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Women's health > Week 11 Hospital discharge and Newborn Assessment > Flashcards

Week 11 Hospital discharge and Newborn Assessment Flashcards

1
Q

What are thigh injections prior to newborn d/c?

A

Vitamin K

Hep B vax

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2
Q

What do you give to the eyes prophylaxis?

A

CT & GC

1% tetracycline ointment

erythromycin ointment

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3
Q

What would you administer to a baby with Hep B negative mother?

A

Hep B vax any infant >2g within 1st 24 hours

<2g administer at 1 month old or at hospital dc…whatever comes first

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4
Q

what would you administer to baby of a mother positive for HEP B?

A

Hep B vaccine to ALL infants within 24 hrs regardless of weight

AND

admin Hep B Immunoglobulin

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5
Q

What does the newborn screen look for?

When is it done

A

Disorders that are…

  • metabolic
  • hormonal
  • hematologic
  • infectious

within 48 hrs birth

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6
Q

What are factors that effect newborn screening results?

A
  1. obtaining too early
  2. abx
  3. blood transfusion
  4. failure to wipe away 1st drop blood
  5. not enough feeding “fed state”
  6. inadequate sample
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7
Q

What 2 diseases need immediate treatment for if positive on newborn screen?

A

Galactosemia

Maple syrup urine disease

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8
Q

What are the maternal factors for “at risk infants” that warrant glucose screening?

What are neonate factors?

A

Maternal Factors

  • diabetic or GD baby (will have increased insulin levels at birth)
  • Preeclampsia
  • substance abuse
  • Exposure to medications

Neonate factors

  • Prematurity-esp 34 to 37 weeks
  • LGA or SGA
  • HIE event or birth injury
  • sepsis
  • congenital cardiac, endocrine, inborne errors of metabolism
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9
Q

What are common symptoms of hypoglycemia in neonate?

What are rarer symptoms?

A

Common

  • irritability
  • tremors
  • Lethargy

Rarer

  • SZ
  • hypotonia
  • feeding difficulty
  • Respiratory distress
  • high pitched cry
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10
Q

When do you do a newborn hearing screen?

A

Screen at 1 month,

Identify deficit by 3 months

Receive tx by 6 months

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11
Q

What are the three fetal shunts?

A

Ductus venosus

Foramen ovale

Ductus arteriosus

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12
Q

When is congenital heart disease screening done?

How is this done?

A

After 24 hours

Pre and Post ductal pulsox screening

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13
Q

What is a normal pre and post ductal pulsox screening?

A

R hand & L foot

Normal: both hands & foot >95% with <3% difference between them

If abnormal = URGENT referral ped cardiology

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14
Q

What is the newborn discharge criteria? 5

A
  1. Stable VS = axillary 36.5-37.4, RR <60, HR 80-180
  2. Established feeding = 2+ feedings
  3. Established elimination = 1 void 1 stool
  4. Screening and therapies completed
  5. Parent education completed
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15
Q

If an infant fails initial hearing screen a repeat screen should be done within ___ months

Congential Heart Disease screening is considered normal if pre/post ductal sats are ____ and there is less than ___ discrepancy between hand and foot

A

If an infant fails initial hearing screen a repeat screen should be done within 3 months

Congential Heart Disease screening is considered normal if pre/post ductal sats are >95% and there is less than 3% discrepancy between hand and foot

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16
Q

Every infant should be screened for hyperbilirubinemia prior to hospital d/c or at first primary care visit if discharged before ____ of life

The metabolic newborn screen should be obtained within ____ after birth

A

Every infant should be screened for hyperbilirubinemia prior to hospital d/c or at first primary care visit if discharged before 72 hours of life

The metabolic newborn screen should be obtained within 24 hours after birth

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17
Q

What is APGAR?

what are normal scores?

When do you score?

A
  • Appearance (color)
  • Pulse (HR)
  • Grimace (reflex irritability/response)
  • Activity (muscle tone)
  • Respiration (breathing ability)

Normal 7-10

1 min & 5 min after birth THEN Q5 min for 1st 20 mins if <7

18
Q

What are factors that can influence APGAR?

A
  • maternal sedation
  • congenital conditions
  • gestational age
  • trauma
  • subjectivity score of clinician
19
Q

What are normal vital signs in a newborn?

A

T = 97.7 - 99

HR 80 - 180

RR 30-60

Bp not done

Pain = FLACC

20
Q

What is a normal ___ for a FT infant?

Head circumference

Weight

Length

A

Head Circumference: 12 to 15 inches

Weight: 5 lbs 8 oz - 8 lbs 13oz

Length: 18 - 22 inc

21
Q

What are pathologic heart sounds?

A

Holosystolic, diastolic, grade 3+ or harsh

22
Q

Describe a Still’s murmur

Where is it heard?

How to make it louder?

A

Benign & most common

  • vibratory
  • musical
  • Hear at L sternal border
  • Louder when supine
23
Q

Describe a Patent ductus arteriosus? where to auscultate

A
  • Continuous machine-like murmur
  • Upper L sternal border
24
Q

Describe an atrial septal defect and where to auscultate

A
  • Grade 2 - 3 systolic ejection murmur
  • Split S2
  • Upper L Sternal Border
25
Q

Describe a ventral septal defect and where it can be heard

A
  • harsh systolic
  • Palpable thrill
  • Left Lower Sternal border
26
Q

What are findings in the newborn that require further investigation?

A

Hemangioma

Cafe au lait spots

Petechaie

Vesicular Rash

27
Q

When is petechiae normal on a newborn?

What can it be associated with?

A

Requires IMMEDIATE referral for work up

  • Normal on presenting parts but resolve within 48 hours AND don’t get new sites
  • Associated with TORCH infection & sepsis
28
Q

What can a vesicular rash on a newborn mean?

Would you treat it?

A
  • HSV
  • Varicella
  • *can both present in a few days
  • Bacterial Staph & strep infection

Treat IV acyclovir

29
Q

Difference between Caput Succedaneum and Cephalohematoma

A

Caput Succedaneum (scalp edema)

  • pitting
  • resolves in 48 hours

Cephalohematoma

  • Does NOT cross suture lines
  • Risk factor for jaundice & sepsis
  • worse before better 3 to 4 months to resolve
30
Q

What type of murmur has a machine line sound quality?

A

PDA

31
Q

When should the umbilical cord fall off?

When should the diastasis recti resolve?

A

7 to 10 days

1st few weeks

32
Q

When should the testicles descend?

A

descend by 3 to 6 months

33
Q

How do you test CN III, IV, & VI in a newborn?

A

Eye movements

Vestibulo-ocular reflex “doll’s eyes maneuver”

  • Head turned there is conjugate eye movement in opposite direction
34
Q

How do you assess CN V, VII, IX & X?

A

Feeding

assesses sucking and swallowing

35
Q

If an infant is crying you assess _____ for symmetry

What cranial nerves are assessed with the quality and strength of a cry?

A

If an infant is crying you assess CN VII for symmetry

CN IX & X are seen with quality & strength of cry

36
Q

When should the Moro Reflex be gone?

Sucking reflex?

A

Moro: 4-6 months

Sucking 2 to 3 months

37
Q

When should the rooting reflex be gone?

Plantar grasp?

Palmar grasp?

A

Rooting: 4 months

Plantar grasp: 9 to 12 months

Palmar grasp: 5 to 6 months

38
Q

Up to what age should the babinksi reflex be positive?

A

Disappear at 2 years

39
Q

True or false

  1. Torticollis and clavicle fractures occur as a result of birth trauma?
  2. Unilateral or bilateral undescended testes on newborn exam require immediate referral to surgery for further monitoring?
  3. It is common to see diastasis recti & umbilical hernias on PE of a premature infant?
  4. The Moro reflex disappears by 12 months of age?
A
  1. True
  2. False; evaluation at 3 months if not descended
  3. True
  4. False; disappears by 6 months
40
Q
A

Women's health (10 decks)

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