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test 4 Flashcards

1
Q

neonate period

A

first 30 days. Baby has to adjust to extrauterine life.
They need to complete this list

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2
Q

physiological adjustments baby needs to make after birth

A

establishing and maintaining respirations
adjusting to circulatory changes
regulating temp
ingesting, retaining, and digesting nutrients
eliminating waste
regulating weight

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3
Q

first period of reactivity

A

first 30 mins of life
stabilization of HR, RR
alert, responsive, usually hungry
golden hour- Use this time to do skin to skin and get baby breast feed. Allows bonding before baby goes to sleep

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4
Q

sleep phase

A

after first period of reactivity

may last from minutes to hours, difficult to awake

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5
Q

second period of reactivity

A

2-8 hours after birth
peristalsis increases

first meconium may occur, gagging, spiting up

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6
Q

when are babies weighed

A

they are weighed every 24 hours

not weighed right after birth typically

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7
Q

what gets suctioned first if needed

A

mouth before nose!

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8
Q

what causes initiative of breathing

A

chemical- increased co2
mechanical- Negative thoracic pressure, baby cries and draws air into lungs
thermal- cold environment
sensory- drying baby off, suctioning

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9
Q

normal new born breathing

A

nose breathers- not mouth
chest and abdomen rise synchronously
shallow and irregular pattern with pauses lasting under 20 secs
30-60 breaths/min

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10
Q

abnormal newborn breathing

A

grunting
nasal flaring
retractions- skin is retracting with ribs
seesaw respirations
persistant cyanosis
tachypnea >60
gasping

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11
Q

newborn resp distress

A

around 120 breaths per minute. Intubation needed

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12
Q

TTN (transient tachypnea of newborn)

A

baby isn’t transitioning as well as should. Encourage more skin to skin or if its bad then possibly nursery

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13
Q

2 cardio changes that occur with birth

A

Foramen ovale - closes quickly after baby starts breathing
Ductus arteriosus- doesn’t shut for 24-48 hours.

Murmur could be heard as ductus arteriosus is closing

If ductus doesn’t close- cardio symptoms may occur

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14
Q

acrocyanosis

A

bluish discoloration of hands and feet
normal if within first 24 hours bc of extrauterine circulation transition.
does not occur in all babies

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15
Q

why are babies at risk for heat loss

A

Blood vessels are closer to skin, don’t have much fat, they don’t shiver

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16
Q

how can baby warm up

A

We want a thermo environment that is warm - skin to skin, hat, blankets, flexion of muscles, metabolize brown fat

thermogenesis- baby makes own heat by moving

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17
Q

4 heat loss mechanisms

A

conduction- occurs if touching something cold- heat transfers to it
convection- from air moving toward them like fan
evaporation- could occur if wet
radiation- heat transfer from one object to another without physical contact. ex- cold wall near by

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18
Q

brown fat

A

only in newborns
amount increases with gestational age

usually present for several weeks unless cold stress

Once it is burnt off its gone.
Metabolized, could warm a infant, but calories and oxygen will be burned to do this

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19
Q

what could happen when a baby is cold

A

hypoglycemia- due to a increased metabolic rate to produce heat

acidosis- Brown fat converted to heat and fatty acids, fatty acids lower pH

Hypoxia- requires extra o2 to produce heat

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20
Q

desired temp for baby

A

36.5 to 37.5 C
(97.7 to 99.5 F)

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21
Q

what can cause hyperthermia in newborns

A

they dont sweat, too much heat/clothes

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22
Q

what should 24 hour bilirubin be

A

under 7

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23
Q

bilirubin in babies

A

Unconjugated bilirubin- cant be excreted. Must go to liver to get conjugated to get excreted by stool.

if bilirubin to high in baby, could cause kernicterus (neuro issues)

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24
Q

Why are all babies at risk for elevated bilirubin

A

there RBC have a shorter life, and there livers are immature

this would be physiologic hyperbilirubinemia

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25
what puts babies at even more risk to develop elevated bilirubin
Coombs positive, breast feeding if not effective, prematurity, family history this would be pathologic hyperbilirubinemia
26
when should baby have first stool and pee
first day of life
27
harlequin sign
half of babys face turns red
28
petechiae in newborn
could be from traumatic birth or sign of menigitis
29
mottling
purple rings occur when baby is cold
30
vernix caseosa
waxy white substance found on newborns. more common in preterm
31
desquamation
newborn peeling skin. more common in post term
32
nevus vasculosus or "strawberry mark"
raised red bits on newborn. they go away with time
33
nevus flammerus "port wine stain"
red mark on newborn face. Skin will not blanch with this and it does not go away
34
caput succedaneum
edema of scalp. goes away on its own
35
subgaleal hemorrhage
collection of blood between skull and periosteum. goes away on its own
36
cephalohematoma
bleeding under scalp, treatment is needed
37
if newborns are tremoring at rest, what may the issue be
NAS, hypoglycemia, neuro issue
38
newborn reflexes
sucking and rooting swallowing grasp extrusion glabellar tonic neck moro stepping babinski
39
what sense is not fully developed when baby is born
vision
40
six sleep-wake states
deep sleep light sleep drowsy quiet alert active alert crying
41
APGAR meaning
activity pulse grimace appearance respiration best score is a 10
42
0 points for APGAR
activity absent pulse absent grimace floppy appearance blue respiration absent
43
1 point APGAR
flexed arm and leg pulse below 100 bpm grimace- minimal response to stimulation appearance- blue extremities pink body respirations slow and irregular
44
2 point APGAR
Active activity pulse over 100 grimace- prompt response to stimulation pink appearance vigorous cry (respirations)
45
what to worry about for LGA babies
BG
46
where is head circumference measured at
above eyebrows
47
where should babys ears line up
eye length
48
what to assess in umbilical cord
number of vessels hernia sign of infection
49
hydrocele
fluid in scortal sac
50
what on hand may be a indication of down syndrome
simian crease
51
what do you need to know to graph bilirubin
hours of age lab result (TSB) gestational age risk factors
52
phototherapy
for jaundice baby needs eye protection, skin care, turned q2, monitor temp
53
how are infants lab drawn
by heel
54
when should umbilical cord fall of
2 weeks do sponge bath until its off
55
what is common find for labia in newborns
edema there also may be some discharge or pink stains in diaper
56
what can u do for baby hip dysplasia
ortolani maneuver
57
scale that estimates baby's gestational age
Ballard scale
58
benefits of skin to skin
faster and easier transition better temp, resp and glucose reg lower stress levels breastfeed longer improved maternal bonding less anxiety for mother
59
meds for newborn
vitamin K for clotting hep B vaccine eye prophylaxis for gonorrhea as it may cause blindness
60
circumcision care
monitor for bleeding monitor for infection don't bathe until circumcision looks normal wrap penis with Vaseline and gauze until healed to prevent scab from falling off
61
what hormone prepares mom for milk
prolactin
62
what are breast feeding moms at lower risk for
postpartum hemorrhage
63
what can occur when breast feeding early on
after pains
64
how many feeds should newborns have in 24 hours
8-12 feedings should be done every 2-4 hours but as baby is hungry
65
how many pee/poos should baby have on day one
one pee and one poo day 2- two pee , two poo day 3- three pee, three poo
66
by day 5 of life, how much should baby pee/poo
they should have 3 stools and 6-8 wet diapers
67
how long is breast milk good for
room temp - 5 hours refrigerator - 5 days freezer- at least 5 months dont microwave breast milk!
68
how much should babys eat
day 1-2 - 15-30 mL per feeding then should be increased 5-10 mL per day and should be 90-150 mL by end of second week
69
newborn birth injuries
skull fractures- linear or depression fractured clavicle peripheral nervous system injury facial paralysis neuro injury (such as from o2 injuries, blood flow issues, etc)
70
fractured clavicle signs and symptoms
crepitus over the area absence of moro reflex on that side feeling of dislocation immobilize arm by swaddling them when dressing baby- use affected arm first, and when taking clothes off use nonaffected arm
71
peripheral nervous injury
also called erbs palsy nerve injury- branchial plexus could heal in 3-6 months if not permanent avoid pulling on arms do PROM exercises in a week or 2. baby cant move arm teach parents how to dress and undress do not immobilize
72
facial paralysis care
cant close mouth so may need to be tube feed at first eye may dry out wince one cant close so we will need to prevent this
73
Hypoxic ischemic brain injury (HIE)
Brain injury due to lack of oxygen
74
what puts babies more at risk for neuro injuries
the lower the gestational age, the higher the risk
75
examples of neuro injury problems
cerebral palsy seizures hydrocephalus
76
therapeutic hypothermia
used for hypoxic ischemic brain injury we cool them because it slows the neurological damage
77
early onset sepsis in newborns
acquired in perinatal period from direct contact with GI/GU tracts- UTI, frequent cervical checks, meconium stained fluid most common organisms- GBS, E coli usually manifests within 72 hours of birth high morality- 3-40% progresses rapidly
78
late onset neonate sepsis
acquired in hospital/community most common cause- Staph. could also be E coli, enterobacter cloacae, canida usually occurs at 7-30 days of age mortality rate 2-20%
79
signs of neonate sepsis
apnea, bradycardia tachypnea grunting nasal flaring, retractions tachycardia hypotension temperature instability irritability seizures lethargy decreased perfusion jaundice pallor feeding intolerance abdominal distention petechiae
80
TORCH acronym
5 infectious diseases these are harder diseases to identify Toxoplasmosis Other (like hep B, HIV, syphilus) Rubella (german measles) Cytomegalovirus (CMV) Herpes simplex virus (HSV)
81
signs of withdrawl in newborns from substance abuse
irritability hyperactivity exaggerated moro reflex high pitched cry tremor fever diaphoresis mottled skin poor feeding frantic uncoordinated suck dehydration V/D disrupted sleep patterns temp instability
82
how to drug test baby
urine sample of baby and mom tells what mom took recently meconium of baby tells us a bigger picture
83
common congenital defects
congenital heart disease abdominal wall defects imperforate anus neural tube defects cleft lip or palate club foot developmental dysplasia of hip
84
preterm infant risk factors
previous preterm maternal infections multiple gestation htn placental issues diabetes heart disease kidney disease smoking drug use poor nutriton weakened cervix younger than 17 or older than 35 conceiving via IVF multiple miscarriages/abortions
85
nursing care for substance abuse
cluster care decrease stimuli NAS scoring skin care swaddle tight encourage breastfeeding bonding hydration
86
if mom is RH- and baby is RH+ what needs to be done
rho-gam within 72 hours of delivery in case of another future pregnancy if mom gets pregnant again, rho-gam will need to be given again at 26-28 weeks if we don't do this, moms antibodies will attack future baby baby will most likely need phototherapy
87
when is indirect vs direct coombs test given
indirect when mom is pregnant direct when mom is post partum
88
infants of diabatic mother issues
congenital abnormalities RDS extreme prematurity macrosomia hypoglycemia mom needs to maintain euglycemic status to prevent these!
89
high risk problems related to preterm infants
thermoregulation hypoglycemia hyperbilirubinemia sepsis resp function cognitive and motor delays
90
why is RDS common in premies
they dont have surfuctant yet
91
necrotizing enterocolitis (NEC)
The most common neonatal intestinal emergency, characterized by intesntinal ischemia. could lead to bowels spilling into perineum Goals: Stabilize infant, treat infection, rest intestinal tract needs to be treated with abx. discontinue feedings, NG tube for abdomen depression, Initiate IV fluids. monitor vitals. encourage mom to breast pump and freeze
92
s/s of NEC
*not tolerating feeds, poor perfusion, mottled skin, bilious vomiting, grossly bloody stools, abdominal distention, decreased UO, hypotension, lethargy, jaundice, unstable body temp
93
care of high risk infant
assess resp suport thermoregulation protect from infection hydration nutrition

maternity (4 decks)

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