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5032 - OB/Peds > Exam 1P - Care of the Newborn > Flashcards

Exam 1P - Care of the Newborn Flashcards

(112 cards)

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1
Q

Detergent-like lipoproteins detectable by 24-25 weeks

A

surfactant

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2
Q

what percent of fetal lung fluid is absorbed by the time of birth?

A

65%

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3
Q

what is the purpose of fetal lung fluid?

A

helps expand the alveoli and aids in lung development

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4
Q

____ reduces surface tension within the alveoli

A

surfactant

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5
Q

when do surfactant levels increase?

A

during labor and immediately after birth

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6
Q

___ can be given in preterm labor to help increase surfactant production

A

betamethasone

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7
Q

____ can also delay surfactant production

A

diabetes

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8
Q

when does lung development stop?

A

once the neonate is out of the uterus

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9
Q

T/F - surfactant can be given exogenously

A

T

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10
Q

what are the 4 main types of triggers that lead to first newborn respiration

A

(1) chemical
(2) mechanical
(3) thermal
(4) sensory

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11
Q

chemical triggers for first newborn breath include

A

(1) decreased pH
(2) increased CO2
(3) chemoreceptors
(4) stimulation of medulla / respiratory center

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12
Q

mechanical triggers for first newborn breath are

A

(1) chest is compressed during birth
(2) expulsion of fluid
(3) recoil after birth that eases the first breath

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13
Q

thermal trigger for first newborn breath are

A

skin senses change in environmental temperature - triggers respiratory center

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14
Q

sensory triggers for first newborn breath include

A

(1) touch
(2) light
(3) sounds
(4) smell
(5) discomfort

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15
Q

when do the CV shunts close for newborns?

A

shortly after birth

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16
Q

the initiation of respiration leads to ____

A

the closing of the three shunts because of pressure changes

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17
Q

what are the predisposing factors that lead to heat loss?

A

(1) thin skin with blood vessels close to the surface
(2) little SQ fat
(3) newborns have 3x more SA to body mass than adults
(4) rate of heat loss is 4x greater than that of adults

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18
Q

what is the protective factor for newborm thermoregulation?

A

flexed position (reduces the amt of skin surface exposed)

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19
Q

what are the 4 methods of heat loss?

A

(1) evaporation (wet skin)
(2) conduction
(3) radiation
(4) convection (air)

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20
Q

nursing implications for evaporation

A

(1) keep infant dry
(2) remove wet diapers
(3) minimize exposure during baths

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21
Q

nursing implications for conduction

A

(1) put the baby on prewarmed sheet
(2) cover weighing scaled / x-ray with warm blanket

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22
Q

nursing implications for radiation

A

(1) keep baby cot away from cold walls
(2) cover baby if stable

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23
Q

nursing implications for convection

A

(1) avoid air current
(2) manage babies inside incubator
(3) organize work to minimize opening portholes
(4) provide warm, humidified O2

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24
Q

neutral thermal environment for an undressed infant should be

A

89.6-92.3 F

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25
neutral thermal environment for a dressed infant should be
75.2-80.6 F
26
what are 5 signs of a cold infant?
(1) restlessness (2) crying (3) increased flexion and activity (4) vasoconstriction / acrocyanosis (5) body metabolism increases
27
increase in body metabolism can lead to ____
hypoglycemia
28
what is an early sign of an infant being cold?
acrocyanosis
29
____ is caused by peripheral vasoconstriction
acrocyanosis
30
_____ is the primary source of heat production
non-shivering thermogenesis (NST)
31
the metabolism of brown fat / adipose tissue to produce heat
non-shivering thermogenesis
32
newborns can increase heat production by ____ using NST
100%
33
what is the basic rule of thumb for newborn dressing?
one extra layer than what the parent is wearing
34
____ is not fully activated until after birth
immune system
35
what is NOT a reliable indicator of infection in the newborn period?
fever
36
____ is a common indicator of infection
hypothermia
37
signs of newborn infection are ___
nonspecific
38
IgG crosses the placenta in the 3rd trimester and provides ___
passive immunity
39
___ (immunoglobulin) passes the placenta, but not ___ or ____
IgG; NOT IgM or IgA
40
___ protects against gram negative bacteria; Increases rapidly a few days after birth
IgM
41
____ protects the GI and respiratory systems; produced after birth
IgA
42
which type of feeding can lead to temporary GI issues?
formula feeding
43
gastric emptying is quicker for infants who are ____
breastfed (compared to formula-fed)
44
_____ can lead to regurgitation
relaxed cardiac sphincter
45
____ is stimulated when the stomach fills and leads to stooling
gastric colic reflex
46
all ___ enzymes are deficient until 7 months, except protein and lactose
digestive
47
____ is deficient until 4-6 months of age
pancreatic amylase
48
____ is present in breastmilk and produced by saliva until 3 months
amylase
49
____ helps in fat absorption and is present in breastmilk
lipase
50
___ and ___ are the major carbohydrates in an infant's milk diet
protein; lactose
51
Breastfeeding is encouraged because ____ and ____ are produced and shared in breast milk
lipase; amylase
52
the 3 important jobs of the newborn liver are
(1) glucose maintenance (2) conjugation of bilirubin (3) crucial role in iron storage, metabolism of drugs, and production of coagulation factors
53
when is glucose stored as glycogen in the fetal liver?
3rd trimester
54
in order to be excreted bilirubin must be ____ because ____
conjugated; it needs to be water soluble
55
____ is stored in the fetal liver and spleen in the last months of pregnancy
iron
56
non-breastfed infants should be given ____-fortified milk
iron
57
physiologic jaundice is ____
transient hyperbilirubinemia
58
T/F: Physiologic jaundice is a normal process
T
59
bilirubin levels peak at ____ mg/dL
5-6
60
when do bilirubin levels peak?
days 2-4
61
when do bilirubin levels begin to fall after peak?
days 5-7
62
when do we get worried about bilirubin levels?
(1) when they reach 10 or higher (double digits) (2) levels continue to trend upwards
63
____ is caused by an accelerated destruction of fetal RBCs and increased reabsorption of bilirubin by the liver
physiologic jaundice
64
____ develops in 13% of breastfed infants by 1 week of age
early-onset breastfeeding jaundice
65
early-onset breastfeeding jaundice is primarily due to _____
insufficient fluid intake
66
what is the primary intervention for someone with early-onset breastfeeding jaundice (or risk for)?
help the parent to stimulate milk production and increase infant intake
67
____ Usually occurs after the first 3-5 days of life and lasts 3 weeks to 3 months
late-onset breastfeeding jaundice
68
why does late-onset breastfeeding jaundice occur?
substances in the maternal milk may increase absorption of bilirubin from intestine or interfere with conjugation
69
explain the treatment for late-onset breastfeeding jaundice
(1) close monitoring of total serum bilirubin (TSB) + at least 8-12 feedings/day (2) if TSB levels rise too high - phototherapy; continue BF (3) if dangerously high - may order formula feed for 1-3 days
70
jaundice that is not physiologic or r/t breastfeeding is ____
pathologic jaundice
71
the key difference between pathologic jaundice and other types is ____
pathologic jaundice typically appears within 24 hours of birth
72
____ is a result of excessive destruction of RBCs or problems with bilirubin conjugation
pathologic jaundice
73
some causes of pathologic jaundice can include
(1) sepsis (2) blood incompatibilities (3) metabolic d/o (4) increased hemolysis of RBCs
74
____ is double-digit bilirubin levels that do not resolve
hyperbilirubinemia
75
diagnosis of hyperbilirubinemia
(1) physical exam (2) lab testing - total serum bilirubin (TSB)
76
___ is used if bilirubin levels are significant
phototherapy
77
____ is treatment performed in the NICU
exchanged transfusion
78
why is hemorrhage a risk for newborns?
newborns lack intestinal bacteria to make Vitamin K -> Vitamin K is needed to make clotting factors -> Prothrombin levels are low during first few days of life
79
what is given within 1 hr after birth to activate prothrombin?
Vitamin K
80
Vitamin K is given ___ (route)
IM
81
why is meconium formed in utero?
because intestines are not absorbing nutrients yet (still the placenta)
82
transitional stools characteristics
thin, brown to green
83
breastfed stools are often described as
yellow, gold, mushy, seedy
84
formula-fed infant stools are often described as
pale yellow to light brown; pasty
85
normal breastfed infant has ____ stool per day until 6 weeks of age
3 or more
86
most babies void within _____ of birth
24 hours
87
when would we be worried about a baby voiding?
if 2 days pass without a void
88
the initial bladder volume is ___
6-44 mL of urine
89
newborn assessment immediately after birht
(1) need for resuscitation, clear airway, dry baby (2) newborn stability to initiate early attachment
90
newborn assessment 1-4 hours after birht
(1) adaptation to extrauterine life (2) determination of gestational age / size (3) ongoing assessment for high-risk problems
91
newborn assessment within 24 hours or before discharge
(1) complete physical exam (2) nutritional status and ability to feed (3) complete all screenings
92
"golden hour" refers to ___
when the newborn is most initially alert
93
nursing interventions during the golden hour include...
(1) initial assessment and APGARs (2) eye-to-eye and skin-to-skin (3) first feedings (if stable (4) vit K injection (5) erythromycin ointment
94
newborns may ____ during the second period of reactivity
pass the first meconium
95
eye prophylaxis given to all newborns is ____
erythromycin 0.5% ophthalmic ointment
96
____ can blur vision temporarilty
erythromycin
97
what is the purpose of APGAR?
to evaluate the need for intervention post-birth
98
timing of APGARs is
1 minute nad 5 minutes post-birth
99
what is the nursing role for APGARs?
complete APGAR assessment
100
APGAR scores of ____ require intervention
<7
101
APGAR score of ___ is critical
0-3
102
APGAR score of ____ is below normal
4-6
103
in hours 1-4 after birth, what are the key items for the nurse? (9)
(1) VS q30m (2) identify infant and initiate security system (3) ht, wt, length, head circ (4) gestational size / age (5) skin color (acrocyanosis) (6) suck and swallow (7) reflexes and movement (8) anomalies (9) skin-to-skin as much as possible!
104
SGA is ____ percentile
<10th
105
LGA is ____ percentile
>90th
106
AGA is ____ percentile
10th-90th
107
why is gestational age important?
can be risk factors for certain conditions
108
____ exam is used to look at external and neurologic characteristics
Ballard
109
the two parts of the Ballard exam are
(1) external physical characteristics (2) neurologic characteristics
110
when checking newborn head, we are looking at
sutures
111
when checking newborn neck, we are looking for
webbing, clavicle
112
when we are assessing newborn fingers and toes, we are assessing
(1) color (2) clubbing (3) webbing

5032 - OB/Peds (30 decks)

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