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OB > Newborn Care > Flashcards

Newborn Care Flashcards

1
Q

Normal axillary temperature range

A

36.5 to 37.4 Celsius

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2
Q

Four physiologic risk factors for hypothermia

A
  1. newborn has decreased subq fat and thin epidermis
  2. newborns blood vessels are closer to the skin surface
  3. newborns head is larger than body
  4. newborns body surface is large compared to their weight
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3
Q

Aside from physiologic risk factors, what are others newborn risk factors for hypothermia

A
  1. all newborns during first 8-12 hrs of life (first half day of life)
  2. premature newborns
  3. prolonged resuscitation efforts
  4. sepsis
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4
Q

How long after birth does a newborns temperature stabilize

A

About 72 hours (3 days)

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5
Q

What three defenses does the newborn have to combat decreasing body temperature

A
  1. flexed posture
  2. brown fat
  3. peripheral vasoconstriction
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6
Q

What does a flexed posture do for a newborn

A

decreases surface area exposed to the colder environment, thus keeping baby warmer

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7
Q

What is brown fat and what is it’s purpose

A

It is fat located around the shoulders and down the sternum and spine of a baby, and it helps to warm the baby after birth

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8
Q

At what point does brown fat begin to develop in fetus

A

26-30 weeks

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9
Q

How does brown fat help to keep baby warm

A

Compared to ordinary fat, a baby’s brown fat is more vascular with a richer nerve supply which increases the heat production by 100%

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10
Q

What is acrocyanosis

A

blue discoloration of a part of the body

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11
Q

conduction v. convection

A 
conduction = loss of heat from cool surface
convection = loss of heat from cool air
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12
Q

radiation type of heat loss is

A

loss of body heat to cool surfaces that are not in contact with the body

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13
Q

example of radiation heat loss

A

body heat lost due to cold window nearby

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14
Q

5 ways to reduce baby’s risk for heat loss

A
  1. dry them immediately after birth
  2. place skin to skin with mother
  3. hat, shirt, and wrap to promote flexion
  4. do not place directly on cold surfaces like a scale
  5. if no skin to skin available, please baby under radiant warmer
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15
Q

initial signs of hypothermia in infant

A

increased movement, flexed position, increase HR and RR

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16
Q

later signs of hypothermia in infant

A

mottled(patchy)/pale skin, lethargy, hypoglycemia, weak cry

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17
Q

During the initial newborn assessment what is done immediately after birth

A

vital signs and assessment every 15 minutes for first hour (total of 4 times)

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18
Q

During the 1-4 hours after birth what assessments/actions are done

A
  • gestational age evaluation
  • erythromycin ointment
  • vitamin k injection
  • weight, length, head/chest circumference
  • identification
  • Hep B vaccine (if mother consented)
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19
Q

What is involved in the identification process after birth of a baby

A
  • maternal thumbprint
  • infant thumbprint
  • banding
  • security alarm
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20
Q

What are the 6 neuromuscular indicators of gestational age

A
  • posture
  • square window
  • arm recoil
  • popliteal angle
  • scarf sign
  • heel to ear
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21
Q

What are the 6 physical criteria for the gestational age assessment

A
  • skin
  • lanugo
  • plantar surfaces
  • breast buds
  • eye/ear
  • genitals
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22
Q

By how many weeks give or take is the gestational age assessment accurate by

A

accurate within 2 weeks

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23
Q

Gestational Age: Preterm

A

born before 37 weeks, no matter the birth weight

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24
Q

Gestational Age: Term

A

born b/w 39 wks and end of 42 wks

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25
Q

Gestational Age: Postterm

A

born after 42 wks

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26
Q

Gestational Age: Postmature

A

born after week 42 wks and is a sign of placental insufficiency

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27
Q

What is normal newborn weight

A

2500g to 4200g

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28
Q

Avg gestational age (AGA)

A

weight between 10th and 90th percentile

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29
Q

Small for gestational age (SGA)

A

weight below 10th percentile

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30
Q

Large for gestational age (LGA)

A

weight above 90th percentile

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31
Q

Does birth weight classification take into consideration gestational age at birth?

A

no it is regardless of gestational age

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32
Q

LBW

A

low birth weight

less than or equal 2500g

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33
Q

VLBW

A

Very Low Birth Weight

less than or equal 1500g

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34
Q

ELBW

A

Extremely Low Birth Weight

less than or equal 1000g

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35
Q

IUGR

A

Intrauterine Growth Restriction

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36
Q

What are some IUGR risk factors

A

multiple births, smoker, AA mother, HTN, pre-eclampsia, malnutrition, substance abuse

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37
Q

Average newborn weight measurement is (in lbs, oz)

A

7lbs, 8 oz.

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38
Q

Average head circumference of newborn (cm)

A

32-37 cm

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39
Q

What does the modified Ballard Assessment determine

A

gestational age

40
Q

What is assessed in the modified ballard assessment (there are 15)

A
  • axillary temp
  • pain score
  • heart
  • lungs
  • head and face
  • neck
  • clavicles
  • chest
  • abdomen
  • umbilicus
  • extremities
  • hips
  • genitalia
  • anus and rectum
  • trunk and spine
41
Q

ballard assessment: heart

A
  • apical pulse rate and rhythm
  • murmur
  • brachial and femoral pulse
42
Q

ballard assessment: lungs

A
  • resp. rate
  • effort
  • sounds
  • grunting
  • rales
43
Q

ballard assessment: head and face

A
  • symmetry
  • fontanels
  • molding
  • cephlohematoma
  • caput succuduem
  • vacuum extracter
  • forcep marks
44
Q

ballard assessment: eyes

A
  • shape
  • subconjuctival hemorrhage
  • edema
45
Q

ballard assessment: eyes

A
  • development of cartilage
  • ear canal
  • position
46
Q

ballard assessment: nose

A
  • flaring

- patency (obligatory nose breather)

47
Q

ballard assessment: mouth

A
  • lip color
  • cleft
  • Epstein’s pearls
  • natal teeth
  • palate
48
Q

ballard assessment: tongue

A
  • movement
  • frenulum
  • suck
49
Q

ballard assessment: neck

A
  • nodes
  • swelling
  • ROM (range of motion)
50
Q

ballard assessment: clavicles

A
  • symmetry

- fracture

51
Q

ballard assessment: chest

A
  • symmetry
  • sternum shape
  • breast buds
  • retractions
52
Q

ballard assessment: abdomen

A
  • bowel sounds
  • contour
  • palpate for distention
53
Q

ballard assessment: umbilicus

A
  • AVA (two arteries, one vein)

- cord clamp

54
Q

ballard assessment: extremities

A
  • posture
  • ROM
  • symmetry
  • skin folds
  • number of digits
  • capillary refill
  • pulses
  • reflexes
55
Q

ballard assessment: hips

A
  • ortolani’s sign
56
Q

ballard assessment: male genitalia

A
  • penis (precipice not easily retractable, opening of urethral meatus)
  • scrotum (testes descended 90% of time)
57
Q

ballard assessment: female genitalia

A
  • labia majora covering labia minora
  • white discharge is normal
  • pseudomenstruation is normal
58
Q

ballard assessment: anus and rectum

A
  • anal wink reflex
  • voids
  • stools
59
Q

ballard assessment: trunk and spine

A
  • palpate spine fully
  • gluteal folds even
  • tufts of hair
  • pilonidal dimple
  • cleft
60
Q

what is caput succedaneum

A

bulging on head as a result of fluid

61
Q

what is cephalhematoma

A

bulging on head as a result of blood buildup

62
Q

what are Epstein pearls

A

protein filled white or yellowish cysts in newborn mouth

63
Q

what is ankyloglossia

A

front of newborns tongue attached to base of mouth

64
Q

what is a sacral dimple

A

dimple right above baby’s butt crack

65
Q

what is normal blood glucose of newborn

A

40-100 mg/dl

66
Q

how is a newborn’s blood glucose level sampled

A

obtained through a heelstick, either on the lateral or medial aspect of heel

67
Q

what is considered hypoglycemia in a newborn

A

BG less than 45 mg/dl

68
Q

most likely risk factors for hypoglycemia

A

cold stress or infant diabetic mother (IDM)

69
Q

what is IDM

A

infant diabetic mother

70
Q

less likely risk factors for hypoglycemia

A

asphyxia, sepsis, respiratory distress, LGA, SGA, LBW, IUGR

71
Q

newborn symptoms of hypoglycemia

A

jitteriness, pallor, cyanosis, temp instability

72
Q

first interventions for hypoglycemic baby

A
  • feed

- skin to skin to warm if hypothermic

73
Q

if BG instability is severe or persistent what might be needed

A

IV dextrose

74
Q

pathologic jaundice v. physiologic jaundice

A

pathologic jaundice is a more like a disease process rather than a symptom, whereas physiologic jaundice should resolve once what is causing it is resolved

75
Q

what percentage of newborns experience physiologic jaundice

A

50%

76
Q

what is jaundice

A

increase in unconjugated bilirubin - hyperbilirubemia

77
Q

what is breastmilk jaundice

A

when baby experiences jaundice as a result of a factor in milk that increases the absorption of bilirubin

78
Q

what interventions are there for breastmilk jaundice

A

most don’t need any intervention

79
Q

when would breastmilk jaundice develop

A

in second week of life

80
Q

when does physiologic jaundice usually develop

A

more than 24 hrs after birth

81
Q

what are normal bilirubin levels for premature babies

A

8, 12, 15, 15

82
Q

what are normal bilirubin levels for full term babies

A

6, 10, 12, 10

83
Q

what are the major risk factors for physiologic jaundice

A
  • gest. age 35-36 wks
  • prev. sibling received phototherapy
  • bruising or cephalohematoma
  • east Asian race
  • exclusive breastfeeding, especially if not going well
84
Q

treatment of physiologic jaundice

A
  • feedings frequently
  • monitor stool (amount, color, consistency)
  • doctor follow up 1-2 days after leaving hospital
  • phototherapy
85
Q

what can cause pathologic jaundice

A
  • rH incompatability
  • blood group incompatability
  • metabolism and excretion disorders
86
Q

what can result from pathologic jaundice if untreated

A

bilirubin deposits in brain resulting in hearing loss, mental retardation, cerebral palsy, and death

87
Q

what does phototherapy for jaundice involve

A

exposure of newborn to high intensity blue light spectrum, use of eye protectors, 30 mins out for feedings, monitor intake and output

88
Q

how does phototherapy treat jaundice

A

facilitates biliary excretion of unconjugated bilirubin

89
Q

how long do you do sponge baths for newborns

A

until the cord stump falls off and circumcision is healed

90
Q

how often do you bath newborn

A

two to three times a week

91
Q

when does umbilical cord usually fall off

A

7-10 days

92
Q

can alcohol be used to clean umbilical cord

A

no

93
Q

should umbilical cord be covered by diaper or shirt or exposed to air

A

exposed to air, fold shirts and diapers

94
Q

signs of infection as umbilicus

A
  • fever
  • redness or pus
  • swelling or moistness 2 weeks after stump falls off
  • bulging after stump falls off
95
Q

at what point should umbilical cord be clamped

A

within 24 hrs of birth

96
Q

important procedures for circumcision care

A
  • use clear water to clean plastibell ring until it falls off
  • petrolatum gauze or Vaseline in front of diaper for 12-24 hrs if gomco/mogen
97
Q

is yellowish film over glans normal or abnormal after circumcision

A

normal part of healing

OB (7 decks)

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