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EMER 115 > LO10 Neonates > Flashcards

LO10 Neonates Flashcards

1
Q

Pre-term
term
postterm

A
  • Pre-term: An infant delivered at less than 37 completed weeks of gestation
  • Term: an infant born at 37 to 42 weeks of gestation
  • Postterm: an infant born at more than 42 weeks of gestation
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2
Q

Transition from fetus to newborn

A
  • As newborns begin to breed the lungs expand with air and pulmonary vascular resistance drops
  • blood flows to the lungs for gas exchange
  • Fetal circulation switches to a functional adult circulation by the closure of the ductus venosus, the ductus arteriosus and the foreman ovale
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3
Q
  • Polycythemia
A

: an abnormally high red blood cell count caused by a delay in clamping the umbilical cord and keeping the infant below the level of the placenta

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4
Q

when to bag baby

A
  • For very preterm infants younger than 32 weeks plastic wrap maybe used to wrap the newborns body prior to drying
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5
Q

where do you assessrespiratory rate, respire Tori effort, pulse rate and pulse ox measures on a newborn

A

right arm

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6
Q
  • Oxygen saturations greater than 90% are typically not reached until
A

6 to 7 minutes after birth

- room air or 30% oxygen should be used to resuscitate newborn if required

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7
Q

Need for Resuscitation

A
  • if the baby has a normal breathing pattern, and a pulse greater than 100 but maintains central cyanosis provide free flow supplemental oxygen
  • if the newborn is apneic or has a pulse less than 100 after 30 secs of drying and stimulating begin bag valve mask
  • after 30 secs of adequate ventilation with bvm with 100% oxygen if the infants heart rate is less than 60 begin compressions
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8
Q
  • Set flow rate of oxygen at
A

5lpm

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9
Q
  • Choanal atresia
A

: boney or membrane is obstruction of the back of the nose preventing airflow can be rapidly fatal but usually responds to a placement of an oral airway or a gloved finger

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10
Q
  • Pierre robin sequence
A

: series of developmental anomalies including a small chin, cleft palate and posteriorly position tongue that frequently leads to airway obstructions

o positioning the patient prone may relieve obstruction if not insert OPA

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11
Q

bag valve mask

- Indicated when a newborn is

A

o Apnea
o Pulse less than 100
o Peristant central cyanosis despite breathing 100% oxygen

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12
Q
  • Signs of respiratory distress that suggest a need for ventilation include
A

include periodic breathing, intercostal retractions, nasal flaring and grunting on expiration

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13
Q
  • Tidal volume of a neonate is
A

5 to 8 ml/kg

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14
Q

ventilating

A
  • Ventilate 40-60/min
  • Count breath-two-three, breath-two-three
  • Continue as long as pulse is under 100 or resp rate is ineffective
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15
Q

Intubabtion

- Indicated when:

A

o Meconium stained amniotic fluid is present and newborn is not vigourous

o Congential diaphragmatic hernia: abdominal organs herniate to chest cavity

o No response to BVM and chest compressions

o Prolonged ppv and hospital is more than 30mins away

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16
Q

Chest compressions

A
  • Indicated if pulse rate remains less than 60 bpm despite positioning, clearing the airway, dragon stimulation and 30 seconds of effective PPV
  • To rescue her technique with the thumbs is the preferred and recommended technique when possible
  • Depth is 1/3 of the chest
  • No interruption in chest compressions at any time
  • The person ventilating delivers of breath during the sequence breed and
  • Compression to ventilation ratio of 30 to 2 for single rescuer and 15 to 2 for multiple rescuers
  • Pulse rate is assessed at 60 second intervals and once the pulse is above 100 bpm gradually slow the rate and decrease the pressure of the positive pressure ventilation
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17
Q

Epinephrine

- Indicated

A
  • Indicated with the infant has a pulse rate less than 60 after 30 seconds of effective ventilation and 30 seconds of chest compressions
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18
Q
  • Hypoxic newborn that is severely anaemic will look
A

pale not cyanotic

19
Q

Diaphragmatic hernia

A
  • Abnormal opening in the diaphragm most commonly on the left side
  • Heart sound shifted to the right, decreased breath sounds on the left, bowel sounds heard in the chest and scaphoid abdomen
  • Mortality may be as high as 50%
20
Q

Apnea

A
  • Respiratory pause greater than or equal to 20 seconds common in infants delivered before 32 weeks but rarely seen in the first 24 hours after delivery
  • Risk factors include prematurity, infection, prolonged or difficult labor, drug exposure, hypoglycemia, hypothermia, seizures and metabolic disorders
21
Q

Premature low birth weight

A
  • Weighing less than 2500 g is considered low birth weight
  • If a newborn is delivered prior to 24 weeks of gestation or weighs less than 500 g and he’s born outside of center equipped to manage such deliveries the newborn is unlikely to survive
  • Premature newborns are at higher risk for respiratory distress due to surfactant deficiency
22
Q
  • Subtle seizure
A

is characterized by high deviation, blinking, sucking and peddling movements of legs and apnoea

23
Q
  • Tonic seizure
A

may be classified as focal or generalized

24
Q

o Focal tonic seizure

A

the persistent posturing of one limb, the neck, or the trunk with horizontal eye deviation is characteristic of a focal tonic seizure

25
Q

o Generalized tonic seizure

A

more common and typically involve atomic flexion of arms with tonic extension of legs

26
Q
  • Clonic seizures
A

: maybe classified as either a focal seizure if one body part is involved or a multi focal seizure if multiple body parts are involved

27
Q
  • Myoclonic seizure
A

: categorized as focal, multifocal and generalized

o The jerks in myoclonic seizures are much more rapid and do not have rhythm

28
Q

o Focal myoclonic

A

: activity often involves flexion of arms

29
Q

o Multifocal myoclonic

A

activity involves twitching of multiple body parts

30
Q

o Generalized myoclonic

A

: bilateral jerking with flexion of the arms, and occasionally flexion of the legs

31
Q
  • Hypoxic ischaemic encephalopathy
A

usually secondary to prenatal asphyxia is the single most common cause of seizures in both term and preterm infants
o Characteristically occur in the first 24 hours over 2 to 3 days

32
Q
  • Hypoglycemia
A

most frequently sent an infants who are small for the gestational age, those who are large for gestational age and those whose mothers were diabetic during pregnancy neurological symptoms consist of jitteriness, hypoTonia, apnea, poor feeding and seizures’

33
Q

Assessment and management of seizures

A
  • Obtain vital signs and oxygen saturations
  • provide additional oxygen
  • assisted ventilation
  • blood pressure evaluation
  • IV access
  • D 10 W solution may be given as an IV bolus to millilitres per kilogram if the newborns blood glucose level is less than 2.6 mmol/l
34
Q
  • Average normal temperature of a newborn is
A

37.5 the range is 36.6 to 37.2

35
Q

o Evaporation heat loss occurs

A

when water evaporates from the skin and respiratory tract

36
Q

convection heat loss occurs

A

to cooler surrounding air the extent of heat loss depends on the air temperature and air movement

37
Q

o In conduction heat loss occurs

A

occurs to cooler solid objects in direct contact with the body

38
Q

radiation heat loss occurs

A

to cooler surrounding objects not in direct contact with the body

39
Q

Hypothermia

A
  • Drop in body temperature to less than 36
  • May have pale skin and acrocyanosis
  • May present with apnea, bradycardia, sinuses, irritability and a weak cry
  • Extremely hypothermic babies the face and extremities may appear bright red
40
Q

Hypoglycemia

A
  • Blood glucose level less than 2.6 mmol per litre
  • Most infants remain asymptomatic until glucose falls below 2.2 mmol per litre for significant time
  • Symptoms of hypoglycaemia include cyanosis, apnea, irritability, poor sucking or feeding and hypothermia
  • Also associated with lethargy, tremors, twitching or seizures, coma, tachycardia, tachypnoea or vomiting
41
Q
  • Meconium plug syndrome
A

the passage of meconium is delayed in the first 24 hours of life

42
Q
  • Caput succedaneum
A

swelling of the soft tissue of the infant scalp as it presses against the dilating cervix
o very common

43
Q
  • cephalohematoma
A

Area of bleeding between the parietal bone and it’s covering periosteum

44
Q
  • linear skull fractures
A

skull fractures are occasionally seen in difficult births

EMER 115 (7 decks)

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