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Nursing Semester 2 > Toni - Week 4/5 - Exam 3 > Flashcards

Toni - Week 4/5 - Exam 3 Flashcards

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1
Q

when are APGAR scores done?

A

done during newborn assessment at 1 min and 5 min of age

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2
Q

what does an APGAR score assess?

A

assesses how well newborn is adapting to extrauterine life

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3
Q

what happens when the score is less than 7 at the 5 minute assessment?

A

an additional score is done at 10 minutes

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4
Q

what do low APGAR scores indicate?

A

low scores indicate baby needs assistance adapting to extrauterine environment

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5
Q

what does APGAR stand for?

A

Activity, Pulse, Grimace, Appearance, and Respiration

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6
Q

what does acrocynosis mean?

A

baby’s body is pink and extremities are blue.

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7
Q

what’s an APGAR score of 0-3 indicate?

A

very concerned

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8
Q

what’s an APGAR score of 4-6 indicate?

A

may need a little help

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9
Q

what’s an APGAR score of 7-10 mean?

A

non concerning.

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10
Q

Newborn Respirations: what is the first breath triggered by?

A
  • ↓ O2, ↑ CO2, ↓ pH levels
  • Temperature change, noise, light
  • ↓ external pulmonary pressure
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11
Q

Newborn Respirations: what are the 4 characteristics of newborn lungs/respirations?

A
  • lungs lined with surfactant
  • excess lung fluid is normal in the first hour
  • obligate nose breathers (don’t block nose, may not breath through mouth)
  • breaths = irregular and raise abdomen
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12
Q

T/F; the first breath is the biggest breath.

A

TRUE

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13
Q

Newborn Respirations: what is surfactant?

A

substance that keeps alveoli open - like putting soapy substance in a balloon - doesn’t adhere to each other.

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14
Q

Newborn Respirations: what are 5 things to assess?

A
  • listen to breathing (wheezes/grunts)
  • observe effort (look at chest - retracting/shadowing by ribs is abnormal)
  • observe skin color (make sure central is pink)
  • check cap refill at sternum
  • ausculatate lungs anteriorly and axillary areas
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15
Q

Newborn Respirations: what are 3 interventions that we can do to improve respirations?

A
  • reposition to facilitate drainage
  • bulb syringe mouth then nose
  • percussion/postural drainage
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16
Q

what does grunting sound like?

A

sounds like singing - respiratory distress`

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17
Q

Temperature Regulation: what are the 4 reasons that babies are predisposed to heat loss?

A
  • large body surface: body weight ration
  • head proportionally larger (1/4 body)
  • thin skin; vessels near surface
  • small musculature; cannot shiver to warm up
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18
Q

Temperature Regulation: what are the 3 characteristics of brown adipose tissue?

A
  • one time supply
  • found in term infants
  • generates heat first day of life
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19
Q

Temperature Regulation: how does brown adipose generate heat?

A
  • non-shivering thermogenesis, relies on O2 + glucose
  • can cause hypoxia + hypoglycemia
  • *energy inefficient - we don’t want a baby to do this
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20
Q

Temperature Regulation: what are 7 things we can do to regulate temperature?

A
  • remove wet blankets and dry
  • skin to skin contact or under warmer
  • maintain flexed position
  • no drafts/cold surfaces
  • delay bath until temp stable
  • apply hat and warm blankets
  • monitor temp and actively warm if < 97.7 F (36.5)
  • ***recheck temp after 15 minutres
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21
Q

Temperature Regulation: what do we do if low temps persist even after warming?

A

Report!!! Because chronic hypothermia is a sign of sepsis

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22
Q

Temperature Regulation: what should be done if a baby is too hot?

A

take hat off, unswaddle

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23
Q

what are the three different stages of transitioning to extrauterine life?

A
  • 1st period of reactivity
  • period decreased responsiveness
  • 2nd period of reactivity
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24
Q

what occurs during the 1st period of reactivity?

A
  • 30 min - 2 hr after birth
  • awake/alert
  • nursing/attachment (vigorous suck reflex)
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25
Q

what occurs during the period decreased responsiveness?

A
  • 2 - 4 hrs deep sleep
  • HR/RR slow
  • difficult to awaken
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26
Q

what occurs during the 2nd period of reactivity?

A
  • awakes from deep sleep
  • alert; increased tone
  • may exhibit hunger cues
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27
Q

what are some hunger cues?

A
  • hand in mouth (early sign)

- crying (late sign of hunger)

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28
Q

what are the different newborn reflexes?

A
  • morro reflex (arms extended C with hands)
  • palmar grasp
  • sucking reflex
  • stepping reflex (may prepare for develop of walking)
  • babinski reflex (stroke heel to toe - 6 - 24 mo)
  • rooting reflex
  • thumb below toes - curl around finger ( if -, concerning)
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29
Q

what are the 3 characteristics of a newborn head?

A
  • 1/4 body length
  • 32 - 37 cm
  • fontanels (anterior - close 18mo; posterior - 6 wks)
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30
Q

what are the two conditions that can happen to a newborn head?

A
  • caput succedaneum - edema under skin; bubble across suture line (won’t last long)
  • cephalohematoma - takes 6 wks to resolve; hard, colorful blood beneath periosteum; ↑ bilirubin → breakdown of RBC
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31
Q

what are normal/abnormal findings concerning newborn eyes?

A

normal: subconjunctival hemorrhage - pressure from vaginal delivery
abnormal: discharge

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32
Q

what is abnormal concerning newborn nose?

A

discharge from the nose is abnormal

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33
Q

where are the ears normally sitting?

A

normally at eye level

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34
Q

what are the 5 characteristics of a newborn GI system?

A
  • meconium within 24 hrs (thick,black)
  • yellow stools by day 5 (teach - this is how you know getting enough breast milk)
  • no intestinal bacteria (need vitamin K shot)
  • digest proteins/carbs easily
  • regurgitation common - teach difference b/t vomit and spit up
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35
Q

what are the 5 characteristics of the newborn GU system?

A
  • 6-8 voids per day by 1 week of age
  • genitalia edematous and pigmented (expression of maternal hormone)
  • uric acid crystals (orangey pink - teach)
  • female pseudomenstruation (expression of maternal hormone)
  • undescended testicle (cryptorchidism - should come down over time )
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36
Q

newborn skin: what does the color look like?

A

depends on activity and H+H levels

  • mostly ruddy (red) d/t an increased H + H - glows red
  • can be moddled - pink/white color
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37
Q

newborn skin: what 7 skin conditions can a newborn have?

A
  • petechiae/ecchymosis (tiny hemorrhages/bruising)
  • acrocyanosis (hands/feet blue)
  • erythema toxicum (flea bite rash - small pustules on new born skin - temporary)
  • milia (normal finding - disappears)
  • lanugo (hair/furry - disappears)
  • vernix caseosa (creamy/cheesy coating, early born babies, protective, rub it in skin)
  • mongolian spots (blue pigment in body - dark skinned infants - bruise-like - disappears at age 4)
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38
Q

newborn skin: what occurs with newborn nipples?

A

nipple engorgement and discharge - maternal hormones

  • happens in both male and females
  • temporary
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39
Q

newborn skin: what should we assess the spine for??

A

observe spine for dimple or tuft of hair - spina bifida

40
Q

what are the 5 newborn behavioral responses?

A

orientation, habituation, motor maturity, self-quieting, and social behaviors

41
Q

behavior: describe orientation.

A

response to human voice - “look how baby widens eyes - he’s looking at you” - also helps with bonding

42
Q

behavior: deceive habituation.

A

the ability of infant to respond less to stimulation over time - some do, some don’t - parents will create environment that’s quiet and less light

43
Q

behavior: describe motor maturity.

A

hunger, pain, temperature, handling, cry or awaken -> tremor of chin -> motor immaturity common -> startling is normal, jerky movement. consistent? now bring to attention.

44
Q

behavior: describe self-quieting.

A

ability of infant to bring to a lower stage (ie thumb to mouth) others need to be consoled -> should be consolable -> inconsolable may have something wrong (trust gut)

45
Q

behavior: describe social behavior.

A

swaddling; not cuddling? thrashing/arching.. may thing baby doesn’t like me - some babies prefer not to be close - like to look around - adds belly pressure

46
Q

what is normal range for newborn HR?

A

100-150 bpm

47
Q

what is normal newborn RR?

A

30-60 breaths per minute

48
Q

what is a safe range for newborn temperature?

A

36.5-37.5C (97.7-99.5F)

49
Q

when and where is BP taken?

A

BP taken at birth in R arm and R leg - we don’t do this - BP followed up only if abnormal

50
Q

how can we assess pain?

A

high pitches cry, difficult to calm - use NIPS scale

51
Q

when and where is O2 sat taken on a newborn?

A

O2 sat taken on right arm and right leg

- assessed before DC to rule out congenital heart disease

52
Q

what should O2 sat be in a newborn?

A

O2 sat greater or equal to 95% in both extremities

- difference between upper/lower < 3%

53
Q

T/F: vital signs reflect baseline even when a baby is crying.

A

FALSE. not baseline - take again when baby is consoled

54
Q

what are the benefits of breastfeeding in relation to the mother?

A
  • decreased risk of cancer (ovary, breast, and uterus)
  • decreased risk of osteoporosis
  • decreased risk of CV disease
  • decreased risk of type 2 DM
  • decreased risk of PP depression
  • decrease ovulation - delay menses
  • increased weight loss
  • promotes involution
  • facilitates bonding
55
Q

why is breastmilk the superior infant food?

A
  • absorbable (use breast milk so well; may be little left to make stool)
  • fresh and safe
  • living tissues (full of Ig - treated like blood in hospital)
56
Q

what benefits do infants get from breast milk?

A
  • passive immunity from mom
  • decreased illness + allergies
  • decreased incidence of SIDS
  • decreased risk of obesity
  • decreased risk of RSV, UTI, Type 1 DM, lymphoma
  • increased IQ (cognitive development)
57
Q

what is the process map of breast feeding anatomy?

A

alveoli produce milk - muscle around alveoli send milk forward - pores allow milk transfer - oxytocin produces let down reflex

58
Q

what “law” does breast milk follow?

A

the law of supply and demand. more milk removed; the more milk produced (pump pump pump!)

59
Q

what is a good breast feeding position?

A
  • mom sitting up straight with baby at chest level

- place nose to nipple, chest to chest, chin to breast, and wait for wide open mouth

60
Q

describe the cross cradle?

A

hand same side as breast forms nipple and areola to U shape; other hand supports neck and shoulders

61
Q

describe the football hold.

A

infant head and shoulders in palm of hand, body supported on forearm. Nipple and areola formed in C shape.

62
Q

what does pain indicate during a feeding?

A

malpositioning

63
Q

how should a baby look when latched?

A
  • lips flanged on areola (cover 1 - 1 1/2 inches of areola, and bottom lip covers more than upper)
  • audible swallowing
64
Q

how can a baby be detached from the breast?

A

Mom breaks latch with finger between areola and lip

65
Q

what should be assessed after detachment?

A

nipple shape (look like lipstick tube → straight)

66
Q

what does LATCH (score system) stand for?

A

latch, audible swallowing, type of nipple, comfort (breast/nipple) and hold

67
Q

when is the LATCH score taken?

A

at least once during shift

68
Q

how much milk do breasts make in a day?

A

25 - 35 oz/day

69
Q

how much does an infant (1 - 6 mo) drink in a day?

A

25 - 35 oz/day

70
Q

what is an average size of a breast milk “meal”?

A

3 - 5 oz

71
Q

what is the pattern of normal infant weight gain?

A
  • loses 5 - 10% of birthweight; > 10% loss pathological
  • regain birthweight by day 10
  • 1 oz/day first 3 to 4 months
  • doubles by 6 months; triples by 1 year
72
Q

what is a newborn’s stomach size at day 1, day 2, one week, and one month?

A

day 1: size of cherry (5 -7 mL)
day 2: size of walnut (22 - 27 ml)
week 1: size of apricot (40 - 60 ml)
month 1: size of large egg (80 - 150)

73
Q

how often should breastfeeding be offered?

A

feed on demand 8 - 12/day
one or both breasts per feed
alternate 1st breast each feed

74
Q

what are 4 hunger cues?

A

rooting, sucking on fists, clenched fists, and crying (late sign)

75
Q

what is an intervention for flat/inverted nipples?

A

nipple/breast shield (we don’t initiate → lact. specialist does)

76
Q

what are 4 interventions for sore nipples?

A
  • reposition
  • lanolin in b/t feeding
  • hydrogel pads (ordered)
  • assess for candida (red nipples/thrush in baby)
77
Q

what are 4 interventions for low milk supply?

A
  • frequent feedings (wake baby up q2hr)
  • offer both breasts
  • “finish” one side before switching
  • pump after feeds
78
Q

what can be used as galactagogues? (promotes more milk supply)

A
  • fenugreek (OTC, teas, pills, etc)

- domperidone (↑ prolactin; antiemetic)

79
Q

if mothers can’t/won’t breastfeed, what is recommended?

A

American Academy of Pediatrics (AAP) recommends breastmilk or FORMULA for 1st year.

80
Q

what are the different types of formula?

A

powdered, concentrated, and ready-to-feed

81
Q

what are the 4 recommendations when it comes to handling formula?

A
  • sterilization of equipment recommended
  • pathogens found in powered formula → mix with boiled water > 70C (158F)
  • Don’t microwave → bring to room temp in warm water
  • discard any unused formula after 2 hrs
82
Q

what 10 things should be implemented for bottle feeding?

A
  • feed on demand q 3 - 4 hrs
  • watch for hunger cues
  • avoid use as first calming option
  • allow baby to pace feeding
  • hold close, head elevated
  • allow baby to take nipple
  • keep nipple full of formula
  • alternate sides
  • pause to burp during and after feeding
  • allow baby to determine when finished
83
Q

what is the 3 steps to newborn heel sticks?

A
  • warm heel for 5 min prior
  • avoid milking
  • 1 drop is wiped away
84
Q

what are the 3 complications of heel sticks?

A

scarring, infection, and osteomyelitis (delays walking)

85
Q

what are the 3 newborn screen tests?

A
  • phenylketonuria (PKU)
  • Galactosemia
  • Congenital hypothyroidism
86
Q

what is PKU and how can it be treated?

A
  • cannot metabolize phenylalanine (protein), causes mental retardation if untreated
  • treatment: diet - controlled
87
Q

what is galactosemia and how can it be treated?

A
  • cannot metabolize galactose, can cause mental retardation and dehydration if untreated
    treatment: diet - controlled
88
Q

what can congenital hypothyroidism cause and how can it be treated?

A

can cause intellectual disability if untreated

tx: hormone replacement

89
Q

what 3 things occur for newborn prophylaxis?

A

erythromycin opthalmic ointment
vitamin K
Umbilical cord kept clean and dry

90
Q

what is erythromycin opthalmic ointment for and when do we apply

A

prevents newborn eye infections

apply within 1 hr of birth; leave on 1 minute - wipe off excess

91
Q

what is vitamin K for and when do we admin?

A

to prevent newborn hemorrhage; newborn gut sterile; cannot make vitamin K; Admin IM within 1 hr of birth into the thigh

92
Q

what is the hepatitis vaccine and when is it given?

A

Immunization against Hep B virus; Admin IM vastus lateralis; recommended for all infants; only vaccine given to newborn; requires MD order, obtain parent consent

93
Q

what is the recommended schedule for hep B vaccine?

A

0, 1, and 6 months

94
Q

what is the AAP statement on circumcision?

A

has health benefits/outweighs the risks; should be option for parents; explain benefits and risks to parents; obtain informed consent; analgesia must be provided

95
Q

what are the benefits of circumcision?

A

prevention of UTI, penile cancer, STI including HIV,

96
Q

what are the 5 things to teach parents regarding circumcision?

A
  • wash gently with water
  • apply neosporin or petroleum jelly as ordered (to diaper too)
  • expect crusted yellow exudate for 2 - 3 days
  • monitor for bleeding and infection
  • should void by 8 hrs post procedure
97
Q

what are the 2 different methods of circumcision?

A

plastibell and gomco clamp

Nursing Semester 2 (21 decks)

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