Study your flashcards anywhere!

Download the official Cram app for free >

  • Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/66

Click to flip

66 Cards in this Set

  • Front
  • Back
What is the time frame for the neonatal stage?
Birth to 28 days of life
Why is this period so important and critical
because 2/3 of all infant mortality occurs in this period. first 24h most vital
Adaptation to extrauterine life
Initiation of breathing
reflex triggered by change in environment
Neurologic reflexes of chemoreceptors
arterial PO2 falls
Arterial CO2 Rises
Arterial pH falls
What is surfactant and what is its role?
a phospholipid that lines the alveoli of the lungs and lowers surface tension.
Prevents alveoli from collapsing
What side of the heart has a higher pressure
the right side has higher pressure because the lungs are non functional inuteros
HIGH PULMONARY VASCULAR RESISTANCE
TEMPERATURE REGULATION
balance b/w heat loss and production
critical to survial
shivering mechanism is nonfunctional
NON-SHIVERING THERMOGENESIS-BROWN FAT
WAYS IN WHICH BABIES LOSE HEAT
EVAPORATION-wet diaper, wet hair, insensible water loss
CONDUCTION-warm hands & stethoscope
CONVECTION-drafts, AC, air currents
RADIATION-keep crib away from windows and outside wall
AT WHAT TEMP DO YOU NEED TO TAKE ACTION
IF axillary temp is less that 97.7
Behavioral Adaptations
what affects neonate behavior
Gestational age
time elapsed since labor/delivery
time of day
last feeding
stimuli
maternal medication
What is the Apgar scoring system used for?
Evalutes the newborns need for resussitation
When is the Apgar test performed?
done twice. 1 minute after birth and 5 min after birth
high correlation between low apgar at 5 min and mortality/morbidity
Peramiters of Apgar test
If score < 4 need VIGOROUS ressusitation ie intubation
B/W 4-6 vigorous stimuli ie O2
B/W 7-10 baby stable
ASSESSMENT

Temp
axillary
normal range 97.7-99 (36.5-37.2)
heat loss due to less thermal insulation, surface blood vessals and larger body surface in relation to wt.
Heat conservation mechanisms
flexed position
vasoconstriction
ASSESSMENT
Cardiovascular
heart rate- full min apical
PMI- 4th intercostal space
asleep-80-90
awake 90-170
BP: 60-80/40-50
ASSESSMENT
Blood volume
related to when cord is clamped. if clamped late BV is high, if early BV low
ASSESSMENT
RESP
count full min 30-60
apnea <15sec normal
chest and abd rise together
shallow/irregular
nose breathers except when crying
When should you never feed a baby
if resp >60
ASSESSMENT
Signs of Resp distress
seesaw resp-chest and abd don't move together
expiratory grunting
retractions
rate<30
rate>60
nasal flaring
ASSESSMENT
Head assessment
tape above brow
32-36.8cms
important for baseline
ASSESSMENT
Chest
tape at nipple line
2cms<head
ASSESSMENT
Length
head to heel
flat surface
45-55cm
ASSESSMENT
EYES
normal:conjuntival hemmorage, symmetry,red light reflex, muscules immature, visual distance 17-20cm, B&W and patterns
ASSESSMENT
EARS
well formed
firm cartilage
correct placement
hearing similar to adult
responds to mothers voice
all NH babies screened
What might low ears indicate
kidney abnomilie
NEONATAL REFLEXES
Rooting
infant turns head toward stimulus and opens mouth
NEONATAL REFLEXES
Palmar and plantar
place finger in palm of hand or base of toes, fingers curl around examiners fingers, toes curl downward
NEONATAL REFLEXES
Tonic neck or fencing
supine, turn head to one side
with infant facing left side, arem and leg on that side extend:opposite arm and leg flex
NEONATAL REFLEXES
MORO
place infant flat surface make a loud abrupt noise(drop crib as in movie) thumb and index finger form C
NEONATAL REFLEXES
STEPPING
infant will simulate walking, altering flexion and extension of feet.
NEONATAL REFLEXES
Babinski
on sole of foot, begin at heel, stroke upward and across ball of foot. toes hyperextend with dorsiflexion of big toe
ASSESSMENT
GI
able to digest simple carbs/proteins. little fat
stomach hold 30-90ml=freq feeding
lwr esophageal sphicter immature=spit up
colon sterile=vit k shot as unable to produce vit k without flora
ASSESSMENT
Fluid maintence
100ml/first 10kg/day
50ml/2nd 10kg/day
ASSESSMENT
nutritional status
sleeps between feedings
loses no more than 10% of birth weight
good skin tugor
voids 6-8x/day
2-3BM
ASSESSMENT
Stooling patterns
merconium-first 24-48h
transitional stool-3rd day
milk stool
ASSESSMENT
hematopoietic
RBC-4.8-7.1
Leukocytes-18,000@birth than decreases
Platlets-200-300,000
FETAL HEMOGLOBIN-carries 20-50% more O2 than adults Hb
Sepsis in neonate see decrease in WBC
ASSESSMENT
Renal system
approx 40ml urine in bladder at birth
6-10x/day normal
amt- 15-60mg/kg/day
normal to see uric acid crystals in diaper(red) in hosp setting
Why are neonates at such high risk for dehydration?
limited ability to concentrate urine up to three monthes of age
anterior fontenal depressed if dehydrated
DEFINE

DESQUAMATION
Peeling skin
wont see in a preterm baby
DEFINE

VERNIX CASEOSA
A protective sebaceous deposti covering the feus during interauteine life. It is not necessart to remove after delivery
DEFINE
ACROCYANOSIS
A BLUE OR PURPLE MOTTLED DISCOLORATION OF THE EXTREMITIES WSP FINGES,TOES AND/OR NOSE. Vasomotor instability.normal and should resolve
DEFINE
LANUGO HAIR
Downy hair covering the body.
DEFINE
Simian line/crease
when tje two flexion creases appear to fuse and form a single transverse crease. mayindicate downs or other syndromes
DEFINE
TELANGIECTATIC NEVI
Storks kiss
Enlarged superficial blood vessels
able to blanche
DEFINE
MONGOLIAN SPOTS
a blue or mulberry-colored spot usually in sacral region. usually disappears over months/years
DOCUMENT as it looks like bruise. seen in African Americans and Asians
DEFINE
MILIA
small white sebacious glands
(white heads)
DEFINE
ERYTHEMA TOXICUM
Newborn rash also called baby acne
ASSESSMENT
Skeletal system
more cartilage than ossified bone
head is 1/4 of body
arms longer than legs
cephalocaudal development (head to tail)
ASSESSMENT
Extemeties, spine and skin folds
symetric and equal
fingers and toes are wqual with naild
spine is straight and easily flexed
no dimpling
MOLDING
the head shapes itself to fit the birth canal. Cranial sutures cross (overidding sutures) Should return to normal in a week
What is the difference between a CAPUT SUCCEDANEUM and CEPHALHEMATOMA?
the caput crosses the suture line and the hematoma does not
the hematoma is between the periostum and skull bone
what is a subfalea hemorrhage/hematoma?
dark red blood beneath the falea aponeurotica(dense CT of the scalp) and over the cranium.
common during the birth process
may extend to neck(often first sign)
What is Ortolani's maneuver
Tests for hip dyplasia
ASSESSMENT
Reproductive system
male-don't retract foreskin, testes descended
female-common to see discharge/blood
vernix b/w labia
labia majora covers minora and clitoris
BREAST swelling may occurs
ASSESSMENT
Neuromuscular system
almost completely developed at birth
rapid growth of brain during infancy
growth of cerebellum complete at 1 year
Brain rq's glucose/O2 for metabolism
transient tremors-normal but should not last beyond 1month
SLEEP/WAKE STATES
SLEEP: deep-unarousable
quiet-arousable
sleep 16-18hr/day
WAKE: Drowsy
Quiet-alert OPTIMUM
Active-alert
Crying
TEMPERMENT
hereditary
influences behavior
have parent adapt not child
Easy child, slow to warm up and difficult. difficult it is hard to pick up cues, irregular
SELF-QUIETING BEHAVIORS
withdrawal
oushing away w/hands and feet
breaking eye contact
turning head
falling asleep
fussing
crying
ASSESSMENT
PAIN
us riley infant pain scale
uses behavior, physiological and autonomic responses, metabolic
Pain treatment
Non-pharmacological- swaddling, pacifier, oral sucrose
pharmacological-topical, local, tylenol, opiods
Describe disorganized behavior
physical and behavioral response to environment. see in pre-term babies, babies born to mothers who drink/drugs, painful procedures.
babies are irritable, fussy, increase/decreased muscle tone, change in reflex, color, VS, baby flaing in crib
Some teaching points
lay baby on R side after feed ing for gastric emptying
warm h2o not pre-packaged wipes
Always have bulb syringe in crib
erythromycin ointment to prevent gonarhhea conjunctivitis
CIRCUMCISION
REMOVAL OF PREPUCE
irritation may occur
no difference if hygiene properly followed
may/maynot affect sexual feeling
increased risk of UTI if uncircumcised
circumcision provides some protection against cancer
analegesia should be used
CIRCUMCISION CARE for RN
monitor bleeding q1h for 12hr
monitor voiding
gentle pressure for bleeding
if uncontrolled intermittent pressure call MD
NO PRE-PACKAGED WIPES
vasoline to site after diaper change
no vasoline if plasiball used
CIRCUMCISION teaching points for parents
check for bleeding
observe for urination
keep clean
yellow exudate normal
change diaper q4
fanfold diaper
s/s infection
comfort
CORD CARE
clamp removed when cord is dry, approx 24h
keep diaper away from area
observe for s/s infection
usually falls off 10-14 days
IM INJECTIONS
Vit K for prevention of hemorrhagic disease
HEP B
if mom positive give hepititis immuneblobulin w/i 12hours