227-5
Jaundice treatment
feeding, UV lights
Lanugo
fine hair
Normal GI adaptation
first void within 24 hrs, voids 8-8x a day by day 3-4. Can have pink crystals in urine. Which are Ca+ and urate int he urine that causes these. Not blood.
Closure of foramen ovale
flap in the septum between the left and right atira. Closes functionally at 1-2 hours after birth, permanently at 6 months
Club foot
foot is turned out
First period of reactivty
from birth-30 mins/1 hr. HR and RR more rapid. Wide awake, alert, increase muscle activity. Good time to initiate breastfeeding
Cerebral palsy
from not enough o2 during birth, doesn't get better
What affects thermogenic adaptation?
gestation age and body size
Simian crease
hand pic, with down syndrome
Acne
happens from levels of hormones from mom
Radiation
if you put baby near a cold surface (like a window)
Immunological adaptation
immature at birth, low levels of immunoglobulins, immature leukocytes, symptoms of infections are subtle
Mottling
immaturity of vascular system
5 major changes in cardiovascular system
increased aortic pressure, decreased venous pressure, closure of foramen ovale, closure of ductus arteriosus, closure of ductus venosus
What two things cause foramen ovale to close?
increased systemic resistance and decreased pulmonary resistance
What three things cause the ductus arteriosis to close?
increased systemic resistance, decreased pulmonary resistance, and prostaglandin levels (causes vasodilation, after birth they drop.)
Physiological adaptation for heat production
increasing metabolic rate, muscle activity to generate heat, peripheral vasoconstriction, and non-shivering thermogenesis
The perinatal nurse explains the cardiopulmonary adaptations that occur in the neonate to a student nurse. Which of the following statements accurately describes the sequence of these changes? a. "As air enters the lungs, the PO2 rises in the alveoli, which causes pulmonary artery relaxation and results in an increase in pulmonary vascular resistance." b. "As the pulmonary vascular resistance increases, pulmonary blood flow increases, reaching 100% by the first 24 hours of life." c. "Decreased pulmonary blood volume contributes to the conversion from fetal to newborn circulation." d. "Once the pulmonary circulation has been functionally established, blood is distributed throughout the lungs."
"Once the pulmonary circulation has been functionally established, blood is distributed throughout the lungs."
The pediatrician has ordered vitamin K 0.5 mg IM for a newborn. The medication is available as 2 mg/mL. How many milliliters (mL) should the nurse administer to the baby? Calculate to the nearest hundredth.
0.25 mL
physiological anemia
as HgF is dying and getting replaced with HgA they can get jaundice. is normal
later neonatal respiratory assessment
auscultation of lungs, respiratory efforts, symmetry of chest movement, placement and size of breast tissue, extra nipples, nasal patency
Normal pulse for newborn
110-160, right after birth it might be as high as 180 for first hour, should come back down.
By 36-38 weeks gestation the GI system is able to
digest essential carbohydrates. Has limited ability to digest fats-due to deficiency in amylase, lipase and bile salts
Level of Reactivity
evaluation of neuro maturity and if there was any exposure to chemicals, drugs, etc. Will be highly alert and jittery
How can a newborn lose heat?
evaporation, conduction, covection, radiation
The following four babies are in the neonatal nursery. Which of the babies should be seen by the neonatologist? a. 1-day-old , 100 beats per minute, in deep sleep. b. 2-day-old, T 97.7 F, slightly jaundiced c. 3-day-old, breastfeeding every 4 hours, jittery d. 4-day-old, crying, papular rash on an erythematous base.
3-day-old, breastfeeding every 4 hours, jittery
Adaptations of cardiovascular system are triggered by what
expulsion of placenta, clamping of umbilical cord, taking of first breaths
Birth stomach capacity
6ml/kg. At end of first week 90 mL
A newborn was born weighing 3,278 grams. On day 2 of life, the baby weighed 3,042 grams. What percentage of weight loss did the baby experience? Calculate to the nearest hundredth.
7.19
Normal RR for newborn
30-60, shallow, diaphragmatic, irregular
The nurse notes that a newborn, who is 5 minutes old, exhibits the following characteristics: heart rate 108 bpm, respiratory rate of 29 with lusty cry, pink body with bluish hands and feet, some flexion. What does the nurse determine the baby's Apgar score is? a. 6 b. 7 c. 8 d. 9
8
Salivary glands immature
don't have much saliva for first 3 months
Polydactyly
extra fingers or toes
Thermal factors that influence first breath
dramatic change in temp when they leave the uterus
AchodroplasiA
dwarfism
When does the posterior fontanelle close?
smaller one, around 2 months of age
What temp should the baby be at (minimal)?
97.9, axillary temp
Inability to move lower extremities
spinal cord injury
What is the normal BS for a newborn
40-60
Transitional stool
still slightly green, not sticky or hard
# of cord vessels in umbilical cord
AVA 2 arteries, 1 vein
Coagulation of the blood
Activated by vitamin K, coagulation factors synthesized by liver, levels may vary according to gestation age
Second period of reactivity
Activity- more awake and alert, responsive to stimuli, hand/mouth movements. VS- HR fluctuating. GI system- BS present, usually pass first stool during this time. Mucous- have a lot in general, getting rid of mucous from utero, bulb syringe suctioning will be important
The nursery nurse is careful to wear gloves when admitting neonates into the nursery. Which of the following is the scientific rationale for this action? a. Meconium is filled with enteric bacteria. b. Amniotic fluid may contain harmful viruses. c. The high alkalinity of fetal urine is caustic to the skin. d. The baby is high risk for infection and must be protected.
Amniotic fluid may contain harmful viruses.
What do you want to watch for in neonatal respiratory assessment
Apnea >20 seconds, flaring of nares, retractions, grunting with expiration, RR <30 or >60, asymmetry of chest wall, chest deformities
Peristalsis
stomach empties every 2-4 hrs
A neonate's 5-minute Apgar assessment reveals the following: active motion; pulse 126 beats/minute; grimace and coughing during suctioning; good color all over; and respirations that are slightly irregular with weak cry. What action by the nurse is most appropriate? a. Assess oxygen saturation and administer oxygen if needed. b. Document the findings in the chart and begin the identification process. c. Facilitate bonding and help the mother initiate breastfeeding if desired. d. Place the baby in skin-to-skin contact on the mother's bare abdomen.
Assess oxygen saturation and administer oxygen if needed.
Closure of ductus arteriosus
Closed functionally within 72 hours, permanently 3-4 weeks. May reopen if there is some sort of congenital heart defect.
Ballard scale
assessment of baby to see where they fall on the scale of how old they really are. Ex: 40 week baby that looks 36 weeks. Normal to be 2 weeks up or down from date
A full-term newborn was just born. Which nursing intervention is important for the nurse to perform first? a. Dry baby thoroughly b. Assess APGAR score c. Insert eye prophylaxis d. Elicit the Moro reflex
Dry baby thoroughly
A nurse is assessing an infant who has a large bruise around his neck and face from a nuchal cord. What other assessment finding correlates with this condition? a. Elevated serum bilirubin b. Irritability with gentle handing c. Large-for-gestational-age measurements d. Obvious vertebral defects
Elevated serum bilirubin
What medications do they give the baby right after birth?
Erythromycin and Vitamin K
What vaccine can they start before discharge?
Hepatitis B, need consent
A nursing student asks the registered nurse why babies get dehydrated so easily. What response by the nurse is most accurate? a. Babies are so tiny that a small water loss leads to big problems. b. Infants tend to lose more water through insensible losses. c. Because they don't drink much at a time, skipping a feeding is harmful. d. Infants' long intestines have more surface area from which to lose water.
Infants' long intestines have more surface area from which to lose water.
To reduce the risk of hypoglycemia in a full-term newborn weighing 2,900 grams, what should the nurse do? a. Maintain the infant's temperature above 97.7 F b. Feed the infant glucose water every 3 hours until breastfeeding well c. Assess blood glucose levels every 3 hours for the first 12 hours d. Encourage the mother to breastfeed every 4 hours.
Maintain the infant's temperature above 97.7 F
How does the newborn receive immunity?
Maternal circulation=passive IgG. Colostrum and breast milk )IgA, IgM)
Period of inactivity and sleep
May last up to 2-4 hours. Activity- recovering from stress of birth, decreased muscle activity, difficult to awaken. VS- will be decreased as they are sleeping
Cardiopulmonary transition
O2 within alveoli -> decreased resistance to pulmonary system -> increase in pulmonary blood flow -> transition from fetal to newborn circulation
When does the anterior fontanelle close?
around 18 months of age, larger one
What do you watch for in the skin assessment of newborn?
Pallor, deep purple color, petechiae, central cyanosis, jaundice, extensive bruising, hairy nevi, low hairline, lighter color hair in one area
A mother, 1 day postpartum from a 3-hour labor and spontaneous vaginal delivery, questions the nurse because her baby's face is "purple". Upon examination, the nurse notes petechiae over the scalp, forehead, and cheeks of the baby. the nurse's response should be based on which of the following. a. petechiae are indicative of severe bacterial infections b. Rapid deliveries can injure the neonatal presenting part c. Petechiae are characteristic of the normal newborn rash d. The injuries are a sign that the child has been abused
Rapid deliveries can injure the neonatal presenting part
Hypoglycemic risks
SGA & preterm, LGA & IDM, post term and IUGR, asphyxia, infection, cold stress
A mother notes that her baby has a "bulge" on the back of one side of teh head. She calls the nurse into the room to ask what the bulge is. The nurse notes that the bulge covers the right parietal bone but does not cross the suture lines. The nurse explains to the mother that the bulge results from which of the following? a. Molding of the baby's skull so that the baby could fit through her pelvis. b. Swelling of the tissues of the baby's head from the prssure of her pushing. c. The position that the baby took in her pelvis during the last trimester of her pregnancy. d. Small blood vessels that broke under the baby's scalp during birth.
Small blood vessels that broke under the baby's scalp during birth.
A nurse takes a newborn's initial set of vital signs and records the following: Temperature: 97.9°F (36.6C), pulse: 198 beats/minute, respirations: 78 breaths/minute, blood pressure: 64/44 mm Hg. What does the nurse conclude about this infant? a. Hypotensive: needs IV fluid administration b. Hypothermic: needs to be put in an incubator c. Tachycardic: take pulse again when baby is not crying d. Tachypneic: suction if needed, administer oxygen per protocol
Tachypneic: suction if needed, administer oxygen per protocol
Regarding the % of weight loss in the previous question this is an appropriate amount to be lost on day 2. True False
True
What do you need for PLT and clotting factors, production and maturation?
Vitamin K
Regular body size
Weight: 2,500-4,300 g Length: 18-22 inches Head: 13-15 inches Chest: 12-13 inches Abdomen: 12-13 inches
Brown nevi
a big mole, can be cancerous
Sensory factors that influence first breath
a lot of stimuli, lights, rubbing of baby, etc
The nurse is discussing the neontal blood screening test with a new mother. The nurse knows that the teaching was successful when the mother states that the test screens for the presence in the newborn of which of the following diseases? Select all that apply. [mark all correct answers] a. Hypothyroidism b. Sickle Cell Disease c. Galactosemia d. Cerebral Palsy e. Cystic Fibrosis
a, b, c, e
The perinatal nurse describes infant feeding cues to a new mother. These feeding cues include which of the following behaviors? (Select all that apply.) [mark all correct answers] a. Mouth movements b. Moving the hand to the mouth c. Sticking the tongue out d. Vocalizations e. Yawning
a, b, d
A perinatal nurse assesses a term newborn for respiratory functioning. The nurse will document which of the following findings as normal for a neonate? (Select all that apply.) [mark all correct answers] a. Breathing pattern that can be shallow, diaphragmatic, and irregular b. Periodic episodes of apnea c. Respiratory rate of 20-40 breaths/minute while sleeping d. Respiratory rate of 60-80 breaths/minute e. The neonate's lung sounds are moist during early auscultation
a, d
What do you want to watch for in GI assessment?
abdominal distention, absence of BS, discharge from umbilical cord, palpation of abdominal mass, imperforate anus
Blood volume change
affected largely by timing of umbilical corn clamping, influenced by gestational age and presence of any prenatal or postpartum hemorrhage. Higher risk for jaundice
The nursery charge nurse is assessing a 1-day-old female on morning rounds. Which of the following findings should be reported to the neonatologist as soon as possible? Select all that apply. [mark all correct answers] a. Blood in the diaper b. Grunting on expiration c. Deep red coloring on one side of the body with pale pink on the other side. d. Lacy and mottled appearance over the entire chest and abdomen. e. Flaring of the nares during inspiration.
b, e
Kernicterus
bilirubin staining of the basal nuclei of the brain
Hepatic adaptation is responsible for what?
blood glucose, iron storage, bilirubin conjugation, coagulation of blood
Cephalohematoma
blood trapped under the skin, does not cross the suture line, often from traumatic injury
Nonshivering thermogenesis
breaking down brown fat to stay warm. Skin receptors recognize a drop in temp -> alert SNS -> brown adipose tissue used for heat production
Irian
breastfeed female infants longer than male
Chemical factors that influence first breath
brought on by stress of birth. Cause the sensory in the brain to start breathing. Hypoxia, acidosis, and hypercarbia
Closure of ductus venosus
by the liver, once it closes it has enhanced blood flow to the liver. Closed once the umbilical cord is clamped. Closes permanently by end of 1st week of life
First breath is influenced by what four things?
chemical factors, sensory factors, thermal factors and mechanical factors
Mechanical factors that influence first breath
come from vaginal birth, squishing through the birth canal, squeezes this out a bit and the baby recoils air. (C-Section babies struggle with this)
Torticollis
contracture on one side of neck muscle, neck will be pulled on one side
Blood glucose is stored as glycogen in liver during the last 4-6 weeks of gestation which is
converted to glucose by the liver
Native American
cradle boards
Central cyanosis
cyanosis around mouth and upper chest. Can be a circulatory problem, needs immediate investigation
Asians, Hispanics, Eastern Europeans, some Native Americans
delay initiating breastfeeding
Risk factors for jaundice
diabetes, ethnicity, prematurity, delay in feeding, delayed cord clamping, traumatic births, liver immaturity, neonatal complications
Intestinal length
is long in relation to their size. Helps increase absorption. At risk for dehydration
glomerular filtration rate
is low, can't get rid of fluid rapidly, increase reabsorption of Na+. Reach adult rate around 2 yrs old
All newborns are at high risk for cold stress because
large body area r/t body mass, limited SQ fat, limited ability to shiver, thin skin, blood vessels close to surface
Circumcision benfits
less risk of STIs, infection, UTIs in eldery
Conduction
losing body heat to a colder surface
Convection
losing heat to colder air currents
Evaptoration
loss of heat through moisure
What do you want to watch for in later cardiovascular assessment?
loud murmur- VSD. Soft murmur-larger defects, pallor, rapid breathing, cyanosis around lips, low sats
Metabolic screening
mandated panel to test for genetic and metabolic disorders. Include: PKU, galactosemia, cystic fibrosis, sickle cell, congenital hypothyroidism, congenital adrenal hyperlasia. Test for ones that you can prevent or minimize complications
African Americans
may squirt breast milk into newborns eyes
Latin American and Filipino
may use abdominal binder or "belly band"
Anencephaly
missing part of brain or skull
Formula stools
more adult looking, stink, more formed
Kidney function
nephrons are functions at 34-36 weeks, not full mature until after bith
Erythema toxicum
newborn rash
Physiological jaundice
normal process by which RBCs are broken down. Usually takes 2-4 days for it to show up
Hypotonia
not enough muscle tone
musculoskeletal assessment
observation of movements, head lag, passive ROM, assessment of hip, clavical inspection
Pathological jaundice
occurs within first 24 hrs, there is something else wrong with baby. Most common is blood incompatibility problem
lLater GU assessment
palpation of scrotum, inspection of urethra
Thermoregulation is essential for
physiological adaptation
Acrocyanotic
pink body, blue hands and feet
Presence of meningocele
protrusion of the meninges or meningomyelocele
Neutral Thermal Environment
range of temp in the newborns body can maintain a temp with minimal o2 consumption and metabolic demands
Hypoglycemic symptoms
shaky, jitters, diaphretic, hypothermia
Fetal alcohol syndrome (FAS)
short palpable fissure, flat upturned small nose, flat midface, thin upper lip, microcephaly
Later cardiovascular assessment
skin and mucous membrane colors, palpate chests for thrills or heaves, HR 110-160, cap refill, peripheral pulses, cord, murmurs not uncommon initially
Iron storage
stored in fetal liver during last few weeks of gestation. Influenced by total Hgb, length of gestation, and adequate maternal intake. Iron the baby stores up in utero should last 6 months (this is why you start giving iron fortified foods at 6 months)
Erythropoietin
substance that regulates RBC production. Go down once baby gets o2 so there isn't so much RBC production
Breast milk stool
sweet smell, seedy, yellowish
What do you want to watch for in a later GU assessment?
swelling of scrotum (some is normal), micropenis (less than 2 cm-can indicate pituitary problems), ambiguous genitalia
Caput succedaneum
swelling, from baby being head down and fluid going there. Can cross the suture line.
Later GI assessment
symmetry, BS, passage of meconium, palpate for hernias, inspecption of anus for patency
Meconium
tarry, sticky, black. First stool. Contains amniotic fluid, salts, etc. Want to see within first 24 hrs
Vernix
the white, cheesy substance that covers the fetus to protect the skin from chapping
Hypertonia
too much, r/t withdrawal
Gestational age
usually look at gestational age by date (mom's last regular period)
Syndactyly
webbing
Milia
white dots on forehead, nose, chin. Clogged with fluid
Cardiac sphincter immature
why you see spit up
Erb's palsy
will hold one arm at the side
