Week 4 Flashcards
Neonatal Care
Normal temp for a baby in Celsius?
36.5-37.2
Normal temp for a baby in Fahrenheit?
97.7-99
What pain scale is done for the baby in postpartum?
NIPS scale
What pain scale is done for the baby in NICU?
N-PASS scale
where might you find IgG Immunoglobulins?
Blood and extracellular fluid
which immunoglobulin crosses the placenta to provide passive immunity when you born
IgG
where might you find IgA?
External secretions such as tears, saliva, mucus
what is the function of IgG?
Crosses the placenta to provide passive immunity for newborns
Provides long term immunity after recovery or vaccine
what is the function of IgA?
Present in breast milk to provide passive immunity for breastfed infants
what type of immunoglobulin is present in breast milk to provide passive immunity for breastfed infants?
IgA
what type of immunoglobulin is found in secretions of all mucous membranes?
IgA
where is IgM found?
Blood
what immunoglobulin is produced first during an infection and what follows?
IgM and then IgG
what immunoglobulin is first produced by the maturing immune system of infants
IgM
What type of immunoglobulin is found on receptors of B lymphocytes?
IgD
What type of immunoglobulins are important in allergic reactions?
IgE
what are two types of active humoral immunity?
Vaccines and natural immunity from antigens
What are two types of passive immunity?
Natural passive immunity from placental transmission of antibodies
Artificial passive immunity of gamma globulin
What are the four mechanisms of heat loss?
Conduction, convection, evaporation, radiation
what are some physiologic ways the neonate response to cold?
Increase in metabolic rate
Increase of muscle activity
peripheral vascular constriction
metabolism of brown fat
what can overheating or over bundling an infant at sleep cause?
SIDS
what are some ways to prevent hypothermia in infants? *cold stress?
Parent infant skin to skin contact with warm blanket
Remove wet blankets
Place a stocking cap on the baby
*Wrap neonate and warm blankets
*If the temperature remains below 97.7°F place the neonate under a preheated warmer unwrapped
Monitor blood glucose levels so it doesn’t lead to hypoglycemia
Delay baths
Maintain a NTE
Place neonate away from walls and windows
*Monitor temp every five minutes when rewarming
why are neonates at higher risk for thermoregulatory problems? (3)
Higher body surface area to body mass ratio
Higher metabolic rate
Limited and immature thermoregulatory abilities
loss of heat due to cold hands is called______?
Conduction
loss of heat due to air currents such as air conditioners or oxygen masks is called______?
Convection
loss of heat due cold walls of isolette or cold equipment near neonate is called______?
Radiation
what is it called when there is loss of heat that occurs when water on the neonates skin is converted to vapors?
Evaporation
what is it called when there is a transfer of heat to cooler surfaces by direct skin contact?
Conduction
what is it called when there is loss of heat from the neonates warm body to cooler air currents?
Convection
What are some factors that negatively affect thermoregulation?
Decrease subcutaneous fat
Decreased BAT in preterm neonates
Large body surface
Loss of body heat from convection, radiation, conduction, and or evaporation
loss of heat during bathing or directly after birth is called______?
Evaporation
where is BAT located in a neonate?
Neck, thorax
axillary area
Interscapular area
Around adrenal glands and kidneys
what are three things that BAT promotes?
Increase in metabolism
heat production
Heat transfer to the peripheral system
What is a passing pulse or CCHD screening?
95% or greater in more than one extremity and less than a three percent difference in the post and preductal
what is it called when there is loss of heat from the neonate to cooler objects that are not in direct contact with the neonate?
Radiation
what is another name for nonshivering thermogenesis?
Brown adipose tissue
when are brown adipose tissue reserves most rapidly depleted?
During periods of cold stress
preterm neonates have abundant or limited BAT?
Limited
Pulse ox reading are taken where?
In either foot post ductal
Right hand -preductal
what are some physiologic responses to cold stress?
Increased caloric consumption which leads to hypoglycemia
metabolic acidosis which leads to decreased surfactant production and respiratory distress
What is the level for hypoglycemia in infants?
Less than 40-45 mg/dL
Why is erythromycin given?
As a prophylactic treatment for gonococcal and chlamydial eye infections
what is the term that describes excessive heat loss that leads to hypothermia and results in utilization of compensatory mechanisms to maintain any unique body temperature?
Cold stress
what are some signs and symptoms of cold stress?
Axillary temperature below 97.7°F
cool skin
Lethargy
Pallor
Tachypnea
Grunting
Hypoglycemia
Hypotonia
Jitteriness
Weak suck
what are risk factors of cold stress?
Prematurity and small gestational size
hypoglycemia
Prolonged resuscitation efforts
Sepsis
Neurological, endocrine, or cardiorespiratory problems
Risk factors for hypoglycemia
Macrosomic babies, LGA, SGA
Infection
Respiratory distress
Trauma from birth
Hypothermia
Neonatal resuscitation
Infants of diabetic mothers
Post term and preterm
what are signs and symptoms of hypoglycemia in infants? (HITJAL)
Jitteriness
Apnea
Lethargy
Hypotonia
irritability
Temperature instability
how are vitamin K shots given?
Intramuscularly in the vastus lateralus muscle to prevent hemorrhage
what are nursing actions for hypoglycemia in infants?
Monitor for signs and symptoms
Assess blood glucose level
Assist women with breastfeeding
Feed neonate either formula or dextrose water per protocol
Maintain NTE to decrease cold stress risk
when are hepatitis B vaccines given?
One dose before discharge
Second dose 1-2 month
3rd dose between 6 and 18 months
If the mom is HepB positive, what would you do for the baby?
Give Hepatitis B immune globulin (HBig) within 12 hours with the hep B vaccine
where are hepatitis B vaccines given?
IM Vastus lateralis
What would you do if the circumcision wound starts to bleed?
Hold pressure
What are the three types of circumcision?
Gompco clamp
Plastibell
mogen
What gauge needle would you use for infants?
25 g or 5-8 needle
What are contraindications for circumcision?
Preterm neonate
Neonates with genitourinary defect
Bleeding problems
Compromising disorder such as respiratory distress syndrome
What are benefits of circumcision?
Decreased incidence of UTO and STI
What are preop procedures for circumcision?
Consent
Verify that neonate has voided
Ensure that neonate does not eat 2-3 hrs before procedure
Administer acetaminophen 1 hr before procedure
when should parents notify the physician after circumcision?
Bleeding larger than the size of a quarter is present
signs of infection
unit has not voided within 24 hours
what is the normal excretion rate for full term neonates?
15 to 60 milligrams per kilogram of urine per day when the first few days and increases to 250 to 400 milliliters by the first month
what are some ways to manage pain for a circumcision?
Administering acetaminophen in one hour to procedure
Applying topical anesthetic cream prior to procedure
Positioning newborn in semi recumbent position on padded infant
administering oral Tylenol for at least 24 hours post procedure
what is the normal excretion rate Of a neonate by the end of the first month of life?
250 to 400 milliliters kilogram
Blood on the diaper of newborn girls is referred to as
Pseudomenstruation
typically neonates pass _____ stools a day but by one month it is normal for breastfed infants to pass is one every _____due to breast milk being more easily digested, while bottle fed infants continue to pass ___ stools per day
Several, other day two
what might a pink to rust stain on two or more diapers indicate?
Presence of urate crystals and dehydration
what drug given to the mother can delay or decrease urinary output in neonates?
Magnesium sulfate
some parent teachings for circumcision care?
Watch for bleeding and signs of an infection
inform parents that the gospel fall off on its own
Instruct parents to fasten diapers loosely
for which type of circumcision would you apply a protective lubricant over the circumcision site?
Gomco or mogen clamp
for which circumcision method is lubricant not recommended?
Plastibell
Why might preterm neonates have a higher risk for kidney problems?
the GFR is initially low and can cause dehydration, and toxicity of drugs
when is transitional stool usually?
Starts on the third day and continues for three to four days
what color is transitional stool?
Black to greenish black, to greenish brown, to greenish yellow
greenish black to greenish yellow stool is a phase of stool characteristics that occurs in what type of neonates?
Transitional that occurs in both breast fed and formula fed neonates
how might formula fed stool look and smell?
Dry, and more formed than breastfed stools. Pale yellow or brownish yellow and has an unpleasant odor
how might breastfed stool look? And smell?
Yellow to golden yellow and semi formed with a pasty consistency and sour odor
____ neonates tend to have more stool per day than_____ neonates
Breastfed, formula-fed
on day four what type of stool would you expect?
Yellow, soft, and watery
how many stools would you expect breastfed neonates to pass in a day?
4-8
on day three what type number and number of wet diapers should you expect in a neonate?
Transitional, loser greenish, black greenish, or brown with three stools and 5-6 wet diapers
why might neonates appear uninterested in feedings during the first few days?
They are in a quiet sleep state
what are characteristics of meconium?
This is the first stool eliminated and is sticky, thick, black, and odorless
what is the neonatal stomach emptying rate?
Once every two to four hours
what are some signs of Down syndrome?
Spacing of the eyes are wide, the outer canthus of the eye is higher than the ears
when is transitional stool usually?
Starts on the third day and continues for three to four days
Why would you stick your fingers in the newborns’ mouth?
Check for suck/swallow reflex
Cleft palate
Epstein pearls on the gums
Frenulum check
when is meconium stool first passed usually?
24 to 48 hours
what is caput succedaneum?
Localized soft tissue edema of the scalp that can cross the suture line
This results within the first week of life
what is cephalohematoma?
A hematoma within the periosteum and skull that appears within the first few hours of birth and can increase in size over the next few days
Does not cross suture lines
why is a tight frenulum on infants considered bad?
It can affect breastfeeding
what are the causes of cephalohematoma?
Trauma to the head during prolonged labor
Forceps delivery
Vacuum extractor
what should you check in male infants?
The urethral meatus location
low set ears and palmar crease are signs of what condition?
Down syndrome
If the labia ____ covers the labia ____, the baby is closer to ____, and if it is exposed the baby is more____
Majora, minora, term, minora
what should you check in an infant’s nose?
Check for patency by including one nostril and looking for flaring
what are extra digits in either finger is called?
Polydactyly
what is it called when there’s webbing of the fingers?
Syndactyly
what might hip clicks be a positive sign for?
Ortolani
dislocation
how long after a cord is clamped should you remove the clamp?
After 24 hours or right before discharge
what is the sacral dimple?
It is a dimple that might be closed or open and if open can signal an abnormality or get infected later
uneven gluteal folds may signal what?
Hip dysplasia
In infants, the more rugae them more ___ baby is.
term
might skin tags on an ear be related to?
Kidney problems
When should murmurs disappear?
Within 2 days of birth
A displaced PMI might indicate what?
Cardiomegaly
What are some normal skin conditions of a newborn?
Acrocyanosis
Newborn rash
Mongolian spot
Lanugo
Milia
Vernix caseosa
What can cause thrush in newborns?
Formula fed baby
What constitutes microcephaly?
Head circumference below the 10th percentile
When are tears produced in infants?
Two months
what might cause bradypnea in infants?
Maternal analgesia or anesthesia
jaundice within the 1st 24 hours is____ usually related to problems of the_____
Pathological, liver
what might happen to the fontanelles if a baby is crying?
Bulging
the more term an infant is the____ the amount of vernix
Less
In what position should a newborn’s extremities be?
Flexed position with rapid recoil of the extremities to a flexed position
Blue sclera might be an indicator of what?
Osteogenesis imperfecta
brittle bone disease
how would you elicit the moro reflex?
let the head drop back slightly
what would you expect from a moro reflex?
Symmetrical abduction and extension of the arms and legs and legs flex up to the trunk with the neonate making a “c” shape with a thumb and index finger
what kind of response would the startle response be similar to?
Moro, but Signal partial or possible deafness
what position would a baby assume if they are being tested on the tonic neck?
Fencing
in which reflex with the neonate turn his head towards the direction of the stimulus and open his mouth?
Rooting
how would you elicit a rooting response from a baby?
Brush the side of the cheek near the corner of the mouth
when would you expect the rooting reflex?
From birth and disappearing between three and six months
when would you expect the sucking reflex?
Present at birth to 10 to 12 months
when would you expect the Palmer grasp?
From birth to three to four months
What might it mean if a baby does not present a sucking response?
Recently fed or premature or neurological defects
when would you expect the plantar grasp?
From birth to three to four months
what would you expect in the babinski response?
Hyperextension and fanning of the toes when the soul of a foot is stroked upward
what would you expect with a plantar grasp?
toes flexing down in a grasping motion
when would you expect the stepping or dancing reflex?
From birth to three to four weeks
what would you expect in the stepping or dancing reflex?
The new unit stepped up and down in place when their feet are a flat surface
Where should you do a heel stick?
The lateral or medial aspect of the heal to decrease the risk of nerve damage
in which reflex would you turn the head of the neonate to the side so that the chin is over the shoulder?
Tonic neck
when would you expect the tonic neck reflex?
Between birth and six weeks disappearing by four to six months
What is test conducted when the neonate Is asleep or lying still, and electrodes electrical activity of the cochlea, auditory nerve
Automated auditory brain stem response
What are some newborn screenings?
PKU, Hearing
Otoacoustic emissions records what response
Response of outer hair cells of the cochlea to clicking sounds
When should the umbilical cord stump detach?
In about 2 weeks
How tall should babies be?
18-20.5 in
Weight of infants should be?
5lb5oz to 9 lbs
what should the head circumference be?
12.5 to 14 inches
What is Phenylketonuria?
Error of metabolism where the body is unable to metabolize foods such as breast milk
What is harlequin sign?
One sign of the body is pink and the other is white
What might harlequin sign indicate?
Vasomotor instability
Pulse ox reading are taken where?
In either foot post ductal
Right hand -preductal
What is a passing pulse?
95% or greater in more than either extremities with 3% or less difference in both pre and post ductal reading
How often should a newborn be bathed?
Routine cleansing with water at each diaper change but not daily
what kind of soap should you use for a baby?
Mild soap with a neutral pH
what part of the body should you not soap?
The face
when is the best time to bathe a baby? Why?
Before a feeding to decrease the risk of emesis
What order should you Clean the baby?
The eyes to the buttocks, the dirtiest
What is it called when health infants younger than 5 months cry uncontrollably?
Colic
What might be prescribed for diaper rash?
Zinc oxide
Should the babies belly button with the cord attached be submerged in water?
Controversial but should follow the institutions policy
what are some methods for soothing colicky infants?
Sway the baby and walk around
Pacifier
Swaddle
Place the infant abdomen facing down over the knees and pat the back
Baby bouncer
Joy ride in the car
Put the infant in a car seat on top of a running clothes dryer
Walk in a stroller
What babies are considered colicky?
Healthy infants who cry 3 hours for 3 or more week and for at least three weeks
What are interventions to promote and support breastfeeding?
Formal breastfeeding education
Direct support of mothers during session
Training of primary care staff and breastfeeding techniques for support
Peer support
what is the composition of human milk?
Proteins, carbohydrates such as lactose, and cholesterol, vitamins and minerals, antibodies
what are the 3 stages of human as the body establishes the lactation process?
Colostrum
Transitional milk consisting of colostrum and milk
Mature milk consisting of foremilk and hind milk
What is the yellowish breast fluid that is present for two to three days after birth?
Colostrum
which type of breast milk has higher levels of protein and lower levels of fat, carbohydrates, and calories then other types of milk?
Colostrum
What type of milk is composed of 20% solids and 80% water?
Mature milk
what type of milk consists of colostrum and milk?
Transitional milk
what stage human milk last from day 3 to 10?
Transitional milk
what is the difference between foremilk and hind milk?
Foremilk is produced and stored between feedings end hind milk is produced towards the end of a session and has higher fat content.
which has a higher water content foremilk or hind milk?
Foremilk
In which part of the breast is milk produced?
The alveolar glands
success in breastfeeding depends on what five factors?
Women’s desire to breastfeed
Proper positioning
Latching on
Supply
Transferring of milk
what are some ways to position the breasts to assist with latching on?
Mother placing one hand around the breast several inches behind areola
the newborn is brought to the breast
what is the position called when the newborn is held off to the side?
Football or clutch
what is the newborns ability to grasp the breast and to effectively suckle called?
Latching-on
what are the steps to get a baby to latch?
Align nipple with baby’s nose
place the baby’s mouth one to two inches beyond the base of the nipple
to remove the baby insert a finger into the corner of the baby’s mouth to break the seal
What happens if you prop bottles?
Choking, otitis media, tooth decay
At what angle should you hold a bottle to feed a baby?
As much as you can to fill the nipple full of milk
what are signs of successful breastfeeding?
When the woman a tugging sensation when the newborn suckles
latch on pain is no longer than 10 seconds otherwise pain is a sign of poor latch
newborn’s tongue is between the lower gum and breast
swallowing can be heard
What should you do with unused formula from the bottle at the end of the feeding?
discard
what is the most critical and immediate physiological change that occurs in the transition from fetus to neonate?
Establishment of extra uterine respirations
What type of water should you used for formulas?
Distilled or boiled non-fluoride
what are two factors that negatively affect the transition to extrauterine respirations?
Decrease surfactant levels related to immature lungs
Persistent hypoxemia and acidosis that leads to constriction of pulmonary arteries
What are some signs of respiratory distress?
Cyanosis
Retractions of the chest wall
Abnormal respiration patterns such as apnea and tachypnea
Nostril flaring
Grunting
Hypotonia
tachypnea
What are the three factors that initiate extrauterine respirations?
Sensory, Mechanical and chemical stimuli
during the delivery process what is ejected out of the baby’s lungs?
About 30 milliliters of amniotic fluid
what phospholipid is responsible for peeping the alveolar sac partially open at the end of exhalation?
surfactant
what are two physical abnormalities of a chest?
pigeon chest and funnel chest
what are the respirations that define apnea?
Cessation of breathing or more than 20 seconds
What are the babies that get mechanical stimuli?
Those that pass through the vaginal canal
____ ______can be a sign of normal fluid which will be absorbed through the lymphatics
scattered crackles
What is it called when the chest wall sinks when breathing?
Chest retractions
when does the ductus venosus usually close?
Closes permanently within two weeks
under what condition does the foramen ovale close?
When the left atrial pressure is higher than the right atrial pressure
when does the ductus arteriosus close?
Within 15 hours but can sometimes be heard as a murmur upon auscultation
Which circulatory shunt can sometimes be heard a murmur?
Ductus arteriosus
What intervention causes the closure of ductus venosus shunt?
decreased blood flow and pressure through the shuntvia clamping of the cord
What development of the fetus completes the transition from fetal to neonatal circulation complete?
Functionally closed shunt
how long does it take for lung fluids to be cleared in most term infants?
Within the 1st four hours of life
Where in the refrigerator should breast milk be stored
in the back of the fridge
what are the steps to express milk manually?
- Wash hands
- massage each quadrant
- form the letter C with the thumb at the 12:00 position and forefinger at the 6:00 position
- push the thumb and finger towards the chest wall
- lean over and direct the spray of milk into a clean container
- repeat several times
- occasionally massage distal areas
- reposition fingers at 3:00 and 9:00 and repeat
when is a good time to express milk?
At the end of a feeding session
How long can you store breast milk at room temperature?
6 to 8 hours
how long can you store expressed milk in a refrigerator?
Up to five days
how long can you store expressed milk in a freezer Attached to a refrigerator?
Three to six months
how long can you store expressed milk in a deep freezer?
6 to 12 months
How should you thaw breast milk?
Bottle or bag in the refrigerator overnight
placing it under warm running water or bottle warmer
setting it in a container of warm water
how should you not thaw breast milk?
In a microwave oven or stove top
what are advantages of formula feeding?
Anyone can feed that invent
autonomy for the mother
decreases the frequency of feedings since digestion of formula is slower than that of human milk
what are some disadvantages to formula feeding?
Need for increased:
time to prepare formula
cost
risk of infection from lack of antibodies
risk of childhood obesity and insulin-dependent diabetes
What type of flow rates would you use for a newborn infant?
Slow flow
What is the composition of manufactured formulas and what is it missing?
50% more protein than human milk
Uses veggie oils that are easier to digest than animal fat but devoid of cholesterol, essential for brain development
What type of nipple flow rate is good for infants under 6 months?
Medium flow
What type of nipple flow is good for older infants?
Fast
Prolonged underdilution of formulas can cause what?
Constipation and eventually dehydration
How long can prepared formula bottles be kept in the fridge?
48 hrs max
What feeding position can decrease the risk of otitis media?
Head slightly higher than the trunk of the body
How much formula should newborns take in?
½-1 oz per feeding during the first few days of life to 2 ½-3oz per feeding by day 4 and gradually increases to 32 oz
How often can newborns be fed?
On demand or every 3-4 hours
Why is the liver important in blood coagulation?
Coagulation factors II, VII, IX, and X are synthesized in the liver
if a neonate misses a vitamin K shot then what is it at risk for?
Delayed clotting and hemorrhage
the decline of maternally acquired vitamin K levels is greater in _____ neonates, neonates with a history of _____ _____, and neonates of mothers who are on __.
breastfed, perinatal asphyxia, warfarin
where is vitamin K synthesized in the body?
Intestinal flora
what can cause need newborns skin to be jaundiced?
Indirect and direct and hyperbilirubinemia
difference between indirect and direct bilirubin
indirect is a fat soluble substance from RBC breakdown which is converted to direct bilirubin a water soluble substance from liver enzymes
what type of bilirubin can be excreted in urine and stool?
Direct bilirubin
what is the pathophysiology of jaundice?
There is an increase in the neonates RBC turnover and an increased RBC count at birth leading to a proportionately greater amount of bilirubin production that shows up in the skin
what are some common side effects of vitamin K injection?
Arrhythmia, pain, swelling at the injection site
Why is vitamin K needed in surgery and for blood coagulation?
Vitamin K is required for the hepatic synthesis of blood coagulation factors, II, VI, IX, X
how soon should a neonate get a vitamin K shot?
IM within one hour of birth
how does liver function affect blood coagulation?
It stores fat soluble vitamins a comma D, E, K, and iron
What are the normal parameters for bilirubin?
Ok if less than 6 at 24 hrs
Less than 11 at 48 hrs
What are some causes of jaundice?
ABO incompatibility and birth trauma
Where are some areas to press on to assess for jaundice?
Nose, forehead, or sternum
Why is it important for a jaundiced baby to eat?
So they can poop out the bilirubin
what does the Coombs test detect in neonates?
The antiglobulin or other hemolytic diseases related to RH or ABO incompatibility with a positive test of the baby
What are some common steps taken to prevent abduction?
Footprints and photo ID of infant
Arm bands of mother, father, and neonate, checked when entering or taking or returning
Never leave the baby unattended
Put the baby on the far side of the room away from the door to the hallway
What are the safe levels for bilirubin at 24 and 48 hours?
less than 6 and less than 11
What are normal respirations for a newborn?
30-60 bpm
What is a normal pulse for a newborn?
110-160
