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NURS ADN004 Maternity > Week 6 Nursing Care of the Healthy Newborn > Flashcards

Week 6 Nursing Care of the Healthy Newborn Flashcards

1
Q

Neonatal period is the first _____ days of life

A

28 days of life

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2
Q

Cord clamping initiates the following:

A

Occlusion of the umbilical vessels
Occlusion and thrombosis of ductus venosus
Increase in systematic pressure to maintain blood flow to the heart

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3
Q

Clamping of the umbilical cord eliminates what as the reservoir for blood

A

The placenta

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4
Q

Onset of respirations causes rise in PO2 in the lungs and a decrease in what?

A

Pulmonary Vascular resistance

This then increases pulmonary blood flow and increases pressure in the left atrium

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5
Q

After the left atrium what happens to the pressure?

A

Decreases pressure in the right atrium of the heart, then causes the foramen ovale to close

Closes within minutes after birth secondary to a decreased pulmonary vascular resistance and increased left heart pressure

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6
Q

With an increase in oxygen levels after the first breath, an increase in what occurs?

A

Systematic Vascular resistance occurs

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7
Q

When systematic vascular resistance occurs this decreases ?

A

Vena Cava return which reduces blood flow in the umbilical vein- constricts and becomes a ligament with functional closing.

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8
Q

Closure of the ductus venosus causes an increase in pressure where?

A

In the aorta

Force closure of the ductus arteriosus within 10-15 hours after birth

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9
Q

Birth occurs and then what happens with lung ventilation

A

Increase blood flow to the lungs
Decrease pulmonary vascular resistance
Increase venous return to the LA

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10
Q

When the umbilical cord is cut, then what happens?

A

Increase lower systematic resistance
Decrease venous return to the RA
Closure of ductus venosus

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11
Q

Pressure increased in LA or RA? Closes?

A

LA and closes foramen ovale

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12
Q

Bi directional blood flow through the DA and causes what?

A

DA constriction and closure

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13
Q

Increases stroke volume of the LV

A

True

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14
Q

In pulmonary atresia how is the blood flow?

A

Reversed blood flow direction from aorta to pulmonary trunk

RV is hypoplastic- Very small

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15
Q

Lung ventilation in pulmonary atresia includes

A

Small increase blood flow to the lungs
Decrease pulmonary vascular resistance
Small increase venous return to the LA

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16
Q

Umbilical cord cut in pulmonary atresia

A

Increase lower systematic resistance
Decreases venous return to the RA
Closure of the ductus venous

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17
Q

Pressure higher in LA or RA in pulmonary atresia

A

RA

Foramen Ovale open

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18
Q

Unidirectional blood flow through the DA in

A

Pulmonary Atresia

DA can not close

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19
Q

The first initiates the inflation of the

A

Lungs

Decrease pulmonary pressure by DILATION of pulmonary vessels

Increase in blood flow through pulmonary vasculature causes constriction of the DA when PO2 > 50mm Hg

Increase in blood flow to the left heart from constriction of the DA

Closure of the FO due to increase in pressure in the left atrium

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20
Q

What are functional closures?

A

Closure of fetal structures

DA, FO are functional closures

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21
Q

How can FO and DA reopen?

A

Apnea or conditions resulting in hypoxia
Crying
Cold stress

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22
Q

Hematologic norms for neonates

A

Normal range is 80-110 ml/ kg

20% less volume, but 20% more RBC mass when compared with adult

Hct is 48-72%

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23
Q

Most body fluids after birth are?

A

Extracellular
- More puffy and swollen
- Also why baby lose so much weight in 1-2 days

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24
Q

Blood constituents RBC is

A

Shorter life than adult RBC
80% fetal Hgb, falls 50% by 5 weeks
Hgb norm 17-19

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25
Q

Term neonate has enough iron to maintain Hgb production for

A

6 months then require diet with additional iron

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26
Q

HR is

A

120-160 BPM
Slow when sleeping
Increase in moving or crying

Deviations rechecked in 15-30 min

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27
Q

Systolic murmurs and sinus arrhythmia are not uncommon

A

True

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28
Q

Average BP is

A

78/42 not routinely assessed

Skin color may be an indicator of cardiac anomaly

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29
Q

Production of lung fluid diminishes how many days before labor?

A

2-4 days

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30
Q

How much lung fluid remains in the passageway of a full term newborn?

A

80- 100 ml

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31
Q

During birth what happens to the fetal chest?

A

Compressed and squeezes fluid

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32
Q

C section infants lack the what?

A

Squeeze
May have wetter lungs after delivery

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33
Q

Breathing is initially stimulated by?

A

Pressure changes, temperature changes, chemoreceptor stimulation from hypoxia and stimulation of skin

1st breath occurs in 1st minute

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34
Q

Initial breath requires large amount of ?

A

Negative intrathoracic pressure

Will see them pull in initially- Seeing ribs

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35
Q

Half of initially inspired air remain in alveoli, which means?

A

Less negative pressure required in each subsequent breath

  • Never fully empty alveoli keeps them puffy
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36
Q

Respiratory Characteristics of Neonate

A

Normally irregular and shallow - periodic breathing

30-60 RR

Obligated nose breathers- Not nose suction a lot

Simultaneous chest movement, exaggerated diaphragmatic activity

Requires adequate surfactant production to maintain inflation of alveoli and adequate respiratory status

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37
Q

Requires adequate surfactant production to maintain inflation of alveoli and adequate respiratory status

A

If preterm
- Assess resp. status and ensure alveoli open
- Artificial surfactant to help keep open alveoli open up there own system catches up

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38
Q

What is given to increase development of surfactant before baby is born and given during labor?

A

Betamethasone

Chest circumference norms is 30-33 cm

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39
Q

Decrease rate of glomerular flow and limited secretion of solutes

Limited tubular reabsorption

Limited ability to concentrate urine

A

Neonate Renal System Characteristics

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40
Q

How many % void after 24 hours and how many 48 hours?

A

93%- 24 hr
100%- 48 hr

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41
Q

Initial bladder volume is how much in urine?

A

6-44 ml

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42
Q

How many voids per day is considered in normal?

A

6-8 voids

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43
Q

What happens if newborn does not void within 24 hours?

A

Nurse should assess adequacy of fluid intake

Bladder distention

Restlessness

Symptoms of pain

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44
Q

Term infant should have coordinated what?

A

Suck- swallow reflex

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45
Q

What sphincter is relaxed in neonate?

A

Cardiac
Slower emptying time

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46
Q

Initial size of stomach is

A

Gumball or marble

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47
Q

After 24-36 hr stretches to size of

A

Ping pong ball

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48
Q

After 3-4 days becomes the size of the a

A

Chicken Egg

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49
Q

HCI levels in neonate are?

A

Decreased

More preterm the lower they are

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50
Q

Newborn can digest what?

A

Simple Carbs and Protein

Less able to digest complex carbs and fats due to limited amylase and lipase

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51
Q

When is meconium formed?

A

In utero after 28-29 weeks usually

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52
Q

When should newborns pass meconium?

A

Within 24 hours

Frequency of bowel movements varies

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53
Q

What color are transitional stools?

A

Thin, brownish stool seen in 3-6 days

3-6 stools per day is common

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54
Q

What color are breast feeding stools?

A

Loose golden color may pass stool with each feeding

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55
Q

What color is bottle feeding stool?

A

Firm, pale yellow with sour odor

Generally pass 1-2 day irritating to skin.

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56
Q

Normal poop color can be

A

Greenish tan

Can signal of teething or baby getting over stomach bug.

Fussy and gassy? Sign of cow’s milk allergy

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57
Q

Dark green stool can be indicator of?

A

Iron in baby formula

No concern

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58
Q

If stool is bright green and frothy

A

Too much foremilk and not enough fatty hindmilk

59
Q

Bright yellow stool is indicator of?

A

Medications or food eaten by mom

60
Q

Mustard yellow is normal stool color

A

True

61
Q

Solid foods can result in what color of stool?

A

Orange

Also medications
Does not indicate problems usually

62
Q

Red color stool Okay?

A

Yes tiny specs okay

May be red from swallowing blood from nipples

May be certain foods

BLOODY or BRIGHT red may indicate infection, allergy, GI injury or other medical reason

63
Q

Black stools of newborn may indicate?

A

Not adequate nutrition or not digesting properly

Older baby could be due to iron in diet

Iron supplement may indicate GI bleeding

64
Q

Gray color stool may be indicator of?

A

What your child may eat

May be liver or gallbladder problem

65
Q

Chalky white poop can be sign of what organ not working properly?

A

Liver

66
Q

Healthy stools of a new born should be ?

A

Yellow seedy and runny

Darker and thicker

67
Q

Transition of stools go from what to what

A

Meconium- transitional- Milk stool

68
Q

Breast fed newborns stool is

A

Yellow gold, loose, stringy to pasty, sour smelling

69
Q

Formula fed newborns stool is

A

Yellow, yellow green, loose, pasty, or formed, unpleasant odor

70
Q

Newborn liver is slightly less_______ than adult liver

A

Active

May have difficulty conjugating bilirubin

71
Q

What plays crucial role in iron storage?

A

The liver

Carb metabolism- Development of enzymes and coagulation

72
Q

Why do we give Vitamin K?

A

Prevents bleeding

Not a vaccine

Mom must sign if refuses

73
Q

Head bleeds can cause what?

A

Developmental disabilities
Other brain issues
Death

74
Q

The liver function of a newborn is

A

Immature

75
Q

What is the liver responsible for?

A

Detoxifying medications

Storing iron in utero

76
Q

Where does bilirubin conjugation occur?

A

Liver
Passed out in digestive tract
and urinary tract

77
Q

Bilirubin is the by product of?

A

Destruction of RBCs

Unconjugated Hg

78
Q

bilirubin is bound to

A

Albumin and is transferred to liver- bound to intracellular proteins

79
Q

Which enzyme leads to unconjugated bilirubin attached to glucuronic acid

A

UDGPT

Leads to conjugated bilirubin

80
Q

Where is conjugated bilirubin excreted?

A

Common bile ducts into duodenum

81
Q

In the intestine bacteria transforms conjugate bilirubin into

A

Urobilinogen
Stercobilinogen
- Excreted as stone in the stool

82
Q

Bilirubin can or can not change back?

A

Can be changed back to unconjugated Bilirubin

83
Q

How does it get unconjugated?

A

High beta- glucuronidase activity

Delayed colonization of intestinal tract

84
Q

Physiologic jaundice occurs % in term and % in preterm

A

50% Term

80% Preterm

85
Q

What causes physiologic jaundice?

A

Caused by accelerated destruction of fetal RBCs and increased reabsorption of bilirubin by the liver

86
Q

Physiological jaundice occurs within 24 hours or more

A

True

87
Q

Pathological Jaundice is less than

A

24 hours

88
Q

What may cause increase amount of bilirubin in the liver?

A

Forceps or vacuum extraction can create more bilirubin to be handled by liver especially if bad bruising

Cephalhematoma

Increased blood volume from delayed cord clamping with faster RBC destruction leads to increased bilirubin in blood

89
Q

Newborn does not take in calories or feed enough can lead to impaired

A

Conjugation of bilirubin

90
Q

Mothers that are breastfeeding can cause increase in?

A

Bili Levels

Later called breastfeeding jaundice
Enzyme in breastmilk that slows the process

91
Q

Why is there defect in bilirubin excretion because of?

A

Decreased GI motility

Leads to decreased oxygen tom the liver

92
Q

Increased Bilirubin reabsorption leads to reduced

A

Bowel motility
Intestinal obstruction
Delayed passage of meconium

This may lead to increased circulation of bilirubin in enterohepatic pathway and results in higher bilirubin levels

93
Q

Pathological jaundice results from ?

A

Rapid and excessive buildup of bilirubin

94
Q

Generally due to to what for pathological jaundice?

A

ABO
Rh incompatibility
Infection or trauma

95
Q

When does pathological jaundice usually occur?

A

24 hours of life

Levels become high very fast

96
Q

Pathological jaundice may not respond well to what?

A

Phototherapy- particular cases in isoimmunization from Rh incompatibility or ABO incompatibility requiring exchange transfusion

97
Q

Delayed or ineffective treatment of pathological jaundice may lead to?

A

Kernicterus

Bilirubin induced neurologic toxicity

98
Q

Phototherapy protocols should include

A

Cover eyes and genitals
Hydration
Vitals
Labs
Bonding

If baby stays and mom goes home

99
Q

Neonate immune system is fully developed?

A

False

Not until after birth fully activated

Newborn has poor hypothalamic response to pyrogens

100
Q

What is not reliable indicator of infection for neonate?

A

Infection

101
Q

Breastfed newborn may have what from mother?

A

Passive immunity

102
Q

When do newborns begin to produce IgA

A

4 weeks intestinal mucosa

103
Q

Last 4 weeks of passive immunity

A

During 3rd trimester

Preterm infant more susceptible to infection

104
Q

Normal edema under the scalp from pressure of labor

Will resolve in a day or two

Does cross suture line

A

Caput

105
Q

Blood in between scalp and periosteum

Takes several weeks to resolve

Does not cross suture line

May pre dispose to jaundice

A

Cephalhematoma

106
Q

Male reproductive for infant should be

A

Testes descended
Scrotum edematous
Hypo/ Epispadias

107
Q

Female reproductive for infant

A

Labia edematous
Majora covers minora if less may be preterm
Ovaries contain all primitive ovum

May have pseudo menstruation from maternal hormones

108
Q

Name head deviations of skeletal system

A

Moulding

Head is 1/4th of body

Hydrocephaly, microcephaly, Anencephaly

109
Q

Excessive cooling may lead to

A

Cold stress

Profound depression of cold stress

110
Q

Thermal Stimuli

A

Significant decrease in environmental temperature after birth

Stimulates skin nerve endings

Newborn responds to rhythmic respiration that are irregular more sawtooth in formation

111
Q

What occurs when skin receptors perceive a drop in environmental temperature

A

Non shivering thermogenesis

Newborn shivers metabolic doubles

Increase in muscle activity

112
Q

What is the primary source of heat in hypothermic newborns

A

Brown fat

Found along scapula and kidneys

Very dense circulatory system and heats infant quickly

Appears 26 to 30 weeks

Increases until 2-5 weeks after birth

Once you use it it is gone

113
Q

Nonshivering thermogenesis

A

Cold

Noreepi released from symp. nerve endings

Brown fat metabolism

Heat production

114
Q

Transfer of heat between two objects with direct contact

A

Conduction

115
Q

Flow of heat from body surface to cooler surrounding air or air circulating body surface

A

Convection

Removed from incubator

116
Q

Loss of heat when a liquid is converted to a vapor

A

Evaporation

117
Q

Loss of body heat to cooler solid surfaces in close proximity but not direct contact

A

Radiation

118
Q

Nursing care of neonate includes

A

Fetal to neonatal transition
Treat problems
Provide teaching
Interaction
Adequate nutrition

119
Q

Initial screening for neonates

A

Apgars
Physical Exam
Eyes and thighs

120
Q

Admission to mother baby care

A

Report from L and D
Review Hx and Prenatal
Review Intrapartal
Assessment

121
Q

APGAR

A

A apperance
P pulse
G grimace
A activiy
R respiratory

122
Q

Prior to 37 weeks is

A

Preterm

123
Q

38-42 weeks is

A

Term

124
Q

Post-term or post dates

A

After 42 weeks

125
Q

Post mature is

A

After 42 weeks with signs of placental aging

126
Q

Size For Gestational Age includes

A

SGA
AGA
LGA

127
Q

8x/24
Infant initiated
Small Stomach capacity
8-12 diapers
Feeding cues

A

Breast Feeding

128
Q

Every 3-4 hours
Less feeding cues
Burp after 15-30 ml
Suck in more air

No juices and waters

A

Bottle Feeding

129
Q

LATCH stands for

A

Latch
Audible swallowing
Type of nipple
Comfort
Hold and positioning

130
Q

Name selected screenings for newborns

A

PKU
CHD
Hearing Universal Screening

131
Q

Safety Measures includes

A

Check bands
Back to sleep
No bottle propping
Thermoregulation
Parent teaching
Immunizations

132
Q

Dismissal care includes

A

Teaching
Labs
Follow up care
Danger signs
Environment

133
Q

Dangers signs indicating a problems include

A

Nasal flaring and chest retractions
Grunting on exhalation, labored breathing
Generalized cyanosis, flaccid posture
Abnormal breath sounds and rates
Abnormal HR and newborn size

134
Q

Labor contractions with cervical changes prior 36.6 weeks

A

Preterm Labor

135
Q

PROM

A

Premature rupture of membranes prior to onset of labor at any gestational age

136
Q

PPROM

A

Rupture of membranes prior to 36.6 weeks

137
Q

Born between 24-36 weeks and 6 days

A

Preterm infant

Appearance depends on gestational age

138
Q

Complications of preterm infant includes

A

RDS MAS
hypothermia
Hypoglycemia
NEC
CNS Trauma

139
Q

Cold Stress can lead to

A

Metabolic Acidosis

140
Q

Newborns of drug addicted mothers include

A

NAS

Eat Seep and Console

141
Q

If nonpharmacological measures not work for Eat sleep and console assessment what do we do?

A

Start morphine 0.05 mg/ kg dose every 3 hr

Increase by 0.01

142
Q

Fetal demise is

A

Fetal intrauterine death after 20 weeks gestation

Causes vary
- Cord accident
- Trauma
- Placental abruption

143
Q

Neonatal Death

A

Infant death after delivery of a 20 week or greater gestational age

Causes include
Prematurity
Congenital abnormality
Injury
infection

144
Q
A

NURS ADN004 Maternity (11 decks)

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