Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
146 Cards in this Set
- Front
- Back
|
3 phases of transition into extrauterine life
|
1-1st period of reactivity
2-Period of decreased responsiveness 3-2nd period of reactivity |
|
|
1st Period of Reactivity:
-general description of neonate -duration -RR -HR |
active and alert
30min-2hrs >60 >160 |
|
|
Why is breastfeeding best immediately after delivery
|
1st period of reactivity, baby is active and alert, good time for baby & mom to learn
|
|
|
Period of Decreased Responsiveness:
-general description of neonate -duration -RR -HR -T |
lethargic, dead asleep
2hrs-4hrs <60 + apnea (20-30sec) 100-120 low temp |
|
|
What transitional phase is baby most vulnerable to poor thermoregulation
|
period of decreased responsiveness
|
|
|
2nd Period of Reactivity
-general description -duration -RR -HR |
-increased mucous production
-10min-several hours -tachypnic -tachycardic |
|
|
During what transitional phase should the nurse be prepared to suction the neonate
|
2nd period of reactivity
|
|
|
General description of a "hungry cry"
|
metronome
|
|
|
3 stimuli that initiate neonate's first breath
|
1-Pressure Changes
2-Temp Changes 3-Chemical Changes |
|
|
What shifts simultaneously as baby initiates his first breath
|
circulatory system
|
|
|
Explain the pressure changes associated with neonate's first breath
|
greatest negative pressure bc it has to force fluid out of lungs
|
|
|
Explain the temperature changes associated with neonate's first breath
|
temp sensors on baby skin that detect drop in temp from intrauterine life and external environment which stimulates the brain to initiate breathing
|
|
|
Explain the chemical changes associated with neonate's first breath
|
decreased levels of O2, increased levels of CO2; elevated levels of CO2 stimulate breathing
|
|
|
What causes the respiratory/circulatory shift
|
-decreased P in lungs (no fluid)
-closure of DA, DV & FO |
|
|
What is a result of the respiratory/circulatory shift
|
increased circulation to the pulmonary system, increased lung expansion and clearance of fluid
|
|
|
4 methods of heat loss r/t thermoregulation
|
-convection
-conduction -evaporation -radiation |
|
|
Define "convection"
|
heat loss due to air current, flow, or by movement creating a breeze
|
|
|
Define "conduction"
|
heat loss due to direct contact with a cooler object
|
|
|
Define "radiation"
|
heat loss from a cooler environment that is nearby
|
|
|
Examples of neonatal heat loss via evaporation
|
-birth process
-wet diaper -wet hair from bath -spit up |
|
|
Examples of neonatal heat loss via convection
|
-drafts
-AC -people walking around crib |
|
|
Examples of neonatal heat loss via conduction
|
-scale
-cool hands |
|
|
Examples of neonatal heat loss vis radiation
|
through the sides of the crib/incubator ie/ windows, cooler air
|
|
|
3 methods neonates use for thermogenesis
|
1-NST
2-increased m. activity 3-increased BMR |
|
|
What is "brown fat metabolism"
|
NST - alternative means of heat regulation since baby doesn't shiver
|
|
|
Describe how "brown fat" acts as a thermoregulator
|
-uses O2, ATP & glucose
-dense blood supply, n. endings -senses drop in T to produce heat |
|
|
When is "brown fat" produced, how long do we have it, and what is it's purpose
|
-26-30 wks gestation (in utero)
-2-5wks after birth -back up system |
|
|
When does fetus acquire suck-swallow coordination
|
-32wks gestation
-1500g |
|
|
How many cc's can a neonate's stomach house
|
30-60cc's
|
|
|
Types of stool in order of appearance
|
-meconium
-transitional -milk |
|
|
What time frame do you expect neonate to pass meconium
|
w/in 1st 24h of life
|
|
|
Describe the color of milk stools
|
seedy yellow
|
|
|
In the first 3 days of life is it normal for the neonate to have stool every time he feeds
|
yes
|
|
|
By the 3rd day of life, how many stools do we expect to see
|
1-3 stools/day
|
|
|
How many wet diapers should we tell mom to expect? By what day should she expect to see this?
|
6-8 wet diapers by 4th day of life
|
|
|
What information do urate crystals give us
|
the baby is slightly dehydrated
|
|
|
Is it normal to see vaginal blood in the diaper
|
yes, in females; mommy's hormones
|
|
|
Define acrocyanosis. When should it resolve?
|
peripheral cyanosis of the hands and feet that should resolve w/in 48hrs
|
|
|
When should Mongolian spots resolve by?
|
school-aged (~5yrs)
|
|
|
Common places for stork bites
|
ear and back of neck
|
|
|
Erythema Toxicum: what is it? what causes it? describe it's pattern? how do we treat it? when should it resolve?
|
benign rash; unknown; comes and goes; no tx; w/in 2wks
|
|
|
What are milia
|
appearance-like white heads that are actually distended sebaceous glands
|
|
|
What is the purpose of vernix?
|
protects the skin fetus
|
|
|
What term describes the fine hair found on the neonates skin
|
lanugo
|
|
|
When should we expect facial bruising to resolve
|
w/in a few days
|
|
|
Describe caput succedaneum
|
edema seen over the presenting part of the head from the birthing process; crosses the suture line
|
|
|
What form of swelling crosses the suture line, what does not?
|
caput succedaneum; cephalahematoma
|
|
|
If a baby comes to the NBN with caput succedaneum, when should we expect to see it resolve
|
3-4 days
|
|
|
Describe a cephalohematoma
|
a collection of blood with clear edges that does not cross the suture line
|
|
|
Why doesn't a cephalohematoma cross the suture line
|
the bleeding is held between the bone and its covering, the periosteum
|
|
|
Should we be concerned about molding?
|
no it will resolve on its own; it is a normal occurrence from the birthing process
|
|
|
What components make up a newborn assessment?
|
-APGAR
-VS -Measurements -Vitamin K and Erythromycin -Physical Exam -Reflexes -GA assessment (NM & physical) |
|
|
What is a very generalized purpose of a newborn assessment?
|
to make sure there are no gross anomalies
|
|
|
Why is the purpose in administering Vitamin K
|
it isn't produced naturally for ~8 days; it is an important clotting factor
|
|
|
What is the purpose of administering the opthalmic ointment
|
erythromycin is an antibiotic used to prevent infection
|
|
|
Normal VS
|
T=97-99.5F
RR=30-60 HR=120-160 BP: 65-95/30-60 |
|
|
Under what circumstances would you expect to take a baby's BP?
|
if there is a murmur
|
|
|
Normal ranges for HC and CC of full-term baby
|
HC: 13-15in, 33-35cm
CC: 12-13in, 30-33cm |
|
|
Normal range for length of full-term baby
|
19-21in, 48-53cm
|
|
|
Normal range for BW of full-term baby
|
5.3-8.5lbs, 2500-4000g
|
|
|
How much weight does a baby lose after they're born?
|
7-10%
|
|
|
GA: preterm, term, postterm, post-mature syndrome
|
pm <37wks
t = 37-42wks pt > 42wks syndrome > 42wks + s&s's placental insufficiency |
|
|
Rangers for: LGA, AGA, SGA
|
LGA > 4000g, 90th percentile
AGA = 2500g-4000g, 10th-90th SGA < 2500g, 10th percentile |
|
|
Ranges for: LBW, VLBW, IUGR
|
LBW < 2500g
VLBW < 1500g IUGR (intrauterine growth restriction) = doesn't meet expected norms |
|
|
What important factor needs to be considered in VLBW babies?
|
< 1500g hasn't achieved suck-swallow coordination
|
|
|
What is an APGAR score?
|
rapid assessment of transition assigned at 1min and 5min
|
|
|
What assessments are made when performing APGAR
|
-HR
-Respiratory Effort (cry) -Muscle Tone -Reflex Irritability -Color |
|
|
Describe each range of an APGAR score: 0-3, 4-6, 7-10
|
0-3 = serious distress
4-6 = moderate difficulty 7-10 = no diff. adjusting |
|
|
What do we need to make sure we educate mom about concerning the sucking reflex?
|
it is not only associated w/ hunger
|
|
|
What reflex is good to access when trying to feed the baby?
|
extrusion
|
|
|
What reflex is good for mommy-baby bonding?
|
crawling; place baby on mom's chest
|
|
|
What is the difference between a moro reflex and a startled baby?
|
fists are not clenched with moro reflex
|
|
|
Describe Babinski
|
Extension of big toe, fanning of the other toes (positive babinski is normal)
|
|
|
Premature neonates have greater/less flexibility than full term neonates?
|
greater
|
|
|
Premature neonates have dry/moist skin in comparison to postterm neonates?
|
moist
|
|
|
Describe the female genitalia of a premature neonate
|
prominent clitoris and labia minora
|
|
|
Complications commonly seen in neonates
|
-jaundice
-dehydration -weight loss -cold stress -respiratory stress -hypoglycemia -sepsis |
|
|
What is bilirubin derived from
|
release of Hgb from breakdown of RBC's and myoglobin in muscle cells
|
|
|
What is bilirubin derived from
|
release of Hgb from breakdown of RBC's and myoglobin in muscle cells
|
|
|
What happens in order for the conversion from hgb to bilirubin to occur
|
Hgb is phagocytized by reticuloendothelial cells
|
|
|
What happens in order for the conversion from hgb to bilirubin to occur
|
Hgb is phagocytized by reticuloendothelial cells
|
|
|
What form is bilirubin released in
|
unconjugated form
|
|
|
What form is bilirubin released in
|
unconjugated form
|
|
|
What is the problem with unconjugated bilirubin
|
it makes deposits in different organs
|
|
|
What is the problem with unconjugated bilirubin
|
it makes deposits in different organs
|
|
|
Examples of bilirubin deposit sites
|
sclera, skin, mucosa, brain
|
|
|
Examples of bilirubin deposit sites
|
sclera, skin, mucosa, brain
|
|
|
What is another term for unconjugated bilirubin
|
indirect bilirubin
|
|
|
What is another term for unconjugated bilirubin
|
indirect bilirubin
|
|
|
How is indirect bilirubin found in the blood?
|
bound to albumin
|
|
|
How is indirect bilirubin found in the blood?
|
bound to albumin
|
|
|
Indirect bilirubin is soluble/insoluble
|
relatively insoluble
|
|
|
Indirect bilirubin is soluble/insoluble
|
relatively insoluble
|
|
|
Explain how indirect bilirubin makes its way into extravascular sites
|
unconjugated/indirect bilirubin not bound to albumin permeates vasculature and makes its way into extravascular sites
|
|
|
Explain how indirect bilirubin makes its way into extravascular sites
|
unconjugated/indirect bilirubin not bound to albumin permeates vasculature and makes its way into extravascular sites
|
|
|
Explain the pattern of bilirubin
|
cephalocaudal (top, down)
|
|
|
Explain the pattern of bilirubin
|
cephalocaudal (top, down)
|
|
|
Examples of Newborn Jaundice
|
-hyperbilirubinemia
-physiologic -pathological -kernicterus |
|
|
Examples of Newborn Jaundice
|
-hyperbilirubinemia
-physiologic -pathological -kernicterus |
|
|
Prevalence of physiological jaundice
|
50% = benign
|
|
|
Prevalence of physiological jaundice
|
50% = benign
|
|
|
Onset of physiological jaundice
|
> 24h
|
|
|
Onset of physiological jaundice
|
> 24h
|
|
|
Levels of inconjugated serum bilirubin with physiological jaundice
|
<=12mg/dL
|
|
|
Levels of inconjugated serum bilirubin with physiological jaundice
|
<=12mg/dL
|
|
|
Treatment for physiological jaundice
|
-frequent feedings
-phototherapy |
|
|
Treatment for physiological jaundice
|
-frequent feedings
-phototherapy |
|
|
Explain how frequent feedings work as treatment for clearing increased levels of bilirubin
|
bilirubin is excreted in stool
|
|
|
Feeding recommendations for bottle feeding and breast feeding to treat physiological jaundice
|
bottle q3h
breast q2h |
|
|
How does phototherapy work as treatment for pathological jaundice
|
UV light breaks up unconjugated bilirubin
|
|
|
Levels of unconjugated serum levels of bilirubin seen in pathological jaundice
|
>=13mg/dL
Increases >0.5mg/dL/hr |
|
|
What other conditions are often associated with pathologic jaundice
|
Hepatosplenomegaly
Anemia |
|
|
What is Kernicterus
|
bilirubin encephalopathy
|
|
|
Survival rate of pt's with Kernicterus
|
50%
|
|
|
Longterm complication of Kernicterus
|
neurological problems, death
|
|
|
Early signs of cold stress in an infant
|
-crying
-restlessness -increased activity |
|
|
How does infant try and overcome cold stress and what complications may result
|
-NTS (uses O2 and glucose)
-m. activity&crying (use glucose) -hypoglycemia and acidosis |
|
|
What are some general signs of respiratory distress
|
-nasal flaring
-retractions -grunting -RR >60, RR <30 -apnea > 20s |
|
|
If an infant is experiencing respiratory distress where might be the first place you observe retractions
|
intercostals
|
|
|
Early and late signs of respiratory distress r/t RR
|
early >60, late <30
|
|
|
After birth, the neonate loses 7-10% of their BW; how many days does it take for this to occur
|
3-5 DOL
|
|
|
When does the baby regain the 7-10% wt. loss experienced in the first 3-5 DOL
|
2 weeks, 14 days
|
|
|
Signs of dehydration
|
-few wet diapers
-sunken fontanel -lethargy |
|
|
How many wet diapers should a baby produce per day
|
6-8
|
|
|
Glucose level seen in hypoglycemia
|
<35mg/dL
|
|
|
If a baby appears "jitty" what might we suspect?
|
hypoglycemia
|
|
|
How can you determine the difference between a baby suffering from hypoglycemia and a baby suffering from a seizure
|
if the baby stops shaking when you hold them suspect hypoglycemia
|
|
|
Tx for hypoglycemia in low risk pt and more severe cases
|
-feeding
-IV |
|
|
S&S of hypoglycemia
|
-jittery**
-irregular resp/apnea -cyanosis -weak, high pitched cry -feeding difficulty/hunger -lethargy -twitching -eye roll -seizures |
|
|
Describe hunger patterns of a hyoglycemic baby
|
they may be starving or they may not have enough energy to eat
|
|
|
Respiratory s&s's of neonatal sepsis
|
-apnea
-tachypnea -nasal flaring -grunting -decreased O2 sat |
|
|
CV s&s's of neonatal sepsis
|
-bradycardia
-tachycardia -hypotension -decreased perfusion -decreased CO |
|
|
CNS s&s's of neonatal sepsis
|
-temp instability
-lethargy -hypotonia -irritability -seizures |
|
|
GI s&s's of neonatal sepsis
|
-abdominal distention
-feeding intolerance -V/D |
|
|
Integumentary s&s's of neonatal sepsis
|
-jaundice
-pallor -petichiae |
|
|
After the baby is born what are 2 things that have to be done before the baby can leave mom
|
footprints and ID band
|
|
|
Postnatal care
|
-suction
-cord clamp -vitamin K -eye ointment -footprint & ID -APGAR -warm blanket -encourage bonding -initiate breastfeeding |
|
|
If bottle-feeding, how many oz of formula should a nurse educate mom to feed the baby and how often?
|
2oz q3-4h
|
|
|
How many stools should the nurse educate mom to be expecting each day if bottle feeding/ if breastfeeding
|
1-3, more
|
|
|
How should the baby be laid to sleep?
|
on their back
|
|
|
How many times a week should the baby be bathed?
|
2-3x or less
|
|
|
What type of bath should be used for the baby?
|
sponge bath until the cord falls off
|
|
|
How long does it normally take for the cord to fall off
|
2 weeks
|
|
|
What would be a good use for vaseline on a baby?
|
circumcision
|
|
|
Should we apply vaseline to the cord site? Why or why not?
|
no, should be kept clean and dry
|
|
|
When should mom contact the doctor after discharge?
|
-fever > 100.4
-lethargy -decreased appetite -decrease urine/stool -color (pale, yellow, blue) -any feelings of uncertainty |
