chapter 18 OB

APGAR: respiratory effort

0 - absent 1 - slow, irregular 2 - regular 30-60, crying

APGAR: Heart rate scores

0: absent 1: <100 2: >100

APGAR: skin color

0: cyanotic or pale 1: appropriate body color, blue extremities 2: completely appropriate color (pink on both trunk and extremities)

APAGAR: muscle tone

0: limp, flaccid 1: some flexion, limited resistance to extension 2: tight flexion, good resistance to extension with quick return to flexed position after extension

APGAR: reflex irritability

0: no response 1: grimace or frown when irritated 2: sneeze, cough, or vigorous cry

APGAR is used to evaluate a newborn's physical condition at __ minute and __ minutes after birth

1 and 5

an additional apgar assessment is done at ____ minutes if the 5 minute score is less than 7 points

10

newborn heart rate

110-160

anterior fontanel closes by ___-___ months, measures 4-6 cm at the largest diameter (bone to bone)

18-24

when should PKU be screened?

24-48 hours after protein feeding (PKU)

newborn respirations

30-60 breaths/min

expected length of a newborn

44-55 cm

newborn blood pressure

50-75 mmHg systolic, 30-45 mmHg diastolic

__-__ diapers per day indicates adequate hydration

6-12

posterior fontanel should be closed by __-___ weeks

6-12

At birth, a newborn's assessment reveals the following: heart rate of 140 bpm, loud crying, some flexion of extremities, crying when bulb syringe is introduced into the nares, and a pink body with blue extremities. The nurse would document the newborn's Apgar score as: 5 points 6 points 7 points 8 points

8 points

a normal newborn apgar score should be ___ to ___ points

8-10

newborn temperature

97.7-99.5

APGAR scoring

A= appearance (color all pink, pink and blue, blue [pale]) P= pulse (>100, < 100, absent) G= grimace (cough, grimace, no response) A= activity (flexed, flaccid, limp) R= respirations (strong cry, weak cry, absent)

newborn assessment of the nose

Normal: small, midline and narrow, ability to smell. Abnormal: malformation or blockage

erythema toxicum

a benign, idiopathic, generalized, transient rash that occurs in up to 70% of all newborns during the first week of life

where should pulse be counted on a newborn?

apical

umbilical cord could have two _________ and one ______

arteries, vein

mongolian spots

benign blue or purple splotches that appear solitary on the lower back and buttocks of the newborns, but may occur as multiple over the legs and shoulder; usually disappear spontaneously within the first 4 years of life

The nurse administers a single dose of vitamin K intramuscularly to a newborn after birth to promote: Conjugation of bilirubin Blood clotting Foreman ovale closure Digestion of complex proteins

blood clotting

nevus flammeus (port-wine stain)

capillary angioma located directly BELOW the dermis, laser and intense pulsed light have been used to remove larger lesions with some success optimally within 1 year of age, will not fade

poorly demarcated soft tissue swelling that crosses suture liens

caput succedaneum

swelling does not cross suture lines

cephalhematoma

ophthalmia neonatorum

conjunctivitis of the newborn that causes neonatal blindness

caput succedaneum

describes localized edema on the scalp that occurs from the pressure of the birth process; commonly observed after prolonged labor

molding

elongated shaping of the fetal head to accommodate passage through the birth canal

the ballard scale

gestational age assessment made by parameters of physical and neuromuscular maturity. points are given for each assessment parameter, with a low score of -1 point or -2 points for extreme immaturity to 4 or 5 points for postmaturity

A prophylactic agent is instilled in both eyes of all newborns to prevent which of the following conditions? Gonorrhea and chlamydia Thrush and enterobacter Staphylococcus and syphilis Hepatitis B and herpes

gonorrhea and chlamydia

conjunctivitis usually contracted during birth when the baby comes in contact with vaginal discharge of the mother infected with __________ and _________

gonorrhea and chlamydia

Which one of the following immunizations is most commonly received by newborns before hospital discharge? Pneumococcus Varicella Hepatitis A Hepatitis B

hepatitis B

an enlarged head may indicate

hydrocephalus or increased intracranial pressure

newborn assessment of mouth

intact soft and hard palate, sucking pads inside the cheeks, a midline uvula, a free-moving tongue, working gag, swallow, and sucking reflexes

a small amount of __________ (fine downy hair) may be observed over the shoulders and on sides of the face and upper back

lanugo

cephalhematoma

localized subperiosteal collection of blood of the skull which is always confined by one cranial bone

newborns can lose up to 10% of their initial birth weight by 3-4 days of age secondary to loss of ______, extracellular fluids, and limited food intake

meconium

a small head may indicate

microcephaly caused by rubella, toxoplasmosis, or SGA status

_______ is suctioned first, then the ____ to help prevent aspiration of fluid into the lungs by an unexpected gasp

mouth, nose

milia

multiple pearly whit or pale yellow unopened sebaceous glands frequently found on a newborn's nose

erythromycin

must receive an installation of prophylactic agent in their eyes within an hour or two of birth

ways a newborn's hearing can be screened

otoacoustic emission (OAE) or automated auditory brain stem response (ABR)

vitamin K

promotes blood clotting by increasing the synthesis of prothrombin by the liver

newborn assessment of ears

recoil quickly when folded and released, should not be low set

harlequin sign

refers to dilation of blood vessels on only one side of the body, transient and lasting as long as 20 minutes and no intervention is needed; commonly seen in LBW newborns

RAPP assessment

respiratory activity perfusion position

nevus vasculosus

strawberry mark or strawberry hemangioma, benign capillary hemangioma in the dermal and subdermal layers; raised, rough, dark red, sharply demarcated; tend to resolve by age 3 without treatment

reflexes tested on newborn assessment

sucking, moro, stepping, tonic neck, rooting, babinski, palmer grasp, plantar, galant

stork bites

superficial vascular areas found on the nape of the neck, eyelids, and between the eyes and upper lip caused by a concentration of immature blood vessels and are most visible when the newborn is crying; variant and disappear completely within the first year

vernix caseosa

thick white substance that protects the skin of the fetus formed by secretions from the fetus's oil glands and is found the first 2-3 days after birth in body creases and hair, will be absorbed into the skin

epstein pearls

when milia appear in the newborn's mouth and gums