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61 Cards in this Set

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What are the causes of respirations in the neonate?
Chemical factors: catecholamines, and UC stimulate medulla
Mechanical factors: squeeze through vagina, crying
Thermal Factors: cold air stimulates medulla
Sensory Factors: sound and touch
What is the normal RR in infants and the characteristics of breathing?
30-60 breaths/min
(dec with sleep, inc with agitation)
Diaphragmatic initially
Periodic Breathing (count for a full min) normal: <20sec of apnea
Breathing through nose
What are the signs of respiratory distress?
Dyspnea
Cyanosis (in feet and hands normal) (central in abdomen and mucous membranes - bad)
Nasal Flaring (normal in first 4-6hrs)
Expiratory grunting (ok in 1st hrs)
Intercostal retractions
What is the CV adaptation in the neonate?
Ductus venosus and foramen ovale close
Pulmonary blood pressure drops
Ductus arteriosis becomes a ligament and sounds like a murmur if re-opened
What should you assess about the Cardiorespiratory status?
Choanal atresia (closed nares, leading to inc RR effort)
Color: pallor, ruddy, acrocyanosis
Heart sounds (murmur normal in first hrs of life)
Brachial and femoral pulses easiest to feel
Don't check BP (except baseline)
What are the expected CV vital signs?
HR: 120-160
Resting HR: 80-90
Crying HR: 180
Average BP: 65-95/30-60
What is the APGAR scoring system?
A: activity (absent, arms and legs bent, active movement)
P: Pulse (absent, <100, >100)
G: Grimace (flaccid, some flexion, active motion - sneeze cough pull away)
A: Appearance (blue/pale. body pink extremities blue, completely pink
R: Respirations (absent, slow irregular, vigorous cry)

7-10 excellent
4-6
0-3
What are the newborn causes of heat loss?
Convection: flow of heat from the body to open air
Radiation: loss of heat from the body to a cooler solid surface not in direct contact (move from window)
Evaporation: loss of heat when liquid is converted to vapor (dry completely after bath)
Conduction: loss of heat to cooler solid surface in direct contact with (scale)
How often should you assess the APGAR score?
1 min
5min
sometimes 10mins after birth
What replaces shivering in neonates?
brown fat metabolism
Gestational age affects it because its developed in the later stages and preterm baby wouldn't have it
What are the compensatory mechanisms of cold stress in a baby?
Inc metabolic rate (inc use of glucose and oxygen = hypoglycemia and hypoxia)
Brown fat metabolism (metabolic acidosis and jaundice)
Vasoconstriction (pale cold skin)
What is hyperthermia caused by?
>37.5
Swaddled babies (red, vasodilated)
Sepsis (vasoconstricted, cool, pale)
What is the difference between fever and hyperthermia?
fever has other signs:
not feeding
vomiting
not sleeping
Where should you assess T in neonate?
axillary and rectal
What are the hematologic adaptations in neonates?
Inc RBC 4.8-7.1 mill
Inc Hgb 14-22
Inc Hct 44%-64%
Inc WBC 30,000
Dec Vit (give dose PP)
Why does anemia occur in neonates?
the blood supply is slowly decreased because the maternal supply is gone reaching a low at 4-6 weeks PP causing anemia.
What are the adaptations of the GI?
Gastric emptying is slower
Intestines grow normal flora and break down Vit K
Digestive enzymes there except amalyse and lipase
What is caulic caused by?
mom's diet (cabbage)
esogeal sphincter (spitting)
What does meconium look like?
greenish black viscous with occult blood
passed in first 12-24hrs
What does transitional stools look like?
3rd day of life
green-brown to yellow brown
contain milk curds
What does milk stool look like?
BM: watery no smell
Formula: smell, thicker

diarrhea has a color change
Why is the glucose storage depleted quickly after birth?
Inc energy needs
dec glucose production
inc RBC
inc brain size
Stress (cold stress, circumscision, SMScreen, labor stress)
What is the normal BG in an infant and what is Tx for hypoglycemia?
Normal: 40-80

<40:
warm up or feed, check BG again
if still <40 take blood sample
Where can jaundice be found in an infant?
forehead
sclera
chest
tip of the nose

the older the baby the less the bilirubin
What is normal conjugation in neonate?
the bilirubin is soluble and excreted
What are the types of hyperbilirubinemia?
physiologic jaundice (resolves on own in 24hrs)
pathologic (non) jaundice
BF jaundice
true BM jaundice
What is non-physiologic jaundice?
when physiologic jaundice stays past 24hrs and causes Kernicterus (irreversible Cx)
How is physiologic jaundice treated?
meconium passing
What is breastfeeding jaundice?
early
when the baby isn't breast fed right and there's dec calories, fluids, and dehydration
What is breast milk jaundice?
later
unknown cause r/t breast milk
What is normal urine characteristics in neonates?
straw colored and odorless

3-5mL per hr
What is important to understand about the renal system in a neonate?
Urine dilution and dec concentration (1.001-1.020)
insensible water loss from RR
A/B balance is altered because of the dec bicarbonate
What are the nursing considerations of circumcision?
Pain
bleeding 30-45mins
signs of infection - pus, swelling, smell
Education: Vaseline, don't pull off bell (will fall off in 7-10 days), clean with water no soap)
What is important to understand about the immune system?
less effective in fighting off infection
IgG (placenta)
IgM
IgA (BM)

get TDAP (moms and dads)
What are the periods of reactivity?
First period of reactivity (1st 2hrs PP)
Period of sleep (8hrs)
Second period of reactivity
What are the behavioral states of the baby?
Quiet sleep state
Active sleep state
Drowsy state
Quiet alert state
active alert state
crying state (difficult for moms)
What are the normal findings of the fontanels?
Anterior:
flat (normal)
sunk in (dehydrated)
full (infection)

Posterior:
should be open
What is the difference between caput succedaneum and cephalohematoma?
Caput succedaneum:
fluid, edema, crosses midline

Cephalohematoma:
predisposes inc bilirubin r/t bruising
blood doesn't cross midline
What should you assess for in the face?
eye reactivity
symmetry
ear to eyes line
birth mark
What should you assess about the neck and clavicals?
trauma presence
nerve damage
run fingers over clavicle
nape of the neck (storks bites)
What should you assess about the cord?
count vessels (3)
dry out (mucous is bad)
What should you assess in the extremities?
dislocated hibs
cap refil <3 secs
reflexes (flexed, grasps)
pulses - brachial, femoral
creases in the hand (don't want single line)
What should you educate the patient on r/t the cord?
clamp removed in 48hrs
clean with water
keep dry
turn diaper in or out (prevent rubbing)
falls off in 7-10days
What should you assess about the vertebral column?
intact
dimple at the bottom
make sure theres no opening
How often should you weigh the baby and whats normal weight loss?
once at delivery and 12hrs after
monitor weight and length routine
10% in first 2 weeks
>10% is r/t water loss, not eating fully, renal dysfunction
What are the reflexes that are important to assess?
Rooting
Swallowing
Palmar grasp (finger in hand and baby curls fingers around hand)
Planter grasp (touch base of foot and baby curls toes)
Babinski (run finger up foot and baby should extend toes)
Moro (extention of legs and hands in C position when startled)
Stepping reflex
tonic neck reflex (turn head to one side when sleeping and arm on that side will flex and other arm will extend)
Whats the difference between tremors and seizures?
when you put your hand on the baby the tremors should stop

seizures will continue
What are the screening tests for newborns?
Hearing loss (not conductive more likely to have a speech delay)
Metabolic screen: PKU, cystic fibrosis, sickle cell test
Hypothyroidism
Galactosemia
Hemoglobinopathies
Congenital adrenal hyperplasia
after 24hrs the tests are related to protein (without food protein isn't present)
What is important to educate about bottle feeding?
Bottle doesn't need to be propped (ear infection, can choke)
head elevated while feeding
use 90mL in week
stay with the same brand
mix formula correctly
adding water dec calories
What is phototherapy?
used to treat elevated bilirubin levels
What is pseudomenstruation
vaginal bleeding with surge of estrogen
What is pseudomenstruation
vaginal bleeding with surge of estrogen
What is milia?
white bumps on the nose
What is erythema toxicum?
red blotches on face or trunk
What is important to assess about the breasts?
don't want too far or too close together
3rd nipple is normal
What are mongolian spots?
blue-ish black spots in AA and native americans- go away in 5 years
What is the ballard score?
assess gestational age based on neuromuscular activity and physical maturity
What neuromuscular assessments are made for the ballard score?
posture (flexed)
square window (wrist flexion)
Arm recoil (<90 angle)
Popliteal angle (<90 angle)
Scarf sign (elbow doesn't cross midline)
Heel to ear (<90 angle)
What are the physical maturity characteristics in ballards score?
skin
languno
plantar surface
breasts
eyes and ears
genitals
When does follow up occur?
7 days PP
Who is an early discharge candidate?
at 36hrs - 48hrs
poops and pees
feeding
bilirubin (based on age)
BG levels
Temperature Normal