UNIT 5 NEW BORN CARE & CHANGES CHAPTER 22

Question 1

What is the normal Respiratory Rate for a newborn

Answer 1

30-60breaths per minute
breath pattern may be irregular

Question 2

On assessment, you new born patient’s chest is retracting , he also presents with nasal flaring, and grunting. Is this an expected finding in new borns?

A. Yes
B. No

Answer 2

B. No

These songs indicate respiratory distress, Intervention must be made

Question 3

What is the normal heart rate of a new born?

Answer 3

*110-170
* Foramen Ovale closes
* Ductus arteriosis constricts

Question 4

WHAT DOES THIS ACRONYM STAND FOR, When is the time frame it is done?

A
P
G
A
R

Answer 4

A- Appearance
P- Pulse
G- Grimace (Irritability
A-Activity and muscle tone
R-Respiratory Tone

Done 1-5 minutes after the delivery of the baby

Each letter is graded from 0 1 2

The higher the APGAR score , the greater the baby’s well being.

Question 5

What is this baby’s APGAR SCORE?

Appearance
Baby is centrally cyanotic

Puulse
No pulse detected

Grimace
Facial reaction to stimulation

Activity(Muscle Tone)
No spontaneous movements noted

Respiration
No Respirations noted

Answer 5

2- APGAR

Question 6

Steps of Neonatal Rescuitation

Answer 6

1.Stimulate baby by rubbing NOT SHAKING, suctioning, warm dry rubbing

2.Administer oxygen, blow by(oxygen in there facet directly on their face), incubate

3.Final Step , Cheast compressions ( Medications such as Epinephrine)

Question 7

What is usually done during the first two hours of life of the baby with the Mothers Consent?

Answer 7

Immediate interventions
* Eye prophylaxis
* Vitamin K prophylaxis

Question 8

Benefits of Eye prophylaxis

Answer 8

The American Academy of Pediatrics (AAP Committee on Infectious Diseases, 2021) and the U.S. Preventive Services Task Force (USPSTF, 2019) recommend instilling a prophylactic agent in the eyes of all newborns to prevent ophthalmia neonatorum or neonatal conjunctivitis.

To prevent ophthalmia neonatorum in newborns of mothers who are infected with N. gonorrhoeae. Eye prophylaxis for ophthalmia neonatorum is required by law in most U.S. states and in some Canadian provinces.

Question 9

Is it only recommended that babies that are delivered through vaginal birth only receive eye prophylaxis

A. Yes
B. No

Answer 9

B. No

Because ascending infection can occur, eye prophylaxis is recommended for all newborns, including those born by cesarean

In the United States, erythromycin 0.5% ophthalmic ointment is the recommended prophylactic medication to prevent infection from Neisseria gonorrhoeae (see Medication Guide: Eye Prophylaxis: Eryth- romycin Ophthalmic Ointment, 0.5%). Without prompt treatment, this infection can lead to blindness. Eye prophylaxis is usually admin- istered within the first hour after birth. It may be delayed up to 2 hours until after the first breastfeeding so that eye contact and parent-infant attachment and bonding are facilitated

Question 10

Neonatal Dosage for Eye prophylaxis

Answer 10

Apply a 1- to 2-cm ribbon of ointment to the lower conjunctival sac of each eye.

Question 11

Vitamin K prophylaxis benefits

Answer 11

To prevent vitamin K deficiency bleeding (hemorrhagic disease) of the newborn.

Question 12

Should male patient who are candidates for circimscion who’s parents has refused Vitamin K injection, be able to get a circumscion?

A. No
B. Yes

Answer 12

A. No

Male infants who do not receive the vitamin K injection are significantly more likely to bleed post-circumcision, and many provid- ers will decline performing this procedure when the newborn has not received vitamin K

Question 13

Should you administer the vitamin K injection before or action skin to skin bonding with mom?

A. Before
B. After

Answer 13

B. After

recommend that every newborn receive a single dose of phytonadione 0.5 to 1 mg to prevent vitamin K deficiency bleeding (VKDB). Administration of this injection should be delayed to allow the infant to spend some skin-to-skin time with the parents and for the first breastfeeding.

\Clotting factor-prevents hemorrhagic complications
* Newborn sterile bowel;
* E-coli makes vitamin K
* IM injection 0.5mg to 1 mg
* Normal newborns start to produce own vitamin K by day 8
-sufficient quantity at 4 months

Question 14

Why is it important to be maintain post temperature in a New Born?

Answer 14

Effective newborn care includes maintenance of a neutral thermal en- vironment (see Chapter 22). Cold stress increases the need for oxygen and can deplete glucose stores. The infant can react to exposure to cold by increasing the respiratory rate and can become cyanotic.

If the newborn does not remain skin-to-skin with the mother dur- ing the first 1 to 2 hours after birth, the nurse places the thoroughly dried infant under a radiant warmer or in a warm incubator until the body temperature stabilizes. The infant’s skin temperature is used as the point of control in a warmer with a servo-controlled mechanism. The control panel is usually set between 36°C and 37°C (96.8°F and 98.6°F) to maintain the healthy term newborn’s skin temperature at approximately 36.5°C to 37°C (97.7°F to 98.6°F).

Question 15

What tool would you use for a newborn to maintain a clear and patent Airway?

Answer 15

Bulb syringe

In general, the healthy term infant born vaginally has little difficulty clearing the airway. Most secretions are moved by gravity and brought by the cough reflex to the oropharynx to be drained, swallowed, or wiped away. If the airway is obstructed, then the mouth and nasal pas- sages can be gently suctioned with a bulb syringe

Question 16

Should vigorous Suctioning be used in a newborn?

A. Yes
B. No

Answer 16

B. No

Vigorous suctioning should be avoided; it can cause trauma to fragile tissues. Routine chest percussion and suctioning of healthy term or late- preterm infants should be avoided.

Question 17

Is fine crackles an expected finding during an assessment after a cesarean birth?

Answer 17

. The nurse should auscultate the infant’s chest with a stethoscope to assess for abnormal breath sounds or inspiratory stridor. Fine crackles may be auscultated for several hours after birth, especially in neonates born by cesarean

Question 18

Function of Bulb syringe

Answer 18

clear secretions from mouth &
nose
* Remove air from syringe away
from infant’s face
* Clear mouth first

Question 19

First period of reactivity

Answer 19

First period of reactivity-up to 30
minutes after birth

Assessment findings
30 MINUTES
* Heart rate increases to 160-180 beats/min
* Decreases after 30 minutes to baseline
* Infant alert, spontaneous startles, crying, & head
movement

Period of decreased responsiveness 60-
100 minutes
Infant is pink
* Respirations rapid & shallow to 60
breaths/minute
* Sleeps or has a marked decrease in motor activity

Question 20

Second
period of
reactivity

Answer 20

Lasts from 10 minutes to several
hours
* Occurs between 2 & 8 hours after
birth
* Tachycardia, tachypnea can occur
* Meconium passed
* Increased muscle tone, changes in
skin color, and mucus production

Question 21

Normal Newborn Weight

Answer 21

Normal Newborn Weight
* Average 2500-4000 g. ( 5 lbs. 5 oz.- 8 lbs. 8 oz.)
* Female 3400 g. (7 lb. 5 oz.)
* Male 3500 g. (7 lbs. 7 oz.)

• Normal newborn length
• Average 50 cm (19 ½ in)
• 45-55 cm (17¾ - 21½ in)
• Head circumference: 33-35 cm (12.9-13.7
  in.)

Question 22

When is the gestational assessment done?

A. 10hrs after birth
B. 5hrs after birth
C. 4hrs after birth
D. 2hrs after birth

Answer 22

Gestational Assessment:
done first 2 hrs. of age

Assess maturity markers
in newborn to correlate
with gestational age

Question 23

Your newborn patient weighs 2500 grams and was born at 37 weeks gestation? Which answer best fits the classification of their weight?

A. appropriate for gestational age
B. large for gestational age- 90%
C. small for gestational age-10%
D. Intrauterine growth

Answer 23

A. appropriate for gestational age

Question 24

Sleep wake cycle of baby

Answer 24

• Sleep 16-18 hours per day
• Deep sleep
• Light sleep
• Drowsy
• Quiet alert
• Active alert
• Crying
• 50% REM sleep gradually decreases

Question 25

When can baby’s see in color?

Answer 25

• Term can see up to 2 ½ feet away
• Clearest vision about 17-20 cm (6-7
  in.) away
• See color about 2 months of age
• Newborn can track parents’ eyes

Question 26

Normal findings for male & female genital area

Answer 26

• Edema of genitals common
  in both sexes
• Note maturational
  characteristics
• Female labia majora cover
  labia minora
• Male testes are down,
  scrotum pendulous with good
  rouge

Question 27

Does cold stress increases oxygen and glucose needs?

Answer 27

• Cold Stress increases oxygen & glucose
  needs

THERMOREGULATION FOR BABY
* Normal temperature 36.5-37.5 C (97.6-99.5
F)

Stabilization OF Temperature(* Minimize heat loss with procedures)
* Skin to skin
* Dry skin immediately
* Warm blankets, hat, shirt, pants, socks
* Radiant warmer
* Minimize heat loss with procedures

Question 28

When should a baby defecate meconium stool?

A. within 4 hours of delivery
B. within 72 hrs of delivery
C. after 30 days
D. with 24 hrs of delivery

Answer 28

D. with 24 hrs of delivery

Newborn Stool
* At birth meconium lines bowel, large bilirubin content
* Dark green-black, thick, sticky
* Mucous plug possible with first meconium
* Pass first meconium usually by 24 hours of age
* Meconium ileus suggestive of cystic fibrosis

Question 29

Your female new born patient is expelling pink to bloody discharge from her vagina. The mother is concerned. What is the correct teaching?
A. the baby is hemorrhaging internally due to dystocia
B. I understand your concerns, This is an expected finding for female new borns.
C. I will contact the doctor
D. this is a normal finding for macrocosmic babies

Answer 29

B. I understand your concerns, This is an expected finding for female new borns.

Males 90% testicles descended at birth
* Females thick mucous vaginal discharge;
can be pink or bloody

An increase in estrogen during pregnancy followed by a drop after birth causes female newborns to have mucoid vaginal discharge (Fig. 22.5) and even some slight bloody spotting. In term neonates, the labia majora and minora cover the vestibule

Question 30

Urogenital Presentation

Answer 30

Urine present before birth
* “Brick dust” urine, orange, uric crystal
stains normal
* 1 wet diaper/day of age to day 4; then 6-
8 wet/day

• Common for breast swelling in both
  sexes
• Males 90% testicles descended at birth
• Females thick mucous vaginal discharge;
  can be pink or bloody

Question 31

How many wet diapers per day should a 4 day old new born have?

A. 4 wet diapers
B. 13 wet diapers
C. 10 wet diapers
D. 20 wet diapers

Answer 31

A. 4 wet diapers

Question 32

You notice there is a Brick dust” urine, orange, uric crystal stains present during your new born assessment? What is your next action?

A. document the finding
B. Inform HCP of the in finding
C. Initiate IV access
D. Advocate for your patient by asking for Tylenol to be ordered

Answer 32

A. document the finding

Urine present before birth
* “Brick dust” urine, orange, uric crystal
stains normal

Question 33

Common New Born Complications

Answer 33

Birth injuries
* Soft-tissue; skeletal injuries(broken clavikal , brachial plexus)
* Lacerations
* Physiologic problems
* Jaundice-hyperbilirubinemia-yellow hue
to skin
* Phototherapy
* Exchange transfusions
* Hypoglycemia-tremor, jittery
* Hypocalcemia-tremors , seizures, numbness and tingling

Question 34

Is facial bruising a;life threatening disorder in a newborn who was delivered through vaginal birth?

A. Yes
B. No

Answer 34

B. No

Question 35

Benefits of Vernix>

Answer 35

It may have antibacterial properties. Vernix could protect your newborn baby from getting a skin infection shortly after birth. It has antioxidant properties. Vernix contains antioxidants like vitamin E and melanin, which help slow down cell damage due to free radicals

It has emollient and antimicrobial properties and prevents fluid loss through the skin; it also has antioxidant properties

Question 36

Caput succedaneum

Answer 36

Caput succedaneum is a generalized, easily identifiable edematous area of the scalp, most often on the occiput (Fig. 22.15A). With vertex presentation, the sustained pressure of the presenting part against the cervix results in compression of local vessels, slowing ve- nous return.

usually disappears spontaneously within 3 to 4 days. Infants who are born with the assistance of vacuum extraction usually have a caput in the area where the cup was applied. Bruising of the scalp is often seen in the presence of caput succedaneum.

CROSSES SUTURE LINE

Question 37

Cephalhematoma

Answer 37

is a collection of blood between a skull bone and its periosteum; it does not cross a cranial suture line (see Fig. 22.15B). A cephalhematoma is firmer and better defined than a caput.

AT RISK FOR JAUNDICE

Question 38

What causes a Jaundice in new borns?

Answer 38

Increased levels of bilirubin

Question 39

What are the prerequisites in order for a new born to get Phototherapy secondary rot jaaundice?

Answer 39

EYE PROTECTION

DIAPER

NO OINTMENT TO CREAMS ON BABY CAN INDUCE BURNS

Question 40

What is this diagnostic test used for

Transcutaneous
Bilirubin Test

Answer 40

Transcutaneous
Bilirubin Test
Blood test more
reliable, this test
more convenient
& not invasive

Question 41

Lab and diagnostic test for new borns

Answer 41

Universal newborn screening
Genetic diseases
Inborn errors of metabolism
Critical congenital heart disease
Newborn hearing screening
* Collection of specimens
* Heel stick
* Venipuncture
* Obtaining urine specimen

Question 42

Common Congenital Skin Anomalies

Answer 42

Congenital dermal melanocytosis or slate gray nevi (formerly known as Mongolian spots) bluish black areas of pigmentation, can appear over any part of the exterior surface of the body, including the ex- tremities. They are most common on the back and buttocks (Fig. 22.8). These pigmented areas occur most frequently in newborns whose ethnic origins are Latin America, Asia, Africa, or the Mediterranean area, but can occur in White infants.

NEVI
Nevus simplex, also known as salmon patches, telangiectatic nevi, “stork bites,” or “angel kisses,” is the result of a superficial capillary defect and occurs in up to 80% of newborns. They are usually small, flat, and pink and are easily blanched

A port-wine stain, or nevus flammeus, is usually visible at birth and is due to an asymmetric postcapillary venule malformation. It is usually pink and flat at birth but darkens with time, becoming red or purple and pebbly in consistency. True port-wine stains do not blanch on pressure or disappear. They are found most commonly on the face and neck (

Erythema toxicum, a transient rash, is also called erythema neonato- rum, newborn rash, or flea bite dermatitis. It first appears in term neo- nates during the first 24 to 72 hours after birth and can last up to 3 weeks of age. It has lesions in different stages: erythematous macules, papules, and small vesicles

Distended, small, white sebaceous glands noticeable on the newborn face are known as milia (Fig. 22.7). Although sweat glands are present at birth, term infants usually do not sweat for the first 24 hours. By day 3, sweating begins on the face, then progresses to the palms.

Question 43

ONGOING INTERVENTIONS

Answer 43

Protective environment
* Positioning:Infants should be placed in the supine position for sleep during the first year of life to reduce the incidence of sudden infant death syn- drome (SIDS)
* Infection control factors
* Support development of relationships
* Establish thermal regulation
* Temperature
* Establish feedings and GI function
* Feeding patterns
* Preventing infant abduction

Question 44

New Born Reflex

Answer 44

Babinski
Rooting
Sucking
Moro
Plantar
Palmar
Crawl reflex

Question 45

What is an indicated fining in hip dysplasia

Answer 45

Folds in one leg than the other

Question 46

Therapeutic and surgical procedures

Answer 46

Circumcision
* Recommendations
* Parental decisions: religion,
tradition, culture, social norm,
hygiene
* Procedure
* Care of the newly circumcised infant

Question 47

What are the different types of circumcision procedures?

Answer 47

Gomco Circumscision

Plastibell circumscision

Question 48

How do you manage Neonatal pain?

Answer 48

Non-pharmacologic
* Oral sucrose, breastfeeding,
nonnutrive sucking
* Skin-to-skin, kangaroo care, swaddling
* Pharmacologic
-Tylenol

Question 49

Does mother need to sign consent in order for a hearing test to be done on baby?

A. Yes
B. No

Answer 49

A. Yes

occurs in about 1:1000 live
births.
Early detections = better
outcomes

Question 50

Important Discharge Instructions for mom

Answer 50

Parental teaching
* Car seat safety
* Nonnutritive sucking
* Bathing
* Umbilical cord care
* Infant follow-up care
* Cardiopulmonary resuscitation
* Practical suggestions

Question 51

Are these signs of Integumentary problems?

“Any pallor, plethora (deep purplish color from increased circulating RBCs), petechiae, central cyanosis, or jaundice”

YES
NO

Answer 51

YES

Close observation of the newborn’s skin color can lead to early detection of potential problems. Any pallor, plethora (deep purplish color from increased circulating RBCs), petechiae, central cyanosis, or jaun- dice is noted and documented. The skin is examined for signs of birth injuries such as forceps marks and lesions related to fetal monitoring. Bruises or petechiae can be present on the head, neck, and face of an

Question 52

What is the best position babies should be in to prevent SIDS?

a. Side lying
b. prone
c. supine
d. leg lateral

Answer 52

c. supine

Infants should be placed in the supine position for sleep during the first year of life to reduce the incidence of sudden infant death syndrome (SIDS)\

Question 53

Safe sleep parameters

Answer 53

Always lay the baby flat in bed (in the bassinet or crib) on his or her back for sleep, for naps, and at night. Do not place your infant on the abdomen for sleep.
* Room-sharing, but not bed-sharing, is recommended for the first year; this is most important for the first 6 months.
* Never put your baby on a cushion, pillow, beanbag, or waterbed to sleep. Your baby may suffocate.
* Avoid soft bedding, including bumper pads, blankets, pillows, stuffed toys, or other soft objects in the baby’s crib because of the risk for suffocation.
* Donotcoverthebabywithblanketsorquilts;dressthebabyinlightsleep clothing such as a sleep sack or one-piece sleeper.
* Checkyourbaby’scribforsafety.Slatsshouldbenomorethan2.25inches apart. The space between the mattress and sides should be less than two finger widths. The bedposts should have no decorative knobs.
* Thecribmattressshouldbefirmandshouldfitsnuglyagainstthecribrails.
* Donotuseacribwithdroprails.
* Coverthemattresswithatight-fittingsheet.
* Supervised,awaketummytimeisrecommendedeachdaytofacilitatemo-
tor development.
* Donotrelyonhomemonitorsordevicesthataremarketedtodecreasethe
risk of sudden infant death syndrome (SIDS) (e.g., wedges or positioners).
* Offerapacifieratnapandbedtime.
* Do not tie anything around your baby’s neck. For example, a pacifier tied
around the neck with a ribbon or string can strangle your baby.
* Avoid exposing your bab to cigarette or cigars moke inyourhomeorother places. Passive exposure to tobacco smoke greatly increases the likelihood that your infant will have respiratory symptoms and illnesses. It also in-
creases the risk for SIDS.

Question 54

Should the bay be front facing or rear facing when in a car seat?

A. Rear
B. Front

Answer 54

• Always place your baby in an approved car safety seat when traveling in a motor vehicle (car, truck, bus, van), train, or airplane.
• Your baby should be in a rear-facing infant car safety seat from birth for as long as possible until exceeding the car seat’s limits for height and weight. The car safety seat should be in the back seat of the car (see Fig. 23.21).

Question 55

Should mom use a car sear that has been in a accident?

Yes
No

Answer 55

No

If the parents do not have a car safety seat, arrangements should be made to make an appropriate seat available for purchase, loan, or donation. Parents need to be cautioned about purchasing a secondhand car safety seat without knowing its history. They should never use a car seat that was involved in a moderate to severe crash, is too old, has visible cracks, does not have a label with the model number and manufacture date, does not come with instruc- tions, is missing parts, or was recalled

Question 56

Risk factors for SIDS

Answer 56

Prematurity
* Male infant
* Age 2-3 months, reported to 1yr
* African, Native American, Inuit family history
* Secondhand smoke
* Parents under 20 years
* Overheat/excessive bedding
* Prone sleeping

Question 57

What is Lanugo

Answer 57

Lanugo is soft, fine hair covering a fetus while inside the uterus. It helps protect them and keeps them warm while they grow.
THERMOREGULATION

Question 58

What is the normal range of head circumference for a new borns head?

Answer 58

Term: 32.5–37.5 cm (12.5–14.5 in)

Question 59

Normal range length of new born?

Answer 59

Term: 46–56 cm (18–22 in)

Question 60

Normal range for chest circumference

Answer 60

Term: 30–33 cm (11.8–13 in)

Question 61

Normal range of weight for new born?

Answer 61

2700–4000 g (6–9 lb)
Acceptable weight loss: 5%–10%
or less in the first 3–5 days

ABNORMAL
Weight #2700 g (preterm, small for gesta- tional age, rubella syndrome)
Weight 4000 g (large for gestational age, maternal diabetes, heredity—normal for these parents)
Weight loss more than 10% (growth fail- ure, breastfeeding difficulty, dehydration)

Question 62

Signs of umbilical cord infection

Answer 62

Signs of umbilical cord infection are moistness, oozing, discharge, and a reddened base around the cord.

Question 63

Moro

Answer 63

Moro

A loud noise bumping the surface of the crib, suddenly lowering the newborn’s head while holding him/her causing sudden extension and abduction of the arms ending up in an embracing like motion.

Question 64

Tonic

Answer 64

Turn the infant’s head to one side, and the arm and leg will extend on
that side. with flexion of the opoosite arm and leg. (Assumed by sleeping infants)

Question 65

Palmer

Answer 65

Placing an object or finger in hands of new born . They will grasp it tightly

Question 66

Planter

Answer 66

applying pressure at the base of the foot and the toes will curl

Question 67

Babinski

Answer 67

Stroke the sole of the foot. the his toe dorsiflexes and the other toes
Flare outwards fanning out

Question 68

Blinking

Answer 68

Bringing an object close to the eye at a fast pace will induce closure of
the eye.

Question 69

Check blood flow

Answer 69

check right hand and left foot

left foot 95
right hand 97

NO MORE THAN 5 DIFFERENCE TO INDICATE PROPER PERFUSION