Family Health Exam 1-3

Front 1

Nursing Assessment in Identification of Infection

Back 1

- Recent exposure to infectious agents
- Prodromal symptoms
- Immunization history
- History of having the disease

Front 2

How Do you Prevent Spread of Disease?

Back 2

1. Primary prevention of the disease: Immunization

2. Control spread of disease to others:
- Reduce risk of cross-transmission of organisms
- Infection control policies
- Handwashing

Front 3

What are prodromal symptoms?

Back 3

Those symptoms that occur between early manifestation and clinical observation.

Front 4

What children are immunodeficient?

Back 4

- Receiving steroid therapy
- Other immunosuppressive therapies (chemo)
- Generalized malignancies (leukemia)
- Immunologic disorder (HIV)

Front 5

Why use caution with Compromised Children?

Back 5

- Risk for complications from communicable diseases, especially varicella (chickenpox) and erythema infectiosum (EI)-fifth disease
- Risk for viremia (virus in blood) from varicella zoster virus (VZV)

Front 6

What intervention is necessary for a fever and uncontrolled rash?

Back 6

Isolation until diagnosis is confirmed.

Front 7

Diptheria

Back 7

- Source: Discharge from mucous membrane of nose, skin, and open lesions
- Transmission: Direct contact with infected person Incubation period: 2-5 days
- Period of communicability:
usually 2 weeks, up to four weeks

Resembles common cold, sore throat, fever, cough, toxemia, shock and death within 6-10 days if untreated

Front 8

Chickenpox

Back 8

- AGENT: Varicella Zoster Virus
- SOURCE: Respiratory Tract
- TRANSMISSION: Direct Contact, Droplet, Airborne and Contaminated Objects
- INCUBATION PERIOD: 2-3 weeks
- PERIOD OF COMMUNICABILITY: Probably 1 day before eruption of lesion to 6 days after first crop of vesicles crusted.

Fever, malaise, highly pruritic rash, begins as macules and then progresses rapidly to vesicles.
Strict isolation precautions in hospital, until vesicles have dried. Isolate high risk children from infected children.

Front 9

Erythema Infectiosum (Fifth Disease)

Back 9

AGENT: Human Parvovirus HPV
SOURCE: Infected person
TRANSMISSION: Unknown, possibly respiratory secretions
- INCUBATION PERIOD: 4-14 days, as long as 21 days
- PERIOD OF COMMUNICABILITY: Before onset of symptoms, for a week after onset of symptoms

Three stages…I erythema on face (slapped face)
II maculopapular rash on upper extremities, III rash subsides but reappears with irritation.

Front 10

Roseola

Back 10

AGENT: Human Herpes virus
SOURCE: Unknown
TRANSMISSION: Unknown, virtually limited to children 6 months to 36 months of age
- INCUBATION PERIOD: 5-15 days
PERIOD OF COMMUNICABILITY: Unknown

Persistent high fever, rose-pink macules, nonpruritic.

Front 11

Rubeola (Measles)

Back 11

- AGENT: Virus
- SOURCE: Respiratory tract secretions, blood, and urine
- TRANSMISSION: Direct contact with droplets
- INCUBATION PERIOD: 10-20 days
- PERIOD OF COMMUNICABILITY: From 4 days before to 5 days after rash appears

Fever, malaise, cough, conjunctivitis, Koplik spots. Also have photophobia.

Front 12

What are Koplik spots?

Back 12

They are small, white spots (often on an reddened background) that occur on the inside of the cheeks early in the course of measles.

Front 13

Mumps

Back 13

- AGENT: Paramyxovirus
- SOURCE: Saliva
- TRANSMISSION: Direct contact or with droplet spread
- INCUBATION PERIOD: 14-21 days
- PERIOD OF COMMUNICABILITY: Immediately before and after swelling occurs

Fever, headache, parotitis (enlarged parotid glands)

Front 14

Pertussis (Whooping Cough)

Back 14

- AGENT: Bordetella pertussis
- SOURCE: Respiratory tract
- TRANSMISSION: Direct contact
- INCUBATION PERIOD: 6-20 days
- PERIOD OF COMMUNICABILITY: Before onset of paroxysms and up to 4 weeks after

Cough most often occurring at night, whooping sound.

Front 15

Poliomyelitis

Back 15

- AGENT: Enterovirus, type 1-3
- SOURCE: Feces and oropharyngeal secretions
- TRANSMISSION: Direct contact
- INCUBATION PERIOD: 7-14 days
- PERIOD OF COMMUNICABILITY: Not known, up to 1week in throat and 4 weeks in feces.

Fever, sore throat, headache, pain and stiff neck, central nervous system paralysis.

Front 16

Rubella (German Measles)

Back 16

- AGENT: Rubella virus
- SOURCE: Nasopharyngeal secretions, blood stool and urine
- TRANSMISSION: Direct contact
- INCUBATION PERIOD: 14-21 days
PERIOD OF COMMUNICABILITY: 7 days before and 5 days after appearance of rash

Rash appears on face and rapidly spreads , complications are rare. Most benign of all childhood illnesses.

Front 17

Scarlet Fever

Back 17

- AGENT: Group A streptococcus
- SOURCE: Nasopharyngeal secretions
- TRANSMISSION: Direct contact
- INCUBATION PERIOD: 2-5 days
- PERIOD OF COMMUNICABILITY: During incubation and period of illness, approximately 10 days.

Fever, headaches, malaise and lymphadenopathy

Front 18

lymphadenopathy

Back 18

swelling of one or more lymph nodes

Front 19

Conjunctivitis

Back 19

- In newborns: chlamydia, gonorrhea, or herpes simplex virus
- In infants: may be sign of tear duct obstruction
- In children: causes are bacterial (most common), viral, allergic, or foreign body

Front 20

Communicable Disease Assessment

Back 20

- Identification of infectious agent
- Recent exposure to a known case
- prodromal symptoms
- immunization history
- history of having the disease
- NURSING DIAGNOSIS (formulate nursing diagnosis for knowledge deficit)

Front 21

Communicable Disease Plan of Care & Implementation

Back 21

- Child will not spread infection
- Child will not experience complications
- Child will have minimal discomfort
- Child and family will receive adequate emotional support/education

Front 22

NURSING DIAGNOSIS: Risk for infection related to susceptible host and infectious agents.

Back 22

- Institute infection control practices
- Work with family to ensure adherence to therapeutic regimen
- Report disease of health department to monitor outbreak
- Identify susceptible individuals in community
- Promote public education on prevent/spread of communicable diseases

Front 23

NURSING DIAGNOSIS: Risk for injury related to disease complications, trauma to skin from scratching

Back 23

- Involve parent and child in planning and carrying our therapeutic regime
- Monitor vital signs and lab values to detect early signs of potential complications
- Observe skin to detect signs of scratching, trauma, infection
- Institute seizure precautions
- Maintain good body hygiene
- Proper hydration

Front 24

NURSING DIAGNOSIS: Pain related to skin lesions, malaise

Back 24

- Use comfort measures such as vaporizer, gargling, lozenges to keep membranes moist
- Use nonpharmacologic techniques for pain reduction
- Adminster analgesics, antipyretics, and antipuritics.
- DO NOT USE SALICYLATES

Front 25

NURSING DIAGNOSIS: Social isolation related to environmentally imposed constraints

Back 25

- Explain reason for confinement to child
- Enlist child’s assistance with enforcing restrictions to provide increased sense of control
- Allow child to play with isolation supplies
- Encourage parents to stay with child during hospitalization

Front 26

Atraumatic Care

Back 26

the provision of therapeutic care in settings, by personnel, and through the use of interventions that eliminates or minimizes the psychologic and physical distress experienced by children and their families in the health care system

Front 27

What is done to minimize local reaction from a vaccine?

Back 27

Select adequate needle size(1-inch)
Inject into the vastus lateralis or ventrogluteal muscle. The deltoid may be used in children >18 months.

Front 28

What is done to minimize pain from a vaccine?

Back 28

- Apply topical anesthetic
- Distraction techniques
- Never tell a child “It won't hurt”

Front 29

Immunization Contraindications& Precautions

Back 29

- Anaphylactic reactions previously
- Moderate to severe illness with or without a fever
- DPT/DPaT:
Encephalopathy within 7 days of administration or fever of 105
- OPV: infection with HIV or household member of HIV positive
- Known altered immunodeficiency
- MMR: Pregnancy,
Known altered immunodeficiency,
Recent IGG vaccination
- Hib: anaphylactic reaction to bakers yeast
- Varicella: Immunosuppression and
Pregnancy

Front 30

How many periods of reactivity are there?

Back 30

3

Front 31

First period of reactivity

Back 31

- Lasts up to 30 minutes
- baby's HR increases to 160 - 180bpm (decreases after 30min.)
- Decrease in motor activity after period

Front 32

Second period of reactivity

Back 32

- Last between 30 - 120 min.

Front 33

Third period of reactivity

Back 33

- Occurs 2 - 6 hrs after birth
- Tachycardia, tachypnea occur
- Meconiuim passed

Front 34

Physiologic Adaptations: Respiratory system

Back 34

- Initiation of breathing
- Signs of resp distress
- Maintaining adequate O2 supply

Front 35

3 ways that breathing is initiated

Back 35

1. Chemically
2. Cold
3. Chest expands

Front 36

Physiologic Adaptations: Cardiovascular system

Back 36

- HR and sounds (averages 120 - 140bpm)
- b/p 60-80/40-50
- blood volume

There is a change in pressure which closes the shunts

Front 37

Physiologic Adaptations: Hematopoietic system

Back 37

- RBCs and hemoglobin (physiologic anemia)
- Leukocytes
- Platelets
- Blood Groups

Front 38

What is acrocyanosis?

Back 38

Sluggish peripheral circulation in infants

Front 39

Physiologic Adaptations: Thermogenic system

Back 39

- Thermogenesis
- Heat Loss
- Temp regulation

Front 40

Why are newborns given a shot of vitamin K?

Back 40

They cannot synthesize it.

Front 41

What is larger, an infants head or chest?

Back 41

Head

Front 42

4 Ways that heat can be lost

Back 42

1. Convection
2. conduction
3. radiation
4. evaporation**

Front 43

What happens to a baby's heat when there is a problem?

Back 43

It decreases

Front 44

What is mottling?

Back 44

marked with spots or blotches of different shades or colors

Front 45

When does normal physiological jaundice occur?

Back 45

Happens after 24 hrs of birth

Front 46

physiological adaptations: GI

Back 46

- Digestion: can hold 1-1.5 ounces in stomach.
- stools: meconium passes within 1st 24hrs
- Signs at risk for GI problems: bowel obstruction, meconium ileus, cystic fibrosis

Front 47

meconium ileus

Back 47

Obstruction of the intestine (ileus) due to overly thick meconium, the dark sticky stuff that is normally present in the intestine at birth and, after trypsin and other enzymes from the pancreas have acted on it, is normally passed in the feces after birth. Meconium ileus results from a deficiency of trypsin and other digestive enzymes from the pancreas, as in cystic fibrosis (fibrocystic disease of the pancreas, mucoviscidosis).

Front 48

physiological adaptations: hepatic system

Back 48

- iron storage
- carbohydrate metabolism
- conjugation of bilirubin
- physiologic jaundice
- breastfeeding and jaundice
- coagulation
- signs of risk for hepatic system problems

Front 49

physiologic jaundice

Back 49

Yellowish staining of the skin and whites of the newborn's eyes (sclerae) by pigment of bile (bilirubin). In newborn babies a degree of jaundice is normal. It is due to the breakdown of red blood cells (which release bilirubin into the blood) and to the immaturity of the newborn's liver (which cannot effectively metabolize the bilirubin and prepare it for excretion into the urine). Normal physiologic jaundice of the newborn typically appears between the 2nd and 5th days of life and clears with time.

Front 50

kernicterus

Back 50

A type of brain damage associated with athetoid cerebral palsy (uncontrollable movement of the face, body, arms, and legs) and deafness. Kernicterus is due to marked jaundice in the newborn period. The high blood level of the pigment bilirubin results in its deposition in the brain, which damages the brain. >20 bili level

Front 51

What is the normal range for a bili check?

Back 51

5-8

Front 52

What must be done if a bili check result is 10-12?

Back 52

repeat the test

Front 53

Breastfed baby's stool

Back 53

yellow and seedy

Front 54

Bottle-fed baby's stool color

Back 54

yellow-brown

Front 55

Urates in infant urine

Back 55

orange/red uric acid crystals

Front 56

Skin Desquamation

Back 56

dry skin, 40+ week babies

Front 57

What is caput succedaneum?

Back 57

Caput succedaneum is a circular swelling and bruising of the scalp usually seen on top of the head toward the back, which is the part of the scalp most often leading the way through the birth canal. This will fade over a few days.

Front 58

What is subgaleal hemorrhage?

Back 58

Bleeding in the potential space between the skull periosteum and the scalp galea aponeurosis.

Front 59

What is cephalhematoma?

Back 59

a collection of blood that has seeped under the outer covering membrane of one of the skull bones. This is usually caused during birth by the pressure of the head against the mother's pelvic bones. The lump is confined to one side of the top of the baby's head and, in contrast to caput succedaneum, may take a week or two to disappear.

Front 60

What is mongolian spot?

Back 60

smooth blue-gray or slighty brown patches which can be found on the lower back and buttocks area of some East Asian and Native American Infants and babies. It may look somewhat like a bruise or rash. It normally vanishes three to five years after birth and almost always by puberty.

Front 61

What are pseudo menses?

Back 61

Exposure to the mother's hormones before birth -- and withdrawal from them at birth -- may cause temporary conditions in a newborn. Maternal hormones are among those chemicals that penetrate the placental barrier and have an influence on the fetus. During pregnancy the hormone estrogen is particularly high. This is the hormone that causes breast enlargement in the mother. Similar influences are commonly found in newborns, both boys and girls, by the third day after birth. Newborn girls may initially have prominent labia as a result of the estrogen exposure. They sometimes also experience a type of vaginal discharge called pseudomenstruation due to the withdrawal of the maternal hormones. The discharge is white and occasionally tinged with blood. This condition is common and should not last beyond the first week of life.

Front 62

Signs of risk for skeletal problems in an infant

Back 62

- hip click
- club feet

Front 63

Newborn reflexes

Back 63

- rooting
- sucking
- swallowing
- grasp
- babinski
- moro

Front 64

What is Molding?

Back 64

an abnormal head shape that results from pressure on the head during childbirth.

Front 65

newborn respirations

Back 65

30-60

Front 66

When is an apgar test done?

Back 66

At 1 and 5 minutes after birth.

Front 67

When would a 10-minute apgar test be done?

Back 67

If the infant scored 7 or lower.

Front 68

What outweighs completing the apgar?

Back 68

resuscitation

Front 69

What is the pupose of the apgar test?

Back 69

For rapid assessment of the newborn during their transition to life outside of the womb.

Front 70

What 5 things does the apgar test include?

Back 70

heart rate, respiratory rate, muscle tone, irritability, and color

Activity, Pulse, Grimace, Appearance, Respiration

Front 71

What do babies usually score on the apgar test and why?

Back 71

They usually score a 9 because their hands and feet are usually blue.

Front 72

What is included during the initial physical assessment of the newborn?

Back 72

- external: skin color, conditon, presence of meconium staining, length of nails and creases on the soles of the feet, check nasal patency.
- Chest: auscultate heart, note rate, rhythm and presence of murmur; respirations note rate and quality of breath sounds.
Abdomen: bowel sounds and the number of vessels in the cord.
- Neuro: check muscle tone, assess reflexes, palpate fontanels and sutures (they should be palpable). In a V-birth sutures usually overlap.
- GU: note external sex characteristics, check anal patency, watch for passage of urine and stool.
- In general: check for symmetry and note any gross structural malformations.

Front 73

What 2 traits do most newborns have?

Back 73

Usually a murmur because the foramen ovale hasn't closed completely and some crackles due to fluid being in the lungs.

Front 74

What else do you check for in an initial newborn assessment?

Back 74

- Physical injury r/t the birth
- Check skin for erythema, ecchymosis, petechiae, abrasions, lacerations, edema

Front 75

What are some common injuries r/t the birth?

Back 75

bruising, dystocia, clavical (intact), hip click

Front 76

What are some key nursing interventions for a newborn?

Back 76

- Assess color, cry and activity
- Dry newborn off as much as possible
- Keep newborn warm
- Watch for secretions, bulb syringe as necessary
- Maintain universal precautions
- Promote maternal/child bonding!
- Eye prophylaxis ointment
- Vitamin K IM injection
- Hepatitis B (Brockton Hospital) IM
- Umbilical cord care
- ID Bracelets

Front 77

When is a baby usually deep suctioned?

Back 77

After a C-section birth.

Front 78

After what act can you stop universal precautions with a newborn?

Back 78

After the first bath (be sure to wear a shield with a boy!)

Front 79

Why is Eye prophylaxis ointment given?

Back 79

To kill bacteria (gonorrhea)

Front 80

Why is vitamin K given?

Back 80

To help with clotting

Front 81

What is done for umbilical cord care?

Back 81

Keeping area clean.

Front 82

When does the umbilical cord fall off?

Back 82

takes 7-14 days or 1-2 weeks.

Front 83

Intrauterine growth restriction (IUGR)

Back 83

- Applied to fetus whose rate of growth does not meet expected norms

Front 84

Early onset IUGR, is usually due to what?

Back 84

During the 1st and 2nd semester due to chromosome abnormality, disease, or severe problems with placenta.

Front 85

What are some reasons for IUGR?

Back 85

The baby didn't get the necessary nutrients and oxygen for proper growth and development of the organs. This is related to blood flow.

Front 86

Low Birth Weight (LBW)

Back 86

2500g or less

Front 87

Very Low Birth Weight (VLBW)

Back 87

1500g or less

Front 88

Preterm or premature

Back 88

before completion of 37 weeks

Front 89

Term

Back 89

38 to end of 42 weeks

Front 90

Postterm

Back 90

after week 42

Front 91

Postmature

Back 91

after completion of 42 weeks and showing effects of progressive placental insufficiency

Front 92

What is done from 2 hours after birth until discharge?

Back 92

- Routine testing: Blood glucose, Urinalysis, Bilirubin levels
Complete blood count (CBC)
- Newborn genetic screening
- Newborn hearing screening
- Collection of specimens: heel stick, Venipuncture, obtaining a urine specimen,
Restraining the infant

Front 93

What should a newborn's blood glucose be?

Back 93

40-60

Front 94

Where do you do a heel stick?

Back 94

on the sides of the foot, not the middle.

Front 95

What is given for pain during a circumcision?

Back 95

Tylenol, lidocaine, or emla.

Front 96

What do you watch for after a circumcision that isn't related to bleeding?

Back 96

voiding

Front 97

How do you keep the glans from sticking to the diaper?

Back 97

By applying petrolatum around the glans after each diaper change and by changing the diaper at least every 4 hours.

Front 98

What happens to the glans penis after circumcision after the first 24 hours?

Back 98

It's normally dark red during healing and becomes covered with a yellow exudate. This is part of the normal healing process. Do not remove exudate.

Front 99

Circumcision Care

Back 99

- Check for bleeding
- Check for urination after the procedure
- Keep area clean
- Check for s/s of infection
- Keep the glans from sticking to the diaper

Front 100

Newborn Sponge Bath

Back 100

- Try to minimize heat loss, wash body first, head last
- Wash with warm water and appropriate soap
- Daily bath is not necessary
- Wash cord separately

Front 101

How often do breastfed babies need to be fed?

Back 101

every 2 hours

Front 102

How often do bottlefed babies need to be fed?

Back 102

every three hours

Front 103

Personal Liability

Back 103

the nurse is always accountable for the outcome of his or her actions in carrying out nursing duties. The rule of personal liability requires the professional nurse to assume resp for patient harm that is a result of a nurse's negligent acts.

Front 104

Personal liability with floating and cross training

Back 104

Nurse is not allowed to perform tasks, render service when he/she lacks the required knowledge or skill. In any patient care situation, the RN should perform only those acts for which he/she has been prepared and demonstrated skill.

Front 105

Supervisor Liability

Back 105

usually involves triage, delegation, supervision, reporting performance deficits, chain of command as well as inadequate training, failure to periodically evaluate staff, failure to discipline or terminate unsafe staff and negligence in developing appropriate policies and procedures. Liability for negligent supervision may be based on improper delegation, improper supervision, negligent judgement.

Front 106

Types of Employer Negligence

Back 106

- Vicarious liability
- Respondeat Superior
- Ostensible Authority

Front 107

Exceptions to Respondeat Superior

Back 107

- "Borrowed Servant" or "Captain of the Ship"

Front 108

Vicarious liability (substituted liability)

Back 108

When one person is liable for the negligent actions of another person, even though the first person was not directly responsible for the injury. For instance, a parent sometimes can be vicariously liable for the harmful acts of a child and an employer sometimes can be vicariously liable for the acts of a worker.

Front 109

Respondeat Superior

Back 109

A legal rule that the principal or employer is liable for harms done by agents or employees while acting within the scope of their agency or employment.

Front 110

Ostensible Authority

Back 110

The facility is liable for negligence of independent contractor if patient had rational basis to believe that the independent contractor was a facility employee.

Front 111

Corporate Negligence

Back 111

Responsibility to hire qualified employees, responsibility to monitor and supervise their performance and act upon substandard performance.

Front 112

Idemnification

Back 112

Employer may recover from responsible person, damages paid under doctrine of respondent superior provided the employer is at fault ONLY because of the employee's negligence and the employer incurs monetary damages because of employee's negligence.

Front 113

Duty to Seek Medical Care

Back 113

Nurse is expected to exercise good judgement and intervene on behalf of the patient...

Front 114

What are the most common Medication Errors?

Back 114

Most common errors reported are: improper dose and quantity, administering wrong medication, omission. Standard of care requires that nurses must understand the medications that they are administering and use judgement in following orders. Medication errors are difficult to defend because they are easily preventable.

Front 115

Abandonment

Back 115

Unilateral termination of care and treatment by the health care provider without patient consent and/or adequate notice. Charges of abandonment are usually made against physicians. Failure to adequately monitor patients on inpatient units can lead to charges of abandonment.

Front 116

Incident Reports

Back 116

Agency record of accident or unusual occurrence. They are used to make facts available to the agency, contribute statistical data, help prevent future incidents. They are not part of the medical record. NEVER chart that an incident report was filed.

Front 117

Tort

Back 117

Civil wrong or injury committed by one person against another person or property. Unintentional tort - negligence and malpractice.

Front 118

Defamation

Back 118

Takes place when something untrue is said or written about a person, resulting in injury to that person's good name and reputation.

Front 119

Libel

Back 119

written defamation

Front 120

Slander

Back 120

oral defamation

Front 121

Violation of a controlled substance act

Back 121

drugs obtained illicitly through work

Front 122

The four development stages are described in Piaget's theory

Back 122

1. Sensorimotor stage: from birth to age 2 years (children experience the world through movement and senses and learn object permanence)

2. Preoperational stage: from ages 2 to 7 (acquisition of motor skills)

3. Concrete operational stage: from ages 7 to 11 (children begin to think logically about concrete events)

4. Formal Operational stage: after age 11 (development of abstract reasoning).

Front 123

What would be a warning sign of ineffective adaptation to extrauterine life if noted when assessing a 24-hour-old breastfed newborn prior to discharge?

Back 123

Apical heart rate of 90 BPM, slightly irregular, when awake and active. The heart rate of a newborn should range between 120 to 140 beats per minute especially when active. The rate should be regular with sharp, strong sounds.

Front 124

When caring for a newborn the nurse must be alert for signs of cold stress which would include what?

Back 124

Increased respiratory rate. Additional signs of cold stress, include increased activity level and crying (increase BMR and heat production) and hypoglycemia as glucose stores are depleted. Newborns are unable to shiver as a means to increase heat production; they increase their activity level instead.

Front 125

When weighing a newborn, the nurse should...

Back 125

Weigh the newborn at the same time each day for accuracy. Weigh newborn undressed for accuracy with hand above, not on, the abdomen for safety. Clean scale paper is used.

Front 126

Babinski reflex

Back 126

refers to the flaring of the toes when the sole is stroked.

Front 127

Tonic neck reflex

Back 127

refers to the "fencing posture" a newborn assumes when he is supine and turns his head to the side.

Front 128

cremasteric reflex

Back 128

refers to retraction of testes when chilled.

Front 129

The nurse must administer erythromycin ophthalmic ointment to a newborn after birth. The nurse should...

Back 129

Cleanse eyes from inner to outer canthus prior to administration. It should be applied into the conjunctival sac to avoid accidental injury to the eye. It should not be flushed out.

Front 130

A newborn has just been circumcised. The nurse's first priority would be to...

Back 130

Assess penis for bleeding

Front 131

Following circumcision of a newborn, the nurse provides instructions to its parents regarding post-circumcision care. The nurse should tell the parents to...

Back 131

Expect a yellowish exudate to cover the glans after the first 24 hours

Front 132

When placing a newborn under a radiant heat warmer to stabilize temperature after birth, the nurse should...

Back 132

Prewarm the radiant heat warmer and place the undressed newborn under it. The thermistor probe should be placed on the upper abdomen away from the ribs. It should be covered with reflective material. Rectal temperatures should be avoided since rectal thermometers can perforate the intestine, and the temperature may remain normal until cold stress is advanced.

Front 133

What initiates breathing in a newborn?

Back 133

It's the result of a reflex triggered by pressure changes, exposure to cool air temp., noise, light, and other sensations. Chemoreceptors in the aorta and carotid bodies initiate neurologic reflexes when arterial O2 pressure (PO2) falls.

Front 134

When does the respiratory reaction occur?

Back 134

Within 1 minute of birth.

Front 135

What are some signs of respiratory distress in a newborn?

Back 135

Nasal flaring, intercostal or subcostal retractions, or grunting with respirations.

Front 136

What's the respiratory rate for a newborn?

Back 136

30-60 breaths per minute.

Front 137

What can a normal newborn digest?

Back 137

Simple carbs and proteins, but has a limited ability to digest fats.

Front 138

At what level does jaundice appear in a newborn?

Back 138

Until the bilirubin level reaches 5mg/dl.

Front 139

When does jaundice in a newborn require attention?

Back 139

If jaundice occurs prior to 24 hrs after birth or beyond 7-10 days after birth.

Front 140

Trust vs Mistrust

Back 140

Infant. Needs maximum comfort with minimal uncertainty
to trust himself/herself, others, and the environment

Front 141

Autonomy vs Shame and Doubt

Back 141

Toddler. Works to master physical environment while maintaining self-esteem.

Front 142

Initiative vs Guilt

Back 142

Preschooler. Begins to initiate, not imitate, activities; develops
conscience and sexual identity.

Front 143

What happens at approximately 18 months of age nutritionally?

Back 143

Most toddlers manifest decreased nutritional need with a decrease in appetite, a phenomenon known as physiologic anorexia.

Front 144

12 to 18 months of age nutritionally

Back 144

The growth rate slows, decreasing the child's need for calories, protein, and fluid. The need for minerals such as iron, calcium, and phosphorus is still high.

Front 145

What happens nutritionally at age 4?

Back 145

The child seems to enter another period of finicky eating.

Front 146

What does cold do to a newborn?

Back 146

Cold stress increases the need for O2 and may deplete glucose stores.

Front 147

What respiratory rates are signs of distress for a newborn?

Back 147

Respirations less than 30 or greater than 60.

Front 148

What are some standard lab values for newborns?

Back 148

Hemoglobin 14-24 g/dl
Hematocrit 44-64%
Glucose 45-65 mg/dl
Leukocytes 9.0-30.0
Bili <2.0 mg/dl

Front 149

Relating to the use of car seats, what must be done with an infant born less than 37 weeks gestation and with birthweight less than 2500 grams?

Back 149

They should be observed in a car seat for a period of time before discharge. They are monitored for apnea, bradycardia, and a decrease in O2 saturation.

Front 150

What can a sore throat signify?

Back 150

It's most often a symptom of a minor viral infection, although it can signal diphtheria or a strep infection, such as scarlet fever.

Front 151

What is exanthem?

Back 151

a widespread rash, usually viral, and usually occurring in children. It represents either a reaction to a toxin produced by the organism, damage to the skin by the organism or an immune response. Exanthems may also be due to a drug, most commonly antibiotics.

Front 152

What can reduce both morbidity and the mortality rate for children with measles?

Back 152

Vitamin A.

Front 153

What increases itching?

Back 153

overheating.

Front 154

What is often given for severe itching?

Back 154

Antipruritic medication such as diphenhydramine (Benadryl) or hydroxyzine (Atarax).

Front 155

What is usually given for a sore throat?

Back 155

With lozenges, saltine rinses, and analgesics.

Front 156

True or false:
The white blood cell count increases significantly when the newborn develops infection

Back 156

False

Front 157

True or false:
Jitteriness and tremors may indicate that the newborn is experiencing hypoglycemia

Back 157

True

Front 158

True or false:
Abdominal movements are counted when determining the respiratory rate of newborns

Back 158

True

Front 159

True or false:
The wink reflex can be used to test the sphincter

Back 159

True

Front 160

True or false:
Breast tissue in full-term male and female newborns may be swollen and secrete a thin milky-type discharge

Back 160

True

Front 161

What is a generalized, easily identifiable edematous area of the scalp usually over the occiput area?

Back 161

Caput succedaneum

Front 162

What is a collection of blood between the skull bone and its periosteum as a result of pressure during birth?

Back 162

Cephalhematoma

Front 163

What is a sudden, transient newborn rash characterized by erythematous macules, papules, and small vesicles?

Back 163

Erythema Toxicum

Front 164

When assessing a newborn boy at 12 hours of age, the nurse notes a rash on his abdomen and thighs. The rash appears as irregular reddish blotches with pale centers. What should the nurse do?

Back 164

Document the finding as erythema toxicum.

Front 165

True or false:
The thermistor probe of a radiant heat panel should be taped to the upper quadrant of the abdomen just below the intercostal margin (ribs) on the right or left side.

Back 165

True

Front 166

True or false:
A newborn whose mother received magnesium sulfate during labor may be lethargic after birth.

Back 166

True

Front 167

True or false:
If bleeding is noted after a circumcision, the nurse should apply gentle pressure to the site of bleeding using a folded sterile gauze pad.

Back 167

True

Front 168

True or false:
When using a bulb syringe, the nose should be suctioned before the mouth.

Back 168

False

Front 169

A newborn male has been designated as large for gestational age. His mother was diagnosed with gestational diabetes late in her pregnancy. The nurse should be alert for signs of hypoglycemia. What assessment finding would be consistent with a diagnosis of hypoglycemia?

Back 169

Cyanosis. Other signs would include apnea, jitteriness/twitching, irregular respirations, high-pitched cry, difficulty feeding, hunger, lethargy, eye rolling, and seizures.