Test 7 Adjusted

Question 1

1a. Determine what would classify a newborn as low birth weight, very low birth weight, and extremely low birth weight? (Know the actual grams for each)

Answer 1

 Low birth weight (LBW); weight less than 2,500 g
 Very low birth weight (VLBW); weight less than 1,500 g
 Extremely low birth weight (ELBW); weight less than 1,000 g.

o Very low birth weight using the gestational age assessment tool.

Question 2

1c. Describe the physical characteristics of a post-term newborn (skin and ears) and a pre-term newborn(lanugo).

Answer 2

Post term: skin and ears
 The skin is dry, cracked, wrinkled, peeling, and whiter than that of the normal newborn.
 Cartilage thick; pinna stiff

Preterm: lanugo
 Abundance of fine downy hair up to 34 weeks gestation
 Lanugo is on the extremities, back, and shoulders.

Question 3

2.What are the characteristics of an asymmetrically growth restricted newborn?

Answer 3

 Asymmetrically growth-restricted newborn’s head is large in comparison with the body (“head sparing.”)

 When the three growth measurements (weight, length, and head circumference) are plotted on a standard growth chart, one or two of the measurements fall below the 10th percentile.

Question 4

3. Identify the most widely known contributing factor to a large for gestational age newborn.

Answer 4

 Maternal diabetes, particularly if it is poorly controlled, is the strongest known contributing.

Question 5

4a. Describe the main cause of a preterm newborn?

Answer 5

 Multiple birth (polyhydramnios) due to fertility treatments

Question 6

4b. Which complication is the most critical of a preterm newborn?

Answer 6

 Respiratory

Question 7

5b. Explain what causes respiratory distress syndrome (RDS).

Answer 7

 RDS occurs in the preterm newborn because the lungs are too immature.

 The premature infant’s lungs are deficient in surfactant and thus collapse after each breath, greatly increasing the work of breathing.

Question 8

6b. Describe the contributing factors for transient tachypnea of the newborn.

Answer 8

 Commonly occurs in newborns born by cesarean delivery.
 Prematurity (being small for gestational age)
 Maternal diabetes
 Maternal smoking during pregnancy

Question 9

7b. What would be a probable indication(manifestations) of hemolytic disease in the newborn.

Answer 9

 Pallor
 Edema
 Jaundice
 An enlarged spleen and liver
 Anemia

Question 10

8. Describe the priority nursing care for the newborn with hemolytic disease receiving phototherapy

Answer 10

 A newborn who has mild-to-moderate disease(jaundice) usually receives hydration and phototherapy after birth.
 IF NEWBORN UNDERGOING PHOTOTHERAPY, THE NURSE SHOULD ASSESS FOR DEHYDRATION (25% more fluid) AND ENCOURAGE BREASTFEEDING 1-2 HOURS.

 Place the lights above the isolette at an appropriate height. If the lights are too far away from the newborn, the therapy will not work. If they are too close, the newborn may receive burns.
 The infant is nude, except for a small covering over the genitalia, to maximize the skin surface area exposed to the light. A pad or diaper is placed under the perineal area to collect urine and feces.
 Turn the newborn every 2 hours to rotate the area of exposure. Do not turn off the lights except to feed and to change the diaper.
 Always shield the newborn’s eyes from the ultraviolet light. Carefully apply eye patches to avoid eye irritation. If the eye patch is too loose, it can slip down and obstruct the nares or lead to retinal damage from the light.
 Remove the patches every 4 hours to cleanse the eyes and examine for irritation, inflammation, and dryness. Clean and change the patches daily.

Question 11

9b. Explain the clinical manifestations of FAS

Answer 11

(Fetal Alcohol Syndrome)
 Hyperactive
 Irritable
 Has trouble sleeping?
 Tremors or Seizures
 Low birth weight (LBW)
 Small height and head circumference
 Short palpebral fissures (eyelid folds)
 Reduce ocular growth, flatten nasal bridge.

Question 12

9b. How to prevent FAS

Answer 12

 The woman should stop drinking at least 3 months before she plans to become pregnant and abstain from using any alcohol use during pregnancy.
 Screening women of reproductive age for alcohol problems
 Encouraging women to obtain adequate prenatal care.

Question 13

11b. What is the priority nursing diagnosis and goals for a baby with spinal bifida?

Answer 13

 Maintain sac integrity and prevent infection.

Question 14

12. Give an example of how to promote family coping of a newborn with Spinal Bifida. (Think comfort)

Answer 14

 Encourage family members to express their feelings and emotions as openly as possible.
 Provide privacy as needed for the family to mourn together over their loss, but do not avoid the family because this only exaggerates their feelings of loss and depression.
 If possible, encourage the family members to cuddle or touch the newborn using proper precautions for the safety of the defect.
 With the permission of the health care provider, the newborn may be held in a chest-to-chest position to provide closer contact.

Question 15

13a.Describe communicating hydrocephalus and non-communicating hydrocephalus.

Answer 15

 In the communicating type of hydrocephalus, no obstruction of the free flow of CSF exists between the ventricles and the spinal theca; rather the condition is caused by defective absorption of CSF, which increases pressure on the brain or spinal cord.

 In the noncommunicating type of congenital hydrocephalus, an obstruction occurs, and CSF is not able to pass between the ventricles and the spinal cord. The blockage causes increased pressure on the brain or spinal cord.

Question 16

13b. What are the signs and symptoms of increased intracranial pressure in an infant?

Answer 16

 Irritability
 Restlessness
 Personality change
 High-pitched cry
 Ataxia
 Projectile vomiting
 Failure to thrive.
 Seizures
 Severe headache
 Changes in level of consciousness
 Papilledema.

Question 17

14. What could the LVN do if the client shows signs or symptoms of increased intracranial pressure?

Answer 17

 Notify Physician

Question 18

15b. What are the signs and symptoms for the newborn with ventral septal defect (VSD)?

Answer 18

 Some severely affected newborns may show cyanosis earlier.
 Feeding difficulties, Poor weight gain, resulting in slowed growth and development.
 Dyspnea and easy fatiguability
 Attacks of paroxysmal dyspnea are common during infancy and early childhood.
 An anoxic spell is heralded by sudden restlessness, gasping respiration, and increased cyanosis that lead to a loss of consciousness and possibly convulsions.
 Characteristic loud, harsh murmur associated with a systolic thrill is occasionally heard on examination.

Question 19

16b. How does a child find their own limitations, and what they do to relieve their symptoms with Tetralogy of Fallot?

Answer 19

 Children are rather sensible about finding their own limitations and usually limit their activities to their capacity if they are not made unduly apprehensive.
 This young child may assume a squatting position, which reduces the return flow to the heart, thus temporarily reducing the workload of the heart.

Question 20

17b. Explain the priority nursing intervention to prevent post-op injury after a Cleft-lip or Cleft-palate repair. (Injury being the key word)

Answer 20

 Nothing is permitted in the infant’s mouth, particularly the thumb or finger, elbow restraints are necessary. The thumb, although comforting, may quickly undo the repair or cause undesirable scarring along the suture line.

Question 21

19a. What are the manifestations for congenital hip dysplasia?

Answer 21

 Audible click when examining the newborn using the Barlow sign and Ortolani maneuver.
 Asymmetry of the gluteal skin folds (higher on the affected side)
 Limited abduction of the affected hip. The affected side cannot be abducted more than 45 degrees.
 Apparent shortening of the femur

Question 22

19b. What is important to watch for in the child with hip spica cast.

Answer 22

 Nursing focuses for the infant in an orthopedic device or a cast, comfort and maintaining skin integrity are major concerns.
 Check the toes for circulation and movement. Check the skin at the edges of the cast for signs of pressure or irritation.
 Observe the infant in a cast carefully for any restriction of breathing caused by tightness over the abdomen and lower chest area. Vomiting after a feeding may be an indication that the cast is too tight over the stomach.

Question 23

20b. What is the most severe complication if untreated Phenylketonuria (PKU)?

Answer 23

 If untreated, causes severe intellectual disability in most but not all affected children.

Question 24

21b. State what a woman with PKU must do if she wants to get pregnant.

Answer 24

 If a woman who has PKU decides to have a child and is not following a diet low in phenylalanine, she should return to following the dietary treatment for at least 3 months before becoming pregnant. Continue diet throughout pregnancy.

Question 25

22. List the biggest complications of a child with Downs Syndrome.

Answer 25

 Greater susceptibility to leukemia!!!

Question 26

25. What to do for premature babies in the NICU (THINK QUITE SETTING)?

Answer 26

 Decreasing environmental noise and stress, maintaining flexed positioning, and clustering care to conserve energy.
 As the preterm infant grows, they increasingly need sensory stimulation. Mobiles hung over the isolette and toys placed in or on the infant unit may provide visual stimulation. A radio with the volume turned low, a music box, or a wind-up toy in the isolette may provide auditory stimulation. An excellent form of auditory stimulation comes from the voices of the infant’s family, health care providers, and nurses talking and singing. Being bathed, held, cuddled, and fondled provides needed tactile stimulation.

Question 27

26. What can be harmful to preemie when given too much O2?

Answer 27

 Eyes and lungs