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112 Cards in this Set
- Front
- Back
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When does the prenatal interview occur with a pediatrician?
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before the baby is born, usually in the thrid trimester, but some parents will find one before they conceive
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In general, what is covered in the prenatal interview in terms of the baby?
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-what, how much, and when the baby needs to eat
-what to do if a baby is sick -when the baby will need scheduled visits -safety -handling- soft spots -herbs/ingestions |
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In general, what is covered in the prenatal interview in terms of the mother?
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attachment
memory diet fatigue post-partum depression |
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In general, what is covered in the prenatal interview in terms of the father?
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attachment
anxiety the family/values |
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How often will all well fed babies urinate/defecate?
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about 8 times per day
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Do newborns frequently get sick?
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no
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What should you tell parents to do if their baby is crying?
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ask...
Is the baby hungry? wet? sleepy? LAST check the temperature |
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For the first 30 days of life, any temperature above _____ should be considered abnormal
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100.5
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In the first days of life, what infection is of most concern? What pattern would a fever with it follow?
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GBS
two peaks at 48 hour and 14 days |
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In the first 30 days of life, what should be done with a baby with a fever?
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a full septic workup!
CBC Blood culture CMS UA culture LP - do NOT give antipyretics until the workup is complete |
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What are the schedules visits for child from birth on?
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newborn
2, 4, 6, 9, 12, 15, 18, 24 months then yearly |
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When do children typically receive immunizations?
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2, 4, 6, and 12 months
the next set at age 4 |
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What is the desirable house temperature for a family with a baby?
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72 degrees F
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How can you avoid over-bundling your baby?
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Have them wear one extra layer of the same material as the adult in the house
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What should the maximum water temperature for a baby be?
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110 degrees F (book says 120, but he likes it to be less)
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Until what point shoudl you avoid submerging your baby in bathwater?
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until the umbilical stump has fallen off and the circumcision has healed
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How often should you bathe your new baby?
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every 2-3 days at first, if you bathe them too much they will get a rash
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What is it a good idea to do with lotion on your new baby?
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test it on a small portion of skin and wait a day to be sure that the baby has no reaction to it before covering them in it
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Is it a good idea for parents to use herbal soothing medications for their babies?
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no- unless you know what the effects are and how they are made.
and they are not FDA regulated, so how can you know...? |
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what happens to the short term memory in mom's after delivery?
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it's pretty bad right after delivery
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What is one way to decrease fatigue in the new mother?
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take some time away from the baby to relax and interact with other adults- should help decrease anxiety and help milk production
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What does APGAR assess int eh newborn?
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HR
Respiratory effort muscle tone reflex irritability skin color |
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How is HR scored on APGAR?
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2= >100
1= <100 0= absent |
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At what HR should chest compressions in a newborn be initiated?
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less than 60
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How is respiratory effort scored on APGAR?
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2= baby crying
1= slow, irregular 0= absent |
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In there is no spontaneous breathing immediately at birth, what is done?
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PPV- positive pressure ventillation
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How is muscular tone scored on APGAR?
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2= active motion
1= some flexion of extremeites 0= limp |
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What should you check for if the only problem with apgar is a low score on muscular tone?
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pain meds given to mom during labor and delivery
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How is irritability scored on APGAR?
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2=grimace or cough
1=grimace 0=absent |
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How does Dr. Msibi like to do APGAR?
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does the startle reflex, because it checks tone and irritability at the same time
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How is color assessed using APGAR?
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2= pink
1= extremities blue or body pale 0= blue baby |
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In a dark-skinned newborn, how can you assess their color?
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by looking at mucous membranes
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What is important when trying to resuscitate a baby?
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among many others, make sure the baby is warm (but not too warm!)- place on warmer
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What are some possible things that are involved in resuscitation of the newborn?
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PPV
meconium aspiration intubation primary/secondary apnea chest compressions length of resusciation start oxygen early |
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How might a PDA show up in physical exam of a newborn?
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differences in pulses between the R and L arm
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What cognitive milestone should a baby develop between 0-3 months?
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-look back and forth between objects
-watches an object moved slowly through the line of sight |
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What communicative development should a child achieve between 0-3 months?
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-startled by loud noises
-turns head toward speaker -makes noises other than crying -differentiated cry for fatigue, hunger, and pain |
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What social/emotional development should a child achieve between 0-3 months of age?
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-looks at adult faces
-stops crying when talked to, picked up, or comforted -turns at will toward or away from person/situation |
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What adaptive reflexes should your baby have between 0-3 months
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sucking
rooting -open mouth and sticks out tongue in anticipation of feeding -expresses displeasure when clothes are pulled over head -enjoys bath- indicated pleasure when placed in warm water |
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What is the sucking reflex?
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babys sucks a nipple when placed in mouth
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What is the rooting reflex?
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turns mouth toward hand rubbing cheek
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In the first month, term babies can gain about/up to ______ per day?
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2 oz
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How often/how much do babies 0-3 months eat?
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1-3 hrs for breastfeeding
2-4 hours for formula about 100 Cal/kg/day |
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What are normal sleep patterns for a 1-3 month baby?
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sleeps about 14-15 hours per day for appx 4-6 hours at a time
somewhere in this time, day-night confusion comes to an end |
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What are some signs of possible developmental delays in a 3 month old baby?
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does not smile at people
cannot support head well does not grasp and hold objects |
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What are some signs of possible developmental delays in a 3-4 month old baby?
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- does not babble
- does not reach for and grasp toys |
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What are some signs of possible developmental delays in a 4 month old baby?
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- does not bring objects to mouth
-begins babbling, but does not try to imitate any of your sounds - does not push down with legs when feet are placed on a firm surface |
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What is a sign of possible developmental delays in a 2 month old baby?
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does not notice hands
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What is a sign of possible developmental delays in a 2-3 month old baby?
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does not follow moving objects with eyes
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What are some signs of possible developmental delays in a 0-3 month old baby?
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- does not seem to respond to loud noises
- crosses eyes most of the time (occasional crossing of the eyes is normal in the first months) -has trouble moving one or both eyes in all directions -does not pay attention to new face or seems very frightened by new faces or surroundings |
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What does a baby eat from 0-4 months. HOw often? How much?
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breast milk or formula only
appx every 1-4 hours appx 1-4 oz |
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How long will 0-4 month old babies nurse? How often will a baby feeding normally go to the bathroom?
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breast 5-20 minutes per side
urinate or defecate about 6-8 times per day |
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Around what time is rice cereal added to the baby's diet? What might this cause and how do we prevent it?
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4-6 months
constipation- so can add 2-4 oz of juice per day to diet |
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When is baby food added to the baby's diet and how?
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6-9 months
start with first stage foods- because have one type of food per jar use one kind for 3-4 days to see if baby is allergic to food once you have used 2 or more you can combine them using stage 2 |
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When do we add table food into the baby's diet and how?
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baby can eat whatever the family eats except for eggs and peanut butter
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When can babies be weaned?
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12+ months
usually switch to whole milk until age 3 when you move to 2% if baby is obese, you may want to start 2% earlier |
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What are several risk factors that mothers of advanced age have with a pregnancy?
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high risk pregnancy
placental insufficiency premature delivery genetic disorders |
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What is some information that is part of the maternal record for a newborn?
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serology- age, race, gravada/para, rubella vaccination status, hepB antigen status, GC/clamydia status, HIV status, etc
family/genetic history maternal medications |
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What is some information that is part of the newborn history?
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the delivery record- Was there prom?, artificial vs spontaneous, GBS prophylaxis
infant record- APGAR scores resuscitation- if done, what was done and how long? |
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What should be done with babies born to mothers who are HBsAG positive?
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hepatitis B vaccine and and hep b immunoglobulin within 12 hours of delivery
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What should be done with a newborn of a mom with an unknown HBsAG status?
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hepatitis B vaccine and and hep b immunoglobulin within 12 hours of delivery
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What does an apgar score of 0-3 mean?
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the baby requires immediate resuscitation
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When is the apgar score taken?
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at 1 and 5 minutes, and every 5 minutes after that until an appropriate score is obtained
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What should the newborn exam consist of in general?
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qucke feel
auscultation (heart) lungs GI head, ears, eyes, nose, mouth, neck chest, abdomen, neuromusculoskeletal, skin |
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What do you want to examine on the newborn during the quick feel?
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baby should be naked and you want to observe their:
position on the warmer breathing color symmetry obvious trauma size symmetry! |
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What do you want to auscultate for in the newborn?
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S2- listen at midaxillary line, dub sound, mitral and tricuspid valves, check for murmurs
S1- listen at left sternal border, Lub sound aortic and pulmonary valves * use both the bell and diaphragm |
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Evamining the hear on a newborn, what should you palpate for?
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thrills
hyperactive precordium pulses rate |
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What will pulses show in coarctation of the descending aorta in a newborn?
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perhaps poorer pulses in lower extremities than in upper extremities
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How may a PDA show up in a newborn in terms of their pulses?
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difference between pulses in right and left arm
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If a baby isn't moving their legs, what might you check for?
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spina bifida
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How does a pneumothroax present in a newborn?
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distant breath sounds
respiratory distress: -nasal flaring -intercostal retractions -grunting -persistent cyanosis |
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How is transient tachypnea of the newborn treated?
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percussion and drainage- usually done as part of resuscitation and stimulation
CXR- may be necessary if there is respiratory distress |
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What is one condition that could result in asymmetry of the lungs?
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diaphragmatic hernia
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What do you listen for in the GI system of a newborn?
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bowel sounds
abdominal bruits (could be abdominal aortic stenosis--you probably wont see it at birth, but you can hear it-- or AV malformation of the liver) |
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What do you check on the head of a newborn?
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hair
sutures trauma position of structures size and symmetry bruits |
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What do you check on the PE of the ears for a newborn?
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cartilage
tags brachial cleft cysts (look at the neck, could have air comign out of it) |
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What do you check on the PE of the Nose for the newborn?
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bridge
septum turbinates cartilage symmetry |
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What do you check on the PE of the eyes for the newborn?
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red reflex
congenital cataract glaucoma coloboma anaridia asymmetry |
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What is coloboma?
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a hole in one of the structures of the eye, such as the lens, eyelid, iris, retina, choroid or optic disc
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What is anaridia?
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a rare congenital condition characterized by the underdevelopment of the eye's iris. This usually occurs in both eyes. It is associated with poor development of the retina at the back of the eye preventing normal vision development. Aniridia does not always cause lack of vision, but usually leads to a number of complications with the eye
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What do you check the mouth of a newborn for?
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clefts
inclusion cysts epstein pearls natal teeth tongue tied |
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When is being tongue tied a problem?
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When the baby can't push his tongue past the lower gums
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What are epstein pearls
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Epstein pearls are harmless, protein filled, whitish-yellow cysts that form on the gums and roof of the mouth in a newborn baby
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What are inclusion cysts?
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Harmless small cysts that appear along the crest of the gum ridge
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What do you check the neck of a newborn for?
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masses
supraclaviculat retractions torticollis |
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When must torticollis be fixed in an infant and why?
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ASAP, because otherwise the brain develops to think that the head being tilted to the side is how it shoudl be and if the child's head is turned to normal they will see double
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What do you examine the newborn chest for?
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symmetry, expansion
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What do you examine the newborn abdomen for?
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masses
genetalia circumcision |
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What so you do for the newborn neuromusculoskeletal exam of hte newborn?
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asses for symmetrical ROM
look for birth trauma (fractured clavicle, humurus) look for nerve trauma check reflexes- moro, grasp, rooting |
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What is the Ballard score?
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you use a chart with pictures and descritptions to evaluate the baby. The result estimates the gestational age of the infant. there is a neuromuscular maturity component and a physical maturity component. This also helps determine the nutrition the baby needs
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All infants in Michigan are screened for ________ disorders. what are the subcategories of these disorders?
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50
AA disorders, FA disorders organic acid disorders, endocrine disorders hemoglobinopathies other disorders, hearing |
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List some examples of what newborns are screened for at birth.
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RDS, hyperbilirubinemia, lethargy
cyanosis, vomiting bilious vs. none, hypoglycemia, seizures, sepsis, AA deficiencies organic acid disorders, FA disorders, endocrine disorders hemoglobinopahties, CF, galactosemia |
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What is RDS associated with?
how does it present? |
prematurity, sepsis, pneumothorax, aspiration
grunting, retractions, nasal flading, cyanosis, hypoxia |
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When does hyperbilirubinemia develop? what if it's earlier? What is the abnormality related to?
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after first 24 hours of life
can mean significant hemolysis age and rate of rise |
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What produces the worst hyperbilirubinemia in newborns?
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Rh incompatibility
followed by ABO incompatibility followed by both |
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What could be causing a newborn to be lethargic?
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hypoglycemia
pain meds magnesium epidural/spinal |
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What could be causing an newborn to be cyanotic?
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they are cold
hypoglycemia sepsis lung or heart problems |
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What is bilious vomiting in a newborn associated with?
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obstruction
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What is hypoglycemia in a newborn associated with?
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maternal diabetes
stress sepsis LGA large sugar-filled meal prior to delivery |
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What a seizures in a newborn associated with?
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idiopathic
encephalophaty CP trauma |
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What organisms are associated with sepsis in a newborn?
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GBS
e. coli listeria |
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What are some AA disorders in the newborn screen?
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PKU
homocysteinuria MSUD |
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What are some organic acid disorders that newborns are screened for?
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malonic acidemia
propionic acidemia |
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What are some fatty acid disorders that newborns are screened for?
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MCAD (medium chain acyl Co A dehydrogenase deficiency)
VCAD (long chain acyl CoA dehydrogenase def) |
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What are some endocrine disorders that newborns are screened for?
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congenital hypothyroidism
congenital adrenal cell hyperplasia |
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What are some hemoglobinopathies that newborns are screened for?
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s/beta thalassemia
sickle cell anemia |
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What are some "other" things newborns are screened for?
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CF
galactosemia |
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What are the maternal orders for a mom with GBS?
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-intrapartum abx: prophylaxis required
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What are the indications for maternal abx prophylaxis for GBS?
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1. previous infant with invasive GBS or currently GBS +
2. GBS status unknown (ex, pt delivers before 37 weeks) 3. ROM > or = 18 hours prior to delivery 4. intrapartum fever >100.4 |
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When do you give a newborn abx for GBS?
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maternal abx for chorioamniocentesis with full septic workup
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When do you wait on newborn for abx for GBS?
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if maternal prophylaxis was done at least 2 doses prior to delivery
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What are the maternal orders for an HIV + mom?
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HIV PCR on admission and delivery
IV Zidovudine (2 mg/kg) first hour then 1 mg/kg per hour as a continuous infusion until delivery NO breastfeeding adult infectious disease consult for mom consider c-section if HIV RNA PCR >1000 copies/cc |
