Ch 21-24 objectives

Question 1

Vitamin K administration

Answer 1

Admin within 1 hour of birth

.5-1mg IM 25g needle
90 degrees vastus lateralis

Question 2

Eye treatment post birth

Answer 2

Prophylaxis for opthalmia neonatorum

Erythromycin ointment or tetracycline topical

Remove drainage w/ sterile saline and cotton

Question 3

Baby temp checks

Answer 3

Shortly after birth

Q30min til stable, more freq. if abnormal

Question 4

When should Hep B globulin be given

Answer 4

Within 12 hours birth

Question 5

Congenital heart screening

Answer 5

Pulse ox should be 95%+

Question 6

Newborn and calories

Answer 6

Need more cals from formula than breastmilk

May lose up to 10% birth weight- should be evaluated after 7%

Regain weight after two weeks

Question 7

Breast milk pros

Answer 7

Infection preventing, stimulates leukocytes, immunoglobulins

Lowers risks of

• SIDS
• Asthma
• Diabetes

Improve cog development

Question 8

Breastfeeding hormones

Answer 8

Suckling causes prolactin and oxytocin release

Question 9

Breastfeeding positions

Answer 9

Across chest

Football

Laying next to mom

Question 10

Breast engorgement interventions

Answer 10

Proper fitting bra

Massage breasts

Cold between feedings
Heat just before feedings

Try to release milk frequently

Question 11

Preterm gestational age

Answer 11

before 37 weeks

Question 12

Late preterm gestational age

Answer 12

34-36 weeks

Question 13

Term gestational age

Answer 13

38-41 weeks

Question 14

Post term gestational age

Answer 14

Over 42 weeks

Question 15

Preterm concerns

Answer 15

Resp
Fluids
Skin
Infection
Pain
Nutrition
Temp

Question 16

Preterm respiratory

Answer 16

Low surfactant until 34 weeks
Poor cough reflex

Apneic spells, periodic breathing

Side lying or prone position helpful (while being watched)

need suction

Question 17

Preterm thermoregulation

Answer 17

rapid heat loss

Immature temp regulation in brain

Maintain neutral thermal environment

Question 18

Preterm skin

Answer 18

Very fragile skin, prone to infection (NO IgG!!)

Watch for diaper rash

avoid iodine, alcohol wipes

Question 19

Avoiding overstimulation in pre term infants

Answer 19

Cluster care: multiple tasks performed at once

Rest periods for baby

Reduce stimuli: Noise, lights

Question 20

Motor development pre term baby

Answer 20

Reposition every 2-3hr gently and slowly. Hands midline

Question 21

Acrocynosis

Answer 21

Blue lips, fingers, feet

NORMAL

Question 22

Periodic breathing vs apneic spells

Answer 22

Periodic breathing: cessation for 5-10sec w/o other changes–followed by 10-15sec rapid respirations. NORMAL

Apneic spells: Cessation for over 20 seconds or less but w/bradycarida, cyanosis, pallor.

Question 23

Signs of overstimulation in pre term

Answer 23

BP, HR, RR instability

Cyanosis, pallor

Flaring nares, low O2 sats, apnea
Coughing

Stiff extended arms and legs
Arching
Worried look
Turning away from eye contact
Regurgitation, hiccuping
Fatigued

Question 24

signs of maternal drug exposure

Answer 24

Irritable, jittery, restless
seizures
Rigid muscles
Excess suckling
Diarrhea/weight loss/Vomiting

Tachypnea
Retractions, apnea

HTN, Diaphoresis

Question 25

Risks for post term infants

Answer 25

Decreased placental functioning Meconium aspiration (from amniotic fluid) Low amniotic fluid Labor intolerance Decreased oxygen Hypoxia, malnourishment

Question 26

Intraventricular hemorrhage

Answer 26

Bleeding into/around ventricles of brain Rupture of blood vessels, can cause IICP S&S: Determined by severity - Low muscle tone/lethargy - Bradycardia - Poor respiratory status - Hct drop - Tense fontanelle - Seizures Interventions: - Ultrasound at 7 days old - Maintain respiratory function - Watch for hydrocephele - May need shunt to drain fluid

Question 27

Retinopathy of Prematurity

Answer 27

Blood vessel injury in eye Visual impairment LASER SURGERY

Question 28

Broncho-pulmonary dysplasia

Answer 28

Damage to lungs, need to be on vent for long time S&S: - inability for vent weaning - Tachycardia/pnea - Retractions, wheezing, crackles - Resp acidosis, cyanosis Interventions; -Maternal steroids to reduce prematurity Supportive antibiotics, bronchodilators, diuretics (pulmonary edema) HIGH cals

Question 29

Necrotizing enterocolitis

Answer 29

Intestinal inflammation S&S: - Inc abd girth/tenderness - Low to no bowel sounds - Loops of bowel seen through abd wall - Vomiting, vomiting bile - Occult blood AIR IN INTESTINAL WALL Management (preventative) - Probiotics, preventing NEC - Breastfeeding Management (treatment) - Antibiotics - NPO - Gastric suction - surgery maybe Ostomy may be indicated, can lead to SBS

Question 30

Short Bowel Syndrome

Answer 30

S&S: - Malabsorption - Diarrhea - Failure to thrive Interventions:

Question 31

Short Bowel Syndrome

Answer 31

S&S: - Malabsorption - Diarrhea - Failure to thrive Interventions: - Surgery - TPN primary source - Restore fluids/electrolytes post surgery Begin enteral nutrition asap

Question 32

Transient tachypnea of Newborn

Answer 32

Resolves in 24-48hr Inadequate absorption of lung fluid

Question 33

Normal bilirubin range

Answer 33

Under 5 first 24 hrs.

Question 34

Early onset sepsis

Answer 34

Acquired during birth Prolonged rupture of membranes/prolonged labor Chorioamnionitis Symptomatic within 72hr RAPID PROGRESSION

Question 35

Late onset sepsis

Answer 35

During or after birth, before or after discharge Sx 8-90days after birth

Question 36

Newborn signs of sepsis

Answer 36

Temp instability Resp problems Odd feeding habits