Maternity Final Exam

A new mother asks the nurse why newborns receive an injection of vitamin K after delivery. What will be the best response from the nurse?

"Newborns lack the intestinal flora needed to produce vitamin K, so it is given to prevent bleeding episodes."

Birth weight variations:

*Normal weight for full-term baby: 2500-4000g* -Appropriate for gestational age (AGA): approximately 80% of newborns; normal height, weight, head circumference, body mass index -Small for gestational age (SGA) or IUGR: weight <2,500 g (5 lb 8 oz)* at term or below the 10th percentile -Large for gestational age (LGA): weight >90th percentile on a growth chart;*weight >4,000 g (8 lb 13 oz) at term, primarily diabetic mothers (macrosomia) -Low birth weight (LBW): <2500 -Very low birth weight (VLBW): <1500 -Extremely low (ELBW): <1000

Initial Newborn Assessment continued:

-Abdomen: should be soft and nondistended -Hips: Ortolani--> check to see patency of hips, if theres a click sound= congenital hip dysplasia >congenital hip dysplasia: asymmetrical legs, gluteal folds -Foot: babinski (+) toes fan out up until 2 years of age, post 2 years= sign of brain damage ->arms flexed, feet drawn up to abdomen is GOOD muscular function

Dealing with Perinatal loss:

-Any pregnancy loss and/or neonatal death up to 1 month of age, profound experience for the family, avoidance is a common reaction -Nurses must be aware of personal feelings: Communicate empathy, allow time and privacy to grieve, consistency with care -Be there for patient, therapeutic communication "I'm sorry for your loss", or simply stay in the room with the patient to make them feel less alone

Initial Newborn Assessment:

-Apgar Scoring= take at 1 minute of life and 5 minutes -Length (18-22 inches for full term) -Physical maturity: skin texture, lanugo (preterm baby will have this), plantar creases, breast tissue (witch's milk in newborns=normal due to withdrawal of maternal estrogen), eyes & ears, genitals -head (32-38 cm) circumference is supposed to be bigger than chest (30-36) by 1/3 cm -take temp LAST if it is 100.4 --> FEVER, first temp on baby is done rectally but if there is any resistance STOP. Atresia= rectum has resistance (signs: if bby hasn't passed meconium) -baby should void within 24-48 hours, diarrhea is NOT normal in newborn

Hepatic system function:

-Bilirubin conjugation (fat soluble--> water soluble by mom in utero) -Three groups of jaundice based on mechanism of accumulation of bilirubin: >Overproduction >Decreased conjugation >Impaired excretion

Cleft Lip and Palate:

-Cleft lip is done FIRST (3-6 months) and involves fissure or opening in lip -Cleft palate (18 months) involves roof of mouth >most common craniofacial birth defect >management: cleft lip, surgical repair between 6-12 weeks; cleft palate, surgical repair between 6-18 months, promote parental bonding

Retinopathy of prematurity:

-Developmental abnormality affecting immature blood vessels of the retina >ROP typically develops in both eyes due to hyperoxemia (because of assisted ventilation and high oxygen exposure), acidosis, or shock -Risk factors: hypertension, substance abuse, preeclampsia, heavy cigarette smoking, placental insufficiency, weighing less than 1500 g or born at 28 wks gestational or less -Management: administer oxygen therapy cautiously, administer mydriatic eye agent 1 hr before ophthalmic exam appointment, protect newborns eyes from light

Educate mother on breast-feeding:

-Engorgement: can try to prevent by feeding baby on demand, cues of hunger could be baby is fussy, and sucking -Educate patient on benefits of breastfeeding but do NOT force -Baby needs to LATCH on in order to feed -Breastfeeding could help prevent PPH bc it release oxytocin-->prevents bleeding -Can also prevent PPD -Don't add water to ready-to-feed formula--> could dilute and cause seizures, and never feed baby on back--> could cause ear infection!

Initial Newborn Assessment continued:

-Eyes: subconjuctival hemorrhage--> redness in baby eyes, due to intraocular pressure in eye when mom is pushing vaginally (10-15%) >erythromycin: inner canula to outer -Genitalia: >girls experience pseudomenstruation (due to withdrawal of maternal estrogen), vaginal discharge, streak of blood, swollen labia= all normal >boys: hypospadias and epispadias = NO CIRCUMSCISION, hydrosil--> shiny scrotum filled with fluid= leads to infertility issues, undescended testes= infertility issues--> Orchidopexy procedure (palpate testes and make sure they are both descended) -Circumcision: BEFORE--> make sure they've received vitamin K (in vastus lateralis) to prevent bleeding, NPO, hold feeding 1/2 hrs before procedure, mom has to CONSENT. DURING--> put sugar on pacifier during procedure or acetaminophen prophylactically, or topical cream anesthetic. AFTER--> make sure baby isn't bleeding, make sure he is able to void. > the two types of Circumcision: Gomco (foreskin totally removed) and Mogen >yellow crust over penis after Circumcision= NORMAL, dont peal or touch it is healing!!

Initial Newborn Assessment continued:

-Face of baby: >if you pull ears forward, they should recoil back quickly >assess lips (cleft lip and palate): sucking/rooting reflex should disappear 4-6 months >cleft palate: more vascular, 18 months >Epstein pearls: small, harmless cysts that form in a newborn's mouth during the early weeks and months of development -Neck: should be able to turn side to side, if not= nuccal rigidity (meningitis) , palpate clavicle for any signs of CREPITUS (possible indication of clavicular fracture) -Cord falls off itself around 5-14 days, keep it CLEAN and DRY--> keep diaper away from cord stump >omphalitis= an infection of the umbilicus and/or surrounding tissues, occurring primarily in the neonatal period >discoloration of stump= infection ! >day 5-10/14 cord should fall off on its own, do NOT immerse baby into tub until cord falls off

SGA Newborn Assessment : Typical characteristics

-Head disproportionately large compared to rest of body -Wasted appearance of extremities; loose dry skin -Reduced subcutaneous fat stores -Decreased amount of breast tissue -Scaphoid abdomen (sunken appearance) -Wide skull sutures -Poor muscle tone over buttocks and cheeks (flaccid) -Thin umbilical cord

Postterm Newborn:

-Inability of placenta to provide adequate oxygen and nutrients to fetus after 42 weeks -*Dry, cracked, wrinkled, peeled skin*; possibly meconium-stained -Long, thin extremities; *long nails*; creases cover entire soles of feet -Wide-eyed, alert expression -Abundant hair on scalp -Thin umbilical cord -*Limited vernix and lanugo*

Meconium aspiration syndrome:

-Inhalation of particulate meconium with amniotic fluid into lungs; secondary to hypoxic stress -barrel-shaped chest, prolonged tachypnea, intercostal retractions, respiratory distress, cyanosis, end-expiratory grunting

Newborn Reflexes:

-Moro: disappears 3-6 months -Grasp: disappears 3-4 months -Rooting: disappears 4-6 months -Babinski: disappears 2 years of age

Initial Newborn Assessment: Signs indicating a PROBLEM

-Nasal flaring, chest retractions= signs of respiratory distress -Grunting on exhalation, labored breathing= signs of alveoli collapse, respiratory distress -Generalized cyanosis (LATE sign), flaccid body posture (neurologic disorder) -Abnormal breath sounds, RR, HR, newborn size -Stridor-->BAD--> obstruction -IUGR: intrauterine growth restriction (<2500g)

Newborn Infections:

-Neonatal sepsis: bacterial, fungal, or viral microorganisms or their toxins in blood or other tissues >Classification - Congenital (intrauterine) - Early onset (perinatal period) - Late onset -Risk factors: elevated C-reactive protein, positive cultures

Omphalocele and Gastroschisis:

-Omphalocele: umbilical ring defect with evisceration of abdominal contents into external peritoneal sac -Gastroschisis: herniation of abdominal contents through abdominal wall defect (no peritoneal sac) >risk factors; protrusion of abdominal contents, sac, evidence of other congenital anomalies >preoperative care: apply sterile dressing over, preventing hypothermia, maintaining perfusion to abdominal contents, protecting exposed contents from trauma and infection, preventing intestinal distention, and maintaining fluid and electrolyte balance >postoperative care; parent-newborn interaction

SGA Newborn assessment: common problems

-Perinatal asphyxia= lack of blood flow or gas exchange to or from the fetus in the period immediately before, during, or after the birth process -difficulty with thermoregulation= takes about 24 hrs for hypothalamus to work after birth -hypoglycemia= how do you know? the baby starts to shake, has tremors -polycythemia= increased RBC's -meconium aspiration -hyperbilirubinemia -birth trauma

Selected screening for newborns:

-Phenylketonuria (PKU): NO breastfeeding, problem with phenyl enzyme--> cant break down protein -Congenital hypothyroidism -Galactosemia= rare, hereditary disorder of carbohydrate metabolism that affects the body's ability to convert galactose to glucose -Sickle cell anemia (congenital)

Gestational age:

-Preterm/premature: prior to 37 weeks gestation -Term: 38-42 weeks gestation

Bladder Exstrophy:

-Protrusion of bladder onto abdominal wall -Separation of rectus muscles and symphysis pubis -Boys also with epispadias -Initial bladder closure within 48 hours of birth; further reconstruction at age 2 to 3 years

Bronchopulmonary Dysplasia (BPD):

-Referred to as chronic lung disease; need continued oxygen after initial 28 days of life -Causes: surfactant deficiency, pulmonary edema, lung immaturity, barotrauma from mechanical ventilation, fluid overload -Management: administration of steroids in mother (antepartal period) and exogenous surfactant to newborn, *high calorie diet plan*, pump breastmilk then add more nutrients to fortify it , bronchodilators -S+S: tachypnea, poor weight gain, tachycardia, sternal retractions, nasal flaring, bronchospasm, hypoxia -Risk factors: male, preterm birth <32 weeks, nutrition deficiency, white, excessive fluid intake, patent ductus arterioles, severe RDS treated with mechanical ventilation >1 week, sepsis

Respiratory system adaptations:

-Role of surfactant: surface tension reducing lipoprotein that prevents alveolar collapse >24-28 wks--> surfactant, at 32-33 wks it is released into bloodstream >NEED betamethasone or artificial surfactant to prevent alveoli from collapsing= respiratory distress -Respirations: 30-60 breaths/minute; irregular, shallow, unlabored; short periods of apnea (<15 sec); symmetrical chest movements >labored breathing= NOT good >exceeds 20 seconds of transient apnea= respiratory distress!! >crying--> helps open up the lungs (if the baby doesn't cry= tap butt/feet)

Preterm newborn:

-Surfactant develops between 24-28 weeks and enters bloodstream around 32 weeks, it decreases surface tension >if mom didn't receive betamethasone then baby gets an artificial surfactant= CUROSURF--> thru ET tube or umbilical area -breast feeding helps reduce incidence of necrotizing enterocolitis (NEC)

Gestational age variations:

-Term: Born from the first day of the 38th week through 42 weeks -Preterm: Born before completion of 37 weeks -Late preterm: Born between 34 and 36-6/7 weeks -Postterm: Born beyond 42 completed weeks

Characteristics predisposing newborn to heat loss (fluid filled environment)::

-Thin skin; blood vessels close to the surface LOSE MORE HEAT -Lack of shivering ability; limited stores of metabolic substrates (glucose, glycogen, fat) -Limited use of voluntary muscle activity -Large body surface area relative to body weight *>brown fat= hides mitochondria* *>non-shivering thermogenesis* -Lack of subcutaneous fat; little ability to conserve heat by changing posture -No ability to adjust own clothing or blankets to achieve warmth -Infants cannot communicate that they are too cold or too warm

Common concerns during newborn period:

-Transient tachypnea of the newborn is normal--> provide oxygen therapy BUT be careful to not give too much oxygen= ROP (retinopathy of prematurity)!!!! Be sure to frequently check respiratory status -Physiologic jaundice (hyperbilirubinemia)--> baby must receive phototherapy -Hypoglycemia: sign is jitteriness--> FEED BBY FIRST!! (breastfeed, formula, glucose)...after 1 hour then check blood sugar level >if jitter but cant feed--> check blood sugar level

Initial Newborn Assessment continued:

-Vitals: 110-160 HR, 30-60 RR= count for 1 full minute because it is irregular. Transient apnea--> normal, as long its no longer than 15-20 seconds -Head of baby: molding of sutures--> overriding of sutures helps deliver baby vaginally 1. cephalohematoma= caused by electrodes on baby's head, edema, accumulation of blood under skin, more severe bc it lingers on for months, risk for infection and jaundice, does NOT cross suture lines 2. Caput succedaneum: edema on baby's head that'll subside in few days, caused by baby being in perineum for prolonged time, CROSSES suture lines (C/S) -Fontanelles: depressed (dehydration), bulging (ICP) >anterior= diamond, closes 12/18 months >posterior= triangular, closes 2/3 months

Administering prescribed medications:

-Vitamin K= IMPORTANT to prevent bleeding, give within first few MINUTES (also keep in mind to be sure baby has received vitamin K before getting circumcision) >phytonadione: (vitamin K) is used to prevent bleeding -Eye prophylaxis: Erythromycin--> can be given within 1 HOUR -which can you hold to provide skin to skin? Erythromycin

A nurse is assessing a term neonate and notes transient tachypnea. When reviewing the mother's history, which conditions would the nurse most likely find as contributing to this finding? Select all that apply

-cesarean birth -use of heavy sedation during labor

APGAR scoring:

-total of 10 points, each letter is 2 points. -score of 8/9 is good, but less than 7 is a problem! A= appearance (if baby has acrocyanosis= give 1 pt.) P= pulse HR , we want >100bpm G= grimace, reflex irritability (sneeze, cough, or cry is good) A= activity (flexed, flaccid, limp)= we want FLEXED R= respirations (strong cry, weak cry, absent)

SGA Newborn assessment: nursing management

-weight, length and head circumference measurements -serial blood glucose monitoring= every 3 hours the first 12-24 hrs of life due to risk for hypoglycemia -IV infusion of dextrose 10%

The 2 major types of jaundice:

1. *Pathologic*: MOST SERIOUS!!!!!! if you see manifestations of jaundice within FIRST 24 hours of life >causes: Rh incompatibility, ABO incompatibility, Erythroblastosis fetalis 2. *Physiologic*: POST 24 hrs, dehydration could cause this--> breastfeeding can help -s+s: yellow skin and sclera (bc bilirubin deposited in skin) >age and bilirubin are inversely related >bilirubin should decrease as baby ages >can also be deposited in the BRAIN= Kernicterus (baby could end up brain dead)

Four physiologic categories of congenital heart disease:

1. Defects causing increased pulmonary blood flow (atrial or ventricular septal defect) 2. Defects causing obstructed blood flow out of the heart (aortic stenosis) 3. Defects causing decreased blood flow (Tetralogy Fallot)--> *put in squatting position= compensatory mechanism to increase blood flow to heart* 4. Defects involving mixed (desaturated or saturated) blood= *Dextro-Transposition of the Great Arteries* is a birth defect of the heart in which the two main arteries carrying blood out of the heart - the main pulmonary artery and the aorta - are switched in position, or "transposed" >risk factors: maternal disorder of phenylketonuria (PKU), maternal use of anticonvulsants; estrogen, progesterone, lithium (mood stabilizer), warfarin, or isotretinoin(for acne)

Ultimate treatment for hyperbilirubinemia (jaundice):

1. High-Intensive Phototherapy: UV light that breaks down bilirubin so baby can excrete it, liver is immature and lacks enzymes= this is why baby breaks down bilirubin slower than mom >cover baby's eyes, put diaper, make sure baby is fed around the clock >cluster care, minimize interruptions, check bilirubin levels for effectiveness 2. Exchange blood transfusion in pathologic jaundice bc levels are high = prevent Kernicterus

Etiology leading to Preterm birth:

1. infections/inflammation 2. Maternal or fetal distress (knot in the cord, placenta insufficiency) 3. Bleeding in mom (placenta previa/abruptio) 4. stretching

How long is the neonatal period for a newborn?

28 days

Hypoglycemia in a mature infant is defined as a blood glucose level below which amount?

45 mg/100 ml whole blood

How many wet diapers per day is considered normal?

6-8 wet diapers!!

When assessing a preterm newborn, which would the nurse expect to find? a. limited lanugo b. few palmar creases c. wrinkled, thick skin d. wide-eyed expression

B. Few palmar creases

Peri-/intraventricular hemorrhage (PVH/IVH):

Bleeding in the brain due to fragility of cerebral vessels; most common in the first 72 hours after birth, grades I to V >possibly no symptoms >unexplained drop in hematocrit, pallor, poor perfusion, seizures, lethargy, weak suck, high pitched cry, hypotonia (decreased muscle tone)

Small for gestational age (SGA) newborns:

Conditions affecting fetal growth - <28 weeks leading to overall growth restriction (never catch up in size) - >28 weeks, intrauterine malnutrition (normal growth potential with optimal postnatal nutrition) • IUGR for some SGA newborns (asymmetric versus symmetric) • girls thrive more as premature babies than boys

Neural Tube Defects:

Congenital CNS disorders; occur when the neural tube fails to close properly- normally occurs between 17th and 30th days of gestation >FOLIC ACID intake is important! >risk factors: Celtic ancestry, female, maternal diabetes, low socioeconomic status, anticonvulsant use, low folic acid intake, maternal obesity and malnutrition

Mechanisms of heat exchange:

Evaporation: MOST COMMON, loss of heat when a liquid s converted to a vapor--> dry baby's body to prevent heat loss, give hat, bath Conduction: transfer of heat from object to object when the two objects are in *direct contact* with each other--> cold hands coming into direct contact with the baby (or cold stethoscope), how to avoid? put blanket over cold scale when weighing baby, rub hands together to warm up before touching baby Convection: flow of heat from body surface to cooler surrounding air or to *air circulating* over a body surface--> near window/door with cold air coming in, avoid placing baby near window/door, place in room temp Radiation: loss of body heat to cold, solid surfaces in close proximity but NOT in direct contact--> don't put anything cold in the baby's crib. AVOID putting the wet blanket you dried the baby with, in the crib -swaddle baby with ONE arm out -do NOT give baby bath until AFTER 24 hours--> can cause hypoglycemic, hypotonic--> exceptions: if mom is HIV & HepB+ you would give baby sponge bath and HepB vaccine and immunoglobin within first 12 hours of life

The newborn has been placed in skin-to-skin contact with his mother. A blanket covers all of his body except his head. His hair is still wet with amniotic fluid, etc. What is the most likely type of heat loss this baby may experience?

Evaporative

TRUE OR FALSE Arm recoil is one measure of assessing a newborn's physical maturity?

FALSE -its a measure of a newborns neuromuscular maturity

TRUE OR FALSE The majority of small-for-gestational-age newborns experience IUGR

FALSE. -IUGR could be full term infants with growth restrictions, causes could be mom has hypertension or uses cocaine

Neonatal Asphyxia:

Failure to establish adequate, sustained respirations after birth -insufficient oxygen delivery to meet metabolic demands -lack of oxygen and blood flow to the brain

Initial Newborn Assessment continued:

HepB--> need consent, only give if hepB is (-), if mother is hepB is (+)= they need HepB vaccine, and hepatitis B immune globulin (HBIG) within first 12 hours of life If mother is HIV(+)= 3 tests will be done, and breastfeeding is contraindicated >herpes= CAN breastfeed if there are no lesions on breasts

Normal newborn blood values:

Hgb ( 16-18 g/dL) Hct (46-68%) Plt (150,000-350,000) RBC (4.5-7.0) WBC (10-30,000) -delayed cord clamping (for only 1 minute)--> increases RBC of baby -Delayed cord clamping at birth has shown to benefit neonates with increased placental transfusion leading to higher haemoglobin concentrations, additional iron stores and less anaemia later in infancy, *higher red blood cell flow to vital organs*

Infants of diabetic mothers:

High levels of maternal glucose crossing placenta, stimulating increased fetal insulin production leading to somatic fetal growth >*full rosy cheeks, ruddy skin color, short neck, buffalo hump, massive shoulders, distended upper abdomen, excessive subcutaneous fat tissue, hypoglycemia, birth trauma* >hypocalcemia, hypomagnesemia, polycythemia, hyperbilirubinemia

Newborns are primarily dependent on three immunoglobulins, which ones are they?

IgG, IgA (breastmilk), and IgM

Hyperbilirubinemia:

Imbalance in rate of bilirubin production and elimination; total serum bilirubin level >5 mg/dL >Physiologic jaundice= 3rd-4th day of life >Pathologic jaundice= within first 24 hours, Kernicterus, Rh incompatibility, ABO incompatibility

If baby is in respiratory distress due to failure of ductus arteriosus closure, what three things can you give?

Indomethacin, caffeine, or IV ibuprofen

A nurse is caring for a preterm newborn born at 29 weeks' gestation. Which nursing diagnosis would have the highest priority?

Ineffective thermoregulation related to decreased amount of subcutaneous fat

Birth Trauma:

Injuries due to the forces of labor and birth >precipitous labor could cause this because it is FAST >fractures (shoulder dystocia), brachial plexus injury, cranial nerve trauma, head trauma (cephalohematoma, caput succedaneum)

The nursing instructor is teaching a class on the physiologic prosperities involved with the birthing process. The instructor determines the session is successful when the students correctly match surfactant with which function?

It keeps alveoli from collapsing with breaths.

What is a manifestation of underlying medical condition Hyperbilirubinemia?

Jaundice !!!

LATCH method for assessing breastfeeding sessions:

L: how well infant latches onto breast A: amount of audible swallowing T: type of nipple C: level of comfort H: amount of help the mother needs

Esophageal atresia and tracheoesophageal fistula:

Lack of normal separation of esophagus and trachea during embryonic development -Esophageal atresia: congenitally interrupted esophagus -Tracheoesophageal fistula: abnormal communication between trachea and esophagus -Assessment: hydramnios (too much fluid), copious frothy bubbles of mucus and drooling, abdominal distention >coughing, choking, cyanosis

Respiratory distress syndrome:

Lung immaturity and lack of alveolar surfactant -expiratory grunting, nasal flaring, chest wall retractions, see-saw respirations, generalized cyanosis, heart rate >150-180, fine inspiratory crackles, tachypnea -chest xray: hypoaeration, underexpansion Management: ventilation (CPAP, PEEP), exogenous surfactant (if mom didn't receive betamethasone and baby born prematurely), clustering of care; prone/side-lying position to help with respiratory distress and make sure to monitor!!, fluids and vasopressors

Persistent pulmonary hypertension of the newborn:

Marked pulmonary hypertension causing right to left extrapulmonary shunting and hypoxemia -Assessment: tachypnea within 12 hrs after birth, cyanosis, grunting, retractions, systolic ejection murmur >echocardiogram: right to left shunting of blood

Transient tachypnea of the newborn:

Mild respiratory distress; pulmonary liquid removed slowly or incompletely; *resolution by 72 hours of age* -Assessment: maternal sedation or birth by c-section, tachypnea, expiratory grunting, retractions, labored breathing, nasal flaring, mild cyanosis, RR 100-140, barrel-shaped chest, slightly decreased breath sounds

Congenital conditions:

PRESENT AT BIRTH -Neural tube defects (anencephaly, spina bifida, meningocele, myelomingocele) -Microcephaly -Hydrocephalus -Choanal atresia -Congenital diaphragmatic hernia -Cleft lip and palate -Esophageal atresia and tracheoesophageal fistula -Omphalocele and gastroschisis -Imperforate anus -Hypospadias and epispadias -Bladder exstrophy -Congenital clubfoot (feet are facing inwards, how newborn is positioned in utero) -Developmental dysplasia of the hip

Large for gestational age (LGA) common problems and management:

Problems: Birth trauma (should dystocia, hypoxia), hypoglycemia, polycythemia, hyperbilirubinemia Management: blood glucose monitoring first 24 hrs of life, oral feedings with IV glucose, if baby starts to jitter FEED FIRST then monitor levels

Imperforate Anus:

Rectum ends in blind pouch or fistulas between rectum and perineum >assessment: absence of anal opening, no passage of meconium, signs of intestinal obstruction

Large for gestational age (LGA) newborn risk factors and characteristics:

Risk factors: maternal diabetes, multiparty, prior history of macrocosmic infant, postdated gestation, maternal obesity, male fetus and genetics Characteristics: large body, plump, full faced, proportional increase in body size, poor motor skills, difficulty regulating behavioral states

A nurse is teaching a new mother about what to expect for bowel elimination in her newborn. Because the mother is breastfeeding, what should the nurse tell her about the newborn's stools?

Stools should be yellow-gold, loose, and stringy to pasty.

Characteristics of newborn stools:

Stools: meconium, then transitional stool, then milk stool >Breast-fed newborns: Yellow-gold, loose, stringy to pasty, sour-smelling >Formula-fed newborns: yellow, yellow-green, loose, pasty, or formed, unpleasant odor

TRUE OR FALSE The underlying problem associated with meconium aspiration syndrome in utero involves hypoxic stress.

TRUE

What should the nurse expect for a full-term newborn's weight during the first few days of life?

There is a loss of 5% to 10% of birth weight in formula-fed and breastfed newborns.

Necrotizing enterocolitis (NEC):

Three pathologic mechanisms: 1. bowel ischemia 2. bacterial flora 3. effect of feeding -*S+S: abdominal distention and tenderness, bloody stools, feeding intolerance (bilious vomiting), sepsis, lethargy, apnea, shock* -KUB (x-ray of the kidney, uterus and bladder): air in bowel wall; dilated bowel loops

Acquired conditions of the newborn:

Typically occur at, or soon after, birth - Neonatal asphyxia - Transient tachypnea of the newborn - *Respiratory distress syndrome (nasal flaring, tachypnea, retractions)* - Meconium aspiration - Persistent pulmonary hypertension of the newborn - Bronchopulmonary dysplasia - *Retinopathy of prematurity (too much oxygen)* - Peri-/intraventricular hemorrhage (PVH/IVH) - *Necrotizing enterocolitis (NEC)* - Infants of diabetic mothers - Birth trauma - Newborns of perinatal substance-abusing mothers - Hyperbilirubinemia - Newborn infections

A nurse is assessing the sensory capabilities of a newborn. Which is the least mature sense at birth?

Vision

Preterm newborn characteristics:

Weight <5.5 lb, Scrawny appearance, Poor muscle tone, Minimal subcutaneous fat, Undescended testes, *Plentiful lanugo*, Poorly formed ear pinna (delayed recoil of ear), Fused eyelids, Soft spongy skull bones, Matted scalp hair, Absent to few creases in soles and palms, Minimal scrotal rugae; prominent labia and clitoris, Thin transparent skin, *Abundant vernix* -Common problems: hypothermia, hypoglycemia, hyperbilirubinemia, immaturity of body systems -Management: oxygenation (be careful to prevent ROP)!!!, baby needs to gain 5 lbs before being sent home

When providing care to a newborn with necrotizing enterocolitis (NEC), the nurse would need to report which finding immediately?

abdomen appearing red and shiny -an abdomen that appears red and shiny in a newborn with NEC indicates peritonitis and must be reported immediately!!

A newborn's primary method of heat production is through nonshivering thermogenesis. This process oxidizes which substance in response to cold exposure?

brown fat

An infant typically requires how many calories per kilogram per day during the first 3 months? a. 80 b. 95 c. 110 d. 150

c. 110 -bby loses 5-10% of baby weight (few days after) of 10 lbs -6 months weight 2x, 1 year weight triples

An obese woman with diabetes has just given birth to a term, large-for-gestational-age (LGA) newborn. Which condition should the nurse most expect to find in this infant?

hypoglycemia

Which finding is indicative of hypothermia of the preterm neonate?

nasal flaring -Nasal flaring is a sign of respiratory distress. Neonates with hypothermia show signs of respiratory distress (cyanosis, increased respirations, low oxygen saturation, nasal flaring, and grunting)

At birth, the infant has dry, cracked skin, absence of vernix, lack of subcutaneous fat, fingernail extending beyond the fingertips, and poor skin turgor. Based on these findings, how would the nurse would classify this neonate?

postterm

The nurse assesses preterm infants as they come for routine well-baby checkups. The nurse will carefully assess the infant's vision to assess for which potential complication related to their birth?

retinopathy

A 36-week neonate born weighing 1,800 g has microcephaly and microphthalmia. Based on these findings, which risk factor might be expected in the maternal history?

use of alcohol

Preterm babies have an abundant amount of ______ & ________.

vernix caseosa & lanugo -premature baby's are also flaccid

At what point should the nurse expect a healthy newborn to pass meconium?

within 24 hours after birth

Newborns of substance-abusing mothers:

•Most common substances: tobacco, alcohol, and marijuana •Fetal alcohol syndrome: physical and mental disorders appearing at birth and remaining problematic throughout the child's life •Neonatal abstinence syndrome: drug dependency acquired in utero manifested by neurologic and physical behaviors -Management: swaddle baby, boy placed on morphine sulfate, phenobarbital to prevent/control seizures >*withdrawal signs: lethargic, high pitched cry, sneezing, tremors* >*withdrawal from heroin: yawning*