Physical And Gestational Age Assessment Flashcards
What is a velamentous cord insertion?
Cord vessels split and connect on the edge rather than the center of the placenta
What is the optimal length of corticosteroids?
2-7 days after the initial dose but at least 24hrs if treatment
What gestations can you use the New Ballard Score?
20 to 44 weeks
What does mottling indicate?
Reflects vasomotor instability and unequal capillary blood to cutaneous tissue
What is malformation?
A structural defect or organ or tissue resulting from abnormal development
Ex. Congenital heart defect, neural tube defect
What is deformation?
Altered form or position of a body part. Fully formed but influenced by in interior environment
Ex. Clubfoot, altered head shape
What is disruption?
Defect of a body part due to a break down if normally developed tissue
Ex. Amniotic banding
What is dysplasia?
Tissue anomaly due to abnormal organization of cells in that tissue
Ex. Hemangioma
What can plethora indicate?
Ruddy or red appearance
May indicate polycythemia
What is epidermolysus bullosa?
Blistering internally and externally
May be autosomal dominant or recessive
What is staphylococcal scalded skin syndrome?
Skin response to staph aureus, scalded skin appearance
What is erythema toxicum?
Newborn rash, erythematous macules each containing a central papule (yellow or white)
Most often on trunk, arms, and perineal areas
What is pustulat Melanosis?
Benign, transient, pustules and vesicles, not red, single or in clusters
What is vascular nevi?
Stork bites- nervus simplex (blanch when pressure applied, forehead, nape of neck, eyelids)
Port wine stain- nervus flammeus (most common on back of neck, on face associated with Sturge-Weber Syndrome, will not blanch)
What are Cafe-au-lait spots?
Light tan or brown macular with well defined borders
What is scaphocephaly or dolichocephaly?
Fusion of sag girls suture; narrow skull elongated (toaster head)
What is brachycephaly?
Fusion of coronal suture, widened skull with shortened AP dimension
What is plagiocephaly?
Closure of a coronal or lambdoidak suture on one side
Asymmetrical appearance of head, flattened
What is anencephaly?
Failed closure of neural tube without skull formation
What is caput succedaneum?
Results if restriction in venous return and lymph flow
Swelling at delivery, extends across sutures and has poorly defined borders, edema shifts to dependent position, resolves 24-48 hrs
What is cephalahematoma?
Subperiosteal hemorrhage, not present at birth, increases size over first day of life, unilateral, swelling doesn’t cross suture lines, resolves after several months
Waardenburg’s Syndrome
Localized patches of hyperpigmentation
What is cutis aplasia?
Localized absence if skin associated with trisomy 13
What may hair whorls represent?
Abnormal brain growth or development
What is Hypertelorism and hypotelorism?
Widened distance between orbits
Decreased distance between orbits
Cornea, iris and pupils related to maturity of fetus
Cornea cloudy at birth
Iris- dark blue until 3-6 months of age
Pupils- pupils equal, round and reactive to light. Reflexes present after 28-30 weeks
What is the most common congenital anomaly of the eye?
Coloboma- cleft shaped fissure, can be sporadic or In association with trisomy 13, 18 or CHARGE sequence (coloboma, heart defect, choanal atresia, retardation, genitalia and ear abnormalities)
What is the red reflex?
Color range normal red to yellow
White (leukocoria) congenital cataracts, tumor
Absence- retinoblastoma, glaucoma or hemorrhage
What is ankyloglossia?
Tongue tied or short frenulum
What is Beckwith- Wiedemann?
Large tongue (macroglossia), abnormal wall defects, Wilma’s tumors, renal abnormalities and facial Nevus
What is choanal atresia or stenosis?
Membranous or bony obstruction; bilateral or unilateral
Unable to pass ng down side obstructed
What is microstomia?
Very small mouth, may be associated with Trisomy 18
What is macrostomia?
Large mouth, associated with mucopolysaccharidosis, Beckwith-Wiedemann syndrome or hypothyroidism
What are mucosal cysts?
Epstein’s pearls: small white epidermal cysts found in hard or soft palates and in gum margins; disappear within a few weeks
Bohn’s nodule: found on the guns and equivalent to milia on the skin
Skin tags
Usually benign
If associated with other features such as CHARGE, or family deafness or increased risk should have renal ultrasound
What is Goldenhar’s Syndrome?
Preauricular ear appendages, wide range of facial, ear and vertebral defects
Cystic Hygroma
Cyst located posterior the sternal plateau, mastoid muscle, and extending into the scapula and axillary and thoracic compartments
Can distort the anatomy of the airway
What is the absence of clavicles called?
Cleidocranial dysostosis
Witch’s milk
Milky discharge produced in response to maternal hormones
Can last 1-2 weeks with enlargement
Where is the first heart sound heard? S1
Produced by closure of mitral and tricuspid valves accentuated at birth
Increase in intensity: PDA, VSD, tetralogy of Fallot, anemia, hyperthermia, and arteriovenous fistula
Where is the second heart sound heard? S2
Sound produced by closure of aortic and pulmonary valves
S2 single sound at birth; splitting I’d S2 normal at 1-2 days
Why is wide splitting of the S2 abnormal?
Associated with atrial septal defect, pulmonary stenosis, mitral, regurgitation, or partial anomalous, pulmonary venous, return, and right, bundle branch block
What can muffled heart sounds indicate?
May indicate pneumopericardium, pneumomediastinum, or CDH
Loudness or quality of heart murmurs
Grade I: barely audible,
grade II: soft, but easily audible
grade III: moderately loud, but no thrill
grade IV: loud
grade V: very loud Audible with stethoscope placed lightly on chest grade VI; extremely loud, audible with stethoscope place near chest
What grade of pulses is normal?
+2: difficult to palpate, may be obliterated with pressure, normal in newborn
How can the vestibular system be enhanced?
Rocking
Why are early minimal enteral feedings used in very low birth weight neonates?
Improve gastrointestinal function
Research based advantages of using humidity in an incubator
Improved maintenance of fluid and electrolyte balance
Non shivering thermogenesis in the nrp are is responsible for heat
Production
What is the main energy parental nutrition contains?
Carbohydrates
Why does the dosing of gent differ in preterm compared to term?
Glomerular filtration rate
Maternal magnesium sulfate adm during labor places the neonate at risk for?
Motor depression
What is neonatal development based on?
An orderly sequence based upon readiness and maturation
Minimum inhibitory concentration (MIC) refers to what?
Lowest concentration of anti microbials that stop the spread of organism
Risk factors for neonatal hypoglycemia include
HIE
A late preterm neonate is born with a hematocrit of 33%. Which of the following labs will be most helpful in finding the cause of anemia?
Reticulocyte count
Why is gastroesopagheal reflux frequent in the nicu?
Gastric emptying time is inversely correlated with gestational age
Pregnant, blood type A has received Rh immune globulin at 27 weeks, after delivery at term, her neonate is 0+ and there is a positive direct antibody test on the cord blood. What does this mean?
A consequence of the maternal Rh immune globulin
In addition to an increased resp rate, the most common manifestation of TTN is
Increased WOB
In the majority of individuals with Down syndrome, the trisomy of chromosome 21 results from
Nondisjunction- splitting of chromosomes
How can you Support parental roles in the nicu?
Providing parents with a schedule of the daily nicu routibes
Functional closure of the ductus arteriosus occurs as a result of
Increased arterial oxygen tension
A premature neonate has been consistently engaging in hand to mouth movements. The nurse should
Recognize these behaviors as a form of self consolidation
After 6 hrs of calcium replacement, the serum calcium level of a neonate remains below normal. Which lab should be done next?
Serum magnesium
What is the primary etiology of TTN?
Retained lung fluid
A 1300g neonate wearing only a diaper is placed in a single walled incubator with an inside temp if 35. How is the neonate going experience heat loss?
Radiation
What does parental nutrition provide?
Carbohydrates
Caudad to Cephlad is what?
Head vs tail
What is a PDA?
Opening between pulmonary artery and aortic artery
What is the biggest risk if Ecmo?
Bleeding
What electrolyte does Lasix affect?
Lowers calcium
Which genetic disease is the common name for trisomy 18?
Edwards syndrome
What is measured in the quad screen?
Alpha-fetopreotein, human chorionic gonadotropin, estriol and inhibit-A
Which breech presentation presents with buttocks only passing through birth canal?
Frank breech
What defects are seen with Tetralogy if Fallot?
VSD, pulmonary stenosis, right ventricular hyper trophy and overriding aorta
Sign of fluid overload with end stage renal disease
Increase in BP
How many calories a day does a preterm infant require per day?
100-150 kcal/kg/day
Is electrolyte imbalance as risk of ecmo?
No
When does acute alcohol withdrawal start in a newborn?
3-12 hours after birth
Which blood type is considered universal and can receive any blood product?
AB+
Periventrucular leukomalacia is often the cause of which condition?
Cerebral palsy
What is the normal glucose level of CSF?
35-120 mg/dL
Which electrolyte can help to reduce the incidence of neurological deficits in premature infants?
Magnesium
What does autosomal dominant mean?
One parent needs to pass on the gene for the disease to occur
Which defect is in chromosome 22?
DiGeorge syndrome
Does Turners affect males or females?
Females only
Which diuretic can increase the concentration of serum calcium?
Thiazide diuretics (hydrochlorothiazide)
What is didactic caregiving?
Stimulating the infant
Physical and verbal means of stimulation
What labs should be monitored with indomethacin?
Kidney function and platelet count
Pulmonary stenosis is untreated, which chamber of the heart is most affected?
 Right ventricle

What is the most common cause of DIC?
Sepsis
Where does bio transformation/metabolism of drugs occur most often in neonate
Liver
What is most common cardiac abnormality with trisomy 18?
Atrial septic defect
Which of the following skin lesions may be associated with neurofibromatosis?
Cafe au lait spots
When is lanugo typically shed?
32 to 36 weeks
With pulmonary atresia, the circulation of blood to the lung is through what?
Ductus arteriosus
What is the normal value for serum phosphorus in a neonate?
4.6 to 8 mg/dL
How can you enhance the vestibular system?
Holding and swaying with neonate
Which TE fistula is most common?
Distal TEF with esophageal atresia
Polycythemia is associated with hyper viscosity in what?
Chronic hypoxia
What is venous ECMO primarily used for?
Respiratory support
What is the energy requirement for entirely fed preterm neonates?
105-120 kcal/kg
When do late onset Group B strep infections usually appear?
Between one week and three months
With total anomalous pulmonary venous return where is there no direct blood flow?
To the left side of the heart 
With congenital primary hypothyroidism lab results indicate
TSH >40 mU/L and low T4
What is the recommended protein intake for preterm neonates?
3.5 to 4 g/kg/d
 Which mineral is important for Neonatal nutrition in order to maintain the acid base balance?
Potassium 
Lipids should not exceed how much of caloric intake?
50%
It’s only 10% of iron is absorbed from formula what percentage of iron is absorbed from breast milk?
80%
What does substituting lactose with glucose polymers in feeding accomplish?
It lowers the osmotic concentration of formulas
How many kcal/dL does colostrum contain?
67
What is the typical increase in feeding volume rate?
30-40 ml/kg/day
What is the purpose of giving amino acid infusions to treat hypoglycemia in a preterm neonate?
Promote insulin secretion
Hyperventilation causes
Respiratory alkalosis
What does meconium ileus typically indicate?
Cystic fibrosis
What can hypocalcemia cause?
Jitteriness
What is a cyanotic congenital heart disease?
Hypoplastic left heart syndrome
At what age should a neonate be able to lift the head when lying prone?
6 weeks
Does a caput cross suture lines?
Yes! As well as subgaileal
What is the recommended supplemental iron does for a low birthweight preterm neonate?
2 mg per kg per day beginning at two months
What is the normal value for conjugated bilirubin in a neonate?
Less than 0.6 mg/dL.(10 umol/l)
Define assessment, it is noted to have a imperforated anus. What is the next step?
 Assess for fistula
Symptoms of TTN usually appear within what timeframe?
36 hrs
What is appropriate effluent from a new colostomy?
Greater than 2ml/kg/hr
What should a neonate with potter facies be evaluated for? (Epicanthal folds, low set ears, smooth philtrum, retrognathia, orbital hypertelorism)
Pulmonary hypoplasia
If anyone else has autosomal recessive, polycystic, kidney disease, that usual prognosis is that the child will reach end, stage renal disease, by what age?
Early to mid childhood
In order to use an automated peritoneal dialysis machine for renal failure in a neonate, feel volumes must be at least?
100 ML
What is indicated by treatment of focal intestinal perforation?
Peritoneal fluid culture
What are characteristics signs of tracheal stenosis in a neonate?
Biphasic strider and dyspnea
Follow a tracheostomy what is the purpose of stay sutures?
Maintain an open stoma
After 24 hours for phototherapy for treatment of hyper bilirubinemia, the new needs bilirubin should drop how much?
30-40%
What needs monitored carefully when receiving gentamicin?
Renal function
What stage of HIE can seizures occur?
Stage 2
Does a cephlahematoma cross suture lines?
No
What is the leading cause of symmetric IUGR?
Intrauterine infection
What are craniotabes?
Soft spots on the skull that collapsed and recoil with pressure
What is genetic disorder is typically involved with rock-bottom feet?
Trisomy, 13
What is the most common cyanotic heart defect?
Tetralogy of fallot
What is a marker for osteogenesis imperfecta?
Blue Scalera
What is likely to cause a low rusting heart rate in a newborn?
 you need a lupus characterized by congenital heart block
What is the best rib location to assess the point of maximal intensity in the immediate newborn period?
5th
D
D
D
A
What is most influential to achieve optimal weight gain?
Protein
What is colostrum made of?
80 whey, 20 casein
C
D
B
What us the purpose of adding carnitine to tpn?
Transpose long chain fatty acids
A
D
B
B
Heroin abuse when would you expect to see neonatal symptoms?
First 24-72 hours
D
A
A
A
