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maternal child health RN > Powerpoints Test 2 Module 5 > Flashcards

Powerpoints Test 2 Module 5 Flashcards

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1
Q

When does the transition from intrauterine to extrauterine life begin?

A

Once the umbilical cord is clamped and the infant takes the first breath….. the transition from intrauterine to extrauterine life begins.

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2
Q

Newborns Thermogenic Adaptation

A

Cold stress
Large body area
Limited subcutaneous fat
Limited ability to shiver
Thin skin and blood vessels close to surface
Non-shivering thermogenesis uses brown adipose tissue

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3
Q

How soon to start the apgar scoring?

A

At 1 minute and 5 minutes

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4
Q

Immediate nursing care at birth includes?

A

Mother–infant identification

•Infection/injury prevention
Eye prophylaxis
Vitamin K injection
Hepatitis B vaccine (parental consent required)

  • Assess blood glucose
  • Hematocrit and hemoglobin
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5
Q

Skin assessment of the neonate

Mongolian Spots

Erythema Toxicum

Lanugo

Milia

A

Dark spots on back

Red dry areas on face

Fine thin hair

White pustules

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6
Q

Assessment of the Infant’s Head

eyes?

Ears?

Lips?

Chin?

A

Symmetry of head

Eyes: shape, size, placement, coordinated lid movement; red reflex; gross vision

Ears: shape, size, placement, hearing

Lips: movement, color

Chin: appropriate size

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7
Q

How to assess Head: Fontanels

A

Estimate size
•Fullness without bulging: normal
•Bulging and tense with large head circumference: increased intracranial pressure
•Sunken: dehydration

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8
Q

Head-

Diffuse edema, crosses suture lines, disappears in few days

A

Caput succedaneum

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9
Q

Subperiosteal hemorrhage
Does not cross suture lines
Persists for weeks

A

Cephalhematoma

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10
Q

Newborn mouth and neck assessment

A

Mouth

Epstein pearls
Teeth
Ability to suck
Hard and soft palate

Neck
Torticollis

Facial features

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11
Q

Respiratory system assessment newborn

A
  • Symmetry in chest movement
  • Breast tissue
  • Nasal patency
  • Respiration rate, pattern, and use of accessory muscles
  • Auscultate lungs, anterior and posterior
  • Abdominal movements should be synchronous with the chest movements
  • Skin color
  • Capillary refill
  • Signs of distress
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12
Q

Cardiovascular system assessment of newborn

A 
Inspection and auscultation
Point of maximum impulse
Heart rate
Capillary refill
Peripheral pulses
Auscultate all areas: murmurs
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13
Q

GI system assessment

A

Abdominal inspection, including umbilical cord
Auscultate bowel sounds, upper abdomen for gastric bubble, and heart sounds of the abdominal aorta
Palpation

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14
Q

usually passes within the first 8-24 hours of life

  • Absence of this by 72 hours of life may be indicative of an obstructive bowel problem
  • Consists of particles found in amniotic fluid such as vernix, skin cells, hair and cells that have been shed by the intestinal tract

•Greenish-black and viscous at first
•Gradually change to transitional stools:
-thinner and greenish-brown to yellowish brown
-1-10 times over a 24 hour period

A

Meconium

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15
Q

Conditions that warrant further assessment in newborns in GI

A

Abdominal distention
Absence of bowel sounds
Discharge from umbilical cord/site
Abdominal mass

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16
Q

Urinary system assessment in newborn

A 
Hips abducted
Palpate and inspect scrotum, testes, and penis
Male: retract foreskin
Palpate and inspect female genitalia
Anus and anal wink reflex
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17
Q

Common findings in male newborns

A

Scrotal swelling
Smegma
Hypospadias-ventral
Epispadias-dorsal

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18
Q

What to assess in newborns urine

A

Nursing assessments
•Careful monitoring of I/O
-Normally void 2-6 times in a 24 hour period during the first 2 days of life
-by fourth day of life, output should increase to more than 6 voids in a 24 hour period
•Assess appearance of urine
•Rusty colored urine can be normal with first voiding and is related to the kidneys having difficulty removing waste products from the blood
-Small amounts of protein and glucose are present in the urine
-Urate crystals: pink-red in color are excreted in urine.
-Disappear after the first few days of life
-Can be mistaken for blood

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19
Q

Common findings in female newborns

A

Hymenal tags
Vernix caseosa on labia
Pseudomenstruation

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20
Q

Conditions that warrant further assessment in perineal area newborn

A 
Undescended testicles
Micropenis
Ambiguous genitalia
Imperforate hymen
Imperforate anus
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21
Q

Musculoskeletal system assessment in newborn

A

Observe infant’s movements in crib
Inspect for differences in extremity length and size
Assess muscle tone and symmetry
Gentle passive ROM to assess joint rotation
Assess head lag
Skin folds on thighs

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22
Q

Musculoskeletal issues that warrants further assessment

A

Fractured clavicle- Palpate for separation of bone ends and for crepitus.
-bruising/swelling/pain
•Polydactyly- Extra digits
•Syndactyly- Webbing
•Simian crease- Single, straight crease in the middle of the palm of one or both hands.
-Down’s syndrome

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23
Q

Neurological assessment in newborn?

A 
Reflexes-
Breathing and Blinking
Swallowing
Stepping
Babinski
Grasping
Moro
Startle
Galant
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24
Q

Neurological issues that warrant further assessment

A

Erb’s palsy
•brachial plexus injury
•

Cerebral palsy
•

Spina bifida

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25
Q

Newborn care

A 
Newborn metabolic screening tests
Circumcision
Ensuring optimal nutrition
Discharge planning for the infant and family
Child care
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26
Q

Jaundice in babies - complications

Normal biliruban?

Tx?

A

Jaundice (cont’d)

Complications
Bilirubin encephalopath

?

Light phototherapy
Cover eyes and genitals
No lotion

27
Q

Car seat safety

A

Middle Rear facing in car
Remove heavy outerwear of infant prior to placing and buckling
Buckle Harness fastened and placed at infants armpit level.

28
Q

Newborn Metabolic Screening Tests

A

cystic fibrosis

sickle cell anemia

phenylketonuria (PKU)

A lack of proper conversion results in a buildup of toxic blood levels of phenylalanine, a condition that causes central nervous system damage

29
Q

High risk newborns

Gestational age?

A 
Gestational age (GA): length of time in utero
•Preterm (delivered at or before the completion of 37 weeks’ gestation)
•Term (delivered any time from 38 to 41 completed weeks’ gestation)
•Post-term (newborn delivered on or after 42 weeks’ gestation)
30
Q

High risk newborns

Birth weight?

A

Birth weight:
Low birth weight (LBW) (< 2,500 g)
Very low birth weight (VLBW) (< 1,500 g)
Extremely low birth weight (ELBW) (< 1,000 g)

31
Q

High risk newborns

Small for gestational age infants

A

SGA newborns are those born at any GA with a birth weight that falls below the 10th percentile on the growth charts

32
Q

High risk newborns

Large for gestational age newborns

A

Infants born > 90th percentile on the growth chart
Can be genetically large
More commonly, exposed to imbalance of nutrients in utero
Example: newborn who weighs 3,750 g (8 lb 4 oz) at 40 weeks’ gestational age

33
Q

High risk new born

Premature

A

Prematurity classified by weeks of gestation:
Severe prematurity: birth at 23 to 26 weeks
Moderate prematurity: birth at 26 to 34 weeks
Late preterm: birth at 34 to 37 weeks

34
Q

High risk infants

Respiratory distress

Cause?

S/s

A

Developmental respiratory disorder

Affects preterm newborns (what is given prior to delivery to help present?)

Due to lack of lung surfactant

Signs and symptoms
Expiratory grunting
Nasal flaring
Cyanosis in room air
Rapid breathing (tachypnea)
Labored breathing (retractions)
Decreased breath sounds, often with rales

Note: Beractant (Survanta) lowers minimum surface tension and increases pulmonary compliance and oxygenation in preterm newborns

35
Q

high risk

Neonatal absence syndrome NAS

S/s

Nursing care?

How often to score infant?

A 
signs and symptoms
IRRITABLE
TREMORS
LOOSE STOOLS
SNEEZING
INCESSANT CRYING
Nursing care
Provide quiet and dark environment
Provide comfort measures
Gently rock and hold infant
Some infants prefer not to be held

Score infant every 3 hours using neonatal abstinence scoring tool

36
Q

High risk

SIDS

Sudden infant death syndrome

Prevention?

A

Prevention: Recommendations from American Academy of Pediatrics for safe sleep environment include:

“Back to sleep” for every sleep
Firm mattress
Keep newborn in parent room; NOT in parent’s bed
Remove all soft objects and loose bedding from crib
Decrease smoking in pregnancy and in the house of a newborn
Offer pacifier at nap time and bedtime
Do not let newborn get overheated

37
Q

Amniotic fluid supports newborns respiratory system how?

A

Supports fetal lung development

38
Q

Intrapulmonary fluid supports newborns respiratory system how?

A

Reduce his pulmonary resistance to bloodflow

Initiation of air breathing

39
Q

Surfactant supports newborns respiratory system how?

A

Lung expansion stimulates surfactant

Decreases surface tension within alveoli

34-36 weeks gestation production supports enough for alveolar stability

Reduced production in diabetics mothers

40
Q

Pulse within 30 minutes beats how many bpm?

Newborn

A

110-160

41
Q

Newborn capillary refill should be?

A

Less than 3 seconds
Adequate

Greater than 4 seconds, possible underlying problem

42
Q

Ph issues with newborn exposure to cold

Increases respiration’s — vasoconstriction—-decreases o2 to tissues ——increases glucose—— decreases po2 —-=

A

Metabolic acidosis

43
Q

Mechanisms for neonatal heat loss

A

17-8 in book

44
Q

Fetal hgb carries how much more oxygen than adults ?

What vitamin infants have none of

17-2 lab values for infants

Increase 12 hours after birth

A

20-50%

Vitamin k - risk for bleeding issuesn

45
Q

Establish airway how?

A

Suction - mouth then nose 18-1

46
Q

Provide warmth how?

A

Dry infant

Place on mother abdomen , heated blankets

Place beneath radiant heater

Cap

47
Q

The immediate neonatal assessment

A

Establish airway first

Provide warmth

Observe respiratory effort, color , muscle tone

Stimulate neonate to breathe deeply and cry

Assess heart rate, temperature

Note obvious abnormalities

Check and record number of umbilical cord vessels

48
Q

S/s of neonatal distress

A 
Cyanosis 
Tachycardia above 160
Tachypnea greater than 70
Sternal or rib retractions
Grunting 
Nasal flaring
49
Q

Later neonatal assessment

A

Body positioning 18-3

Skin color

Body size

Level of reactivity

Measurements and determination of gestational age - Ballard tool 18-13

50
Q

Normal newborn findings

WT

Head and chest circumstance

Skin

Movement

A

2500-4000gram - loses 5-10% of weight in first 3 days

Head and chest aprox the same

Skin may have acrocyanosis

Normal spontaneous movement bilat extremities

51
Q

What to teach parents about newborn care?

18-38 and 18-39

A

Temperature assessment - axillary

Bathing

Nail care and unbelical cord care

Clothing

Diapering - below umbilical cord stump

Attachment

52
Q

Hyperbilirubinemia risk factors

Physiologic jaundice

Pathologic jaundice

Breastfeeding

Breast milk jaundice

17-2

A

Appears 25-48 hits after birth

At birth - 24 hours

2-4 days

10 days

53
Q

Jaundice tx

A

19-18 and 19-19

54
Q

Fetal lung maturity is determined by the ?

A

L/S ratio and PG values

55
Q

At birth 3 fetal shunts ?

close and promote circulation to accommodate oxygen intake by the lungs

A

DFD

Ductus arteriosus,

foramen ovale,

ductus venosus

56
Q

The neurological system including the pns, sns are what at birth?

A

Underdeveloped

57
Q

Term used to denote a lack of intrauterine fetal growth

Usually results in a small for gestational age newborn

A

Intrauterine growth restriction

58
Q

S/s or characteristics of a SGA small for gestational age newborn?

A

Wasted muscle tissue
Lack of brown fat
Abdominal is often sunken in or scaphoid
Eyes appear large with a wise old man look
Fingernails are often long
Meconium stained thin cord is often present

19-4

59
Q

Conditions affecting the SGA newborn

A

Cold stress such as prolonged hypothermia

Pain

Hypoglycemia (preterm or high risk are considered hypoglycemic when bs 50-60

Polycythemia (elevated hemocrit) greater or equal to 65%

60
Q

Newborns large for gestational age risks

A

Newborns with a diabetic mother

TTN (transient tachypnea of newborn) delayed clearance of fetal lung fluid

Hypocalcemia

Hypo-magnesia

Birth injuries

Brachial plexus injuries 19-8

Fractures

61
Q

Normal newborn calcium levels

Low calcium can produce what in newborns? May also have low what?

A

Greater than 7.5 or 8 in prematures

Seizures

Low bs

19-5

62
Q

Ballard assessment?

A

?

63
Q

RDS- resp distress syndrome in newborn

Priority intervention

A

Airway maintenance and oxygenation

64
Q

Types of oxygen therapy for newborn

A

Humidifier oxygen

continuous positive airway pressure (cpap)

maternal child health RN (15 decks)

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