week 6 Flashcards

1
Q

convection, radiation, evaporation, or conduction?

The loss of heat as water evaporates from the newborn’s skin.
- Examples: Wet skin after birth, bathing, or diapering.
- Prevention: Drying the newborn immediately after birth, using warmed blankets, and minimizing bath time.

A

evaporation

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2
Q

Male newborn genitals
-Term or Preterm?
- Small scrotum
- Few rugae (wrinkles)
- Testes are palpable in the inguinal canal
-Term or Preterm?
- Testes are lower in scrotum
- Rugae

A

Male genitals
-Preterm
- Small scrotum
- Few rugae (wrinkles)
- Testes are palpable in the inguinal canal
-Term
- Testes are lower in scrotum
- Rugae

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3
Q

Should void by ________ hours, if not contact HCP

Stool
- meconium (1st stool) within ______ hours
- after that stool will appear different based on ___________

A

48 hours

24 hours

breastfeed vs formula feed

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4
Q

Umbilical cord care
- Clamp until _______
- Falls off 7-10 days usually, maybe more

A

Umbilical cord care
- Clamp until dried
- Falls off 7-10 days usually, maybe more

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5
Q

newborn skin
- __________ – thin, transparent, veins prominent, smooth feet (no creases)
- ___________– opaque, no vernix, creases on feet
- ____________ – dry, peeling

post term, preterm, term

A

Skin
- Preterm – thin, transparent, veins prominent, smooth feet (no creases)
- Term – opaque, no vernix, creases on feet
- Post term – dry, peeling

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6
Q

Apgar score

are all of these 0, 1, or 2 points?

  • Completely pink color
  • HR/pulse above 100 bpm
  • Vigorous cry with reflex irritability
  • Active motion with muscle tone
  • Good cry (respiratory effort)
A

2 points

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7
Q

treatment of transient tachypnea ( when the baby’s lungs retain fluid from the womb, making it difficult to breathe) of the new born
SATA
- chest xray
- oxyhood
- IV fluids
- Tube feed (if RR over 60, aspiration risk)
- ambulation

A
  • chest xray
  • oxyhood
  • IV fluids
  • Tube feed (if RR over 60, aspiration risk)
    X- ambulation
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8
Q

Yellow color of skin/sclera due to increased bilirubin levels from RBC breakdown
- Normal levels 4-6

A

jaundice

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9
Q

Apgar score

are all of these 0, 1, or 2 points?

  • Body pink, extremities blue in color
  • HR/pulse is slow, under 100
  • Grimace with reflex irritability
  • Some flexion with muscle tone
  • Slow, irregular respiratory effort
A

1 point (everything in between 0 and 2, not absent but not great either)

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10
Q

Pathological or physiological jaundice?

BAD
- r/t other condition/pathology
- Occurs within the first 24 hours of life
- Treatment - May use phototherapy or blood transfusion

A

Pathological jaundice = BAD

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11
Q

s/s of hypothermia or hyperthermia?

  • bradycardia
  • tachycardia
    -tachypnea
  • restless
  • irritability
  • shallow and irregular respirations
  • respiratory distress
  • apnea
  • hypoxemia
  • metabolic acidosis
A

hypo - bradycardia
hyper - tachycardia
both -tachypnea
hypo - restless
hyper - irritability
hypo - shallow and irregular respirations
hypo - respiratory distress
both - apnea
hypo - hypoxemia
hypo - metabolic acidosis

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12
Q

Nursing interventions & pharmacological treatment: NAS and withdrawal SATA
- Depends on drug withdrawaling from
- Morphine and methadone most common 1st line meds
- Adjunctive use of phenobarbital or clonidine to treat opioid withdrawal
- Buprenorphine – prevents intrauterine fetal seizures and other withdrawal symptoms, mom heroin use
- May require NICU admission
- continued drug use may be encouraged

A
  • Depends on drug withdrawaling from
  • Morphine and methadone most common 1st line meds
  • Adjunctive use of phenobarbital or clonidine to treat opioid withdrawal
  • Buprenorphine – prevents intrauterine fetal seizures and other withdrawal symptoms, mom heroin use
  • May require NICU admission
    X- continued drug use may be encouraged
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13
Q

Caput succedaneum or Cephalhematoma?

Collection of blood between scalp and skull bone
- Doesn’t cross suture line
- Appears day 1-2
- Disappears weeks - months

A

Cephalhematoma

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14
Q

Newborn bath
______ hours or more after birth

A

Newborn bath
6 hours or more after birth

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15
Q

Thermal changes initiating newborn respiration

increase or decrease in environmental temp after birth triggers newborn RR to increase?

A

Thermal changes
- decrease in environmental temp after birth = newborn RR increase
- avoid prolonged exposure to cold = cold stress/apnea

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16
Q
  • When infants experience cold stress, they begin to metabolize ____________ (brown fat or subq fat) stores
  • if the baby is not warmed and the cold stress continues, s/s of ___________ (hypo or hyperthermia) appear
A

When infants experience cold stress, they begin to metabolize brown fat stores, if the baby is not warmed and the cold stress continues, s/s of hypothermia appear

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17
Q

newborn Ear variations

Placement of ears
- Low set
- Consider syndromes such as down syndrome or intellectual disabilities

Ear form and cartilage distribution
- Term or Preterm? – shapeless, flat, no recoil
- Term or Preterm? – cartilage, curving, good recoil

A
  • Preterm – shapeless, flat, no recoil
  • Term – cartilage, curving, good recoil
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18
Q

signs of respiratory distress SATA
- nasal flaring
- fever
- intercostal or xiphoid retractions
- expiratory grunting or sighing
- seesaw respirations

A

signs of respiratory distress
- nasal flaring
X- fever
- intercostal or xiphoid retractions
- expiratory grunting or sighing
- seesaw respirations

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19
Q

Factors influencing the outcome of at-risk neonates
- Birth weight
- Gestational age
- time of delivery
- Intrauterine growth
- Type and length of illness
- Environmental factors
- Maternal factors
- Maternal-neonatal separation

A
  • Birth weight
  • Gestational age
    X- time of delivery
  • Intrauterine growth
  • Type and length of illness
  • Environmental factors
  • Maternal factors
  • Maternal-neonatal separation
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20
Q

all s/s of hypothermia or hyperthermia?

  • tachycardia, tachypnea, apnea
  • warm extremities, flushing, perspiration (term babies)
  • dehydration
  • lethargic, hypotonia
  • poor feed
  • irritability
  • weak cry
A

hyperthermia

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21
Q

Neonatal resuscitation protocol

should nurse intervene?

  • preterm baby, no tone, not breathing or crying
  • Labored breathing or persistent cyanosis
  • Apnea or gasping, HR <100
  • HR <100
  • HR <60
A

yes = intervene (warm, dry, stimulate, position airway, suction)

yes = intervene (position airway, suction, pulse ox, O2 or CPAP)

yes = = intervene (PPV, pulse ox, cardiac monitor)

yes = intervene

yes = intervene (chest compression, O2, epinephrine)

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22
Q

s/s of newborn illness SATA
- Absence of breath for 10 secs
- Inconsolable infant
- Continuous high pitched cry
- Discharge from umbilical cord
- Bleeding from circumcision

A

X- Absence of breath longer than 20 secs
- Inconsolable infant
- Continuous high pitched cry
- Discharge or bleeding from umbilical cord, circumcision, or any other opening

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23
Q

newborn size
- _____________ = <5.5 lbs
- ______________ = <3.3 lbs
- ______________ = <2.2 lbs

Very low birth weight VLBW, Low birth weight LBW, Extremely low birth weight ELBW

A
  • Low birth weight LBW = <5.5 lbs
  • Very low birth weight VLBW = <3.3 lbs
  • Extremely low birth weight ELBW = <2.2 lbs
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24
Q

newborn Eye variation

Transient strabismus, Doll’s eye, Subconjunctival hemorrhage

______________– red sclera, resolves itself
_______________– cross eyed, normal up to 4 mos, resolves itself or may be treated later
________________– due to underdeveloped head/eye coordination, normal up to 12 weeks, resolves itself

A

Eye variation
Subconjunctival hemorrhage – red sclera, resolves itself
Transient strabismus – cross eyed, normal up to 4 mos, resolves itself or may be treated later
Doll’s eye – due to underdeveloped head/eye coordination, normal up to 12 weeks, resolves itself

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25
convection, radiation, evaporation, or conduction? The loss of heat from a newborn's body to a cooler solid surface nearby, without direct contact. - Examples: Cold walls, windows, or equipment. - Prevention: Placing the newborn away from cold surfaces, and using radiant warmers.
radiation
26
bulb vs suction catheter after delivery? - Meconium plugs - Only used when infant comes out with no tone, pale, limp, no respiratory effort
suction catheter
27
Modified Finnegan neonatal abstinence score sheet T/F - Assessment tool - Scores severity of withdrawal from opioids - Monitors and documents infants clinical response to withdrawal - 21 most frequently observed symptoms - Each symptom assigned score, all symptoms observed during the scoring interval are added together for the total score - Scoring is dynamic, not static
all true
28
T/F - alveoli are the first to form during development of lungs? - the younger the baby, the fewer alveoli, the more severe RDS is likely to be?
F - alveoli are the last to form during development of lungs T - the younger the baby, the fewer alveoli, the more severe RDS is likely to be
29
Skin variations - Vernix caseosa – - Milia – - Telangiectatic nevi – - Mongolian spots – - Nevus flammeus – - Nevus vasculosus –
- Vernix caseosa – cheesy - Milia – white bumps on face - Telangiectatic nevi – stork bites - Mongolian spots – birth marks, mistaken for bruises - Nevus flammeus – port wine stain - Nevus vasculosus – strawberry mark
30
- overheating from incubators, radiant warmers, or environmental temp - maternal fever - maternal epidural anesthesia - phototherapy lights, sunlight - excessive swaddling - infection - CNS disorders – asphyxia - Dehydration can cause ___________
hyperthermia
31
Clubfoot - To assess – move foot to midline, resistance = clubfoot Sole plantar creases - As gestation progresses, proceeds to heel - Preterm or Term – creases? - Preterm or Term – smooth?
- Term – creases - Preterm – smooth
32
Preterm/Premature baby d/c T/F - Wait until 36-40 weeks gestation - Look for Factors that predict normal g&d - Head lag test - When lifted from prone position, babys head should hang below body - baby is quiet and calm, even when hungry - Appropriate amount and pattern of weight gain according to growth curves - Neurologic responses appropriate for corrected age
- Wait until 36-40 weeks gestation - Look for Factors that predict normal g&d X- Head lag test - When lifted from prone position, baby should raise head parallel to body X- Ability to cry vigorously when hungry - Appropriate amount and pattern of weight gain according to growth curves - Neurologic responses appropriate for corrected age
33
Common causes of indicated preterm birth SATA - Fetal disorders - IUGR - Polyhydramnios - oligohydramnios - Hydrops - Birth defects - Multiple gestation - Twin to twin transfusion syndrome TTTS – rare condition that affects identical twins in the womb where the blood supply of one twin moves to the other shared placenta - striae
- Fetal disorders - IUGR - Polyhydramnios - oligohydramnios - Hydrops - Birth defects - Multiple gestation - Twin to twin transfusion syndrome TTTS – rare condition that affects identical twins in the womb where the blood supply of one twin moves to the other shared placenta X- striae
34
s/s of newborn illness SATA - Refusal of 2 feedings in a row - Drowsy infant, refusing to feed for 8 hours - Difficulty waking baby - Cyanosis w/ a feeding - Cyanosis w/out a feeding
all
35
new born Respirations - First 2 hours of life RR is increased – up to ______ breaths/min - Normal respiratory _____ - _______ breaths/min
Respirations - First 2 hours of life RR is increased – up to 70 breaths/min - Normal respiratory 30-60 breaths/min
36
Nursing care for jaundice T/F - Keep baby warm 97.7 F + - Monitor amount of stools - Encourage early feedings - Increase Frequency of feeding 8-12 x in 24 hours – stimulates gut to poop bilirubin out - phototherapy - Wear diaper - Eye protection - Monitor hydration - Allow for bonding
all true
37
newborn Mouth variation - Assess suck – finger glove in mouth - Cleft lip and palate – risk for _________, monitor for _____________ and _____________ while feeding - Precocious teeth - Epstein’s pearls – harmless cysts, resolves itself
Mouth - Assess suck – finger glove in mouth - Cleft lip and palate – risk for aspiration, monitor for respiratory distress and aspiration while feeding - Precocious teeth - Epstein’s pearls – harmless cysts, resolves itself
38
s/s of respiratory distress syndrome, Neonatal abstinence syndrome, or Newborn withdrawal? - Vigorous, excessive suck - Vomit - Poor weight gain - poor feed – doesn’t eat a good amount, takes longer than 30 mins to feed - Sensitive gag reflex - Diarrhea
NAS and Newborn withdrawal s/s
39
convection, radiation, evaporation, or conduction? The loss of heat from a newborn's body to a cooler solid surface through direct contact. - Examples: Cold examination table, scale, stethoscope or clothing. - Prevention: Warming equipment before use, using pre-warmed blankets, and avoiding direct contact with cold surfaces.
conduction
40
consequences of newborn hyperthermia SATA - Hypotension - Dehydration - Seizures - Apnea - Hypernatremia - Respiratory distress
all - Hypotension and dehydrations (from increased water loss) - Seizures and apnea (from high core temp) - Hypernatremia - Respiratory distress
41
T/F Lanugo decreases as gestational age increases?
true
42
Apgar score are all of these 0, 1, or 2 points? - Pale blue color - Absent HR/pulse - Absent reflex irritability - Limp muscle tone - Absent respiratory effort
0
43
- Intrauterine growth restriction IUGR = rate of growth doesn’t meet _____________________ - Symmetric or Asymmetric IUGR = weight, length, head circumference all affected - Symmetric or Asymmetric IUGR = head normal but body is disproportionately small below 10th percentile - Increased risk of respiratory depression, sepsis, death is associated with symmetric or asymmetric IUGR?
- Intrauterine growth restriction IUGR = rate of growth doesn’t meet expected growth plan - Symmetric IUGR = weight, length, head circumference all affected - Asymmetric IUGR = head normal but body is disproportionately small below 10th percentile - Increase risk of respiratory depression, sepsis, death
44
which is done Prior to d/c - Hearing screening - Vision screening - Test for PKU (Guthrie blood test) after 24 hours of breast milk or formula feeding - Hep B - Hep B immunoglobulin - Circumcision - Parent education
- Hearing screening X- Vision screening - Test for PKU (Guthrie blood test) after 24 hours of breast milk or formula feeding - Hep B – all babies - Hep B immunoglobulin – baby’s with positive Hep B moms - Circumcision - Petroleum jelly with diaper change - Parent education - Swaddle infant - Back to sleep - Car seat safety - Infant CPR - Routine pediatric appointments
45
Fontanelles – - soft and flat = - sunken = - bulging =
Fontanelles – -should be soft and flat -sunken = dehydrated - gather more information, ask mom about number of wet diapers and feeding sessions over last 24 hours -bulging = ICP or crying - SBAR provider about ICP concern
46
convection, radiation, evaporation, or conduction? The loss of heat from a newborn's body to the surrounding cooler air. - Examples: Drafts, open windows, or air conditioning. - Prevention: Keeping the newborn away from drafts, using radiant warmers, and maintaining a warm environment.
convection
47
T/F When crying vitals will be slightly low and that is normal? Pulse ox reading screens for congenital heart disease in newborn?
F - Consider when crying – vitals will be slightly elevated and that is normal T - Pulse ox reading screens for congenital heart disease in newborn – low O2 levels indicate heart issues
48
all s/s of hypothermia or hyperthermia? - Acrocyanosis - Cool, mottled, pale skin - Hypoglycemia – they are using blood sugar to warm up - Transient hyperglycemia - Bradycardia - Tachypnea, restlessness, shallow and irregular respirations - Respiratory distress, apnea, hypoxemia, metabolic acidosis - Decreased activity, lethargy, hypotonia - Feeble cry - poor feed, Decreased weight gain
hypothermia
49
signs of respiratory distress SATA - tachypnea RR 76 - RR 22 - RR 40 - Central cyanosis – blue body and/or mouth - Circumoral cyanosis – blue mouth
signs of respiratory distress - tachypnea - RR outside of 30-60 breaths/min normal range - Central cyanosis – blue body and/or mouth - Circumoral cyanosis – blue mouth
50
Newborn vitals Pulse - Normally _____-______ (when is best time to assess?) - Sleep ______ - Vigorous cry __________ - locations to check pulse _________ and ____________
Newborn vitals Pulse - Normally 110-160 (at rest, best time to assess) - Sleep 80 - Vigorous cry 180 - Brachial and femoral pulse
51
observe umbilical for _________
hernia
52
Polydactyly, Simian crease, or syndactyly? Single line in palm – consider down syndrome Webbing Extra digits
Simian crease - Single line in palm – consider down syndrome Webbing – syndactyly Extra digits – polydactyly
53
Caput succedaneum or Cephalhematoma? Soft tissue swelling between scalp and skull bone - Will cross suture line - Appears at birth - Disappears hours – days
Caput succedaneum
54
which are s/s of hypothermia, hyperthermia or both? - hypoglycemia - transient hyperglycemia - dehydration - decreased activity - lethargy - hypotonia - poor feed - weak cry
hypo - hypoglycemia (using BS to warm up) hypo - transient hyperglycemia hyper - dehydration both - lethargy both - hypotonia both - poor feed both - weak cry
55
Term baby expected appearance T/F - Creases on soles of feet - Vernix only in skin creases - Instant recoil to ears - Prominent breast bud tissue - Increased lanugo
- Creases on soles of feet - Vernix only in skin creases - Instant recoil to ears - Prominent breast bud tissue X - lanugo decreases as fetus matures, term baby would have little to none
56
which are s/s of hypothermia or hyperthermia or both? - acrocyanosis - warm extremities - flushing - perspiration (term babies) - cool, mottled, pale skin
hypo - acrocyanosis hyper - warm extremities hyper - flushing hyper - perspiration (term babies) hypo - cool, mottled, pale skin
57
bulb vs suction catheter after delivery? - Mouth, then nose - Non meconium substance
bulb suction
58
Hypoglycemia s/s -Jittery/tremors/shivering -Seizures -Hypothermia -Breathing problems -asthma
-Jittery/tremors/shivering - remember baby cant shiver when cold so this would be a sign of something going on -Seizures -Hypothermia -Breathing problems X-asthma
59
s/s of respiratory distress syndrome, Neonatal abstinence syndrome, or Newborn withdrawal? - High pitched cry - Hyperirritability, difficult to console - Restlessness - Increased muscle tone - Exaggerated reflexes - Tremors, jerks, shaking - Seizures - Sneezing, hiccups, yawning - Short, unquiet sleep
NAS and Newborn withdrawal s/s
60
s/s of respiratory distress syndrome, Neonatal abstinence syndrome, or Newborn withdrawal? - Stuffy nose - Sneezing, yawning - Mottled - Tachypnea – greater than 60 breaths/min - Fever, Sweating - Hyperthermia - Diaper rash - Facial scratches - Pressure-point abrasions
NAS and Newborn withdrawal s/s
61
progressive respiratory distress noted by at least 6 hours of age until 72 hours of age
transient tachypnea of the new born
62
- Birth injury - Large baby - Shoulder dystocia - Difficult birth can cause fracture of which bone?
Fractures clavicle
63
Hep B immunoglobulin or Hep B ______________– all babies _____________ – baby’s with positive Hep B moms
- Hep B – all babies - Hep B immunoglobulin – baby’s with positive Hep B moms
64
Erythromycin T/F -Eye prophylaxis to prevent Hep B -Caused by untreated chlamydia or gonorrhea in mom -Can cause blindness in babies -Give to newborns with positive moms -Within 30 mins of birth -Applied inner to outer eye -Placed directly on eye
X - Eye prophylaxis to prevent conjunctivitis - Caused by untreated chlamydia or gonorrhea in mom - Can cause blindness in babies X - Give to all newborns - Within 30 mins of birth - Applied inner to outer eye - Placed directly on eye
65
Chemical changes initiating newborn respiration increased or decreased CO2? and increased or decreased pH and O2? triggers baby’s brain respiratory center to do first breath/gasp
increased Pco2 and decreased pH and Po2 = triggers baby’s brain respiratory center to do first breath/gasp
66
which ways can surfactant development in the alveoli be stimulated SATA - giving mom betamethasone - ROM - oxygen therapy - warming environment baby is born in
- giving mom betamethasone - steroid - ROM – a sign to the body to get surfactant production going X - oxygen therapy X- warming environment baby is born in
67
Newborns are at risk for cold/heat loss because of these issues with thermoregulation SATA - Large surface area-to-body mass ratio - high subq fat (low brown fat) - low body water content - Immature skin leading to evaporated water and heat loss - Poorly developed metabolic thermal stress (cant shiver) - Altered skin blood flow (peripheral cyanosis)
Newborns are at risk for cold/heat loss because - Large surface area-to-body mass ratio X- Low subq fat (more brown fat) X- High body water content - Immature skin leading to evaporated water and heat loss - Poorly developed metabolic thermal stress (cant shiver) - Altered skin blood flow (peripheral cyanosis)
68
heal stick BS is warranted for babies with SATA - Maternal DM - LGA - SGA - baby is shivering Bs level should be _____ or higher
heal stick BS is warranted for babies with SATA - Maternal DM - LGA - SGA - baby is shivering = hypoglycemia s/s 40 or higher
69
which infant would get a finnegan score SATA - All infants with maternal history suggesting narcotic/opioid use - Infants exhibiting s/s of narcotic/opioid withdrawal - All infants with low socioeconomic parents
- All infants with maternal history suggesting narcotic/opioid use - Infants exhibiting s/s of narcotic/opioid withdrawal X- All infants with low socioeconomic parents
70
when to do finnegan score -baseline =___ hours after birth -Continue scoring every 4 hours, before/after each feeding? -Scores 8 or + - Score every 2 hours until NAS meds started - Score every 4 hours or after every feeding while on NAS meds
When to score - 2 hours after birth for baseline - Continue scoring every 4 hours, after each feeding - Scores 8 or + - Score every 2 hours until NAS meds started - Score every 4 hours or after every feeding while on NAS meds
71
Effect of premature birth on g&d T/F - The more premature, the more risk for g&d problems -Preterm babies can still perform the same as full term babies -Age of all preemies are adjusted when development is evaluated
T- The more premature, the more risk for g&d problems F- Preterm babies will not perform the same as full term babies T- Age of all preemies are adjusted when development is evaluated
72
umbilical cord ___ arteries ___ veins
- 2 arteries - 1 vein
73
kangaroo care vs radiant warmer after delivery - ________________ – option for stable infants - ________________ – option for c/s infants, unstable infants, infants requiring close assessment
- Kangaroo care – option for stable infants - Radiant warmer – option for c/s infants, unstable infants, infants requiring close assessment
74
75
s/s of newborn illness SATA - Temp above 100.4 F – axillary - Temp below 97.7 F – axillary - Continual rise in temp - Forceful or frequent vomit - excessive burping
- Temp above 100.4 F – axillary - Temp below 97.7 F – axillary - Continual rise in temp - Forceful or frequent vomit X- excessive burping
76
newborn Back -Assess spine -Sacral dimple (pilonidal dimple) - Closed/open indentation or pit at the base of spine - If ________ must r/o - Spina bifida occulta - Tethered cord syndrome
Back - Assess spine - Sacral dimple (pilonidal dimple) - Closed/open indentation or pit at the base of spine - If open must r/o - Spina bifida occulta - Tethered cord syndrome
77
Hip dislocation - Ortolanis maneuver or Barlows maneuver? - (dislocation maneuver) – if hip is dislocated, will feel femur move out of acetabulum, brings legs together - (realignment maneuver) – if hip is dislocated, will hear hip click back into place (positive sign), brings legs apart
Hip dislocation - Barlows maneuver (dislocation maneuver) – if hip is dislocated, will feel femur move out of acetabulum, brings legs together - Ortolanis maneuver (realignment maneuver) – if hip is dislocated, will hear hip click back into place (positive sign), brings legs apart
78
Dubowitz ballard gestational age assessment = Looks at neuromuscular maturity and physical maturity Lower/Higher score = higher gestational age Lower/Higher score = lower gestational age
Higher score = higher gestational age Lower score = lower gestational age
79
are these signs of readiness to feed? - Rooting - Sucking - Bobbing head - aware and alert
yes
80
Cardiopulmonary changes -Closure of foramen ovale -Increased systemic vascular resistance and decreased pulmonary vascular resistance -Closure of ductus venosus -Closure of ductus arteriosus __________ = enhances perfusion of body systems _________ = between atriums __________ = blood flows from aorta to pulmonary artery ___________ = perfusion of liver
Cardiopulmonary changes - Increased systemic vascular resistance and decreased pulmonary vascular resistance = enhances perfusion of body systems - Closure of foramen ovale = between atriums - Closure of ductus arteriosus = blood flows from aorta to pulmonary artery - Closure of ductus venosus = perfusion of liver
81
Moms on methadone or buprenorphine should be encouraged to breastfeed b/c SATA - it can delay the onset of withdrawal symptoms - decrease severity of withdrawal symptoms - decrease need for pharmacological treatment - it should not be encouraged b/c puts the baby at risk for exposure to teratogenic substance
- it can delay the onset of withdrawal symptoms - decrease severity of withdrawal symptoms - decrease need for pharmacological treatment X- it should not be encouraged b/c puts the baby at risk for exposure to teratogenic substance
82
resolves, fades, or permanent? - Vernix caseosa – cheesy - Milia – white bumps on face - Telangiectatic nevi – stork bites - Mongolian spots – birth marks, mistaken for bruises - Nevus flammeus – port wine stain - Nevus vasculosus – strawberry mark
- Vernix caseosa – cheesy, wash it off with newborn bath - Milia – white bumps on face, resolves itself - Telangiectatic nevi – stork bites, may fade - Mongolian spots – birth marks, mistaken for bruises, permanent - Nevus flammeus – port wine stain – permanent - Nevus vasculosus – strawberry mark – may fade
83
lanugo vs vernix? fine, downy hair that covers a fetus's body white, cheesy substance that covers a baby's skin while in the womb
lanugo - fine, downy hair that covers a fetus's body vernix - white, cheesy substance that covers a baby's skin while in the womb
84
newborn size - Small for gestational age SGA = below ________ percentile - Appropriate for gestational age AGA = between ______ and ______ percentile - Large for gestational age LGA = above ________ percentile
- Small for gestational age SGA = below 10th percentile - Appropriate for gestational age AGA = between 10th and 90th percentile - Large for gestational age LGA = above 90th percentile
85
Nursing interventions & Nonpharmacological treatment: NAS and withdrawal SATA - Skin to skin - Swaddle - Gentle waking - Quiet, low light, minimal stimulation - Calm music - Massage therapy - Cluster care - Encourage parental involvement and rooming in - Moms on methadone or buprenorphine should formula feed - Finnegan scoring
Nursing interventions Nonpharmacological treatment - Skin to skin - Swaddle - Gentle waking - Quiet, low light, minimal stimulation - Calm music - Massage therapy - Cluster care - Encourage parental involvement and rooming in X - Moms on methadone or buprenorphine should be encouraged to breastfeed b/c it can delay the onset of and decrease severity of withdrawal symptoms, also decrease need for pharmacological treatment - Finnegan scoring
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- Normal = ___________ breathing – pauses in breathing up to 20 secs - Abnormal = __________ breathing – pauses in breathing over 20 secs
- Normal = periodic breathing – pauses in breathing up to 20 secs - Abnormal = apneic breathing – pauses in breathing over 20 secs
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Tonic neck Palmar and plantar grasp Moro/startle Rooting Suck Babinski Stepping these are all
reflexes born with
88
Skin color -Completely ________ – desired -Acrocyanosis – blue hands/feet or body/mouth -Central cyanosis – blue hands/feet or body/mouth
Skin color - Completely Pink – desired - Acrocyanosis – blue hands and/or feet - Central cyanosis – blue body and/or mouth
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should the nurse suggest feeding newborn with hyperthermia frequently to replace fluids?
yes - Breastfeed newborn frequently to replace fluids
90
newborn Resting posture - Preterm – extended or flexed? - Term – extended or flexed?
Resting posture - Preterm – extended - Term – flexed (helps preserve heat)
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Common causes of indicated preterm birth SATA - Diabetes - pain - Chronic HTN - Pre-eclampsia - Abruption - Previa - Gallbladder disease
- Diabetes X- pain - Chronic HTN - Pre-eclampsia - Abruption - Previa - Gallbladder disease
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s/s of newborn illness SATA - 2 green watery stools in a week - No wet diapers for 18-24 hours - Fewer than 6-8 wet diapers per day (after 4 days old) - Eye drainage
X- 2 consecutive green watery stools - No wet diapers for 18-24 hours - Fewer than 6-8 wet diapers per day (after 4 days old) - Eye drainage
93
Erb’s palsy or Epstein’s pearls? - type of brachial plexus injury that occurs most commonly during childbirth. - The brachial plexus is a network of nerves that controls movement and sensation in the arm and hand.
Erb’s palsy
94
breast vs formula feed? - Feed Q 2-3 hours - Burp in between each breast - feed Q 3-4 hours - burp after ½ formula
breast - Feed Q 2-3 hours - Burp in between each breast Formula - feed Q 3-4 hours - burp after ½ formula
95
- Preterm or Term newborns are at greatest risk for cold/heat loss? - Preterm or Term newborns lack ability to do the flexed posture for preserving heat? - Preterm or Term newborns have very thin skin with capillaries close to the surface that make them unable to preserve heat?
Preterm newborn – at even greater risk for cold/heat loss because - Lack of flexed posture for preserving heat - Very thin skin with capillaries close to the surface
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NAS complications SATA - Respiratory distress - Jaundice - Congenital anomalies - IUGR - Behavioral abnormality - Withdrawal - General complications from preterm birth (if it was necessary for fetal health)
all
97
Examples of Infants at greatest risk of developing physiological jaundice or pathological jaundice? - 2 day old infants born at 35 weeks - 2 day old SGA baby who is having difficulty breastfeeding - 2 day old baby diagnosed with a cephalhematoma
Examples of Infants at greatest risk of developing physiological jaundice - 2 day old infants born at 35 weeks = preterm liver - 2 day old SGA baby who is having difficulty breastfeeding = if they aren’t eating then they’re not pooping, and that’s how they get rid of excess bilirubin - 2 day old baby diagnosed with a cephalhematoma = collection of blood
98
Measure length - Head circumference - Chest circumference - Length head to toe is head or chest circumference bigger in newborn?
- Head circumference bigger than chest circumference
99
Female newborn genitals -Preterm/Term? - Prominent clitoris - Labia majora small and widely separates -Preterm/Term? - Labia majora covers labia minors and clitoris
Female genitals -Preterm - Prominent clitoris - Labia majora small and widely separates -Term - Labia majora covers labia minors and clitoris
100
new born BP - Goes up or down after birth? - Cap refill
BP - Goes down after birth
101
Gestational age - – 20 to 36 6/7 weeks - – 34 to 36 6/7 weeks - – 37 to 38 6/7 - – 39 to 40 6/7 weeks - – 41 to 41 6/7 weeks - – 42 weeks + Full term, Late preterm, Early term, Late term, Preterm, Post term
Gestational age - Preterm – 20 to 36 6/7 weeks - Late preterm – 34 to 36 6/7 weeks - Early term – 37 to 38 6/7 - Full term – 39 to 40 6/7 weeks - Late term – 41 to 41 6/7 weeks - Post term – 42 weeks +
102
Vitamin K shot - Newborns lacking vitamin K in gut when born - Vitamin K = clotting factor - Risk of thrombosis - Goes in vastus lateralis - 90 degree - Don’t aspirate - Needle length smaller than 1.5 inches - Dose 0.5 – 1.0 mL
Vitamin K shot - Newborns lacking vitamin K in gut when born - Vitamin K = clotting factor X - Risk of bleeding/hemorrhage - Goes in vastus lateralis - 90 degree - Don’t aspirate - Needle length smaller than 1.5 inches - Dose 0.5 – 1.0 mL
103
Pathological or physiological jaundice? - Occurs after the first 24 hours of life - Treatment – increase feedings 8-12 times/day, may use phototherapy
physiological jaundice
104
Newborn head - Larger or smaller than body? - About 1/4 of body size? - Contains 6 or 8 bones?
Newborn head - Larger than body - About ¼ of body size - Contains 6 bones
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new born Temp - ______.7 F – _____.5 F - location?
Temp - 97.7 F – 99.5 F - Axillary
106
which are RDS risk factors SATA - Preterm infant - c/s delivery - maternal DM - baby has an infection - baby has hypothermia - slow vaginal delivery
RDS risk factors - Preterm infant – surfactant lacking - c/s delivery – fluid doesn’t get squeezed out - maternal DM – hyperinsulinemia and hyperglycemia reduce fetal surfactant production - stress on baby – infection, cold stress, hypothermia X- slow vaginal delivery
107
T/F SmallGA and IUGrowthRestriction infants are at greater risk of death?
true
108
causes of transient tachypnea of the new born - SATA - LGA - SGA - Late preterm infants - Maternal over sedation - Maternal bleeding - Prolapsed cord - Breech birth - Maternal diabetes - c/s birth
- LGA X- SGA - Late preterm infants - Maternal over sedation - Maternal bleeding - Prolapsed cord - Breech birth - Maternal diabetes - c/s birth
109
newborn under radiant warmer is showing signs of hyperthermia, which would be appropriate treatment options SATA - Move away from heat - Undress newborn - lower room temp - give newborn bath
- Move away from heat - Undress newborn - lower room temp when in incubator X- give newborn bath
110
which Periods of reactivity is best for bonding and breastfeeding? 1st period of reactivity - 30 mins after birth Sleep phase - 2-4 hours 2nd period of reactivity - 4-6 hours
1st period of reactivity - 30 mins after birth - Good for bonding and breastfeeding
111
Babies more prone to having extra fluid still in lungs after delivery: - Quick vaginal labor - c/s delivery - slow vaginal labor
- Quick vaginal labor - c/s delivery b/c during vaginal birth process, fetal chest is compressed and squeezes fluid out
112
Genitalia variations for Male or Female? -Hypospadias – urethral opening on underside of penis -Epispadias - urethral opening on topside of penis -Phimosis – cant retract foreskin -Hydrocele – swelling in scrotum -Cryptorchidism – teste(s) fail to descend -Pseudo menstruation Hold _______________ if hypospadias/epispadias is a concern
Male - Hypospadias – urethral opening on underside of penis - Epispadias - urethral opening on topside of penis - Phimosis – cant retract foreskin - Hydrocele – swelling in scrotum - Cryptorchidism – teste(s) fail to descend Hold circumcision if hypospadias/epispadias is a concern Female - Pseudo menstruation
113
Encourage breastfeeding in 1st hour to help regulate _______
blood sugar
114
Caput succedaneum or Cephalhematoma? Potential results of unresolved _______________ - Jaundice (high bilirubin) - Anemia - Hypotension
cephalhematoma - Collection of blood between scalp and skull bone
115
Mechanical changes initiating newborn respiration - Fetus knows to decrease production of lung fluid 2-4 days prior to delivery - Still 80-100 mL of fluid in infant lungs at delivery - During vaginal birth process, fetal chest is _____________________
- During vaginal birth process, fetal chest is compressed and squeezes fluid out
116
Treatment for newborn with RDS - SATA - Oxygen therapy - CPAP - Mechanical ventilation - Surfactant admin - Thermoregulation in incubator - massage therapy - ECMO - Heart/lung machine allows baby’s lungs to rest and heal
- Oxygen therapy - CPAP - Mechanical ventilation - Surfactant admin - Thermoregulation in incubator X- massage therapy - ECMO - Heart/lung machine allows baby’s lungs to rest and heal
117
Sensory changes initiate respirations in newborns SATA - light - sounds - gravity - touch
ALL
118
are neonates considered at-risk SATA - Mom low socioeconomic status - Limited access to healthcare - No prenatal care - Exposure to environmental dangers - Pre-existing maternal conditions - Medical conditions r/t pregnancy - Pregnancy complications - Average gestational age
- Mom low socioeconomic status - Limited access to healthcare - No prenatal care - Exposure to environmental dangers - Pre-existing maternal conditions - Medical conditions r/t pregnancy - Pregnancy complications X- Average gestational age
119
Common causes of indicated preterm birth SATA - Heart disease - VTE - Asthma - HIV - active HSV - convenience - Obesity - AMA
- Heart disease - VTE - Asthma - HIV - active HSV X- convenience - Obesity - AMA
120
- newborn Weight loss - Term babies lose _______ of birth weight - Preterm babies lose _______ of birth weight - Weight gain - Double birth weight by 6 mos - Triple birth weight by 12 mos
Measure weight - Weight loss - Term babies lose 5%-10% of birth weight - Preterm babies lose 15% of birth weight - Weight gain - Double birth weight by 6 mos - Triple birth weight by 12 mos
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Apgar score A – P – G – A – R – Apgar score taken at _____ min and ___ min
Apgar score A – appearance (color) P – pulse (HR) G – grimace (reflex irritability) A – activity (muscle tone) R – respiratory effort Apgar score taken at 1 and 5 minutes