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NICU Certification Review > Physical And Gestational Age Assessment > Flashcards

Physical And Gestational Age Assessment Flashcards

1
Q

What is a velamentous cord insertion?

A

Cord vessels split and connect on the edge rather than the center of the placenta

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2
Q

What is the optimal length of corticosteroids?

A

2-7 days after the initial dose but at least 24hrs if treatment

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3
Q

What gestations can you use the New Ballard Score?

A

20 to 44 weeks

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4
Q

What does mottling indicate?

A

Reflects vasomotor instability and unequal capillary blood to cutaneous tissue

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5
Q

What is malformation?

A

A structural defect or organ or tissue resulting from abnormal development

Ex. Congenital heart defect, neural tube defect

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6
Q

What is deformation?

A

Altered form or position of a body part. Fully formed but influenced by in interior environment

Ex. Clubfoot, altered head shape

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7
Q

What is disruption?

A

Defect of a body part due to a break down if normally developed tissue

Ex. Amniotic banding

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8
Q

What is dysplasia?

A

Tissue anomaly due to abnormal organization of cells in that tissue

Ex. Hemangioma

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9
Q

What can plethora indicate?

A

Ruddy or red appearance

May indicate polycythemia

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10
Q

What is epidermolysus bullosa?

A

Blistering internally and externally

May be autosomal dominant or recessive

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11
Q

What is staphylococcal scalded skin syndrome?

A

Skin response to staph aureus, scalded skin appearance

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12
Q

What is erythema toxicum?

A

Newborn rash, erythematous macules each containing a central papule (yellow or white)

Most often on trunk, arms, and perineal areas

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13
Q

What is pustulat Melanosis?

A

Benign, transient, pustules and vesicles, not red, single or in clusters

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14
Q

What is vascular nevi?

A

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)

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15
Q

What are Cafe-au-lait spots?

A

Light tan or brown macular with well defined borders

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16
Q

What is scaphocephaly or dolichocephaly?

A

Fusion of sag girls suture; narrow skull elongated (toaster head)

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17
Q

What is brachycephaly?

A

Fusion of coronal suture, widened skull with shortened AP dimension

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18
Q

What is plagiocephaly?

A

Closure of a coronal or lambdoidak suture on one side

Asymmetrical appearance of head, flattened

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19
Q

What is anencephaly?

A

Failed closure of neural tube without skull formation

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20
Q

What is caput succedaneum?

A

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

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21
Q

What is cephalahematoma?

A

Subperiosteal hemorrhage, not present at birth, increases size over first day of life, unilateral, swelling doesn’t cross suture lines, resolves after several months

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22
Q

Waardenburg’s Syndrome

A

Localized patches of hyperpigmentation

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23
Q

What is cutis aplasia?

A

Localized absence if skin associated with trisomy 13

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24
Q

What may hair whorls represent?

A

Abnormal brain growth or development

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25
Q

What is Hypertelorism and hypotelorism?

A

Widened distance between orbits

Decreased distance between orbits

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26
Q

Cornea, iris and pupils related to maturity of fetus

A

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

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27
Q

What is the most common congenital anomaly of the eye?

A

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)

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28
Q

What is the red reflex?

A

Color range normal red to yellow

White (leukocoria) congenital cataracts, tumor

Absence- retinoblastoma, glaucoma or hemorrhage

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29
Q

What is ankyloglossia?

A

Tongue tied or short frenulum

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30
Q

What is Beckwith- Wiedemann?

A

Large tongue (macroglossia), abnormal wall defects, Wilma’s tumors, renal abnormalities and facial Nevus

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31
Q

What is choanal atresia or stenosis?

A

Membranous or bony obstruction; bilateral or unilateral
Unable to pass ng down side obstructed

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32
Q

What is microstomia?

A

Very small mouth, may be associated with Trisomy 18

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33
Q

What is macrostomia?

A

Large mouth, associated with mucopolysaccharidosis, Beckwith-Wiedemann syndrome or hypothyroidism

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34
Q

What are mucosal cysts?

A

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

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35
Q

Skin tags

A

Usually benign

If associated with other features such as CHARGE, or family deafness or increased risk should have renal ultrasound

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36
Q

What is Goldenhar’s Syndrome?

A

Preauricular ear appendages, wide range of facial, ear and vertebral defects

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37
Q

Cystic Hygroma

A

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

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38
Q

What is the absence of clavicles called?

A

Cleidocranial dysostosis

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39
Q

Witch’s milk

A

Milky discharge produced in response to maternal hormones

Can last 1-2 weeks with enlargement

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40
Q

Where is the first heart sound heard? S1

A

Produced by closure of mitral and tricuspid valves accentuated at birth

Increase in intensity: PDA, VSD, tetralogy of Fallot, anemia, hyperthermia, and arteriovenous fistula

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41
Q

Where is the second heart sound heard? S2

A

Sound produced by closure of aortic and pulmonary valves

S2 single sound at birth; splitting I’d S2 normal at 1-2 days

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42
Q

Why is wide splitting of the S2 abnormal?

A

Associated with atrial septal defect, pulmonary stenosis, mitral, regurgitation, or partial anomalous, pulmonary venous, return, and right, bundle branch block

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43
Q

What can muffled heart sounds indicate?

A

May indicate pneumopericardium, pneumomediastinum, or CDH

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44
Q

Loudness or quality of heart murmurs

A

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

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45
Q

What grade of pulses is normal?

A

+2: difficult to palpate, may be obliterated with pressure, normal in newborn

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46
Q

How can the vestibular system be enhanced?

A

Rocking

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47
Q

Why are early minimal enteral feedings used in very low birth weight neonates?

A

Improve gastrointestinal function

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48
Q

Research based advantages of using humidity in an incubator

A

Improved maintenance of fluid and electrolyte balance

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49
Q

Non shivering thermogenesis in the nrp are is responsible for heat

A

Production

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50
Q

What is the main energy parental nutrition contains?

A

Carbohydrates

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51
Q

Why does the dosing of gent differ in preterm compared to term?

A

Glomerular filtration rate

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52
Q

Maternal magnesium sulfate adm during labor places the neonate at risk for?

A

Motor depression

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53
Q

What is neonatal development based on?

A

An orderly sequence based upon readiness and maturation

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54
Q

Minimum inhibitory concentration (MIC) refers to what?

A

Lowest concentration of anti microbials that stop the spread of organism

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55
Q

Risk factors for neonatal hypoglycemia include

A

HIE

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56
Q

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?

A

Reticulocyte count

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57
Q

Why is gastroesopagheal reflux frequent in the nicu?

A

Gastric emptying time is inversely correlated with gestational age

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58
Q

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

A consequence of the maternal Rh immune globulin

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59
Q

In addition to an increased resp rate, the most common manifestation of TTN is

A

Increased WOB

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60
Q

In the majority of individuals with Down syndrome, the trisomy of chromosome 21 results from

A

Nondisjunction- splitting of chromosomes

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61
Q

How can you Support parental roles in the nicu?

A

Providing parents with a schedule of the daily nicu routibes

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62
Q

Functional closure of the ductus arteriosus occurs as a result of

A

Increased arterial oxygen tension

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63
Q

A premature neonate has been consistently engaging in hand to mouth movements. The nurse should

A

Recognize these behaviors as a form of self consolidation

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64
Q

After 6 hrs of calcium replacement, the serum calcium level of a neonate remains below normal. Which lab should be done next?

A

Serum magnesium

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65
Q

What is the primary etiology of TTN?

A

Retained lung fluid

66
Q

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?

A

Radiation

67
Q

What does parental nutrition provide?

A

Carbohydrates

68
Q

Caudad to Cephlad is what?

A

Head vs tail

69
Q

What is a PDA?

A

Opening between pulmonary artery and aortic artery

70
Q

What is the biggest risk if Ecmo?

A

Bleeding

71
Q

What electrolyte does Lasix affect?

A

Lowers calcium

72
Q

Which genetic disease is the common name for trisomy 18?

A

Edwards syndrome

73
Q

What is measured in the quad screen?

A

Alpha-fetopreotein, human chorionic gonadotropin, estriol and inhibit-A

74
Q

Which breech presentation presents with buttocks only passing through birth canal?

A

Frank breech

75
Q

What defects are seen with Tetralogy if Fallot?

A

VSD, pulmonary stenosis, right ventricular hyper trophy and overriding aorta

76
Q

Sign of fluid overload with end stage renal disease

A

Increase in BP

77
Q

How many calories a day does a preterm infant require per day?

A

100-150 kcal/kg/day

78
Q

Is electrolyte imbalance as risk of ecmo?

A

No

79
Q

When does acute alcohol withdrawal start in a newborn?

A

3-12 hours after birth

80
Q

Which blood type is considered universal and can receive any blood product?

A

AB+

81
Q

Periventrucular leukomalacia is often the cause of which condition?

A

Cerebral palsy

82
Q

What is the normal glucose level of CSF?

A

35-120 mg/dL

83
Q

Which electrolyte can help to reduce the incidence of neurological deficits in premature infants?

A

Magnesium

84
Q

What does autosomal dominant mean?

A

One parent needs to pass on the gene for the disease to occur

85
Q

Which defect is in chromosome 22?

A

DiGeorge syndrome

86
Q

Does Turners affect males or females?

A

Females only

87
Q

Which diuretic can increase the concentration of serum calcium?

A

Thiazide diuretics (hydrochlorothiazide)

88
Q

What is didactic caregiving?

A

Stimulating the infant
Physical and verbal means of stimulation

89
Q

What labs should be monitored with indomethacin?

A

Kidney function and platelet count

90
Q

Pulmonary stenosis is untreated, which chamber of the heart is most affected?

A

 Right ventricle


91
Q

What is the most common cause of DIC?

A

Sepsis

92
Q

Where does bio transformation/metabolism of drugs occur most often in neonate

A

Liver

93
Q

What is most common cardiac abnormality with trisomy 18?

A

Atrial septic defect

94
Q

Which of the following skin lesions may be associated with neurofibromatosis?

A

Cafe au lait spots

95
Q

When is lanugo typically shed?

A

32 to 36 weeks

96
Q

With pulmonary atresia, the circulation of blood to the lung is through what?

A

Ductus arteriosus

97
Q

What is the normal value for serum phosphorus in a neonate?

A

4.6 to 8 mg/dL

98
Q

How can you enhance the vestibular system?

A

Holding and swaying with neonate

99
Q

Which TE fistula is most common?

A

Distal TEF with esophageal atresia

100
Q

Polycythemia is associated with hyper viscosity in what?

A

Chronic hypoxia

101
Q

What is venous ECMO primarily used for?

A

Respiratory support

102
Q

What is the energy requirement for entirely fed preterm neonates?

A

105-120 kcal/kg

103
Q

When do late onset Group B strep infections usually appear?

A

Between one week and three months

104
Q

With total anomalous pulmonary venous return where is there no direct blood flow?

A

To the left side of the heart 

105
Q

With congenital primary hypothyroidism lab results indicate

A

TSH >40 mU/L and low T4

106
Q

What is the recommended protein intake for preterm neonates?

A

3.5 to 4 g/kg/d

107
Q

 Which mineral is important for Neonatal nutrition in order to maintain the acid base balance?

A

Potassium 

108
Q

Lipids should not exceed how much of caloric intake?

A

50%

109
Q

It’s only 10% of iron is absorbed from formula what percentage of iron is absorbed from breast milk?

A

80%

110
Q

What does substituting lactose with glucose polymers in feeding accomplish?

A

It lowers the osmotic concentration of formulas

111
Q

How many kcal/dL does colostrum contain?

A

67

112
Q

What is the typical increase in feeding volume rate?

A

30-40 ml/kg/day

113
Q

What is the purpose of giving amino acid infusions to treat hypoglycemia in a preterm neonate?

A

Promote insulin secretion

114
Q

Hyperventilation causes

A

Respiratory alkalosis

115
Q

What does meconium ileus typically indicate?

A

Cystic fibrosis

116
Q

What can hypocalcemia cause?

A

Jitteriness

117
Q

What is a cyanotic congenital heart disease?

A

Hypoplastic left heart syndrome

118
Q

At what age should a neonate be able to lift the head when lying prone?

A

6 weeks

119
Q

Does a caput cross suture lines?

A

Yes! As well as subgaileal

120
Q

What is the recommended supplemental iron does for a low birthweight preterm neonate?

A

2 mg per kg per day beginning at two months

121
Q

What is the normal value for conjugated bilirubin in a neonate?

A

Less than 0.6 mg/dL.(10 umol/l)

122
Q

Define assessment, it is noted to have a imperforated anus. What is the next step?

A

 Assess for fistula

123
Q

Symptoms of TTN usually appear within what timeframe?

A

36 hrs

124
Q

What is appropriate effluent from a new colostomy?

A

Greater than 2ml/kg/hr

125
Q

What should a neonate with potter facies be evaluated for? (Epicanthal folds, low set ears, smooth philtrum, retrognathia, orbital hypertelorism)

A

Pulmonary hypoplasia

126
Q

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?

A

Early to mid childhood

127
Q

In order to use an automated peritoneal dialysis machine for renal failure in a neonate, feel volumes must be at least?

A

100 ML

128
Q

What is indicated by treatment of focal intestinal perforation?

A

Peritoneal fluid culture

129
Q

What are characteristics signs of tracheal stenosis in a neonate?

A

Biphasic strider and dyspnea

130
Q

Follow a tracheostomy what is the purpose of stay sutures?

A

Maintain an open stoma

131
Q

After 24 hours for phototherapy for treatment of hyper bilirubinemia, the new needs bilirubin should drop how much?

A

30-40%

132
Q

What needs monitored carefully when receiving gentamicin?

A

Renal function

133
Q

What stage of HIE can seizures occur?

A

Stage 2

134
Q

Does a cephlahematoma cross suture lines?

A

No

135
Q

What is the leading cause of symmetric IUGR?

A

Intrauterine infection

136
Q

What are craniotabes?

A

Soft spots on the skull that collapsed and recoil with pressure

137
Q

What is genetic disorder is typically involved with rock-bottom feet?

A

Trisomy, 13

138
Q

What is the most common cyanotic heart defect?

A

Tetralogy of fallot

139
Q

What is a marker for osteogenesis imperfecta?

A

Blue Scalera

140
Q

What is likely to cause a low rusting heart rate in a newborn?

A

 you need a lupus characterized by congenital heart block

141
Q

What is the best rib location to assess the point of maximal intensity in the immediate newborn period?

A

5th

142
Q
A

D

143
Q
A

D

144
Q
A

D

145
Q
A

A

146
Q

What is most influential to achieve optimal weight gain?

A

Protein

147
Q

What is colostrum made of?

A

80 whey, 20 casein

148
Q
A

C

149
Q
A

D

150
Q
A

B

151
Q

What us the purpose of adding carnitine to tpn?

A

Transpose long chain fatty acids

152
Q
A

A

153
Q
A

D

154
Q
A

B

155
Q
A

B

156
Q

Heroin abuse when would you expect to see neonatal symptoms?

A

First 24-72 hours

157
Q
A

D

158
Q
A

A

159
Q
A

A

160
Q
A

A

NICU Certification Review (3 decks)

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