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SEM 1 > W6: Newborn Assessment > Flashcards

W6: Newborn Assessment Flashcards

1
Q

3 components of physiologal adjustments for newborns

A
  • establishing and maintaining respirations
    -adjusting to circulatory changes
  • regulating temperature
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2
Q

Chemical factors of establishing respirations

A

activation of chemoreceptors on carotid arteries & aoorta d/t fetal hypoxia
contraction temporarly decreases uterine blood flow and gas exchange = transient fetal hypoxia
dec PO2, inc PCO2, dec blood pH
stimulation of respiration centre

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3
Q

thermal factors of establishing respirations

A

cold extrauterine environment
stiumulates receptors in the skin resultng in stimulation of the respiratory centre in the medulla
(cold stress important for initializing breathing)

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4
Q

mechanical factors of establishing respirations

A

changes in intrathoracic pressure from compression of the chest during vaginal breath
relieve of the perssure results in negatice intrathoracic pressure which helps draw air into lungs
crying of baby (increases air distribution in lung, + pressure keeps alveoli open)

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5
Q

sensory factors of establishing respirations

A

handling or drying, lights, sounds, smells stimulate respiratory centre
pain associated w/ birth

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6
Q

cirulatory changes after birth

A

expansion of lungs increases BP –> dec in pulmonary pressure –> dec shunting of blood to ductus arterious and closure of ductus arteriosus

in pressure in LA of the heart & low pressure in RA cause foramen ovale to close

faliure of closure = patent foramen ovale = surgical repair

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7
Q

physiological: why are newborns at tisk of heat loss-hypothermia

A

larger body surface to body weight
less adipose tissue & fat in newborns
underdeveloped sweating and shivering mechanisms
blood vessels closer to skin surface = heat loss

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8
Q

Newborn Heat-Loss: Evaporation

A

loss of heat when water evaporates from the skin &b resp tract

  • falling completely dry after bathing
  • dry baby quickly and remcoe we towels/blankets
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9
Q

Newborn Heat-Loss: Conduction

A

heat loss from the body surface to cooler surface in direct contact

-prewarm incubator/radiant warmer to ensure warm matress
-cover x-ray plates & scales
- prewarm hands, blankets, equipments
- weighing the newborn should have a protective cover to minimize conductive heat loss

  • skin to skin!!
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10
Q

Newborn Heat-Loss: radiation

A

heat loss to surrounding colder solid objects (not in direct contact)

keep incubator, table, cots away from outside walls
dress baby
avoid exposing direct air

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11
Q

Newborn Heat-Loss: convection

A

heat loss from the body surface to cooler ambient air

  • temp should be 22-26
    -cover baby head
    -wrap/dress baby
    -warm o2
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12
Q

describe cold stress

A

cold
–> oxygen consumption inc –> pulmonary + peripheral vasoconstriction –> decreasing oxygen uptake by the lungs & oxygen to tissues –> aerobic glycolysis —> dec pO2 + pH –> metabolic acidosis

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13
Q

What are the components of APGAR

A

apperance
pulse
grimace
activity
respiration

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14
Q

APGAR: Apperance

A

0 = pale/blue
1= extremeties blue
2= pink

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15
Q

APGAR: Pulse

A

0 = no pulse
1 = <100 bpm
2 = >100 bpm

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16
Q

APGAR: Grimace

A

0= no response to stimulation
1 = grimaces or weak cry
2 = cries and pulls away

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17
Q

APGAR: Activity

A

0 = no movement
1= arms, legs flexed
2= active movement

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18
Q

APGAR: Respiration

A

0= no breathing
1= slow irregular
2= strong cry

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19
Q

Interpreting APGAR Score

A

0-3 = severe distress
4-6 = moderate difficulty
7-10 = minimal-no difficulty

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20
Q

when do you reassess APGAR scores

A

is the score is less than 7 @ 5 mins, you reassess at 10-20 mins

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21
Q

when is APGAR score done?

A

1-5 mins after birth

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22
Q

PA: Respiratory System

A

observe for 1 full min
auscultate

normal = 30-60 bpm
shallow & irregular
apneic periods of 5-10 secs as fluid is absorbed/expelled
possible crackles (1st hour PP)
acrocyanosis - normal during transition

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23
Q

Signs of Respiratory Distress

A

chest retractions
grunting w/ expirations
increase use of intercostal msucles
nasal flaring
respiration rate <30 / >60

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24
Q

PA: Cardiovascular System

A

110-160 bpm
- <110/160< = reeval after 30m-1hr
heart murmurs for first 6 mo
BP: 60-80/40-50
Fetal Hb: 14-24g/dl
Blood volume: 300mls

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25
PA: Cardiovascular Abnormal
persistent tachy (>160) persistent brady (<100) anemia hypovolemia hyperthermia sepsis congenital heart block hypoxemia normal sinus brady hypothermia unrqual/absent pulses dec./inc. BP
26
How long does anterior fonatel take to close?
18 months
27
how long does it take porterior fonatel take to close
8-12 months
28
Widely spaces sutures =
hydrocephaly
29
premature closer of sutures =
craniocynostosis
30
Signs of Fonatel Concerns
full bulging (tmor, hem, infection) large, flat, soft (malnutrition, hydrocephaly, delayed bone age, hypothyroidism) depressed = dehydration
31
Cephalhematome
d/t pressure of L&D, forceps largest on 2nd-3rd day (boggy, edemous) does not cross suture lines resolves in 3-6 weeks not aspirated d/t risk of infection increase risk of jaundice
32
capcut succedaneum
localized edematous area of the soft tissue of scalp (compression of vessels, slow venous return) extends beyond suture lines disappears spontaneously within 3-4 days
33
PA: Mouth
lips symmetrical pink, moist lips + mucosa suckling blisters (from breastfeeding latch) saliva not excessive intact hard + soft palate freely moving tongue tongue not protuding sucking pads inside cheeks uvula midline anatomical groove in palate to accomadate nipple (gone by 3-4 years)
34
epstein's pearls
small, firm, white cysts on gyms, resolve on its own during 1st weeks
35
PA: Common Conditions of the Mouth
thrush: white plaque, similar to milk curds, not easilt scraped off precocious= teeth at birth cleft lip/palate short lingual frenlum (tongue-tie) asymmetry in movement of lips (seventh cranial nerve paralysis) cyanosis, circumoral pallor (resp distress, hypothermia)
36
PA: Female genitalia
labia: size, labia not fused, ambiguous genitalia milky vaginal discharge (m. hormones) psuedomenses d/t hormones vaginal tag (hymenal tag), disappears in a couple weeks swelling of breast tissue (male & femle) d/t hyperestrogenism, some d/c
37
PA: male genitalia
hypospadias - circumcision contraindicated epispadias phimosis tight prepuce hydrocele discolouration of testes - testicular torsion crepitus of groin or scrotal sac = hernia cryptochidism
38
hypospadias
hole on bottom
39
epispadias
hole on top
40
phimosis
foreskin cannot fully retract
41
hydrocele
fluid around testes
42
cryptochidism
undescended testes
43
PA: Skin
pink, perfused capilary refill <2secs good skin turgor skin is soft, dry acrocyanosis (6-8 hrs pp) post-mature: dry skins, cracking on hands + feet pre-mature: loosse, wrinkled skin mottling: due to temp
44
PA: Abnormal Skin
mottling: due to temp instability, overstimulation, tense, shiny, tight skin = edema, cold, shock, infection
45
PA: Extremeties
assess ROM of arms & shoulders leg length symmetrical gluteal crease club foot = talipes equinovrus back: straight & flexible pilondial dimple: cleft base of sacrum, benign digitd: extra: polydactyly webbind= syndactyly
46
Suckling Reflex
sucking when anything placed in mouth OR touches lips
47
Rooting Reflex
infant turns head when side of mouth/cheek is stimulated present for 3-4 months for latching
48
Moro Reflex
startling infant symmetrical extending of arms out, knee flex lasts 6mo sensitive neurological ass.
49
Babinski refelx
hyperextension of toes when sole is stroked from heel up to ball of foor gone by 1 yr
50
Prophylactic & Screening Measures
0.5% erythromycin eye ointment within 1 hr (gonnocacal) vit k injection 1 hr (hem) heb B at birth, HBIG 12 hrs after (active m hep b) blood glucose, basleine @2hr - GDM,LGA, SGA= 30m-1hr heel prick (bilirubin, pku, sickle cell, hypothyroidism) screening for congenital heart disease (O2) - repeat is >3% diff between two reading, or <94% - right hand + foot hearing loss
51
Pain in Newborns: oxygentation
inc satutation dec arterial saturation
52
Pain in Newborns: Skin
pallor flushing diaphoreis palmar sweating
53
Pain in Newborns: vocalization
crying whimpering groaning
54
Pain in Newborns: Facial Expression
grimace brow furrow chin quivering eyes closed mouth open- squarish
55
Pain in Newborns: body movements & posture
limb withdrawal thrashing rigidity flaccidity fist clenching
56
Pain in Newborns: changes in state
changes in sleep-wake cycle feeding behaviours activity levels fussiness irritability
57
Pain Management
not-nutritive sucking on paciifer oral sucrose in small amounts skin-skin contact (kangaroo) breastfeeding, breast milk swaddling wrapping touch, massaging, rocking, holding, environmental modification
58
High Risk: Jaundice
hyperbilirubinemia (340mcmol/L) for first 28 days cause: increase bilirubin level short lifespan of RBC immature liver heaptic obstruction
59
Physiologcal Jaundice
appears 24 hrs of age, resolves w/o tx
60
pathological jaundice
appears within 24 hrs untreated = bilirubin neurotoxic to brain >100mcmol/24hrs bilirubin encephalopathy (lethargym seizure, death, poor sucking, irritability)
61
kernicterus
irreversivle long term consequences of bilirubin toxicity hypotonia delayed motor skils cerebral palsy hearing loss gaze abnormalitiess
62
phototherapy
reduced level of circulating unconjugated bilirubin to keep it from increasing levels begin to decrease within 4-6 hours
63
Phototherapy precautions
newborn's eyes protected by shield (retinal damange) temperature should be closely monitored q2hr possibility of heat loss and dehydration feeding is critical no ointments (heat absorption & cause burns) maintain skin integirty - loose stool due to bilirubin breaskdown
64
ELBW
<1000g
64
Preterm Risk
repiratory distess thermal instability hypoglycemia jaundice feeding difficulties neurodevelopment issues infection
65
Preterm Complication
RDS patent ductus ateriosus periventrical-intraventricular hemorrhage nectrotizing entercolitis
66
NC: Nutrition & Hydration
breastfeeding gavage feeding (nasogastric, orogastric tube) gastrostomy feeding (tube) supplemental parenteral fluids
67
NC: skincare
use skin products with caution rinse with waters afterwards minimal use of adhesive tape - delayed removal
68
LGA
higher incidence of birth injuries asphyxia congentical anomalies
69
Causes of LGA
maternal DM maternal obsesity hx of LGA babies geentic anomalies excessive weightgain during pregnancy
70
Infants of diabetic mothers
higher risk of hypoglycemia high maternal blood sugar levels during fetal life, leads to hyperinsulnism removal of newborn glucose supply = hyperinsulnism --> neurological damage, death
71
clincal signs: infant of mother w/ DM
macrosomia/LGA plump, full faced abundant vernix caseosa plethora listless, lethargic meconium stained hypotonia

SEM 1 (11 decks)

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