMcPg4) for an instructional video on infant CPR and Choking.
67
Are blue hands and feet normal for a newborn for the first 24 hours?
Yes! This is due to the baby's underdeveloped circulatory system.
68
What could depressed/sunken fontanels indicate?
Dehydration: baby will need fluids.
69
What could bulging fontanels indicate?
Bulging fontanels could indicate **fluid in the brain** caused by malformations, tumors, hemorrhage, infections or trauma.
70
How many wet diapers should a newborn have **daily**?
At least **6 wet diapers a day** in order to know the baby is getting fed adequately.
71
When does the sucking (rooting) reflex disappear?
By about 4 months old.
72
# Signs and symptoms:
Respiratory distress syndrome in an infant
* tachypnea and grunting
* nasal flaring
73
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## Footnote
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