Newborn Care

Front 1

Period of time considered a newborn

Back 1

28 days

Front 2

needs of infant in utero taken care of through

Back 2

placenta
(temp, O2, BS, electrolytes, waste products out)

Front 3

how baby physically prepares for transition out of womb

Back 3

lung fluid decreases (several weeks prior to birth)
chest compressed as go through birth canal (creates pressure change for first breath)

Front 4

characteristics of a newborn

Back 4

respiration-periodic,irregular bc immature lungs
circulation-
elimination-[] urine difficult bc kidneys
glucose-pancreas not regulating BS well
thermoregulation-isn't able to perform own, so must keep warm, lose heat easily
immature liver-can't store Vitamin K or excrete bilirubin

Front 5

cord without 2 arteries & 1 vein

Back 5

high risk for developmental probs

Front 6

infant w meconium stained amniotic fluid-
interventions

Back 6

suction aggressively
assess lung sounds
take pulse ox
monitor for resp distress

Front 7

The Apgar score rates-

Back 7

respiration (crying)
reflexes (irritability)
pulse (heart rate)
skin color of body/ extremities
muscle tone
(measures direct and indirect indicators of vital fns)

Front 8

When are Apgar's done?

Back 8

1 min
5 min
-done again at 10mins after if low (<8)
(low scores assoc w developmental probs)
if known risks, pediatrician will be present

Front 9

Once abcs established--what do you do?

Back 9

cut the cord
do secondary assessment
(physical assessments, reflexes, common anomalies-clavicle,shoulder probs? breathing probs?)

Front 10

Reasons infants have trouble w thermoregulation

Back 10

-(high priority
-lack brown fat
-unable to shiver
-large bsa (4x > than adults)
-poor neurological control
(<97 = acidosis, potentially fatal)

Front 11

4 ways newborns lose heat?

Back 11

-evaporation ('wet'-dry ASAP)

-convection ('blowing'-windows, fans, vents)

-conduction ('touching'-blankets, bedding, hats, steth.)

-radiation ('atmosphere'- nearby ice machine, radiant heater)

Front 12

consequence of loss of temp?

Back 12

HYPOXIA
-met rate
-periph vasoconstriction
-pulmonary vasoconstriction

-O2 demands go up, O2 supply goes down resulting in hypoxia

Front 13

risk of bili lights?

Back 13

risk for hyperthermia

Front 14

early signs of hypothermia

Back 14

-twitching
-poor feeding
-any neuro symptoms

Front 15

respiratory patterns
what is ok?
not ok?

Back 15

OK=
irregular breathing
30-60
nasal / abd breathers
acrocyanosis

NOT OK =
central cyanosis
grunting
retractions
nasal flaring

Front 16

normal reflexes indicate

Back 16

neuromuscular integrity

Front 17

abnormal reflexes may indicate alterations in-

Back 17

-T
-glucose
-Ca level
-hypoxia
-maternal drugs
-in between 1st and 2nd period of reactivity (when in deep sleep)
-trauma
-changes in reflex status- assess glucose, T,

Front 18

1st period of reactivity vs 2nd period of reactivity?

Back 18

1st period= first 30 mins awake, active, hungry

deep sleep 4-6 hrs (hard to wake, no interest to suck)

2nd period = awake 4-6 hours

Front 19

LGA
AGA
SGA

Back 19

LGA (>90%)-risk for low BS, assess feeding patterns, stress importance of regular feedings)
AGA (betw 10-90%)
SGA (<10%)

Front 20

Ballard / Dubowitz exam

Back 20

scoring system that determines how many weeks of gestational age completed(not by due date)
grouped -preterm, term, post term)
assessed in two ways-
physical charactreristics
and
neuromuscular maturity (not reflexes but general muscle tone)

Front 21

Ballard/ Dubowitz physical characteristics assessed by-

Back 21

eye/ear
-skin
-lanugo
-plantar surface
-breast
-genitals

Front 22

Ballard/ Dubowitz neuromuscular maturity assessed by-

Back 22

-posture
-square window
-arm recoil
-popliteal angle
-scarf sign
-heel to ear

Front 23

normal weight loss for first few days?

Back 23

5-10 % of body weight in first 3 days
elimination, milk supply limited, ability to eat not decveloped, interest in sleep greater

Front 24

to calculate weight loss-

Back 24

convert weight to ounces (16 oz =1 lb)

subtract 10% of ounces

Front 25

3 interventions instituted in the delivery room for newborns

Back 25

ID bands
Vitamin K
eye drops

Front 26

Vitamin K

Back 26

produced in normal flora-stored as fat soluble vit in liver
used for clotting

risk for brain hemorrhage/ damage due to insufficiency

Front 27

newborn eyedrops

Back 27

preventsneonatal blindness
(opthalmia neonatorum)
-causes mild conjunctival irritation
-delay to promote bonding

Front 28

signs of respiratory distress

Back 28

rapid resp
cyanosis
flaring of the nares
retractions
grunting
assymetrical expansion of the chest

Front 29

normal BP

Back 29

legs and arms (both measured and should be same)
65-80/
30-40

Front 30

mongolian spots

Back 30

deep bluish on butt/ back
(common on non-caucasian babies)

Front 31

how do you check for patency of the nose?

Back 31

block one side, then other

Front 32

caput succadenium

Back 32

edema of the soft tissue that will disappear w/in 1-3 days
result of head pushing on cervix

Front 33

encephalhematoma

Back 33

does not cross sutures*
bleeding between periosteum and the bones (may be on one or both sides of bone)
resolves w/out treatment

Front 34

skin tags sometimes assoc w

Back 34

renal malformations

Front 35

epsteins pearls

Back 35

small white hard cysts on the palate or gums

Front 36

what is implied if circumoral cyanosis gets better with crying?
or it worsens?

Back 36

-better=need for stimulation, better oxygenation

-worse= may indicate cardiac problems

Front 37

rooting

Back 37

stroke side of mout towards that side

Front 38

suck

Back 38

elicit byu touching lips or palate (less so if just ate, sick, or preterm)

Front 39

infants neck-
if it has fat pad/ webbing?

Back 39

should be reported

Front 40

umbilical

Back 40

bluish whit in color
2 arteries, 1 vein
(kidney abnormal, if art missing)

Front 41

moro reflex

Back 41

startle

Front 42

ortalani's sign

Back 42

audible hip click

Front 43

babinski reflex

Back 43

stroke outside of foot, from heel to toes

toes should fan outward, while big toe sould dorsiflex

-refelx disappears w/in a few weeks
-absence= neurological problems

Front 44

spine assessment of newborn

Back 44

prone placement
look for straight and flat
column -palpate for alignment, bulges,
indentation/tufts hair=spina bifida
sacrum-dimpling (pilunital cyst/ sinus)

Front 45

genitals of female

Back 45

edematous (esp if breech)
vernix
tag
vag discharge tinged w blood (pseudomenstruation)

Front 46

Maternal HIV
how to reduce risk transmission?

Back 46

give retrovirals
C-section
bathe prior to Vit K & eyedrops
no breastfeeding

also-support for mom

Front 47

teach HIV mom

Back 47

watch for fever
ensure mom has thermometer, knows how to take temp
if fever (<3 mos.) requires hospitalization (lumbar puncture
requires 18 mos for accurate testing for baby

Front 48

risk for babies with HIV mother

Back 48

FTT
(failure to thrive)
FUO
(fever of inknown origin)
delayed G&D

Front 49

maternal gestational diabetes

concerns for the newborn?

Back 49

LGA
changes in insulin/sugar causes infants to have low BS probs

assess for hypoglycemia
(monitor T-closely r/t glucose)

Front 50

Why are babies LGA when mom has diabetes?

Back 50

high BS levels in mom brings extra glucose to baby

causes baby to have extra weight

Front 51

what symptoms will one see with newborn hypoglycemia?

Back 51

manifests as neuro problems
-twitching
-poor feeding
-abnormal reflexes

(bc 90% of glucose bathes the brain fluid)

*esp at risk-LGA, SGA, mat. diabetes

Front 52

maternal substance abuse-what do you need to assess w mother?

Back 52

type of drug?
when taken last?
corroborate w family members for truthfulness

this gives info about when newborn will experience withdrawal

Front 53

if drug test positive in newborn, what do you need to do?

Back 53

alert dyfus
and
involve social work team

need to be non-judgmental

involving mom important for nb best interest
determine amt of care mom can be involved w/

Front 54

what interventions are important for newborn born addicted to substance

Back 54

observe for irritability,
possibility for seizures
poor feeders

hold off on feeding baby-speak to pediatrician for appropriate feeding method
(assess reflexes)
document feedings meticulously
sm amts in low stimulant environment
positioning (side-lying (if monitoring-to help prevent aspiration)
continuous monitoring

Front 55

what are the two sub-tracts of the spinothalamic tract?

Back 55

neospinothalamic, paleospinothalamic

Front 56

effect of herpes on newborn

Back 56

herpes encephalitis

Front 57

maternal alcohol use on the effect of the nb

Back 57

FAS
(characteristic facial features)
high risk for cardiac
and hearing probs
neuro probs
behavior probs
breathing probs
feeding probs

Front 58

smoking effects on newborn

Back 58

constricts blood vessels (SGA)
risk for SIDS
ear infections

Front 59

problems with placental circ
PIH
post term
placental insuffic
abruption/ previa

Back 59

run famut from no deficit to
hypoxia in utero
SGA if significant loss of placental circ
meconium stained amniotic fluid
delay in growth and development
severe neuro/developmental probs
altered reflexes

Front 60

Hip dysplasia-who's at risk?

Back 60

breech
and
preemies

Front 61

how do you diagnose hip dysplasia?

Back 61

assymetrical gluteal fold
ortalani's click
barlow's maneuver

Front 62

treatment of hip dysplasia

Back 62

double diaper (mild)
-to immobilize

Pavlik harness

also assist parent w grief (clothes, teaching, car seat)

Front 63

caput succadeneum

Back 63

emerges at birth
resolves in 24 hours
crosses suture line (if just swelling)

Front 64

cephalhematoma

Back 64

emerges 12-24 hours
resolves 2-3 weeks
does not cross suture line
'increased risk for jaundice

Front 65

preterm infants problems

Back 65

RDS (decr surfactant)
-monitor cont (may not show right away)
-anticipate steroid admin
-put on high O2
-arrange feedings to reduce resp distress & aspiration
((high O2 long term can cause retinopathy/blindness))
gavage feedings (so they can conserve energy, O2, promote growth)

Necrotizing enterocolitis
(lose circ to portion of bowel ---abd distention, restlessness, fever)
-cardiac probs
-jaundice

adjust developmental norms
-BPD (bonchopulmonary dysplasia)

Front 66

TTN

Back 66

transient tachypnea of the newborn (>60 breaths/min)

-difficult to distinguish from cardiac problems
1% nbs
-can't feed bc breathing so fast
(or feedings small, burp freq)
-observe/document weight, growth
-resolves spontaneously
-longer time to transition

Front 67

Who is at risk for TTN?

Back 67

C-sect
diabetic/ asthmatic mothers

Front 68

Shoulder dystocia-who is at risk?

Back 68

LGA
prolonged second stage of labor

Front 69

Assess for shoulder dystocia how?

Back 69

assymetry of arm movement
palpate clavicle
look for Erb's palsy
weakness?

Front 70

Interventions for shoulder dystocia

Back 70

immobilize
consult for pediatrician

damage can be partial/complete/temp/perm

Front 71

interventions for nb under phototherapy

Back 71

expose skin as much as possible
protect eyes
increase intake to replace
-fluid losses
-incr protein for conjugation
-increase stools

Front 72

physiologic jaundice

Back 72

AFTER 24 hours
-normal cause (from RBC cell breakdown)
may/maynot require bililights
treat if bili >16

Front 73

pathologic jaundice

Back 73

MAY occur Before 24 hours
ABO incompatibility
-may require transfusion**

Front 74

breastfeeding jaundice

Back 74

NO Kernicterus
when?? 6 days to 6 weeks
why?? fatty acids in breastmilk
what to do? stop breastfeeding!!
resume BF when bili levels normal (usually 24 hours after)

Front 75

2 newborn screenings

Back 75

-Audiometric screening
-Genetic screening (must have been feeding 24 hrs before test is accurate)