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N352: Practice of Nursing I > OB Module 1: Part 2 - The Newborn > Flashcards

OB Module 1: Part 2 - The Newborn Flashcards

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1
Q

The newborn experiences many physiological changes when transitioning to extra uterine life, these changes involve establishment of what things?

A
  1. Pulmonary Gas Exchange
  2. Neonatal Cardiovascular Pattern
  3. Stable Serum Glucose Level
  4. Thermoregulation
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2
Q

Assessment and monitoring of neonatal adaptation is needed for early detection of what complications?

A

Hypoxia
Cold Stress
Hypoglycemia
Infection
Polycythemia
Hyperbilirubinemia

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3
Q

What are some of the Key Newborn Assessments

A
  1. VS, especially temperature, but BP is rarely done
  2. Nutrition
  3. Elimination
  4. Transition to extrauterine life
  5. activity state
  6. umbilical cord status

7/8/9. (Only if indicated) Glucose monitoring, bilirubin, circumcision assessment

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4
Q

Apgar Score

A

This score is indicative of the need for resuscitation, NOT the degree of asphyxia in a newborn

Each factor is scored 0, 1, or 2 and a lower number indicates need for resuscitation

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5
Q

When are infants apgar scored?

A

At 1 and 5 minutes of life, and if needed at 10 minutes

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6
Q

What are the 5 factors apgar scored?

A

Heart Rate

Respirations

Muscle Tone

Reflex Irritability

Color

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7
Q

Fetal lungs secrete ___ ___ throughout pregnancy

A

lung fluids

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8
Q

When does lung fluid production diminish in the fetus?

A

2-4 days before the onset of SPONTANEOUSLY OCCURRING LABOR (may not all be gone if we induce labor)

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9
Q

How much lung fluid remains in the passageway of a full term newborn?

A

80-100 mL of lung fluid

(This will need to be expelled or absorbed after delivery)

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10
Q

How is part of the lung fluid pushed out of the infant?

A

During labor and birth, fetal chest is compressed and this squeezes part of the fluid out

This is called VAGINAL SQUEEZE

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11
Q

What 2 ways is the remaining infant lung fluid disposed of?

A
  1. Vaginal Squeeze
  2. Absorption by the lymphatic system
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12
Q

Why can you hear fine crackles over the lungs in the newborn?

A

Because of the lung fluid remaining there

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13
Q

Transient Tachypnea of the Newborn (TTN)

A

A repsiratory complication at risk of developing in infants that have difficulty clearing the remaining lung fluid

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14
Q

Why are C Section babies at higher risk for TTN

A

They did not get the vaginal squeeze to force some fluid out

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15
Q

Why is the chest recoil so important to the initiation of infant resp. stimulation?

A

It can mechanically stimulate the first breath and respiration (chest recoil occurs during vaginal squeeze)

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16
Q

What are some Chemical Stimuli that initiative infant respiration?

A
  1. Increased PCO2 and decreased pH and PO2 from inspiratory gasp
  2. Changes in aortic and carotid chemoreceptors which trigger the brains respiratory center
  3. Hormonal - prostaglandin drop
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17
Q

Inspiratory Gasp

A

first infant breath

triggered by increased PCO2 and decreased pH and PO2

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18
Q

How does a drop in prostaglandins contribute to respiration in the newborn?

A

It is released by the placenta during pregnancy to suppress respiration, but with the clamping of the cord - the levels drop and there is a rise in inspiratory drive

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19
Q

How does PO2 rise in the newborn?

A

It starts at 65% in the first minute of life, and then increases 5% every minute for 5 minutes and then is at 90-95% at ten minutes

Skin goes cyanotic to pink remarkably fast

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20
Q

What is the mechanical stimuli that initiates infant respiration?

A

Natural result of a normal vaginal birth as the “vaginal or thoracic squeeze” is released at the delivery of the chest allowing for lung expansion

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21
Q

What is the thermal stimuli that initiates infant respiration

A

Significant decrease in environmental temperature after birth stimulates skin nerve endings leading to the newborn responding with rhythmic respiration

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22
Q

Excessive cooling of the infant may lead to…

A

profound respiratory depression as a result of “cold stress”

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23
Q

Sensory Stimuli: How does Intrauterine life differ from Newborn Experiences at delivery?

A

Intrauterine: Dark, sound dampened, fluid filled environment, weightless

Newly Born: Light, sounds, gravity effects, abundance of tactile/auditory/visual stimuli

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24
Q

Normal newborn respiratory rate is __ to ___ breaths per minute

A

30 to 60 BPM

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25
Q

Initial newborn respirations may be what in regard to depth and rhythm?

A

diaphragmatic, shallow, irregular

VERY ERRATIC - listen for a minute

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26
Q

Respiratory rate of the newborn increases with ___

A

crying (easy to get respirations then but increases the rate)

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27
Q

In a newborn it is important to do what when counting respirations?

A

count for a full minute since its so erratic

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28
Q

Is apnea in a newborn abnormal?

A

Apnea 5-15 seconds is not abnormal (periodic breathing) but pauses longer than 20 seconds are apnea that needs additional assessment

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29
Q

Periodic Breathing

A

a common breathing pattern in the first few hours of life

It consists of pausing lasting from 5 to 15 seconds (apnea)

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30
Q

S/S of Respiratory Distress in the Newborn Include…

A

increased/decreased respiratory rate <30->60

flaring of nares

expiratory grunting

see-saw breathing

retractions

color changes

circumoral cyanosis – general cyanosis

decreased muscle tone

problems with temperature regulation

increased water loss

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31
Q

The first sign of respiratory distress in an infant is usually?

A

Flaring of the nostrils (followed by expiratory grunting)

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32
Q

What is the primary resp. issue for a newborn that can lead to distress?

A

potential for the alveoli to collapse causing larger areas of the lungs to collapse later

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33
Q

What may a baby do to keep alveoli inflated?

A

Close the epiglottis while exhaling to try and keep the alveoli inflated

It sounds like humming and is done to keep surface tension

This appears as the second sign of resp. distress, expiratory grunting

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34
Q

Acrocyanosis

A

a common finding in newborns of cyanosis of the hands and feet

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35
Q

Circumoral Cyanosis

A

A not uncommon finding of cyanosis around the mouth in newborns due to the fact the tissue is thin and highly vascular in this area

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36
Q

Is cyanosis in the trunk abnormal?

A

Yes, you need to then monitor O2 Saturation

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37
Q

See Saw Breathing

A

A later sign of resp. distress where the abdomen and chest effort is alternating in breathing

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38
Q

Why and When does temperature regulation become a problem in resp. distress?

A

Moist warm air is leaving quickly while cool air is coming in

occurs later down the road

Also since muscle ton is relaxing, the infant cools faster from increased surface area

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39
Q

Cardiovascular adaptation requires the transition from __ to __ circulation (which differ0 with the change from ___ to __ gas exchange

A

fetal to neonatal

placental to pulmonary

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40
Q

The fetal lungs are essentially ___. Most blood does what in utero?

A

nonfunctional. Most blood bypasses the lungs and is shunted to other parts of the body

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41
Q

Foramen Ovale

A

opening between the right and left atriums in the fetus

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42
Q

How does oxygenated blood return in fetal circulation?

A

Oxygenated blood returns to the fetus from the placenta through the placental vein.

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43
Q

40-60% of Fetal Blood bypasses…

A

the liver via the DUCTUS VENOSUS and enters the inferior vena cava

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44
Q

As the fetal blood enters the right atrium, what happens next?

A

50-60% of the blood is shunted across the atrium through the foramen ovale to the left atrium

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45
Q

How does pressure differ in fetal circulation?

A

There is LOW systemic resistance and HIGH pulmonary resistance

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46
Q

60% of fetal blood from the right ventricle…

A

is shunted through the ductus arteriosus to the umbilical arteries and toward the placenta

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47
Q

What things change and why do they change from fetal to neonatal circulation?

A

Openings and Shunts (like the ductus venosus, ductus arteriosus, foramen ovale) close and the pulmonary pressure becomes less than the systemic pressure leading to neonatal blood flow

This occurs due to the pressure changes that occur

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48
Q

What causes the pressure resistance in circulation shift from fetal to neonatal circulation?

A

Initiation of respirations by the infant and clamping of the cord changes it to low pulm. res. and high systemic res.

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49
Q

The shift of circulatory resistance cause a pressure closure ….

A

of the foramen ovale in the heart. The ductus arteriosus begins to constrict almost immediately after

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50
Q

How does blood flow in neonatal circulation

A

right atrium –> right ventricle –> pulmonary arteries –> lungs –> pulmonary veins –> left atrium –> left ventricle –> aorta

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51
Q

The newborn cardio assessment should start with …

A

a general color assessment (especially oral mucosa and trunk)

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52
Q

Acrocyanosis

A

occurs in the first 7-10 days

it is not unusual for the hands and feet to remain blue

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53
Q

Circumoral Cyanosis

A

blue tint to the skin surrounding the lips, but not on the lips

this is normal and is simply the blue color of the veins just below the skin in this area

You may notice this blue tint most of the time

When the arterial blood in this area diminishes for various reasons, you will see the blue tint of the veins underneath

Does not include mucosa

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54
Q

General Cyanosis

A

blue tint to the skin that covers the face, trunk, and extremities

Associated with poor oxygenation of the tissues and is an ominous sign

Can be respiratory or cardiac in origin

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55
Q

How is newborn heart rate assessed?

A

Taken apically at the FOURTH INTERCOSTAL SPACE, LEFT

Listened to FOR A FULL MINUTE

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56
Q

What is normal apical heart rate of a newborn?

A

110-160 BPM at rest

Can be 80-100 when asleep

Can be up to 180 when stressed

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57
Q

___ may increase heart rate and respiratory rate

A

crying

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58
Q

What heart rates warrant further investigation?

A

consistently high (above 180) or low (below 100)

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59
Q

Heart Murmurs in Newborns

A

Not an uncommon finding

Most non pathological and disappear by 6 months

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60
Q

Although newborn murmurs are not uncommon…

A

ALL MURMURS WARRANT FURTHER INVESTIGATION AND ASSESSMENT

Hearing a murmur in a newborn is the most common means of recognizing cardiac disease

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61
Q

What may make a murmur an abnormal finding in a newborn?

A

if accompanied by poor feeding, cyanosis, pallor, or apnea

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62
Q

Estimated Blood Volume of a Term Infant

A

80 mL/kg of body weight (or 92 mL/kg if you delay clamping like you should)

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63
Q

How may blood volume in a newborn vary?

A

Varies with amount of placental transfusion received by the newborn during expulsion of placenta (the vaginal squeeze forces blood back into the placenta temporarily so do not clamp the cord immediately - wait 30s to a few minutes to allow blood flow back)

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64
Q

Blood volume increases by ___% with delayed cord clamping

A

50%

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65
Q

Peripheral blood flow in the newborn can be ___, and cause …

A

sluggish, and cause RBC stasis (increased stasis)

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66
Q

You should not take blood samples from the ___ in a newborn

A

periphery (since it is slow)

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67
Q

H&H levels are ___ in ___ blood than ___ blood

A

H&H levels are higher in capillary blood than in venous blood

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68
Q

Blood samples taken from ___ samples are more accurate than those taken from __ samples

A

venous; capillary

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69
Q

In the new O2 rich environment, what may occur for the babies RBCs?

A

Breakdown from the extra RBC, leaving bilirubin which causes Jaundice

Bilirubin needs to be bound to a protein that is excreted but there is only so much

If the breakdown is excessive, there can be hyperbilirubinemia and we may need to help treat

(Wanna see jaundice after a few days, not immediately at birth)

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70
Q

How does Newborn blood lab values differ?

A
  1. total blood volume 82.3 to 92.6 ml/kg depending on clamp time at three days of life
  2. H&H are both higher than adults (14-20 dL and 43-64%) - this is to catch more oxygen coming to it
  3. WBCs are elevated
  4. Blood glucose is elevated (40-80 or 45-95 mg/dL at 6 hours of life)

these are all at delivery values

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71
Q

What is normal glucose levels in the newborn?

A

Between 40-80 mg/dL ion the first 6 hours of life and then 45-90 mg/dL after that

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72
Q

What glucose levels are hypoglycemic in the newborn and how can it be treated?

A

Glc below 40-45 mg/dL

Treated with feeding or a 10% dextrose in sterile water feeding

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73
Q

Persistent hypoglycemia in the newborn can result in …

A

neurological damage in the newborn

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74
Q

Newborn Hypoglycemia results from what things?

A

Inadequate availability of glucose (poor feeding)

Abnormal endocrine regulation (infants of diabetic mothers)

Increased utilization of glucose (cold stress, infection)

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75
Q

___ is the primary fuel for the newborn and is stored in the ___ as ____

A

glucose; liver; glycogen

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76
Q

Hypoglycemia can be __-__ and can result in ___ and ___ ___

A

life-threatening; seizures; learning disabilities

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77
Q

Which is more common in premature and small for gestational age infants, hypo or hyperglycemia?

A

Hyperglycemia

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78
Q

S/S of Infant Hypoglycemia

A

S/S of hypoglycemia are frequently absent despite extremely low blood glucose levels though!

Jitteriness

Hypothermia

Diaphoresis

Hypotonia

Irritability, tremors, muscle twitching, seizures

Abnormal cry

Poor feeding

Lethargy

Resp. distress, tachypnea, apnea

Cyanosis, Tachycardia, cardiac failure, cardiac arrest

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79
Q

What is the most common symptom of hypoglycemia? Second most common?

A

Most common: Jitteriness (but this is also a withdrawal symptom)

2nd: Hypothermia

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80
Q

Normal Newborn Temperature

A

> 97.6 F

Rarely elevated

Below 97.6 F is abnormal and can lead to significant distress from cold stress

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81
Q

Temperature instability indicates ___

A

infection (or even hypoglycemia)

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82
Q

What is the preferred method to take newborn temperature? What are some alternatives?

A

Preferred: Axillary

Alternative: Axillary, Continuous skin probe, Rectal

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83
Q

Newborn temperature is rarely ___ in regard to infection

A

elevated

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84
Q

Research indicates ___ and ___ methods are accurate indicators of body temperature

A

tympanic and (digital) axillary

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85
Q

Heat Stress or Cold Stress is related to ___ issues

A

metabolic

like hypoglycemia, increased O2 consumption, increased lactic acid production, increased metabolic acidosis and death

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86
Q

Heat loss in the newborn can occur through what 4 mechanisms?

A

Conduction

Convection

Radiation

Evaporation

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87
Q

Conduction

A

Loss of heat when the newborn touches something and heat is moved to that object or surface

Occurs if the baby is placed on a cold surface like a weighing scale or cold mattress

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88
Q

Convection

A

Loss of het to air that is circulating and is cooler/Newborn is exposed to cooler surrounding air

Heat loss increased with air movement

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89
Q

Radiation

A

Loss of heat from the infant when heat moves to cooler objects in the general area like the walls or window

Transfer of warmth from the baby to cooler objects in the vicinity even if they baby is not actually touching them

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90
Q

Evaporation

A

Loss of heat from moisture on the skin evaporating away

This is highly significant when the infant first is born and after the first bath!!

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91
Q

___ is the main form of heat loss initially due to the amniotic fluid on the baby’s body

A

evaporation

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92
Q

What is the first step of neonatal resuscitation?

A

Very vigorous drying of the baby - the cutaneous stimulation helps and this gets rid of amniotic fluid to prevent further complication with cold stress

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93
Q

In regard to convection, a baby risks getting cold even at a room temperature of ___C(___F) if there is a draft. This changes to __-__F if the infant is naked and ___-___F if the infant is dressed)

A

30C(86F)

89-92 F Naked

75-80 F Dressed

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94
Q

What exactly is cold stress?

A

cold stress is a body temperature rectally of less than 97.6F w/ symptoms

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95
Q

What should you do if you get a newborn temp of 97.6 F or lower?

A

First, repeat under the other arm. If the reading is still low report to the nurse immediately. The infant will either need skin to skin temperature contact with the mother or be placed in a radiant warmer

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96
Q

What kind of infants are at greater risk for cold stress?

A

smaller and preterm infants

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97
Q

Symptoms of Hypothermia

A

Body cold to touch

Hypoglycemia (no fuel to make heat)

Restlessness, irritability, tachypnea

Pallor or mottling

Lethargy, decreased activity, hypotonia

central cyanosis, expanding acrocyanosis

Poor feeding, weak suck

Bradycardia

Feeble cry, shallow/irregular respirations, apnea

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98
Q

Non-shivering Thermogenesis

A

Shivering that occurs when skin receptors perceive a drop in environmental temperature

The newborn will shiver and double the metabolic rate and increase muscle activity

All of this is done to generate heat

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99
Q

What is the primary source of heat in the hypothermic newborn?

A

BAT - brown adipose tissue (Fat)

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100
Q

BAT

A

Brown Adipose Tissue (Fat)

Primary source of heat in the hypothermic newborn

Less plentiful and available to Premes rather than Full Term Infants

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101
Q

When does BAT appear in the fetus? How long will it increase after birth?

A

Appears in fetus at 26-30 weeks, increases until 2 to 5 weeks after birth

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102
Q

How do newborns respond to hypothermia?

A

They increase their metabolism by breaking down their limited BAT stores

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103
Q

In what areas is BAT located?

A

around the:

scapula

kidneys

adrenals

head

neck

heart

great vessels

axilla

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104
Q

BAT Metabolism leads to what things? And what do these results lead an infant vulnerable to?

A
  1. Increased metabolism –> Hypoglycemia vulnerable
  2. Increased O2 Metabolism –> Tissue hypoxia vuln.
  3. FA production –> metabolic acidosis vuln –> increased serum bilirubin
  4. Increased local temp –> increased axillary temp (may seem stable erroneously)
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105
Q

___ is the best treatment for Hypothermia

A

PREVENTION

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106
Q

Treatments for Hypothermia

A

Prevention

Dry infant immediately after birth

Use a hat

Keep room warm

Use skin to skin with mom or a radiant warmer

Delay bathing until over 98F consistently

Rewarm after bath

Dress appropriately and use blankets as needed

Educate parents

Monitor temps and symptoms

return to the radian warmer if temperature is unstable

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107
Q

Why are babies sometimes not bathed until after 24 hours of birth?

A

To allow needed bacterial colonization

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108
Q

The newborn has enough intestinal and pancreatic enzymes to digest what things?

A

Simple carbohydrates

Proteins

Fats

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109
Q

What thing can a newborn not digest?

A

Starch

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110
Q

By birth, what actions of digestion and absorption have the newborn experienced?

A

Swallowing
Gastric Emptying
Propulsion

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111
Q

Breast milk is __% digestible and is digested in __-__ hours

A

90%; 2-3 hours

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112
Q

Compared to breast milk, cows milk formula is digested in __-__ hours

A

3-4 hours

113
Q

Meconium

A

first newborn stool

formed in utero and is made over several weeks

passed within 24 hours usually but must be out by 48 hours (frequency of bowel movement varies)

114
Q

How do meconium stool, breast milk stool, and cows milk stool compare?

A

Meconium - extremely dark green or black and it is sticky and adheres to the baby so we need to assure we get it all off

Breast milk - pale yellow, no obvious curdling, small in amount since 90% is digested

Cows milk - curdling and yellow - larger in amount

115
Q

Initial newborn bladder volume is __ to __ mL of urine

A

6-44 mL

116
Q

__% of newborns void by 24 hours after birth, and ___% void by 48 hours after birth

A

93;100

117
Q

How may diapers are normally seen on days 1, 2, 3, 4, 5, 6+ after birth?

A

1 - 1 diaper
2 - 2 diaper
etc…

day 6+ its about 6-8 wet diapers a day

118
Q

What is the immune system like for the fetus and newborn?

A

The immune system is not fully activated until after birth, so the newborn has poor hypothalamic response to pyrogens

119
Q

___ is not a reliable indicator of infection - in the newborn period, ___ is a more reliable indicator of infections

A

fever; hypothermia

120
Q

You rarely see a temperature elevation until a week or two after birth because…

A

there is no pyrogen reaction from hypothalamic response

121
Q

Passive Newborn Immunity

A

Lasts 4 weeks

Passive immunity occurs and is gained during the third trimester and through antibodies in the mothers breast milk

122
Q

Why are preterm infants more susceptible to infection?

A

Antibodies move from the mom to fetus in the last 4 weeks of pregnancy - this is why premes are at higher risk for infection since they lost some of that time or all of it

123
Q

Breastfed newborns may have additional what?

A

passive immunity from mother

124
Q

Newborns start to produce secretory ___ in the intestinal mucosa at _ weeks

A

IgA; 4 weeks

125
Q

Normal Length of an Infant

A

18-22”

Average 20”

126
Q

Normal Weight of Infant

A

2500-4000g (5 lbs 8 oz- 8 lbs 13 oz)

Average is 3405 g (7 lbs 8 oz)

127
Q

Birth Weight is influenced by …

A

ethnic origin

maternal weight and age

overall size

128
Q

A newborn transitioning to extrauterine nutrition can lose how much birth weight in the first few days?

A

as much as 10% of its birth weight

129
Q

SGA

A

Small for gestational age at term

weight <10 percentile - this is less than 6 pounds

130
Q

LGA

A

Large for gestational age at term

weight >10 percentile - this is more than 9 pounds

131
Q

There are ___ associated with either SGA or LGA

A

complications

132
Q

What is the average size of a newborn’s head?

A

Circumference is about 12.5 to 14 inches - that is about 1/4 of the bodies size!!!

133
Q

What sort of things should be checked about the head on the newborn assessment?

A

Circumference

Fontanelles

Overriding Sutures

Checks for issues like cephalo hematoma, subgaleal hemorrhage, and caput succedaneum

134
Q

Fontanelles

A

Openings in the skull where the sutures have not closed yet (normal finding) and is the “soft spot”

There is an anterior and posterior one

135
Q

Anterior Fontanelle

A

Diamond shaped opening toward the front of the dorsal side of the skull

136
Q

Posterior Fontanelle

A

Triangle shaped opening toward the back of the skull but it CAN be closed at delivery so you may be unable to palpate

137
Q

Overriding Sutures

A

Craniosyntosis where the skull plates close/overlap and cause pressure for the ever growing brain

The fetal skull is a series of plates that can slip one over and under the other to allow the skull to compress and elongate to get through to pelvis usually

138
Q

Molding

A

Coning of the head that occurs in the head of the newborn at delivery

139
Q

Cephalo/a Hematoma

A

Area of bleeding into the scalp following delivery related to trauma of the scalp

Has more distinct edges than caput succedaneum

140
Q

Subgaleal Hemorrhage

A

Bleeding between the scalp and skull that often occurs from the use of a vacuum extractor (hematoma)

This occurs on a more superficial layer than an epidural hematoma which is below the skull bones while subgaleal is above

distinct edges are here but it is much larger than a cephalo/a hematoma

141
Q

Caput Succedaneum

A

swelling of the scalp itself

tends to cross the suture line (right to left side)

Less defined edges

142
Q

How does Caput and Succedaneum differ from Hematomas in the newborn?

A

Caput Succadaneum - will cross suture lines (go over fontanelle regions)

Hematomas will not cross suture lines since the vessels do not cross over

143
Q

What skin colors could be seen in newborns?

A

Pink

Jaundice

Pallor

Cyanosis

144
Q

Pink Skin Tone

A

normal skin tone in the majority of the average newborn body

it is pink because of high hemoglobin and hematocrit

145
Q

Jaundice and the Newborn

A

Common AFTER 24 hours, but BEFORE 24 hours is abnormal

146
Q

Pallor and the Newborn

A

NOT NORMAL IN THE NEWBORN

can be an indicator of blood loss, anemia, or hypoxia

Sometimes pallor can be the result of normal genetic coloring, so make sure to view the parents as well!

147
Q

Cyanosis and the Newborn

A

Acrocyanosis is normal (hands and feet)

However, Cyanosis of the trunk and body is not normal, and may be indicative of hypoxia

148
Q

What sort of findings might you see upon a newborn skin assessment?

A

Turgor
Vernix
Milia
Lanugo
Stork Bites
Erythema
Post Date Effects on Skin
Mongolian Spots

149
Q

Newborn Skin Turgor

A

slight dryness, especially in the extremities

150
Q

Skin turgor is a good indicator of ___ rather than ___ in newborns

A

gestation (how far along baby was in pregnancy); hydration

151
Q

How may skin differ between pre term, full term, and post term infants

A

Pre term tends to have juicy skin, term babies are a little dry or normal skin consistency, post term skin tends to by dry and peeling

152
Q

Vernix

A

a cheesy, fatty substance that covers the fetus’ skin and protects it from the water environment of the womb starting at 24 weeks

Begins to breakdown and disappear at 38 weeks

153
Q

What might it mean if there is little or a lot of vernix?

A

Little - may mean that they are post term

Lot - may be pre term

154
Q

Milia

A

Congested sebaceous glands that resemble “whiteheads” usually seen on the nose cheeks or chin of the newborn

155
Q

Lanugo

A

Fine downy hair on the infant’s body

Common on ears, upper back, on face

The more pre term they are the more likely and more amount of lanugo they may have, but it is also indicative of certain ethnic groups too

156
Q

Stork Bites

A

Temporary areas of increased vascularization often seen on the back of the neck, eyelids, and forehead

These are usual

157
Q

Erythema Toxicum

A

normal newborn rash often seen generalized over the body

Not an abnormal finding

It is slightly raised and red, not abnormal but does need to be documented

158
Q

What are the post date effects on skin for a newborn

A

very dry

parchment like skin

cracking at joints common

peeling of kin

159
Q

Mongolian Spots

A

a blueish discoloration which resembles deep bruising.

Common over dorsal area and buttocks, sometimes upper thigh posteriorly

Mongolian sports are more common in people of far east, Mediterranean, and African descent

Needs documentation to make sure no one misconstrues it as child abuse

160
Q

What should be seen about the newborn nose on assessment?

A

Flat

Babies are nose breathers

Sneezing is common

Should have normal glabellar reflex and habituation

may see a deviated septum

161
Q

Glabellar Reflex and Habituation

A

Eyes blink upon touching the bridge of the nose but they will habituate to the stimuli over time

162
Q

What is the benefit of habituation in the newborn?

A

It allows the newborn to notice and interpret stimuli, and to tune out things that they do not need to be neurologically bombarded by (that’s why maybe a loud house has a baby that grows used to it while a quiet house has an easily disturbed baby)

163
Q

What may constant and frequent sneezing be indicative of in an infant?

A

While sneezing is normal, this constant and frequent amount may be indicative of withdrawal

164
Q

Deviated Septum

A

This can be either a nose that was compressed to one side during pregnancy or delivery, or a bone deformity

Its slightly off if you look at the septum

165
Q

What are normal mouth and throat findings in a newborn?

A

Normal to have no teeth, or maybe natal teeth

Palate and lip should be cleft-less

Rooting, sucking, and extrusion reflex present

Possible Epstein Pearls

166
Q

Rooting Reflex

A

If the newborn is stroked near the lips , the baby will open the mouth toward that side of being stroke to search for a nipple

167
Q

Sucking Reflex

A

If a finger or nipple or something like a binky is placed in the infant mouth than it will begin to suck

168
Q

Extrusion Reflex

A

Reflex that occurs when the infant is full from feeding

It will do tongue thrusting to push out the nipple

169
Q

Epstein Pearls

A

Cysts

Small, pale, yellow or white in color

Sometimes are seen on the roof of the mouth

170
Q

What are normal eye assessment findings in a newborn?

A

Clear

Positive Cornea red reflex, blink reflex, dolls eye reflex present

Pseudo Strabismus

Clear eye discharge

Scleral hemorrhage

Eyes should be straight plane across face (not tilted up or down)

171
Q

Neonatal eyes can see…

A

at the time of delivery

172
Q

What is the focal distance of a newborn’s eyesight?

A

The distance between the crick of a mother’s elbow and the mother’s face (very short at first)

173
Q

What is, psychologically, the one goal in the first year of life for the infant?

A

To learn to trust that one individual will be responsible for their care and feeding - learn to trust who can care for them

174
Q

Blink Reflex

A

Reflex, kinda like glabellar, where we check whether the infant blinks if the cornea is touched

But this reflex is only done if the healthcare professional is suspicious of decreased reactions

175
Q

Cornea Red Reflex

A

A finding in newborns that should be positive

It rules out newborn cataracts

176
Q

Pseudo Strabismus

A

“False Lazy Eye”

They had lived in a dark environment so they have underdeveloped eye muscles

177
Q

Doll’s Eye reflex

A

Should be present at delivery

When the head is moved to the left or right the eyes will remain stationary (thus moving in relation to the head) when positive

178
Q

What is interesting about the clear eye discharge of a newborn?

A
  1. The parents tend to do some sort of treatment of the eye since there is abnormal stuff from delivery on it
  2. If there is gonorrhea or chlamydia issues then an ointment can be applied
  3. A lot of this discharge is r/t eye prophylaxis
179
Q

Scleral Hemorrhage

A

A common finding in the newborn from the vaginal squeeze

It causes a bursting of vessels in the white of the eye

180
Q

How should the eyes be spaced on a newborn?

A

The eyes should be spaced so there is a middle space between them about the size of an imaginary third eye

181
Q

What are normal findings on assessment of newborn ears?

A

Position should be in line with the inner and outer canthus of the eye

It should recoil

Hearing should be present

182
Q

What are some abnormal findings on assessment of newborn ears?

A

Skin tags

Skin depression

183
Q

Abnormal position of the ears may be indicative of…

A

various disorders

184
Q

Why do we check newborn ear recoil?

A

It is an assessment for gestational age

If it is adequate, there should be recoil if the pinna comes forward because of adequate cartilage formation

185
Q

How should hearing be immediately after birth for the newborn?

A

It should be present, but in the first 24 hours there is often amniotic fluid, cells, vernix that can initially diminish sounds

We do a hearing exam after 24 hours because of this

Should still be able to react to noise

186
Q

Skin tags on Newborns

A

May be in front of ear or on pinna

Correlated with a renal abnormality

187
Q

Skin Depressions in front of the ear in Newborns

A

A finding that correlates with hearing deficit on the affected side

188
Q

What findings are normal upon assessment of the newborn chest?

A

Proper contour

proper chest circumference

Breast bud present in girls

proper nipple spacing

Possible supernummary nipples

189
Q

Breast engorgement is ___ in the neonatal period

A

rare

190
Q

What is the normal infant chest contour ratio?

A

1:1

191
Q

The average infant chest circumference is __-___ inches

A

12-13”

192
Q

Breast buds on infants are usually how big at term?

A

0.5-1 cm

193
Q

Nipple to nipple spacing is about ___ cm apart

A

7.5 cm

194
Q

Supernummary Nipples

A

Extra nipples

Tend to follow the nipple line on either side down

195
Q

Normal Abdomen findings in the newborn?

A

Umbilicus clamped

Abdomen slightly rounded

Bowel sounds present

Voiding check

Brick Dust urination

Femoral Arteries normal bilaterally

196
Q

When is the umbilicus clamped?

A

for the first 24 hours

197
Q

What is the setup for the umbilical cord?

A

AVA

2 Arteries and 1 Vein

198
Q

The infant abdomen should normally be ___ ___

A

slightly rounded

199
Q

A newborn should have ___ in the first 24 hours

A

BM (and voided)

200
Q

Brick Dust Urination

A

A not abnormal finding that must be documented

It is a bloody looking (but not actually bloody) color urine from high uric acid concentration

201
Q

What are normal findings in a male infant genitalia assessment?

A

2 descended testes - r/t maturity

Scrotum may look comparably large/edematous - and should have rugae

Check for absence of hypospadias, epispadias, hydrocele

Possible to see circumcision

202
Q

Hypospadias

A

Condition where the opening of the penis is on the underside rather than the tip

203
Q

Epispadias

A

Condition where the opening of the penis is on the upperside rather than the tip

204
Q

Hydrocele

A

Excessive amniotic fluid buildup in the scrotum

May appear edematous

205
Q

What are normal female genitalia infant findings in newborns?

A

Infants should have the labia slightly edematous and touching at term

Pseudo menstruation can occur

206
Q

The more flat the infant labia…

A

the more pre term she is

207
Q

Pseudo Menstruation

A

can occur in response to the withdrawal of hormones after delivery

Small amounts of bloody mucus may comes out days immediately after delivery

208
Q

What are common back and rectum findings upon assessment of the newborn?

A

Patency of anus and spine

Absence of a dimple at the base of the spine

Possible Mongolian spots

Leg folds equal on both sides + average length legs

209
Q

Pilonidal Dimple

A

A possible abnormal dimple at the base of the spine that could be an opening to the spinal column (could lead to infection)

210
Q

What is an important thing that is assessed during assessment of the lgs?

A

Hips

Check for congenital hip dysplasia

211
Q

The newborn extremities should be …

A

normally flexes with maturity

212
Q

What things about the newborn extremities needs to be assessed?

A

ROM

Acrocyanosis

Reflexes

Clubbing of the Feet

Abnormalities suck as Polydactyly and Syndactyly

Assess for abnormal flatness or roundness of feet

Assess for fixed posturing of the fingers or toes

213
Q

Abnormal Findings upon newborn Extremity Assessment

A

Clubbing of Feet

Simian Crease

Roundness of Feet (looks charcot like)

Syn and Poly dactyly

Fixed posturing of the fingers

214
Q

Simian Crease

A

a crease horizontally through the middle of the hand indicative of some other abnormal condition

215
Q

Syndactyly

A

less than the normal number of fingers and toes

216
Q

Polydactyly

A

More than the normal number of fingers and toes

217
Q

What criteria are assessed in a newborn pain assessment?

A

Face
Legs
Activity
Crying
Consolability

218
Q

A higher pain assessment score indicates..

A

more pain

219
Q

Infant States of Awareness

A
  1. Sleep States
  2. Awake States
220
Q

What are the 2 sleep states in infants

A

Quiet Sleep

Active Sleep (REM)

221
Q

Active Sleep

A

REM Sleep state for infants

Can see them sucking in this state

A deep sleep follows

222
Q

What are the 4 awake states in infants

A

Drowsy

Quiet Alert

Active Alert

Crying

223
Q

Drowsy

A

Waking up or falling asleep - between the quiet alert and sleep states

224
Q

Quiet Alert

A

resting, eyes open, looking around environment

calm

225
Q

Active Alert

A

agitated infant more likely to go into crying

226
Q

What is the best state to perform newborn assessments and reflexes?

A

Quiet Alert

227
Q

Newborns are capable of observing ___ and ___ to it

A

environments and responding to it

228
Q

The reason that the best time to do newborn assessment is the quiet alert state is because…

A

they are most capable of responding to their environment at this time

229
Q

The best position for the mother to have with the baby during quiet alert is…

A

En face positioning

230
Q

There are ___ periods of reactivity in the newborn

A

2

231
Q

The First Period of Reactivity

A

About 30 min to an hour (maybe longer), occurs right after birth of baby

Newborn is awake and active

Appears hungry (best time to breastfeed) and has a strong reflex

Natural opportunity to start breastfeeding

Vital signs are elevated at this time

232
Q

The Second Period of Reactivity

A

Period of reactivity lasting 4-6 hours in a normal newborn

The baby “crashes and burns” making breast feeding hard as they are now overwhelmed with new stimuli

1st Period –> 4-6 hours of deep sleep –> 2nd Period where baby is acutely alert, first meconium passes and another great period to begin breast feeding will begin

Newborn will suck root and swallow in this period, pass meconium, and the heart and respiratory rates increase, so the nurse will be alert for apneic periods

233
Q

What position does a newborn tend to stay in?

A

Tend to stay in a flexed position and will resist straightening

Hands will remain clenched

234
Q

What is the typical behavior pattern for a newborn?

A

Will sleep a majority of the time, and wake for feeding - is easily consoled when upset

235
Q

What are some behavioral capabilities of newborns that assist in adaptation to extrauterine life?

A
  1. Habituation
  2. Self Quieting Ability
236
Q

The Self Quieting Ability

A

Baby is able to quiet themselves by doing something like putting their thumb in the mouth to silence them

237
Q

Newborn Sleep States

A

Deep or quiet sleep and active rapid eye movements (REM)

238
Q

Length of sleep cycle depends on ___

A

age (of the newborn)

239
Q

Newborns need time to sleep because …

A

growth hormone secretion depends on regular sleep patterns

240
Q

Alert States

A

1st 30-60 m after birth, many newborns display quiet alertness

Nurses use alert states to facilitate feedings and encourage bonding and breastfeeding

241
Q

In the alert state, increasing wakefulness indicates what?

A

maturing ability to maintain consciousness

242
Q

A newborn is able to be alert, follow, and fixate on complex visual stimuli…

A

for short periods of time

243
Q

Infant (visual) orientation shows preference for what?

A

sharp contract between dark and light more so than colors at birth

244
Q

The focal distance of an infant is approximately?

A

18 inches with a range from 6-24 inches

245
Q

Newborns can process and respond to visual and auditory stimulation, and should be able to be alert and search for appealing auditory stimulus. What kind of auditory stimulus is more appealing to them?

A

High pitch voices (ex: baby talk) - which is repeated and undergoes habituation

246
Q

Olfactory wise, newborns are able to …

A

select people by smell (can smell mom)

247
Q

In regards to taste and suckling, a newborn is able to …

A

respond selectively to different tastes (mothers milk v other milk)

248
Q

Newborns are very sensitive and like being ___, ___, and ___

A

touched, cuddled, and held

249
Q

Newborns are able to attend to and interact with ___ ___

A

their environment

250
Q

What sort of prophylaxis can a newborn be given after screening?

A

Eye prophylaxis

Vitamin K

Hepatitis B (3 Hep B shots with maternal consent)

251
Q

Why is Vitamin K given as a newborn prophylaxis?

A

They cannot process yet without the proper gut bacteria that gives off Vit K usually, and since Vitamin K is a clotting factor we want to give it to prevent rupturing followed by stroke

252
Q

What sort of screening tests are done on infants?

A

Hearing

Metabolic Screening (43 tests in NYS)

Transdermal Bilirubin/Serum Bilirubin (check for abnormal jaundice)

O2 Sat

Drug Screening

Glucose (if appropriate)

Gestational Age

253
Q

What does O2 sat screen for?

A

Pre Symptomatic Cardiovascular Defects

254
Q

Why do we screen for gestational age in the newborn?

A

To see whether physical findings correlate to where the baby should be

255
Q

Important Infant Eye related Reflexes

A

Glabellar

Pupillary

Doll’s Eye

256
Q

Glabellar Reflex

A

The newborn’s eyes will blink with the first 4-5 taps on the bridge of the nose

(Followed by habituation reflex where it will stop blinking)

257
Q

Pupillary Reflex

A

Infant pupils should respond to light

258
Q

Doll’s Eye Reflex

A

Baby eyes will come open in sitting position

Head is initially lagging but the baby will use shoulders to correct head position

Eyes will stay fixed as head is moved meaning there is eye movement

259
Q

Important Infant Mouth related Reflexes

A

Sucking

rooting

Extrusion

260
Q

Sucking Reflex

A

Mechanism in 3 steps:

  1. Front of tongue laps on finger
  2. Back of tongue massages middle of the finger
  3. Esophagus pulls on tip of finger
261
Q

When does the sucking reflex disappear?

A

12 months

262
Q

Rooting Reflex

A

if you touch the newborn on either side of the cheek, the baby will turn to find breast

263
Q

When does the rooting reflex disappear?

A

around 4-7 months

264
Q

Extrusion Reflex

A

When the tongue is touched, the infant will push the tongue outward or forward

265
Q

Palmar Grasp Reflex

A

You can give one forefinger to each infant hand - they will grasp them both

You are then able to pull the baby to a sitting position with those forefingers

266
Q

When does the palmar grasp reflex disappear?

A

by 5-6 months

267
Q

Plantar Grasp Reflex

A

If you stroke the inner sole, the toes will curl (“grasp”) around the examiner’s finger

268
Q

When does the Plantar grasp reflex disappear?

A

It lessens by 8 months, but will usually disappear by 9-12 months

269
Q

Babinski Reflex

A

If you stroke the outer sole of the infant, the toes will spread with the great toe undergoing dorsiflexion (going up)

270
Q

When does the Babinski reflex disappear?

A

Usually it disappears around 12 months

271
Q

Moro Reflex

A

“Startle Reflex” - Present at birth

It can be triggered usually by a loud noise or if the infant’s head falls backward

The infant will spread their arms and legs widely and extend the neck. They will then bring their arms back together and cry.

272
Q

When does the Moro reflex disappear?

A

around 3-6 months

273
Q

Fencing Reflex

A

“Tonic Neck” Reflex

A postural reaction present at birth

If the baby is lying on the back, turn the head to one side - this causes the arm and leg on the side that they are looking to extend or straighten while the other side will flex

274
Q

When does the Fencing Reflex disappear?

A

by 4-9 months

275
Q

Incurvation Reflex

A

“Gallant Reflex” - present at birth

If infant is on stomach and you stroke the neck to the spinal cord (paravertebral area) on the middle to lower back, it will cause the back to curve toward the side that is being stroked

276
Q

When does the incurvation reflex disappear?

A

by 3-6 months

277
Q

Step Reflex

A

When holding the infant under the arms, support the head, and allow the feet to touch a flat surface. The infant will appear to take steps and walk.

278
Q

When does the Step Reflex disappear?

A

by 2-3 months

279
Q

When does the step reflex reappear?

A

as they learn to walk around 10-15 months

N352: Practice of Nursing I (14 decks)

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