T3 - Newborn Nursing Care (Josh)

Question 1

What are the Four Conditions for maintaining an adequate O2 supply?

Answer 1

Clear airway

Establishment of respirations

Adequate circulation, perfusion, and cardiac function

Adequate thermoregulation

Question 2

Which order do we suction the neonate?

Answer 2

mouth before nose

**M comes before N

Question 3

Nursing Interventions for Neonatal Respiratory System

Answer 3

Support baby w/ head to side

Compress bulb syringe and suction SIDE OF MOUTH first
**avoid touching center back of mouth (gag reflex)

Suction each side of NOSE

Deeper suction w/ DeLEE x 5 secs or less

Question 4

How much Vit K do we give to newborn?

Answer 4

0.5 - 1mg

***5/8 in needle w/ a TB syringe

Question 5

How often is neonate body temp assessed?

Answer 5

q30 minutes until stable

Question 6

Nursing actions to maintain body temp?

Answer 6

Position crib away from wall/windows

Perform exams under heat panel

Delay bath until temp stable

Question 7

Which temp source?

Answer 7

axillary (book)

rectal (in real life sometimes)

Question 8

Which med do we give in newborn eyes?

Answer 8

Erythromycin

***may also use Tetracycline 1% or Silver Nitrate 1%

***prevents inflammation r/t gonorrhea infection

Question 9

Which med should be injected within 1 hr of birth?

Answer 9

Vit K (0.5 - 1 mg)

***helps w/ clotting factors

Question 10

How long should mom wait to give a tub bath?

Answer 10

until cord separates (10-14 days)

Question 11

Clean cord w/ —.

Answer 11

water

***no evidence that antiseptic/antimicrobial agents help

Question 12

Which scale is used to classify neonates based upon maturity and intrauterine growth?

Answer 12

Ballard Scale

Question 13

Ballard Scale:

What constitutes preterm?

Question 14

Ballard Scale:

What constitutes early term?

Answer 14

37-38.6 wks

Question 15

Ballard Scale:

What constitutes full term?

Answer 15

39-40.6 wks

Question 16

Ballard Scale:

What constitutes late term?

Answer 16

41-41.6

Question 17

What does PKU test look for?

Answer 17

Kenicterus

***ketones in urine

Question 18

Ballard Scale:

What constitutes post term?

Answer 18

42 wks or more

Question 19

Ballard Scale:

What constitutes post mature?

Answer 19

over 42 wks w/ placental insufficiency effects

Question 20

What info is needed for Ballard Scale assessment?

Answer 20

weeks gestation

length

weight

had circumference

Question 21

When would the Gestational Age Assessment be done?

Answer 21

after transition period (~ 4 hrs)

***based on neuromuscular and physical maturity

Question 22

Common lenght and weight of neonate?

Answer 22

length = 17.7 - 21.7 in

weight = 5.5 - 8.8 lb

Question 23

What is difference b/t a Cephalhematoma and a Caput Succudanum?

Answer 23

Cephalhematoma – collection of blood

Caput Succudanum – collection of fluid

Question 24

What are some common soft tissue injuries in neonates?

Answer 24

Cephalhematoma

Caput Succudanum

Bruising

Question 25

The -- fontanel is diamond shaped. The --- fontanel is triangle shaped.

Answer 25

Anterior Posterior

Question 26

What will newborn chest look like?

Answer 26

~ 1/2 inch smaller than head Breast tissue present Nipple Discharge

Question 27

What is syndactaly?

Answer 27

webbing of digits

Question 28

What will the ears be in line with?

Answer 28

pinna in line w/ outer canthus of eye ***low set ears a sign of Down's Syndrome

Question 29

Genitalia assessment in neonates:

Answer 29

Enlarged Discharge may be present in female neonates (pseudomenses) Testicles descended in male neonates

Question 30

Treatment for Hypothermia

Answer 30

Swaddle in double warm blankets If temp does not respond --> return to radiant warmer per protocol Observe for respiratory distress (cold stress increases O2 need) Observe for signs of hypoglycemia – cold stress  uses up glucose on board

Question 31

Which plasma glucose level in full-term infant requires intervention?

Question 32

Before circumcision, we should hold ---

Answer 32

feeding

Question 33

Which type of clamp used in circumcision makes procedure bloodless?

Answer 33

Yellen (Gumco) Mogen clamp ***apply petroleum jelly or antibiotic ointment afterwards

Question 34

Which type of circumcision procedure requires no ointment?

Answer 34

Plastibell

Question 35

No -- until circumcision heals.

Answer 35

tub baths ***do NOT clean off yellow exudate

Question 36

Urine assessment

Answer 36

Usually 6-8X day if getting enough to eat Urine pale; poorly concentrated Document all voiding especially post circumcision No voiding documented first 24 hours --> MD notified

Question 37

Place neonate on which side to encourage stomach emptying?

Answer 37

right side ***never place on stomach (ASPARATION)

Question 38

Conditions in which breastfeeding should be avoided?

Answer 38

Active TB Hep B or Hep C HIV Cancer Maternal drug use

Question 39

Why would a drug addict mom be asked to pump?

Answer 39

1) they may have to use it to aid in DTs Only a very small amount will be given to the baby and ONLY if the baby is experiencing sever withdrawals and other measures have not worked. 2) other reason is to see if the mother is continuing drug use.

Question 40

Storage of breast milk.

Answer 40

Rigid plastic containers Refrigerate (48-72 hrs) Frozen (1 mth) ***6-12 mths if deep freezer

Question 41

How should frozen milk be thawed?

Answer 41

fridge under running water

Question 42

Type 1 DM mom will likely have a --- baby.

Answer 42

big ***all that sugar is transferred to baby in utero ***baby will be hypoglycemic postpartum

Question 43

Which newborn tests are required by all states?

Answer 43

PKU Hypothyroid Hearing Screen

Question 44

When should PKU and Hypothyroid screens be performed?

Answer 44

24 hrs from 1st good feeding

Question 45

To test for PKU, infant needs to have ingested ---

Answer 45

milk in adequate amounts

Question 46

Accumulation of PKU result in ---

Answer 46

mental retardation ***can be prevented if treatment stared early

Question 47

What is PKU test looking for?

Answer 47

phenylalanine (essential amino acid) in the urine

Question 48

What is Galactosemia?

Answer 48

absence of an enzyme that metabolzes galactose and that results in damage to liver, brain and eyes ***galactose is "milk sugar"

Question 49

Treatment of Galactosemia?

Answer 49

eliminate breast milk ***baby cannot be safely breastfed b/c lacks the enzyme to break down galactose (milk sugar)

Question 50

Signs of a sick infant

Answer 50

Lethargy Temp > 100F Vomiting or Green Liquid stools Refusal of 2 feedings in a row Depressed fontanels Dry mucous membranes