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week 6 COPY Flashcards

1
Q

bulb vs suction catheter after delivery?

  • Mouth, then nose
  • Non meconium substance
A

bulb suction

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2
Q

bulb vs suction catheter after delivery?

  • Meconium plugs
  • Only used when infant comes out with no tone, pale, limp, no respiratory effort
A

suction catheter

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3
Q

umbilical cord
___ arteries
___ veins

A
  • 2 arteries
  • 1 vein
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4
Q

kangaroo care vs radiant warmer after delivery

  • ________________ – option for stable infants
  • ________________ – option for c/s infants, unstable infants, infants requiring close assessment
A
  • Kangaroo care – option for stable infants
  • Radiant warmer – option for c/s infants, unstable infants, infants requiring close assessment
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5
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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6
Q

Apgar score
A –
P –
G –
A –
R –

Apgar score taken at _____ min and ___ min

A

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

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7
Q

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
A

0

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8
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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9
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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10
Q

Newborn vitals
Pulse
- Normally _____-______ (when is best time to assess?)
- Sleep ______
- Vigorous cry __________
- locations to check pulse _________ and ____________

A

Newborn vitals
Pulse
- Normally 110-160 (at rest, best time to assess)
- Sleep 80
- Vigorous cry 180
- Brachial and femoral pulse

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11
Q

new born Temp
- ______.7 F – _____.5 F
- location?

A

Temp
- 97.7 F – 99.5 F
- Axillary

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12
Q

new born Respirations
- First 2 hours of life RR is increased – up to ______ breaths/min
- Normal respiratory _____ - _______ breaths/min

A

Respirations
- First 2 hours of life RR is increased – up to 70 breaths/min
- Normal respiratory 30-60 breaths/min

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13
Q
  • Normal = ___________ breathing – pauses in breathing up to 20 secs
  • Abnormal = __________ breathing – pauses in breathing over 20 secs
A
  • Normal = periodic breathing – pauses in breathing up to 20 secs
  • Abnormal = apneic breathing – pauses in breathing over 20 secs
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14
Q

new born BP
- Goes up or down after birth?
- Cap refill

A

BP
- Goes down after birth

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15
Q

T/F

When crying vitals will be slightly low and that is normal?

Pulse ox reading screens for congenital heart disease in newborn?

A

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

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16
Q
  • 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
A

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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17
Q

Measure length
- Head circumference
- Chest circumference
- Length head to toe

is head or chest circumference bigger in newborn?

A
  • Head circumference bigger than chest circumference
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18
Q

Skin color
-Completely ________ – desired
-Acrocyanosis – blue hands/feet or body/mouth
-Central cyanosis – blue hands/feet or body/mouth

A

Skin color
- Completely Pink – desired
- Acrocyanosis – blue hands and/or feet
- Central cyanosis – blue body and/or mouth

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19
Q

newborn Resting posture
- Preterm – extended or flexed?
- Term – extended or flexed?

A

Resting posture
- Preterm – extended
- Term – flexed (helps preserve heat)

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20
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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21
Q

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

A

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

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22
Q

T/F

Lanugo decreases as gestational age increases?

A

true

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23
Q

observe umbilical for _________

A

hernia

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24
Q

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

A
  • 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
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25
Q

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

A

lanugo - fine, downy hair that covers a fetus’s body

vernix - white, cheesy substance that covers a baby’s skin while in the womb

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26
Q

Dubowitz ballard gestational age assessment = Looks at neuromuscular maturity and physical maturity

Lower/Higher score = higher gestational age
Lower/Higher score = lower gestational age

A

Higher score = higher gestational age
Lower score = lower gestational age

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27
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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28
Q

Female newborn genitals
-Preterm/Term?
- Prominent clitoris
- Labia majora small and widely separates
-Preterm/Term?
- Labia majora covers labia minors and clitoris

A

Female genitals
-Preterm
- Prominent clitoris
- Labia majora small and widely separates
-Term
- Labia majora covers labia minors and clitoris

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29
Q

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

A

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

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30
Q

Skin variations
- Vernix caseosa –
- Milia –
- Telangiectatic nevi –
- Mongolian spots –
- Nevus flammeus –
- Nevus vasculosus –

A
  • 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
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31
Q

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
A
  • 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
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32
Q
  • Birth injury
  • Large baby
  • Shoulder dystocia
  • Difficult birth

can cause fracture of which bone?

A

Fractures clavicle

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33
Q

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.
A

Erb’s palsy

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34
Q

Polydactyly, Simian crease, or syndactyly?

Single line in palm – consider down syndrome

Webbing

Extra digits

A

Simian crease - Single line in palm – consider down syndrome

Webbing – syndactyly

Extra digits – polydactyly

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35
Q

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?

A
  • Term – creases
  • Preterm – smooth
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36
Q

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
A

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

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37
Q

Newborn head
- Larger or smaller than body?
- About 1/4 of body size?
- Contains 6 or 8 bones?

A

Newborn head
- Larger than body
- About ¼ of body size
- Contains 6 bones

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38
Q

Fontanelles –
- soft and flat =
- sunken =
- bulging =

A

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

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39
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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40
Q

Caput succedaneum or Cephalhematoma?

Soft tissue swelling between scalp and skull bone
- Will cross suture line
- Appears at birth
- Disappears hours – days

A

Caput succedaneum

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41
Q

Caput succedaneum or Cephalhematoma?

Potential results of unresolved _______________
- Jaundice (high bilirubin)
- Anemia
- Hypotension

A

cephalhematoma - Collection of blood between scalp and skull bone

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42
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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43
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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44
Q

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

A

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

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45
Q

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 _____________________

A
  • During vaginal birth process, fetal chest is compressed and squeezes fluid out
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46
Q

Babies more prone to having extra fluid still in lungs after delivery:
- Quick vaginal labor
- c/s delivery
- slow vaginal labor

A
  • Quick vaginal labor
  • c/s delivery

b/c during vaginal birth process, fetal chest is compressed and squeezes fluid out

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47
Q

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

A

increased Pco2 and decreased pH and Po2 = triggers baby’s brain respiratory center to do first breath/gasp

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48
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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49
Q

Sensory changes initiate respirations in newborns SATA
- light
- sounds
- gravity
- touch

A

ALL

50
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

51
Q

signs of respiratory distress SATA
- tachypnea RR 76
- RR 22
- RR 40
- Central cyanosis – blue body and/or mouth
- Circumoral cyanosis – blue mouth

A

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

52
Q

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?
A

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

53
Q

which are RDS risk factors SATA
- Preterm infant
- c/s delivery
- maternal DM
- baby has an infection
- baby has hypothermia
- slow vaginal delivery

A

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

54
Q

which ways can surfactant development in the alveoli be stimulated SATA
- giving mom betamethasone
- ROM
- oxygen therapy
- warming environment baby is born in

A
  • 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
55
Q

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

A
  • 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
56
Q

progressive respiratory distress noted by at least 6 hours of age until 72 hours of age

A

transient tachypnea of the new born

57
Q

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

A
  • LGA
    X- SGA
  • Late preterm infants
  • Maternal over sedation
  • Maternal bleeding
  • Prolapsed cord
  • Breech birth
  • Maternal diabetes
  • c/s birth
58
Q

treatment of transient tachypnea 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
59
Q

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

A

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

60
Q

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.

A

convection

61
Q

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.

A

radiation

62
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

63
Q

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.

A

conduction

64
Q

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)

A

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)

65
Q
  • 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?
A

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

66
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

67
Q
A
68
Q

s/s of hypothermia or hyperthermia?

  • hypoglycemia
  • transient hyperglycemia
  • dehydration
  • decreased activity
  • lethargy
  • hypotonia
  • poor feed
  • weak cry
A

hypo - hypoglycemia (using BS to warm up)
hypo - transient hyperglycemia
hyper - dehydration
both - lethargy
both - hypotonia
both - poor feed
both - weak cry

69
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

70
Q

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

71
Q

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
A

hypothermia

72
Q
  • 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 ___________

A

hyperthermia

73
Q

consequences of newborn hyperthermia SATA
- Hypotension
- Dehydration
- Seizures
- Apnea
- Hypernatremia
- Respiratory distress

A

all

  • Hypotension and dehydrations (from increased water loss)
  • Seizures and apnea (from high core temp)
  • Hypernatremia
  • Respiratory distress
74
Q

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

A
  • Move away from heat
  • Undress newborn
  • lower room temp when in incubator
    X- give newborn bath
75
Q

should the nurse suggest feeding newborn with hyperthermia frequently to replace fluids?

A

yes - Breastfeed newborn frequently to replace fluids

76
Q

Tonic neck
Palmar and plantar grasp
Moro/startle
Rooting
Suck
Babinski
Stepping

these are all

A

reflexes born with

77
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

78
Q

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

A
  • 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
79
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
80
Q

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

A

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 +

81
Q

T/F

SmallGA and IUGrowthRestriction infants are at greater risk of death?

A

true

82
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
83
Q

newborn size

  • Small for gestational age SGA = below ________ percentile
  • Appropriate for gestational age AGA = between ______ and ______ percentile
  • Large for gestational age LGA = above ________ percentile
A
  • 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
84
Q
  • 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?
A
  • 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
85
Q

Common causes of indicated preterm birth SATA
- Diabetes
- pain
- Chronic HTN
- Pre-eclampsia
- Abruption
- Previa
- Gallbladder disease

A
  • Diabetes
    X- pain
  • Chronic HTN
  • Pre-eclampsia
  • Abruption
  • Previa
  • Gallbladder disease
86
Q

Common causes of indicated preterm birth SATA
- Heart disease
- VTE
- Asthma
- HIV
- active HSV
- convenience
- Obesity
- AMA

A
  • Heart disease
  • VTE
  • Asthma
  • HIV
  • active HSV
    X- convenience
  • Obesity
  • AMA
87
Q

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

A
  • 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
88
Q

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
A

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

89
Q

heal stick BS is warranted for babies with SATA
- Maternal DM
- LGA
- SGA
- baby is shivering

Bs level should be _____ or higher

A

heal stick BS is warranted for babies with SATA
- Maternal DM
- LGA
- SGA
- baby is shivering = hypoglycemia s/s

40 or higher

90
Q

Hypoglycemia s/s
-Jittery/tremors/shivering
-Seizures
-Hypothermia
-Breathing problems
-asthma

A

-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

91
Q

Encourage breastfeeding in 1st hour to help regulate _______

A

blood sugar

92
Q

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

A

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

93
Q

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

A

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

94
Q

Newborn bath
______ hours or more after birth

A

Newborn bath
6 hours or more after birth

95
Q

are these signs of readiness to feed?
- Rooting
- Sucking
- Bobbing head
- aware and alert

A

yes

96
Q

breast vs formula feed?

  • Feed Q 2-3 hours
  • Burp in between each breast
  • feed Q 3-4 hours
  • burp after ½ formula
A

breast
- Feed Q 2-3 hours
- Burp in between each breast

Formula
- feed Q 3-4 hours
- burp after ½ formula

97
Q

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

A

1st period of reactivity
- 30 mins after birth
- Good for bonding and breastfeeding

98
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

99
Q

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

A

jaundice

100
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

101
Q

Pathological or physiological jaundice?

  • Occurs after the first 24 hours of life
  • Treatment – increase feedings 8-12 times/day, may use phototherapy
A

physiological jaundice

102
Q

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
A

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

103
Q

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
A

all true

104
Q

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
A

NAS and Newborn withdrawal s/s

105
Q

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
A

NAS and Newborn withdrawal s/s

106
Q

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
A

NAS and Newborn withdrawal s/s

107
Q

NAS complications SATA
- Respiratory distress
- Jaundice
- Congenital anomalies
- IUGR
- Behavioral abnormality
- Withdrawal
- General complications from preterm birth (if it was necessary for fetal health)

A

all

108
Q

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
A

all true

109
Q

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

A
  • All infants with maternal history suggesting narcotic/opioid use
  • Infants exhibiting s/s of narcotic/opioid withdrawal
    X- All infants with low socioeconomic parents
110
Q

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

A

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

111
Q

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

A

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

112
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
113
Q

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

A
  • 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
114
Q

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

A
  • 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
115
Q

Hep B immunoglobulin or Hep B

______________– all babies
_____________ – baby’s with positive Hep B moms

A
  • Hep B – all babies
  • Hep B immunoglobulin – baby’s with positive Hep B moms
116
Q

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

A
  • 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
117
Q

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

A
  • Temp above 100.4 F – axillary
  • Temp below 97.7 F – axillary
  • Continual rise in temp
  • Forceful or frequent vomit
    X- excessive burping
118
Q

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

A

all

119
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

120
Q

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

A

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

121
Q

s/s of hypothermia or hyperthermia?

  • acrocyanosis
  • warm extremities
  • flushing
  • perspiration (term babies)
  • cool, mottled, pale skin
A

hypo - acrocyanosis
hyper - warm extremities
hyper - flushing
hyper - perspiration (term babies)
hypo - cool, mottled, pale skin

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