Newborn Assessment / Complications Flashcards
(99 cards)
1
Q
What is the optimal body temperature range for a newborn?
A
36.5 - 37.5 °C
2
Q
What does a newborn temperature of 36.5 - 36.0 °C indicate?
A
Cold stress - cause for concern
3
Q
What does a newborn temperature of 36.0 - 32.0 °C indicate?
A
Moderate hypothermia - danger, must warm baby
4
Q
What does a newborn temperature of < 32.0 °C indicate?
A
Severe hypothermia - urgent, risk of brain damage
5
Q
What are the effects of cold stress in a newborn? (3)
A
- Hypoglycemia
- Hyperbilirubinemia
- Respiratory distress
6
Q
Describe the nursing interventions associated with cold stress in a newborn (3)
A
- Heel stick for hypoglycemia
- Increase environmental temperature
- Warm IV fluids prior to infusion
7
Q
What can occur as a result of warming an infant’s body temperature too rapidly? (2)
A
- Hypotension
- Apnea
8
Q
Which type of heat loss are newborns most susceptible to?
A
Evaporation heat loss
9
Q
Describe evaporation heat loss
A
Water converted into vapor (ex. wet skin after birth)
10
Q
Describe convection heat loss
A
Warm skin surface to cool air currents (ex. air vent draft)
11
Q
Describe conduction heat loss
A
Warm skin surface to cool surface - DIRECT contact (ex. cold stethoscope)
12
Q
Describe radiation heat loss
A
Warm skin surface to cool surface - INDIRECT contact (ex. cold nearby walls)
13
Q
What is the primary risk associated with wall suctioning / DeLee catheter?
A
Bradycardia
14
Q
What is the RR of a newborn within the first 2 hours after birth?
A
60 - 70
15
Q
What is the normal RR of a newborn?
A
30 - 60
16
Q
Describe the normal breathing pattern of a newborn
A
Breathing may periodically pause for 5 - 15 seconds with no other changes
17
Q
A breathing pause of ______ indicates apnea
A
> 20 seconds
18
Q
What other signs may be associated with apnea in an infant? (2)
A
- Skin color changes
- Bradycardia
19
Q
Decreased peripheral circulation results in ______
A
Acrocyanosis
20
Q
What is the expected apical pulse for a newborn?
A
120 - 150 BPM
21
Q
What is the expected apical pulse for a newborn when sleeping?
A
100 BPM
22
Q
What is the expected apical pulse for a newborn when crying?
A
180 BPM
23
Q
What is the expected BP for a newborn?
A
71 / 49
24
Q
A systolic BP of ______ in a newborn should be reported
A
< 60
25
A diastolic BP of ______ in a newborn should be reported
< 25
26
Describe the initial weight loss of a newborn after birth
5 - 10% of birth weight within first 5 - 10 days
27
Describe newborn stools in the first 48 hours
Meconium - thick, tarry, black
28
Describe newborn stools in the first 3 - 4 days
Transitional - thin, brown / green
29
Describe breastfed newborn stools
Pale yellow, liquid
30
When do newborns first void?
Immediately after birth
31
How is infant temperature measured?
Temperature probe placed on abdomen - verify with axillary temp for 3 min
32
If an infant has a high axillary temperature, the nurse should verify via ______
Rectal temperature
33
What reflexes are assessed in a newborn? (6)
- Moro
- Suck
- Root
- Babinski
- Tonic-neck
- Palmar / plantar grasp
34
What causes an extended moro reflex?
Maternal substance use
35
How does cephalohematoma differ from caput succedaneum?
Does not cross suture lines
36
When does cephalohematoma disappear?
2 - 3 weeks
37
Dark, flat pigmentation of lower back / buttocks of a newborn is known as ______
Mongolian spots
38
Tiny white papules on the face of a newborn are known as ______
Milia
39
An innocuous pink papular rash with superimposed vesicles on the back / abdomen / chest of a newborn is known as ______
Erythema toxicum neonatorum - "newborn rash"
40
What is the purpose of eye prophylaxis?
Prevention of gonococcal infection - possible exposure from mother
41
When should newborns be treated with eye prophylaxis?
Within 1 hour of birth
42
What medications are used for eye prophylaxis? (3)
- 1% silver nitrate
- 1% tetracycline
- 0.5% erythromycin
43
What is the purpose of 0.5% erythromycin opthalmic ointment?
Prevents chlamydial infections as well as gonorrhea
44
How is hemorrhagic disease prevented in newborns?
Vitamin K injection
45
What are the side effects of vitamin K injection? (2)
- Ecchymosis
- Pain / edema at injection site
46
What drug is used for vitamin K injection?
AquaMEPHYTON (Vit K1)
47
When should newborns be treated with vitamin K injection?
Within 1 hour of birth
48
What dosage of vitamin K is given to newborns?
0.5 - 1.0 mg
49
What needle size is used for vitamin K injection?
5/8 inch, 25 gauge needle (very short / thin)
50
Where is the injection site for vitamin K in a newborn?
Vastus lateralis - largest muscle / best for injections until age 2
51
Describe the education associated with umbilical cord care (2)
- Wipe the cord stump with alcohol daily and leave open to air dry
- Monitor for infection
52
Describe the use of glucose in newborns during the first 4 - 6 hours (2)
- Main source of energy (high metabolic demand)
- Used for respiration and heat production
53
How is carbohydrate metabolism assessed in a newborn?
Heel stick via dextrostix
54
When is glucose assessed via dextrostix?
On admission and 4 hours later
55
What glucose range is normal for a newborn?
45 - 90
56
What is the primary nursing intervention for a newborn glucose < 45?
Early feed with glucose water / breast milk
57
What are the manifestations of hypoglycemia in a newborn? (12)
- Tachycardia
- Tachypnea
- Tremors
- Cyanosis
- Respiratory distress
- Poor muscle tone
- Poor suck reflex
- High-pitched cry
- Hypothermia
- Lethargy
- Irritability
- Seizures
58
______ is a good sign for a newborn with hypoglycemia
Lusty / vigorous cry - indicates adequate breathing
59
Describe education associated with circumcision (2)
- Keep site clean / dry
- Apply vaseline to tip of penis
60
Describe nursing considerations associated with circumcision (2)
- NEVER forcibly retract the foreskin
- Administer Vitamin K before circumcision
61
When does newborn screening take place?
Within 48 hours after birth
62
Describe the diagnosis of PKU
Blood test 24 - 48 hours after protein ingestion
63
Describe the treatment of PKU
Strict adherence to low phenylalanine diet
64
What are the manifestations of PKU? (3)
- Musty odor
- Altered eating patterns
- Decreased pigmentation
65
When are effects of opiate / cocaine exposure seen in newborns?
48 - 72 hours
66
What are the manifestations of infant narcotic withdrawal? (6)
- Unrelieved irritability
- Exaggerated moro reflex
- Poor suck reflex
- High-pitched cry
- Tremors
- Sweating
67
How often should neonatal abstinence scoring be conducted?
Every hour until score > 8
68
Infants suffering from narcotic withdrawal sleep for ______ between feedings
2 hours
69
What drug is used for the pharmacologic management of infant narcotic withdrawal?
Morphine
70
What causes of transient tachypnea of the newborn? (2)
- Polyhydramnios - excess fluid in the lungs
- C-section - chest is not squeezed during labor
71
Meconium aspiration usually occurs in ______
Post-term infants
72
Why is it important to investigate jaundice even though it is generally common in newborns?
Rule out pathological hyperbilirubinemia
73
What is direct bilirubin?
Water-soluble bilirubin that has been processed by the liver
74
What is indirect bilirubin?
Fat-soluble bilirubin that has not been processed by the liver
75
What are the risk factors associated with hyperbilirubinemia? (6)
- RBC destruction
- Immature liver
- Pre-term infants
- Cephalohematoma
- Dehydration
- Polycythemia
76
Polycythemia is specifically common in ______
Newborns of diabetic mothers - due to insulin use
77
Describe pathologic hyperbilirubinemia (2)
- Caused by underlying condition
- Occurs < 24 hours after birth
78
What bilirubin levels are associated with pathologic hyperbilirubinemia? (2)
- Serum bilirubin increase of > 5 mg / day
- Total bilirubin > 15 mg
79
Describe physiologic hyperbilirubinemia (2)
- Common, temporary, harmless
- Occurs > 24 hours after birth
80
What bilirubin levels are associated with physiologic hyperbilirubinemia?
Serum bilirubin of > 6 mg BEFORE noticeable jaundice
81
When is the peak of physiologic hyperbilirubinemia?
3 - 5 days after birth
82
Describe interpretation of a direct Coomb's test
If test comes back positive for antibodies, newborn's RBCs are being attacked / broken down too quickly - indication of jaundice / hemolytic disease
83
What is kernicterus?
Build-up of bilirubin in the brain - can cause permanent brain damage
84
Management of hyperbilirubinemia is focused on ______
Preventing kernicterus
85
What is the indication for phototherapy for hyperbilirubinemia?
Serum bilirubin ≥ 12 mg
86
When should phototherapy for treatment of hyperbilirubinemia take place?
25 - 48 hours after birth
87
Describe the monitoring associated with phototherapy (2)
- Hydration status
- Body temperature
88
What are the side effects of phototherapy? (2)
- Loose, frequent stools
- Skin color changes / rash
89
What treatment is used for dangerously high bilirubin levels?
Exchange transfusion
90
When is Apgar scoring conducted?
At 1 and 5 minutes after birth
91
An Apgar score of ______ is considered normal
7 - 10
92
An Apgar score of ______ indicates some difficulty, and may require further medical attention
4 - 6
93
An Apgar score of ______ requires resuscitation
0 - 3
94
What is considered small for gestational age?
< 10th percentile of growth curve
95
What is considered large for gestational age?
> 90th percentile of growth curve
96
______ is the most common metabolic problem associated with small for gestational age infants
Hypoglycemia
97
Type I diabetic mothers are more likely to have ______ infants
Small for gestational age
98
Gestational diabetic mothers are more likely to have ______ infants
Large for gestational age
99
Describe nursing interventions for a macrocosmic infant (2)
- Monitor for hypoglycemia
- Frequent feedings
