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Module 4A Flashcards

1
Q

what is RAPP

A

Newborn assessment tool
Respiratory
Activity
Perfusion/color
Position/tone

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2
Q

When is the 1st, 2nd and 3rd RAPP assessment performed?

A

1st in birthing area
2nd within 2-4hrs
3rd before discharge

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3
Q

What are some signs that indicate a problem in initial newborn assessment

A

Nasal flaring
Chest retractions
Grunting on exhalation
labored breathing
Generalized cyanosis
Abnormal breath sounds
Abnormal respiratory rates (+60, -25)
Flaccid body posture
Pallor
Apneic episodes
Abnormal HR (+160, -100)
Abnormal size of body

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4
Q

When is APGAR score done?

A

At 1 minute
5 minutes
and again at 10 mins if 5 min score was less than 7pts

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5
Q

What does 1 min and 5 min apgar score tell us?

A

1min - data about newborns initial adaptation to extrauterine life
5 min - Newborns overall CNS

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6
Q

What 5 parameters are assessed with APGAR?

A

A - appearance (color)
P - Pulse
G - grimace (reflex irritability)
A - activity (muscle tone_
R - Respiratory

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7
Q

How does APGAR scoring work?
What does final scores mean?

A

0-2 for each category. 0-absent or poor. 2-normal response
8-10- normal
4-7 moderate difficulty
0-3 Severe distress in adjusting

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8
Q

When a newborn is expierencing physiologic depression what predictable manner do APGAR scoring disappear?

A

Pink color is lost
then respiratory effort
then tone
followed by irritability reflex and finally hR

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9
Q

What is expected lenght for full term newborn

A

17-22in

44-55cm

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10
Q

What are normal newborn weights?

A

Grams - 2500-4000g
(5lb8oz - 8lb14oz)

Anything higher or lower is considered outside normal range

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11
Q

Newborns can lose how much weight by 3-4 days?
when is weightloss usually regained?

A

10%
Regained by 10th day

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12
Q

How are newborn birth weights classified?
Low
Very low
Extremely low

A

Low - >2500g/>5,5;b
Very low- >1500g / 3/5lb
Extremely low- >1000g/>2.5lb

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13
Q

What is HR and RR for immediate newborn
-How often assessed after birth? then after stabilized?

A

HR - 110-160
RR - 30-60
Assessed q 30 until 2 hours post birth then q 8hours

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14
Q

Once born, gestational age is determined by what 2 tests?

A

Ballard gestational age
or Ballard scale

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15
Q

What weeks are gestational age

Preterm
Term
Post-term
Postmature

A

Preterm - before 37 wks
Term- 38-42
Post-term - after wk 42
Postmature - after 42 and signs of placental aging

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16
Q

Newborns can also be classified by weight
SGA - Small for gestational age
AGA - Appropriate for gestational age
LGA - Large for gestational age

A

SGA - Small for gestational age - less than 10th percentile (less than 5.5;b)
AGA - Appropriate for gestational age - between 10th-90th percentile
LGA - Large for gestational age - more than 90th percentile (over 9lb)

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17
Q

What 2 medications are given to immediate newborn

A

Vitamin K
Eye prophylaxis erythromycin or tetracycline ophthalmic ointment

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18
Q

Ophthalmia neonatorum

A

Hyperacute purulent conjunctivitis occuring during first 10 days of life

Contracted by birth with mom with gonorrhea and chlamydia / potentially blinding

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19
Q

What is a typical newborn head circumference

A

32-38cm (13-15in)

*should be 1/4 of newborn length or 1/2 length + 10cm

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20
Q

What could a small infant head indicate

A

Microcephaly caused by rubella, toxoplasmosis, SGA status

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21
Q

What could a enlarged infant head indicate

A

hydrocephalus or increased intracranial pressure

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22
Q

What should infant chest circumference be

A

1-2cm less than head circumference

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23
Q

Acrocyanosis

A

Persistent cyanosis of fingers, hands, toes and feet with mottled blue or red discoloration and coldness

*normal and intermittent

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24
Q

Vernix Caseosa

A

Thick white substance that protects skin of fetus
2-3days post birth

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25
Stork bites
Salmon patches - superficial vascular areas found on nape of neck, eyelids, between eyes and upper lip
26
MIlia
multiple pearly white or pale yellow unopened sebaceous glands freq found on newborn nose, chin or forehead Disappear in 2-4wks
27
Epstein pearls
When Milia occur in newborns mouth and gums
28
Mongolian spots
Benign blue or purple splotches that appear solitary on lower back and but of newborns, may occur on legs and shoulders
29
Erythemia toxicum
Benign generalized transient rash that occurs in up to 70% of all newborns during 1st week of life consisting of small papules that resemeble flea bites
30
Harlequin sign
Dilation of blood vessels on only one side of body. Appearance of wearing a clown suit. Distinct midline demarcation -From immature autoregulation of blood flow commonly seen in low birth weight **last 20 min no intervention needed
31
Nevus flammeus
Port wine stain Commonly appears on newborn face and other body areas Capillary angioma located below dermis / flat with sharp demarcations and purple red Permenant assoc with structural malformations, bony/musclur overgrowth, certain cancers
32
Nevus Vasculosus
Strawberry mark Benign capillary hemangioma in dermal or subdermal layers. Raised, dark red and sharply demarcated. Commonly in head Common in premature infants less than 1500g
33
Microcephaly
Head circumference more than two standard deviations below avg or less than 10% of normal parameters for gestational age caused by failure of brain development
34
Conditions assoc with microcephaly
Seizures Developmental delay Intellectual disability Hearing loss problem with vision, movement, balance and feeding
35
Macrocephaly
Usually benign that does not require intervention Head circumference more than 90% of normal, related to hydrpcephalus
36
Large fontanels
More than 6cm in anterior and more than 1cm in posterior Poss assoc with malnurition, hydrocephaly, congential hypothroidism, trisomies 13, 18, 21 and various bone disorders
37
Sucking reflex
Elicited by gently stimulating newborns lips by touching them Normal - open mouth and begin sucking motion
38
Moro reflex aka Embrace reflex
Occurs when neonate is startled PLace baby on back, support upper body w/o lifting then release newborn suddenly Normal - throw arms outward and flex knees, then arms return to chest, fingers spread to form a C shape
39
Stepping reflex
Holding newborn upright and inclined forward with soles of feet touching a flat surface Normal - baby should make stepping motion
40
Pseudomenstruation
Vag discharge from female baby composed of mucus mixed with blood present during first few weeks of life No treatment
41
Tonic neck reflex
Resembles stance of a fencer Lie newborn on back, turn babies head to one side, arm which baby is facing whould extend straight with hand partial open. Arm on other side is flexed and fist clentched. Reversing direction on which fetus is turned reverses position
42
Babinski reflex
Present at birth, disappears by 1 year Stroking lateral sole of food from heel across ball of foot. Toes should fan out **diminished response indicates neurological problem and needs follow up
43
Palmer grasp Planter grasp
Palmer - place a finger on newborns open palm. Babies hand will close around finger, attempting to remove finger will cause baby to tighten grasp Planter - Place finger just below toes. Toes typically curl over finger
44
Truncal incurvation reflex (galant reflex)
Present at birth and disappears in a few day sto 4 wks Prone position, apply firm pressure and run finger down either side of spine. Caues pelvis flex toward stimulated side. Indicated T2-S1 innervation Lack of response indiacted neurologic or spinal cord problem
45
Anocutaneous reflex (anal wink)
Stim perianal skin close to anus. External sphincter will constrict Indicated s4-S5 innervations
46
How many urine diapers indicated a hydrated newborn?
6-12 a day
47
When does umbilical cord slough off
7-10days
48
Is cord bleeding or drainage normal
No - bleeding may occur is cord clamp is loose Drainage is sign of infection, needs immediate treatment
49
Risks of circumcision
INfection Hemorrhage Skin dehiscence adhesions Urethral fistula Pain
50
Benefits of circumcision
UTIs less common STI less common Lower rate of penile cancer
51
Preop circumcision prep includes
12hrs or older Received Vit K Voided normally at least once Not eaten for last hour Written consent Correct ID
52
What is continued care for circumcision
Assess for bleeding q 30mins for 2 hours Docu 1st void Squeeze soapy water daily and pat dry Apply petroleum jelly every diaper change
53
Factors assoc with increased hearing loss in newborns
Congenital infections (rubella, herpes, toxoplasmosis) Craniofacial anomalies Low birth weight Postnatal infections (Bacterial meningitis) Head truma Hyperbilirubinemia Exposure to ototoxic drugs (aminoglycosides) Perinatal asphyxia
54
What are caloric needs for newborn? What are fluid requirments for newborn
110-120 cal/kg of body weight 100-150ml/kg daily
55
Breast milk and formula contain how many cal/oz?
20cal/oz
56
AAP recommends all infants receive daily supplement of how much vitamin D
400iu starting first few days of life to prevent rickets and deficiency
57
What is Soy formula usually given for
Infants with Galactosemia Its corn based
58
What is Hypoallergenic formula usually given for
Infants with milk protein allergy Extensively hydrolyzed Corn or sucrose source
59
What is nonallergenic formula usually given for
INfants with milk protein allergy Amino acids as a protein source Corn or sucrose carb source
60
What is antireflux formula usually given for
Infants with gastric reflux Protein source - cows milk Carb source - lactose thickened with rice starch
61
What are the types of holds for feeding
Football - under arm pit Crosscradling Across the lap Side lying
62
What are some readiness cues that a baby is ready for food
about 6 months Consume 32pz daily Ability to sit up with minimal support and turn head Reduction of protrusion reflex Demonstrating interest in food Ability to open mouth automactically when food approaches

247 (11 decks)

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