Unit 6 Flashcards

Question

Initiation of Breathing Mechanical Factors

Answer 1

- When a baby is born vaginally, there is pressure exerted on the intrathoracic cavity - The compression of the chest is a mechanical factor that helps stimulate breathing (this doesn’t happen with C/S). - Compression of the chest also helps get out the fluid that the baby swallowed (concerned about C/S babies having more fluid in the lungs because they don’t have this). - Crying increases positive pressure and helps the lung stay inflated (keeps alveoli open) -

Answer 2

With birth the newborn enters the extrauterine environment in which the temperature is significantly lower. The profound change in environmental temperature stimulates receptors in the skin, resulting in stimulation of the respiratory center in the medulla.

Answer 3

Sensory stimulation occurs by... - Handling by the obstetric health care provider - Suctioning the mouth and nose, - Drying by the nurses. Environmental factors (lights, sounds, smells) stimulate the respiratory center.

Answer 4

- Short periodic breathing episodes and no evidence of respiratory distress or apnea (>20 s) are normal - Anything greater than 20 seconds is BAD. Notify HCP - Babies are nose breathers, do not obstruct the nose. - The reflex response to nasal obstruction is to open the mouth to maintain an airway. This response is not present in most infants until 3 weeks after birth, therefore cyanosis or asphyxia can occur with nasal blockage.

Answer 5

- Nasal flaring - Intercostal or subcostal retractions - Suprasternal or subclavicular retractions with stridor or gasping most often represent an upper airway obstruction. - Grunting: usually occurs on expiration - Apneic episodes can be related to events such as rapid increase in body temperature, hypothermia, hypoglycemia, or sepsis. (Bad if > 20 s) - Tachypnea: Listen to lungs front and back to see if they have any fluid. Percussion: turn baby on side and pat it on the back. Rub with heel of hand -> moves fluid out of system. Could also be due to RDS - Report a RR of <30 or >60 - Report Seesaw or paradoxic respirations (exaggerated rise in abdomen with respiration as the chest falls)

Answer 6

Expected Findings - First and second sound sharp and clear Normal Variations - Murmur, especially over base or at left sternal border in interspace 3 or 4 - Can hear murmur first 1-5 minutes if there is no functional closure of ductus arteriosus and foramen ovale *** Should not hear 1-2 hours later Deviations from Normal - Murmur (possibly functional) - Dysrhythmias/irregular rate - Distants sound (pneumopericardium) - Poor quality - Extra sound - Heart on right side of chest (dextrocardia, often accompanied by reversal of intestines)

Answer 7

Expected Finding - Peripheral pulses equal and strong Deviations From Normal - Weak or absent peripheral pulses (decreased cardiac output, thrombus, possible coarctation of aorta if pulses not equal from side to side or upper to lower, bounding)

Answer 8

- Around 100 mL per kilogram - Delayed cord clamping: can help with blood volume (wait 30-60 seconds) - Delayed cord clamping (DCC) expands the blood volume from the so-called placental transfusion of blood to the newborn by as much as 100 mL, depending on the length of time to cord clamping and cutting. - Cord milking: “milking” the blood into baby (increases blood volume) - Increases hematocrit and baby’s iron stores -> lower risk for anemia

Answer 9

Expected Findings - Generally pink - Acrocyanosis (trunk is pink, extremities are blue) common for the first 48 h after birth Normal Variations - Mottling - Harlequin sign - Plethora - Nevus simplex - Erythema toxicum/neonatorum (“newborn rash”) - Milia - Petechiae over presenting part - Ecchymoses from forceps in vertex births - Mongolian Spot Deviations from Normal - Dark red (preterm, polycythemia) - Gray (hypotension, poor perfusion) - Pallor (cardiovascular problem, CNS damage, blood dyscrasia, blood loss, twin-to-twin transfusion syndrome, infection) - Cyanosis (hypothermia, infection, hypoglycemia, cardiopulmonary diseases, neurologic or respiratory malformations) - Generalized petechiae (clotting factor deficiency, infection) - Generalized ecchymoses (hemorrhagic disease) - Nevus flammeus (port-wine stain) - Infantile hemangioman (nevus vascularis)

Answer 10

Central Cyanosis, Blue lips - NEVER Okay Pallor of the skin - Cardiac issue, hypoxia during labor - Anemia, peripheral vasoconstriction (asphyxia, sepsis) Persistent tachycardia - Anemia, hypovolemia, hyperthermia, or sepsis Persistent bradycardia - Congenital heart block or hypoxemia Unequal or absent pulses, bounding pulses, and decreased or elevated BP - Cardiac issue

Answer 11

Red blood cells - When babies are born, they have a higher level of RBCS than we do - Newborn RBCs are immature and break down easily (shorter life span) Leukocytes - Normal for leukocytosis at birth: ranging from 9000 to 30,000/mm3 - The initial high WBC count of the newborn decreases rapidly, and a stable level of 12,000/mm3 is normally maintained during the neonatal period - Newborns are susceptible to infection. Platelets - Vitamin K to jumpstart clotting factors Blood Groups - Cord blood is taken to figure out blood type and Rh

Answer 12

- Thermoregulation is the maintenance of balance between heat loss and heat production. - Preferably done on Mom's chest - Skin-to-skin contact with the mother is an effective means of reducing conductive and radiant heat loss - Drying the infant quickly after birth is essential to prevent hypothermia Babies are at higher risk of heat loss... - Newborns have a thin layer of subcutaneous fat. The blood vessels are close to the surface of the skin. - Newborns have larger body surface–to–body weight (mass) ratios than children and adults.

Answer 13

1. Convection: Flow of heat from the body surface to cooler ambient air - Newborns in open bassinets are wrapped to protect them from the cold - A cap may be worn to decrease heat loss from the infant’s head. 2. Radiation: loss of heat from the body surface to a cooler solid surface not in direct contact but in relative proximity. - Bassinets and examining tables are placed away from outside windows - Avoid direct air drafts. 3. Evaporation: loss of heat that occurs when a liquid is converted to a vapor. In the newborn: result of moisture vaporization from the skin - Dry newborn after birth - Careful when bathing (stable temp, limited to 5 min) 4. Conduction: loss of heat from the body surface to cooler surfaces in direct contact - The newborn is placed on a prewarmed bed - The scales used for weighing the newborn should have a protective cover

Answer 14

Babies can't shiver. When temp lowers… 1. Increased metabolic rate -> lowers blood glucose 1. Muscle activity increases (general flexion) leads to increased O2 consumption -> tachypnea 1. Vasoconstriction 2. Use Brown Fat (increased cellular metabolic activity to brain, heart, liver) = nonshivering thermogenesis 3. If that doesn't work = cold stress (BAD) Reserves of brown fat, usually present for several weeks after birth, are rapidly depleted with cold stress.

Answer 15

If you see tachypnea, lowered blood sugar -> check temperature! If temperature isn’t fixed, nonshivering thermogenesis begins. Cold stress makes the increased metabolic rate, increased O2 consumption, hypoglycemia worse. Increased O2 consumption could lead to hypoxia and peripheral vasoconstriction, which could lead to metabolic acidosis. Hypoglycemia leads to decreased surfactant production. All of this could lead to respiratory distress.

Answer 16

99.5°F or above If hyperthermia is due to environmental factors (too many blankets, mom is hot, too many clothes on) - Skin vessels dilate, which causes the baby to appear flushed - Hands and feet are very warm to touch - Baby extends arms and legs Hyperthermia due to sepsis - Skin vessels are constricted - Color is pale - Hands and feet are cold to touch

Answer 17

- An infant should void within 24 hours of life. - 98% of infants void within 30 hours of life. - If a newborn has not voided within 48 hours of life it may indicate a renal impairment. - Number of voids = number of days (Day 2 = 2 voids, Day 3 = voids) . - After day 4, there needs to be 6-8 voids per day

Answer 18

- Normal for babies to lose 5-10% of weight after delivery - Should NOT lose more than 10% - Breastfeed babies tend to lose more than formula fed babies (still less than 10%) - Babies should regain however much they lost within 14 days of delivery - 75% of newborn’s weight is water

Answer 19

- The neonate is unable to move food from the lips to the pharynx; therefore placing the nipple (breast or bottle) well inside the baby’s mouth is necessary. - Babies can’t fight back bacteria like we can; make sure feeding supplies are clean - Intestines are not mature until 4-6 months - Capacity of the stomachs grown exponentially in the first week. Hold 10 mL on day 1 By end of the week, the stomach can hold about 90 mL - All babies spit up, this is normal. Keep baby upright after feeding to help decrease spit up

Answer 20

Meconium * Greenish black and viscous and contains occult blood. * Composed of amniotic fluid and its constituents, intestinal secretions, shed mucosal cells, and possibly blood * Passage of meconium should occur within the first 24-48 h, although it can be delayed up to 7 days in very low birthweight infant Transitional Stools * Usually appear by third day after initiation of feeding * Greenish brown to yellowish brown; thin and less sticky than meconium; can contain some milk curds Milk Stool * Usually appears by the fourth day * Breastmilk: yellow to golden, pasty in consistency; resemble a mixture of mustard and cottage cheese, with an odor similar to sour milk * Commercial infant formula: Stools pale yellow to light brown, firmer consistency, stronger odor than breast milk stools

Answer 21

- Concerning if first stool isn’t passed within first 24-48 hours (sign of obstruction) - Look at anus. An active "wink" reflex means baby has sphincter control - Forceful vomiting and forceful diarrhea is not normal

Answer 22

40-60 mg/dL: normal blood glucose for baby - In utero, the baby gets glucose from mom - Once baby is cut off from mom, the baby gets glucose from breast or bottle - Before feeding, the baby is not getting any glucose. - 30-90 minutes after delivery: low point of glucose

Answer 23

Jittery/Irritable Lethargic Apnea - Feed baby before glucose gets to low point ** feeding within the first hour can avoid the baby experiencing hypoglycemia - Signs baby is ready to eat: moves to nipple, rooting reflex, tongue movement - LATE sign of hunger: crying **

Answer 24

- Newborn RBCs are immature and easily broken down - Since RBCs have a shorter lifespan and there's more of them, there is an increased production of Bilirubin - RBC is broken down to heme and globin - Heme is broken down to iron and bilirubin - Bilirubin can be conjugated or unconjugated - Conjugated bilirubin is excreted easily - Unconjugated bilirubin needs to bind to albumin to be excreted

Answer 25

- Ability of body to get rid of unconjugated bilirubin depends on digestion and stooling pattern -> if peristalsis is good, things are coming out - Good feeding practice is a good way to get rid of bilirubin (and gets meconium out faster) - Feeding every 2-3 hours - If levels of unconjugated bilirubin gets high -> jaundice

Answer 26

Blood glucose < 40 mg/dl Not every baby is screened. Automatically screen if mom is diabetic, baby is small for gestational age or large for gestational age May do another screening after baby is fed

Answer 27

- Serum calcium < 7.8 to 8 mg/dl in term infants and slightly lower (7 mg/dl) in preterm infants - Can present similarly to hypoglycemia (if interventions for hypoglycemia are not working, check for hypocalcemia) - Symptoms are same as hypoglycemia EXCEPT for high-pitched cry in hypocalcemia - Usually self-resolving

Answer 28

- Appears after 24 hours of age - Commonly peaks at 3-5 days of life - Occurs in over half of newborns, 80% of preterm babies - Commonly due to increase in RBCs - Assess in good lighting - Sclera and mucous membranes: common place to see jaundice first - Screening: usually every 8 to 12 hours - You can figure out if it’s jaundice by blanching the skin area (if jaundice it comes back yellow, then pinky red) - Feeding is key to preventing jaundice - First milk of breastfeeding (colostrum) acts as a laxative

Answer 29

- Breastfeeding exclusively (true milk takes a while to come in, or if baby is not latching on well) - Preterm babies or any baby <38 weeks - Diabetic mom - Bruising (difficult birth) - Sibling had jaundice - Hematoma - East Indian Race - Excessive weight loss - Hypoxia, acidosis, hypothermia, hypoglycemia - Delayed or infrequent feedings

Answer 30

- Liver plays an important role in blood coagulation - Coagulation factors, which are synthesized in the liver, are activated by vitamin K - The lack of intestinal bacteria needed to synthesize vitamin K results in transient blood coagulation deficiency between the second and fifth days of life. - The administration of intramuscular vitamin K shortly after birth helps to prevent vitamin K deficiency bleeding (VKDB)

Answer 31

IgG - Location: Blood, ECF - Passive Immunity - Important to fight infection (bacteria, viruses) IgA - Location: Breastmilk - Passive Immunity - Neutralize bacterial and viral pathogens in intestines - Lessen the risk for allergy and food intolerance IgM - Location: Blood - 8th week of gestation - Important to fight blood-borne infection

Answer 32

Infection is one of the leading causes of morbidity and mortality - Irritability - Lethargy - Poor Feeding - Vomiting or Diarrhea - Tachypnea - Pale/mottled skin - Decreased reflexes (hypotonia)

Answer 33

- A cheeselike, whitish substance that is fused with the epidermis and serves as a protective covering - A complex substance that contains sebaceous gland secretions. - It has emollient and antimicrobial properties and prevents fluid loss through the skin; it also has antioxidant properties - Removal of the vernix is followed by desquamation of the epidermis - There is evidence that leaving residual vernix intact after birth has positive benefits for neonatal skin - Desquamation (peeling) of the skin

Answer 34

Lanugo - Fine lanugo hair may be noted over the face, shoulders, and back. Milia - Distended, small, white sebaceous glands noticeable on the newborn face are known as milia Mongolian Spots - Bluish black areas of pigmentation. hey are most common on the back and buttocks

Answer 35

Nevus simplex: also known as salmon patches, telangiectatic nevi, “stork bites” or “angel kisses” - Usually small, flat, and pink and are easily blanched - Common sites are the upper eyelids, nose, upper lip, and nape of the neck Nevus Flammeus - Port-wine Stain - It is usually pink and flat at birth but darkens with time, becoming red or purple and pebbly in consistency. - They are found most commonly on the face and neck

Answer 36

AKA erythema neonatorum, newborn rash, or flea bite dermatitis. It has lesions in different stages: erythematous macules, papules, and small vesicles "Newborn acne"

Answer 37

Swelling of breast tissue (edematous) Normal for it to be swollen, red, increased pigmentation Labia usually swollen Reproductive system problems - Ambiguous genitalia: further testing - Hypospadias: urethral opening is located on the ventral surface of the penis - Epispadias: urethral opening is located on the dorsal surface of the penis For hypospadias and epispadias, circumcision is not done at normal time (tissue may be needed)

Answer 38

- Resolves on its own within 3-4 days - Extends across suture lines - Generalized, easily identifiable edematous area of the scalp - "Put a cap on it"

Answer 39

- Collection of blood between a skull bone and its periosteum - Does NOT cross suture lines - Firmer and better defined than caput - Resolves on its own within 2-8 weeks - Scan is done to make sure it is not worse -> not a subgaleal - Due to forcep or vacuum delivery

Answer 40

- More severe; do not resolve on their own - Due to forcep or vacuum delivery

Answer 41

- Brain grows exponentially after delivery - The brain requires glucose as a source of energy and a relatively large supply of oxygen for adequate metabolism. - Some babies have fine tremors at birth, but they should not stick around past newborn stage (28-30 days) - Posture: Flexion of the arms at the elbows and the legs at the knees. Hips are abducted and partially flexed. Intermittent fisting of the hands is common.

Answer 42

- Touch infant’s lip, cheek, or corner of mouth with nipple or finger. - Infant turns head toward stimulus and opens mouth in search of sucking source (e.g., nipple, finger); begins to suck when nipple or examiner’s finger is inserted into mouth. - Response is difficult if not impossible to elicit after infant has been fed; if response is weak or absent, consider preterm birth or neurologic defect.

Answer 43

- Feed infant; swallowing usually follows sucking and obtaining fluids. - Swallowing is usually coordinated with sucking and breathing and usually occurs without gagging, coughing, apnea, or vomiting. - If response is weak or absent, it can indicate preterm birth, effects of maternal analgesics or anesthetics, or illness that needs investigation. - Sucking, swallowing, and breathing are often uncoordinated in preterm infant.

Answer 44

- Place finger in palm of hand. - Infant’s fingers curl around examiner’s finger.

Answer 45

- Place finger at base of toes. - Toes curl downward around examiner’s finger.

Answer 46

- Touch or depress tip of tongue. - Newborn forces tongue outward.

Answer 47

- Tap over forehead, bridge of nose, or maxilla of newborn whose eyes are open. - Newborn blinks for first four or five taps. - Continued blinking with repeated taps is consistent with extrapyramidal signs.

Answer 48

- With infant in supine neutral position, turn head quickly to one side. - With infant facing left side, arm and leg on that side extend; opposite arm and leg flex (turn head to right, and extremities assume opposite postures). - After 6 weeks, persistent response is sign of possible cerebral palsy.

Answer 49

- Hold infant in semisitting position, allow head and trunk to fall backward to angle of at least 30 degrees (with support). OR Place infant supine on flat surface; perform sharp hand clap. - Symmetric abduction and extension of arms are seen; fingers fan out and form a C with thumb and forefinger; slight tremor may be noted; arms are adducted in embracing motion and return to relaxed flexion and movement. A cry may accompany or follow motor movement. Legs may follow similar pattern of response. - Preterm infant does not complete “embrace”; instead arms fall backward because of weakness.

Answer 50

- Hold infant vertically under arms or on trunk, allowing one foot to touch table surface. - Infant will simulate walking, alternating flexion and extension of feet; term infants walk on soles of their feet, and preterm infants walk on their toes.

Answer 51

- Place newborn on abdomen. - Newborn makes crawling movements with arms and legs.

Answer 52

- Use finger instead of percussion hammer to elicit patellar, or knee-jerk, reflex; newborn must be relaxed. - Reflex jerk is present; even with newborn relaxed, nonselective overall reaction may occur.

Answer 53

- With infant in supine position, examiner extends one leg of infant and presses down knee. Stimulation of sole of foot of fixated limb should cause free leg to flex, adduct, and extend as if attempting to push away stimulating agent. - Opposite leg flexes, adducts, and then extends.

Answer 54

- On sole of foot, beginning at heel, stroke upward along lateral aspect of sole; then move finger across ball of foot. - All toes hyperextend, with dorsiflexion of big toe—recorded as a positive sign.

Answer 55

- Pull infant up by wrists from supine position with head in midline. - Head lags until infant is in upright position; then head is held in same plane with chest and shoulder momentarily before falling forward; infant attempts to right head.

Answer 56

- Place infant prone on flat surface; run finger down back approximately 4-5 cm lateral to spine, first on one side and then down the other. - Trunk is flexed, and pelvis is swung toward stimulated side.

Answer 57

- Place infant in supine position, partially flex both lower extremities, and apply light pressure with fingers to soles of feet. Normally, while examiner’s fingers maintain contact with soles of feet, lower limbs extend. - Both lower limbs should extend against examiner’s pressure

Answer 58

- These are spontaneous behaviors. - Responses can be slightly depressed temporarily because of maternal analgesia or anesthesia, fetal hypoxia, or infection.

Answer 59

Eyes are immature at birth Pupils are active -> pupillary reflex Can only see 2.5 feet in front of them Takes 2-3 months to discriminate colors

Answer 60

Should be able to hear and turn head towards a noise Accustomed to hearing mom’s heartbeat All babies have a routine hearing screening before discharge (if they fail, they are referred for a follow-up)

Answer 61

Smell - Babies can smell extremely well - Can discriminate between their mother’s smell and a different person Taste - Can distinguish difference in breast milk Touch - Most sensitive area is their face (rooting reflex) - If bruising to face, there is less sensitivity

Answer 62

Sleep-Wake States: depends on gestational age, feeding patterns - Two sleep states: deep sleep and light sleep - Four wake states: drowsy, quiet alert, active alert, and crying Babies sleep 16-19 hours a day in the first 6 weeks Factors Affecting Newborn Behavior - Gestational age: the more closer to term, the more able to regulate between sleep and awake states - The more preterm: may go from sleep to crying - Time: Time elapsed from birth, previous feedings, - Stimuli: Touching the baby elicits a response. Lights in a room, sounds, the more a baby is stimulated. Stimulated by mother: the more stress and tense the mom is, the baby can pick up on it and this cause them to not feed as well or fall asleep as easily Medication - IV pain medication: want 4 hours between when mom got medication and baby is delivered

Answer 63

Expected Finding - None in the first 24 h of life Normal Variation - Physiologic jaundice in up to 60% of term infants in first week of life Deviation from Normal - Jaundice within first 24 h (increased hemolysis, Rh isoimmunization, ABO incompatibility)

Answer 64

Rates Neuromuscular and Physical Maturity It assesses six external physical and six neuromuscular signs. Each sign has a numeric score, and the cumulative score correlates with a maturity rating (gestational age) Estimates how many weeks old the baby

Answer 65

AGA: appropriate for gestational age - Between 10 and 90th percentile LGA: large for gestational age - 90th and above percentile - Higher risk for hypoglycemia (obesity later in life, diabetes) SGA: small for gestational age - 10th and below percentile - Higher risk for issues with thermoregulation, jaundice, hypoglycemia Birth weight significantly impacts mortality. The lower the birth weight, the higher the mortality. The lower the gestational age, the higher the mortality.

Answer 66

Late Preterm: 34 0/7 through 36 6/7 - Late preterm babies have a more difficult time transitioning to extrauterine life (respiratory, temperature, blood sugar) Preterm: prior to 37 0/7 Early Term: 37 0/7 through 38 6/7 - These babies have a harder time than full term transitioning to extrauterine life (respiratory issues) Full Term: 39 0/7 through 40 6/7 Late Term: 41 0/7 through 41 6/7 Postterm: 42 0/7 and beyond Postmature: 42 6/7 and showing signs of placental insufficiency

Answer 67

- Ruptured capillaries caused by increased pressure baby goes through during birth process - More common in vaginal delivery - Most of the time they resolve in about 5 days, and don’t need a specific treatment - Usually does not cause later problems - Educate and reassure parents

Answer 68

- Localized discoloration can appear over the presenting part as a result of forceps- or vacuum-assisted birth - Ecchymoses and edema can appear anywhere on the body. - Petechiae (pinpoint hemorrhagic areas) acquired during birth can extend over the upper trunk and face. - To differentiate hemorrhagic areas from a skin rash or discolorations, blanch the skin - Hemorrhagic areas (petechia) and ecchymosis will not blanch - Skin discolorations/rashes will blanch - Forceps injury and bruising from the vacuum cup occur at the site of application of the instruments

Answer 69

Fractured clavicle secondary to shoulder dystocia, bruising on shoulder

Answer 70

- A forceps injury commonly produces a linear mark across both sides of the face in the shape of forceps blades. - If the skin is broken, then the affected areas should be kept clean to minimize the risk for infection. - These injuries usually resolve spontaneously within several days with no further intervention. - Accidental lacerations can be inflicted with a scalpel during a cesarean birth. - They are usually superficial and need only to be kept clean. - If skin closure is needed, an adhesive substance or strips may be applied. Sutures are rarely needed.

Answer 71

Universal Newborn Screening - Detects rare diseases that are not symptomatic at birth - Blood sample (prick baby’s heel) - Needs to be done AFTER 24 hours of age* but before discharge Newborn Hearing Screening - Recommended before hospital discharge or no later than 1 month of age. - Newborns who do not pass the initial hearing screening test should have the test repeated as part of follow-up care. Screening for Critical Congenital Heart Disease (CCHD) - Pulse ox testing - Measures oxygen levels -> testing for hypoxemia (sign of congenital heart defect - Needs to be done AFTER 24 hours of age* but before discharge

Answer 72

Adequate space, appropriate lighting, elimination of potential fire hazards, safety of electrical appliances, adequate ventilation, and controlled temperature and humidity

Answer 73

- Hand hygiene!! - Limit visitors, no sick visitors, most hospitals don't let young siblings in to visit - Wear gloves (especially when dealing with fluids) - No fake nails/nail polish - Appropriate cleaning and decontamination of the physical environment

Answer 74

- Infant bracelet security system - Keep mom and baby together as much as possible - Nurses teach mothers and their families to check the identity of any person who comes to remove the newborn from their room. - Families are also encouraged to question why and where their infant is being taken.

Answer 75

- If the mother becomes sleepy while holding her newborn, she should be instructed to call for help or place her newborn in the supine position in the bassinet. - Newborns are always transported in their bassinets and are never carried in arms outside the mother’s room.

Answer 76

- WITH consent, Hep B is given to a newborn - IM injection - Given within 24 hours after birth

Answer 77

- Removal of all or part of the foreskin - Most of the time this is done before discharge, not on day baby is born or day of discharge - Vaginal: next day, C/S: day 2 - Health benefits: Reduce risk of UTIs (esp in 1st year of baby’s life), Reduce risk of penile cancer, Reduced risk of acquiring HIV - Parents have to consent to it - Religion/culture play a part in parental decision - Jewish families: most of the time, this is a religious practice done on the 8th day of life by someone trained in the Jewish community - This is called bris - By 8th day of life, clotting factors are starting to work, reduced risk of hemorrhage

Answer 78

- To prepare the infant for the circumcision, he is positioned on a plastic restraint form - Obstetrician does the procedure - Numbing shot or cream (lidocaine) is used for pain - Sugar water on a pacifier is used for a calming effect Gomco or Mogen Clamp: surgical removal of foreskin - Monitor for bleeding! If you see bleeding apply pressure with gauze PlastiBell: Plastic rim stays in place - Let it fall off NATURALLY, do not pull it off, should fall off in about a week Care Management - Teach how to keep site clean and dry: change diaper frequently, only use water to clean (3-4 days), petroleum for 4-7 days apply diaper loosely over penis, sponge bathing till it is healed) - Monitor output after procedure, note when the first void is - Check for infection: The glans of the penis is dark red after circumcision and then becomes covered with yellow exudate in 24-48 h, which is normal and will persist for 2-3 days - Provide Comfort: Provide comfort measures such as holding the baby skin to skin, breastfeeding, cuddling, swaddling, or rocking.

Answer 79

- Containment (swaddling): comforting to newborns - Nonnutritive sucking (pacifier, sucking on finger) - Oral glucose (sugar water) - Skin-to-skin contact: helps regulate the baby, calms the baby - Breastfeeding (nutritive sucking) - Distraction: stroking the baby’s face, talking to them

Answer 80

- Usually related to circumcision: lidocaine - Morphine and Fentanyl are commonly used if further pain management is needed - Nonopioid: ONLY Acetaminophen *** try to avoid till 6 months NO IBUPROFEN

Answer 81

- Take temperature axillary - Normal temperature (97.7 - 99.4) - When to call doctor: high/low temp - Difference between environmental hyperthermia and sepsis hyperthermia - Dress infant appropriately and protect the skin from exposure to direct sunlight. - Causes for change in body temperature: overwrapping and cold stress, and the body’s response to extremes in environmental temperatures.

Answer 82

- Normal respirations: 30-60 bpm - Count for 1 full minute - Bulb syringe: suction mouth before nose - Deflate the bulb syringe, put it in, let in inflate to get things out - Avoid sick people, don’t take out newborn in public on a regular basis - If going out in public, stay outside (where they get fresh air) - Avoid people who smoke

Answer 83

- Six to eight voids per day (Day 4 and so on) - Number of voids equal to number of days old (1-3) - Urine should be pale yellow - Newborn stools should gradually transition from meconium to yellow - 1-3 stools per day - Breastfed infants should have at least three stools every 24 hours for the first few weeks. Formula-fed infants may stool less. - Projectile vomiting: NOT normal - Water ring around diarrhea: NOT normal - Spitting up is okay

Answer 84

- Safe sleep: sleep on back with nothing in crib - Prop up baby when feeding to prevent aspiration, regurgitation - Support head when holding; pick baby up with one hand under head, and one under body

Answer 85

- Diaper rash is most common - Diapers should be checked often and changed as soon as the infant voids or stools. - The infant’s skin should be allowed to dry completely before applying another diaper. - Erythema toxicum “newborn acne” and milia are normal

Answer 86

- Tell parents to dress the child for the environment as they dress themselves - A cap or bonnet is needed to protect the scalp and minimize heat loss if the weather is cool or to protect against sunburn. - For sleep, infants can be placed in a safe sleeping bag or sleep sack with fitted neck and arm openings and no hood. - Don't use swaddling for sleep once infant can roll over

Answer 87

- Rear facing - In back seat - Go to fire department/police station to make sure it’s positioned correctly - Car seat challenge: specific to babies born before 37 weeks. Put baby in car seat in hospital for 1.5-2 hours and observe baby for apnea, bradycardia, and a decrease in O2 saturation.

Answer 88

- Should not introduce pacifier to baby being breastfed until breastfeeding practices are well-established (usually 2-3 weeks) - Don’t force a baby to take a pacifier - Pacifiers must be cleaned often and replaced regularly

Answer 89

- Do not submerge baby in water - Best place to bathe baby: kitchen sink - Sponge bath - Don’t “need” to be bathed everyday; Once a week is fine (skin needs to go through natural things after delivery). In general, infants should not be bathed more frequently than every other day

Answer 90

- Keep area clean and dry - Cord stump: common place for infection and sepsis - Let it fall off naturally, don’t pick at it - Watch for signs of infection: redness, warmth, swelling, drainage - Don’t let diaper cover the cord (open to air) - Cord should naturally fall off in the first 2 weeks - Do not use alcohol to dry the cord

Answer 91

- Follow-up care after discharge from the birthing facility usually occurs within 48 to 72 hours at the pediatric clinic or health care provider’s office. - This is especially important for breastfed newborns for monitoring their weight and hydration status. - Parents should receive instruction in relieving airway obstruction and CPR.

Answer 92

Interpretation of crying and use of quieting techniques - SSC, warmth, patting, back massage, swaddling Recognizing signs of illness - Call doctor for fever (100.4 °F) - Projectile vomiting or frequent vomiting - Continuous diarrhea with water ring - Not voiding and stooling as they should (decreased) - Breathing difficulties (too fast, making “funny sounds”) - Hyperactivity (jittery), hypoactivity (lethargy) - High pitched cry or inconsolable crying - Bleeding - Drainage (ears, eyes, etc) - Cyanosis - Green vomit (bilious)

Answer 93

Hispanic: breastfeeding is considered the norm - Los dos casas: combine breastfeeding and formula feeding - Thinks baby gets extra nutrients from formula feeding - Can lead to them stopping breastfeeding earlier than we want them to African American: Formula feeding is more common Muslim: Breastfeeding is the norm for the first 2 years of life Western culture: Put babies on a schedule -> scheduling when the newborn should feed (pros and cons to it) Hispanics, Vietnamese, Chinese, East Indians, and Arabs: "Hot" foods are best (chicken, broccoli, rice)

Answer 94

Newborns - Galactosemia - Baby needs “special milk” due to a disorder like galactomsemia Mothers - Positive for human T cell lymphotropic virus types I/II - Untreated brucellosis - Active tuberculosis - Active herpes simplex lesions on the breasts - HIV infection In most first world countries, it is contraindicated In some third world countries where HIV is more prevalent, the benefits of breastfeeding outweigh the risk of baby getting HIV

Answer 95

Women with active TB can breastfeed when they have been treated for at least 2 weeks and are deemed noninfectious

Answer 96

Fluids - Breastmilk: 80% water - Should not be given just water (not nutritious), they need nutritious breast milk or formula Energy - Most human milk and formula has 20 kcals/ounce Carbs - Should be around 40-50% of what baby is taking in Fat - Around 50% of what baby is taking in (very important) Protein - Breast milk Whey: Casein Ratio is 70:30 - Formula Whey: Casein Ration is 20:80

Answer 97

Human milk is easier to digest Stooling patterns Formula fed babies have fewer stools than breastfed babies * Breastmilk: yellow to golden, pasty in consistency; resemble a mixture of mustard and cottage cheese, with an odor similar to sour milk * Commercial infant formula: Stools pale yellow to light brown, firmer consistency, stronger odor than breast milk stools

Answer 98

Vitamins - With the exception of vitamin D, human milk contains all of the vitamins required for infant nutrition - Vitamin D supplement - Take infant outside for natural Vitamin D Minerals - Baby has enough iron stores at delivery for 4-6 months (delayed cord clamping increases iron stores) - Around 4-6 months, pediatrician recommends iron supplements and continuing until the infant is consuming iron-containing complementary foods such as iron-fortified cereals.

Answer 99

How much formula baby needs (increases over time because stomach can hold more) How often baby should be fed Early hunger cues: rooting reflex, smacking/sucking

Answer 100

Formula fed baby should be fed every 3-4 hours (Breastfed babies need to feed more often) Babies get growth spurts at 10 days, 3 weeks, 6 weeks, 3 months, 6 months Give 30 mL more formula during growth spurts

Answer 101

- During feedings parents are encouraged to sit comfortably, holding the infant close in a semi-upright position with good head support - Semi-upright position helps with spit up - Give baby opportunity to burp several times throughout feeding (especially midway and at end) - Signs baby has had enough: Baby falls asleep, spits out the nipple, seals the lips, turns the head away, or ceases to suck,

Answer 102

- Parents need to know what to do if the infant spits up. - They may need to decrease the amount of feeding or feed smaller amounts more frequently. - Burping the infant several times during a feeding such as when the infant’s sucking slows down or stops can decrease spitting. - Holding the baby upright for 30 minutes after feeding can help - Parents should be instructed in proper cleaning of all equipment used in formula preparation and feeding.

Answer 103

Cow’s milk–based formulas Soy-based formulas - Galactosemia - Congenital lactase deficiency Casein- or whey-hydrolysate formulas Amino acid formulas

Answer 104

Reduced risk for… Ear infections Celiac disease Type 1 and Type 2 diabetes Obesity later in life SIDS Asthma `

Answer 105

Mother - Oxytocin helps uterus contract, reducing risk for postpartum hemorrhage - Reduces risk of maternal cancers (ovarian, breast) - Reduce risk of T2D and HTN Families/society - Doesn’t cost anything - Don’t have to buy bottles and throw them away - Breastfed babies get sick less -> reduced health care cost

Answer 106

Exclusive breastfeeding – first 6 months Continued breastfeeding – at least 12 months Appropriate complementary solid foods are added to the diet in second 6 months - Reduced risk of allergies

Answer 107

- Baby sucking - Tells hypothalamus to remove prolactin inhibition from anterior pituitary gland, producing prolactin - Hypothalamus tells posterior pituitary gland to release oxytocin - Prolactin is responsible for milk secretion - Oxytocin is responsible for milk duct contraction

Answer 108

Prolactin - During pregnancy, prolactin helps produce milk. - After mom gives birth, there is a lowering of progesterone levels which releases prolactin - First 10 days after birth: highest prolactin levels Oxytocin - Responsible for Let-Down Reflex - Thoughts, sights, sounds, or odors that the mother associates with her baby (or other babies), such as hearing the baby cry, can trigger Let-Down Reflex - Milk ejection occurs as a response Prolactin and Oxytocin are "Mothering Hormones" - Many women report feeling thirsty or very relaxed during breastfeeding, probably as a result of these hormones.

Answer 109

Stage I: 16-18 weeks gestation - The breasts prepare for milk production by producing colostrum Stage II: First 2-3 days after delivery. - Begins with birth as progesterone levels drop sharply when the placenta is removed. Baby is receiving colostrum. Colostrum acts as a laxative to get rid of bilirubin Stage III: Day 10 - "Official” mature milk. (true milk can come in at days 3-5)

Answer 110

- Baby gets foremilk first then hindmilk - Hindmilk contains more fat, so educate mom to feed 15-20 min per breast to ensure baby can get necessary fat - Main immunoglobulin: IgA - IgG, IgM, IgD, and IgE are also present - Infants have fairly predictable growth spurts (at approximately 10 days, 3 weeks, 6 weeks, 3 months, and 6 months), when more frequent feedings stimulate increased milk production

Answer 111

- Hand-to-mouth or hand-to-hand movements - Sucking motions - Rooting reflex—infant moves toward whatever touches the area around the mouth and attempts to suck - Mouthing: sticking tongue out

Answer 112

Positioning - For a C/S mom, side-lying or football/clutch hold is most comfortable - "Cradle position" can be used, but is uncomfortable for C/S moms - Tummies (mom and baby) need to be touching in cradle and side lying position - Support the head Latch - Need to latch on to areola as well as nipple - Make sure nipple far enough in baby’s mouth (can’t move tongue) - A baby sucks frequently, swallows every so often - Audible swallowing is a good sign of feeding

Answer 113

Frequency of feedings - Newborns: 8-12 times a day or every 2-3 hours Duration of feedings - Average time = 15-20 minutes per breast

Answer 114

- Milk 'in' by day 3-4 - Firm tugging sensation on nipple as infant sucks, no pain - Contractions and vaginal bleeding while feeding - Feels relaxed and drowsy while feeding - Increased thirst - Breasts soften, feel lighter while feeding - Warm rush/tingling in breasts with let down

Answer 115

- Latches without difficulty - Bursts of 15-20 sucks/swallows per time - Audible swallowing is present - Easily releases breast at end of feeding - Infant appears content after feeding - At least 3 substantive bowel movements - 6-8 wet diapers in 24 hrs after day 4

Answer 116

- With sound breastfeeding knowledge and practice, supplements are rarely needed (Vit D, Iron) - Can pump and feed from bottles - For bottles and pacifiers, wait to use till breastfeeding is established (2-3 weeks) to avoid nipple confusion

Answer 117

If mom has had an augmentation, they are more successful in breastfeeding. If mom had reduction, they are less successful in breastfeeding.

Answer 118

These women are more likely to experience delayed onset of lactogenesis stage II and to experience problems with insufficient milk production compared with women of average weight

Answer 119

- Same medications that are contraindicated in pregnancy are contraindicated in breastfeeding (except ibuprofen) - Alcohol goes through breast milk - "Pump and dump" if drinking alcohol - Smoking strongly discouraged - Can have caffeine in moderation - Ask pediatrician about use of herbal preparations while breastfeeding

Answer 120

Engorgement (breast full of milk, skin firm and tight) - Common first few days postpartum - If mom experiences it after 3-5 days, the best thing to do is to put baby to breast more often - Cold packs can be put on breasts, but do it AFTER feeding (causes constriction) - Before feeding, can put heat pads on breast - Hand massage, “hand pump” - Motrin Sore nipples - Very common in first few days - Not normal: painful, bleeding, cracked nipples

Answer 121

Could be due to mom’s anatomy, some medications, stress* Different interventions: put baby skin to skin, mom in comfortable position, mom may need to pump instead of breastfeeding

Answer 122

- A milk duct can become plugged or clogged, causing an area of the breast to become swollen and tender - Most often the result of inadequate removal of milk from the breast - Can lead to mastitis - Massaging can make the pain worse - Application of warm compresses to the affected area and to the nipple before feeding helps promote emptying of the breast and release of the plug. - Frequent feeding is recommended,

Answer 123

- Infection of the breast (commonly in upper outer portion of breast tissue) - Engorgement - Hot, red area where the infection is - Flu-like symptoms: fever, chills, malaise, body aches, headache, nausea, and vomiting. - Go to HCP!!! - Antibiotic treatment - Motrin, tylenol as needed - Continue to empty breast - Baby can still feed from that breast

Answer 124

2.2 lb per kg 1000 g in 1 kg 16 ounces per lb

Answer 125

- Dilated newly formed capillaries occupying the entire dermal and subdermal layers with associated connective tissue hypertrophy - Lesion is raised, sharply demarcated, bright or dark red rough-surfaced swelling - May be present at birth or appear during the early weeks after birth. - Common sites are the scalp, face, back, and anterior chest.

Answer 126

Expected finding: - Edema confined to eyelid (d/t erythromycin) - Opacity: few large blood vessels visible indistinctly over abdomen - After pinch released, skin returns to original state immediately. - Subcutaneous fat deposits (adipose pads) over cheeks, buttocks. - Vernix caseosa - Lanugo: Over shoulders, pinnae of ears, forehead Normal variation: - Slightly thick; superficial cracking, peeling, especially of hands, feet - No visible blood vessels, a few large vessels clearly visible over abdomen - Some fingernail scratches - Variation in amount of subcutaneous fat - Usually more vernix caseosa found increases, folds - Variation in amount of lanugo Deviations: - Edema on hands, feet; pitting over tibia; periorbital (overhydration; hydrops) - Texture thin, smooth, or of medium thickness; rash or superficial peeling visible (preterm, postterm) - Numerous vessels visible over abdomen (preterm) - Texture thick, parchment-like; cracking, peeling (postterm) - Skin tags, webbing - Papules, pustules, vesicles, ulcers, maceration (impetigo, candidiasis, herpes, diaper dermatitis) - Loose, wrinkled skin (prematurity, postmaturity, dehydration: fold of skin persisting after release of pinch) - Tense, tight, shiny skin (edema, extreme cold, shock, infection) - Lack of subcutaneous fat, prominence of clavicle or ribs (preterm, malnutrition) - Absent or minimal vernix caseosa (postmature) - Abundant vernix caseosa (preterm) - Green color vernix caseosa (possible in utero release of meconium or presence of bilirubin) - Odor of vernix caseosa (possible intrauterine infection) - Absent lanugo (postmature) - Abundant lanugo (preterm, especially if lanugo abundant, long, and thick over back) Head

Answer 127

Expected Finding - 1/4th of Body Length - Molding - Anterior fontanel 5 cm diamond, increasing as molding resolves - Posterior fontanel triangle, smaller than anterior - Palpable and separated sutures - Hair: Silky, single strands lying flat; growth pattern toward face and neck Normal variation - Caput succedaneum; possible ecchymosis - Slight asymmetry from intrauterine position - Lack of molding (breech, preterm, C/S) - Variation in fontanel size with degree of molding - Difficulty in feeling fontanels possible because of molding - Possible overlap of sutures with molding - Variation in amount of hair Deviations - Cephalhematoma - Subgaleal hemorrhage - Severe molding (birth trauma) - Indentation (fracture from trauma) - Full, bulging fontanel (tumor, hemorrhage, infection) - Large, flat, soft fontanel (malnutrition, hydrocephaly, delayed bone age, hypothyroidism) - Depressed fontanel (dehydration) - Widely spaced sutures (hydrocephaly) - Premature closure (fused) sutures (craniosynostosis) - Fine, wooly hair (preterm) - Unusual swirls, patterns, or hairline; or coarse, brittle (endocrine or genetic disorders)

Brainscape's Knowledge GenomeTM

Unit 6 Flashcards

Brainscape's Knowledge Genome^TM