newborn assessment and care 2

Question 1

tonic neck

Answer 1

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

Question 2

palmer

Answer 2

0-4/6 mo

Question 3

plantar

Answer 3

0-9/12mo

Question 4

moro

Answer 4

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

Question 5

rooting

Answer 5

harder if recently fed
0-4mo

Question 6

babinski

Answer 6

toes flare
change 1 yr -> toes curl

Question 7

stepping

Answer 7

0-3/4 mo

Question 8

bladder

Answer 8

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

Question 9

bowel

Answer 9

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

Question 10

at risk neonates

Answer 10

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

Question 11

factors for at risk neonates

Answer 11

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

Question 12

preterm

Answer 12

20 - 36^6

Question 13

late preterm

Answer 13

34 - 36^6

Question 14

full term

Answer 14

39 - 40^6

Question 15

early term

Answer 15

37 - 38^6

Question 16

late term

Answer 16

41 - 41^6

Question 17

post term

Answer 17

42+

Question 18

low birth weight

Answer 18

<2500g or 5.5lb

Question 19

very low birth weight

Answer 19

<1500g or 3.3 lbs

Question 20

extremely low birth weight

Answer 20

<1000g or 2.2 lbs

Question 21

small for gestational age

Answer 21

plot below 10th percentile

Question 22

appropriate for gestational age

Answer 22

plot between 10th and 90th percentile

Question 23

large for gestational age

Answer 23

plot above 90th percentile
>4000g

Question 24

intrauterine growth restriction

Answer 24

rate of growth does not meet expected growth patterns

Question 25

symmetric IUGR

Answer 25

weight, length, head circumference all affected

Question 26

asymmetric IUGR

Answer 26

head normal but body small <10th percentile

Question 27

preT causes

Answer 27

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)

Question 28

newborn assessment

Answer 28

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

Question 29

neonatal resuscitation protocol

Answer 29

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

Question 30

vitamin K

Answer 30

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

Question 31

attachment

Answer 31

skin to skin, rooming in

Question 32

erythromycin

Answer 32

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

Question 33

bath

Answer 33

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

Question 34

periods of reactivity

Answer 34

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

Question 35

nutrition

Answer 35

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

Question 36

breastfeed

Answer 36

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

Question 37

formula

Answer 37

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

Question 38

nutrition: assessment

Answer 38

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

Question 39

daily assessment

Answer 39

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

Question 40

jaundice

Answer 40

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

Question 41

NAS: cm

Answer 41

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

Question 42

NAS: complications

Answer 42

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

Question 43

NAS: assessment

Answer 43

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

Question 44

NAS: nc

Answer 44

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

Question 45

NAS: pharm

Answer 45

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

Question 46

before d/c

Answer 46

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)

Question 47

prematurity G+D

Answer 47

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

Question 48

s of newborn illness

Answer 48

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

Question 49

injections

Answer 49

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