VN 34 test 7 adjusted

Question 1

1a. Determine what would classify a newborn as low birth weight, very low weight & extremely low weight using the gestational age tool (pg.428)

Answer 1

 Less than 2,500g
 Less than 1,500g
 Extremely low less than 1,000g

Question 2

1c. Describe the physical characteristics of a post-term newborn versus a pre-term newborn. (pg.428 Table 20-1)

Answer 2

Preterm Newborn (born @ less than 37wks)
 Lanugo: Abundance of fine downy hair on extremities back & shoulders up to 34 wks gestation

Postterm newborn (born @ greater than 42 wks):
 Skin: Leathery, cracked, and wrinkled
 Ear: Cartilage thick; pinna stiff

Question 3

2. The characteristics of asymmetrically growth restricted newborn (Pg.430,451)

Answer 3

 Head is large in comparison w/the body “head sparring”
 Falls below the 10th percentile on one or sometimes two of the measurements (weight, length & head circumference, usually the birth weight is most commonly affected.)

Question 4

3. Identify the most widely known contributing factor to a large for gestational age newborn. (pg.432)

Answer 4

 Maternal diabetes, particularly if it is poorly controlled

Question 5

4a. Describe the main causes of a preterm newborn & which complication is the most critical

Answer 5

Main cause: Multiple births because of polyhydraminos due to fertility treatments

Complication: Respiratory distress

Question 6

5b. Explain what causes respiratory distress syndrome (RDS). (PG.434)

Answer 6

 RDS occurs in the preterm newborn because the lungs are too immature.
 The premature infant’s lungs are deficient in surfactant & thus collapse after each breath, greatly increasing the work of breathing.
 The lower the gestational age, the higher the risk of RDS.
 The risk is highest in neonates below 28wks gestation

Question 7

6b. Contributing factors of transient tachypnea (pg.444)

Answer 7

 commonly occurs in newborns born by cesarean delivery
 prematurity
 being small for gestational age
 maternal diabetes
 maternal smoking during pregnancy

Question 8

7b. What would be a probable indication of hemolytic disease in the newborn(pg.447)

Answer 8

 Pallor
 Edema
 Jaundice
 Enlarged spleen & liver
 Anemia

Question 9

8. Describe the priority nursing care for the newborn with hemolytic disease receiving phototherapy (pg.447)

Answer 9

 A newborn who has mild-to-moderate disease (jaundice) usually receives hydration and phototherapy after birth.
 If a newborn is undergoing phototherapy, the nurse should assess for dehydration & encourage breastfeeding 1-2hrs (Infants undergoing phototherapy need as much as 25% more fluids to prevent dehydration.)
 Don’t place the lights too close, can cause burns (too far, therapy wont work)
 Only place covering over genitalia to maximize the skin surge area exposed to light (turn newborn q 2hrs)
 Always shield the newborn’s eyes from the UV light
 Remove eye patches q4hrs to cleanse the eyes & examine for irritation, inflammation & dryness, clean & change the patches daily.
 Monitor the serum bilirubin levels routinely when the infant is receiving phototherapy.

Question 10

9b. Manifestations of fetal alcohol syndrome (FAS) (pg.449)

Answer 10

 Hyperactive & irritable
 Trouble sleeping
 Tremors or seizures
 Low birth weight, small height & circumference
 Short palpebral fissures (eyelid folds), reduced ocular growth, flattened nasal bridge.

Question 11

9b. prevention of FAS (pg.449)

Answer 11

 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 12

11b. What is the priority nursing diagnosis and goals for spina bifida client?

Answer 12

 Maintain sac integrity and prevent infection

Question 13

12. Give an example of how to promote family coping of a newborn with Spina Bifida. (Pg.458)

Answer 13

 Encourage families to express their feelings & 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.
 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 14

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

Answer 14

Communicating 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.

Non-communicating hydrocephalus
 Congenital hydrocephalus is most often the obstructive or noncommunicating type.
 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 15

13b. What are the signs and symptoms of increased intracranial pressure in an infant? (pg.460)

Answer 15

 Severe headache
 Changes in LOC
 Ataxia
 Restlessness
 Failure to thrive
 Seizures
 High pitched cry
 Irritability
 Personality change
 Papilledema
 Projective vomiting

Question 16

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

Answer 16

 Notify Physician

Question 17

15b. What are the signs and symptoms for the newborn with ventral septal defect (VSD)? (pg.466)

Answer 17

 Cyanosis if pulmonary vascular resistances produces pulmonary HTN (pg.464)
 Feeding difficulties & poor weight gain resulting in slowed growth & development
 Dyspnea & easy fatigability
 Attacks of paroxysmal dyspnea are common during infancy and early childhood.
 Anoxic spell: sudden restlessness, gasping respiration & increased cyanosis that lead to a loss of consciousness & possibly convulsions.
 Loud harsh Murmur, bounding pulse & fatigue (pg.464)

Question 18

16b. How does a child find their own limitations, and what they do to relieve their symptoms of Tetralogy of Fallot. (pg.466)

Answer 18

 Exercise tolerance depends in part on the severity of the disease; some children become fatigued after little exertion.
 In the past, on experiencing fatigue, breathlessness, and increased cyanosis, the child was described as assuming a squatting posture for relief. (Squatting apparently increased the systemic oxygen saturation.)

Question 19

17b. Explain the priority nursing intervention to prevent post-op injury after a Cleft-lip or Cleft-palate repair. (injury being the key word) (Pg.473)

Answer 19

 nothing is permitted in the infant’s mouth, particularly the thumb or finger, elbow restraints are necessary. (If thumb goes in infants mouth can undo the repair/cause undesirable scarring along suture line)

Question 20

19a. Clinical manifestations of hip dysplasia(pg.480)

Answer 20

 An audible click when examining the newborn using the Barlow sign and Ortolani maneuver
 Asymmetry of the gluteal folds of the thighs.
 Limited abduction of the affected hip.
 Apparent shortening of the femur.

Question 21

19b. What is important to watch for in the child with hip spica cast. (pg.480,481,482)

Answer 21

 Check the toes for circulation and movement.
 Check the skin at the edges of the cast for signs of pressure or irritation.
 Comfort and maintaining skin integrity are major concerns. (pg.480)
 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 22

20b. What is the most severe complication of PKU if untreated? (pg.483)

Answer 22

 severe and progressive mental/intellectual deficiency.

Question 23

21b. State what a woman with PKU must do if she wants to get pregnant(pg.483)

Answer 23

 Follow 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 24

22. List the biggest complications of a child with Downs Syndrome. (PP slide 30)

Answer 24

 Greater susceptibility to leukemia

Question 25

25. Why do we need to provide a quiet setting for babies in the NICU? (pg.441)

Answer 25

 decreasing environmental noise and stress, maintaining flexed positioning, and clustering care to conserve energy. (low volume on radio, music box, or a wind up toy ok for auditory stimulation, as well as voices of infants family and nurses)

Question 26

26. What can cause harm to preemie’s eyes and lungs? (freebie)

Answer 26

 too much o2