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newborn assessment and care 2 Flashcards

1
Q

tonic neck

A

supine, turn head, extremities on that side straighten, other side flex
0-4 mo
fencer

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2
Q

palmer

A

0-4/6 mo

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3
Q

plantar

A

0-9/12mo

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4
Q

moro

A

startle, arms straighted, hands out, knees flexed, arms to chest, fingers = “c”
0-6mo

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5
Q

rooting

A

harder if recently fed
0-4mo

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6
Q

babinski

A

toes flare
change 1 yr -> toes curl

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7
Q

stepping

A

0-3/4 mo

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8
Q

bladder

A

void by 24 hr (most) - 48 hr (notify hcp if not)
6-8 diapers/day

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9
Q

bowel

A

meconium = thick, sticky, get off
breastfeed = yellow and seedy, easier to digest (more BM)
formula = less BM, firmer and browner
imperforate anus

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10
Q

at risk neonates

A

low SES (mom), limited access to care, env dangers, preexisting conditions, medical conditions related to pregnancy, pregnancy complications

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11
Q

factors for at risk neonates

A

birth weight, GA, IUG, type and length of illness, env factors, maternal factors, maternal-neonatal separation

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12
Q

preterm

A

20 - 36^6

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13
Q

late preterm

A

34 - 36^6

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14
Q

full term

A

39 - 40^6

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15
Q

early term

A

37 - 38^6

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16
Q

late term

A

41 - 41^6

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17
Q

post term

A

42+

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18
Q

low birth weight

A

<2500g or 5.5lb

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19
Q

very low birth weight

A

<1500g or 3.3 lbs

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20
Q

extremely low birth weight

A

<1000g or 2.2 lbs

21
Q

small for gestational age

A

plot below 10th percentile

22
Q

appropriate for gestational age

A

plot between 10th and 90th percentile

23
Q

large for gestational age

A

plot above 90th percentile
>4000g

24
Q

intrauterine growth restriction

A

rate of growth does not meet expected growth patterns

25
Q

symmetric IUGR

A

weight, length, head circumference all affected

26
Q

asymmetric IUGR

A

head normal but body small <10th percentile

27
Q

preT causes

A

DM, chronic htn, preE
obstetric disorder or rf in pregnancy (abruption, previa, gallbladder disease)
medical disorder that affects pregnancy (heart disease, VTE, asthma, HIV, active HSV, obesity)
advanced maternal age
fetal disorder (IUGR, poly.oligo, hydrops, birth defect, multigestational)

28
Q

newborn assessment

A

GA
LGA/SGA
heel stick (glucose) want 40mg+, 30 min after feed
maternal DM, LGA, SGA
s/s hypogly: jittery, hypotherm, breathing issues
neuromuscular and physical maturity -> want higher score

29
Q

neonatal resuscitation protocol

A

sniffing position (dont hyperextend neck)
stimulate, if <100bpm -> CPAP and pulse ox, still <100 -> intubate, <60 -> CPAP with compressions

30
Q

vitamin K

A

no bacteria to synthesize
bleeding, not enough in breast milk
6mo risk for bleed

31
Q

attachment

A

skin to skin, rooming in

32
Q

erythromycin

A

conjunctivitis (chlamydia or gonorrhea) within 30 min, remove secretions before

33
Q

bath

A

6hr+, prevent cold, bonding, 1-2x/wk, water on face, sponge until cord off (3wk), not right after feed, do under warmer, genitals last, folds and creases

34
Q

periods of reactivity

A

1st: 30 in, active, awake, hungry, strong suck reflex, bond, breastfeed
sleep: HR and RR drop, 2-4 hr
2nd: awake, alert, longer (4-6hr), HR and RR increase

35
Q

nutrition

A

cals: 45.5 - 52.5 per pound per day or 100-115 cal per day
64 - 73mL per pound per day or 140-160mL/day
gain 1oz/day for first 6 mo on formula
gain 0.5oz/day for first 6 mo with breastfeed

36
Q

breastfeed

A

ideal balance of nutrients, composition varies for GA and stage of lactation
immunologic
return to prepreg weight
bonding, hormones (PPD), societal barriers, work
maternal diet matters, save money, pump, special bra, fridge
convenient (temp, preparation), mom must be available, discomfort

37
Q

formula

A

additives, missing ingredients, nutritional value stays same, overfeeding, feed less freq - slower digestion
no immunologic properties, allergies, contamination
when mom milk not available
both parents participate
expensive
prepare (time), less convenient for travel and night feeding, mother not needed

38
Q

nutrition: assessment

A

readiness: rooting, sucking, head bob
infant: awake, alert, assess physiologic status during feed
breast v formula (q3-4)
breast: q2-3, on demand, place on mothers chest, can begin in birthing room ASAP, supply and demand, burp btw breast, formula = 1/2, support head

39
Q

daily assessment

A

VS, weight, feedings, I+O, umbilical cord care, skin color change
umbilical cord care: clamp until dry, out of diaper, dye or not, 7-10 days

40
Q

jaundice

A

RBC breakdown
pathological: 1st 24hr, phototherapy (diaper, eye protection, hydration, bonding), blood transfusion, caused by Rh, liver issue, BAD
physiological: PreT, after first 24hrs, increase feedings 8-12x/day, phototherapy
nc: warm, monitor stools, early feedings

41
Q

NAS: cm

A

high pitch cry, hyperirritable, increased tone, exaggerated reflex, tremors/jerks, seizures, sneeze, hiccups, yawns, short sleeps
disorganized/vigorous suck, excessive suck, v, poor weight gain, sensitive gag reflex, d, poor feed (little and/or takes long time)
stuffy nose, mottled, tachypnea, sweat, hyperthermia
excorlated butt, knees, elbows, facial scratch, pressure point abrasions

42
Q

NAS: complications

A

resp distress, jaundice, congenital anomalies (already present), IUGR, behavior abn, withdrawal, and preT complications
hospital for 5 days

43
Q

NAS: assessment

A

finnegan: severity of opioid withdrawal
monitor response to withdrawal, dynamic scoring of 21 symptoms (periods)
known hx or s/s
2hr after birth, q4hr, after each feed until better -> after feed
8+ = q2 until meds started -> q4 or after each feed

44
Q

NAS: nc

A

skin to skin, swaddle, gentle wake, quiet, low stim, low light, calm music or massage therapy
mild s: support/comfort cafe
cluster care
parents involvement, rooming in
breast feed delays onset and decrease severity and pharm treatments
moms on methadone or buprenorphine should breastfeed

45
Q

NAS: pharm

A

NICU, match drug selection to cause of withdrawal
1st line: morphine and methadone; sublingual buprenorphine better than oral morphine, decrease length of stay
adjunct phenobarbital or clonidue for opioid withdrawal
buprenorphine to prevent intrauterine fetal seizures

46
Q

before d/c

A

hearing: fluid in ears (repeat)
guthrie for PKU 24 hr after feeding (heel stick)
immunizations: hep B (2nd at 1 mo, 3rd at 6-18 mo) + hep B IG if mom +
circumcision: gomco, plastibell, mogen clamp, watch for excess bleed/drainage, careful with diaper change (stick)
parent edu: swaddle (arms tight, legs loose), back to sleep, car seat (rear facing), infant CPR, routine appt (1-2 days)

47
Q

prematurity G+D

A

earlier = more effect
wont perform as others of same age -> age of all premies adjusted when dev is evaluated
preT d/c 36-40 wk GA: no headlag, vigorous cry when hungry, good growth curve, neuro response appropriate for corrected age

48
Q

s of newborn illness

A

T >100.4 or <97.7, continual increase
forceful or freq v, refuse 2 feeds in a row, hard to wake, cyanosis, no breath <20s, inconsolable, constant high pitch cry, discharge or bleed, 2 green watery stools, no wet diapers for 18-24 hr, <6-8 diapers after 4 days old, eye drainage

49
Q

injections

A

vastus lateralis, 90 degrees, dose should be 0.5-1 mL, L = 5/8”

ob - 332 (15 decks)

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