Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

531 > Week 11 Examining NB > Flashcards

Week 11 Examining NB Flashcards

1
Q

Prep for discharge: Eyes & Thighs

A
  • eye prophylaxis first hour of life (erythromycin or tetracycline) to prevent chlamydia / gonorrhea conjunctivitis
    • NB immature hepatic systems → bleeding risk
  • thighs; vitamin K & hepatitis B vaccine
    • vit K w/in 1-6 hrs after birth
    • hep b: first 24 hrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Gonorrhea conjunctivitis can lead to

A

blindness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

chlamydia conjunctivitis can lead to

A

pneumonia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

single vitamin K injection lasts

A

til 6months until solid foods

vitamin K doesn’t cross placenta and not in breastmilk/formula

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

For Infants Born to Hepatitis B NEGATIVE mother

A
  • give vaccine if > 2000 grams within the first 24 hours
  • if < 2000 grams- (4lbs 4 oz)
    • administer at 1 month of age or at hospital discharge, whichever comes first
  • 1 kg = 2.2 lbs
  • 1000 g = 1 kg = 2.2 lb
  • **many women asymptomatic that have hep B
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

For Infants Born to Hepatitis B POSITIVE mother

A
  • Administer Hepatitis B vaccine to all infants within the first 24 hours regardless of weight

AND

  • Administer Hepatitis B immunoglobulin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

discharge screening:

newborn metabolic disorder screening

A
  • Metabolic, hormonal, hematologic, infectious
  • Recommended Uniform Screening Panel (RUSP) aka Newborn Screen (NBS) has 35 core conditions, 26 secondary conditions
  • Simple heel prick between 24-48 hrs after birth. Drops of blood are blotted on a special absorbent filter card
    • Air dry for 4 hours → state’s Newborn Screening lab- takes 10-14 days for results
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Factors that can affect Newborn metabolic screening (NBS) results

A
  • obtaining too early
    • Before 24 hrs of life
  • antibiotics
  • blood transfusion
  • failure to wipe away first drop of blood
  • not enough feeding
  • inadequate sample
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

NBS result treatments

A
  • Institute immediate treatment for a positive screen for:
      • Galactosemia
        • Rare auto recessive met disorder, can’t metabolise sugar galactose
      • Maple Syrup Urine Disease (MSUD)
        • Rare auto rec metabolic disorder
        • Can’t metabolize amino acids causing sweet ordor or newborn urine
    • Excluding these 2; this is SCREENING test. All other +’s need more testing to confirm
  • Otherwise no treatment for any other + screening results until further testing confirms diagnosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Discharge screening:

Glucose screening

A
  • Glucose tends to drop 25 mg within the first 1-2 hours after birth
    • after 4 hrs, 25-35g is threshold, then > 45g
  • Screening NOT rec for healthy full term infants
  • At risk infants need screening if:
    • Diabetic or GD- baby used to increased glucose so has increased insulin levels at birth
    • Preeclampsia/HTN
    • Substance abuse
    • Exposure to medications (tocolytics, glucose)

Neonate

  • Prematurity- esp late preterm 34-37 weeks
  • LGA or SGA
  • HIE event or birth injury
  • Sepsis
  • Congenital cardiac, endocrine, inborn errors of metabolism disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  • if infant is showing signs/sx’s of hypoglycemia..?
  • what if there are no sx’s but low blood sugars?
A
  • give IV glucose!
  • if not showing sx’s, recommend feeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

s/sx hypoglycemia in neonates

A
  • Most Common:
    • Irritability
    • Tremors
    • Severe: Lethargy, changes in LOC
  • Can also be seen:
    • Seizures
    • Hypotonia
    • Feeding difficulty
    • Respiratory distress
    • High pitched cry
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

discharge screening:

jaundice screening

A
  • using transcutaneous hyperbilirubinemia or jaundice monitor or blood draw
  • If discharged sooner than 72 hours→ do at primary care office
  • F/u in 1 -2 day
  • High levels of unconjugated bilirubin lead to jaundice from immature hepatic system and lack of PO
  • Screen if “too high too soon” or shows up w/in first 24 hrs → pathologic cause than physiologic
  • Jaundice goes head to toes
    • further down body = higher the level of bilirubin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

ALWAYS get family history! Did mom have a previous child that had hyperbilirubinemia?

A
  • If yes, that’s a huge risk factor for future pregnancies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

discharge screening:

hearing loss

A
  • Otoacoustic Emission Test (OAE) [top pic]: using probe in ear measures ciliary hair movement
  • Automated Auditory Brainstem Response (AABR) [bottom pic]:
    • Measures acoustic nerve and brain respond to sound. Tones are played through headphones and electrodes measure brain’s response to sound.
  • If no pass initial hearing screen → repeat testing within 3 months
  • Goal: screen by 1 month, identify deficit by 3 months, be receiving services and/or treatment by 6 months of age
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

discharge screening:

when to do congenital heart disease screening

A
  • Clamp umbilical cord → the transition from fetal circulation to neonatal circulation
  • Arteries and veins constrict and systemic blood pressure increases
  • When systemic vascular resistance > pulmonary vascular resistance the 3 major fetal shunts close
    • Ductus Venosus
    • Foramen Ovale
    • Ductus Arteriosus
  • Screening is performed after 24 hours of life to detect any potential congenital cardiac anomalies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how to screen for congenital heart disease

A
  • screen AFTER 24 hours of birth, before discharge
  • Pre and postductal pulse oximetry screening
    • Right hand and Left foot test both at the same time
    • Normal results: both hand and foot 95% > and < 3% difference between them
  • Discrepancies should receive urgent referral to pediatric cardiology
    • If < 95% or difference hand/foot sat > 3%
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Newborn Discharge Criteria

A
  • Stable vital signs
    • Axillary temp 36.5-37.4 C
    • RR <60
    • No signs of distress
    • HR 80-180 bpm
  • Established Feeding
    • At least 2+ feedings
  • Established Elimination pattern
    • At least 1 void and 1 stool
  • Screening and therapies completed
  • Parent education completed
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Rooting lasts until

A

4 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

sucking reflex ends at

A

2-3 months

21
Q

moro lasts until

A

6-8 months

22
Q

Plantar grasp lasts until

A

8-10 months

23
Q

palmar grasp lasts until

A

5-6 months

24
Q

tonic neck resolves by

A

6 months

25
Q

truncal incurvation/galant reflex resolves by

A

4 months

26
Q

babinski reflex

A
  • occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot
  • Positive babinski is normal up to 2 years of age, diminishes after 1 yr
27
Q

CN 1

A

CN 1 = alcohol pad to nose = grimace/make a face

28
Q

CN II

A

blink in response to bright light (optic blink reflex)

recognition of objects introduced into visual fields

29
Q

CN III, IV (4), VI

A

pupillary response to light, extra ocular movements tracking, ptosis

vestibulo-ocular reflex (doll’s eyes maneuver). When the head is turned, there is conjugate eye movement in the opposite direction.

30
Q

CN VII

A

Crying - symmetry of facial expressions

31
Q

CN V

A

light facial touch and assess response

32
Q

CN IX, X

A

quality and strength of crying

symmetrical rise of soft palate, gag reflex

33
Q

CN V, VII, IX, X

A

Feeding - sucking and swallowing

34
Q

CN VIII

A

response to sound made outside of visual fields

clap → blink → hearing intact

35
Q

Common NB skin findings

A
  • acrocyanosis
  • harlequin sign (unilateral color change (LBW))
  • erythema toxic
  • milia
  • mongolian spots
  • **strawberry hemangioma (refer orbital/large hemangioma or in airway)
  • nevus simplex
  • **cafe au last spots( > 6 greater than1 cm = w/u for neurofibromatosis)
  • port wine stain
  • stork bites
  • lanugo (premie)
  • linea nigra
  • vernix caseosa
  • neonatal acne
36
Q

abnormal skin findings

immediate referral for workup

A
  • Petechiae
    • Normal on presenting parts
      • Resolve 24-48 hrs
    • If head down from vaginal delivery, expect petechiae on head but if breech or c section, see petechiae on butt
    • But if see it ANYWHERE else = sx’ of infection
    • Doesn’t grow; don’t get new sites
      • rule out sepsis and TORCH
  • Vesicular rash
    • HSV and varicella → clustered vesicles a few days after birth
      • if high suspicion → start IV acyclovir ASAP! (dont need culture first)
    • Bacterial infections like staph and strep
37
Q

still’s murmur

A
  • most common innocent heart murmur, vibratory and musical in nature, along left sternal border, louder when supine
38
Q

pathologic murmur red flags

A

holosystolic, diastolic, grade 3 or higher, harsh

  • PDA: continuous machine-like murmur,
    • Heard best at left sternal upper Sternal Border
  • ASD: grade 2 or 3 systolic ejection murmur, ULSB, split S2
  • VSD: harsh holosystolic, LLSB, sometimes can palpate thrill
    • If can palpate thrill, the intensity is at least grade 4 / 6
39
Q

cephalohematoma is a risk factor for

A

jaundice and sepsis

40
Q

ear pits/tags evaluate

A
  • hearing and renal system
  • Assess placement of ear by drawing Imaginary line to inner campus to outer campus of the eye to occipitus
  • If top of pinna ear touches imaginary line = ear is correctly placed
41
Q

light spot /leukocoria can indicate

A

retinoblastoma - refer!

42
Q

diastasis recti

A

1 cm gap, bulges when cries, resolves in 1 week

43
Q
  • Cryptorchidism
A

failure to descend is associated with increased risk of testicular cancers and reduced fertility (should descend by 3-6 months- orchiopexy if not descended by 1 yr)

44
Q
  • If patient has bilateral undescended testes with micropenis, or bifid scrotum
  • or fused labia / clitoromegaly
A

prompt eval for ambiguous genitalia

45
Q

torticollis

A
  • twisting of neck
  • most common in Multiple sclerosis anomaly
  • Assess for torticollis by parent “does the infant only look 1 way , sleep 1 side, feed 1 direction, or holding head like that?
  • Birth trauma of sternocleidomastoid, can lead to plagiocephaly (flat head from toricollis = misalignment of ear) and ear misalignment
    • Send to PT for correction
46
Q

maneuvers for hip dysplasia

A
  • Barlow → dislocate
  • ortolani → relocate
  • symmetry of skin folds (gluteal/ femur)
  • feet: size, shape, positioning
47
Q

parental discharge education

A
  • General care of infant- bathing, diapering, cord care, circ care, temperature
  • Infection control- handwashing, caregiver vaccinations
  • Feeding- breast/bottle, schedule, burping, storage, concerning patterns
  • Elimination- voiding/stooling with each feed, concerning patterns
  • Sleep- positioning, location
  • Safety- car seat, fall prevention, siblings, pets, CPR, Emergency Services contact information
48
Q

dialysis recti and umbilical hernias are more common in

A

premature infants

49
Q

Most formula-fed infants will feed at least

A

8x a day

on average, FF infants take 2.5 oz formula for every lb of body weight

531 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions