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44 Cards in this Set
- Front
- Back
In utero, the fetus produces surfactant between ___ and ___ weeks. Surfactant keeps the alveli from collapsing. The fetus practices breathing movement in utero, causing fluid to build up in the lungs.
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34 and 36
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The resipiratory system is stimulated by four processes/stimuli that together cause the infant to take its first breath when born. Describe these 4 types of stimuli.
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chemical: decrease in pH
decrease in PO2 increase in PCO2 (changes in atmospheric pressure) thermal: temp changes sensory: cold air, touch, drying off - stimulates skin sensors mechanical: squeezing on the way out helps get fluid out |
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In contrast to a vaginal delivery, a ______ delivery baby will have gurgly wet sounds because baby weren't squeezed on the way out (to get fluid out)
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c section
needs suctioning |
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Shortly after birth, you may hear a _____ when you listen to the heart because fetal shunts are still open.
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murmor
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Infants lose heat quickly because they have 3 times more _____ area than adults and lose heat 3 times faster. They have thin skin and blood vessels are close to the skin. They use vasoconstriction to maintain heat in addition to ..... (a 3 word mechanism)
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non-shivering thermogenesis- increased flexion/activity to maintain heat. They don't shiver because the brown fat warms the blood.
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Where is brown fat located?
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interscapular area
neck axillae sternum adrenals kidneys abdominal aorta |
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What are the methods of heat loss? Describe each one.
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evaporation
conduction convection radiation |
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What are the hazards of cold stress?
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increased need for oxygen
respiratory distress decreased surfactant produc. hypoglycemia metabolic acidocis jaundice |
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How does metabolic acidosis occur in the cold infant? How does this lead to jaundice?
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Use up all the brown fat-->
increase in fatty acids --> metabolic acidosis--> jaundice Jaundice occurs because fatty acids attach to albumin and billi has nothing to attach to, builds up. |
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It is common to see jaundice in the 3rd or 4th day, when would it be a red flag to see jaundice in the newborn?
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1st 24 h
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Why can an infant become dehydrated quickly?
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immature kidneys
GFR not optimized til age 1-2 can't concentrate urine quickly |
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Babies are 78% water. How much fluids do they need the 1st 2 days when kidneys are immature ? How about after that?
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40-60 ml / kg in 1st 2 days
100- 150 ml / kg after |
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Describe # of diapers expected on each day after birth. When is the first void usually?
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1 - 1 diaper
2 - 2 3 - 3 4 - 6 12- 24 h after birth (1-2 voids first few days) |
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We should hear bowel sounds after the ______ hour.
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first
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The cardiac ______ is weak, which is why babies often regurgitate.
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sphincter
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How often should a mom breastfeed? If bottle feeding, how often? Why is there a difference?
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breast- q 2 to 2 1/2 h
bottle- q 3 to 3 1/2 h Breast milk empties faster. Formula is harder to digest, delays gastric emptying (also can be caused by excess mucous). |
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HGB & HCT levels for newborn
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....
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blood volume for newborn
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85 ml per kg
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Term baby glucose needs
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Day 1 40-60 mg /dl
after 50-90 mg/dl |
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Pretty much all the systems are immature, what systems are particularly immature and make dehydration, drug metabolism, and fighting infection difficult?
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kidneys
liver immune system (immature leukocytes may not respond to infection) |
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The first place you will see jaundice is the eyes, then the skin, if it gets to the ____ it's a big problem.
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brain
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Physiologic jaundice is considered normal. Between days 2-4 bilirubin level peaks at about ____
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5-6 mg per dl
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Pathological jaundice is abnormal and requires investifation.. It ias a level higher than ___ in a full term infant. Jaundice associate with breastfeeding is very ___.
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12 mg/ dl
rare |
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Does caput secudaum or cephalhematoma indirectly cause jaundice?
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cephalhematoma-
Any trauma resulting in bruising just adds more RBCs to the equation, meaning more to break down--> more jaundice |
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Factors that increase hyperbilirubinemia
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hemolyis of excess erthrocytes
short life of erythrocytes liver immaturity intestinal factors delayed feeding trauma- bruising fatty acids from cold stress or asphyxia |
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s/s of infection in newbotn
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vague symptoms
lethargic passive diarrhea feeding difficulties inability to localize infection more likely to get sepsis |
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Passive immunity only effects the infant for about ____ months and doesn't protect against everything.
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2-3
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The first ___ or so it's ok to have some acrocyanosis but if after ___ h this coloring is present then it's a bad sign.
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day
48 |
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Which types of birthmarks are permanent?
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cafe au lait
nevus flammeus (portwine stain) mongolian spots |
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Which birthmark is known as the stork bite? It is flat and should fade by about age __
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telangiectatis nevue
2 |
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The ____ _______, or nevus vasculosus is raised, is uauyll on the leg or back, and will fade eventually. Sometimes they become apparent shortly after birth.
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strawberry hemangioma
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In apgar scoring, what # needs an intervention?
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6 or less- needs help
7-10 ok |
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True eye color is shown by ___ to __ months
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6 to 12
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How often do we do VS on newborn?
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q 30 min until stable
and then q 4 to 8 h depending on policy |
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Normal Temperature in newborn
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axillary
36.5 - 37.5 C 97.7-99.5 F rectal 36.5 - 37.6 C 97.7-99.7 F |
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Normal BPM when listening to apical pulse of newborn...
Normal RR |
120- 160
100 sleeping 180 crying Respirations 30-60 /min |
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Risk Factors for hypoglyemia
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prematurity (don't have adequate glyocgen stores)
postmaturity (uses up glucogen because placenta only lasts so long, after 40 weeks starts to calcify) IUGR asphyxia & cold stress- use up glycogen stores large for gestational age (excess insulin to cover glucose) small for gestational age maternal diabetes maternal intake of terbutaline |
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Why is the use of terbutaline a risk factor for hypoglycemia?
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side effect is rapid heart rate for both mom and baby, which uses up lots of glycogen
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Some infants may be asymptomatic but what are some s/s of hypoglycemia?
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jitteriness (could be neuro)
poor muscle tone sweating from head tachypnea dyspnea apnea cyanosis low temp poor suck (could be neuro) high pitched ry lethargy irritability seizures/ coma |
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With any breathing issue, check ____ first because it's the easiest thing to check and it's quick.
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glucose!
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Calorie & Fluid needs for term newborn
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Calories
110- 120 kcal/kg (50 - 55 kcal/lb) Fluid: 100 - 150 ml/kg after first 2 days of life |
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How do you convert celcius to fahrenheit? (just for you julie!)
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multiply the Celsius temperature by 9/5 and then add 32.
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Fahrenheit to celsius?
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subtract 32 and then divide by 5/9
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periods of reactivity
brazelton neonatal behavioral assessment scale |
look up
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