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N330 > Nursing Care Of The Newborn And Family > Flashcards

Nursing Care Of The Newborn And Family Flashcards

1
Q

What level apgar may require more interventiosn
What initiates transition to extrauterine life

A

Less than 7

Respirations

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2
Q

Can provide skin to skin and delay full assessment after birth is what

A

Breathing effectively
Pink
No lifethreats

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3
Q

Immediate care following birth (6)

A

Skin to skin
Stimulate and dry
Place hat
Nasal and oral secretions
Matching ID bands
Place security bands

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4
Q

Promote breastfeeding while skin to skin withing when

A

First hour of life

AKA golden hour

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5
Q

When to warm a baby at warmer (3)

A

Preterm
Poor muscle tone
Not crying/breathing

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6
Q

APGAR stands for

A

Appearance (color
Pulse (HR)
Grimace (face/cry)
Activity (tone)
Respiratory

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7
Q

Apgar appearance(color)

A

0: blue/pale

1: body pink, extremities blue

2: completely pink

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8
Q

APGAR: pulse

A

0: absent

1: slow <100

2: >100

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9
Q

APGAR: grimace

A

0: no response

1: grimace

2: cry

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10
Q

APGAR: activity (muscle tone)

A

0: flaccid

1: some flexion of extremities

2: well flexed

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11
Q

APGAR: respiratory

A

0: absent

1: slow, weak cry

2: good cry

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12
Q

New born care

How long we allow skin to skin and baby fed before completing other admission items

Wt
Length
Head circumference

A

1-2hrs

Wt: 2700-4000g
Length: 19-21in
Head circumference 2cm>chest

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13
Q

Early interventions:

Eye prophylaxis
-prevents what
-where it goes

Vit K:
-route
-when given

A

Eye prophylaxis prevents:
-neonatal conjunctivitis
-thin ribbon on lower lid

Vit K:
-IM vastus lateralis
-1-2hr after birth

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14
Q

Classificialtion of gestational age and wt

A

AGA: appropiate for gestational age

LGA: >90% percentile

SGA: <10% percentile

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15
Q

Ballard score used to figure out what

A

Assesses gestational age based on physical maturity and neuromuscular maturity

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16
Q

Physical maturity characteristics (ballard score)

A

Skin
Lanugo
Plantar creases
Breast tissue
Eyes/ears
Genitalia

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17
Q

Ballard score: preterm vs term

Skin texture

A

Term: creases

Preterm: more smooth

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18
Q

Ballard score: preterm vs term

Lanugo

A

Term: balding

Preterm: alot of lanugo

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19
Q

Ballard score: preterm vs term

Plantar creases

A

Term: creases

Preterm: smooth plantar

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20
Q

Ballard score: preterm vs term

Breast tissue

A

Term: developed

Preterm: flat, not developed

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21
Q

Ballard score: preterm vs term

Eyes/ears

A

Eyes:
Term: can open
Preterm: still fused

Ears:
Term:cartilage stiff/recoil
Preterm:thin, no recoil if bent

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22
Q

Ballard score: preterm vs term

Genitalia

A

M:
Term: tesicles in scrotum/decended
Preterm: not descended

F:
Term: labia majora prominent
Preterm: everything there, clitoris prominent

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23
Q

Anthropometric measurements done during physical assessments

A

Length
Wt
Head and chest circumference

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24
Q

Skin assessment finding in babies:

-acrocyanosis
-vernix
-lanugo
-milia
-mongolian spots
-telegiectatic nevi (stork bites)
-nervus flammeus
-erythema toxicum

A

-acrocyanosis: blue hand and feet
-vernix: white on baby (cheesy)
-lanugo: small hairs
-milia: milk spots
-mongolian spots: i know it
-telegiectatic nevi (stork bites): red speckled spot on neck/forehead
-nervus flammeus: red patch
-erythema toxicum: rash

25
Q

Two skin conditions that dont go away

A

-erythema toxicum
-nevus flammeus

26
Q

Head physical assessment

-size we want
When anterior/posterior fontanel go away
-other things you may see

A

2-3cm larger than chest circumference

Anterior/posterior fontanel: go away @ 12-18months

Caput: cross over suture line, edema/swelling

Cephalohematoma: bleeding/firm/bruising

27
Q

Face physcial assessment

Eyes
Ears
Nose
Mouth

A

Eyes: red reflex present (to light), strabismus (cross eyed)

Ears: inspect for low set ears (=down syndrome), skin tags (kidney form at same time as ears so sign of kidneys)

Nose: nose breathers, sneezing normal

Mouth: epsteins pearls(white pearls on gums)
-natal teeth (useless teeth=risk of aspiration)
-white tongue (thrush=fungal) cant wipe off

28
Q

Chest
Abdomen

A

Chest:
-barrel chest early on is okay
-swelling in breast
-witchs milk (galactorrhea) =discharge from babies breast

Abdomen:
-bowel sounds present within a few mins

29
Q

Extremities

Spine/back

A

Extremtiies:
Ortolani barlow maneuver:
test hip ROM (hear click when moving leg in circle (assess for congenital hip dysplasia)

Oligodactly (to few)
Polydactly
Syndactlyly (webbed)

Spine/back:
-pilonidal dimple: spina bifida
-tuft of hair

30
Q

Newborn reflexes (primitive)

Primitive=born w/ and go away within 1 year

Rooting/sucking
Palmar and plantar grasp
Tonic neck
Moro
Babinski
Stepping
Trunk incurvation

A

Rooting/sucking
Palmar and plantar grasp
Tonic neck: pull arm one way, neck follows
Moro: reflex like their falling
Babinski: toes fan out when foot is rubbed
Stepping: hold on surface and look like their walking
Trunk incurvation: rub side of back theyll turn that way

31
Q

Anogential physcial assessment

Check if what is present
Want what to pass within what amount of time

A

Anus present/patent

Meconium passed in first 24 hours

Urine passed within 24 hours

32
Q

Male and female genitalia physcial assessment
Male:
hydrocele, rugae, hypospadias, epispadias

Females:
-what should cover mose
-pseudomenstuation

A

Male:
Hydrocele: fluid filled sac
Scortum should have rugae(wrinkle)
Hypospadias: bottom side (ventral)
Epispadias: top side (dorsal)

Female:
-labia majora cover labia minora and clitoris
-pseudomenstruation (pink discharge)

33
Q

NIPS (neonatal infant pain scale)

A

Just know it is not 0-10

Looks at behaviors

34
Q

Neonatal pain tx (nonpharm)

A

Swaddling
Nonnutritive sucking (pacifier)
Oral glucose
Skin to skin
Breastfeeding

35
Q

Universal newborn screening

Other two screenings

A

Mandated by us law
Early detection of metabolic and genetic d/os
(CF, PKU, SCA)

Others:
Hearing screening
Screening for critical congentical heart disease
-pulse ox on R hand for pre ductal
-L hand for postductal

36
Q

Hep B vaccine

Route
2nd and 3rd dose time

A

IM

2nd dose: 1-2 months

3rd dose: 6-18 months

37
Q

Circumcision requirements

A

Least 12hrs old
Recieved vit K
Had urine output
Informed consent

38
Q

Different types of circumcision

A

Plastibell
Mogen
Gomco clamp

39
Q

Pain management for circumcision

A

Penile nerve block (lidocaine)

EMLA cream

Sucrose

40
Q

Cricumcision care and teaching

What to do for first 24 hrs
Monitor what 2 things
How to clean/ what to avoid
No what until healed
Dont pick at what
Report what

A

1st 24 hrs apply petroleum and gauze (clamp methods only
-mogen and gomco

Monitor bleeding and first urination

Clean with warm water/ avoid baby wiped w/alcohol

No tub baths/ used sponge bath until healed

Dont pick at yellowish scab/mucus

Report:
-frank bleeding
-foul smelling discharge
-lack of void

41
Q

Nutrition

Gold standard
Acceptable alternative
AAP recomends what
What to do during second 6mon period

A

Human milk = gold standard

Iron fortified formula acceptable alternatvie

AAP recommends:
Exclusive breastfeeding of human milk for 1st 6mon and continued breastfeeding for at least 12mon

Second 6mon: solid foods added to diet

42
Q

Breast feeding benefits to infant

A

Reduce mortality

Enhance neurodevelopment

Immunity

Reduce risk for:
GI infection
Inflammatory bowel
Asthma
Lower resp tract infection
SIDS
Obesity
DM
Leukemia

43
Q

Benefit of breast feeding for mom

A

Promotes uterine involution

Reduce postpartum bleeding

Increased maternal role

Save money

Reduce risk for:
Ovarian/endometrial/breast cancer
Osteoporosis
PP depression
DM
HTN
High cholesterol
CVD

44
Q

Lactogenesis

A

Significant drop in progesterone after birth triggers a release of prolactin from anterior pituitary gland
-prepares breast to secrete milk
-supply-meets-demand system

45
Q

Oxytocin with breast feeding

A

Milk ejection reflex (MER) = let-down relfex

Same hormone stimulated uterine contraction during labor = mother who breast feed decrease risk of PP hemorrhage

46
Q

Intiating breast feeding

Intitiate within when
How want baby and mother
Feed on demand (minimum amount per hr)
Position
Latch vs unlatching
Hungercues

A

Intitiate within 1st hr of life

Skin to skin

Feed q2-3hrs

Position belly to belly

Proper latch: mouth completely open, tongue under nipple
Unlatching: put pink to roof of mouth

Hunger cue:
Hand to mouth
Sucking/mouth motions
Rooting reflex

47
Q

How to document amount of feed for breast feeding

A

Time latched till unlatched in minutes

48
Q

Teaching with breast feeding

Duration
Alternate what
Burp when
Avoid what

A

No longer than 30 mins

Alternate breasts

Burp in between and at end of feeding

Avoid caffeine/alcohol

49
Q

Indicators of effective breastfeeding

Urine/poo/wt

A

6-8 wet diapers daily/ pale yellow urine

2-5 loose yellow seedy stools daily

Steady wt gain after 1st week of age

50
Q

Wt loss wanted vs concern

A

Want: 5-10% of birth wt loss

Any more is concern

51
Q

Storage of milk

-room temp
-refrigerator
-freezer

A

Room temp: 4hr

Refrigerator: 4days

Freezer: 6mon to 1yr

52
Q

Formula feeding

How often
Technique
Dont warm bottle how

Common concerns

A

Q3-4hrs

Technques: should be help for all feedings, bottle at 45degree, never propped

No warming in microwave

Common concerns:
-Proper burping, spitting up
-avoid overfeeding

53
Q

Formula feeding prep. And safety

Never do what
Type of water to use
Throw away what

Prepared powder formula can be stored in refridgerator for how long

A

Never dilute bottle

Tap water can be used but must be boiled first (distilled water)

Throw away any remaining formula left in bottle

Prepared powder can be stored 24 hrs

54
Q

Newborn discharge teaching

Temp
Respiratory

A

Temp: use axillary

Respirator:
Signs of resp distress
Use bulb syringe

55
Q

Nursing teaching discharge

Stools

A

3 stools/day

Formula less

56
Q

Newborn discharge

Umbilical cord care
-how long
-what we want
Dont do what
Use what to clean

Bathing:
No more than every what
How to do it

A

Umbilical:
10-14 days
Keep clean/dry
Dont tuck in diaper
Use water to clean

Bathing:
-No more than every other day
-Sponge bath until umbilical stump seperate/circumcision healed

57
Q

When newborn gets wellness checkups

A

2-3 days

58
Q

Newborn discharge teaching

Manifestations to report immediately: (10)

A

Temp >100.4 or <97.9
Poor feeding
Forceful vomiting or freq
Decreased urination
Diarrhea or decreased bowel movements
Jaundice
Cyanosis
Resp depression
Difficulty waking
Bleeding or purulent drainage from umbilicus/circumision

N330 (17 decks)

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