Final Study Flashcards

Question

What cry is an abnormal but expected finding in premature babies?

Answer 1

Place the baby in an upright position on the mother or partner’s chest with no clothing or blankets placed between the infant and the parent. Skin to skin care is facilitated immediately after birth and should be uninterrupted for the first 1-2 hours, unless mom or baby needs special medical attention. Frequent skin to skin care is encouraged in the early days of baby’s life.

Answer 2

Skin to skin care

Answer 3

MEMORY: skin to skin helps babies be hungry as VAMPIRES V - vital signs in the newborn stabilize A - Allows mom and baby to learn each other through senses M - Milk supply is stronger P - promotes bonding and breastfeeding I - Immune and digestive systems are stronger R - reduces bleeding in postpartum moms E - encourages the baby to spend more time in deep sleep and quiet alert states S - stress reduction for baby and parents

Answer 4

body temperature, heartbeat, breathing and blood oxygen levels

Answer 5

A - Activity (muscle tone) P - Pulse G - Grimace (reflex irritability) A - Appearance (skin colour) R - Respiration

Answer 6

1 minute and 5 minutes after birth Repeat scoring every 5 minutes as needed for depressed infants

Answer 7

MEMORY: Persistent Repetition Always Gains Confidence Pulse Respiration Activity (muscle tone) Grimace (reflex irritability) Colour (appearance)

Answer 8

Muscle tone

Answer 9

reflex irritability

Answer 10

0 - absent, limp, flaccid 1 - some flexion, limited resistance to extension 2 - active movement, tight flexion

Answer 11

0 - absent 1 - < 100 bpm 2 - > 100 bpm

Answer 12

0 - floppy, no response 1 - minimal response to stimulation (grimace) 2 - prompt response to stimulation, vigorous crying

Answer 13

0 - blue/pale 1 - pink body, blue extremities 2 - pink

Answer 14

0 - absent 1 - slow and irregular; weak cry 2 - vigorous cry

Answer 15

skin colour

Answer 16

Possibly asphyxiated baby, but should not be used alone as evidence of asphyxia as outcomes studies show that while widely reported, it is often inappropriate

Answer 17

MEMORY: Baby SCAM B - birth weight S - subjectivity of HCP C - congenital anomalies A - age (gestational) M - maternal medications, drug use, and anesthesia

Answer 18

Several components of the score are subjective so the Apgar score is limited in that it provides somewhat subjective information about an infant’s physiology at a point in time.

Answer 19

Resuscitation

Answer 20

The response to resuscitation

Answer 21

110-160 bpm

Answer 22

Pneumothorax Pleural effusion Diaphragmatic hernia You're gonna need a chest ultrasound

Answer 23

Transient tachypnea of the newborn (TTN) Occurs when fluid is retained in the lungs resulting in tachypnea and increased work of breathing TTN may require supplemental oxygen therapy Usually resolves within 48 hours.

Answer 24

Tachypnea Nasal flaring Grunting Retractions Cyanosis

Answer 25

Single first sound and a split second sound

Answer 26

Heart murmurs

Answer 27

Take the blood pressure in all 4 extremities Abnormal findings: -upper and lower pressure gradient difference > 20 mmHg -abnormal femoral pulses Looking for coarctation of the aorta, will need to do a transthoracic echocardiography

Answer 28

Coarctation (narrowing) of the aorta may be noted if the upper and lower pressure gradient difference > 20 mmHg Will need to do a transthoracic echocardiography

Answer 29

- on admission -prior to transfer of newborn from birthing area or operating room - prior to separation of birth person and newborn -upon transport to another facility/unit - following shift handover - prior to medication administration - prior to undergoing procedures - prior to discharge

Answer 30

The birth parent and the newborn. Support person may also get a matching band

Answer 31

From the top of the head to the heel

Answer 32

The greatest diameter of the head, so occipitofrontal line

Answer 33

Average: 3.5 kg (7.5 lbs) Normal: 2.5 - 4.5 kg (5.5 - 10 lbs)

Answer 34

Boys are usually a little heavier than girls

Answer 35

First babies are usually lighter than than later siblings

Answer 36

Large Small

Answer 37

230 g (8 oz) 4 to 5 10 to 12

Answer 38

20 g (0.70 oz) 110 g (4 oz) to 230 g (8 oz)

Answer 39

50 cm (20 inches) 46 cm (18 inches) to 60 cm (22 inches)

Answer 40

4 - 5 cm (1.5-2 inches)

Answer 41

To accommodate for the rapid brain growth

Answer 42

34.5 cm (13.5 inches) 37.6 cm (15 inches)

Answer 43

Weight, height, and head circumference Represents the average of one of the above measurements of an aggregate of a baseline for children

Answer 44

Percentile lines 5%, 10%, 25%, 50%, 75%, 90%, 95% and 97%.

Answer 45

out of 100 normal children her age, 50 will be bigger than she is and 50 smaller

Answer 46

she is bigger than 75 children and smaller than only 25, compared with 100 children her age

Answer 47

The rate of growth over time rather than any one measurement at a single point in time

Answer 48

The child's growth closely follows a percentile line on the chart.

Answer 49

When they have crossed at least 2 percentile lines (i.e. from above the 90th percentile to below the 50th)

Answer 50

Look to see if her growth points have always paralleled the 5th percentile line. If yes, than her growth rate is normal. If she is suddenly falling farther behind, this is more concerning and more investigation might be done.

Answer 51

Also called premature born before 37 completed weeks, regardless of birth weight

Answer 52

born between 34 0/7 and 36 6/7 weeks

Answer 53

born between 37 and 38+6 weeks gestation

Answer 54

born between the beginning of 39 and the end of week 40+6

Answer 55

born in the 41st week

Answer 56

Also called postdate born after 42 weeks + 0 days

Answer 57

born after completion of week 42 and showing signs of placental aging (insufficiency)

Answer 58

Ballard score

Answer 59

The Ballard score is based on the neonate's physical and neuromuscular maturity and can be used up to 4 days after birth (in practice, the Ballard score is usually used in the first 24 hours). The Ballard score is commonly used to determine gestational age. Here’s how it works: Scores are given for 6 physical and 6 nerve and muscle development (neuromuscular) signs of maturity. The scores for each may range from -1 to 5. The scores are added together to determine the baby’s gestational age. The total score may range from -10 to 50. Premature babies have low scores. Babies born late have high scores. Newborn physical examination findings are used by clinicians to estimate gestational age, using the new Ballard score. The Ballard score is accurate only within plus or minus 2 weeks. Newborn clinical assessments of gestational age have been found to overestimate gestational age in preterm infants and underestimate gestational age in small-for-gestational-age infants

Answer 60

+/- 2 weeks gestation Newborn clinical assessments of gestational age have been found to overestimate gestational age in preterm infants and underestimate gestational age in small-for-gestational-age infants

Answer 61

Gestational age

Answer 62

MEMORY: Scrupulously Examine Gestation of Little Premature Babies Skin Eye/Ear Genitals Lanugo Plantar surface Breast

Answer 63

MEMORY: Precise Healthcare Staff Assess Prematurity Signs Posture Heal to ear Square window (wrist) Arm recoil Popliteal angle Scarf sign

Answer 64

IM injection in the vastus lateralis

Answer 65

1.0 mg if birth weight ≥ 1500 g 0.5 mg if birth weight < 1500 g 1500 g is 3.3 lbs

Answer 66

Prophylactic measure to prevent hemorrhagic disease of the newborn (HDN) Without the vitamin K injection, babies are about 80 times more likely to have vitamin K deficiency bleeding. This bleeding can lead to death or serious long-term disability.

Answer 67

Vitamin K is synthesized by intestinal flora which are not present at birth. The introduction of bacteria begins with the first feeding Healthy newborns are able to produce their own Vitamin K by day 7

Answer 68

An oral dose of 2 mg can be given at the first feeding, with follow-up doses given at 2 to 4 weeks of age and 6 to 8 weeks of age. This treatment is not recommended because it is less effective in preventing late hemorrhagic disease of the newborn. Parents should be advised of the importance of the baby receiving the follow-up doses and be cautioned that their infants remain at increased risk of late hemorrhagic disease

Answer 69

Occurs in the first 30-60 minutes of life Described by an alert, exploratory and active newborn Suck is strongest at this time therefore this is the best time to breastfeed Bowel sounds are audible and meconium may be passed Fine crackles may be heard in the lungs as well as some retractions and nasal flaring but this should all resolve by the end of this period Early skin to-skin contact (SSC) begins ideally at birth and involves placing the naked baby, covered across the back with a warm blanket, prone on the mother's bare chest. This time may represent a psychophysiologically 'sensitive period' for programming future behavior, and may benefit breastfeeding outcomes, early mother-infant attachment, infant crying and cardiorespiratory stability.”

Answer 70

Takes place 2 -3 hours after birth The newborn becomes less interested in external stimuli and falls asleep for a few minutes to several hours During deep sleeps, the baby is difficult to arouse Feeding may be difficult Heart rate should stabilize at 100 - 140 bpm and the respiratory rate decrease to 40 to 60 breaths per minute. The newborn should be centrally pink with clear breath sounds and show no signs of respiratory distress. Bowel sounds are audible and peristaltic weaves over the rounded abdomen may be noted

Answer 71

Occurs between 4 - 6 hours after birth and lasts from 10 minutes to several hours Described by an alert, exploratory and active newborn Heart and respiratory rates may increase but should remain within normal limits although brief periods of tachycardia and tachypnea may occur, associated with increased muscle tone, skin colour changes, and mucus production. Meconium is commonly passed during this phase. Most healthy newborns experience this transition regardless of type of birth. Physiological immaturity prevents this in very preterm newborns.

Answer 72

Increasing 57% and 96%

Answer 73

Over half 1 month

Answer 74

Benefits Prenatal education about the importance of breastfeeding. Bonding experience

Answer 75

The support of the partner and family

Answer 76

the benefits of breastfeeding and how they can participate in infant care and nurturing

Answer 77

Current feeding practices in Canada are affected by a long tradition of bottle-feeding and aggressive formula marketing. Beliefs about infant feeding are also deeply embedded in beliefs and practices about child-rearing. Other North American beliefs may include, for example, that children are “spoiled” by being held or carried too much, or that breastfed babies need to learn how to bottle-feed, and feedings need to be scheduled or timed; these beliefs may all affect breastfeeding duration and success.

Answer 78

- immediate skin-to-skin contact after birth - teach responsive feeding to recognize early feeding cues - encourage breastfeeding early and often - teach cues that baby is feeding well - ensure community follow up

Answer 79

At least 8-12 times per day

Answer 80

Exclusive breastfeeding for the first 6 months Introduce complementary foods at 6 months and continue to breastfeed to 2 years and beyond

Answer 81

Each female breast is composed of approximately 15 to 25 segments (lobes) embedded in fat and connective tissues and well supplied with blood vessels, lymphatic vessels, and nerves. Within each lobe is glandular tissue consisting of alveoli, the milk-producing cells, surrounded by myoepithelial cells that contract to send the milk forward to the nipple during milk ejection. Each nipple has multiple pores that transfer milk to the suckling infant. The ratio of glandular to adipose tissue in the lactating breast is approximately 2:1, compared with a 1:1 ratio in the nonlactating breast. Within each breast is a complex, intertwining network of milk ducts that transport milk from the alveoli to the nipple. The milk ducts dilate and expand at milk ejection. The nipple and areola are very elastic so that they can be drawn fully into the infant’s mouth for deep latch-on.

Answer 82

15 to 25 lobes blood vessels, lymphatic vessels, and nerves

Answer 83

glandular alveoli

Answer 84

multiple pores

Answer 85

milk ducts dilate expand

Answer 86

so that they can be drawn fully into the infant’s mouth for deep latch-on

Answer 87

They are milk-producing cells

Answer 88

Myoepithelial cells

Answer 89

Progesterone Prolactin

Answer 90

Lactogenesis

Answer 91

prepares the breasts to secrete milk

Answer 92

Synthesize and secrete milk

Answer 93

The anterior pituitary

Answer 94

highest during the first 10 days after birth, gradually declining over time but remaining above baseline levels for the duration of lactation

Answer 95

In response to newborn suckling and emptying the breasts

Answer 96

No, milk is constantly being produced by the alveoli as the infant feeds

Answer 97

supply-meets-demand system (i.e., as milk is removed from the breast, more is produced)

Answer 98

Decreased milk production

Answer 99

Oxytocin hormone

Answer 100

The suckling infant stimulates the nipple prompting oxytocin production

Answer 101

Posterior pituitary

Answer 102

The milk ejection reflex (MER) Stimulates the cells around the alveoli to contract, squeezing milk into the ducts and towards the nipple

Answer 103

After the mother gives birth, a precipitous fall in progesterone triggers the release of prolactin from the anterior pituitary. During pregnancy, prolactin prepares the breasts to secrete milk and during lactation to synthesize and secrete milk. Prolactin levels are highest during the first 10 days after birth, gradually declining over time but remaining above baseline levels for the duration of lactation. Prolactin is produced in response to newborn suckling and emptying the breasts (lactating breasts are never completely empty; milk is constantly being produced by the alveoli as the infant feeds). Milk production is a supply-meets-demand system (i.e., as milk is removed from the breast, more is produced). Incomplete removal of milk from the breasts can lead to decreased milk production.

Answer 104

Oxytocin a hormone essential to lactation. As the nipple is stimulated by the suckling infant, the posterior pituitary is prompted by the hypothalamus to produce oxytocin. This hormone is responsible for the milk ejection reflex (MER), or let-down reflex. Oxytocin stimulates the cells around the alveoli to contract, squeezing milk into the ducts and towards the nipple

Answer 105

"After pains" of the uterus that occur during and after breastfeeding Oxytocin is the same hormone that causes uterine contractions during labour 3-5 days after birth, and should resolve completely within a week after birth More common in multiparas and patients who gave birth to multiples

Answer 106

MEMORY: once the CORD is cut you have to PUMP PUMP - Postpartum bleeding decreased and more rapid uterine involution - Unique bonding experience - Mental health protection when breastfeeding difficulties are appropriately dressed - Post partum weight loss is faster CORD - Chronic disease risk reduction (ovarian cancer, breast cancer, rheumatoid arthritis, hypertension, hypercholesterolemia, cardiovascular disease, and type 2 diabetes) - Osteoporosis protection - Return of menses delayed - Development of maternal role increased

Answer 107

* Reduced infant and child mortality * Enhanced maturation of the gastrointestinal tract and immune factors * ↓ risk for gastroenteritis, celiac disease, Crohn disease, necrotizing enterocolitis in preterm infants; obesity in childhood, adolescence, and adulthood * helps protect against otitis media, respiratory illnesses such as respiratory syncytial virus and pneumonia, urinary tract infections, bacteremia, and bacterial meningitis * Lower incidence of certain allergies among breastfed infants, particularly for families at high risk * Less likely to die from SIDS * May have a protective effect against childhood lymphoma and type 1 and type 2 diabetes mellitus * Decreased risk of dental malocclusions * May enhance cognitive developmental for term and preterm infants * Pain relief for newborns undergoing painful procedures

Answer 108

L - latch is effective A - audible swallowing T - type of nipple C - comfort level of mom H - holding skills

Answer 109

MEMORY: don't take a good latch for GRANTeD G - glide of jaw is smooth R - Rounded cheeks when sucking A - audible swallowing "ca" sounds N - not easily removed from breast T - tugging sensation D - distortion of nipple not noted after feeding

Answer 110

Cradle hold Cross-cradle hold Football hold side lying Laid back

Answer 111

- hand to mouth or hand to hand movements; sucking on fingers/hands - sucking motions - rooting reflex - mouthing - flexed arms and legs

Answer 112

Flexed arms and legs with clenched fists held over chest and tummy

Answer 113

- comfort in handling the infant - level of confidence - signs of discomfort or pain - recognition of infant hunger cues and signs of satiety

Answer 114

Soft, filling, firmness

Answer 115

Intact, bleeding, blistering

Answer 116

Stage I - secretory differentiation Stage II - secretory activation Stage III - galactopoiesis Stage IV - involution

Answer 117

Secretory differentiation Begins mid-pregnancy to day 2 or 3 postpartum the breasts develop the capacity to secrete breast milk, including the secretion of colostrum

Answer 118

Secretory activation Begins on day 2-3 postpartum until day 8 breast milk volume increases rapidly and then abruptly levels off

Answer 119

Galactopoiesis (means to make milk) From approximately day 9 postpartum and onward The volume of breast milk produced is maintained through a supply and demand mechanism.

Answer 120

Involution occurs, on average, 40 days after the last breastfeed Breast milk secretion ceases

Answer 121

Stage I - secretory differentiation

Answer 122

Stage II - secretory activation

Answer 123

Stage III - Galactopoiesis

Answer 124

Stage IV - involution

Answer 125

Infant - age - weight - stomach capacity - gastric emptying time Mother - storage capacity of the breast

Answer 126

A pattern of breastfeeding in which the baby breastfeeds every hour or so for three to five feedings and then sleeping for 3 to 4 hours between clusters

Answer 127

Rooming-in and skin-to-skin care will help parents recognize and quickly respond to newborn feeding cues “watch the baby, not the clock” If the newborn is stirring, parents should be encouraged to pick the baby up and offer the breast

Answer 128

Parents should be encouraged to wake the baby up to feed Careful assessment of the newborn on how well they are feeding should be done

Answer 129

counting from the beginning of one feeding to the beginning of the next

Answer 130

400 IU per day May be in the formula already, double check your specific type

Answer 131

They actually draw on their iron reserves for the first 6 months and then it will need to be added to the diet (which is when you're introducing solid foods)

Answer 132

Iron-fortified formula is required until 1 year old

Answer 133

None required (there is enough fluids in the milk/formula to meet the needs)

Answer 134

Can make them sleepy as it is transmitted through the breastmilk

Answer 135

Remember that she needs someone to be with her when drowsy and trying to breastfeed for safety

Answer 136

assistance

Answer 137

side-lying or football hold A pillow can help support the newborn

Answer 138

come in late stimulate milk production

Answer 139

psychomotor

Answer 140

Judgement and functioning MER (milk ejection reflex) and milk production

Answer 141

breast milk 30-60 60-90

Answer 142

Some mothers attempt to time their consumption to minimize exposure to their infant (e.g., consume alcohol immediately after a feeding rather than before)

Answer 143

2 hours go outside to smoke

Answer 144

Unusually active and wakeful

Answer 145

Minimal no risk to healthy full-term infants Reduced iron concentration in the breast milk leading to anemia in the infant

Answer 146

MEMORY: body has been MINED of breastmilk M - mastitis I - infection (yeast) N - nipples that are sore E - engorgement D - ducts that are plugged

Answer 147

MEMORY: Problematically DENSER breasts P - painful D - difficulty latching/decreased milk flow E - enlarged N - nipples effaced (flattened) S - shiny E - edematous R - reddened

Answer 148

Any situation causing milk stasis including - delayed initiation of breastfeeding - infrequent or time-restricted feedings - feeding supplementation - inefficient infant latch -breast surgery

Answer 149

Decreased milk production and possible involution (shrinkage) of the breast tissue

Answer 150

Frequent, effective feeding Milk removal via hand expressing or pumping Breast massage

Answer 151

Inadequate emptying of the breasts - engorgement - plugged ducts - sudden decrease in the number of feedings/abrupt weaning - underwire bras Other factors- TIPS - trauma of the breast - ill family members - poor parental nutrition - stress/fatigue

Answer 152

Sore, cracked nipples

Answer 153

staphylococci, streptococci, and E. coli

Answer 154

MEMORY: FAC! this is bad F - fungal infections A - abscess of the breast C - chronic mastitis

Answer 155

Engorgement

Answer 156

Plugged milk ducts

Answer 157

Swollen and tender area of the breast that does not empty or soften with feeding/pumping Mother is afebrile with no generalized symptoms

Answer 158

Breast infection

Answer 159

Take lecithin, a fat emulsifier

Answer 160

poor latch, improper suck, or infection

Answer 161

Express a few drops of milk to moisten the nipple and areola before latch Break the seal of the infants mouth with a finger and readjust to see if the pain resolves Attempt to reposition the infant If it continues, see a nurse/lactation consultant to ensure a good latch and position

Answer 162

ANSWER: these cause the need for a CHIASM from breastfeeding C - cancer therapy in the mother H - HIV in the mother I - Infant galactosemia (rare hereditary disorder where they cant process milk) A - Active TB infection not under treatment in mother S - substance use/some medications M - Maternal HTLV (virus)

Answer 163

Generally occurs within the first hour Ideally after initial transition to extrauterine life - stability of vital signs - bowel sounds - active sucking reflex - effective breathing pattern These will become more obvious to parents who are frequently holding the baby skin to skin

Answer 164

Most baby feed well with any of them, it's really parental preference

Answer 165

Use hot, soapy water using a bottle and nipple brush to facilitate thorough cleansing Most household dishwashers use hot water and are safe for cleaning bottles and nipples. Boiling of bottles and nipples is not always needed. It is best to check with the local Public Health Department regarding recommendations. Recommendations for preterm or vulnerable babies may be more stringent.

Answer 166

fluoride supplementation of 0.25 mg/day is required if the local water supply is not fluoridated.

Answer 167

Parent sitting comfortably, holding the infant closely in a semi-upright position

Answer 168

Gently invite the infant to take the nipple without forcing the infant to finish the bottle

Answer 169

Lower the bottle to slow the flow of milk (I also learned some nipples have larger/smaller flow, so you may want to change up the nipple if this is a consistent issue)

Answer 170

Avoid propping the bottle or letting small children feed the infant unsupervised

Answer 171

Watch for signs of satiation such as the infant - stops sucking - falls asleep - moves their mouth away from the nipple

Answer 172

Can contribute to obesity

Answer 173

It can contribute to nursing-bottle caries, which is decay of the first teeth, resulting from continuous bathing of the teeth with carbohydrate-containing fluid as the infant sporadically sucks the nipple while sleeping

Answer 174

10 to 30 mL for first 48 ish hours 60 to 90 mL by the end of week 1 Use hunger and satiation cues and feed them at least 8 times in 24 hours, even if you have to wake them up, but rigid schedules are not recommended

Answer 175

when they show an adequate weight gain they can be allowed to sleep at night and be fed when they wake up

Answer 176

7-10 days 3 weeks 6 weeks 3 months 6 months Increase each feed by about 30 mL

Answer 177

0 - 1 month: 2-3 oz every 3-4 hours 1 - 3 months: 4-5 oz every 4-6 hours 3 - 6 months: 4-8 oz every 4-6 hours and 2 tbsp of solid food 6 - 9 months: 6-8 oz every 3-4 hours and increase the solid food 9-12 months: 7-8 oz every 6-8 hours and continue to increase the solid food intake

Answer 178

Upright to fill the nipple and decrease the air in the bottle; this prevents the air from going into the infants stomach; this increases the need for burping, and they may need it several times during a feeding

Answer 179

The bottle is held at more of a horizontal angle, when the baby pauses between bursts of sucking, the parent lowers the bottle to slow the flow of milk, until the infant is ready to resume sucking.

Answer 180

Water that is used to make formula needs to be boiled for 2 minutes and the water cooled to no less than 70°C, and then the powder is added (Government of Canada, 2021). Bottled water that is labelled as “sterile” is safe for mixing formula. However, nonsterile bottled water should be boiled for 2 minutes and cooled

Answer 181

- decrease amount of feeding or small amounts more frequently - burp several times when feeding - hold baby upright for 30 minutes after feeding - avoid bouncing or placing on the abdomen soon after feeding

Answer 182

Overfeeding Gastroesophageal reflux

Answer 183

- vomiting 1/3 or more of the feeding at most feeding sessions - projectile vomiting

Answer 184

Consult their health care provider

Answer 185

- cow's milk-based - soy-based (primarily for babies who cannot consume dairy or cultural/religious reasons) - casein or whey-hydrolysate (primarily used for babies who cannot tolerate the cow or soy based) - amino acid (used for infants with multiple food-protein intolerances)

Answer 186

Soy-based formula (this is a rare hereditary disorder of carbohydrate metabolism that affects the body's ability to convert galactose to glucose)

Answer 187

casein or whey-hydrolysate an extensively hydrolyzed protein formula, because about 10 to 14% of infants with cow’s milk–based formula intolerance will also have a soy protein allergy

Answer 188

Surfactant

Answer 189

amniocentesis after the 35th week analysis of amniotic fluid; lecithin-to-sphingomyelin ratio

Answer 190

Establishment of respirations Most newborns spontaneously breathe and are able to maintain adequate oxygenation

Answer 191

pulmonary vasculature Clamping the umbilical cord

Answer 192

There is no single trigger, rather it's the result of a combination of chemical, mechanical, thermal, and sensory factors.

Answer 193

a group of phospholipids that reduce the alveolar surface tension It reduces the pressure required to keep the alveoli in the lungs open with inspiration, preventing total alveolar collapse on exhalation, thus maintaining alveolar stability. The decreased surface tension results in increased lung compliance, helping to establish the functional residual capacity of the lungs Produced in the Type II alveolar cells that make up about 5% of the alveolar surface

Answer 194

more pressure must be generated for inspiration, which can soon tire or exhaust preterm or sick term newborns

Answer 195

Common cause of respiratory distress in a newborn, presenting within hours after birth, often immediately after delivery. Occurs from a deficiency of surfactant, due to either inadequate surfactant production, or surfactant inactivation in the context of immature lungs. Prematurity affects both these factors, thereby directly contributing to RDS.

Answer 196

Chemoreceptors in carotid and aorta activated due to hypoxia associated with labour Medulla's respiratory center stimulated by increased CO2 and decreased O2 levels Clamping the cord may cause a drop in prostaglandin (this hormone inhibits respirations prior to birth)

Answer 197

Changes in intrathoracic pressure - Increases from compression as they pass through the vaginal canal and then drops immediately after they are born drawing air into the lungs Crying increases the distribution of air in the lungs and promotes expansion of the alveoli Positive pressure created by crying helps to keep the alveoli open

Answer 198

The suddenly cold environment as they are born stimulates receptors in the skin resulting in stimulation of the respiratory center in the medulla. Prolonged cold exposure should be avoided though

Answer 199

Stimulated by handling and drying The lights, sounds, and smells of the new environment can also be involved Pain from birth might be involved too

Answer 200

Catecholamine surge

Answer 201

Lung expansion and first breaths pulmonary circulation and lymphatic system air

Answer 202

Functional residual capacity

Answer 203

Maintaining adequate oxygenation Factors include: - meconium aspiration - congenital diaphragmatic hernia - esophageal atresia with fistula (esophagus and trachea have abnormal connections) - choanal atresia (nasal cavity connection to nasopharynx is occluded by soft tissue and/or bone) - congenital cardiac defect - immature alveoli

Answer 204

can experience some lung fluid retention, although it typically clears without deleterious effects on the newborn transient tachypnea of the newborn (TTNB) caused by the lower levels of catecholamines . TTNB usually resolves in 24 to 48 hours.

Answer 205

Shallow and irregular 30-60 breaths/min Respiratory rate increases with activity Periodic breathing includes pauses lasting less than 20 seconds Clear breath sounds equal bilaterally Abdominal breathing is characteristic because their rib cage cannot expand with inspiration like adults Chest and abdomen rise simultaneously with inspiration

Answer 206

- nasal flaring - intercostal or subcostal retractions - grunting with respirations - paradoxical respirations - < 30 resps/min or > 60 resps/min - changes in colour

Answer 207

Suprasternal or subclavicular retractions with stridor or gasping

Answer 208

Analgesics or anesthetics administered to the mother during birth

Answer 209

- rapid increase in body temperature - hypothermia - hypoglycemia - sepsis

Answer 210

Inadequate clearance of lung fluid, or it can be an indication of newborn respiratory distress syndrome (RDS). Tachypnea can be the first sign of respiratory, cardiac, metabolic, or infectious illnesses.

Answer 211

the bluish discoloration of hands and feet, is a normal finding in the first 7 to 10 days after birth

Answer 212

Acrocyanosis

Answer 213

central cyanosis It's a late sign and there is usually significant hypoxia when this appears

Answer 214

lips and mucous membranes are bluish

Answer 215

- inadequate deliver of oxygen to the alveoli - poor perfusion of the lungs that inhibits gas exchange - cardiac dysfunction

Answer 216

Central cyanosis, newborns usually have significant hypoxemia when cyanosis appears.

Answer 217

two umbilical arteries and one umbilical vein surrounding by a gelatin-like extracellular matrix known as Wharton's jelly.

Answer 218

Babies have 1, and it carries oxygenated blood and nutrients from the placenta to the ductus venosus and the liver

Answer 219

Babies have 2, it carries deoxygenated blood and waste from the hypogastric arteries of the infant to the placenta

Answer 220

connects the umbilical vein to the inferior vena cava Post delivery, closed; becoming ligamentum venosum after obliteration, due to loss of blood flow from umbilical vein.

Answer 221

Connects the main pulmonary artery to the descending aorta Post delivery functionally closed almost immediately after birth Anatomical obliteration of lumen by fibrous proliferation requiring 1 to 3 months, becoming ligamentum arteriosum due to increased oxygen content of blood in ductus arteriosus creating vasospasm of its muscular wall. Decreased blood flow through the ductus after birth is due to the change from the low systemic resistance and high pulmonary resistance in the fetus to the high systemic resistance and low pulmonary resistance of the newborn.

Answer 222

A valve opening that allows blood to flow from the right atrium to the left atrium Post delivery it is functionally closed at birth The higher pressure in the left atrium and lower pressure in the right atrium after birth cause the valve to close and the constant apposition (positioned together) gradually leads to fusion and permanent closure within a few months or years

Answer 223

high pulmonary low systemic

Answer 224

Values for newborn BP vary with gestational age and weight. The term newborn’s - average systolic BP is 60 to 80 mm Hg - average diastolic BP is 40 to 50 mm Hg.

Answer 225

Not routinely measured in a newborn Only done if there are cardiovascular symptoms such as - tachycardia - abnormal pulses - murmur - poor perfusion - abnormal precordial activity (movement over the chest wall) MEMORY: cardiac TAMPAnade

Answer 226

BP should be taken in all 4 extremities If the systolic pressure is more than 10 mm Hg higher in the upper extremities than in the lower extremities, further diagnostic testing may be needed.

Answer 227

Preductal - SPO2 site in the right hand Postductal - SPO2 site on either foot Represents the degree of right to left shunting across a patent ductus arteriosus They should all be above 95% and not different by more than 3% 89% of less needs a stat echocardiography

Answer 228

maintenance of balance between heat loss and heat production

Answer 229

Hypothermia

Answer 230

- thin layer of subcutaneous fat - blood vessels close to the skin surface - cooler environments influence the temperature regulation centers in the hypothalamus - larger body surface area to body weight ratios are larger than adults

Answer 231

-convection -conduction -radiation -evaporation

Answer 232

The flow of heat from the body surface to cooler ambient air. Ambient temperature in the newborn care area should range between 22° and 26°C a Newborns in open bassinets are wrapped to protect them from the cold A cap may be worn to decrease heat loss from the newborn’s head.

Answer 233

The loss of heat from the body surface to a cooler solid surface not in direct contact but in relative proximity. Place cribs and examining tables away from outside windows Care providers need to avoid exposing the newborn to direct air drafts

Answer 234

The loss of heat that occurs when a liquid is converted to a vapour (i.e. the moisture from the newborns skin vaporized) Completely dry the newborn directly after birth or with bathing The less mature the newborn, the more severe the evaporative heat loss. Evaporative heat loss, as a component of insensible water loss, is the most significant cause of heat loss in the first few days of life.

Answer 235

The loss of heat from the body surface to cooler surfaces in direct contact. The scales used for weighing the newborn should have a protective cover to minimize conductive heat loss.

Answer 236

Evaporation

Answer 237

Bacterial colonization

Answer 238

30 mL (size of a cherry)

Answer 239

A bowel obstruction related to conditions such as - malrotation - small or large bowel atresia (absence or closure of bowels) - inborn error of metabolism (i.e. cystic fibrosis) - congenital disorder (i.e. Hirschsprung disease or an imperforate anus)

Answer 240

- amniotic fluid - intestinal secretions - shed mucosal cells - possibly blood

Answer 241

Greenish black, tarry consistency Usually passed within 12 to 24 hours of birth; almost all do so by 48 hours

Answer 242

sterile bacteria

Answer 243

A properly functioning GI tract

Answer 244

Appear by third day after initiation of feeding Greenish brown to yellowish brown Thin and less sticky than meconium May contain some milk curds

Answer 245

Usually appears by day 4 Breastfed: yellow to golden, pasty, odour similar to sour milk Formula fed: pale yellow to light brown, firmer consistency, odour more characteristic of a normal stool

Answer 246

Minimum of 1 void per day Frequency of voids increases with age

Answer 247

6-8 voids per day Frequency of voids increases with age

Answer 248

About 15-60 mL/kg

Answer 249

Elongated shape of the skull as a result of overlapping of cranial bones during birth

Answer 250

Capput succedaneum

Answer 251

Easily identifiable edematous area of the scalp, most commonly found on the occiput. Swelling CROSSES SUTURE LINES The sustained pressure of the presenting vertex against the cervix results in compression of local vessels, thereby slowing venous return. The slower venous return causes an increase in tissue fluids within the skin of the scalp, and an edematous swelling develops. May also be caused by vacuum extrication Dissipates in about 3-4 days

Answer 252

Cephalohematoma

Answer 253

A collection of blood beneath the periosteum of the skull. Swelling does NOT cross suture lines. Appears on day 2 or 3 and disappears in weeks or months. Jaundice may result.

Answer 254

Bleeding may occur with spontaneous birth from pressure against the maternal bony pelvis. Low forceps birth and difficult forceps rotation and extraction may also cause bleeding.

Answer 255

Diamond-shaped “soft spot”. Remains open up to 18 months to allow the brain to grow.

Answer 256

Tightness of the sternocleidomastoid muscle, Results in the newborn’s head tilting to one side

Answer 257

Torticollis, which is a tightness of the sternocleidomastoid muscle

Answer 258

Distended, small white sebaceous glands on the nose, chin, and forehead of the newborn They disappear on their own

Answer 259

Milia, they disappear on their own

Answer 260

Also called stork bites Superficial vascular areas (flat, pink, capillary hemangiomas) on nape of neck, eyelids, nose, upper lip, and lower occiput. More visible when crying. Fades in first and second years of life

Answer 261

telangiectatic nevi Also called stork bites Superficial vascular areas (flat, pink, capillary hemangiomas) on nape of neck, eyelids, nose, upper lip, and lower occiput. More visible when crying. Fades in first and second years of life

Answer 262

Also called mottling Lacy patterns of blood vessels under the skin Normal physiological response to cold temperature. Results from NB undeveloped nerve and blood vessel systems. When the skin cools, the blood vessels near the surface contract and dilate alternately. The red color is produced when the vessels expand and the pale part is produced when the vessels shrink.

Answer 263

cutis marmorata Also called mottling Lacy patterns of blood vessels under the skin Normal physiological response to cold temperature. Results from NB undeveloped nerve and blood vessel systems. When the skin cools, the blood vessels near the surface contract and dilate alternately. The red color is produced when the vessels expand and the pale part is produced when the vessels shrink.

Answer 264

Also called a newborn rash and is very common in the first week. Small white or yellow papules or vesicles on the skin. No clinical significance. No treatment

Answer 265

erytheum toxicum Also called a newborn rash and is very common in the first week. Small white or yellow papules or vesicles on the skin. No clinical significance. No treatment

Answer 266

False A major barrier for many patients is the influence of family and friends

Answer 267

False Breast milk contains 87% water, which easily meets the newborn’s fluid requirements. Feeding water to newborns can decrease caloric consumption at a time when they are growing rapidly.

Answer 268

False Human milk contains the two proteins whey and casein in a ratio of approximately 70:30, compared with the ratio of 20:80 in most cow’s milk–based formula (Blackburn, 2018). This whey/casein ratio in human milk makes it more easily digestible and produces the soft stools seen in breastfed infants.

Answer 269

False These “after-pains” are more common in multiparas and patients who give birth to multiples and tend to resolve completely within 1 week after birth.

Answer 270

True Breast milk is specific to the needs of each infant. Wild

Answer 271

False The nipple-erection reflex is an integral part of lactation. Some people have flat or inverted nipples that do not become erect with stimulation; these patients may need assistance to help their newborns achieve an effective latch. Their newborns should not be offered bottles or pacifiers until breastfeeding is well established.

Answer 272

False 8 times in 24 hours

Answer 273

False The amount of the areola in the newborn’s mouth with latch depends on the size of the newborn’s mouth and the size of the areola and nipple. In general, the infant’s mouth should cover the nipple and areola, with more of the areola visible above the baby’s upper lip than below the lower lip

Answer 274

False 2-3 wet diapers and 1 or more meconium or greenish brown transition stools

Answer 275

The introduction of solid foods given to the infant in addition to human milk or formula. It's recommended they be introduced at 6 months of age.

Answer 276

The thick, white substance that protects the skin of the fetus. Common in body creases. Don’t wash it off – it has positive benefits for neonatal skin moisture and integrity.

Answer 277

Vernix caseosa The thick, white substance that protects the skin of the fetus. Common in body creases. Don’t wash it off – it has positive benefits for neonatal skin moisture and integrity.

Answer 278

Soft, downy hair on the body, particularly on the face, shoulders and back. Disappears over the first few weeks of life.

Answer 279

Bluish black areas of pigmentation commonly noted on the back and buttocks. Occurs more frequently in ethnicities from Asia, Africa, Indigenous North America Appear at birth or within first few weeks Fade gradually over months or years

Answer 280

Mongolian spots

Answer 281

Yellowish discolouration of the skin. Caused by excess bilirubin in infants blood

Answer 282

Bilirubin levels

Answer 283

85-102 mcmol/L mcmol/L is micromoles per liter The level of bilirubin at which jaundice is evident varies considerably

Answer 284

First seen in head, especially sclera and mucous membranes Gradually progresses to the thorax, abdomen, and extremities

Answer 285

MEMORY: your liver is a NEWB at the GAME N - Nutritional status E - Extravasated blood (e.g., cephalohematoma or severe bruising). W - Weight B - Blood group G - Gestational age (premature most at risk) A - Age M - Mode of feeding (breastfeeding at higher risk) E - Ethnic background (Asians and Indigenous backgrounds have higher bilirubin levels)

Answer 286

True But there is controversy around the definitions of normal or physiological ranges of total serum bilirubin

Answer 287

Prematurity Prematurity affects liver and brain metabolism and albumin binding sites, placing preterm and late preterm newborns at greater risk for hyperbilirubinemia.

Answer 288

Newborns of Asian and Indigenous backgrounds have higher bilirubin levels.

Answer 289

Breastfeeding newborns are at greater risk of hyperbilirubinemia.

Answer 290

340 mcmol/L

Answer 291

nonpathological 80% 24 hours No treatment

Answer 292

nonphysiological 24 hours 100 mcmcol/L 256 mcmol/L

Answer 293

Should be aligned with outer canthi of the eyes Lower set eyes are characteristic of many syndromes and internal organ abnormalities involving the renal system.

Answer 294

Tongue tie A ridge of frenulum tissue attached to the underside of the tongue, causing a heart-shape at the tip of the tongue Can be surgically incised if causing feeding issues More common in boys, genetic component

Answer 295

A tongue tie or ankyloglossia

Answer 296

Break the suction by inserting their finger into the side of the infants mouth between the gums and keep it there until the nipple is completely out of the newborns mouth

Answer 297

Thrush Candida albicans infection

Answer 298

Candida albicans infection White fungal patches that adhere to mucous membranes of the mouth (cheeks, lips) caused by exposure to Candida albicans Treated with anti-fungal drops Should treat mother too (nipples)

Answer 299

It is normal for both boys and girls Caused by high exposure to maternal estrogen in utero No treatment needed, it usually dissipates in a few weeks

Answer 300

Also called club foot A painless malposition of the feet – can be turned in. May be due to intrauterine positioning, environmental or genetic factors Can be linked to other conditions such as spina bifida Treated with casting, splinting or surgery; and physiotherapy

Answer 301

Talipes equinovarus (aka club foot) Look for spina bifida

Answer 302

Hypospadias - urethral opening on the underside of the penis Epispadias - urinary meatus on the dorsal (top) surface of the glans

Answer 303

The urethral opening is on the underside (ventral aspect) of the penis at any place along the shaft Risk factors: Mothers >35, obesity, fertility or hormone treatments Tx: Surgery – baby should not be circumcised as foreskin might be needed for repair

Answer 304

The urinary meatus is on the dorsal surface (top side) of the glans Rare birth defect Tx: surgery Can also happen in girls where urethral opening is located elsewhere and there are other abnormalities of the genitalia

Answer 305

A collection of fluid surrounding the testes in the scrotum During development, each testicle has a naturally occurring sac around it that contains fluid. Normally, this sac closes itself and the body absorbs the fluid inside during the baby’s first year. However, this doesn’t happen for babies with a hydrocele. Usually resolves by age 1 without intervention

Answer 306

Towards the end of pregnancy

Answer 307

Pseudomenstruation Can present in girls in the first few weeks of life. It is caused by the drop in estrogen experienced when the baby is no longer receiving this hormone from her mother No treatment needed

Answer 308

a vaginal discharge composed of mucus mixed with blood may be present during the first few weeks of life requires no treatment.

Answer 309

whitish discharge from vagina – caused by mother’s estrogen in newborn

Answer 310

Leukorrhea

Answer 311

Condition where socket of hip joint does not form properly – too shallow so that ball of hip is loose and can come out More common in females, left hip and firstborns

Answer 312

Treated with Pavlik harness May need surgery

Answer 313

MEMORY: the hips move ABOUT too much A - asymmetrical gluteal folds B - Barlow test is positive (hip can be popped out of place) O - Ortolani test positive (hip can be popped back in) U - uneven knee levels T - thigh folds uneven

Answer 314

Developmental Dysplasia of the Hip (DDH)

Answer 315

Determines if the hip can pop out of place to assess for Developmental Dysplasia of the Hip (DDH) Examiner places the middle finger over the greater trochanter and the thumb along the midthigh. The hip is flexed to 90 degrees and adducted, followed by gentle downward pushing of the femoral head. If the hip can be dislocated with this manoeuvre, the femoral head moves out of the acetabulum, and the examiner feels a “clunk.”

Answer 316

Determines if the dislocated hip can pop in to place to assess for Developmental Dysplasia of the Hip (DDH) As the hip is abducted and upward leverage is applied, a dislocated hip returns to the acetabulum with a clunk that is felt by the examiner.

Answer 317

Elicited when the side of the newborn’s mouth or cheek is touched. The newborn turns toward that side and opens the lips Disappears 3-4 months

Answer 318

An object placed in the newborn’s mouth or anything touches the lips will elicit this reflex. Disappears after 3 months

Answer 319

Elicited when the newborn is startled or lifted slightly above the crib and then suddenly lowered. The newborn’s arms straighten, hands move outward (fingers fan out), thumb and forefinger form a “C” and knees flex. Slowly the arms return to the chest Disappears 5-6 months

Answer 320

When infant is in a supine position, with head turned to one side, the arm and leg extend on the side to which the head is turned; the opposite arm and leg flex (“fencing” position). Disappears 6-7 months

Answer 321

Place a finger in the newborn’s palm. The newborn’s fingers curl around the examiner’s finger Disappears 2-3 months

Answer 322

Place finger under toes, toes will curl Disappears at 9-10 months

Answer 323

Fanning and hyperextension of all the toes and dorsiflexion of the big toe, occurs when the lateral aspect of the sole is stroked from the heel upwards and across the ball of the foot. Disappears 2 years of age

Answer 324

This reflex is observed when the infant, while prone and stroked along the spine, causes the pelvis to turn to the stimulated side Disappears at 1 month

Answer 325

When held upright with one foot touching a flat surface, the newborn puts one foot in front of the other and “walks” Disappears at 2 months

Answer 326

First - autonomic regulation Second - motor organization Third - State regulation (sleep/wake cycles) Fourth - Attention and social interaction

Answer 327

Quiet alert state

Answer 328

Quiet alert state

Answer 329

State modulation

Answer 330

neurobehavioural preterm

Answer 331

Regulate their body temperature Can take 8 hours or more

Answer 332

Wash hair separate from the body Wash hair, dry it and then apply cap prior to bathing infant body OR Dry infant, wrap in towel or receiving blanket, and then wash infants hair, drying well after with a towel and applying a cap

Answer 333

Test water before baby goes in on inner part of the arm DO NOT put water in after baby Do not leave them alone

Answer 334

cleanest, soiled inner, outer corner plain, warm water a mild non scented soap

Answer 335

Wipe the gums with a soft cloth

Answer 336

Leave it on the skin allowing it to wear off with normal care and handling

Answer 337

Immersing the infant (keeping the shoulders covered)

Answer 338

An important consideration in skin cleansing is preservation of the skin’s acid mantle, which is formed from the uppermost horny layer of the epidermis, sweat, superficial fat, metabolic products, and external substances such as amniotic fluid and microorganisms. To protect the newborn’s skin, it is best to use a cleanser with a neutral pH and preferably without preservatives or with preservatives recognized as safe and well tolerated in newborns.

Answer 339

Do it before or after washing the rest of the body and then dry off completely; this way the body and the head are not wet at the same time

Answer 340

Brands don't matter, but it should be a mild soap/shampoo and unscented

Answer 341

A chronic, recurrent, inflammatory reaction on the skin occurring most commonly on the scalp (cradle cap) The lesions are characteristically thick, adherent, yellowish, scaly, oily patches that may or may not be mildly pruritic. Diagnosis is made primarily on the basis of the appearance and the location of the crusts or scales.

Answer 342

Scalp desquamation is what causes the cradle cap, this can be prevented with adequate scalp hygiene. Frequently, parents omit shampooing the infant’s hair for fear of damaging the “soft spots,” or fontanels. The nurse should discuss how to shampoo the infant’s hair and emphasize that the fontanel is like skin anywhere else on the body—it does not puncture or tear with mild pressure. Remove any scales that present with a find toothed comb or brush after washing to prevent it from becoming full blown cradle cap

Answer 343

When cradle cap lesions are present, the treatment is directed at removing the crusts. Parents should be taught the appropriate procedure to clean the scalp. Education may need to include a demonstration. Shampooing should be done daily with a mild soap or commercial baby shampoo; medicated shampoos are not necessary, but an anti-seborrheic shampoo containing sulfur and salicylic acid may be used. Shampoo is applied to the scalp and allowed to remain on the scalp until the crusts soften. Then the scalp is thoroughly rinsed. A fine-tooth comb or a soft facial brush helps remove the loosened crusts from the strands of hair after shampooing.

Answer 344

Process of dry gangrene Odour alone is not a positive indicator of omphalitis (infection of the umbilical stump) Signs include redness, swelling, exudate, pain in the area

Answer 345

Omphallitis

Answer 346

Once the cord is dry, usually 24-36 hours after birth but it is not routine practice in all hospitals; some send the newborn home with the clamp in place and it will fall off when the cord falls off

Answer 347

disinfected

Answer 348

Fragrance-free detergents

Answer 349

Front to back

Answer 350

Barrier cream

Answer 351

Yes and will go away within the first week

Answer 352

- change diaper as soon as wet/soiled - after using wipes, allow the area to air dry - use zinc based barrier cream after cleaning the baby up - expose the infants bottom to air several times a day (i.e. during tummy time)

Answer 353

It might be fungal and will need to be treated

Answer 354

This dermatitis or skin inflammation appears as redness, scaling, blisters, or papules.

Answer 355

Various factors contribute to diaper rash, including infrequent diaper changes, diarrhea, use of plastic pants to cover the diaper, or a change in the infant’s diet, such as when solid foods are added.

Answer 356

Plain water with mild soap is used to cleanse the diaper area If baby wipes are used, they should be unscented and contain no alcohol. The baby’s skin should be allowed to dry completely before applying another diaper.

Answer 357

often the baby voids or stools

Answer 358

Change to washing with plain water rather than the wipes

Answer 359

Emollients, creams, or other protectants such as zinc oxide

Answer 360

a few days

Answer 361

The usual source of infection is from handling by persons who do not practice adequate hand hygiene. It may also appear 2 to 3 days after an oral infection (thrush).

Answer 362

Candida albicans

Answer 363

dermatitis appears in the perianal area, inguinal folds, and lower abdomen. The affected area is intensely erythematous with a sharply demarcated, scalloped edge, often with numerous satellite lesions that extend beyond the larger lesion.

Answer 364

Anticandidal ointment, such as clotrimazole or miconazole, with each diaper change. Sometimes the infant also is given an oral antifungal preparation such as nystatin or fluconazole to eliminate any gastrointestinal source of infection.

Answer 365

a surgical procedure in which the prepuce, an epithelial layer covering the penis, is separated from the glans penis and excised which permits exposure of the glans

Answer 366

1/3 A little higher at 44%

Answer 367

social medical

Answer 368

“The overall evidence of the benefits and harms of circumcision is so evenly balanced that it does not support recommending circumcision as a routine procedure for newborns”

Answer 369

the inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis

Answer 370

higher This may suggest circumcision's could reduce the risk but unsure if this can be applied to populations in developed countries

Answer 371

phimosis (the inability to retract the skin (foreskin or prepuce) covering the head (glans) of the penis)

Answer 372

reduced HPV

Answer 373

Bleeding and infection

Answer 374

Takes 7-10 days to heal Gently wash penis with warm water after each diaper change Put petroleum jelly on incised area as directed by physician Fasten diaper loosely A thin yellow film will form over incision area – this is normal – leave it.

Answer 375

ring block dorsal penile nerve block (DPNB) topical anesthetic such as eutectic mixture of lidocaine and prilocaine

Answer 376

concentrated oral sucrose non-nutritive sucking swaddling

Answer 377

pharmacological nonpharmacological

Answer 378

Immediately return to parents Encourage breastfeeding and/or skin to skin contact Fussy, disruption of sleep/wake cycles and feeding behaviours Oral acetaminophen can be given before procedure and every 4 hours after

Answer 379

maximum of five doses in 24 hours or a maximum of 75 mg/kg/day.

Answer 380

-baby running fever -signs of an infection (swelling, redness, thick yellow discharge, red streak on the shaft of the penis) -bleeding or bloodstained area larger than a quarter -very fussy, high-pitched cry, or refusing to eat -baby has not passed urine for 12 hours after the procedure

Answer 381

to facilitate early recognition and treatment of several disorders before the onset of symptoms.

Answer 382

Between 24-48 hours

Answer 383

- phenylketonuria (PKU) - galactosemia - congenital hypothyroidism (CH) - Hb defects like sickle cell disease

Answer 384

Congenital hearing impairment

Answer 385

Inborn errors of metabolism (IEM)

Answer 386

Inborn errors of metabolism An umbrella term applied to a large group of inherited diseases caused by the absence or deficiency of a substance essential to cellular metabolism, usually an enzyme. When the normal metabolic process is interrupted as a result of a missing enzyme, an accumulation of substances precedes the interruption, the end product of the process is absent, or the process takes an alternate metabolic pathway. The consequence is manifested as an illness. Most IEMs are characterized by abnormal protein, carbohydrate, or fat metabolism.

Answer 387

b) Do nothing because acrocyanosis is normal in the neonate

Answer 388

b) Apgar is 7 Activity (muscle tone) - flexed limbs - 1 Pulse - > 100 - 2 points Grimace - prompt response to stimulation - 2 Appearance - pink body, blue extremities - 1 Respirations - weak cry -1

Answer 389

d) It involves swelling of the tissue over the presenting part of the fetal head

Answer 390

c) Respiratory rate 40-60 breaths/minute

Answer 391

a) 6 to 8 weeks

Answer 392

a) The parent must note that the newborn has voided b) Petroleum jelly should be used d) The circumcision will require care for 2 to 4 days after discharge e) A large amount of blood should be reported

Answer 393

a) Placing the diaper below the cord e) Using plain water and a Q-tip to cleanse the cord

Answer 394

a) A three-vessel umbilical cord b) Peeling skin on the feet d) Absence of vernix caseosa e) Cyanosis of the hands and feet

Answer 395

c) The plot point falls between the 10th and 90th percentile

Answer 396

a) The physician should be notified if the infant has not voided in 24 hours

Answer 397

c) 50% to 80%

Answer 398

b) Administer RhoGam to the client within 3 days

Answer 399

c) Multiple gestation Multiple gestation, breastfeeding, multiparity and conditions that cause over-distension of the uterus with increase the intensity of afterpains.

Answer 400

b) Days 3 to 10 postpartum

Answer 401

a) Ask the client to empty her bladder

Answer 402

a) Talks to and coos at her son b) Cuddles her son close to her

Answer 403

b) Taking in

Answer 404

c) Stool softeners and fluids

Answer 405

d) Contact the client’s physician for further instructions

Answer 406

e) Ask the client to void b) Place the client in the supine position f) Place one hand on the abdomen just above the symphysis pubis d) Place one hand around the top of the fundus a) Rotate the upper hand to massage the uterus until firm c) Gently press the fundus between the hands using slight downward pressure

Answer 407

d) Ask the client when she last changed her perineal pad

Answer 408

c) Vaginal dryness after the lochial flow has ended

Answer 409

c) Cervical lacerations

Answer 410

a) Cesarean birth, incisional site intact, hemoglobin level 9.8 g/dl normal is 120–160 mmol/L (12–16g/dL)

Answer 411

a) “It is best to observe for jaundice on the sternum.” c) “I will carefully record the newborn’s output, as limiting fluids is helpful.” e) After the TcB meter is used on the newborn, I will need to know the value displayed on the meter and the newborn’s gestational age in order to determine level of risk according to the nomogram

Answer 412

b) Obtain a serum neonatal glucose level Priority is to monitor the neonate’s serum glucose level due to increased risk of hypoglycemia. During pregnancy, the fetus secretes high levels of insulin to counteract the high maternal glucose levels. This elevated insulin secretion in the neonate can lead to severe hypoglycemia after birth. Because the neonate is at risk for hypoglycemia, insulin wouldn’t be appropriate.

Answer 413

d) Wrapping the neonate in the same blanket used for drying

Answer 414

b) “In term neonates, it usually appears after 24 hours.”

Answer 415

b) Jitteriness

Answer 416

b) Hypoglycemia

Answer 417

b) The appearance of jaundice during the first 24 hours indicates a pathological process

Answer 418

d) Flexed position

Answer 419

a) The baby will lose heat by convection, which means he will lose heat from his body to the cooler, ambient air

Answer 420

d) Use the football-hold to avoid incisional discomfort

Answer 421

b) Change the breast pads frequently c) Expose the nipples to air for part of the day d) Wash hands before handling the breast and breastfeeding f) Release the baby’s grasp on the nipple before removing the baby from the breast

Answer 422

b) “I will breastfeed about every 2 hours.”

Answer 423

c) Tickling the baby’s lips with the nipple

Answer 424

a) Baby’s lips are flanged when latched

Answer 425

c) Commercial iron-fortified formula

Answer 426

b) 6 months

Answer 427

d) Intact nipples, firm, tender breasts; transitional milk

Answer 428

c) A hot, reddened area on the breast

Answer 429

a) She feels a firm tugging sensation on her nipples b) The baby sucks with cheeks rounded, not dimpled c) The baby’s jaw glides smoothly with sucking

Answer 430

c) Whatever the position used, the infant’s body should be aligned (ear, shoulder, hip)

Answer 431

a) Frequent feedings during predictable growth spurts stimulate increased milk production

Answer 432

a) Infants should be given only human milk for the first 6 months of life

Answer 433

b) A 6-month-old can usually roll from prone to supine and supine to prone positions c) A 6-month-old may be experiencing teething

Answer 434

a) Holding the head erect c) Sitting on a firm surface without support d) Bearing the majority of weight on legs

Answer 435

d) Turning self from prone to supine c) Turning self from supine to prone b) Sitting alone a) Crawling on hands and knees e) Effectively using pincer grasp

Answer 436

c) Actively searches for a hidden object

Answer 437

a) She is old enough to understand the word “No”

Answer 438

b) 2 months

Answer 439

b) Rear-facing in the back seat

Answer 440

c) This is normal behaviour for a 2-year-old child

Answer 441

b) This is typical behaviour because toddlers are egocentric

Answer 442

c) Ignore the behaviour, provided it is not injurious

Answer 443

d) Reduce the opportunities for a “no” answer

Answer 444

b) Instruct parent that regression commonly occurs c) Encourage use of a security object from home d) Allow client autonomy by offering select choices e) Maintain the toddler’s routine when able

Answer 445

c) Associative

Answer 446

a) The child may think the equipment is alive

Answer 447

a) Cephalocaudal

Answer 448

b) Industry

Answer 449

b) If breast development has not occurred by age 13

Answer 450

c) It is important in establishing trusting relationships

Answer 451

d) You can breastfeed while the injection is being given

Answer 452

a) Minor symptoms can be treated with acetaminophen c) Call the office if the toddler develops a high fever or seizures d) Discomfort at the immunization site and mild fever are common

Answer 453

a) Immunogen

Answer 454

a) HBIg is given to an infant born to a mother who has acute or chronic Hepatitis B infection b) HBIg provides immediate protection d) If the infant is born to an infected mother or to a mother who is a carrier, hepatitis B vaccine and HBIg should be given within 12 hours of birth.

Answer 455

b) Breath holding

Answer 456

Wash hands Explain to parents what you are doing Warm heel first with a cloth soaked in warm water wrapped around foot or use of a disposable heel warmer for 5-10 minutes Repeat hand hygiene and put on gloves Clean area with skin antiseptic and allow to dry Restrain infant foot and then puncture correct site using a spring-loaded automatic puncture device

Answer 457

- have parent hold child - breastfeeding - use sugar drops

Answer 458

Warming the area for 5-10 minutes to dilate the blood vessels in the area Can be accomplished by a cloth soaked with warm water (not hot) and wrapped loosely around the foot provides effective warming. Disposable heel warmers are available from a variety of companies; they should be used with care to prevent burns.

Answer 459

A spring-loaded automatic puncture device causes less pain and requires fewer punctures than a manual lance blade; therefore, manual lance blades should not be used on newborns.

Answer 460

Sudden Infant Death Syndrome SIDS refers to the sudden and unexpected death of an apparently healthy infant usually under 1 year of age, which remains unexplained even after a full investigation” (PHAC, Joint Statement). Peaks between 2 and 4 months

Answer 461

MEMORY: SIMPLE S - sleeping prone I - Indigenous M - male P - premature L - low birth weight E - exposure to cigarette smoke (prenatal and postnatal)

Answer 462

Sleep on their back Limit smoke exposure Do not co-sleep due to risks of parents falling asleep Cool room - overheating is a risk factor Swaddling - should be discontinued once baby tries to turn over Firm bed - so on a crib mattress, not adult mattress, couch etc. Supervised tummy time - strengthens neck so baby is less likely to get pinned by a blanket or crib Safe cribs -No toys or blankets in the crib -No bumper pads -Only one light blanket -Pacifier – keeps them from going into too deep of a sleep Room sharing -Concerns SIDS might be due to immature brain stem, they go to sleep and don’t wake up -Co-sharing is thought to provide another point of reference that is breathing, their body will unconsciously pick up

Answer 463

A flattened area that may develop on the back of the head when infants are left supine while awake or in an infant seat for prolonged periods of time, rather than on their tummy

Answer 464

Positional plagiocephaly

Answer 465

The posterior occiput flattens over time; a transient typical bald spot will develop. As a result of prolonged pressure on one side of the skull, that side becomes misshapen; mild facial asymmetry may develop. The sternocleidomastoid muscle may tighten on the preferential side, and torticollis may also develop.

Answer 466

Physiotherapy exercises to loosen the tight muscle and changing head position from side to side during feeding, carrying, and sleep If not resolved, a customized helmet may be worn to decrease the pressure on the affected side of the skull

Answer 467

Anatomically, they have a barrel chest and flat, curveless spine, making it easier to role from the side to prone position

Answer 468

Supervised time when the conscious infant is placed prone on the floor; should be several times per day for increasing lengths of time Benefits - build neck muscles - prevent misshaped head - develop muscles needed for crawling

Answer 469

Traumatic head injury due to child maltreatment (THI-CM)

Answer 470

Traumatic head injury due to child maltreatment (THI-CM) “THI-CM is defined broadly to include traumatic injury to the head (skull and/or brain and/or intracranial structures), which may also be accompanied by injury to the face, scalp, eye, neck or spine, as a result of the external application of force from child maltreatment” (Public Health Agency of Canada, 2020). Shaking a baby causes a whiplash motion during which the brain repeatedly hits the front and back of the skull causing severe traumatic brain injury THI –CM leads to severe lifelong injuries and death – signs and symptoms include lethargy, vomiting, inability to cry

Answer 471

Traumatic head injury due to child maltreatment (THI-CM) Inconsolable crying is the number one trigger - Parents can get overwhelmed with being unable to stop infant crying Educating parents about what to do when infant is crying is vital to help prevent THI-CM

Answer 472

Period of PURPLE Crying P - peak of crying - baby may cry more each week with the most at 2 months, then less at 3-5 months U - unexpected - may cry and we don't know why R - resists soothing - baby may not stop crying, regardless of what you try P - pain-like face - crying babies look like they are in pain, even when they are not L - long lasting - crying can last as much as 5 hours a day or more E - evening - may cry more in later afternoon/evening

Answer 473

MEMORY: SOBBERS S - Snuggle - holding your baby won't spoil them; they may not want to be passed around though O - Oscillating movements - sway, walk in a wrap/stroller, or a car ride B - Bundle - wrap or swaddle them B - Bath in warm water E - ensure needs are met - change, feed, too hot/cold, check for fever R - Remove stimuli - turn off lights, soft music/white noise may help S - sucking - breastfeeding or pacifier

Answer 474

Bilirubin metabolism - hyperbilirubinemia; jaundice in the newborn Thermoregulation - cold stress; hypothermia Glucose metabolism - hypoglycemia

Answer 475

Conjugated

Answer 476

Conjugated

Answer 477

Splits into heme - > iron globin - > unconjugated bilirubin which must be conjugated before it can be excreted

Answer 478

Unconjugated bilirubin

Answer 479

Indirect bilirubin

Answer 480

Leaves vascular system and enters other extravascular tissues such as skin, sclera, and oral mucous membranes Crosses blood brain barrier - can cause neurotoxicity

Answer 481

MEMORY: FAIL F - fewer bilirubin binding sites A - ability of liver to conjugate is reduced I - Intestines change conjugated bilirubin to unconjugated L - large RBC mass, short RBC lifespan

Answer 482

Hyperbilirubinemia

Answer 483

Bilirubin is a yellow substance formed when hemoglobin (the part of red blood cells that carries oxygen) is broken down as part of the normal process of recycling old or damaged red blood cells.

Answer 484

Liver Bile

Answer 485

Conjugated bilirubin Unconjugated bilirubin

Answer 486

bile duodenum

Answer 487

Hyperbilirubinemia

Answer 488

Yellowing of the skin, scleral, and mucous membranes from a build up of bilirubin

Answer 489

60% term, 80% preterm 1st week unconjugated

Answer 490

All infants in the first 24 hours of life -total serum bilirubin (TSB) -transcutaneous bilirubin

Answer 491

MEMORY: poor liver is BOMBARDED B - breastfeeding (exclusive or partial) O - over signs of jaundice ≤ 24 hours or before discharge at any age M - male sex B - bruising, cephalohematoma, etc. A - age of mother ≥ 25 R - really early baby (premature) D - descent either Asian or European E - extremely sick sibling with hyperbilirubinemia D - dehydration

Answer 492

Both are forms of unconjugated hyperbilirubinemia - physiologic jaundice Breastfeeding Jaundice - early onset - 1st week after birth - insufficient milk intake leads to dehydration resulting in hemoconcentration of bilirubin - fewer bowel movements increases the enterohepatic circulation of bilirubin Breastmilk Jaundice - later onset - after 1st week of life - bilirubin levels peak during weeks 2-3 of life - can persist for 3-12 weeks - cause unknown - it is thought that substances in breast milk interfere with the breakdown of bilirubin

Answer 493

jaundice that occurs in preterm infants (<37 weeks) More likley to require phototherapy

Answer 494

- phototherapy (use AAP nomograms to determine the need for phototherapy - based on TSB and age in hours) - continue breastfeeding - supplemental PO or IV fluids (PO preferred)

Answer 495

Makes bilirubin water soluble by inducing a conformational change

Answer 496

To prevent kernicterus/acute bilirubin encephalopathy

Answer 497

Intrinsic - G6PD deficiency (form of IEM - inform error of metabolism, they are missing an enzyme that helps RBCs function correctly and without it results in hemolytic anemia) - Hereditary spherocytosis (makes the RBCs a sphere shape) - Thalassemia (genetic, reduced or absent Hb production) Extrinsic - Drugs - Iso-immune (ABO, Rh) - Sepsis

Answer 498

- sepsis (also an extrinsic hemolytic cause) - hypothyroidism - cephalohematoma - Gilbert syndrome (liver processes bilirubin too slowly) - Crigler-Najjar (a genetic IEM, inborn error of metabolism, that results in a lack of an enzyme preventing the breakdown of bilirubin)

Answer 499

Coombs test - looks for antibodies that destroy RBCs CBC with differential Blood smear - looks for abnormal appearance of RBCs (hereditary spherocytosis is an intrinsic hemolytic cause and it makes round RBCs) Blood culture - sepsis is a non-hemolytic and extrinsic hemolytic cause

Answer 500

Intrahepatic - Drugs (i.e. antibiotics) - Infections - Genetic/Metabolic Extrahepatic - biliary atresia (have to rule this out; one or more bile ducts are abnormally narrow, blocked, or absent) - choledochal cysts - perforated bile ducts - tumor/mass - cystic fibrosis - galactosemia

Answer 501

the conjugated bilirubin undergoes deconjugation making it unconjugated again. This is then reabsorbed into the enterohepatic circulation

Answer 502

24 hours 2-3 days 1 week nothing (premature babies are the most likely to need phototherapy)

Answer 503

Investigation for other causes of hyperbilirubinemia besides physiologic jaundice

Answer 504

Total serum bilirubin measurements = unconjugated + conjugated

Answer 505

Kernicterus - brain damage due to accumulation of bilirubin in the brain

Answer 506

brain damage due to accumulation of bilirubin in the brain

Answer 507

neurotoxicity

Answer 508

unconjugated

Answer 509

- premature - seriously ill - given certain medications

Answer 510

significant brain injury resulting in - encephalopathy -developmental delay, -cerebral palsy -hearing loss -seizures - death

Answer 511

Blanch the skin over a bony prominence After pressure is released, does the area appear yellow before normal color appears? Can also check oral mucous membranes if not sure

Answer 512

TSB (total serum bilirubin) TcB (transcutaneous bilirubin) 72 hours

Answer 513

transcutaneous bilirubin It estimates the TSB (total serum bilirubin) Device used three times on the sternum

Answer 514

The bilirubin value recorded on the TcB monitor and the postnatal age in hours

Answer 515

Exposure to high intensity light (blue wavelengths) to reduce serum bilirubin in levels Instituted when the TSB level reaches the treatment threshold appropriate for the newborn’s gestational age and age in hours

Answer 516

Baby is placed under lights and undressed down to the diaper to expose as much skin as possible and turned frequently (every 2 hours). Protective eye coverings are applied. Ensure light is at appropriate distance. Left under lights for variable periods of time but typically 2 days a week depending on how much the bilirubin levels in the blood need to be lowered

Answer 517

Periodically measuring bilirubin levels in the blood While jaundice is likely to improve, it is not a reliable guide

Answer 518

Phototherapy

Answer 519

Nothing, once the brain injury has occurred it is permanent

Answer 520

Monitor vitals q4h Occasionally discontinue and remove eye patches (q2-3 h) Assess intake and output (weigh diapers; weigh infant daily) Assess skin and provide care prn Assess serum bilirubin levels as ordered Encourage parent-newborn attachment

Answer 521

Closely linked to hypoglycemia – when they are engaging in thermogenesis but babies cannot shiver, so they will start going to brown fat storage, but these are emergency stores

Answer 522

Evaporation – loss of moisture, including amniotic fluid from their body Conduction – heat loss to direct contact with a cold surface; put a pad down when we weigh them, don’t bathe them in metal sinks Radiation – loss of heat to non-direct surface Convection – loss of heat to fan, air draft etc

Answer 523

- Peripheral vasoconstriction – pale, cool, mottled skin - Lethargy, inactivity - Weakness, hypotonia - Depleted brown fat stores - Respiratory distress - Blood flow is shunted from the brain - Can reopen the right/left shunt in the heart - Metabolic acidosis - Hypoglycemia

Answer 524

Put baby in an incubator/warmer Monitor and treat other associated conditions such as hypoxia, hypoglycemia and apnea

Answer 525

Preterm infants

Answer 526

Loss of heat to the environment balanced with the production of heat

Answer 527

High surface area to volume ratio Low-birth-weight neonates because this ratio is even higher

Answer 528

Occurs when amniotic fluid evaporates from the skin. Evaporative losses may be insensible (from skin and breathing) or sensible (sweating). Other factors that contribute to evaporative loss are the newborn’s surface area, vapor pressure and air velocity. This is the greatest source of heat loss at birth.

Answer 529

Evaporation

Answer 530

Occurs when the newborn is placed naked on a cooler surface, such as table, scale, cold bed. The transfer of heat between two solid objects that are touching, is influenced by the size of the surface area in contact and the temperature gradient between surfaces.

Answer 531

Occurs when the newborn is exposed to cool surrounding air or to a draft from open doors, windows or fans, the transfer of heat from the newborn to air or liquid. Newborn Thermoregulation is affected by the newborn’s large surface area, air flow (drafts, ventilation systems, etc), and temperature gradient.

Answer 532

Occurs when the newborn is near cool objects, walls, tables, cabinets, without actually being in contact with them. The transfer of heat between solid surfaces that are not touching. Factors that affect heat change due to radiation are temperature gradient between the two surfaces, surface area of the solid surfaces and distance between solid surfaces. This is the greatest source of heat loss after birth

Answer 533

Thermogenesis

Answer 534

Metabolic processes Voluntary muscle activity Peripheral skin vasoconstriction Non-shivering thermogenesis - breaking down brown fat

Answer 535

* The brain, heart, and liver produce the most metabolic energy by oxidative metabolism of glucose, fat and protein. * The amount of heat produced varies with activity, state, health status, environmental temperature.

Answer 536

* Increased muscle activity during restlessness and crying generate heat. * Conservation of heat by assuming a flexed position to decrease exposed surface area.

Answer 537

* In response to cooling, peripheral vasoconstriction reduces blood flow to the skin and therefore decreases loss of heat from skin surfaces.

Answer 538

* Heat is produced by metabolism of brown fat. * Thermal receptors transmit impulses to the hypothalamus, which stimulate the sympathetic nervous system and causes norepinephrine release in brown fat (found around the scapulae, kidneys, adrenal glands, head, neck, heart, great vessels, and axillary regions). * Norepinephrine in brown fat activates lipase, which results in lipolysis and fatty acid oxidation. * This chemical process generates heat by releasing the energy produced instead of storing it as Adenosine-5-Triphosphate (ATP). * The rich blood supply to the borwn fat helps transfer this heat to the rest of the neonates body * Increases metabolic rate and oxygen consumption 2-3 times

Answer 539

Non-shivering thermogenesis

Answer 540

non-shivering thermogenesis (brown fat metabolism)

Answer 541

Because the primary method of heat production is the breakdown of brown fat that increases the metabolic rate and oxygen consumption by 2-3 times. When an infant has a respiratory issue, this may result in hypoxia and neurologic damage

Answer 542

nape of the neck, between the scapulae, and around the kidneys and adrenals

Answer 543

Neutral thermal environment (thermoneutrality) This is defined as the environmental temperature at which metabolic demands (and thus caloric expenditure) to maintain body temperature in the normal range (36.5 to 37.5° C rectal) are lowest. The specific environmental temperature required to maintain thermoneutrality depends on whether the neonate is wet (eg, after delivery or a bath) or clothed, its weight, its gestational age, and its age in hours and days.

Answer 544

Sepsis, drug withdrawal, intracranial hemorrhage

Answer 545

Inappropriate use of an external heat source Symptoms -flushed skin -hands a feet warm to the touch -posture of extension (remember neonates usually flex to decrease the surface area to keep them warm)

Answer 546

Sepsis Symptoms -pale -hands and feet are cool

Answer 547

No, not needed for healthy, term babies

Answer 548

2.6 mmol/L

Answer 549

- IDMs (infants of diabetic mothers) - preterm infants (< 37 weeks gestation) - SGA (small for gestational age) infants - LGA (large for gestational age) infants > 90th percentile should be considered at risk

Answer 550

Asymptomatic - after at least one effective feeding, at 2 hours of age, and should be encouraged to feed regularly thereafter Symptomatic - unwell babies require immediate glucose testing

Answer 551

- jitteriness - lethargy - cyanosis - high-pitched or weak cry - poor feeding - hypotonia - temperature instability - respiratory distress - apnea - seizures

Answer 552

- frequent monitoring via heel stick - early initiation of feedings - maintain NTE (neonatal thermal environment) (Put the infant skin-to-skin)

Answer 553

Postpartum

Answer 554

interval between the birth of the newborn and the return of the reproductive organs to their normal nonpregnant state

Answer 555

MEMORY: BUBBLE-LE B = Breasts (firmness) and nipples U = Uterine fundus (location; consistency) B = Bladder function (amount; frequency) B = Bowel function (passing gas or bowel movements) L = Lochia (amount; colour E = Episiotomy/Laceration or Caesarean birth incision (perineum: discomfort; condition of repair, if done) L = Legs (peripheral edema) E = Emotional status (mood, fatigue)

Answer 556

Normal: - Within normal range (36.2° C – 38° C) - Some, slight fever up to 38° C in first 24 hours Deviations: - After 24 hours, above 38° C is abnormal

Answer 557

Normal: - elevated for first hour after childbirth then decreases to 60-100 bpm Deviation: - rapid pulse

Answer 558

Normal: - 16-24/min should decrease to normal prebirth range Deviation: - hypoventilation

Answer 559

Normal: -consistent with BP baseline during pregnancy - orthostatic hypotension for first 48 hours Deviation: - pregnancy-induced hypertension

Answer 560

yes for 48 hours

Answer 561

Yes (normal for slight fever up to 38C for the first 24 hours)

Answer 562

as soon as possible after birth; recommended to place newborn in uninterrupted skin-to-skin contact for 1-2 hours after birth as they will be alert and ready to nurse during this time

Answer 563

- appearance of breasts and nipples - basic breastfeeding technique - teaching about feedings cues - ensure a good latch and sucking ability

Answer 564

Person has decided not to breastfeed or newborn death How to accomplish it: - well-fitted support bra continuously fo r72 hours after birth - avoid breast stimulation (avoid warm water on breasts, sucling, expressing milk) Side effect: - breast engorgement 72-96 hours after birth

Answer 565

- ice (15 min on, 45 min off) - fresh green cabbage leaves on the breasts that are replaced when they wilt - mild analgesic/anti-inflammatory may be used to reduce discomfort

Answer 566

Maternal confidence, also called breastfeeding self-efficacy

Answer 567

Days 1-2: soft Days 2-3: slightly firm (associated with filling) Days 3-5: full, soften with breastfeeding

Answer 568

Normal: -firm, midline -at level of umbilicus in the first 24 hours - involutes 1-2 cm/day Deviation: - soft, boggy, higher than expected - related to uterine atony - lateral deviation - related to distended bladder

Answer 569

uterine atony (i.e., failure of the uterine muscle to contract firmly) If uterine atony occurs, the relaxed uterus distends with blood and clots, blood vessels in the placental site are not clamped off, and excessive bleeding results.

Answer 570

- good uterine tone - preventing bladder distention

Answer 571

6 weeks although striae may persist

Answer 572

A condition during pregnancy in which the abdominal walls seperate

Answer 573

diastasis recti

Answer 574

Uterine atony, vaginal or cervical laceration

Answer 575

- dark red colour - occurs for the first 3 days - a few small clots, no larger than a loonie, particularly in the first few days - blood, decidual and trophoblastic debris

Answer 576

- pinkish or pinkish brown colour - days 3-10 - no clots - leukocytes, old blood, serum and tissue debris

Answer 577

- creamy white or yellowish white - days 10-14; can last 4-8 weeks - no clots - leukocytes, decidua, epithelial cells, mucus, serum, and bacteria

Answer 578

less than 5 cm

Answer 579

Normal: - minimal edema - laceration or episiotomy with wound edges approximated Deviation: - pronounced edema, bruising, hematoma

Answer 580

Normal - dressing is clean and dry, suture line intact Abnormal - redness, edema, warmth, drainage - these are all indications of infection

Answer 581

Warm, red, and drainage

Answer 582

side lying

Answer 583

Vulvar, thankfully they are also generally visible

Answer 584

forceps, episiotomy, or primigravidity

Answer 585

retroperitoneal May be life-threatening lacerated a vessel attached to the hypogastric artery

Answer 586

depends on breastfeeding pattern but mean time is about 6 months

Answer 587

Generally heavier

Answer 588

Ovulation: As early as 27 days after giving birth Periods: Mean time is 7-9 weeks after giving birth with 70% resuming it by week 12

Answer 589

Once the perineal area is comfortable and lochia has stopped

Answer 590

Painful intercourse Lasting or recurring genital pain that occurs just before, during, or after sex

Answer 591

Dyspareunia

Answer 592

No, consider contraceptive options early in the postpartum period

Answer 593

Can cause uterine atony and excessive bleeding after childbirth. A full bladder causes the uterus to be displaced above the umbilicus and well to one side of the midline in the abdomen. It also prevents the uterus from contracting normally.

Answer 594

- epidural anesthesia - extensive vaginal or perineal lacerations - episiotomy - instrument-assisted birth - prolonged labour - after removal of in-dwelling catheter

Answer 595

- assist to washroom or use bedpan - encourage urination (run water, pour warm water over perineum, shower, sitz bath etc.) - analgesics if needed (fear of pain may prevent voiding) - sterile catheter insertion if needed as a last resort

Answer 596

Reduced initially, returns to normal within a month

Answer 597

glucosuria disappears increased BUN pregnancy induced proteinuria resolves ketonuria may occur

Answer 598

Incomplete emptying of the bladder leading to bladder distention and urinary retention; this can increase the risk of UTI

Answer 599

a few days; it's pretty normal to not have one for the first 2-3 days after giving birth

Answer 600

- medications (opioids, mag sulphate etc.) - dehydration -immobility -perineal lacerations/episiotomy -hemorrhoids

Answer 601

- education for measures to prevent constipation - ambulating - increasing fiber - increasing water intake may need stool softeners, especially with extensive perineal repairs

Answer 602

more common in c-section moms

Answer 603

- ambulation - rock in a rocking chair - anti-gas medications may be needed c-section moms should also avoid - drinking carbonated beverages -use of straw - foods that tend to produce gas (i.e. legumes and broccoli)

Answer 604

anti-embolic stockings (TED hose) or sequential compression devices (SCD) boots if longer than 8 hours, in bed exercises should be done to promote circulation in the legs * Alternate flexion and extension of feet. * Rotate ankles in circular motion. * Alternate flexion and extension of legs. * Press back of knee to bed surface; relax. High risk patients for VTE may need a LMW heparin

Answer 605

- BMI > 40 - unexpected c-section -advanced maternal age (>35) - VTE occurred during pregnancy

Answer 606

Because their clotting factors and fibrinogen remain elevated after birth

Answer 607

They are in a hypercoagulable state because their clotting factors and fibrinogen remain elevated after birth

Answer 608

50-80% of the time Symptoms (usually resolve in a few days to a week) - lability, crying for no reason - feelings of being overwhelmed - depression - let-down feeling - restlessness - fatigue - insomnia - headache - anxiety - sadness - anger - loss of appetite

Answer 609

Begins a few days after giving birth, lability peaking around day 5 and subsiding by day 10 They are transient, mild, and time limited, and do not require treatment other than reassurance

Answer 610

* Unable or unwilling to discuss labour and birth experience * Refers to self as ugly and useless * Excessively preoccupied with self (body image) * Markedly depressed * Lacks a support system * Partner or other family members react negatively to baby * Refuses to interact with or care for baby (e.g., does not name baby, does not want to hold or feed baby, is upset by vomiting and wet or dirty diapers) (cultural appropriateness of actions must be considered) * Expresses disappointment over baby’s sex * Sees baby as messy or unattractive * Baby reminds mother of family member or friend they do not like * Has difficulty sleeping * Experiences loss of appetite

Answer 611

Taking in - days 1-2 - dependent behaviour Taking hold - starts days 2-3, lasts 10 days to several weeks - becomes preoccupied with the present Letting go - re-establishes relationships with other people and moves forward accepting the parenting role

Answer 612

Taking hold starts day 2-3 and lasts for 10 days to several weeks

Answer 613

Taking in - days 1-2 - dependent behaviour

Answer 614

Letting go - re-establishes relationships with other people and moves forward accepting the parenting role

Answer 615

Attachment

Answer 616

The process by which a parent comes to love and accept a child and a child comes to love and accept a parent Attachment is developed and maintained through proximity and interaction with the infant Includes mutuality

Answer 617

Insecure-avoidant

Answer 618

Insecure-resistant (sometimes also called anxious)

Answer 619

Insecure-disorganized

Answer 620

Insecure avoidant

Answer 621

Insecure resistant (may also be called anxious resistant)

Answer 622

Insecure disorganized

Answer 623

Asocial or Pre-Attachment Stage - Birth to 3 months - Baby is forming bonds but relationship with objects and humans are similar Indiscriminate Attachment Stage - 6 weeks to 7 months - baby displays more observable social behaviour - preference for people over objects -prefers familiar adults - no stranger danger or separation anxiety Specific or Discriminant Stage - 7-11 months - stranger anxiety displayed - separation anxiety from on particular adult Multiple Attachments - 24 months + - Babies show affection to other adults who regularly spend time with them

Answer 624

3 organized types - secure, avoidant, resistant 1 disorganized

Answer 625

Caregivers response to the infant when the infants attachment system is "activated" like when they feel hurt, upset, frightened etc.

Answer 626

- temporary separation from the mother - changes in mother/father's behaviour - infant coming home

Answer 627

Postpartum hemorrhage (PPH)

Answer 628

Postpartum Hemorrhage PPH is any blood loss that has the potential to cause hemodynamic instability (no defined volume) PPH is often defined as the loss of 500 mL or more of blood after vaginal birth and 1 000 mL or more after Caesarean birth, although normal blood loss for some patients approaches these amounts. PPH may be defined as a 10% decline in hemoglobin concentration and the need for a transfusion

Answer 629

AKA early PPH, occurs within 24 hours after giving birth Most common cause - uterine atony Associated with and condition that causes the uterus to be overstretched and contracts poorly after birth - high parity - polyhydramnios (excessive amniotic fluid) - fetal macrosomia (large baby) - multiple gestation

Answer 630

AKA late PPH, occurs after 24 hours but less than 12 weeks postpartum Due to retained products, infection, or both. This causes subinvolution of the uterus (delayed return of the enlarged uterus to normal size and function)

Answer 631

- uterine tone - trauma - tissue - thrombin

Answer 632

- oxytocin as preventative - gentle cord traction - immediate fundal massage after complete birth

Answer 633

Aim is to increase contractility and minimize blood loss and includes - fundal massage - empty bladder - IV oxytocin Persistent bleeding may require: - misoprostol (synthetic prostaglandin) - blood products - oxygen - bimanual compression

Answer 634

Source of the bleeding just be identified via visual or manual inspection and laboratory findings

Answer 635

- signs of normal involution - potential complications - importance of prompt assessment if PPH occurs

Answer 636

Postpartum infection or puerperal infection

Answer 637

- endometritis - wound infections (c-section, episiotomy) - mastitis - UTI - respiratory tract infections

Answer 638

AKA postpartum infection is more common in -obesity - concurrent medical/immunosuppressive conditions - c-section or other operative birth - prolonged rupture of membranes - prolonged labour - internal fetal monitoring

Answer 639

Endometritis

Answer 640

Infection of the lining of the uterus Usually begins at the placenta site but can spread Higher risk with c-section birth

Answer 641

Fever Increased pulse Chills Anorexia Nausea Fatigue and lethargy Pelvic pain Uterine tenderness Foul smelling profuse lochia

Answer 642

Endometritis

Answer 643

caesarean section and possible 3rd and 4th degree tear BMI over 35 may have a doubled dose of antibiotics

Answer 644

antibiotics wound debridement vital signs promote good hygiene

Answer 645

A wound infection of her tear/laceration

Answer 646

Breast infection Symptoms - usually preceded by inflammatory edema and engorgement - unilateral symptoms - chills/fever - malaise - tenderness/pain - redness - axillary adenopathy (swollen lymph nodes) Treatment - antibiotics - comfort (head/cold application, supportive bra)

Answer 647

ensure good latch and good hygiene

Answer 648

It is ok to keep breastfeeding

Answer 649

Breast abscess

Answer 650

Perinatal mood disorders - anxiety - depression - psychosis

Answer 651

PMD - Perinatal mood disorders 1 in 7 women affected but is often unreported Can happen during pregnancy or within the first 12 months after birth

Answer 652

Baby blues usually resolves within 2 weeks and does not disrupt the postpartum patient's ability to care for themselves and their baby Perinatal mood disorders generally last longer and can be so severe that they are not able to care for themselves or their baby

Answer 653

Yes Risk factor is having a partner that also has postpartum depression

Answer 654

Fatigue Frustration, anger Irritability Indecisiveness Withdrawal from social situations

Answer 655

- begin within a year of giving birth - same as baby blues (lability, crying spells, loss of appetite, difficulty sleeping etc.) but they last longer and are more severe - thoughts of self harm or harming the baby - not having any interest in the baby

Answer 656

- seeing or hearing things that are not there - feelings of confusion - rapid mood swings - trying to hurt self or baby

Answer 657

- baby blues continuing for more than 2 weeks - symptoms of depression getting worse - difficulty performing tasks at home or at work - inability to care for self or baby - thoughts of harming self or baby

Answer 658

Greatest risk - history of anxiety or depression Other risk factors: - Younger age - Unintended pregnancy - History of premenstrual dysphoria - Family history of mood disorders - Marital status/marital discord - Victim of violence - Lower socioeconomic status - Lack of social support - Lower education level - Substance use - Stressful life events in the year before pregnancy - Birth complications - Feeling incompetent, a loss of self, and lonely - Preterm birth, low birth weight, or sick baby - Psychosocial problems - And interpersonal difficulties

Answer 659

Guilty outside

Answer 660

Postpartum depression - supportive care - medication (antidepressant/antianxiety) - ECT - physiotherapy - alternative therapies - hospitalization

Answer 661

Postpartum Psychosis (PPP)

Answer 662

MEMORY: IF DIAPERED :) - Impulsive - Fatigue - Delirium - Insomnia - Auditory or visual hallucinations - Paranoid or grandiose delusions - Emotionality labile - Restlessness - Extreme deficits in judgement - Disorientation

Answer 663

- hospitalization - antipsychotics and mood stabilizers (this may mean breastfeeding is no longer an option) - ECT may also be included If the mother wants to see her baby, it is likely beneficial to do so

Answer 664

early detection and aggressive treatment

Answer 665

An increase in the number and size of cells that results in an increase is size and weight

Answer 666

Gradual change and advancement. When someone becomes more mature, learns, ‘expanding of a person’s capacities’

Answer 667

Development

Answer 668

Gaining competence and adaptability. When someone can function at a higher level

Answer 669

Maturation

Answer 670

When cells and structures are modified to achieve specific characteristic Develop from simple to complex activities and functions

Answer 671

Differentiation

Answer 672

Development

Answer 673

Maturation

Answer 674

Differentiation

Answer 675

Growth and development happen in a direction For example head to toe: Babies have better control of their head before they have control of their hands and feet

Answer 676

Directional trends

Answer 677

There is a sequence to development For example: Babies babble before they talk

Answer 678

Sequential trends

Answer 679

The time it takes to develop It is different for each individual but there are also periods of accelerated development

Answer 680

Developmental trend

Answer 681

A time where an individual is more susceptible to influences (positive or negative)

Answer 682

Sensitive periods

Answer 683

We need to look at their adjusted age, so how old they would be if they had been born at 40 weeks because the growth chart doesn't accommodate for that.

Answer 684

A drop of more than 1 percentile line for height and weight make them more at risk for failure to thrive so they will need more monitoring For head circumference, more than 5% off their percentile line is a red flag immediately

Answer 685

36 months old or any other time the size is questionable as they get older

Answer 686

- disproportionate height and weight - not growing at the expected rate - sudden increase/decrease in growth

Answer 687

Ensure legs are extended and foot is flat against the end and the head is flat against the tip; this is the hardest measurement to be consistent about

Answer 688

Whenever they can stand independently and follow directions, so there isn't a specific age

Answer 689

Girls tend to be smaller, so if they were all on the same chart, girls would appear undersized

Answer 690

Erik Erikson

Answer 691

8 favorable unfavorable

Answer 692

Trust vs mistrust birth to 1 year - Most important attribute to a healthy personality - Loving care is important in developing trust - Mistrust develops when trusting promoting experiences are lacking

Answer 693

Autonomy vs shame and doubt 1 - 3 years - Increasing need to control their bodies, themselves, and environment - Imitating others - Feeling doubt or shame happen when children feel small and self- conscious and when their choices are disastrous, when they are shamed or forced to be dependent - Favorable outcome: self-control and willpower

Answer 694

Initiative vs guilt 3-6 years - Have an ‘inner voice’ - Strong imagination! - Will explore with all their senses - Guilt comes when children have goals or do activities that go against their parents/others and then feeling like those activities are bad which produce a sense of guilt

Answer 695

Industry vs inferiority 6-12 years - Are workers and producers - Want to do projects that they can complete (achievement) - Learn to compete and cooperate - Inadequacy and inferiority can happen when too much is expected of them or they believe they ‘can’t measure up’

Answer 696

Identity vs role confusions 12-18 years - Rapid physical changes - Become very concerned with their appearances - Inability to solve core conflicts result in role confusion - Devotion and fidelity are outcomes that demonstrate success

Answer 697

1 - trust vs mistrust (0-1 year) 2 - autonomy vs shame and doubt (1-3 years) 3 - initiative vs guilt (3-6 years) 4 - industry vs inferiority (6-12 years) 5 - identity vs role confusion (12-18 years)

Answer 698

Stage 1 Trust vs mistrust (0-1 years)

Answer 699

Stage 2 Autonomy vs shame and doubt (1-3 years)

Answer 700

Stage 3 Initiative vs guilt (3-6 years)

Answer 701

Stage 4 Industry vs inferiority (6-12 years)

Answer 702

Stage 5 Identify vs role confusion (12-18 years)

Answer 703

Stage 1 Trust vs mistrust (0-1 years)

Answer 704

Stage 2 Autonomy vs shame and doubt (1-3 years)

Answer 705

Stage 3 Initiative vs guild (3-6 years)

Answer 706

Stage 4 Industry vs inferiority (6-12 years)

Answer 707

Stage 5 Identity vs role confusion (12-18 years)

Answer 708

Nouns Understood Communicated

Answer 709

At all phases of language development more is understood than can be communicated

Answer 710

The first child

Answer 711

Because it manipulates them into getting those needs met (not malicious manipulation lol)

Answer 712

How someone describes themselves Develops gradually Includes body image and self esteem

Answer 713

Evolves and changes during development; very complex Infants - become aware that their body is separate from others Toddlers - identify their body parts

Answer 714

The value an individual puts on themselves Changes with development Assessed based on: - competence - sense of control - moral worth (good vs bad person) - worthiness of love and acceptance

Answer 715

Socialization

Answer 716

Skills and competence that come with mastery

Answer 717

Onlooker play 0-6 months - watch others playing Solitary play 6-12 months - play alone with different toys but in the same area as other children Parallel play 12-18 months - play independently with similar toys as other children in the area Associative play - 18-36 months - play together but no organization Cooperative play - 3 years+ - organized play in a group (like the ability to play as part of a ball team)

Answer 718

Onlooker play (0-6 months)

Answer 719

Solitary play (6-12 months)

Answer 720

Parallel play (12-18 months)

Answer 721

Associative play (18-36 months)

Answer 722

Associative play (18-36 months)

Answer 723

Cooperative play (3 years +)

Answer 724

Sensorimotor Intellectual Socialization Creativity Self-awareness Therapeutic value Moral value

Answer 725

- muscle development, energy release - exploration and movement - fine/gross motor movements

Answer 726

- learning (shapes, colours, etc.) significance and associations - problem solving - language

Answer 727

- establish relationships, learn roles - give and take - right from wrong - prosocial behaviour - cooperative play - empathy

Answer 728

- experiment, fantasy, exploration - can be hindered by conformity and peer pressure

Answer 729

- develop a self-identity - regulate behaviour - test themselves and try roles

Answer 730

- express emotions - release impulses - experiment and test fearful situations - Communicate needs, fears, desires, etc.

Answer 731

right vs wrong reinforced through peer interaction

Answer 732

sharing, empathy and cooperation; resources need to be shared and not just for the one child; moves out of the ego perspective of all of the things are for my use only

Answer 733

heredity - disorders and characteristics like height and personality neuroendocrine factors - growth interpersonal relationships - emotional/intellectual development socioeconomic status environmental hazards stress in childhood (i.e. ACEs)

Answer 734

- hereditary disorders - genetics - height, weight, temperament, personality traits

Answer 735

Hypothalamic-pituitary factors influence growth

Answer 736

Emotional, intellectual, and personality development For small children, their nuclear family and relationship models creates the foundation of what the child understands about what relationships are like

Answer 737

Perhaps related to lack of resources or knowledge

Answer 738

Exposure to hazards like chemical residues, radiation, water or food contamination, etc.

Answer 739

Some children are more vulnerable to stressors Includes ACEs exposure

Answer 740

Media Internet and social media use now needs to be incorporated in parent education and support

Answer 741

Non verbal communication from babies (cooing, smiling, crying) Non verbal communication to babies (cuddling, soothing) Derive comfort from voice, even if they don’t understand the words

Answer 742

Communication should be focused on them (“You can do…” “This will feel cold”) because children are egocentric Children may point or pull pull away Very literal at this age

Answer 743

Based on the criticism and fear they are receiving these days

Answer 744

Immunization schedule - it's different from province to province and varies between countries

Answer 745

A protein found in the blood that is produced in response to foreign substances (e.g. bacteria or viruses) invading the body. Antibodies protect the body from disease by binding to these organisms and destroying them.

Answer 746

The production of antibodies against a specific disease by the immune system. Active immunity can be acquired in two ways, either by contracting the disease or through vaccination. Active immunity is usually permanent, meaning an individual is protected from the disease for the duration of their lives.

Answer 747

Active immunity

Answer 748

- vaccines - contracting the disease

Answer 749

Foreign substances (e.g. bacteria or viruses) in the body that are capable of causing disease. The presence of antigens in the body triggers an immune response, usually the production of antibodies.

Answer 750

A situation in which a sufficient proportion of a population is immune to an infectious disease (through vaccination and/or prior illness) to make its spread from person to person unlikely. Even individuals not vaccinated (such as newborns and those with chronic illnesses) are offered some protection because the disease has little opportunity to spread within the community.

Answer 751

The ability of the immune system to respond more rapidly and effectively to pathogens that have been encountered previously, and reflects the preexistence of a clonally expanded population of antigen-specific lymphocytes

Answer 752

Immunological memory

Answer 753

Protection against disease through antibodies produced by another human being or animal. Passive immunity is effective, but protection is generally limited and diminishes over time (usually a few weeks or months). For example, maternal antibodies are passed to the infant prior to birth. These antibodies temporarily protect the baby for the first 4-6 months of life.

Answer 754

Permanent - active immunity Temporary - passive immunity

Answer 755

2 months 4 months 6 months 12 months 18 months 4 years Grade 6 Grade 9

Answer 756

2 months 4 months 6 months But this is a recent change so all children born before 2018 will get 3 doses over 6 months in grade 6

Answer 757

If they are at high risk from contracting it due: - parent with hep-B - parent hep-B status unknown - Someone living in the home has hep-B

Answer 758

hepatitis B vaccine and hepatitis B immune globulin (HBIG) should be given within 12 hours of birth.

Answer 759

Recombivax HB 5 mcg/0.5 mL Engerix-B 10 mcg/0.5 mL Given at birth, 1 month, and 6 months

Answer 760

Action: Hepatitis B immunoglobulin (HBIG) provides a high titre of antibody to hepatitis B surface antigen (HBsAg). Indication: The HBIG vaccine provides prophylaxis against infection in newborns born to HBsAg-positive mothers. Newborn Dosage: Administer one 0.5-mL dose intramuscularly within 12 hours of birth.

Answer 761

Contains micro organisms (bacteria/viruses) that have been killed, but still capable of inducing the body to produce antibodies Example: inactivated polio virus vaccine

Answer 762

Killed vaccine (inactive) I.e. inactivated polio virus vaccine

Answer 763

A toxin treated by heat or chemical to weaken its toxic effects but retains its antigenicity Example: tetanus toxoid

Answer 764

Toxoid i.e. tetanus toxoid

Answer 765

Vaccine contains a microorganism in live, but attenuated, or weakened form Example: MMR

Answer 766

An organism has been genetically altered for use in vaccines Example: Hepatitis B

Answer 767

An altered organism joined with another substance to increase the immune response Example: Hemophilus influenza type b (Hib)

Answer 768

Live virus vaccine i.e. MMR

Answer 769

Recombinant forms i.e. hepatitis B

Answer 770

Conjugated forms i.e. Hemophilus influenza type b (Hib)

Answer 771

Proteins Adjuvants Preservatives Antibiotics Stabilizers

Answer 772

A substance added to a vaccine to enhance the immune response by degree and/or duration making it possible to reduce the amount of immunogen per dose or the total number of doses required to achieve immunity aluminum salts injection site reactions

Answer 773

Chemicals added to multidose vials to prevent serious secondary infections as a result of bacterial or fungal contamination thimerosal - an ethyl mercury derivative, phenol, 2 phenoxyethanol Controversy re: theoretical risk of thimerosal risk of brain damage – has been refuted

Answer 774

Other substances added to vaccines to: - Support growth and purification of specific immunogens and or the inactivation of toxins - Confirm product quality or stability E.g. Gelatin

Answer 775

Wakefield study Study fully retracted and Wakefield’s name was erased from the medical registry

Answer 776

Cold chain Can destroy or reduce the effectiveness of the vaccine

Answer 777

Usually 15 minutes 30 minutes for children with a history of anaphylaxis

Answer 778

A person with a history of anaphylaxis after previous immunization of the same vaccine or to any component of the vaccine or its container Refer to an allergist to determine specific cause and to assess if vaccines should be avoided and for how long

Answer 779

A condition that may increase the risk of an adverse reaction following immunization or that may compromise the ability of the vaccine to produce immunity In general, vaccines are deferred when a precaution exists

Answer 780

If significantly immuno-compromised, live viral or bacterial vaccines may cause serious adverse events because of uncontrolled replication of the virus or bacteria Immunosuppressed people cannot have live vaccines (precaution/contraindication) Other types - Yes they can, even a less than optimal response may provide important benefit to such patients, who are also at high risk of morbidity and mortality due to vaccine-preventable infection

Answer 781

If a pregnant woman receives a live vaccine, the infection with the vaccine strain virus or bacteria might affect the fetus Safety data for other live virus vaccines in pregnant women are very limited They should not received live vaccines during pregnancy unless their risk from the illness is clearly greater than the potential risk from the vaccine

Answer 782

Subsequent doses of the same vaccine should only be given if the benefit of vaccine outweighs the potential risk of recurrence of the GBS is vaccine is given

Answer 783

Inactivated viral vaccines, bacterial vaccines and toxoids can be used safely in pregnancy

Answer 784

They have an altered immune response and for some infections Are at increased risk of infection and at risk of increased risk of severe outcomes once infected.

Answer 785

It doesn't they should still receive the recommended vaccines according to the routine immunization schedule

Answer 786

Symptoms occur within hours/days - Local tenderness - Erythema (redness) - Swelling - Low grade fever - Behavioural changes (drowsy, reduced appetite) Usually acetaminophen can help with symptoms

Answer 787

Because they multiply for days or weeks

Answer 788

Anaphylaxis

Answer 789

Breath holding spell

Answer 790

Chemical or mechanical initiation of labour Done when continuing the pregnancy could pose risk to mother or baby and no contraindications exist for artificial rupture of membranes Elective: done when there are no medical reasons (discouraged)

Answer 791

Prostaglandins: Cervidil vaginal insert - Ripens the cervix: causes it to soften and begin to dilate and efface Oxytocin - Used to induce or augment labour - Given IV - Uterine tachysystole: (lots of contractions 6 in 10 minutes)

Answer 792

Balloon catheter: ripens and dilates the cervix Dilators: Absorb fluid, expand, causing the cervix to dilate Membrane sweeping: separates the membrane from the wall of the cervix and causes release of prostaglandin and oxytocin Artificial rupture of membranes -Cervix must be ripe -Often done with oxytocin administration Self-induce: nipple stimulation, sex, walking, drinking castor oil, acupuncture

Answer 793

Pt cannot push out baby because of an underlying health condition (such as preeclampsia) there are concerns about baby's heart rate baby is in an awkward position baby is fatigued and there are concerns that they may be in distress Pt is having a vaginal delivery of a premature baby – forceps can help protect baby's head from the pressure/friction of the perineum Pt requires an epidural for pain relief during labour

Answer 794

To mom - vaginal tearing (which can be deep enough to involve the anus/rectum) - episiotomy To baby - a mark on baby's head (chignon) being made by the ventouse cup – this usually disappears within 48 hours - a bruise to baby's head (cephalohaematoma) – this can happen during a ventouse assisted delivery, but the bruise is usually nothing to worry about and should disappear with time - marks from forceps on baby's face – these usually disappear within 48 hours - small cuts on baby's face or scalp – these affect 1 in 10 babies born using assisted delivery and heal quickly - yellowing of baby's skin and eyes jaundice, and should pass in a few days

Answer 795

Blades cover the ears and go around the baby’s head like 2 tablespoons would hold an egg They lock in place to prevent compression of the fetal head (see red arrows) Rotation (and slight traction) is applied during contractions

Answer 796

- cervix fully dilated - bladder emptied - presenting part engaged - ruptured membranes

Answer 797

- lacerations - uterine retention - hematomas

Answer 798

- bruising - palsy - hematoma

Answer 799

- cephalohematoma - scalp lacerations - subdural hematoma

Answer 800

For an assisted birth at less than 36 weeks pregnant, forceps may be recommended over ventouse. This is because forceps are less likely to cause damage to baby's head, which is softer at this point in pregnancy.

Answer 801

scheduled - labour/vaginal birth contraindicated (i.e. abnormal baby positioning, previous c-sections) - labour should not be induced (hypertensive disorders) - placenta previa - active herpes or HIV with high viral load - placenta previa unplanned/emergent - complications in labour (i.e. fetal distress, placental issues) - dysfunctional labour - placental abruption

Answer 802

- Aspiration - Hemorrhage - Atelectasis (Collapsed lung) - Endometritis - Wound dehiscence - Infection - UTI - Bladder injuries - Anaesthesia complications

Answer 803

- Potentially be born premature if due date was not accurate - Asphyxia if uterus and placenta are poorly perfused - Fetal injuries (related to scalpel) - Respiratory problems

Answer 804

skin to skin with the mother or partner

Answer 805

- assess vitals of mom and baby - assess incision and check for signs of infection - monitor for blood loss from incision and vagina - Ensure patent airway - monitor urine output - monitor IV - assess post op pain levels - skin to skin contact with baby and encourage breastfeeding - support ambulation once mom has feeling back in her legs - education regarding diet

Answer 806

Vaginal Birth After Caesarean Section (VBAC) - Low-transverse caesarean birth - ‘adequate’ pelvis - No other uterine scars or history of previous rupture - Available physicians during active labour and ready to preform a caesarean section if necessary

Answer 807

Umbilical cord is below the presenting part, most commonly seen after rupture of membranes Can lead to - fetal hypoxia - newborn asphyxia - neurological brain injury - death

Answer 808

Prolapsed cord EMERGENCY! - get help Help woman into Trendelenburg position with a blanket/pillow under the hips or in a knees to chest, face down type position as this will take the pressure off the cord until it can be corrected

Answer 809

1 month - hands closed 3 months - hands open and will hold something if given 5 months - can voluntarily hold something (they can pick up a soother and put it in their mouth, it's less than graceful but it works) 8-9 months - pincer grasp develops (thumb and finger to pick something up

Answer 810

3 months By 4 months they can lift their head 90 degrees

Answer 811

5 months - roll from front to back 6 months - roll from back to front

Answer 812

7 months - sit up alone leaning forward 8 months - sit unsupported 10 months - can go from prone to sitting up unassisted

Answer 813

9 months - crawling forward 9-10 months - stand while holding onto furniture and can hold themselves up 11 months - walk while holding on to furniture 12 months - walk while holding a hand, may take 1st independent steps 12-13 months - walk along with a wide stance 18 months - run (falls easily though haha) 2 years - jumping

Answer 814

6 months - the know something they cannot see still exists

Answer 815

From 6-8 months Closely linked to object permanence

Answer 816

- can introduce foods at 6 months - offer foods high in iron - do not delay trigger foods that are believed to cause allergies - most calories will still come from breastmilk/formula - foods should not be mixed in a bottle - introduce foods one at a time

Answer 817

- The GI tract has matured and is ready for solids - Teeth begin to come and can help with chewing - Head control is well developed (babies can sit up supported) - Swallowing is better coordinated - Voluntary grasping occurs

Answer 818

Growth Senses

Answer 819

Fine motor development

Answer 820

1 year - can speak about 4 words - 1 word sentences ("up") 2 years - can speak about 300 words - 2-3 word sentences ("hold ball") 3 years - simple sentences and masters grammar rules - learn 5-6 new words/day - count to 3

Answer 821

15 months - can feed themselves (its messy lol) 2 years - use a spoon - dress/undress with minimal assistance 2-3 years - chores such as putting toys away

Answer 822

Toilet training

Answer 823

Between 18-24 months

Answer 824

9-12 hours per night

Answer 825

age 10 in girls age 12 in boys

Answer 826

breast buds (after age 8) menarche (10.5-15 years)

Final Study Flashcards

(904 cards)