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NURP 1 FINAL > WEEK 11 Lecture > Flashcards

WEEK 11 Lecture Flashcards

1
Q

When do you give “eye prophylaxis” and what is it?

A

Give 1 hr after delivery
prevents Chlamydia and Gonorrhea

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2
Q

What medication do you give for eyes?

A

0.5% erythromycin ophthalmic
1% tetracycline

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3
Q

When do you give “thighs” prophylaxis and what is it?

A

1-6hrs after delivery
prevents brain bleed or intestine bleed
ALL newborns have low vit K levels at birth

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4
Q

What medication do you give for thighs?

A

IM injection of VIT K
VIT K does NOT cross the placenta and is NOT available in breastmilk

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5
Q

Gonorrhea occurs how soon after delivery?

A

first 5 days
significant inflammation
corneal involvement
lead to blindness from rupture

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6
Q

Chlamydia occurs how soon after delivery?

A

5 day - 5 weeks
neonatal conjunctivitis has little sx except drainage
* can lead to pneumonia* cough, fever, tachypnea

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7
Q

HEP B

A

first 24hrs of life
*if mom has hep b the newborn has a 90% chance of getting HEP B

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8
Q

Mom HEP B -

A

Hep B vax within 24hrs UNLESS the newborn is <2,000 grams aka 4lbs 4 oz
if <2000 grams, administer at 1 month or until above that weight

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9
Q

Mom HEP B +

A

Hep B vaccine and immunoglobulin

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10
Q

Metabolic Disorder Screening

A

35 core screenings
26 secondary screenings
MANDATORY universal screening for rare disorders

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11
Q

How do you perform the metabolic disorder screeening?

A

heel prick 24-48hrs of live

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12
Q

Screening techniques

A

Wipe away the first drop of blood! Circles on the card need to be filled COMPLETELY.
Air dry the card for 4 hrs and 1-2 weeks for results to come back

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13
Q

Factors that affect screening

A

before 24hrs
abx
transfusion
not eating enough
non-adequate sample

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14
Q

Which 2 screening results require immediate treatment?

A

Galactosemia
Maple Syrup Urine Disease
every other result needs to be re-confirmed

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15
Q

Galactosemia

A

rare autosomal recessive disorder
cannot metabolize

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16
Q

Maple Syrup Urine

A

rare inherited metabolic disorder autorecessive
cannot metabolize amino acids

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17
Q

Glucose screening: what newborns are at risk? MATERNAL FACTORS

A

Born to mothers who were diabetic or have GD
Preeclampsia/HTN
substances (tocolytics)
received glucose

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18
Q

Which newborns are at risK? NEWBORN FACTORS

A

pre-mature (esp late preterm 34-37
LGA/SGA
HIE or injury at birth
sepsis
congenital heart defect
metabolic disorders

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19
Q

S/s of hypoglycemia

A

irritability
LOC changes
tremors
lethargy
high pitched cries
respiratory distress
feeding difficulty
hypotonia
seizures

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20
Q

Do you test all babies for glucose screen?

A

NO glucose is 70% of the maternal value
low as 25

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21
Q

RF or signs of glucose issues (symptomatic)

A

screening is required!

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22
Q

Symptomatic and BS <40

A

give IV glucose

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23
Q

Asymptomatic birth-4hrs

A

early and frequent feedings
feed within 1 hr
screen 30 min later

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24
Q

Asymptomatic birth 4-24hrs

A

feeds every 2-3 hrs and screen prior to each feed

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25
Q

target glucose screen

A

> 45 or higher before feeds

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26
Q

Jaundice screen

A

ALL newborns university screened
*if they are d/c prior to 72 hrs follow up with PCP 1-2 days

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27
Q

Further down the body the higher the level of bilirubin? T/F?

A

TRUE. starts at head to toes, more it spreads the more there is

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28
Q

what causes jaundice?

A

insufficient oral intake
tongue tied
mom’s milk has not come in yet
fam hx “did a sibling have hyperbilirubinemia?”

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29
Q

Hearing screening

A

hearing loss is the most common disorder at birth
*newborn must be sleeping

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30
Q

2 test of hearing screening?

A

Otoacustic emission test and Automated Auditory Brainstem Response

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31
Q

Otoacoustic emission teset

A

measuring sound waves produced in the inner ear, clicking sounds

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32
Q

Automated Auditory Brainstem

A

electrodes on head measures brains response to sound

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33
Q

Why do newborns sometimes lack hearing if they are delierved via C-section?

A

do not pass the hearing screen bc they don’t have pressure from being squeezed out of the vaginal canal

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34
Q

what if they don’t pass and are being d/c’d?

A

re-screened at 3 MONTHS
goal is to prevent speech/language delays

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35
Q

Congenital Heart Disease Screening

A

When the umbilical chord is clamped, the arteries and veins constrict and systemic vascular resistance is greater than pulmonary vascular resistance

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36
Q

closure of 3 main fetal shunts

A

ductus venosus
foreman ovale
ductus arteriosus

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37
Q

Screening for Congenital Heart Disease

A

at least 24hrs after delivery
done by pulse OX
RIGHT HAND
EITHER FOOT R/L

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38
Q

Pulse oxygen screening

A

both >95%
difference between hand and foot <3%
test both at the same time
*MUST BE >24hr after delivery!!!!!!!!!

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39
Q

Caregivers for newborns?

A

influenza and TDAP vaccines need to be up-to-date

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40
Q

can feedings go in the microwave? formula/breastmilks?

A

NO

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41
Q

NO BM for 7-10 days?

A

normal

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42
Q

Normal bowel and bladder?

A
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43
Q

sleeping position?

A

back to sleep

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44
Q

safety?

A

pre-mature infants
car seat fit test

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45
Q

Newborn d/c criteria

A

stable VS
-axillary 97.7-99.0
RR <60
HR 80-180 bmp
no signs of respiratory distress
fed 2x
voided, urine/stool 1x
screening completed
parent education

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46
Q

first pre-natal visit fam gentics

A

3 generations!
family genetics (first relatives) parents, children, siblings
2nd degree grandparents, uncles/aunts, half-siblings
neices/nephews/ great-grandparents
3rd cousins/ great grand
hemochromatosis, mental health, heart disease, cancers, stroke
autosomal recessive disorders: both parents
3 copies aneuploidy

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47
Q

Autosomal recessive disorders (both parents)

A

cystic fibrosis
beta
sickle
Tay-Sachs disease

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48
Q

Aneuploidy

A

downs syndrome
trisomy 12/18

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49
Q

X

A

hemophilia A and B recessive
Huntington dominant
Neurofibromatosis dominant

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50
Q

APGAR scores

A

transition from intra-extra uterine life
indicates cardiac and respiratory

tested at 1 min and 5 min

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51
Q

APGAR 1-5

A

A appearance
P pulse
G grimace
A activity
R respirations

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52
Q

1 min

A

how well baby tolerated birthing

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53
Q

5min

A

information on neonatal transition

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54
Q

7-10

A

normal

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55
Q

<7

A

REPEAT* 5min intervals for the next 20 min

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56
Q

does it indicate a need for recessive measures?

A

no quantifies response to environment

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57
Q

how many arteries/veins?

A

Arteries 2
Veins 1

58
Q

single artery

A

twins
>40
female newborn
caucasian mom

mostly not a big dealio

59
Q

VACTREL

A

25% of 1 artery can cause disorders:

vertebral anomalies
anal atresia
cardiovascular anomalies
tracheal-esophageal fistula
esophageal atresia
rental/radial anomalies
limb defects

60
Q

2 vessels

A

draw labs
chromosomal analysis

61
Q

FLACC scale

A

pain
face, legs, activity, cry, consolibility
ideally want a 0

62
Q

rectal temp?

A

never per text book
axillary instead

63
Q

Auscultation

A

80-180 bmp = normal
Listen at PMI

64
Q

BPs in newborns?

A

not usually routinely
if cardiac issues, do the BPs

65
Q

Normal RR

A

30-60

66
Q

WHO

A

WHO growth standards
healthy infants in optimal conditions
use until age 2

67
Q

CDC

A

growth reference
certain kids at a particular time
2-18 years old

68
Q

Head circumference

A

12-15 inches

69
Q

When do you age correct up until?

A

age correct until TWO

70
Q

Length

A

18-22 inches

71
Q

Weight

A

average full-term 5lbs 8oz to 8lbs 13oz

71
Q

Cardiac

A

5 different areas in chest
s1/s2
s3/4
murmurs
heaves /thrills
perfusion

71
Q

Acrocyanosis

A

blue-ish discoloration after birth in hands and feet
normal in first 48hrs
>48hrs due to COLD STRESS not cardiac

72
Q

Still’s

A

most common innocent murmur
vibratory and musical

heard in the L sternal border, supine position

72
Q

unequal pulses

A

coarctation of aorta

72
Q

Innocent murmers

A

> 90% of murmurs are benign

73
Q

Red flags

A

holosystolic, diastolic, grade 3 or higher, harsh
*refer to cardiology

73
Q

PDA

A

machine-like continuous
upper left SB 4th intercostal space

74
Q

Bad murmurs?

A

GRADE 3 OR HIGHER URGENT REFERRAL
thrill at least a 4

75
Q

VSD

A

harsh, holostysolic
Left lower sternal border
thrill so 4/6

76
Q

ASD

A

grade 2/3 systolic ejection murmur
upper left sternal border
split s2

77
Q

Respiratory

A

depth and regularity
crackles in lungs within first few hrs (amniotic fluid)

78
Q

inspiratory to expiratory

A

1:1
count for 1 FULL MIN

79
Q

respiratory distress

A

retractions, accessory muscles
grunting or noisy breathing

80
Q

Skin

A

port-wine stain
normal

81
Q

Hemangioma

A

incorrectly formed blood vessels that multiply more than they should
increases in size first few months
decreases slow disappears before 10 yrs old

*if near eye refer

82
Q

cafe-au-lai

A

irregular shape
light brown

*****6 more more >1cm:
further workup for neurofibromatosis (tumors on the nerve tissue)

83
Q

Erythema toxicum

A

rash that occurs
yellow/white papules on erythematous base
1-3mm diameter
NO treatment

84
Q

Milia

A

exposed sebacous glands
disappear within 1 months

85
Q

Mongolian spots/slate blue patches

A

lower back
shoulder/hips/legs

*document location/size each time
confused with bruises

86
Q

petechiae

A

normal on presenting parts (on head/butt)

if elsewhere-sx f or infection or growing = concerning for infection

resolves within 24-48hrs of birth
does not grow

87
Q

vesicular rash

A

herpes/varicella

IV of acyclovir ASAP. no waiting for culture

88
Q

Head

A

anterior and posterior fontanells
3rd fontanelle (located along saggital suture)

can either be a normal variant or infection or trisomy 21

89
Q

Palpating the head

A

palpate all 5 suture lines for firmness and mobility
open or overlap d/t molding of the head in labor and birth
within 48hrs overlapping and molding should resolve

90
Q

Microcephaly

A

CNS malformation, infection, genetic syndrome

91
Q

Macrocephaly

A

CNS disorder (brain tumor, hydrocephalus, hereditary)

92
Q

Caput Succedaneum

A

scalp edema
not limited by suture lines (crosses)
usually pitting
resolves in 48hrs

93
Q

Cephalohematoma

A

collection of blood caused by pressure during birth, labor, delivery w suction
can WORSEN before it gets better
does NOT cross suture lines
4-8wks resolves but can be up to 4 months

94
Q

Eyes

A

size, shape, and placement on the face
sclera blue/gray
brown in infants with

95
Q

permanent eye color

A

3-6 months of age

96
Q

Red Reflex

A

intact lens/retina
one pupil with red reflex and one gray/dull white (leucorrhea) congenital infection/retinoblastoma and REFER

Hazy-glaucoma

97
Q

Normal eyes

A

strabismus
subconjunctival/scleara hemorrhages
tearless crying

98
Q

ears

A

firm, flexible, good recoil
inner canthus to the outer canthus to the ocipt - pinna touches the line

99
Q

Ear pit/tag

A
100
Q

Epstein pearls

A

normal, contain keratin

101
Q

Natal teeth

A

early teeth eruptions, need to be removed

102
Q

Neck

A

freely mobile
NO WEBBING

103
Q

Torticolis

A

stiff neck most common anomaly
ask parents “do they favor one side”
can cause plagiocephaly or ear misalignment

104
Q

Nose or mouth breathers?

A

obligatory nose breathers

105
Q

Abdomen

A

round/dull
bowel sounds present by 2hrs of age
palpate soft
liver can be palp at 1-2 cm R costal margin
tip of spleen L side 2-3cm L costal margin

106
Q

Chord

A

loosens in 4-5 days
falls off in 10 days (2 weeks)

Do not need to clean it

107
Q

Diastasis recti

A

1cm gap, budges when cries, resolves in the first few weeks
normal

108
Q

Hypospadias

A

urethral opening at the underneath
cannot be circumcised
use the skin to correct at 6 months-1 yr

109
Q

Epispadias

A

located at the top

110
Q

Hydrocele

A

fluid into inguinal canal
transilluminates and self-resolves/spontaneously in 1-2 yrs

111
Q

Inguinal hernia

A

want to make sure it is reducible
*refer for correction

112
Q

Cryptorchidism

A

non-descended testicles
associated with an increased risk of testicular cancer and reduced fertility *descended by 6 months or refer
orchiopexy (surgery) if not distended by 1 year

113
Q

discharge from female newborn

A

blood first 3-4days, white discharge is normal
withdrawal of hormones

114
Q

Vag skin tag

A

normal, visible hymenal ring

115
Q

term infants/pre term infants

A

prominent labia majora
preterm infants prominent labia minor and clitoris

116
Q

ambiguous genitalia

A

chromosomal analysis

117
Q

alignment of spine

A

straight/Flexible
vertebrae palpate each one

Dimple
tufts of hair

118
Q

Barlow and Ortalani

A

Dislocate
and re-locate with Ortalani
*assess for hip dysplasia
symmetry of gluteal skin folds

119
Q

Neuro

A

watching the newborn
cry, suck, rooting, response to the environment

120
Q

CN V11

A

facial symmetry

crying

121
Q

CN IX (9) and X (10)

A

quality strength of cry

122
Q

CN V (5), VII (7), IX, X

A

feed, suck, swallow

123
Q

CN III, IV, VI

A

Eye movements vestibulo-ocular reflex (doll’s eye)

124
Q

CN II

A

optic blink reflects, in response to bright light

125
Q

CN I

A

under nose alc pad

126
Q

CN V

A

glabela tap between eyes symmetrical blink NOT unilateral

127
Q

CN VIII

A

clap and the infant will blink if hearing is intact
acoustic blink reflex

128
Q

moro

A

6-8 months

129
Q

sucking

A

2-3 months

130
Q

rooting

A

by 4 months

131
Q

planter grasp

A

8-10 months

132
Q

palmer grasp

A

5-6 months

133
Q

no reflex or continues past the age

A

issues with the CNS

134
Q

tonic neck

A

by 6 months

135
Q

grasping

A

5-6 months

136
Q

truncal incurvation/galant

A

6 months

137
Q

babinski

A

normal up until 2 years, usually will diminish at 1 yr
big toe goes up. hyperextending of big toe

NURP 1 FINAL (2 decks)

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