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220 Cards in this Set
- Front
- Back
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What is a neonate?
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birth - 1st 28 days of life
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What is the normal HR of a neonate?
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120-160
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What is the normal RR of a neonate?
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30-60
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List the 6 biological tasks of the neonatal period.
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1. establishing and maintaining respiration
2. adjusting to circulatory changes outside the uterus 3. regulating T 4. ingesting, retaining, and digesting nutrients 5. eliminating waste 6. regulating weight |
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What are the 3 phases of the transition to extrauterine life (the transition period)?
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Transition period:
1. 1st Period of Reactivity 2. Period of Decreased Responsiveness 3. 2nd Period of Reactivity |
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Describe the timeframe of the 1st Period of Reactivity.
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the first 30 min - 2 hr after birth
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Describe the neonate's HR & RR within the 1st Period of Reactivity.
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1st Period of Reactivity:
HR: 160-180 RR: 60-80 w/ brief, normal periods of apnea |
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What is the normal time limit for apnea within the 1st Period of Reactivity?
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no longer than 20 sec.
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During the 1st Period of Reactivity, what should the mother attempt to initiate?
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breastfeeding because the infant is very alert
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How long is the period of decreased responsiveness?
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2-4 hr
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What is the main state of the neonate during the period of decreased responsiveness?
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sleep
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Describe the neonate's vitals during the period of decreased responsiveness.
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period of decreased responsiveness:
*vitals below normal: HR: 100-120 T RR: 30-60 |
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How long does the 2nd period of reactivity last?
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10 min - 2 hr
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Describe the vitals of the neonate during the 2nd period of reactivity.
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*vitals increase above normal
HR: above 160 (tachycardia) RR: above 60 (tachypnea) |
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What other features manifest in the neonate during the 2nd period of reactivity?
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1. muscle tone increases
2. skin color increases 3. increased mucus production |
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What should the nurse do in response to the neonate's increase of mucus production?
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suction because it is difficult to clear
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How long should you listen to a neonate's HR?
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1 full minute
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If you find a heart murmur within the first 24 hrs of birth, is it generally worrisome?
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no---usually due to a PDA (patent ductus arteriosus) that has not yet closed. usually closes within the first 24 hours.
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What does a PDA murmur sound like?
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a machine gun
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What factors enable the neonate to initiate breathing?
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1. response to various stimuli (changes in the environment)
---P,T,Chemical 2. Simultaneous shifts in the circulatory system |
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In order for the neonate to initiate breathing, what P change must occur?
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a large negative P
the infant must force fluid out of the alveoli to the interstitial spaces in the lungs for reabsorption to help produce this |
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Describe the T extremes that the neonate experiences within the first moments of life.
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T in utero: 98.7 F
T in room: 78 F |
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How does the temperature difference experienced after delivery contribute to initiation of breathing?
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Skin sensors send messages to the RESPIRATORY CENTER and tells it to breathe
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At birth, what is the natural respiratory state that the neonate is in?
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natural hypoxic state
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Which vessels respond to changes and blood chemistry brought out by hypoxia?
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Aorta & Carotids
*via the baroreceptor reflex |
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How does the neonate's natural hypoxic state contribute to breathing initiation?
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the decrease in blood O2 and increase in CO2 causes an impulse from the aortic/carotid receptors to the MEDULLA to tell it to breathe
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Describe the process of the CV/Respiratory shift that occurs upon birth, beginning with lung recoil in utero.
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lung recoil-->
P shift--> closure/constriction of DA, DV, FO--> circulatory shift--> decreased pulmonary P--> increased perfusion--> continued lung expansion & clearance of fluid |
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Describe the circulatory route in utero, beginning with the umbilical cord.
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Umbilical cord-->
DV--> 3 splits (branches) in the liver--> fetal heart--> FO--> LA--> LV--> head & upper extremities |
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Describe the blood pathway in utero in the RV.
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the RV blood is shunted to the aorta via the DA
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Why does the blood from the RV shunt to the aorta in utero?
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due to the increased pressure (fluid presence) in lungs
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List 5 CV/Respiratory changes that occur after birth.
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1. FO closes
2. DA & DV become ligaments 3. intracardiac P shift (L increases, R decreases) 4. decreased pulmonary P 5. increased perfusion |
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In terms of thermoregulation, what are neonates at risk for? why?
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hypOthermia due to their head:body ratio
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Hypothermia puts an infant at risk for...
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shock
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Methods of heat loss: define CONVECTION
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heat loss due to air current or flow.
may be caused by people walking by and creating a cool breeze |
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Methods of heat loss: define RADIATION
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loss to cooler environments that might be near a cold surface.
a warmed incubator may lose heat to a nearby window or cold wall |
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Methods of heat loss: define EVAPORATION
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can occur at anytime DURING birth or anytime the infant is WET from insensible water loss
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How should you counteract the evaporation effect when bathing the neonate?
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sponge bath under a heat lamp
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Methods of heat loss: define CONDUCTION
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the loss to cooler object in DIRECT contact
ie scale or provider's hand actually touching the baby |
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Since neonates lose heat faster due to their larger heads, what might an inappropriate T change downward do to O2 consumption?
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might double O2 consumption
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Thermogenesis: How do NB increase their BT?
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1. increase BMR
2. increase muscle activity (move) 3. NST: non-shivering thermogenesis |
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Describe the mechanism behind NST.
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Brown fat metabolism: when the skin detects a drop in T, the SNS begins to metabolize brown fat, causing a heat change.
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What are the requirements and impact of brown fat metabolism?
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Requires lots of O2, energy, ATP, glucose
Impact: can cause exhaustion |
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What is brown fat?
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A very dense substance rich in blood supply and nerve endings
Unique to NB |
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When does brown fat first appear?
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26-30 wk gestation
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The brown fat supply increases until...
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2-5 wks after birth
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3 sites of brown fat in neonates.
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1. sternum
2. between scapulae 3. around kidneys |
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If a baby is born at 37 wk, they have less brown fat. What risk does this pose?
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increased risk of hypothermia
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GI/GU coordination can be affected by...
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1. maternal medicine intake
2. birth weight (not present if BELOW 1500 g) |
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Describe a full term/near term pattern of ingestion.
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suck-swallow-breathe
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At which age is enough coordination developed for ingestion?
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32+ wk
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Describe the digestive state of a NB
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Does not have all the enzymes necessary for complex carb + fat digestion--->breastfeeding
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A baby does not know when to stop feeding. What might happen if he/she is overfed?
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spit up
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Describe a neonate void
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pale, not concentrated
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What is meconium?
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1st stool, passed within the first 12-24 hr of life
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What is the smell & appearance of NB stool dependent on?
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method of feeding (breast/bottle)
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Describe the progression of stool types within the first few days of life.
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1. meconium
2. transitional stool 3. milk stool |
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By day 3 of life, how many stools/day should a NB have?
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1-3 stools/day
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By day 4 of life, how many voids per day (24 HR PERIOD) should a NB have?
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6-8 voids/day
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Describe NB urination.
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usually straw-colored and odorless
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When do most babies have their first void?
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within the first 24 hr
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Describe meconium.
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thick, tarry, sticky
blackish-brown NO odor |
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Describe transitional stool.
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brownish-yellow (some CD yellow?)
present by day 2 or 3 |
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What might the delayed conversion to transitional stool indicate?
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evaluation of eating is necessary
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Describe milk stool.
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CD yellow stool that appears curdy
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At which day does breastfeed stool appear? What is it a sign of?
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day 5
sign of being well fed |
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Compare breastfed stool with formula-fed stool.
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breastfed: bright yellow
formula fed: more well formed. brownish-yellow |
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If a NB is not producing 6-8 wet diapers by day 4 or 5, what might this indicate?
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1. inadequate feeding
2. dehydration |
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What does the presence of urate crystals indicate?
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sign of dehydration
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When is the presence of urate crystals seen?
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common in 1st week
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What is the appearance of urate crystals?
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pink/orange...often mistaken for blood in the urine
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What actions must be taken if urate crystals are discovered?
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reevaluation how the infant/mother feeds
no need for lab analysis |
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What are urate crystals described as.
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"brick dust urine" --- found in areas of the diaper that are soaked with urine
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Describe the time period of normal vaginal blood presence in female infants.
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"mini period" starts 3rd day after birth and continues for a few days & stops
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What is normal vaginal blood related to?
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mom's H in systems
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If there is a large amount of blood in transitional stool, what might this indicate? What should you do?
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1. Vitamin K deficiency
2. Coagulopathy *do work-up |
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Benign integumentary signs
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1. Acrocyanosis
2. Blotchy, mottled skin 3. SubQ fat 4. Mongolian spots 5. "Stork bite" 6. Erythema toxicum 7. Milia 8. Vernix 9. Lanugo |
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What is acrocyanosis?
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PERIPHERAL cyanosis: blue color of hands and feet in most infants at birth
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What might central cyanosis indicate?
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badness: not enough perfusion
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When does acrocyanosis normally resolve?
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within 24-48 hr
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State of subQ fat in NB?
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increases
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What are Mongolian spots? Seen in which populations?
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bluish-black marks that resemble bruises
*especially seen in darker skin tones |
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When do Mongolian spots normally disappear?
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Usually disappear by school age, always by puberty
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What is a "stork bite"?
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red spot on the back of the neck
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What is erythema toxicum and where is it often seen?
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benign rash of unknown cause in NB (appears like chicken pox)
chin |
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What are milia?
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White cysts, 1-2 mm in size
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What causes milia?
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distended sebaceous glands (look like white heads)
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What is vernix?
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thick, white substance that protects the skin of the fetus
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What is lanugo?
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seen in term infants: small amount of fine hair on shoulders, forehead, sides of face, & upper back
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Do you see more or less lanugo in preterm infants?
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more
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Which populations is lanugo more common?
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genetically hairy ethnicities
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When does lanugo typically go away?
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usually within a period of months
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Describe circumoral/perioral cyanosis. is it benign?
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around mouth is cyanotic, but lips and mucous membranes in mouth are pink (ie being perfused)
benign |
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If you see circumoral cyanosis, what should you check to verify that it is benign?
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RR
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When does circumoral cyanosis normally go away?
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within 48 hr
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Why does facial bruising occur in NB (3)? What does it appear like?
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1. born with nuchal cord
2. born precipitiously (v. quick) or difficult 3. baby very large *appears bluish/darkish |
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How quickly does facial bruising disappear?
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within days
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What physical feature is often found in conjunction with facial bruising?
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petichiae
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What are the appearances of Mongolian spots?
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blue
blue-gray/black brownish *depending on skin tone |
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When do Mongolian spots normally disappear?
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3-5 y after birth
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What percentage of NB display erythema toxicum?
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~50%
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When is erythema toxicum manifested?
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in TERM infants: 3 da-2wks
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How long does erythema toxicum last?
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spontaneously resolves after a few days
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When do milia disappear?
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in a few days-weeks when pore size increases
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Do premature babies have more or less lanugo?
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more
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What is caput succedaneum?
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swelling of tissue of presenting part of fetal head
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What causes caput succedaneum?
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P at birth from constant pushing
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When does caput succedaneum usually disappear?
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within 3-4 da
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Where is a common site of caput succedaneum?
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vertex of newborn head
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How does caput succedaneum present?
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localized edema due to decreased perfusion
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T/F: a caput can cross suture lines
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T
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How do you physically assess the presence of a caput?
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test for pitting with 1 finger
*distinguishes caput from cephalohematoma |
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What is the cause of a cephalohematoma?
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vaginal birth trauma or vacuum
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What is a cephalohematoma?
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a collection of blood that occurs below the periosteum (a little more serious than a caput)
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Describe the delineation of a cephalohematoma.
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has clear edges that end at the suture lines. it does not cross the suture lines because the bleeding is held between the bone and its covering (periosteum)
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Describe the time frame of a cephalohematoma.
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-absent at birth
-increases within first 3 days of life -disappears in 2-3 weeks -- months |
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Why does a cephalohematoma take longer to go away?
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reabsorbs very slowly due to the breakdown of RBCs
(puts infants at greater risk for jaundice) |
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Describe a physical assessment of a cephalohematoma.
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no pitting due to presence of fluid
appears ecchymotic |
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What is the cause of molding of the infant skull?
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being pushed through birth canal
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Where does the NB assessment of vital signs take place?
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the labor room
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What is the APGAR score?
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immediate assessment of NB, developed to ass transition to extrauterine life and to determine the need for resuscitation
@1min, @5min |
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What is applied in the initial physical assessment?
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1. Vit K shot in thigh
2. Opthalmic ointment (erythromycin) |
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What is the purpose of a Vit K shot?
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A NB has a sterile GI, lacking the usual flora that synthesizes vit K. The shot boosts the process of having vit K in the body to promote clotting factors.
*w/o shot, body would naturally produce vit K on day 8 |
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What is the purpose of the opthalmic ointment?
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to prevent STIs such as chlamydia and gonorrhea from causing blindness
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Which gross features should you examine for anomalies?
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1. color
2. breathing movements 3. placental arteries and vein (AVA) etc |
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When does the NB and receive a nameband and footprinting?
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before it leaves the room
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What does the presence of reflexes tell you?
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the baby's neurological status
*if they are absent or present for an inappropriately long time, this may indicate a neurological problem |
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Which components of a gestational assessment show how old an infant is?
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1. neuromuscular
2. physical |
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Normal infant T?
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97. - 99.5 F
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Normal infant RR?
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30-60 rpm
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Normal infant HR?
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120-160 bpm
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Normal infant systolic BP?
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65-95 mmHg
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Normal infant diastolic BP?
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30-60 mmHg
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How should you take the T of a NB?
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axillary
*rectal T requires a dr order |
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Ave term length?
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19-21 in (48-53 cm)
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Ave term head circumference?
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13-15 in (33 - 35.5 cm)
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Ave term chest circumference?
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12-13 in (30.5 - 33 cm)
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Ave term weight?
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5.3 - 8.5 lbs (2500-4000 g)
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Define preterm or premature.
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< 37 wk, regardless of birth weight
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Define term
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37 - 42 wk
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Define postterm
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>42 wk
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Define postmature (syndrome)
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> 42 wk with S&S of placental insufficiency
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LGA?
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large for gestational age
>4000g or >90th percentile |
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AGA?
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average for gestational age
10th-90th percentile |
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SGA?
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small for gestational age
<10th percentile |
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LBW?
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low birth weight
<2500g |
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VLBW?
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very low birth weight
<1500g |
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IUGR?
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intrauterine growth restriction (retardation)
doesn't meet expected norms in growth |
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APGAR score of 0-3 indicates...
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serious distress
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APGAR score of 4-6 indicates...
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moderate difficulty
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APGAR score of 7-10 indicates...
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no difficulty adjusting to extrauterine life
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At which APGAR score should you intervene?
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6 or below
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What is the glabellar reflex?
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3 quick blinks
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What is the extrusion reflex?
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brush finger down lips, mouth opens
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What does the traction reflex test for?
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head lag
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What is the startle reflex?
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tap on bed and hands go into fists
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What is the new Ballard's Scale used for?
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estimation of gestational age
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What is Ballard's Scale based upon?
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specific neuromuscular and physical markers
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Give 4 examples of neuromuscular markers.
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1. heel to ear
2. scarf sign 3. popliteal angle 4. square window |
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Give 3 physical markers of gestation.
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1. raw/red skin-->premie
2. dry/cracked skin-->postmature 3. prominent clitoris & labia minora-->premature |
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What is bilirubin?
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a yellow pigment derived from the Hb released by the breakdown of RBCs and myoglobin in muscle cells
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Describe the processing of Hb by RETICULOENDOTHELIAL cells.
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Hb is phagocytized by reticuloendothelial cells-->
converted to bilirubin--> released in an UNconjugated form |
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Describe unconjugated (aka indirect) bilirubin.
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relatively insoluble and almost entirely bound to circulating albumin
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What type of bilirubin can leave the vascular system and permeate other extra vascular tissue?
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UNBOUND bilirubin
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Where doe unbound bilirubin typically deposit?
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skin, sclera
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What occurs if unbound bilirubin reaches the brain?
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neuro problems
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4 types of NB jaundice?
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1. hyperbilirubinemia
2. physiologic 3. pathologic 4. kernicterus |
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What is the prevalence of physiologic jaundice?
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50%
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Onset of physiologic jaundice?
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>24 h after birth
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What is the unconjugated serum bilirubin level in physiologic jaundice?
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12 mg/dl +
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What intervention/therapy should you apply if your pt have physiologic jaundice?
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1. early and frequent feeding
2. phototherapy prn |
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What is the purpose of early and frequent feeding?
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to promote passing of meconium (and .:. bilirubin)
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What is the significance of phototherapy?
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UV light promotes bilirubin breakdown or the conjugation of bilirubin
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What is the duration of physiologic jaundice?
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peaks at day 5 and then decreases
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Describe the pattern of physiologic jaundice
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cephalocaudal (head to toe)
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What is the cause of physiologic jaundice.
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not sure. thought to be the short life span and large amount of RBCs in conjuction with an immature liver
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What is the cause of pathologic jaundice?
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1. ABO dz or Rh incompatibility
or 2. physiologic hyperbilirubinemia |
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What is the onset of pathologic jaundice?
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within 24 hr of life
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Describe the levels of physiologic hyperbilirubinemia that may cause pathologic jaundice.
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1. peaks > 13 mg/dL
or 2. increases > 0.5 mg/dL/hr -a/w HSM or anemia |
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What is kernicterus?
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a bilirubin encephalopathy resulting from a progression of patho or physio jaundice to too high of levels
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Describe the symptomology of kernicterus.
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acute symptoms and long term neuro damage
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What is the survival rate for kernicterus.
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50%
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What parts of the brain does the bilirubin deposit into in kernicterus?
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1. cerebellum
2. basal ganglia 3. hippocampus |
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Why can bilirubin pass the BBB?
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the unconjugated form is lipid soluble
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What are the s&s of kernicterus?
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1. poor suck/feeding
2. haven't passed meconium 3. seizures 4. strange posturing 5. extraparimidal movements 6. hearing loss |
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What are the early signs of a cold infant?
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1. crying
2. restlessness 3. increased activity |
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What does nonshivering thermogenesis (NST) require?
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O2 AND glucose
*due to increased BMR |
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Which activies require glucose?
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muscle activity & crying
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What might cold stress in an infant cause?
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1. hypoglycemia
2. acidosis |
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What is a sign of hypoglycemia?
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jittery
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5 signs of respiratory distress?
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1. flaring
2. retractions 3. grunting 4. rate <30/ >60 at rest (goes down the more they fight) 5. apnea > 20 sec |
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What are the early signs of respiratory distress?
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increased HR & RR (due to effort to try to get oxygen and produce heat, later they tire out)
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How much weight should a NB lose by 3-5 DOL?
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5-10% of birth weight
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Describe the weight of an infant at 14 DOL.
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regain to birth weight
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What percentage of weight loss requires an evaluation by a HCP?
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any loss over 7-10%
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3 signs of dehydration?
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1. fewer wet diapers (EARLY)
2. sunken fontanel (LATE) 3. lethargy (LATE-exhausted from fighting symptoms) |
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What are the early signs of respiratory distress?
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increased HR & RR (due to effort to try to get oxygen and produce heat, later they tire out)
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How much weight should a NB lose by 3-5 DOL?
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5-10% of birth weight
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Describe the weight of an infant at 14 DOL.
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regain to birth weight
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What percentage of weight loss requires an evaluation by a HCP?
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any loss over 7-10%
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3 signs of dehydration?
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1. fewer wet diapers (EARLY)
2. sunken fontanel (LATE) 3. lethargy (LATE-exhausted from fighting symptoms) |
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What is the blood glucose concentration of a hypoglycemic infant?
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<35 mg/dl
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What is the normal blood glucose range in an infant?
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50-70 mg/dl (if below 50, needs to be fed, mildly hypoglycemic)
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What is the therapy used to tx hypoglycemia?
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1. feeding in low risk infant (mild)
2. IV glucose (severe) |
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S&S of hypoglycemia?
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1. JITTERINESS
2. irregular respiration/apnea (inc) 3. cyanosis 4. weak, high pitched cry 5. feeding difficulty 6. hunger 7. lethargy 8. twitching (serious) 9. eye rolling (serious) 10. seizures (serious) |
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What is neonatal sepsis?
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infection in blood or tissues
*can be caused by chorioembryonitis or GBS+ in mother's vaginal canal |
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Most infants getting sick show what sign?
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low T (iv below 36 C, evaluate for sepsis)
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What are the respiratory sxs of neonatal sepsis?
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1. apnea
2. tachypnea 3. grunting 4. nasal flaring 5. retractions *fm low O2 sat |
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What are the CV sxs of neonatal sepsis?
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1. bradycardia
2. tachycardia 3. hypotension *fm decreased perfusion and CO |
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What are the CNS sxs of neonatal sepsis?
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1. T instability
2. lethargy 3. hypotonia 4. irritability 5. seizures |
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What are the GI sxs of neonatal sepsis?
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1. feeding intolerance
2. abdominal distension 3. vomiting 4. diarrhea |
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What are the integumentary sxs of neonatal sepsis?
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1. jaundice
2. pallor 3. petechiae |
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What should you do right when the baby is born to increase the negative pressure in the lungs?
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suction! helps maintain a patent airway
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What are discharge instructions for urination?
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6-10 wet diapers/day
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What are discharge instructions for stool?
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1-3/day (more if breastfed)
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What are discharge instructions for feeding guidlines?
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breast: ~ every 2-3 hr from when you START
bottle: ~2oz every 3-4 hr |
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What are discharge instructions for activity?
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4-5 wakeful periods/day
responds to sounds/voices |
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What are discharge instructions for cleaning?
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spongebath 2-3x/wk or less
cord: keep clean and dry until it falls off (after 2 wks) |
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How long does it take for a circumcision to heal?
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3 days
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How do you wash a circumcision site?
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warm water, NOT alcohol
*may put vaseline on diaper or glans or both |
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What are sxs of an infected circumcision site?
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1. high fever
2. not feeding 3. low BT 4. green exudate/pus 5. excessive swelling |
