Week 6-The Newborn

Question 1

What are the TORCH infections (common causes of neonatal sepsis)

Answer 1

Toxoplasmosis, Other, Rubella, CMV infection (below), Herpes simplex

Question 2

What foods should mom refrain from eating to avoid listeriosis?

Answer 2

Unpasteurized milks/cheeses, raw or smoked seafood, undercooked meats

Question 3

What is the difference between early onset and late onset breastfeeding jaundice?

Answer 3

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

Question 4

What serum level of bilirubin would indicate jaundice?

Answer 4

> 5mg/dL

Question 5

What condition can develop due to neonatal hyperbilirubinemia?

Answer 5

Kernicterus- encephalopathy from high bilirubin blood crossing the blood-brain barrier. Can lead to long term brain damage-intellectual disabilities, hearing loss

Question 6

What conditions can result from brachial plexus injuries?

Answer 6

Erb’s palsy, upper extremity damage, paralysis

Question 7

What does Horner syndrome affect?

Answer 7

The nerve controlling pupil dilation, eyelid control and perspiration

Question 8

What can phrenic nerve paralysis result in?

Answer 8

unilateral paralysis and possibly respiratory failure

Question 9

What is caput succedaneum?

Answer 9

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

Question 10

Define Cephalohematoma

Answer 10

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

Question 11

What is Subgaleal hemorrhage?

Answer 11

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

Question 12

What are common problems associated with posterm newborns?

Answer 12

Meconium aspiration, perinatal asphyxia, hypoglycemia, hypothermia, polycythemia

Question 13

What are common problems associated with preterm newborns?

Answer 13

Hypothermia, hypotonia, hypoglycemia, polycythemia, hyperbilirubinemia, resp distress, neurodevelopmental delay

Question 14

What weight ranges define SGA and LGA?

Answer 14

SGA- <2500 g st term or <10th percentile
LGA- >4000 g at term or >10th percentile

Question 15

List risk factors for LGA

Answer 15

Maternal diabetes, multiparity, hx of macrosomic infant, post term gestation, maternal obesity, paternal height, male fetus, gestational weight gain, genetics

Question 16

List risk factors for SGA

Answer 16

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

Question 17

What fuels non shivering thermogenesis?

Answer 17

Brown fat.
Brown fat is highly vascular, but limited in supply

Question 18

What are the 4 forms of heat loss

Answer 18

Conduction, convection, evaporation and radiation

Question 19

What contributes to newborns high risk for temp instability?

Answer 19

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

Question 20

What complications can cold stress cause for newborns?

Answer 20

metabolic and respiratory acidosis which can worsen RDS, increased metabolism/glycolysis which can worsen hyperbilirubenemia

Question 21

What is a pseudo strabismus?

Answer 21

Both eyes are looking forward but appear to be cross-eyed due to shape of babies’ nasal bridge and eyelid folds

Question 22

What is Craniosynostosis?

Answer 22

when skull bones fuse together early. Can lead to head deformity, impairment and increased pressure on the brain

Question 23

What does APGAR assess?

Answer 23

Appearance (skin colour), pulse, grimace (reflex irritability), activity (muscle tone), and respiration

Question 24

What are the 3 behavioural periods after birth

Answer 24

1. First period of reactivity (30 min to 2 hours after birth)
2. Period of decreased responsiveness (30-120min of life)
3. Second period of reactivity (2-8 hours)

Question 25

What is the harlequin sign?

Answer 25

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

Question 26

What 3 immunoglobulins are newborns dependent on?

Answer 26

IgG, IgA and IgM

Question 27

What is administered 1 hour after birth to prevent ophthalmia neonatrum?

Answer 27

Erythromycin

Question 28

What are the effects of newborn limited renal capacities

Answer 28

-urine has low specific gravity
-low GFR and limited excretion and conservation capability for salt, water loads and drugs

Question 29

What can occur in newborns due to immature nervous control of stomach and cardiac sphincter?

Answer 29

-regurgitation and uncoordinated peristalsis activity

Question 30

What are the benefits of delayed cord clamping?

Answer 30

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

Question 31

How long should cord clamping be delayed according to SOGC

Answer 31

60 seconds
When delayed cord clamping is not possible, cord milking should be considered

Question 32

What is transient tachypnea?

Answer 32

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

Question 33

When are surfactant levels sufficient in utero?
What is used to stimulate fetal surfactant production?

Answer 33

1. At 32 weeks surfactant is sufficient, it is optimal at 35
2. corticosteroids

Question 34

What chemical factors assist in initiating respiration?

Answer 34

hypoxia in labour increases resp drive at birth, stimulates medulla and the carotid receptors

Question 35

What mechanical factors assist in initiating respiration?

Answer 35

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

Question 36

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

Answer 36

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.)

Question 37

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

Answer 37

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.)

Question 38

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

Answer 38

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.)

Question 39

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

Answer 39

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.)

Question 40

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

Answer 40

The ribcage is not compressed and released during birth.

Question 41

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 41

Answer: B
B. We will position our infant on his side for sleeping