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Flashcards in Care of the Newborn and Family Deck (59):
1

When are the two assessments for the APGAR score?

Immediately following birth and again 5 minutes later

2

List the SEVEN points in the APGAR score procedure

-Ensure adequate lighting
-Note time of delivery (first score at 1 minute)
-Act promptly and appropriately to the score
-Repeat score at 5 minutes
-Repeat again at 10 minutes and 15 minutes if active resuscitation is in progress
-Document findings
-Discuss with parents

3

List the FOUR aspects of the midwife's examination of the newborn head

-Look for signs of caput and moulding / Does the head appear asymmetrical?
-Observe for visible signs if trauma
-Feel along suture lines and fontanelles. Are they normal size and appearance?
-Measure head circumference

4

List the FIVE aspects of the midwife's examination of the newborn face

-Eyes - 2, general shape and size, cloudy may be cataracts, discharge may be infection
-Nose - shape and size, note if flaring and react
-Mouth - symmetrical? Inside should be viewed
-Ears - 2, formed and in correct position, skin tags noted
-Milia - pin head sized whited spots

5

List the FIVE aspects of the midwife's examination of the newborn neck

-Examine for symmetry
-Feel to detect presence of swelling
-Head should be able to move from side to side
-Webbing can be unusual - react
-Feel both clavicles to ensure they are intact

6

List the FIVE aspects of the midwife's examination of the newborn arms and hands

-Arms should be the same length
-Arms should both move freely, lack of movement may denote underlying trauma
-The number of digits should be counted. Polydactyly (extra digits) or syndactyly (webbing) should be noted
-Palm should be straightened and creases examined
-Look at the nails

7

List the SIX aspects of the midwife's examination of the newborn chest

-Examine for symmetry
-Sternal recession should be reported immediately
-Nipples and areola should be well formed, accessory nipples noted
-Breasts may appear enlarged, not a concern if no signs of infection
-Heart rate should be 110 - 160 bpm
-Respiration rate should be 40 - 60 breaths per minute

8

List the THREE aspects of the midwife's examination of the newborn abdomen

-Should be rounded and move in synchrony with the chest
-Inspect and gently palpate for swelling
-Umbilical cord should be securely clamped with no signs of haemorhage

9

List the TWO aspects of the midwife's examination of the newborn genitalia

-BOYS, length of penis should be around 3 cm, position of urethral meatus confirmed, do not retract foreskin, palpate scrotum for presence of two testes
-GIRLS, examine for presence of clitoris, urethral and vaginal orifices, Mucoid discharge may be present

10

List the FIVE aspects of the midwife's examination of the newborn legs

-Assess symmetry, length
-Both legs should move freely
-Shape of feet noted
-Count toes
-Look for polydactyly and syndacyly

11

List the TWO aspects of the midwife's examination of the newborn feet

-Positional talipes - contraction of muscles and tendons related to positioning in utero
-Ankles should move freely

12

List the THREE aspects of the midwife's examination of the newborn spine

-Look for obvious signs of swelling or dimpling or hairy patches (could indicate abnormality of the spine)
-Assess curvature by running fingers lightly over the spine
-Gently part cleft of buttocks to look for any dimples, sinuses and to confirm the presence of the anal sphincter

13

List the THREE aspects of the midwife's examination of the newborn skin

-General condition should be observed
-Obvious swelling or spots should be recorded
-Mongolian blue spot may be present and should be differentiated from bruising

14

What THREE things should be measured following the birth?

-Weight in kilograms
-Length in centimetres
-Occipital Frontal Circumference (OFC) - normal range 32-37cm

15

List EIGHT danger signs in newborns

-Poor feeding
-Lethargy
-Convulsions (staring and lip twitching or limb twitches)
-Cold body temperature (less than 35.5 degrees)
-Hot body temperature (more than 37.5 degrees)
-Chest indrawing
-Fast breathing (more than 60 is too fast)
-Jaundice

16

Which vessel carries oxygenated blood from the placenta to the fetus?

Umbilical vein

17

What is the foramen ovale?

The hole in the neonate's heart between the right and left atria

18

What is the ductus arteriosus?

The vessel which allows the blood to bypass the pulmonary arteries and flow in to the aorta

19

What is the ductus venosus?

The vein which allows most of the oxygenated blood to enter directly in to the inferior vena cava, bypassing the liver

20

What is surfactant?

A substance produced in the lungs, which encourages the alveoli to stay open in the newborn

21

What is non-shivering thermogenesis?

The generation of heat in the newborn, by increasing the cellular metabolic rate in skeletal muscle and the breakdown of brown fat

22

What are the TWO types of urinary incontinence and describe each

Stress incontinence
Pelvic floor is weakened, sudden increase in abdominal pressure occurs and external urinary sphincter fails to contract

Urge incontinence
Sudden and uncontrollable urge to urinate

23

What can be used as a preventative strategy for incontinence?

Pelvic floor exercises

24

List FOUR benefits of skin to skin contact

-Prolactin is released (stimulates milk production and bonding)
-Stimulation of oxytocin to calm the mother
-Baby is calmed
-Increased duration of exclusive breastfeeding

25

List the NINE stages of instinctive newborn behaviour

-Birth cry
-Relaxation
-Awakening
-Activity
-Crawling
-Resting
-Familiarisation
-Suckling
-Sleeping

26

How long should skin to skin contact last for?

Until after the first breastfeed

27

What is jaundice?

Yellow discolouration of the skin caused by a raised level of bilirubin in the circulation, a condition known as hyperbilirubinaemia

28

Why is most neonatal jaundice harmless?

The fetal circulation has a greater number of red blood cells with a shorter lifespan so the increased breakdown levels causes a build up of bilirubin

29

When is jaundice normal (physiological jaundice)?

Appears at day 2, peaking at 3-7 days of age with bilirubin levels up to 80 umol/l

30

List SIX possible causes of physiological jaundice

-Infection
-Concealed haemorrhages
-Dehydration
-Increased enterohepatic circulation
-Impaired liver function
-Metabolic disorders

31

List THREE possible causes for pathological jaundice

-Blood group incompatibility
-Infection
-Trauma and bruising

32

When is jaundice considered pathological (not normal)?

Appears at less than 24 hours old
Bilirubin levels rise more than 85 umol/l per day or 5mmol/l per hour
Sick infant

33

What treatment can be given for jaundice?

Phototherapy

34

How does phototherapy work?

Detoxifies bilirubin by converting it in to a water-soluble form which can be excreted by the kidney

35

What is the consequence of a vitamin k deficiency?

An impaired production of coagulation factors by the liver

36

What does VKDB mean?

Vitamin K Deficiency Bleeding

37

What are the THREE types of VKDB and when do they occur?

Early VKDB - within 24 hours of birth
Classic VKDB - between day 1 and 7 of life
Late VKDB - between week 2 and week 12 of life

38

List FIVE gastro intestinal tract problems of the newborn

- Cleft lip and or palate
- Oesphageal atresia
- Tracheal Oesphageal fistula
- Gastro-Oesphageal reflux
- Pyloric stenosis
- Intestinal obstruction

39

What is Oesphageal Atresia?

A congenital abnormality in which there is a blind ending oesophagus

40

What is pyloric stenosis?

The muscles of the pylorus are thickened which prevents the stomach from emptying into the small intestine

41

What are the signs of a bowel obstruction?

- Failure to pass meconium
- Progressive abdominal distention
- Poor feeding
- Bilious vomits

42

What is an imperforate anus? (4 abnormalities)

- The absence of an anal opening
- The anal opening in the wrong place
- A connection joining the intestine and the urinary system
- A connection joining the intestine and vagina

43

What is Hirschsprungs's disease?

The nerves are missing from part of the bowel which then cannot push material through and causes a blockage

44

What is necrotising enterocolitis?

Portions of the bowel undergo necrosis (tissue death)

45

Which class of antibodies do neonate's have at birth?

Immunoglobin G (IgG)

46

By how many weeks gestation are maternal and infant IgG levels equal and when are the infants IgG levels greater?

Equal at 33 weeks
Greater at 40 weeks

47

What FIVE types of antibodies are found in breast milk?

GAMED
IgG
IgA
IgM
IgE
IgD

48

Describe passive immunity in relation to pregnancy and birth

Maternal antibodies passed to the fetus through the placenta and through breast milk

49

Describe natural acquired immunity

Immunity present at birth, which is exposed to different antigens in an environment

50

Describe induced active immunity

Immunity gained from deliberate antigen exposure such as vaccinations

51

Why does the newborn body require a higher demand for glucose than an adult?

The newborn has a higher brain-to-body weight ratio and the brain uses glucose almost exclusively for its energy needs

52

Describe the TWO changes to energy sources that occur in a neonate following birth

Changes from continuous supply to intermittent
Changes from high carb and low fat to low carb and high fat

53

What is hypoglycaemia?

A deficiency of glucose in the blood stream

54

What TWO reasons make detecting and treating neonatal hypoglycaemia very important?

- It deprives the brain of its primary source of metabolic fuel and can lead to brain damage and seizures
- It is a presenting feature of numerous endocrine disorders and inborn errors of metabolism

55

List FOUR things that may cause a neonate to be more at risk of developing hypoglycaemia

- Prematurity
- Hypothermia
- Perinatal asphyxia
- Sepsis

56

List SIX clinical features that would indicate that a neonate should have its blood glucose checked

- Jitteriness
- High-pitched cry
- Seizure activity
- Lethargy
- Poor feeding
- Apnoea

57

What FIVE things does the blood spot test screen for?

PKU - Phenylketonuria
CHT - Congenital hypothyroidism
CF - Cystic fibrosis
SCD - Sickle cell diseases
MCADD - Medium chain acetyl CoA dehydrogenase deficiency

58

What is the puerperium?

The time immediately following childbirth which lasts approximately 42 days during which anatomical and physiological changes brought about by childbirth resolve

59

How soon following birth should the mother have passed urine and opened her bowels?

Urine - 6 hours
Bowel - 3 days