Week 6-The Newborn Flashcards
What are the TORCH infections (common causes of neonatal sepsis)
Toxoplasmosis, Other, Rubella, CMV infection (below), Herpes simplex
What foods should mom refrain from eating to avoid listeriosis?
Unpasteurized milks/cheeses, raw or smoked seafood, undercooked meats
What is the difference between early onset and late onset breastfeeding jaundice?
Early onset breastfeeding jaundice- usually due to breastfeeding difficulties, dehydration causes impaired elimination of bilirubin and it is reabsorbed and recirculated
Late onset breastfeeding jaundice- Occurs once feeding is established (1-2 weeks) and occurs due to breast milk components, not fully understood
What serum level of bilirubin would indicate jaundice?
> 5mg/dL
What condition can develop due to neonatal hyperbilirubinemia?
Kernicterus- encephalopathy from high bilirubin blood crossing the blood-brain barrier. Can lead to long term brain damage-intellectual disabilities, hearing loss
What conditions can result from brachial plexus injuries?
Erb’s palsy, upper extremity damage, paralysis
What does Horner syndrome affect?
The nerve controlling pupil dilation, eyelid control and perspiration
What can phrenic nerve paralysis result in?
unilateral paralysis and possibly respiratory failure
What is caput succedaneum?
swelling of the scalp in a newborn. This swelling causes the scalp to feel spongy, does cross suture lines, typically harmless and starts to go down soon after birth
Define Cephalohematoma
typically harmless condition that causes blood to pool under a newborn’s scalp after a difficult vaginal delivery. Pressure during childbirth, including the use of vacuum extractors, can break blood vessels in the scalp
-Blood build up between periosteum and skull
What is Subgaleal hemorrhage?
an accumulation of blood that forms between newborn’s skull and periosteum. Because the hematoma can spread through a large plane with subgaleal hemorrhage, the amount of blood loss can be significant
What are common problems associated with posterm newborns?
Meconium aspiration, perinatal asphyxia, hypoglycemia, hypothermia, polycythemia
What are common problems associated with preterm newborns?
Hypothermia, hypotonia, hypoglycemia, polycythemia, hyperbilirubinemia, resp distress, neurodevelopmental delay
What weight ranges define SGA and LGA?
SGA- <2500 g st term or <10th percentile
LGA- >4000 g at term or >10th percentile
List risk factors for LGA
Maternal diabetes, multiparity, hx of macrosomic infant, post term gestation, maternal obesity, paternal height, male fetus, gestational weight gain, genetics
List risk factors for SGA
Maternal- hypertension, diabetes, smoking, substance use, victim of abuse, maternal nutrition
Placental- abruption, previa, insufficiency
Fetal- congenital anomalies, genetic disorders, chronic fetal infection, multiple gestation
What fuels non shivering thermogenesis?
Brown fat.
Brown fat is highly vascular, but limited in supply
What are the 4 forms of heat loss
Conduction, convection, evaporation and radiation
What contributes to newborns high risk for temp instability?
Thin skin, blood vessels close to the surface. Lack of shivering ability, limited stores of glucose, glycogen and fat
Limited use of voluntary muscle activity, large body surface area to relatively low weight
Limited sweating ability
What complications can cold stress cause for newborns?
metabolic and respiratory acidosis which can worsen RDS, increased metabolism/glycolysis which can worsen hyperbilirubenemia
What is a pseudo strabismus?
Both eyes are looking forward but appear to be cross-eyed due to shape of babies’ nasal bridge and eyelid folds
What is Craniosynostosis?
when skull bones fuse together early. Can lead to head deformity, impairment and increased pressure on the brain
What does APGAR assess?
Appearance (skin colour), pulse, grimace (reflex irritability), activity (muscle tone), and respiration
What are the 3 behavioural periods after birth
- First period of reactivity (30 min to 2 hours after birth)
- Period of decreased responsiveness (30-120min of life)
- Second period of reactivity (2-8 hours)
What is the harlequin sign?
asymmetric flushing and sweating of the face. It is caused by unilateral blockade of sympathetic fibers, which carry the vasodilator and sudomotor nerves to the face
What 3 immunoglobulins are newborns dependent on?
IgG, IgA and IgM
What is administered 1 hour after birth to prevent ophthalmia neonatrum?
Erythromycin
What are the effects of newborn limited renal capacities
-urine has low specific gravity
-low GFR and limited excretion and conservation capability for salt, water loads and drugs
What can occur in newborns due to immature nervous control of stomach and cardiac sphincter?
-regurgitation and uncoordinated peristalsis activity
What are the benefits of delayed cord clamping?
Increased placental infusion for increased neonatal blood volume at birth of approx. 30%
Increased iron stores
Improved transitional circulation, better establishment of RBC volume, decreased risk for blood transfusion, lower incidence of necrotizing enterocolitis and intraventricular hemorrhage
How long should cord clamping be delayed according to SOGC
60 seconds
When delayed cord clamping is not possible, cord milking should be considered
What is transient tachypnea?
tachypnea, temporary symptoms of resp distress up to 3 days. Common in babies born by C/S. May need supportive care with O2 or CPAP and nutritional support
When are surfactant levels sufficient in utero?
What is used to stimulate fetal surfactant production?
- At 32 weeks surfactant is sufficient, it is optimal at 35
- corticosteroids
What chemical factors assist in initiating respiration?
hypoxia in labour increases resp drive at birth, stimulates medulla and the carotid receptors
What mechanical factors assist in initiating respiration?
Pressure due to passageway is applied to the chest prior to birth. When pressure is removed, the airways open
Thoracic squeezing during birth eliminates a small amount of fluid in the lungs
A mother is concerned that her newborn will be exposed to communicable diseases after she is discharged. While teaching the mother ways to decrease the risk of infection, what type of immunity should the nurse explain was transferred to her baby through the placenta?
Active natural
Passive natural
Active artificial
Passive artificial
Passive natural
(Passive natural immunity is developed from an antigen-antibody response in the mother that is transmitted to the fetus. Active natural immunity is acquired by an individual in response to a disease or an infection. Active artificial immunity is acquired by an individual in response to small amounts of antigenic material (e.g., vaccination). Passive artificial immunity is conferred by the injection of antibodies prepared in another host.)
The nurse is caring for a newborn with a caput succedaneum. What is the priority nursing action?
Supporting the parents
Recording neurologic signs
Applying a hard protective cap on the head
Applying ice packs to the hematoma
Supporting the parents
(Parents need support and reassurance that their newborn is not permanently damaged. Caput succedaneum does not cause impaired neurologic function. No special protection of the head is required; routine safety measures are adequate.)
The nurse in the birthing room is assessing a newborn. Which characteristic would be assigned an Apgar value of 2?
A strong cry
A heart rate of 90 beats/min
Slight flexion of legs and arms
Pink body and blue extremities
A strong cry
(A strong cry indicates effective respiratory function and is assigned a value of 2. If flexion of the arms and legs is slight and movement is diminished, a value of 1 is assigned. A value of 1 is assigned when the body is pink and the extremities are blue. The heart rate should be more than 100 beats/min; therefore a pulse of 90 beats/min is assigned a value of 1.)
A neonate born at 39 weeks’ gestation is small for gestational age. Which commonly occurring problem should the nurse anticipate when planning care for this infant?
Anemia
Hypoglycemia
Protein deficiency
Calcium deficiency
Hypoglycemia
(Hypoglycemia is common in newborns who are small for gestational age because of malnutrition in utero; the nurse can detect this with a blood glucose test and notify the primary healthcare provider. Polycythemia, not anemia, is more likely to occur. Although a protein deficiency may occur, it is not life threatening at this time. Although hypocalcemia may occur, it is not as common as hypoglycemia.)
A client has delivered her infant by cesarean birth. The nurse monitors the newborn’s respiration closely, because infants born via the cesarean method are prone to atelectasis. Why does this occur?
The ribcage is not compressed and released during birth.
The sudden temperature change at birth causes aspiration.
There is usually oxygen deprivation after a cesarean birth.
There is no gravity during the birth to promote drainage from the lungs
The ribcage is not compressed and released during birth.
A home visit nurse is providing health promotion on safety to a family of a 1-week-old infant. Which of the following statements by the parents indicates the need for further teaching?
A. We will swaddle our son to keep him quiet and warm to sleep
B. We will position our infant on his side for sleeping
C. We will give our son a pacifier before placing him in his crib
D. We will place our infant in a rear-facing car seat in the back seat of the car.
Answer: B
B. We will position our infant on his side for sleeping
