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147 Cards in this Set
- Front
- Back
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Normal respirations for a newborn?
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30-60 RR
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Cord clamping (increases/decreases) systemic vascular resistance.
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Increases
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What are the five major changes in cardiovascular adaptation that happen with a newborn?
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Closure of the ductus arteriosus, venosus, and foramen ovale; increased aortic and decreased venous pressure; Increased systemic pressure and decreased pulmonary artery pressure
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Normal HR at birth?
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110-160 with as high as 180.
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What are the four surface to environment losses?
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RECC
Radiation, Evaporation, Convection, and Conduction |
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Losing heat to the mattress, scales, or hand-touch is what kind of heat loss?
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Conduction
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True/False. Babies cannot shiver, so they make up for it by muscular activity like crying or being restless.
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True
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Chemical thermogenesis involves what three actions?
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BOB
Involves use of stored energy brown fat Broken down to glycerol and fatty acids Oxidation of fatty acids is exothermic |
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Hypoglycemia is defined as ___ mg in the first two hours of life.
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30-50 mg/dl, with a nadir of 60-90 minutes after birth
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Which of the following is NOT a reason for hypoglycemia in newborns?
A) Decreased RBC size and circulating volume per kg B) Brain is proportionally larger than body and uses only O2 and glucose C) Immature liver enzymes promote glucose storage D) Increased metabolic needs |
A) INCREASED RBC size and circulating volume per kg is a reason for hypoglycemia (slide 17, Newborn Physiology).
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True/False. The newborn produces twice as much bilirubin as adults.
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True. The NB produces 8.5-10 mg/kg/day of bilirubin which is about twice that of adults. (slide 21, Newborn Physiology)
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How can you tell the difference between physiologic and pathologic jaundice?
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Pathologic jaundice occurs in the first 24 hours of life. Physiologic jaundice peaks around the third day and then declines.
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Physiologic jaundice is described as levels greater than what?
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>15mg/dl in the full term infant, with direct bilirubin <2mg/dl.
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How do direct bilirubin levels vary between pathologic and physiologic jaundice?
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In physiologic jaundice, direct bilirubin is <2mg/dl. In pathologic jaundice, >2mg/dl
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In auscultating a newborn's abdomen at 15, 30, and 45 minutes, you continue to find deficient bowel sounds. What is your next course of action?
A) Do nothing, as this is a normal finding. B) Alert the MD, as this may be a sign of duodenal or jejunal atresia. C) Continue to listen to all four quadrants for one full minute apiece. D) Inquire as to whether baby is being breast or bottle fed, and reassess. |
A) Do nothing. Bowel sounds are usually present within 30-60 minutes of birth.
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Which of the following is not normal finding in a newborn?
A) Bladder volume of 6-44 ml B) Urine specific gravity >1.005 C) Cloudy, concentrated urates D) Bloody discharge |
B) Urine specific gravity >1.005. In neonates, specific gravity usually stays around 1.003. Ability to concentrate urine and excrete excess solutes is limited until 3 months old.
"Brick dust" and bloody discharge in female babies are normal. (slide 35, Newborn Physiology.) |
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Which of the following is consistent with a newborn's immune system?
A) IgA received in utero from mother B) Sepsis resulting in debilitating hyperthermia C) Passive immunity in breast feeding D) Fever as a reliable indicator of infection |
C) Passive immunity in breast feeding
(Slide 36, Newborn Physiology) |
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Erythromycin ointment is used as prophylaxis against what?
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Ophthalmia neonatorum and chlamydial organisms
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True/False. Parental consent must be obtained for PKU and MCAD screening.
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False. Parental consent is NOT required for PKU and MCAD (fatty acid oxidation disorders-- lacking enzymes.) (slide 13, NB Tests and Procedures)
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Cords fall off in how long?
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7-10 days
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Ultrasound dating needs to be done before __ wks to get an accurate age estimation.
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11
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CNS reflexes proceed in a (cephalocaudal/caudocephalad) direction.
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Caudocephalad (slide 9, NB Assessment)
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In the Ballard Neuromusclar Exam, (more/less) flexibility indicates immaturity.
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Less flexibility (slide 13, NB Assessment)
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Nevus vasculosis is also called:
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Strawberry mark
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Nevus flammeus is also called:
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Port wine stain
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In ___, one side of body is dark other is pale. One-sided vasospasm. Transient and not of clinical significance.
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Harlequin sign
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In performing the assessment of a newborn, which of the following should you report to the physician (select all that apply)?
A) When you move the baby's left, her eyes deviate to the right. B) Edematous swelling over the entire head. C) Crying without tears D) Blue sclera in the eyes E) Epstein pearls on her gums F) Rales and wet sounds on lung auscultation |
D) Blue sclera is indicative of osteogenesis imperfecta
All other are normal signs |
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In ___, the opening of foreskin is small and cannot be retracted.
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Phimosis
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Non-descended testes.
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Cryptorchidism
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Simean crease may be associated with:
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Down syndrome or fetal alcohol syndrome
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Adduction of legs (placed together) with gentle
pressure downward to feel for displacement of acetabulum. |
Barlow's maneuver
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Downward hip pressure with gentle abduction. Listen and feel for “clicks” with hip dislocation.
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Ortolani's maneuver
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Run finger along one side and infant’s spine should curve “like a C” toward stimulus
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Galant reflex
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Includes embryonic death, spontaneous abortion, missed abortion, fetal death and neonatal death.
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Perinatal death
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Pregnancy loss less than 500 grams and before 20 weeks gestation with no signs of life. 15-45% of pregnancies end in miscarriage.
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Miscarriage/spontaneous abortion
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State of Texas considers ___ weeks and ___ grams "viability."
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20 weeks and 350 grams
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Regardless of gestational age, showing any evidence of life such as beating of the heart, pulsation of the umbilical cord or defined movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached
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Live born infant
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Fetal death after 20 weeks.
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Stillbirth
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Death of a newborn within the first 28 days of life.
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Neonatal death
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LGA is characterized as weight at or above the __ percentile.
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90th
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True/False. Only a small percentage of LGA babies are infants of a diabetic mother.
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True.
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Which of the following is NOT a factor associated with LGA?
A) Maternal prepregnant weight/weight gain B) Primiparity C) Male gender D) Congenital syndromes/defects |
B) Primiparity
With MULTIPARITY, babies tend to grow larger in utero |
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Which of the following are risks for LGA neonates? (select all that apply)?
A) Hyperglycemia B) Birth trauma due to cephalopelvic disproportion C) Anemia D) Hyperviscosity |
B, D.
HyPOglycemia Birth trauma due to cephalopelvic disproportion Increased incidence of cesarean birth/pitocin induction Polycythemia Hyperviscosity |
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(LGA/SGA) is secondary to maternal renovascular disease. (LGA/SGA) is secondary to fetal hyperinsulinemia.
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SGA; LGA
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Tetany is associated with (hyper/hypo)calcemia.
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Hypocalcemia
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True/False. SGA is the same as IUGR.
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FALSE! IURG refers to advanced gestation with limited fetal growth.
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Asymmetric SGA or IUGR is also called:
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Head-sparing. In Asymmetric SGA and IUGR there is often acute compromise of blood flow, usually in the third semester. Also, poor nutrition and/or poor placental perfusion.
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True/False. IUGR and SGA can both be linked to substance abuse.
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True
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True/False. Both LGA and SGA babies are at risk for hypoglycemia and polycythemia.
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True
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The (symmetric/asymmetric) SGA baby is more likely to "catch up."
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Asymmetric
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Postterm babies are born after ___ weeks.
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42 weeks gestation
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Postmature infants are born with which of the following characteristics (select all that apply)?
A) Increased subcutaneous tissue B) Scaling skin C) Decreased muscle mass D) Meconium staining E) Increased size |
B, C, D, E
Born after 42 weeks, the infants tend to have LOSS of subcutaneous tissue, scaling skin, decreased muscle mass, and/or meconium passage with meconium staining. |
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What are the four things that can occur from meconium aspiration?
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CAPS
Chemical pneumonitis Airway obstruction Pulmonary hypertension Surfactant dysfunction |
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How much meconium do you need in obtaining a sample for neonatal abstinence syndrome?
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5 grams
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Severe hyperbilirubinemia is characterized as direct bilirubin levels >___ or ___% of total bilirubin level.
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>2mg/dl or 20% of total bilirubin level
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In which races is hyperbilirubinemia more common?
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East Asians, Native Americans, or Greeks born in Greece
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What is the test you use to determine hyperbilirubinemia?
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Coombs test
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What are the three principle reactions that occur in phototherapy of severe hyperbilirubinemia?
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Put the Crib by the Sun
Photo oxidation, or bleaching of bilirubin Configurational isomerization changes some bilirubin isomers to water-soluble isomers Structural isomerization forms lumirubin |
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True/False. Water-soluble photo-isomers cannot cross the blood brain barrier.
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True.
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True/False. With a "Joey blanket," you do not need eye protection.
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True.
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Which of the following is NOT a side effect of phototherapy?
A) Increased insensible water loss B) Increased gut motility C) Decreased metabolic rate D) Hyperthermia or hypothermia E) Retinal damage |
C) Decreased metabolic rate
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An exchange transfusion is required if bilirubin is equal to or above ___mg/dl and doesn't respond to phototherapy.
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20mg/dl
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What does albumin do in the treatment of severe hyperbilirubinemia?
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It increases available binding sites and prevents kernicterus.
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The basic problem in a preterm baby with RDS is what?
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Surfactant deficiency
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This is a condition in which the bowel herniates through an abdominal defect?
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Gastroschesis
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What's the difference between an oomphalocele and gastroschesis?
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Gastroschesis has no membrane.
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In this neural tube defect, the bones of the skull do not close completely, and meninges, cerebral spinal fluid and possibly brain tissue protrude into a sac-like formation.
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Encephalocele
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True/False. Breastfeeding is fine with cleft lip.
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True. The breast tissue an close the cleft effectively. Breastfeeding can be difficult, however, with cleft palate.
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What is the basic treatment for RDS?
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Antenatal corticosteroid therapy-- BETAMETHASONE (2 doses 24 hours apart. If time is an issue, 2 doses 12 hours apart.)
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Which of the following are signs of sepsis (select all that apply)?
A) Tachypnea B) Bradycardia C) Flushed skin tone D) Pallor E) Flaccidity |
A, D, E
Tachypnea, pallor, and decreased tone, as well as thermal regulation issues and poor feeding are all signs of sepsis. |
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A newborn infant is diagnosed with gastroschisis. Which measures would you AVOID?
A) PPV or ventilator B) Kerlix soaked in warm saline applied over intestines C) Oral gastric tube D) Plastic wrap or bag |
A) NO PPV or ventilator!
(slide 21, HR Neonate ppt) |
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Ancencephaly typically develops within the ___ and ___ days of pregnancy.
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23rd and 26th
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In this neural tube defect, the bones of the skull do not close completely and may result in brain herniation.
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Encephalocele
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What is the difference between spina bifida and spina bifida occulta?
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In spina bifida occulta, one or more vertebral arches are malformed and covered by a layer of skin, and there is no protrusion of the spine or meninges
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Cleft palate results after the plate fails to close after the ___ week of pregnancy.
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7th or 8th
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Low birth weight is considered how much? Very low birth weight? Extremely low birth weight? Macrosomic?
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LBW: <5lbs 8oz
VLBW: <3lbs 5oz ELBW: <2lbs 3 oz Macrosomic: >8 lbs |
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Twins are usually carried to about __ weeks. Triplets, ___.
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36 weeks; 32 weeks
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Treat hypoglycemia with ___g/kg of dextrose.
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0.25-1g/kg
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This is an acute inflammatory condition in which the goblet cells of the intestine are inactivated.
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NEC
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LGA = weight at or above the ___th percentile.
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90th
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Factors associated with LGA (select all that apply):
A) Multiparity B) Male gender C) Weight gain before pregnancy D) Congenital syndromes/defects |
A, B, C, D
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LGA babies are at risk for (hypo/hyper)glycemia.
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Hypoglycemia
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LGA babies are at risk for (select all that apply):
A) Hypoglycemia B) Anemia C) Hyperviscosity D) Birth trauma |
A, C, D
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Why can moms with GA diabetes give birth to SGA babies?
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SGA births are usually secondary to maternal renovascular disease
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Tetany is indicative of (hyper/hypo)calcemia.
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Hypocalcemia
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SCA = < ___th percentile
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10th
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Asymmetric IUGR usually occurs/begins when?
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Asymmetric (head-sparing) IUGR typically occurs as a result of acute compromise of blood flow, usually during the third trimester.
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(Asymmetric/symmetric) IUGR is usually caused by viral or bacterial causes, chromosomal abnormalities, or FAS.
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Symmetric
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Meconium is rarely found in the amniotic fluid prior to ___ weeks.
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34 weeks
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Severe hyperbilirubinemia is characterized as > ___mg/dl or ___% of total bilirubin level.
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>2mg/dl or 20% of total bilirubin level.
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Besides liver disease, what are some causes of hyperbilirubinemia in the neonate?
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(So Much Liver Hyperbilirubinemia)
Sepsis Maternal oxytocin, sulfa drugs Large cephalohematoma Hemolytic disease of newborn (Rh/ABO) |
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Maternal antibodies are typically associated with the ___ test.
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Coombs
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What 3 reactions occur with photolight therapy for hyperbilirubinemia?
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(Put Crib by the Sun)
Photo oxidation, or bleaching of bilirubin Configuration isomerization changes some bilirubin isomers to water-soluble isomers Structural isomerization forms lumirubin |
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Cord clamping (increases/decreases) systemic vascular resistance.
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Increases
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Normal Hgb for newborn? Hct?
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14-20; 43-63%
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Bradycardia for newborns is considered what HR?
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<100
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Hypoglycemia is defined as ___mg/dl in the first 2 hours of life, with nadir 60-90 minutes after birth.
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30-40mg/dl
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This accounts for 75% of bilirubin in the term neonate.
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Usual destruction of RBCs
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Most babies need how many kcal/kg/day for adequate growth?
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120 kcal/kg/day
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How does mature stool look as compared between bottle fed and breast fed?
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Breast fed stool is yellow, pea-soupy. Bottle fed is paler and formed.
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The ability to concentrate urine and excrete excess solutes is limited until ___ months old.
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3
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IgA is secreted in ___, and protects the upper respiratory system, GI tract, and eyes.
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Colostrum
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Erythromycin is used for prophylaxis against what?
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Opthalmia neonatorium and chlamydial organisms
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Give Hep. B vaccine by the time the baby is how old?
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12 hours.
NOTE: This does does NOT count toward the Hep B 3 dose series! |
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In infants with hearing loss, the goal is to correct by what age?
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6 months for optimal speech and language development.
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(OAE/AABR) screening is able to screen for neural hearing loss.
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AABR
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A patient should not be bathed for how long after circumcision?
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24 hours
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The umbilical cord usually falls off in how long?
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7-10 days
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You are assessing a newborn with the APGAR score. The baby's heart rate is 120, RR of 28, some flexion, grimacing, and with blue extremities. What is the score?
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HR : >100 = 2
RR: Slow = 1 Muscle tone: Some flexion = 1 Reflex irritability: grimace = 1 Color = Body pink, extremities blue = 1 APGAR = 6 |
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The Ballard exam needs to be done by how long after birth?
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2 hours, or it decreases accuracy.
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With the scarf sign, the resistance should (increase/decrease) with GA.
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Increase
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Caput swelling generally resolves within how long?
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12 hours
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"Doll's eyes" are present for how long before they become a neurological emergency?
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10 days is considered normal. Beyond that, and there is probably some neurological problem.
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Physiologic jaundice in term babies is characterized as about ___mg/dl serum bilirubin. In preterm babies, ___mg/dl serum bilirubin.
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>12.9 in term babies, >15 in preterm babies. Anything higher than that is considered PATHOLOGIC JAUNDICE.
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What is the one Ballard test where LESS flexion = immaturity?
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Square window
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In uterine involution, the uterus descends approximately how much per day?
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1 cm
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The uterus involutes into the pelvis by approximately how long?
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2 weeks on average. It approaches pre-pregnant size and position by 6 weeks postpartum.
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In palpating a postpartum mother's uterus, you note it is soft and boggy. What do you suspect?
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Excessive bleeding.
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Continuous bleeding without clots and firm uterus is associated with:
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Vaginal or cervical laceration
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Which lochia is comprised of many different cells, and shows up in the first 2-3 days postpartum?
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Rubra
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Name the order of the lochia as they show up postpartum.
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Rubra (2-3 days)
Serosa (3-10 days) (pinkish brown) Alba (1-2 weeks) (creamy white, mostly WBCs) |
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What is puerperal diuresis?
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In the first 24 hours postpartum, diuresis of 2-3 liters of extracellular fluid.
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Drop in progesterone and estrogen signals the anterior pituitary to secrete what hormone?
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Prolactin
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The colostral phase in endocrine function lasts up to how long?
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72-96 hours
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True/False. Increased postpartum WBC and ESR may obscure true infection.
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True
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What percentage drop in hematocrit is a sign of hemorrhage?
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10%
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Review question! Approximately how much blood is lost during a traditional vaginal delivery? A c-section?
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500 cc; 1000 cc
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Approximately how much weight is lost with birth?
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10-12 lbs
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RhoGAM must be given postpartum within how long to unisoimmunized mothers?
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Within 72 hours
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The "taking in" phase of giving birth lasts approximately how long?
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2 days PP
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When should a mother seek help for postpartum blues?
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If symptoms persist beyond 2 weeks.
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When is the greatest risk for postpartum depression?
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Around 4 weeks PP and around time of weaning.
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Lochia accounts for approximately how much of blood loss?
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25%
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You should not be able to palpate the uterus after day ___.
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10
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In placenta ___, the placenta is adhered to the myometrium.
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Accreta
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In placenta ___, there is an invasion of the placenta into the myometrium.
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Increta
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In placenta ___, the placenta penetrates the myometrium.
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Percreta
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How does mastitis differ from breast engorgement?
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Breast engorgement is bilateral inflammation of the breasts PP day 2 or 3, but resolves within 24-48 hours. With mastitis, only one breast is involved, and requires intervention.
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True/False. Mothers currently experiencing mastitis and on an antibiotic regimen should refrain from breastfeeding until the regimen is complete.
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False. It is SAFE to breastfeed with mastitis, even with antibiotics.
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The most common early onset genital tract infection organism is ___. The most common late onset is ___.
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Early onset: GBS
Late onset: Chlamydia |
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Pelvic cellulitis or infectino of parametrial structures is also called:
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Parametritis.
This is the ascension of infection from injury (laceration) to connective tissue and ligaments into the pelvis. It may be caused by pelvic thrombus and resultant tissue necrosis. |
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What WBC indicators may suggest an infection in the postpartum mother?
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Increase >30% of WBC in 6 hours time
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This is the postpartum period from delivery of the placenta to about 6 weeks.
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Puerperium
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What is the acronym you should use in checking the perineum?
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REEDA
Redness Edema Ecchymosis Drainage Approximation |
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What is BUBBLE-HE?
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Breasts
Uterus Bowels Bladder Lochia Episiotomy Homan's sign Emotional State |
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What is the purpose of the Homan's sign in postpartum mothers?
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Soft dorsiflexion checks for clonus associated with hypertension and preeclampsia.
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At what point is sex okay after giving birth?
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After lochia alba has passed (within six weeks).
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