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130 Cards in this Set
- Front
- Back
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What is the neonatal period
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birth through 28 days of life
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a time of vulnerability for the neonate and warrants careful observation by nurses
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transition period
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What is the first phase of the transition period
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last up to 30 minutes afer birth
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What is the first phase of transiton called
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first period of reactivity
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What happens in the first period of reactivity
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Newborn's heart rate increases rapidly to 160-180 and gradually decreases after 30 min to baseline of 100-120. Respirations are irregular for first 15 minutes. RR- 60-80 with apnea up to 10 sec. Crackles may be present. Exploratory behavior. no bowel sounds. minimal saliva
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What is the second phase of the transition period
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Period of decreased responsiveness
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How long does the second phase the transition period last
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30 min- 2 hours after birth
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What happens during the period of decreased responsivenesss
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Respirations are rapid, and shallow with a rate of up to 60 per minute. HR: 100-120. Color is pink. BOwel sounds are audible.
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The period of decreased responsiveness is followed by
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A second period of reactivity
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How long does the second period of reactivity last
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2-8 hours after birth
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Wht happens during the second period of reactivity
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Infant becomes more responsive to all types of stimuli. Periods of tachycardia and tachypnea, *Meconium is commonly passed at this time
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All newborns experience _____ regardless of gestational age or type of birth
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transition
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What is the most critical adaption
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Effective respirations
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Apnea
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>20 sec
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Where is surfactant produced
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Type II cells
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Most newborns are nose breathers, when does the mouth reflex present
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around 3 weeks after birth
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What are signs of respiratory distress in an infant
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Nasal flaring, retractions, grunting with expirations
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Normal newbory respirations
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shallow and irregular, ranging from 30-60 with short pauses of less than 15 sec
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When do pauses in respirations occur most often
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during the active rapid eye movement and decrease in frequency with age
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Incresed use of what muscles may be a sign of distress
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intercostal muscles
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What respirations, instead of normal abdominal respirations are nto normal and should be reported
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Seesaw
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What should the respiration rate be within the first hour after birth
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40-60 and then 30-60 thereafter
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The ribs of the infant articulate with the spine at a horizontal rather than a
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downward slope
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What breathing is characteristic of newborns
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abdominal breathing, chest and abdomen rise simultaneously with inspiration
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What is closed in heart
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foramen ovale.
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When does the foramen ovale usually close permanently
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within a few months
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what can cause the foramen ovale to reopen
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crying
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When does the ductus arteriosus functionally close
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within the first hours after birth hours
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WHen does the ductus arteriosus permanently close
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within 3-4 weeks.
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When will the ductus arteriosus open
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in response to low oxygen levels
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What is functionally closed witht he clamping of the cord
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umbilical arteries, umbilical vein, and the ductus venosus, they are converted into ligaments within 2-3 months
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The heart rate can increase to
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180
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Heart rate during deep sleep
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85-100
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Heart rate while awake
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120-160
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Heart rate when crying
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180
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If heart rate is too high or low, when should you re-evaluate the rate
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30-60 min
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Where can the heart rate be palpated
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base of the umbilical cord
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When is the heart in an infant
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lies midway between the crown of the head and buttocks, axis is more transverse. PMI: 4th intercostal space and to the left of the mid-clavicular line
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Is an irregular heart uncommon
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no, within the first few hours of life
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What are the heart shounds in neonatal period
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higher pitch, shorter duration, and greater intensity
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What are common during the first few hours after birth
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transiet murmurs
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When do heart murmurs have no pathologic significance
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during the first few days of life
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Newborns systolic blood pressure/ and diastolic
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60-80
40-50 |
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What drop in blood pressure during the first hour of life is common
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15 systolic
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When is the blood pressure in a neonate considered hypertensive
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Mean pressure of 50-70 mmHG
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What is the blood volume of a neonate
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85 ml/kg of body weight. Immediately after birth it averages 300 ml, can increase as much as 100ml depending on attachment to placenta
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What does early clamping of the cord do to the neonates blood volume
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lowers it
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Late clamping of the cord in the neonate changes blood volume
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increases
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What is persistent tachycardia usually associated with
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anemia, hypovolemia, hyperthermia, or sepsis
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What is persistent bradycardia associated with
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congenital heart block or hypoxemia
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What is pallor in the immediate postpartum period often symptomatic of
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anemia, marked peripheral vasoconstriction as a result of intrapartum asphyxia or sepsis
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At birth the RBC count ranges from
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4.8-7.1 x 10>6
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Hemoglobin concentration of newborn
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14-24, decreasing gradually to 12-20 during the first 2 weeks
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On the first day, the hematocrit ranges from
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44%-64% and by the 8 weeks, it is between 39-59%
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Polycythemia
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hematocrit >65%
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Iron stores are sufficient for how long in neonate
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5 months
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Leokocytes of neonate
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18,000 increases to 22,000 the first day after birth, goes to resting level of 11,000-12,000
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Platelets in neonate
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150,000-300,000
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The maintenance of balance between heat loss and heat production
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Thermoregulation
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When does the neonate attempts thermal balance
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first 12 hours
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What do neonates do to conserve heat
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position of flexion
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Flow of heat from the body surface to cooler ambient air
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convection
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What temperature is the nursery kept at
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24c
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body surface to a cooler solid surface not in direct contact but in relative proximity
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Radiation
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liquid is converted to vapor
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Evaporation
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loss of heat from the body surface to cooler surfaces in direct contcat
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Conduction
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attempst to generate heat
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Thermogenesis
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What is the primary mechanism for heat production
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metabolism of brown fat, type of adipose tissue
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If this happens anaerobic glycolysis occurs, increased production of acids.
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Cold stress
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Greater than 37.5C
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Hyperthermia
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When is hyperthermia common
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related to sepsis
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What are the signs of hyperthermia when a baby has sepsis
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stressed; vessels in the skin are constricted, color is pale, and hands and feet are cool
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Almost all palpable masses in the abdomen are
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renal in origin
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If a newborn has not voided within how many hours, there may be renal impairment
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48 hours
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Formula-fed infants may void
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more frequently
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when does urine output increase in breastfed infants
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3 or 4 day
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After the fourth day of life all newbors should have at least how many voiding of straw colored urine every 24 hours
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6-8
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What are the pink tinged stains caused from that appear on the diaper
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acid crystals, normal during the first few days, but if seen later can be a sign of dehydration
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What are thedaily fluid requirements for full-term neonates during the first 2 days of life
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40-60 ml/kg; this increases to 100-150 ml/kg/24hr.
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Loss of birth weight greater than what percent should be evaluated by the heatlth care provider
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7
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What is normal weight loss during the first 3-5 days
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5-10%, over 7 should be a concern
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When should neonate regain the birth weight lost
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within 14 days
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The GFR of a newborn is approximately _____ that of the adult
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30-50%
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Sodium reabsorption in an neonate is
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decreased
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What G.I. enzyme is a neonate not producing
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amylase and lipase (usually produced after 3 months)
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retention cysts, small whitish arease found on the gum margins and the juncture of the hard and soft palate
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epstein's pearls
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capacity of the stomach
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30-90 ml
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greenish black, viscous, and contains occult blood, first pass is sterile
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Meconium
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WHen is meconium usually passed
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within the first 12 hours and almost all by 24 hours
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Breast feed babies will have what in their stools
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small, yellow curds
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formula feed babies will have what in their stools
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green-brown curds
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Breastfed infants should have at least how many stools per day
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3 after day 3 or 4 of life
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What does abdominal distention at birth usually indicate
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a serious disorder such as ruptured viscus or tumors
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What does a scaphoid sunken abdomen with bowel sounds heard in the chest and signs of respiratory distress indicate
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a diaphragmatic hernia
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When allergic to foods, will have soft stools and
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distrinct water ring around the stool
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Meconium from the vagina or urinary meatus is a sign of
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fistulous tract from the rectum
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Where can the liver be palpated
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about 1-3.5 cm below the right costal margin in the midclavicular line
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What is an enlarged liver associated with
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Congenital heart problems, hemolytic disease, or infection
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The liver edge is normally
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sharp and soft
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Iron stores in full term are sufficient for
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4-6 months
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Iron stores in preterm are sufficient for
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2-3 months
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Full-term infants who are breastfed do not need supplemental iron for
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6 months
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There si an initial decrease in serum glucose reaching its lowest level between
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30-90 minutes after birth
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Blood glucose levels stabilize at
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40-80 mg/dl during the first several hours, end of the first week approx. 60-70
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What blood glucose level are considered abnormal and warrant intervention
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below 35
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Indirect bilirubin
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insoluble
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Jaundice is clinically visible when
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bilirubin levels reach 5-7 mg/dl
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The peak indirect bilirubin level may be higher in breastfed infants
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15-17
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jaundice is considered to be pathologic if
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it appears before 24 hours, increases more than .5 mg/dl/hr, peaks at greater than 13 mg/dl in a term infant or is associated with anemia and hepatosplenomegaly
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Jauncie appears in a
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cephalocaudal manner, dissipates in the reverse
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or actue bilirubin encephalopathy, bilirubin is deposited in the basal ganglia and brainstem, disrupting neuronal function
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Kericterus
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When does kernicterus usually occur
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when bilirubin levels are higher than 25 mg/dl
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If kericterus is not treated the infant becomes
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hypertonic, backward arching of the neck and trunk, high-pitched cry,a nd develop fever
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Breastfeeding is associated with jaundice (early-onset) begins at
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2-4 days
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Breast mike jaundice (late-onset) occurs
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beyond the first week of life, typically occurs afer 3-5 days of age and peaks by 2 weeks. may persist for 3-12 weeks
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At birthm most circulating antibodies
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IgG
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when is the production of adult concentrations of IgG reached
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4-6 years
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The fetus is capable of producing IGM by the
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eight week of gestation, reaches adult levels at 2 years
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What membrane protective is missing from the respiratory and urinary tracts unless thenewborn is breastfed
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IgA
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When is infection one of the most leading causes of morbidity and mortality
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first several months of life
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What is one of the most leading causes of morbidity and mortality in neonates
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Infection
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What are signs of serious infection in neonate?
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Temperature instability or hypothermia, do not typically exhibit fever
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What is the greatest risk factor for neonatal infection
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prematurity
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Wht is the protective covering on neonates skin
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vernix caseosa
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When hands and feet appear slightly cyanotic
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acrocyanosis
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A single palmar crease found in Asian infants or infants with Down Syndrome
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Simian Line
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Generalized, edematous area of the scalp, most commonly found on the occiput, extends across suture lines of the fetal skull and disappears sponaneously within 3-4 days
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Caput Seccedaneum
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Between a skull bone and its periosteum, does not cross a crania suture line. Does not bulge when the infant cries. disappears gradually 2-3 weeks
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Cephalhematoma
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Vacuum assisted births have the highest association iwth
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Subgaleal hemorrhage
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Soft compressible mass that crosses suture lines, extends beyond bone and continues after birth. Causes the ears to protrude and may extend down into the neck. Firm mass at the back of the neck
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Subgaleal hemorrhage
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