objective 6

Question 1

what are the 3 transition periods?

Answer 1

period of reactivity
period of decreased responsiveness
second period of reactivity

Question 2

30 mins to 1hr
best time to initiate BF and bonding

Answer 2

period of reactivity

Question 3

1 to 3 hrs
infant either sleeps or becomes less active

Answer 3

period of decreased responsiveness

Question 4

3 to 8 hrs
infant becomes responsive and alert again

Answer 4

second period of reactivity

Question 5

how do we maintain cardiorespiratory function?

Answer 5

Once umbilical cord is clamped & cut, lungs take on function of breathing
Full expansion does not occur for several days
Face, nose, & mouth are gently wiped
Gentle bulb suctioning to clear airways
Infant may be cyanotic at birth
ACROCYANOSIS
Sternal retractions, grunting, flaring nostrils, or resp >60 → requires 02 via face mask and report immediately

Question 6

how do we maintain thermoregulation?

Answer 6

Neonate has unstable heat-regulating system
Hypothermia can lead to cold stress
Hypoglycemia and resp distress
Sweat glands do not function during neonatal period
Risk of elevated temp if overdressed or placed in overheated env
Essential nursing care:
Dried after birth, and placed skin to skin or BF
First bath after 24hrs
Place in warmer, wrap in warm blankets
Place hot on infants head

Question 7

____ of liquids from skin
skin wet from amniotic fluid

Answer 7

evaporation

Question 8

_____ caused by direct contact with a cold surface
cold hands, stethoscopes, scales

Answer 8

conduction

Question 9

_____ caused by heat drawn away from the body by drafts
AC, windows, O2 admin

Answer 9

convection

Question 10

caused by being near a cold surface, although not in direct contact
cold env of walls, windows, placing ice on incubator

Answer 10

radiation

Question 11

Standardized method of evaluating newborns condition immediately after birth

Answer 11

APGAR scoring

Question 12

what are the 5 factors evaluated in APGAR scoring?

Answer 12

HR
Respiratory effort
Muscle tone
Reflex response to suction or gentle stimulation
Skin color

Question 13

no action (continued observation & support)

Answer 13

8-10

Question 14

gentle stimulation (rubbing back)

Answer 14

4-7

Question 15

active resuscitation required

Answer 15

less than 3

Question 16

May not urinate for as long as 24 hrs
Document if infant urinates in birthing room
May be cloudy in color after first void
Should see one wet diaper in first 24 hrs
Diaper count every shift (should be 6-8 wet diapers by day 5-6)

Answer 16

urination

Question 17

This is the first newborn stool
Dark greenish, black thick & tarry
Mixture of amnotic fluid & secretions of intestinal glands
Should be passed before 24hrs post birth
Most pass it within 12 hrs
Meconium should be passed before discharge

Answer 17

meconium

Question 18

usually taken by the axilla (hold arm against side), should be between 36.5-37.5, report any variations

Answer 18

temp

Question 19

count before taking temp as infant may cry when disturbed, count for 1 full min
Newborns pule is irregular and rapid 110-160bpm
Resps are 30-60 breaths/min
Blood pressure is low; averaging 65 to 95 mm Hg systolic over 30-60 mm Hg diastolic

Answer 19

pulse
resps rate
BP

Question 20

what is average length and weight?

Answer 20

Average length
45-55cm
Average weight
2500 to 4000g

Question 21

what is the average head circumference?

Answer 21

33-35cm

Question 22

how do we do cord assessment?

Answer 22

assess 3 vessels
AVA

Question 23

what is normal for pre and post term for skin?

Answer 23

Preterm: thin, transparent
Post-term: peeling

Question 24

what is normal for vernix, pre, term, and post term?

Answer 24

Preterm: covers most of skin;
Term: only in creases
Post-term: absent

Question 25

what is normal for hair pre and post term?

Answer 25

Preterm: heavily covered
Post-term: hair in few places

Question 26

what is normal for ears pre and term?

Answer 26

Preterm: spring back slowly
Term: quickly

Question 27

what is normal for breast tissue pre and term?

Answer 27

Preterm: minimal or none
Term: palpable mass

Question 28

what is normal for genitalia preterm?

Answer 28

Preterm: scrotum smooth and small, labia majora and minora nearly equal in size

Question 29

what is normal for sole creases pre, term, and post?

Answer 29

Preterm: ⅓ foot
Term: ⅔ foot
Post-term: whole foot

Question 30

what are the reflexes that the full-term infant is born with?

Answer 30

Blinking
Sneezing
Gagging
Sucking
Grasping
crying
swallowing

Question 31

when startled, the infant draws their legs up and the arms fan out and then come toward midline in an embrace position

Answer 31

moro reflex

Question 32

what is the abnormal moro reflex?

Answer 32

note the clenches fist of one hand that does not follow a symmetrical embracing motion. This infant requires follow-up care

Question 33

Stroke the side of the foot; big toe dorsiflexes, and the toes flare out

Answer 33

babinski reflex

Question 34

Place object in hand of the newborn and newborn will grasp it tightly

Answer 34

palmar grasp

Question 35

Causes the infants head to turn in the direction of anything that touches the cheek, in anticipation of food

Answer 35

rooting

Question 36

The infant turns the head to one side, and the arm and leg are extended on that side. The opposite arm and leg flex (fencing position)

Answer 36

tonic neck reflex

Question 37

Prancing movements of the legs, seen when an infant is held upright on the examining table

Answer 37

dancing/stepping reflex

Question 38

fetal head conforms to size and shape of birth canal
May have swelling of the soft tissues of the scalp, called caput succedaneum
May see a cephalohematoma: a collection of blood beneath the periosteum of the cranial bone
Does not cross the suture line
Fontanels (soft spots) protect the head during delivery & allow further brain growth

Answer 38

molding

Question 39

Newborn is born with ability to control the head in some positions
normally occur when the newborn is raised for the bed in a supine position
If lasts past 6 months- follow up care required

Answer 39

head lag

Question 40

Yellow tinge to skin
Caused by rapid destruction of excess RBCs
Becomes evident between 2nd and 3rd day of life and lasts 1 week
Treated with phototherapy
Normal process; not harmful to infant
Assessed: transcutaneous bilirubin measurement (TcB) followed by blood work

Answer 40

icterus/hyperbilirubinemia

Question 41

what are the S&S of hypoglycemia?

Answer 41

Jitteriness
Poor muscle tone
Sweating
Respiratory difficulty
Low temp
Poor sucking
High pitched cry
Lethargy
Seizures

Question 42

Test for PKU is mandatory
If infant has this disorder, special formula is started in 1st months of life preventing disability and severe intellectual and development delays
PKU test done on day of discharge

Answer 42

phenylketonuria (PKU)

Question 43

what are the areas of teaching before discharge?

Answer 43

Basic infant care
Bath, diapers, cord care
Safety measures
Suction with bulb syringe, SIDS, safe sleep
Immunization
Follow up appointments
Proper, use of a car seat
S&S of health concerns, & who to contact

Question 44

parents should contact someone if…?

Answer 44

Temp greater the 38 by axilla
Refusal to two feedings in a row
Two green watery stools
Frequency or forceful vomiting
Lack of voiding or stooling
A change in usual behaviour