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Gender And Reproductive Health Finals > 4500 Class 9 — NEONATAL > Flashcards

4500 Class 9 — NEONATAL Flashcards

1
Q

Health assessment techniques and diagnostic tests r/t to the neinate

A
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2
Q

MAIN physiological processesof neonatal transition to extra-uterine life

A
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3
Q

Jaundice — neonate

A
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4
Q

Signs of integumentary problems in neonates

A
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5
Q

Name important newborn reflexes

A

Sucking and rooting

Swallowing

Palmar grasp

Plantar grasp

Moro (or startle)

Stepping or “walking”

Crawling

Babinski (plantar)

Pull to sit postural tone

Add

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6
Q

What is the therapy for hyperbilirubinemia

A
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7
Q

Newborn Nursing Interventions related to the postpartum period

A
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8
Q

MAIN physiological processes of neonatal transition to extra-uterine life

A
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9
Q

What ARE IMPORTANT changes/adaptation in the first 2 hours of life

A

ESTABLISH RESPIRATIONS

Adjust to circulatory changes

Regulate temp

Eliminate waste

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10
Q

What indicates poor sdaptation in fetal heart monitoring?

A

Minimal variability. Heart rate not in range, LATE DECELERATIONS

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11
Q

What does late deceleration indicate?

A

POOR OXYGENATION

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12
Q

WHAT DO WE ASSESS IN THE FIRST STAGE OF LABOUR

A

Fetal positioning/presentation

Internal electronic fetal monitoring

Length

Rupture of membranes — time of ROM (length of ROM), note presence of Scalp

Scalp sampling?
Any sign of fetal distress?

Any complication in labour? Bleeding, eclampsia, tx with magnesium sulphate)

Birther analgesia/anesthesia (fentanyl, morphine)

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13
Q

When GBS pos? How to treat?

A

1 initial dose of 5M units of PENICILLIN

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14
Q

What is a meconium?
Color? When does it usually pass?
Where does it pass?

What can cause it

A

First stool

Green-black in colour, viscous and sticky!

Usually passes within 12-24 hours after birth

May pass in utero — chnages of passing meconium increases in utero after 38 weeks gestation. It is common in breech presentation. Common in anything after 40 weeks — postdates.

It can be caused by hypoxia (induced peristalsis), and spihincter relaxation

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15
Q

Fetal Circulation?

A
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16
Q

Top CHANGES in the heart FROM FETAL TO NEWBORN CIRCULATION

A

DUCTUS VENOSUS

FORAMEN OVALE

Shuts

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17
Q

Why are preterm infants at higher risk of ineffective osygen supply

A

Has immature alveoli

Decrease elasticity, recoil

Less surfactant

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18
Q

How can meconium present itself? (Meconuim Aspirarion Syndrome) MAS

How do we manage

A

Abnormal / atypical FHR patterns

Complications include terminal airway obstruction, respiratory distress, inflammation, and infection

Persistent pulmonary hypertension of newborn!

EFM in labour!!! ⭐️

When during birth, not breathing or crying, has a flat tone
- may intubate to suction below the cords, may need ventilate! ⭐️

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19
Q

What are three things we look for before starting a NEONATAL RESUSCITATION?

A
  1. Term gestation? ~over 37 weeks?
  2. Crying or breathing>
  3. Good tone?

If mo, STAR RESUS

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20
Q

What’s the routine care for neonatal transition?

A

A. Prone on birther’s chest (skini to skin) — maintain warmth/normal temp
B. Clear secretions as needed
C. Dry and stimulate to breathe
D. Delayed cord clamping
E. Newborn stays w parents
F. Ongoing observations

ESTABLISH EFFECTIVE RESPIRATIONS

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21
Q

What are potential benefits of delayed cord clamping in preterm newborns?

A

Decreased mortality

Higher bp and blood volume

Less need for blood transfusion after birth

FEWER brain hemorrhages and

Lower risk of necrotizing enterocolitis

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22
Q

Potential benefits of cord clamping in term newborns

A

Decrease chance of developing iron-deficiency anemia

Maybimprove neurodevelopmental outcomes

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23
Q

Potential adverse effects of DELAYED CORD CLAMPING

A

Delaying resuscitation for compromised newborns

Increased risk of POLYCYTHEMIA (high red blood cell concentration)

Jaundice

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24
Q

CONTRAINDICATIONS of delayed cord clamping (DCC)

A

those who require immediate resus

For infants less than 37 weeks gestational age, DCC only for at least 1 minute

For infants 37 weeks or more. DCC for 1-2 minutes!

COMTRAINDICATIONS OTHERS:

Known or suspected placental abruption

Uncontrolled maternal hemorrhage

Vasa previa

Fetuses with pre-existing volume overload such as hydrops fetalis

Multiple gestation deliverieswhere the second twin is in distress

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25
Q

When do we expect an o2 of 10p%

A

10 mins after birth

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26
Q

Body pink, extremities blue

A

Acrocyanosis

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27
Q

Apgar score that means newborn is on severe distress

A

0-3

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28
Q

Apgar score that means normal transition, little difficulty

A

7-10

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29
Q

What physiological mechanisms happen when a newborn is cold (hypothermia)

A
  1. Thermogenesis - newborns attempt to generate heat by increasing muscle activity, could appear restless and cry, could feel cool due to vasocontriction
  2. Increase in cellular metabolic activity — which increases consumption of oxygen and glucose
  3. Flexiom to reduce exposure
  4. Constriction of blood vessels
  5. Shovering mechanism is not operable in new born — in turn brown fat metabolism — these are higher in preterm infants (increases metabolic activity in the brain, heart, and liver)
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30
Q

What can cold stress lead to? Adverse effect

A
  1. RESPIRATORY DISTRESS
    /metabolic distress
  2. HYPOGLYCEMIA!! They would need more glucose
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31
Q

WEIGHT

Average finding?

Normal VARIATION?

A

Average finding: *3400-3500 grams

Normal bariation: *2500-4000 grams

32
Q

Average finding for LENGTH of newborn

A

45-55 cm

33
Q

What is the method of assessment of *head circumference of a newborn

A

OCCIPITOFRONTAL CIRCUMFERENCE

34
Q

What is the headcircumference of a newborn

AVERAGE FINDING

NORMAL VARIATION

A

AVERAGE FINDING: 33-35 cm

NORMAL VARIATION: 32-36.8 cm

35
Q

TEMPERATURE IN NEWBORN

Average finding

Normal Variation

A

Average: 37

Normal variation: 36.5 - 37.5

36
Q

HEART RATE IN NEWBORNS

Average finding

Normal variations

A

Average findings: 110-160 bpm

Variations: as low as 80-100 when asleep
Up tp 18- bpm if actively crying

37
Q

RESP RATE IN NEWBORNS

Average finding

Normal Variations

A

Average findings: 30-60 bpm

Normal variation: >20 s ,
Stabilization occurs by day 1-2 days

38
Q

SKIN ASSESSMENT (normal findings or variation?)

A

Acrocyanosis
Skin pigmentation begins to deepen after birth
General p\plump appearance
Vernix caseosa (soft cheeselike/whiteish substance —protective)
Lanugo hair

39
Q

SKIN ASSESSMENT
(normal variation or normal finding??)

— superficial cracking/peeling of hands and feet
— mottling extremities due to instability of the newborn circulation
— congenital dermal melancytosis—common to back and buttocks, fade over months
— Nevi / telangiectases / stork bites —flat, pink capillary hemangioma—easily blanched, most fade in fist and second years of life
— erythema toxicum — transient rash (appeards 24-72 hours; can last up to 3 weeks), no clinical significance, no tx required
— petechiae
— MILIA (sweat glands on the face, normal)

A

Normal variation

40
Q

Erythema Toxicum

What is it?
When do we see it?
How long does it last?
Tx?

A

It is a transient rash; erythematous macules, papules, and small vesicles
Appears around w4-72 hours after birth / can last up to 3 weeks
No clinical significance, no tx reauired

41
Q

What is vernix caseosa?
Is it a normal finding or normal variation?

A

It is sof cheeselike/whitetish substance, protective

It is a normal finding

42
Q

What is a milia?

Is it a normal finding or normal variation?

A

It is a small sweat-gland spots, usually found on the face

It if a normal variation

43
Q

What is a telangiectatic nevi?

On a newborn?

Is it a normal finding or a normal variation?

A

It is a stork bite

It is a normal variation

44
Q

What would be a potential concern on SKIN ASSESSMENT

A
  1. Bruising
  2. Jaundice
  3. Central cyanosis
  4. Pallor
45
Q

Moulding in the head/face normal?

A

Yes. May or may not be present

46
Q

Head a _______ (size) as compared to body length

A

A fourth

47
Q

Fontanels and sutures should be? Should not be/

A

Suture lines should be palpable

Both should not be bulging, swollen or sunken

48
Q

Discharge in the eyes on newborn?

A

Should be none

49
Q

What is caput succedaneum?

Is it normal finding? Or normal variation? Unexpected?

A

It is generalized edematous areas of the scalp.

Can be accompanied by exxhymosis.

Crosses suture lines.

It is a normal c]variation.

50
Q

It is the collection of blood between a skull bone and its periosteneum.

(common in forcept birth)

(can result in jaundice)

Does not cross suture lines.

Does mot pulsate or bulge when baby cried

Appears several hours or the day after birth — usually largest on the 2nd or 3rd day

Fullness evolved in 3-6 weeks

A

CEPHALHEMATOMA

51
Q

It is the bleeding into the subgaleal compartment.

Dangerous!

Crosses suture lined

Potential space — loosely arranged connective tissue — blood lss in this space can be severe (*do head circumference assessments!)

A

SUBGALEAL HEMORRHAGE

52
Q

EDEMA AT THE BACK OF THE NECK
MASSES FOR NEWBORNS DELIVERED BY VACUUM EXTRACTION

Potential:
BOGGY SCALP
TACHYCARDIA
INCREASING HEAD CIRCUMFERENCE
FORWARD POSITION IN OF THE NEWBORN’S EARS
CHANGES IN NEWBORN LOC

What does these assessment findings suggest?

What might the the order?

A

SUBGALEAL HEMORRHAGE

May require blood transfusion

53
Q

Thyroid in newborn

Palpable or not?

A

NOT

54
Q

Webbing, masses in neck??

A

No expected

55
Q

Prominent tip of sternum

Normal? Or not

A

Normal

56
Q

Breast nodule in a newborn

What is a normal findong

What is a normal variation

A

Normal finding: ~6mm

Normal variation: 3-10 mm/ potential for discharge

57
Q

Where can fluid retention lead to?

A

TTNB (transient tachypnea of the newborn)

58
Q

Abd breathing

A

Normal variation

59
Q

What is the normal interuterine o2

A

60%

60
Q

After 10 mins (newborn), what should o2 be

A

95%

61
Q

What are signs of respiratory distress

A

Nasal flaring
Intercoastal or substernal retractions
Stridor
Grinting
Gasping
Apnea lasting 20nseconds or longer

62
Q

Mottling

A

Not expected

63
Q

Tachypnea is its most common feature. It is a parenchymal lung disorder from delayed resorption and clearance of fetal alveolar fluod

1-2 hours: RR up to 100 breaths/min along with some grunting, nasal flaring, mild retractions

*usually resolves within 24 hours

A

Transient tachypnea of the newborn (TTN)

64
Q

Ttnb care?

A

Support on feeding
Promote thermal emvironment

Maintain o2 at 90-95%

65
Q

Nb blood vol

A

80-100 ml/kg

66
Q

Heart murmur on nb?

A

Does not signify pathological defect

> 50% disappear by 6 months

It should be assessed in conjunction with overall status(color, appearance, behaviour, feeding)

Note to provider

67
Q

Irregular HR in the first few hourd

A

Not uncommon

68
Q

CVS assessment on a newborn

A

Inspect for visible pulsation in midclavicular line (4th intercoastal space)

Palpate apical pulse (4th intercoastal sapce)

Auscultation of apical pulse for FULL MINUTE for rate (4th intercoastal space)

Auscultate heart sounds (S1 and S2)— should be sharp and clear

69
Q

What does greenish umbilical cord imdicate

A

Meconium staining

70
Q

Important fo synthesis of blood coagulation factors

A

VIT K

71
Q

When do we expect the first stool? Of a newborn

A

24-48 hours

72
Q

How does a newborn’s ABDOMEN look like

A

Round and prominent — like a dome
Soft
Cold be a few visible veins
Movement with resp should be noted

73
Q

When to expect bowel sounds in a newborn

A

After a few minutes

74
Q

How does the umbilical cord look like on assessment

A

Has two arteries, one vein

Clamp should not be bleeding

Usually white\ish grey

Should be odourless

75
Q

What is vernix caseosa?

Normal Finding or variation?

A

It is a sof cheeselike/whitish substance

It is a NORMAL FINDING

76
Q

What is lanugo hair

Is it a NORMAL FINDING ORRR VARIATION

A

It is fine hairs over favc3, shoulders, and back

It is a N FINDING

Gender And Reproductive Health Finals (6 decks)

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