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44 Cards in this Set

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  • Back
In utero, the fetus produces surfactant between ___ and ___ weeks. Surfactant keeps the alveli from collapsing. The fetus practices breathing movement in utero, causing fluid to build up in the lungs.
34 and 36
The resipiratory system is stimulated by four processes/stimuli that together cause the infant to take its first breath when born. Describe these 4 types of stimuli.
chemical: decrease in pH
decrease in PO2
increase in PCO2
(changes in atmospheric pressure)
thermal: temp changes
sensory: cold air, touch, drying off - stimulates skin sensors
mechanical: squeezing on the way out helps get fluid out
In contrast to a vaginal delivery, a ______ delivery baby will have gurgly wet sounds because baby weren't squeezed on the way out (to get fluid out)
c section
needs suctioning
Shortly after birth, you may hear a _____ when you listen to the heart because fetal shunts are still open.
murmor
Infants lose heat quickly because they have 3 times more _____ area than adults and lose heat 3 times faster. They have thin skin and blood vessels are close to the skin. They use vasoconstriction to maintain heat in addition to ..... (a 3 word mechanism)
non-shivering thermogenesis- increased flexion/activity to maintain heat. They don't shiver because the brown fat warms the blood.
Where is brown fat located?
interscapular area
neck
axillae
sternum
adrenals
kidneys
abdominal aorta
What are the methods of heat loss? Describe each one.
evaporation
conduction
convection
radiation
What are the hazards of cold stress?
increased need for oxygen
respiratory distress
decreased surfactant produc.
hypoglycemia
metabolic acidocis
jaundice
How does metabolic acidosis occur in the cold infant? How does this lead to jaundice?
Use up all the brown fat-->
increase in fatty acids -->
metabolic acidosis--> jaundice

Jaundice occurs because fatty acids attach to albumin and billi has nothing to attach to, builds up.
It is common to see jaundice in the 3rd or 4th day, when would it be a red flag to see jaundice in the newborn?
1st 24 h
Why can an infant become dehydrated quickly?
immature kidneys
GFR not optimized til age 1-2
can't concentrate urine quickly
Babies are 78% water. How much fluids do they need the 1st 2 days when kidneys are immature ? How about after that?
40-60 ml / kg in 1st 2 days
100- 150 ml / kg after
Describe # of diapers expected on each day after birth. When is the first void usually?
1 - 1 diaper
2 - 2
3 - 3
4 - 6
12- 24 h after birth (1-2 voids first few days)
We should hear bowel sounds after the ______ hour.
first
The cardiac ______ is weak, which is why babies often regurgitate.
sphincter
How often should a mom breastfeed? If bottle feeding, how often? Why is there a difference?
breast- q 2 to 2 1/2 h
bottle- q 3 to 3 1/2 h

Breast milk empties faster. Formula is harder to digest, delays gastric emptying (also can be caused by excess mucous).
HGB & HCT levels for newborn
....
blood volume for newborn
85 ml per kg
Term baby glucose needs
Day 1 40-60 mg /dl
after 50-90 mg/dl
Pretty much all the systems are immature, what systems are particularly immature and make dehydration, drug metabolism, and fighting infection difficult?
kidneys
liver
immune system (immature leukocytes may not respond to infection)
The first place you will see jaundice is the eyes, then the skin, if it gets to the ____ it's a big problem.
brain
Physiologic jaundice is considered normal. Between days 2-4 bilirubin level peaks at about ____
5-6 mg per dl
Pathological jaundice is abnormal and requires investifation.. It ias a level higher than ___ in a full term infant. Jaundice associate with breastfeeding is very ___.
12 mg/ dl

rare
Does caput secudaum or cephalhematoma indirectly cause jaundice?
cephalhematoma-
Any trauma resulting in bruising just adds more RBCs to the equation, meaning more to break down--> more jaundice
Factors that increase hyperbilirubinemia
hemolyis of excess erthrocytes
short life of erythrocytes
liver immaturity
intestinal factors
delayed feeding
trauma- bruising
fatty acids from cold stress or asphyxia
s/s of infection in newbotn
vague symptoms
lethargic
passive
diarrhea
feeding difficulties

inability to localize infection
more likely to get sepsis
Passive immunity only effects the infant for about ____ months and doesn't protect against everything.
2-3
The first ___ or so it's ok to have some acrocyanosis but if after ___ h this coloring is present then it's a bad sign.
day
48
Which types of birthmarks are permanent?
cafe au lait
nevus flammeus (portwine stain)
mongolian spots
Which birthmark is known as the stork bite? It is flat and should fade by about age __
telangiectatis nevue
2
The ____ _______, or nevus vasculosus is raised, is uauyll on the leg or back, and will fade eventually. Sometimes they become apparent shortly after birth.
strawberry hemangioma
In apgar scoring, what # needs an intervention?
6 or less- needs help
7-10 ok
True eye color is shown by ___ to __ months
6 to 12
How often do we do VS on newborn?
q 30 min until stable
and then q 4 to 8 h depending on policy
Normal Temperature in newborn
axillary
36.5 - 37.5 C
97.7-99.5 F

rectal
36.5 - 37.6 C
97.7-99.7 F
Normal BPM when listening to apical pulse of newborn...

Normal RR
120- 160
100 sleeping
180 crying

Respirations 30-60 /min
Risk Factors for hypoglyemia
prematurity (don't have adequate glyocgen stores)
postmaturity (uses up glucogen because placenta only lasts so long, after 40 weeks starts to calcify)

IUGR
asphyxia & cold stress- use up glycogen stores
large for gestational age (excess insulin to cover glucose)
small for gestational age
maternal diabetes
maternal intake of terbutaline
Why is the use of terbutaline a risk factor for hypoglycemia?
side effect is rapid heart rate for both mom and baby, which uses up lots of glycogen
Some infants may be asymptomatic but what are some s/s of hypoglycemia?
jitteriness (could be neuro)
poor muscle tone
sweating from head
tachypnea
dyspnea
apnea
cyanosis
low temp
poor suck (could be neuro)
high pitched ry
lethargy
irritability
seizures/ coma
With any breathing issue, check ____ first because it's the easiest thing to check and it's quick.
glucose!
Calorie & Fluid needs for term newborn
Calories
110- 120 kcal/kg
(50 - 55 kcal/lb)

Fluid: 100 - 150 ml/kg after first 2 days of life
How do you convert celcius to fahrenheit? (just for you julie!)
multiply the Celsius temperature by 9/5 and then add 32.
Fahrenheit to celsius?
subtract 32 and then divide by 5/9
periods of reactivity

brazelton neonatal behavioral assessment scale
look up