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ob nur 359 > Newborn Assessment > Flashcards

Newborn Assessment Flashcards

1
Q

How to promote physical well-being of newborn

A

Nursing care - Keep baby warm, wash after 24 hours, swaddle,

Physical assessment - reflexes, vitals

Nutrition - get them breastfeeding or on formula

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2
Q

How to promote and establish a functioning family?

A

we must educate and support both parents and grandparents

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3
Q

What are respiratory changes from fetus to newborn?

A

Respirations initiate

Chemically - surfactant reduces tension to reduce O2 concentration

Thermally - Moist infant is cold from exposed air

Mechanical - think vaginal compression or fetal chest during vaginal delivery

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4
Q

Apgar scoring. Scoring the Activity

A

0 - Absent

1 - Flexed arms and legs

2 - Active and moving around

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5
Q

APGAR - Pulse scoring

A

0 - No pulse

1 - Less than 100 bpm

2 - More than 100 bpm

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6
Q

APGAR Grimace scoring (Reflex)

A

0 - Floppy

1 - Minimal response to stimulation

2 - Prompt to respond

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7
Q

APGAR Appearance scoring

A

0 - Blue/pale

1 - Pink body with acrycyanosis

2 - Pink all over

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8
Q

APGAR - Respiration scoring

A

0 - No breathing

1- Slow & Irregular

2- Vigorous cry

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9
Q

When to assess APGAR

A

1 minute of birth

5 Minutes

Again at 10 min is the first two readings were low

Assess and intervene then reassess after interventions are done

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10
Q

Methods of heat loss - Evaporation

A

Wet surface exposed to air = loses heat

Baby comes out wet and water evaporates so baby loses heat

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11
Q

Conduction

A

Newborn comes into direct contact with object cooler than skin

Warm blankets and stethoscopes before placing on the baby

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12
Q

Convection

A

Heat is transferred to air that surrounds he newborn

Losing heat through airflow - try to decrease airflow in room to maintain babys temperature

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13
Q

Radiation

A

Transfer of heat to colder objects that arents in contact with infant.

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14
Q

What are the effects of cold stress?

A

Increased metabolic rate

Non-shivering thermogenesis-metabolism of brown fat

Vasoconstriction

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15
Q

How does increased metabolic rate in cold stress effect the baby?

A

Increase use of glucose and low production of surfactant hypoglycemia with respiratory distress

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16
Q

How non-shivering thermogenesis metabolism of brown fat effects the baby?

A

Increased production of free fatty acids leading to metabolic acidosis and jaundice

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17
Q

How does vasoconstriction of cold stress effect the baby?

A

Pale mottled skin leading to fetal circulatory patterns

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18
Q

What are kennel and klaus’ theory on bonding?

A

Must bond within the first hour of life or it will effect baby for the next 20 years

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19
Q

How to encourage bonding with parents?

A

En face -babies can see 6-8 in in front of them

Encourage breastfeeding asap after delivery

Skin to skin

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20
Q

Periods of reactivity
First period

A

30-60 Min
Vitals - eyes are the most open
Encourage bonding
APGAR
Radiant warming
Meds - Vit K & arithromycin

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21
Q

What are the periods of reactivity?

A

First period - 30 - 60 min

Sleep phase - 1 to 4 hours

Second period - 4 to 12 hours

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22
Q

What happens in the second period

A

4 to 12 hours after birth

Increased sensitivity to internal and external stimuly

Voiding and meconium

Mucus, apnea, emesis

Most active in this phase

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23
Q

Risk of not giving vit K injection to newborns

A

Neonatal hemorrhaging

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24
Q

Normal weight in pounds and gms for newborns

A

2500-4000gms
5.5 - 8lbs

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25
Q

SGA

A

less than 10% SGA

26
Q

LGA

A

More than 90% LGA

27
Q

Normal length of newborn

A

18-22 inches
48-52cm

28
Q

Head circumfrence

A

measure above eyebrow

13-14INCHES
32-36CM

29
Q

Chest circumfrence

A

Measure nipple line

12-13 Inches
30-34 cm

30
Q

Temp of newborns
Pulse

A

97.5-99.5

110-160 bpm
Crying - 180 bpm
Sleeping -100 bpm

31
Q

Blood pressure of newborns

A

Only taken with suspected cardiac issues

Measure at the thigh

Falls around 70/40 as normal

32
Q

Normal Fontanelles

Dehydrated

ICP

A

Flat & pulsing

Bulging - ICP

Sunken - dehydration

33
Q

Molding

A

Cone head normal

Overrided sutures

Resolves quickly

34
Q

Caput Succedenum

A

Crosses suture line like a cap
Cap Swelling

Goes away without treatment

35
Q

Cephalohematoma

A

Over a particular bone
Does not cross suture line

Bleeding, blood clot

36
Q

What will we see when cephalohematoma begins to resolve?

A

Jaundice that starts from head and spreads to the rest of the body

37
Q

Skin of the newborn?

A

Reddish in color, ruddy and smooth

Edema - resolves but causes weight loss as they lose water

Turgor- look for dehydration

38
Q

What to look for in the eyes of newborn?

A

Color and red reflex

Subconjunctival hemorrhage from birth trauma

Chemical conjunctivities from reaction to eye prophylaxis

39
Q

What to look for with ears in newborns

A

Eyes and top of ear should line up - if not possible down syndrom or chromosome abnormalities

Loud noise = startle reflex
Moro reflex - abduct, adduct, cry (Away at 3mos)

Flexible pinna with cartilage - it snaps back

40
Q

What to look for in the nose with newborns

A

They are nose breathers look for patency

Normal sneezing and no bridge

Problems:
Nasal flaring that lasts longer than a few moments after birth
Check for retractions & listen to lungs

41
Q

Mouth and throat assessment in newborn

A

Reflexes: Sucking, Rooting, Gag, Extrusion reflexes

Extrusion usually lost at 4-6mos when solids are introduced

Place finger in mouth and see if sucking reflex is available check for cleft palate at same time

42
Q

Abdominal assessment of the newborn?

A

Dome shaped belly
Soft on palpation
Liver is palpable 2-3cm below right costal margin
Bowel sounds 2 hours post delivery

43
Q

When will be first void and meconium of newborn?

A

Void - within 24 hours

Meconium - Within 24-48 hours

44
Q

Female genitalia of the newborn

A

Edematous at labia and clitoris with vernix between the labia

Moms hormones may have the baby spotting within the first week this is normal!

45
Q

Male genitalia of the newborn

A

Palpable testes - if not palpable may be testicular cancer later in life

Rugae should be formed

Do not clean Smega

Do not retract the foreskin it will not return if you do.

46
Q

Assessment of extremities

A

Normal posture

Equal bilateral movement and tone of all four extremities

Flat feet- will develop the arch later

All creases should be present

Look for simean crease - if coupled with downset ears can be a down syndrome case.

47
Q

Hip dislocation assessment

A

Use ortolani’s maneuver - push knee up and rotate

Look for clicking - can also be r/t breech birth

If not breech baby
check for:
-Clicking
-Unequal leg length
-Asymmetrical skin creases on back of thigh

48
Q

Neuromuscular system assessment of the newborn?

A

-Maintains flexion
-Can hold head erect for few seconds
-When prone turns head to side to breath

49
Q

Troubling signs of the neuromuscular assessment?

A

No movement
Jerking
Quivering
Clonic jerking -Possible Neonatal abstinence syndrome - check urine tox

50
Q

Behavioral assessment

A

Soothed to cuddles - if cannot be soothed look into NAS

Sleeps for at least 16-20 hours a day

Brazelton behavioral assessment - test for ADD

51
Q

Additional care of newborn - Bulb suctioning and sleeping

A

Parent teaching to suction - Bubl suctions - Depress bulb and suction mouth first to avoid aspiration.

Back to sleep - Avoid SIDS

52
Q

Additional care of newborn - Circumcision & PKU

A

Keep clean and dry
Monitor newborn voiding
wrap with ointment

PKU - Must be breast and bottle fed before wait 24-48 hours

53
Q

When to call MD

A

Fever
Blue or color changing
Crying incessantly
No urination

54
Q

Car seat safety

A

Rear face seat until 2 years old

Front face until 40 pounds

Booster up to 7-8 years old

55
Q

Normal skin assessment

A

Milia - Clogged sebaceous glands

Mottling - happens when they’re cold

Vernix

56
Q

Rashes and marks

A

Erythema toxicum (Newborn rash) - Starts are trunk and goes away on its own

Forceps mark - assess symmetry (Neuro check)

Mongolian spots - common in any race by white. Purple ecchymotic skin
Goes away in few weeks/months

57
Q

Birthmarks

A

Port wine stain - more permanent birthmark

Stork bite/ Nevi - Normal - goes away in its own, Found on neck/lips
If blanches will go away quickly

Strawberry hemangioma - Not uncommon and can be found on lower back

Cafe au lait

Petechiae

58
Q

Reflexes - Babkin reflex

A

Stimulated by:
Press, stroke both palms

Mouth opens, eyes close, head tilts forward

Disappears: 3 mos

59
Q

Grasping reflex

A

Stimulated: Place object in palm

Holds it tightly

Disappears: 4 mos

60
Q

Babinski reflex

A

Stimulated: Stroke sole of foot

Foot twists and toes fan out

Disappears: 8 mos

61
Q

Stepping reflex

A

Stimulated: Hold baby under arms not on floor

Stepping motion

Disappears: 2 mos

62
Q

Difference between physiologic and pathologic jaundice in the newborn?

A

Pathological jaundice happens within the first 24 hours

Physiological jaundice occurs 2nd or 3rd day. Not associated with hemolytic disease or other pathologies.

(6-10mg/dl & resolves in 5-7 days)

ob nur 359 (4 decks)

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