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N322 > Newborn Assessment > Flashcards

Newborn Assessment Flashcards

1
Q

VS

A

RR 30-60
BP 60-80/ 40-50

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2
Q

What is the blood volume of an infant?

A

300 mL

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3
Q

Pretern babies blood volume

A

increases d/t greater plasma vol

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4
Q

hematopoietic system

A

increased RBC and hemoglobin and initial leukocytes

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5
Q

What is special about vit K?

A

newborns can not synthesize
vit K injection within the first few days of birth to assist with clotting

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6
Q

Thermoregulation

A

the balance of heat production and loss

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7
Q

What is the goal of thermoregulation?

A

neutral thermal environment

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8
Q

Convection

A

flow of heat from body surface to cooler ambient air. (Need warmer ambient temps, use overhead warmers), wrap baby in blanket, hats (if in open bassinets).

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9
Q

Radiation

A

loss off heat from body surface to cooler not in direct contact with newborn (position exam tables, bassinets away from open windows or direct air drafts).

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10
Q

Evaporation

A

loss of heat when liquid converted to a vapour. (moisture vaporization from skin – be sure to dry skin of newborn after birth/bath quickly. The less mature the more evaporative heat loss. Component of insensible water loss.
Thermoregulation – conserve heat in position of flexion to guard against heat loss (diminishes body surface exposed to environment. Also vasoconstriction of peripheral blood vessels. No shivering mechanism!!!

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11
Q

Conduction

A

heat loss from body surface to cooler surface (use protective cover on weigh scales)

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12
Q

What is important about skin-skin?

A

reduces heat loss, enhances temp and bonding

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13
Q

Thermogenesis

A

internal attempts to generate heat (cellular metabolic activity in brain, heart and liver increases oxygen and glucose consumption)

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14
Q

Brown fat

A

Thermogenesis
Non-shivering thermogenesis occurs through the metabolism of brown fat
Located in interscapular region, axillae, thoracic inlet, vertebral column, around kidneys
Amount increased with gestational age

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15
Q

Cold stress

A

increased RR with oxygen needs - leads to vasoconstriction - can decrease pulmonary perfusion – reopen R to L shunt across ductus arteriosus

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16
Q

Hyperthermia

A

Temp > 37.5 (99.5 F) due to excess heat production or sepsis (radiant warmers, phototherapy, sunlight, increased environmental temp, excess clothing – vasoconstriction)
NEED THREE GOOD TEMPS (before baths, etc)

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17
Q

Voiding

A

Most newborns void at birth (can be missed)
1st day = 1 void
2nd day = 2 voids
3rd day = 3 voids
1 week – 6 – 8 voids

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18
Q

Weight loss

A

5 – 10 % wt. loss in 1st 3 – 5 days is normal due to urine, feces, lungs, increased metabolic rate, intake (colostrum is high fat but not high volume)

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19
Q

Uric acid crystals

A

Uric acid crystal stains can occur, watch for persistence

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20
Q

What is a newborns first stool called?

A

Meconium
greenish/black because it contains occult blood
early, frequent feeds assist in removing stools (and helps with jaundice)

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21
Q

What are signs of GI problems?

A

No stools (bowel obstruction, imperforated anus)
White stools (biliary atresia is blockage in tubes carrying bile from gallbladder to liver)

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22
Q

Transition stools

A

day 3
after feeding
may contain milk curds

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23
Q

Milk stool

A

Day 4
BF - yellow to golden, pasty, smell of sour milk
Formula - pale yellow - light brown, firmer consistency, more odor

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24
Q

Iron storage

A

in liver. At birth - Iron storage sufficient to last 4 to 6 months.
Preterm and SGA infants have lower iron stores
Superior bioavailability of iron in breast milk than in formula
Exclusive BF for 6 months is recommended (WHO) – then supplement with iron rich foods
Formula should contain supplemental iron

25
Q

What does colostrum contain

A

high levels of glucose

26
Q

Vernix caseosa

A

cheese-like whitish substance after 35 weeks
Contains sebaceous gland secretions
Emollient (waxy/fatty substance) and antimicrobial properties preventing fluid loss through skin
Antioxidant properties
Leave vernix intact – decreases skin pH, decreases skin erythema, improves skin hydration

27
Q

Acrocyanosis

A

when hands & feet are slightly cyanotic due to vasomotor instability (if central and persists, then it is treated)

28
Q

Lanugo

A

fine hair over face, shoulders and back

29
Q

Eccymosis

A

edema of face due to face presentation, forceps-assisted birth, vacuum extraction

30
Q

Sweat glands

A

newborns have sweat glands; term infants do not sweat for first 24 hours.

31
Q

Milia

A

small white sebaceous glands on newborn face

32
Q

Desquamation

A

peeling of skin of term newborn begins several days after birth

33
Q

Mongolian spots

A

congenital birthmarks, bluish black areas of pigmentation over any part of exterior (back or buttocks) or body/extremities.

34
Q

Nevi

A

Nevus Simplex (aka stork bites, angle kisses)
Flat, pink capillary hemangiomas; easily blanched. Fade in 1-2 years

35
Q

Erythema toxicum

A

transient newborn rash

36
Q

What does bruising increase?

A

increase risk of hyperbilirubinemia

37
Q

Pseudomenstration

A

Females
mucoid vaginal discharge with slight bloody spotting (increase in estrogen in pregnancy & drop at birth)

38
Q

Male reproductive system

A

testes descend into scrotum by birth; tight prepuce (foreskin) is normal and may cover the urethral opening.
urethra at tip of penis (epispadias and hypospadias are congenital deformations)
Smegma – white cheesy substance found under foreskin
Epithelial pearls – seen on tip of the prepuce (keratinization in squamous cells)
Rugae appear on scrotum (28 – 36 weeks gestation); > 40 weeks – testes palpated in scrotum; rugae cover scrotal sac
Scrotum has extra pigmentation due to maternal estrogen
Hydrocele – accumulation of fluid around testes that usually resolves without intervention

39
Q

Caput succedaneum

A

edematous area of scalp (occiput) due to compression of vessels from pressure on cervix (slows venous return)

40
Q

Cephalhematoma

A

collection of blood between skull bone and periosteum due to pressure against bony pelvis , low forceps, extraction

41
Q

Subgaleal hemorrhage

A

bleeding into subgaleal compartment (loose connective tissue that connects frontal & occipital muscles and forms inner surface of scalp)
assess - boggy scalp, pallor, increased head circ.

42
Q

spine

A

vertebrae flat and straight. Assess for pilonidal dimple (associated with spina bifida)

43
Q

Extremities

A

symmetrical, equal in length, 5 fingers, 5 toes, nails

44
Q

Fontanelles

A

Front (anterior fontanelle)
back (posterior fontanelle)
Side (sphenoidal fontanelle, mastoid fontanelle)

45
Q

Regulation of physiological system

A
  1. Involuntary – HR, Resps, temp
  2. Motor Organization – control random movements, muscle tone, reduce extra activity
  3. State Regulation – ability to modulate consciousness
    Develops predictable sleep and wake states
    Able to react to stress (self-regulation & communication – crying and consolation)
  4. Attention and Social Interaction – stay alert for longer periods; engage socially
46
Q

Areas of assessment

A

Pink (resps)
Warm (temp reg)
Attached (attachment to family)
Sweet (blood sugar)
Organized (maintain optimal state)
Clean (infection prevention strategies)

47
Q

APGAR

A

Appearance
Pulse
Grimace
Activity
Respiration

48
Q

Jaundice definition

A

Jaundice increased level of unconjugated bilirubin in the body. Bilirubin is the yellow product produced by the breakdown of RBC

49
Q

Coagulation of bilirubin

A

When bilirubin is attached to protein and is unable to be excreted is called uncoagulated bilirubin. Needs to be conjugated to be excreted (enzymes help with this)

50
Q

Physiological Jaundice

A

Immature liver. Common in newborns. Develops in 2-4 days (can undevelop it)

51
Q

Pathological Jaundice

A

Within 24 hours after birth – happened right away (encopalopathy and cornictorius). Disease (did not happen naturally). Challenges are more common.

52
Q

Jaundice related to breastfeeding

A

Jaundice caused by not great breastfeeding. Not optimal feeding. Suboptimal intake jaundice. Response – more breastfeeding is good

53
Q

Interventions for jaundice

A

Phototherapy, encourage breast feeding
Physiological – phototherapy (indirect sunlight at home with unsevere jaundice)
Patho – same interventions (more intensive phototherapy) – stays in hospital longer

54
Q

Reflexes

A

Stepping/walking
crawling
babinskys
Swallow
Startle (moro)
sucking
rooting
Grasp

55
Q

First period of reactivity (adaptations of the newborn)

A

Lasts up to 30 minutes after birth
Newborn’s heart rate increases to 160 to 180 beats/min
Respirations may be irregular: 60 to 80 breaths/min (there may be fine crackles, grunting, nasal flaring, retractions)
Baby is alert, spontaneous startle reflex, tremors, crying, movement of head
Bowel sounds present, may pass meconium
Followed by a decrease in motor activity and sleep

56
Q

Period of decreased responsiveness

A

lasts 60-100 minutes

57
Q

Second period of reactivity

A

Occurs 2 to 8 hours after birth
Lasts 10 minutes to several hours
Tachycardia, tachypnea may occur
Meconium commonly passed
Increased muscle tone, changes in skin color, and mucus production

58
Q

Newborn assessment

A

Heart rate - stethoscope or palpation of umbilical cord
RR - resp effort and ausc.
Muscle tone - flexion and movement of extremities
Reflex irritability - response to stimulation
Generalized skin colour

N322 (6 decks)

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