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Unit 4 > Well NB > Flashcards

Well NB Flashcards

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1
Q

How long does it take for the foramen ovale to close?

A

Functional closure happens within hours after birth. 6 months-1 year for permanent closure

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2
Q

How long does it take for the ductus arteriosus to close?

A

12-24 hours for functional
2-3 weeks for permanent

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3
Q

Why are preterm infants susceptible to heat loss?

A

Skin thin
Muscle tone decreased so don’t flex to conserve heat
Blood vessels near surface
Little SQ fat
More surface area

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4
Q

What is acrocyanosis?

A

Blueish hands and feet from heat loss

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5
Q

What is non shivering thermogenesis?

A

NST-Metabolism of brown fat to produce heat
NB’s primary method of heat production

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6
Q

What is role of brown fat in NB and where are locations?

A

Brown fat (also called brown adipose tissue or BAT)
Heat generators for NB’s
—Preemies don’t have enough—
Located in: Axillae, sternum, between shoulder blades, back of neck

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7
Q

When will you see a temp drop in NB using NST (non shivering thermogenesis)?

A

After the fact…by the time see change in rectal temp the brown fat stores have been depleted.

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8
Q

What are the metabolic effects of cold stress in NB?

A

Metabolism rises, glucose stores burn»>hypoglycemia

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9
Q

What are the effects when NB metabolizes brown fat?

A

Increases acid release»>metabolic acidosis
Acid release also releases bilirubin»>jaundice

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10
Q

What are effects of cold stress on respiratory system of NB?

A

Increases demand for O2 and decreases production of surfactant»>hypoxia and respiratory distress syndrome

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11
Q

What is thermoneutral zone for full term naked baby?

A

89-92 degrees

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12
Q

What is thermoneutral zone for full term dressed baby?

A

75-80 degrees

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13
Q

Normal range of RBCs in NB.

A

4.8——-7.1million/microliter

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14
Q

Normal range of hemoglobin in NB.

A

15——24g/dL

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15
Q

Normal range of hematocrit in NB.

A

44%——-70%

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16
Q

Normal range of WBCs in NB.

A

9.1——–30 thousand/mm

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17
Q

Normal range of glucose in NB at 24 hours.

A

40-60

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18
Q

Normal range of glucose in NB at >24hours

A

50-90

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19
Q

What is polycythemia?

A

–Elevated RBC, HGB, HCT–
Increases risk of jaundice

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20
Q

What is considered hypoglycemia in NB?

A

Less than 45

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21
Q

What is kernicterus?

A

Brain damage from elevated bilirubin levels (usually from chronically elevated bili)

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22
Q

What is bilirubin?

A

byproduct of hemolysis (breakdown of RBCs)

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23
Q

Why are bilirubin levels high in NBs?

A

Many reasons:
They make twice as much for 3-6 weeks.
More RBCs with shorter life spans. (dying RBCs mean lots of bili going into blood)
Liver is immature and can’t process fast enough.
Fewer albumin to bind bili.
Intestinal flora isn’t established yet.
(remember they got to poop it out)
If feeding/pooping is slow bili stays in system.

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24
Q

When jaundice starts to become noticeable what are the usual bili levels?

A

5-6

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25
Q

When does “normal” or physiologic jaundice usually peak?

A

Day 2-3. Then will begin to fall.

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26
Q

What is the relationship of breastfeeding and jaundice?

A

Breastfed babies (especially if intake is insufficient) are at a higher risk of developing jaundice.
—Try to get feedings up and closely monitor bili levels. Can supplement with formula but make sure she pumps to maintain supply–

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27
Q

How does colostrum affect bili levels?

A

Natural laxative to get all the meconium out…decreases bili levels.

28
Q

Why are NBs at increased risk of fluid imbalance?

A

Kidneys are immature.
Total body water is easily depleted.
Fluid overload is easy because kidneys easily overwhelmed.
—If under radiant heat or lights insensible fluid loss increases–

29
Q

What is normal intake and output for first 3-5 days of life?

A

Intake: 60-100 mL/kg/daily
Output:1-2 voids daily

30
Q

What is normal intake and output after 3-5 days of life?

A

Intake: 150-175 mL/kg/daily
Output: At least 6 voids daily

31
Q

What are signs of infection in NB?

A

Change in activity, tone, feeding, color.
–Will not see fever, leukocytosis–

32
Q

Why should we always wear gloves handling baby (until they are bathed)?

A

Skin is contaminated with blood, amniotic fluid.

33
Q

What is normal range of respiratory rate for NB?

A

30-60

34
Q

What is periodic breathing?

A

Normal pauses in breathing lasting 5-10 seconds followed by rapid breathing for 10-15 seconds
Very common in preemies.
—Not a concern unless last longer than 20 seconds or have symptoms of oxygen deficiency.—

35
Q

What are common lung sound findings in NB?

A

Lungs can sound moist for first 1-2 hours (especially in CS)

36
Q

Where do you look for retracting?

A

Xiphoid (substernal)
Intercostal
Supraclavicular

37
Q

What is choanal atresia?

A

Blockage or narrowing of one or both nasal passages
—Important part of assessment of NB–

38
Q

What can a red or ruddy color indicate in NB?

A

Polycythemia

39
Q

What is normal range of pulse in NB?

A

120-160 bpm
Can drop to 100 during sleep and go up to 180 when crying

40
Q

What is average BP of NB?

A

95-65 systolic
60-30 diastolic

41
Q

What is normal temp range of NB?

A

97.7-99.5 axillary

42
Q

What is caution when taking rectal temp in NB?

A

Only have 3 cm in anus before a sharp angle. Easy to perforate intestine

43
Q

How do you tell the difference between caput and a cephalohematoma?

A

Caput will cross suture lines-Fluid only. Present at birth

Hematoma (blood) will have an abrupt stop at the suture line. Appears day 2-3

44
Q

What is talipes equinovarus?

A

Clubfoot. Foot will turn inward and cannot be moved to midline

45
Q

What is polydactyly?

A

Extra digit

46
Q

What is syndactyly?

A

Webbing between fingers/toes

47
Q

What is a pilonidal dimple?

A

Dimple at base of spine

48
Q

What are Barlow and Ortolani tests for?

A

Manipulation of legs and hips to test for hip dysplasia or dislocation
Barlow-pushing knees together (adduction)
Ortolani-rolling legs out (abduction)

49
Q

How much weight loss is normal after birth?

A

up to 10% in first few days
At 14 days, usually have regained to birth weight.

50
Q

What is normal head circumference range?

A

32-36 cm
Measured above eyebrow

51
Q

What is normal chest circumference range?

A

30.5-33 cm (ideally at 2 cm smaller than head)
Measured at nipple

52
Q

What is the Moro reflex?

A

Head/trunk allowed to drop 30 degrees.
Arms and legs will abduct with fingers opening and thumbs form C position. Then they will return to flexed body state.

53
Q

Where is normal ear location?

A

Top of pinna should line up with outer canthus of eye

54
Q

What is a tracheoesophageal fistula?

A

Abnormal connection with trachea and esophagus
Will choke, cough and become cyanotic when feed

55
Q

What is hypospadias?
Epispadias?

A

Urinary meatus opens on underside of penis
Epi-Opens on top side of penis

56
Q

What are milia?

A

Tiny white cysts (1mm) over baby’s face.
Go away on own

57
Q

What is erythema toxicum?

A

White/yellow papule with red base
—baby acne—

58
Q

What is nevus simplex?

A

Stork bite
Flat pink on eyelids, nose, nape of neck
Blanches
Goes away on own

59
Q

What is nevus flammeus?
–port-wine stain–

A

Permanent
Flat, pink/purple
Doesn’t blanch

60
Q

What is nevus vasculosus?
Remember vasculosos=vessels
—strawberry hemangioma–

A

Dark red and raised and rough
Usually fade on own

61
Q

APGAR scoring

A

Activity (muscle tone)
Pulse
Grimace (reflexes to touch)
Appearance
Respirations

62
Q

What are some common signs of RDS? (Respiratory distress syndrome)

A

Retractions, grunting, cyanosis, nasal flaring

63
Q

What are cafe au lait marks?

A

Brown birth marks.
Only concerning if there are more than 6 and large (0.5cm or larger)

64
Q

Assess sclera for color. What does grayish blue sclera indicate?

A

Bone disease
Anemia
Cyanosis

65
Q

What does brick dust diaper indicate?

A

Pseudo menstruation or uric acid crystals passed in urine–in females–(normal hormonal change)

66
Q

What is brachial palsy or Erb-Duchenne paralysis?

A

Weakness/paralysis of arm from injury to brachial plexus during delivery. Erb Palsy is most common type

67
Q

When is breastfeeding contraindicated?

A

HIV positive
Active TB
Herpes lesions on breast
Breast cancer
Mom is using drugs, alcohol, smoker, some prescription meds

Unit 4 (4 decks)

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