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Maternal Exam 2 > Term Newborn > Flashcards

Term Newborn Flashcards

1
Q

Categories involved in the APGAR scoring system?

What are the scoring numbers?

A 
Heart Rate
Respiratory Effort
Muscle Tone 
Reflex Irritability
Color

Scoring goes from 0, 1, 2

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2
Q

APGAR Heart rate

A

0 - absent
1 - below 100
2 - above 100

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3
Q

APGAR Respiratory Effort

A

The effort - not the rate.

0- absent
1 - irregular
2 - good crying

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4
Q

APGAR Muscle tone

A

0 - flaccid
1 - some flexion
2 - active motion

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5
Q

APGAR Reflex irritability

What tool will they use?

A

0 - absent/none
1 - grimace
2 - vigorous crying

Use the bulb to cause a gag reflex

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6
Q

APGAR Color

A

0 - pale blue
1 - body pink w blue extremities
2 - completely pink

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7
Q

What is the Max APGAR score?

How long can APGAR scores be carried out?

A

10

10 minutes

  • most babies will be 8 or 10
  • might see a 10 baby if natural birth
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8
Q

Who is really the only person who can’t assign an apgar score?

A

OB

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9
Q

Suctioning used to clear the mouth and nose after birth?

What else does this do?

A

DeeLee Suctioning

Can measure gastric secretions too which can warn you about a GI obstruction
- 5 to 10 is average

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10
Q

What do periods of reactivity describe?

A

How the baby is doing outside the utero cavity

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11
Q

When does the First Period of reactivity occur?

A

First period happens 30 minutes after delivery

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12
Q

First period of reactivity newborn behavior

A

Awake, active, and hungry using the suck reflex. Will try to start breastfeeding due to Oxytocin - which is helped bu skin to skin that happens here too.

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13
Q

First period of reactivity newborn vitals

A

HR 160-180
Irregular Respirations 60 - 80

Due to them being a little stressed and trying to clear fluid from their lungs

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14
Q

First period of reactivity assessment findings

A

Grunting
Retractions
Nasal flaring
Crackles

Also do due to trying to clear lungs.
- They should stabilize

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15
Q

What phase comes after the first period of reactivity? How long is it?

A

Sleep phase where things can stabilize 1-2 hours

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16
Q

Second period of reactivity comes after? How long is that?

A

Second period of reactivity comes after the sleep phase.

2-8 hours

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17
Q

What is the second period of reactivity known as?

A

Known as Stormy phase

  • gagging
  • vomit
  • may not do well at breastfeeding bc now, they’re trying to get rid of fluid.
  • just need to be able to suction and clear it out with bulb syringe at head of bed
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18
Q

When do the alveolar ducts appear?

When do the primitive alveoli ducts appear?

A

20-24 weeks gestation

More apparent ducts form 24-28 weeks gestation.

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19
Q

When does the surfactant develop?

A

By 28-32 weeks

And this is why babies who are 35+ do fairly well bc at 35 they can replace it

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20
Q

What does surfactant do?

A

Lowers surface tension & helps alveoli open

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21
Q

What if the infant doesn’t have decent surfactant?

A

We have exogenous surfactant that we can give them

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22
Q

Fetal breathing movements help the fetas practice for breathing. What is essential for this to occur?

A

Amniotic fluid and lung fluid

Without it, you have hypo-plastic lungs and babies die.

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23
Q

Mechanical changes that baby adapt to breathing and remove the 80-110 mL still in their lungs?

A

Chest compression & chest squeezing during exiting vagina
Gasp & forced exhalation
Crying
Suctioning

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24
Q

Chemical changes that explain mild decels right before delivery?

A

Increased CO2
Decreased pH
Decreased O2
Helps them take first breath.

We don’t want them to be overly stressed tho with decels

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25
Q

What action by us cuts off all oxygen from mom to baby?

A

Cord clamping and from here, they need to breath on their own.

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26
Q

What are some thermal changes that occur?

What if they get too cool or hypothermic?

A

The baby in utero is warm but outside it is cold. This change stimulates nerves to drive breathing

If hypothermic, causes respiratory depression. We will get them under a warmer to avoid this.

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27
Q

Sensory changes that help breathing when born?

A

Baby experiences gravity, touch, voices, lights - all very stimulus like
It increases the baby’s drive to breath

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28
Q

What is the Silverman Anderson index tool?

A

Helps you decide how a baby is doing after birth respiratory wise

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29
Q

Grade 2 of Silverman Anderson index

A

2 - Retractions and lagging on inspiration. The xiphoid will be depressed. The nares flare open so they can get more air. Can hear their expirations with you naked ear

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30
Q

Grade 1 of Silverman Anderson index

A

1 - Slight lag with less retractions, less depression of xiphoid, and minimal flaring.
Will hear expirations with stethoscope

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31
Q

Grade 0 of Silverman Anderson index

A

0 - Abdomen and chest rise and fall together. No retractions. No xiphoid issue. No nasal flaring. No grunting heard

Perfectly normal

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32
Q

What if a baby is a grade 2 or 3 on the Silverman index?

What else can you consider?

A

As long as they move up on scale within hour or so , then they are ok. If it doesn’t improve - send to nicu.

Respiratory rate & O2 sats

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33
Q

What type of breathers are babies?

What age are babies able to mouth breath incase of an obstructtion?

A

Nose breathers with abdominal muscles- and if there is an obstruction they can’t eat either.

3 weeks of age is when they can mouth breathe

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34
Q

How should the abdomen and chest rise and fall?

A

They should rise and fall together

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35
Q

What is the cause of less surfactant?

A

Preterm delivery babies who are born early may have less. This can be an issue in breathing

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36
Q

Persisting hypoxemia and acidosis leads to….

A

Pulmonary arteries will be dilated at first but then go to constricted which isn’t good

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37
Q

Indicators of respiratory diseress

A

Tachypnea comes first (greater than 60 in infants)

Apnea and cyanosis

Flaring nostrils

Hypotonia - poor muscle posture

Grunting

Retractions

Seesaw respirations

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38
Q

Hypotonia

A

poor muscle tone and posture

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39
Q

PFC meaning

A

Persistant Fetal Circulation

  • due to pulmonary vessel constriction
  • and the ductus and foramen ovale aren’t closing

This is not good. PDA = patent ductus
- you want these to close eventually

Will hear rushing sound

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40
Q

What is infant hemoglobin and hematocrit like?

What about hr?

What happens to fetal hemoglobin after delivery?

A

Higher attraction to O2 to keep them from becoming hypoxic

Heart rate is higher to prevent hypoxia as well

Fetal H&H is replaced with adult H&H bc they won’t need it anymore

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41
Q

Normal breathing rate for infant

What will the rhythm be like?

Why do you need to count for 1 full minute?

A

30-60 breathes per minute

Shallow diaphragmatic breathing
Irregular in depth and rhythm

Due to irregularity in breathing bc they do it periodically. Breath pause breath for like 5-15 seconds. No change in color or HR

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42
Q

How long is pause in breathing if they have apnea ?

A

More than 20 seconds

Bradycardia & pale

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43
Q

Hemoglobin level

Hematocrit

A

14-20

43-63%

  • polycythemia if it is higher than 63. means thick blood. Not a good thing bc it increases workload of heart
  • acrocyanosis will be prolonged
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44
Q

wbc

A

10,000 - 30,000

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45
Q

platelets

A

150,000 - 350,000

- same as adults

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46
Q

Lab that can tell you if baby was hypoxic in utero?

A

Reticulocytes : 3 - 7 %

  • immature red blood cell. if theirs is high, it means they had hypoxic episodes of utero
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47
Q

Blood vol

A

82 - 83 ml/kg

- you can calculate this

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48
Q

Glucose levels

A

45-94 in infant

- if lower than 45 they are hypoglycemic

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49
Q

What should resting HR in infants be?

What is the low while sleeping

A

120-160 bmp

80 bpm is low

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50
Q

How long do you listen for murmurs.

What is the trend with audible murmurs and heart defects?

What else should you check?

A

Full minute

The serious heart defects aren’t heard as well due to their hole being so big, it doesn’t make a noise. Small hole has more resistant and makes it louder

Do o2 sat on the baby around 24 hrs of age - but definitely before dismissal.
right arm right leg

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51
Q

What should the femoral and brachial pulses be like?

What does cap refill be like?

Will you do a newborns BP?

A

Check femoral and brachial pulses need to be equal without lag.

Less than 2-3 seconds

No not if they’re not in nicu. We focus on O2 sats.

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52
Q

Abnormal Cardiac findings list

A 
Tachycardia 
Persistent murmur
Abnormal pulses
Poor perfusion via cyanosis
Abnormal precordial activity
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53
Q

Circumoral cyanosis

A

Cyanosis around mouth

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54
Q

Abnormal precordial activity

A

Feeling a thrill - that is not good

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55
Q

What are murmurs due to?

What percent are transient or short term?

A

Turbulent blood flow due to turbulent blood flow from hole

90% so murmurs in first couple days of life aren’t a huge deal unless they don’t go away

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56
Q

Who turns over their rbc quicker? Adults or newborns?

A

Newborns at 70-90 versus

Adults at 120

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57
Q

What is the jaundice in newborns caused from?

A

Sort of like we mentioned already.. the rbc of newborns has higher turn over. And thus they get broken down causing the hyperbilirubin color

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58
Q

How can delayed cord clamping affect the baby?

Treatment?

A

Increased jaundice bc the cord is their line to rbc

Treatment is phototherapy btw

59
Q

Core temp?

What should we do to keep newborn warm?

What can they wear?

A

inner temp
Balance between heat produced and environment

Make environment temp warm, skin to skin, and heat lamp to avoid hypothermia.

Give them a cap to wear on their head since they lose a lot of heat there

60
Q

Challenges to NB temps stability

A

Less subcutaneous fat

Thin epidermis/skin

No fat to cushion vessels (like head)

Poor posture, flaccid doesn’t hold heat in

LGA or 9ibs - does better w cold . They can overheat actually

SGA and preterm - less fat so less tolerate of cold . will need higher environmental temp

61
Q

Types of heat loss in newborns

A

Convection
Radiation
Evaporation
Conduction

62
Q

Small or large body surface compared to mass?

A

Large body surface area compared to mass

63
Q

Convection

Radiation

A

Air or draft that cools baby temp

Cooler objects NEAR the baby (not touching)
- nursery in center of hospital

64
Q

Evaporation

Conduction

A

Wet skin

Something directly in contact w baby skin - cold surface, hands, stethoscope

65
Q

Heat production in NB

Can they shiver?

A

Commonly done by moving around that increases metabolic activity

They can. It is uncommon but it is only happens with significant drop

66
Q

Chemical thermogenesis?

Where is brown fat located?

A

Non-shivering thermogenesis is caused by cool environment causes them to burn their brown fat (2-6% of body weight) for heat

Trunk over adrenals and chest

67
Q

Can brown fat be replaced?

A

No so we try to be conservative and protect them from burning it too fast

  • it’ll eventually be used up tho
68
Q

How long do newborns iron stores last?

A

4-6 months. Depends on moms prenatal care

69
Q

What gives the baby the rounded tummy?

A

Glycogen in liver - which is a good thing. Flat tummy means prone to hypoglycemia

70
Q

When does the liver conjugate the bilirubin?

A

Remember - the rbc turnover from infant to adult?
This applies here.
Bilirubin will conjugate once they are born (used to rely on mom)

71
Q

What is the newborns intestinal flora like?

Treatment

A

Intestinal flora will be sterile & so they can’t make pro-thrombin for vit K! And they are at risk for bleeding

Give vit k around 2 hrs of age
.5 mL IM
- clean skin first

72
Q

What if the infant isn’t given vit k?

A

Hemorrhage

or may not be able to do any procedure if baby needs it

73
Q

Conjugation of bilirubin means?

What must bilirubin pass through to be conjugated?

A

From going to fat soluble to water soluble bilirubin

Attach to albumin in order to pass through liver

74
Q

What happens to bilirubin once in liver?

A

GT enzyme attaches gluco chain to bilirubin for conversion to make it into water soluble now

75
Q

So what all is unconjugated bilirubin?

A

Fat soluble
Indirect
Pre-liver

76
Q

What all is conjugated bilirubin

A

Water soluble
Direct
Post liver

77
Q

indirect bilirubin level

direct?

When will jaundice appears when than tho?

A
  1. 8
  2. 2

indirect serum levels are greater 5-7.0

But remember - the baby is like this bc of the turnover. Not necessarily bc something is wrong. this is just the mechanism of breakdown of heme (recycle) and bilirubin

78
Q

How does jaundice present?

A

Head to toe first. And then check for dependent jaundice by turning them over

79
Q

Kerniticus

Consequence?

A

Hyperbilirubin that crosses over blood brain barrier. Brain cells turn yellow

Permanent irreversible brain damage!!! don’t get sued

80
Q

How to reduce hyperbilirubemia?

A

Feeding the baby. This causes them to poop it out and not get absorbed again
- so if mom says she is feeding the baby but the stool isn’t colored, then something isn’t adding up

81
Q

What is physiologic jaundice?

Do all aged newborns have albumin?

Increased absorption of bilirubin is caused by wat?

A

Accelerated destruction of fetal RBCs that increases bilirubin to the immature liver

No - premies have lack of albumin often. This makes it more prevalent

Increased absorption if they aren’t stooling - remember.

82
Q

What is pathologic jaundice?

How do we know?

What will levels be like?

A

When the patho is not right . Some condition probably caused it

Onset before 24 hrs (since physiologic is after this). A rapid onset

Patho jaundice has way higher levels than 12-14. And it lasts longer

83
Q

Patho reasons to cause Patho jaundice due to Unconjugated or Indirect bilirubin

A 
Rh abnormality
ABO abnormalities
Sepsis
Cephalhematoma
Hemangiomas
Hypoxic insults
Polycythemia
Swallowed blood in delivery
Increased bilirubin recycling
84
Q

Explain Rh reason for patho jaundice

Unconjugated or Conjugated direct

A

RH - mom lacks protein on her rbc when she has an rh+ baby which causes her to produce antibodies that want to destroy baby rbc - which causes destruction of rbc and high bilirubin

Unconjugated or Indirect

85
Q

Explain ABO patho jaundice Unconjugated or Indirect

A

Mom is O and baby is A or B. And if you have O, then the antibodies attack here too.

86
Q

Explain Sepsis patho jaundice

Unconjugated or Conjugated

A

Sepsis decreases rbc and induces anemia.

Unconjugated

87
Q

Explain rbc disorders for patho jaundice

Unconjugated or conjugated?

A

Sickle cell
anemia
-Abnormal rbc get destroyed at faster rate

Unconjugated or Indirect

88
Q

Cephalhematoma for patho jaundice

Unconjugated or Conjugated?

A

(bleed in head from trauma near periosteum) - which breaksdown since it is outside the bloodstream and thus bilirubin is produced

Unconjugated or Indirect

89
Q

Hemangiomas for patho jaundice

Congugated or uncongugated?

A

Birth defect - big angiomas

Unconjugated
or indirect

90
Q

Hypoxic insults for patho jaundice

Unconjugated or conjugated?

A

Slows hepatic function and can’t convert bilirubin

Unconjugated or Indirect

91
Q

Polycythemia for patho jaundice

Unconjugated or Conjugated?

A

High rbc in blood than expected so more wil be destroyed

Unconjugated or Indirect

92
Q

Swallow blood in delivery for patho jaundice

Unconjugated or Conjugated

A

Happens in delivery and they just have to break it down and causes jaundice

Unconjugated or Indirect

93
Q

Increases bilirubin recycle for patho jaundice

Unconjugated or Conjugated

A

Because you don’t poop - maybe due to obstruction or not feeding baby

Unconjugated or Indirect

94
Q

Causes of patho jaundice wit Direct or Conjugated Bilirubin

A 
Neonatal hepatits
Intestinal obstruction
Ischemic necrosis
Parenteral feeds
Metabolic disorders
Hematologic disorders
Ductal Disorders 
- biliary atresia
- tumors

It can pass through the liver but it is not excreted. And direct means the bilirubin that has passed . Excretion issue of post liver

95
Q

Which happens first? Breast feeding jaundice or breast milk jaundice

A

Breast feeding jaundice or poor breast feeding.

And then the breastmilk jaundice or composition

96
Q

Breast feeding jaundice

treatment?

A

Jaundice due to baby being dehydrated bc you aren’t feeding them enough and bilirubin concentration increases. 1st week of birth
Do 15 min on one breast and 15 min on another. Supply and demand
- stimulate the breast more!!!

97
Q

Breast milk jaundice

treatment?

A

Some moms have high free fatty acid and hormone levels and this causes baby bilirubin to be high
- rare but peaks 2-3 weeks later

  • You’ll give baby formula. But you will pump and dumb to keep your supply going
98
Q

How to asses for hyperbilirubemia or jaundice?

A

Blanch

Draw blood
- we draw levels of all newborns within 24 hrs & use bili tool

99
Q

What type of instruction do you absolutely have to give on jaundice?

And what else?

A

Verbal and WRITTEN bc of brain damage possibility due to kerniticus (cerebral palsy, retardation)
- avoid lawsuit by doing this

Have them sign the document for proof!! And document yourself

100
Q

How to check for jaundice in dark skin?

A

Mucous membranes
And baby will get sleepy

but do labs

101
Q

Treatment for hyperbilirubemia?

A

Feed them more

Phototherapy

Exchange transfusion

102
Q

Phototherapy

Exchange transfusion?

A

Blue light or fiber optic blanket that converts bilirubin in skin

Exchange transfusion gives blood and take blood. It specifically takes the rbc coated with antibodies to stop bilirubin production

103
Q

GI

What happens to blood glucose when cord id clamped?

What if baby is LGA or SGA?

A

Cutting cord makes blood glucose drop for first 1-2 hours.

Monitor LGA or SGA blood sugars . Feed them too or else their blood sugar drops to hypoglycemic

104
Q

GI

What reflexes are present at delivery?

A

Sucking, swallowing, empty stomach, and bowel sounds

105
Q

GI

what is the stomach capacity

A

Stomach capacity is tiny. Less than 30 mL. By day three it is 90 ml.

106
Q

GI

conditions?

A

Regurgitation

Projectile vomiting - from pyloric stenosis

GER - not the disease tho

107
Q

GI

what removes the mucus and reduces vomiting during transition period

A

DeLee suctioning

108
Q

GI

When should they urinate?
When should they stool?

A

urinate 24 hrs

stool 48 hrs

109
Q

Weight loss following birth

Do we expect all newborns to lose a little bit of weight?

A

Yes. Should be between 5-8%.
If it is more than 10% then lactation nurses step in especially if they haven’t gained the weight back by 14 days

  • lose, plateua, regain
110
Q

Weight loss following birth

What if the newborn never goes through a weight loss phase?

A

Fluid retention may be occurring and it is unusual

111
Q

If a newborn fails to lose weight in the first couple days, what is the reason?

A

Fluid retention

112
Q

Kidneys

What are the newborns nephron tubules like compared to adults?

How does the GFR affect excretion?

What will pee appear like?

A

Their tubules are underdeveloped (until they turn 2)

Urine won’t be concentrated and they pee in small amounts due to low GFR.

Pee will be often, small amount, odorless, and have no color

113
Q

Kidneys

Why are diapers orange colored

treatment if needed

A

Orange diaper bc of uric crystals. Sort of like a flush of the system. It is not blood.

  • remind parents that al babies do this mostly. Hydrate them
114
Q

Kidneys

What is pseudomenstraution

A

Female infant having blood tinged mucus due to moms hormone drop . Just means female anatomy working

115
Q

Tests to assess the hips

What do these tests look for?

What gender is this more common in?

More common in which position?

A

Barlow - adduct bring in and press down

Ortolani - abduct hips and feel for dislocation

Hip Dysplasia or congenital dislocation of hip
- shouldn’t hear a clunk

More common in females

More common in those in breech position

116
Q

IgG

A

Cross from mom to baby in last months of PG
and is largest group
- so if you are preterm, you won’t give them this

117
Q

igM

A

We draw this from baby. If elevated, means septic baby.

118
Q

igA

What systems does it protect

A

Baby drinks this with moms breast milk.

- protects gi, gu, and respiratory systems

119
Q

What is self quieting and do baby’s have this ability?

Who can’t do this?

A

Can calm themselves & yes the baby can do this

Baby with a mom who smoked, drugs, caffeine

120
Q

What is habituation?

A

Means baby can block the response of repetitive stimuli.

Baby is done w you

121
Q

What is orientation?

A

Baby can look at your face , stare and become fixed

they might look away if they are bored

122
Q

Baby auditory ability?

A

To hear and respond to voices in some way

123
Q

A baby’s Olfactory ability?

A

Can detect and taste their moms breastmilk

Baby prefers sweet things over sour

124
Q

When should you introduce pacifier if you are breastfeeding?

What if the baby is bottlefeeding?

A

After you have established breastfeeding so maybe a week later.
If you use one too early you can have nipple confusion

Bottle-feeders can use it whenever tho bc no difference.

125
Q

Do babies like tactile touch?

How long can you swaddle for?

A

Yes! they love to be touched, held, and swaddled

  • swaddle for first couple months of life only due to hurting their ability to role over.
126
Q

Difference between Cephalhematoma and Caput Succedaneum?

A

Cephalhematoma

  • collection of blood between bone and perisoteal
  • does not cross suture line
  • fairly firm to touch
  • no treatment

Caput Succedaneum

  • collection of fluid
  • will cross the line
  • no treatment
127
Q

Acrocyanosis

A

Blue hands and feet from sluggish capillaries in peripheral

Only lasts a day or so

128
Q

Erythema toxicum

Who has it more?

A

Newborn rash that is red.
Starts on the trunk then spreads all over and then goes away

More common in those with light or sensitive skin

129
Q

Malia

A

Baby acne in the Tzone area.

Use warm water to clean only. No squeezing . just clogged pores

130
Q

Mongolian spots

A

Darkened spots in noncaucasian babies. Look like a bruise but fades by preschool or school

131
Q

Stork Bites or nevi

A

From dilated capillaries at the nape of the neck or above eyes

132
Q

VIT K injection instructions

A

Clean, vastus lateralis, no aspiration

133
Q

Gonorrhea and Chlamydia treatment

Is it required?

Instructions?

What happens if erythromycin ointment isn’t working for Chlamydia?

What if discharge from med isn’t clear but green?

A

Erythromycin ointment in eyes

Required. If they decline , must sign waiver

Massage to improve distribution

Give oral erythromycin or sulfa for chlamydia if not working

Means it is an infection .
The med itself would be clear but if infected then it is green

134
Q

Hep B administration for newborn time?

What if mom is hep B positive?

Hep B antidote?

A

Given in hospital within 24 hrs to newborn . Vit k in one leg, hep b in other

Mom needs hep B immunoglobulin that is weight based

Epineprhine

135
Q

Is circumcision recommended by AAP

A

No - they say parents should have the option.

136
Q

Methods for circumcisoin

A

Gomco/yellen
Mogen
Plastibell - ring will be left behind and will fall off 7-10 days later

137
Q

Which infants get Hearing screening

A

Done on every infant

138
Q

How does the neonatal lab draw?

What conditions does it screen for?

A

State mandated. We send ours to Topeka . Fill in circles with blood

biotinidase deficiency 
adrenal hyperplasia
congenital hypothyroidism 
cystic fibrosis
Hemoglobinopathy
Aminoacid disorder
Fatty acid disorder 
Organic acid disorder
139
Q

CCHD purpose

when do you do it

where do you do it

pass?
repeat?

score needed to repeat?

failing score?

Whats next if you fail

A

Picks up hypoxia with pulse oximetry - bc it is an early sign of heart issue

Do it around 24 hrs of age

Right hand and right foot

Pass = greater than 95% in each extremity as well as less than 3% difference between extremities

Repeat = between 90 and 95

Fail = less than 90

echo is next

140
Q

Who does the hearing screen?

Why do they need to follow up?

A

Audiologist tech does it on floor
Do it before they leave

Need to follow up so it doesn’t affect language development

141
Q

Safe sleep?

ABC?

Can you use a sleep sack?

Pacifier?

should baby be in a car seat with lot of clothes on?

Can infant be in car seat for very long?

A

Avoid sids or accidental suffocation
- not a fate thing

Alone, Back, Crib

  • not in parent bed
  • on the back
  • nothing else in the crib

sleep sack is ok

pacifier can help reduce it

remove blanket and heavy clothing

No- plagiocephaly or flat head
and torticollis - neck is pushed to one side

plagiocephaly - do tummy time

142
Q

When should tummy time be started

A

begin first week of life when baby is awake

supervise them tho

143
Q

vaccinations

A

encourage them

144
Q

9 ways to calm newborn

A 
Swaddling - only for 2 months
Shushing
Sidelying or tummy position
Swinging gently 
Sucking
Sensoorial or voice
sucrose

Maternal Exam 2 (10 decks)

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