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61 Cards in this Set
- Front
- Back
What are the causes of respirations in the neonate?
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Chemical factors: catecholamines, and UC stimulate medulla
Mechanical factors: squeeze through vagina, crying Thermal Factors: cold air stimulates medulla Sensory Factors: sound and touch |
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What is the normal RR in infants and the characteristics of breathing?
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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 |
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What are the signs of respiratory distress?
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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 |
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What is the CV adaptation in the neonate?
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Ductus venosus and foramen ovale close
Pulmonary blood pressure drops Ductus arteriosis becomes a ligament and sounds like a murmur if re-opened |
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What should you assess about the Cardiorespiratory status?
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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) |
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What are the expected CV vital signs?
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HR: 120-160
Resting HR: 80-90 Crying HR: 180 Average BP: 65-95/30-60 |
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What is the APGAR scoring system?
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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 |
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What are the newborn causes of heat loss?
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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) |
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How often should you assess the APGAR score?
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1 min
5min sometimes 10mins after birth |
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What replaces shivering in neonates?
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brown fat metabolism
Gestational age affects it because its developed in the later stages and preterm baby wouldn't have it |
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What are the compensatory mechanisms of cold stress in a baby?
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Inc metabolic rate (inc use of glucose and oxygen = hypoglycemia and hypoxia)
Brown fat metabolism (metabolic acidosis and jaundice) Vasoconstriction (pale cold skin) |
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What is hyperthermia caused by?
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>37.5
Swaddled babies (red, vasodilated) Sepsis (vasoconstricted, cool, pale) |
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What is the difference between fever and hyperthermia?
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fever has other signs:
not feeding vomiting not sleeping |
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Where should you assess T in neonate?
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axillary and rectal
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What are the hematologic adaptations in neonates?
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Inc RBC 4.8-7.1 mill
Inc Hgb 14-22 Inc Hct 44%-64% Inc WBC 30,000 Dec Vit (give dose PP) |
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Why does anemia occur in neonates?
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the blood supply is slowly decreased because the maternal supply is gone reaching a low at 4-6 weeks PP causing anemia.
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What are the adaptations of the GI?
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Gastric emptying is slower
Intestines grow normal flora and break down Vit K Digestive enzymes there except amalyse and lipase |
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What is caulic caused by?
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mom's diet (cabbage)
esogeal sphincter (spitting) |
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What does meconium look like?
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greenish black viscous with occult blood
passed in first 12-24hrs |
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What does transitional stools look like?
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3rd day of life
green-brown to yellow brown contain milk curds |
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What does milk stool look like?
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BM: watery no smell
Formula: smell, thicker diarrhea has a color change |
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Why is the glucose storage depleted quickly after birth?
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Inc energy needs
dec glucose production inc RBC inc brain size Stress (cold stress, circumscision, SMScreen, labor stress) |
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What is the normal BG in an infant and what is Tx for hypoglycemia?
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Normal: 40-80
<40: warm up or feed, check BG again if still <40 take blood sample |
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Where can jaundice be found in an infant?
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forehead
sclera chest tip of the nose the older the baby the less the bilirubin |
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What is normal conjugation in neonate?
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the bilirubin is soluble and excreted
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What are the types of hyperbilirubinemia?
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physiologic jaundice (resolves on own in 24hrs)
pathologic (non) jaundice BF jaundice true BM jaundice |
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What is non-physiologic jaundice?
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when physiologic jaundice stays past 24hrs and causes Kernicterus (irreversible Cx)
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How is physiologic jaundice treated?
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meconium passing
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What is breastfeeding jaundice?
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early
when the baby isn't breast fed right and there's dec calories, fluids, and dehydration |
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What is breast milk jaundice?
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later
unknown cause r/t breast milk |
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What is normal urine characteristics in neonates?
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straw colored and odorless
3-5mL per hr |
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What is important to understand about the renal system in a neonate?
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Urine dilution and dec concentration (1.001-1.020)
insensible water loss from RR A/B balance is altered because of the dec bicarbonate |
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What are the nursing considerations of circumcision?
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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) |
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What is important to understand about the immune system?
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less effective in fighting off infection
IgG (placenta) IgM IgA (BM) get TDAP (moms and dads) |
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What are the periods of reactivity?
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First period of reactivity (1st 2hrs PP)
Period of sleep (8hrs) Second period of reactivity |
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What are the behavioral states of the baby?
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Quiet sleep state
Active sleep state Drowsy state Quiet alert state active alert state crying state (difficult for moms) |
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What are the normal findings of the fontanels?
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Anterior:
flat (normal) sunk in (dehydrated) full (infection) Posterior: should be open |
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What is the difference between caput succedaneum and cephalohematoma?
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Caput succedaneum:
fluid, edema, crosses midline Cephalohematoma: predisposes inc bilirubin r/t bruising blood doesn't cross midline |
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What should you assess for in the face?
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eye reactivity
symmetry ear to eyes line birth mark |
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What should you assess about the neck and clavicals?
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trauma presence
nerve damage run fingers over clavicle nape of the neck (storks bites) |
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What should you assess about the cord?
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count vessels (3)
dry out (mucous is bad) |
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What should you assess in the extremities?
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dislocated hibs
cap refil <3 secs reflexes (flexed, grasps) pulses - brachial, femoral creases in the hand (don't want single line) |
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What should you educate the patient on r/t the cord?
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clamp removed in 48hrs
clean with water keep dry turn diaper in or out (prevent rubbing) falls off in 7-10days |
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What should you assess about the vertebral column?
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intact
dimple at the bottom make sure theres no opening |
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How often should you weigh the baby and whats normal weight loss?
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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 |
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What are the reflexes that are important to assess?
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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) |
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Whats the difference between tremors and seizures?
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when you put your hand on the baby the tremors should stop
seizures will continue |
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What are the screening tests for newborns?
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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) |
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What is important to educate about bottle feeding?
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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 |
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What is phototherapy?
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used to treat elevated bilirubin levels
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What is pseudomenstruation
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vaginal bleeding with surge of estrogen
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What is pseudomenstruation
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vaginal bleeding with surge of estrogen
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What is milia?
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white bumps on the nose
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What is erythema toxicum?
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red blotches on face or trunk
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What is important to assess about the breasts?
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don't want too far or too close together
3rd nipple is normal |
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What are mongolian spots?
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blue-ish black spots in AA and native americans- go away in 5 years
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What is the ballard score?
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assess gestational age based on neuromuscular activity and physical maturity
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What neuromuscular assessments are made for the ballard score?
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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) |
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What are the physical maturity characteristics in ballards score?
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skin
languno plantar surface breasts eyes and ears genitals |
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When does follow up occur?
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7 days PP
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Who is an early discharge candidate?
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at 36hrs - 48hrs
poops and pees feeding bilirubin (based on age) BG levels Temperature Normal |