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Flashcards in Newborn Care Deck (108):
0

What is the first few hours of life as the neonate stabilizes respiratory and circulatory function?

Neonatal transition

1

What must happen in establishment of respiratory function?

Fluid in the lungs must be replaced by air

2

How is fluid in the lungs replaced by air?

It occurs by mechanical force or "squeezing"

3

Where is the fluid in the lungs absorbed?

Into the interstitial tissue, lymphatics and vascular system

4

How much fluid is in the lungs at birth?

Approx 20mL

5

How much fluid is in the entire respiratory tract at birth?

80-120mL

6

What does crying against closed glottis do at birth?

It creates positive pressure inflates alveoli

7

What does lungs expanding with subsequent breaths result in?

Decrease pulmonary vascular resistance

8

What does lungs expanding with subsequent breaths which decrease pulmonary vascular resistance allow?

More pulmonary blood flow (oncotic pressure)

9

What does the fetal experience in chemical stimulation of breathing?

Elevated CO2
Decreased O2
Decreased pH (acidosis)

10

What does the chemical change simulate?

Chemoreceptors in the aorta and carotid arteries

11

What happens after chemoreceptors are stimulated in the aorta and carotid arteries?

Causes stimulation of the respiratory center in medulla which triggers a breath

12

What three things are stimulated that cause a breath to trigger in an newborn?

Chemoreceptors in the aorta and carotid arteries and respiratory center in medulla

13

What is the thermal stimulation of breathing in the newborn?

The decrease in ambient temperature at birth

14

What does decrease in ambient temperature at birth stimulate?

Stimulates nerve endings in skin which sends signal to medulla which triggers a breath

15

When nerve endings in the skin are stimulated what does it send a signal to?

To the medulla which triggers a breath

16

What three things stimulate sensory of breathing?

Touch
Noise
Light

17

If newborn is depressed, what do you do to stimulate breathing?

Rub back vigorously
Flick bottom of foot

18

What is the fluid that lines the alveoli?

Surfactant

19

What is surfactant composed of?

Phospholipids
• lecithin
• sphingomyelin

20

What is the role of Surfactant?

Lowers alveolar surface tension promotes lung compliance

21

When does Lecithin production peak?

At 35 weeks

22

What does Sphingomyelin do?

Remains constant

23

What does the mature L/S ratio?

2:1

24

When a newborn grunts, what is it doing?

Attempting to increase positive pressure in alveoli to keep them down

25

What are the structures of fetal circulation?

Foramen Ovale
Ductus Ateriosus
Ductus Venosus

26

What takes place with the foramen ovale in the first breath?

Decrease in pulmonary vascular resistance
Increase in pulmonary flow

27

What does a fecrease in pulmonary vascular resistance and an increase in pulmonary flow result in?

An increase in venous flow to L heart an increased pressure in L atrium which closes the foramen ovale

28

What causes the foramen ovale to close?

Pressure change

29

When is there a permanent closure in the Foramn Ovale?

6 months

30

What takes place on closure of ductus arteriosus?

Systemic vascular pressure becomes greater than pulmonary vascular pressure

31

When systemic vascular pressure becomes greater than pulmonary vascular pressure what happens?

Blood flow is reversed through the DA and increased pO2 levels cause construction of DA

32

When does the closure of the ductus venosus occur?

When umbilical cord is clamped

33

What us neonatal jaundice?

Physiologic hyperbilirubinemia

34

What percentage of newborns does neonatal jaundice effect?

60% full term and 80% of preterm infants

35

What is the liver of a newborn responsible for?

Conjugating bilirubin for excretion (iron storage)

36

Where is Bilirubin is released in?

In unconjugated form from RBC's

37

Where does bilirubin deposited in?

In tissues, skin, sclera

38

How long does fetal iron stora last?

5 months

39

What bilirubin levels may result in brain damage?

Levels > 17

40

What helps manage neonatal jaundice?

Phototherapy with bili-lights

41

When is jaundice observable?

When bilirubin levels reach 5 mg/dL in caucasions and AA

10-15 in Asians

42

When are bilirubin peak levels?

Term (3-5 days)
Preterm (5-7 days)

43

What are kernicteris?

Pigment deposit in brain

44

What should kernicteris levels be?

25-30mg/dL

45

What should newborn diet contain?

Protein
Fat
Carbohydrate
Water
Vitamins and minerals

46

How long should mother breast feed exclusively?

6 months

47

What is extrusive reflex?

Newborn infant spits out

48

What should the caloric intake be for a newborn?

50-55 kcal/lb/day

49

What is the fluid requirement for a newborn?

64-73 ml/lb/day

50

How much should an infant gain in the first 6 months?

1 oz per day

51

How much should an infant gain in the second 6 months?

0.5 oz per day

52

When should birthweight be regained when formula fed?

10 days

53

When should birthweight be regained when breast fed?

14 days

54

What properties does breast milk have?

Antiviral
Antibacterial
Antigenic inhibiting properties (fewer allergies)

55

What does breast milk lower the risk of?

Childhood:
obesity
Diabetes
Ear infections/tubes
Childhood cancers

56

When breast fed, infants have less _____ and bowel movements are less _________.

Less spit-ups
BM less offensive

57

When is breastfeeding contraindicated?

HIV/AIDS in mother
Breast cancer
When mother requires certain medications
Active TB, HSI in breast

58

When should mother initiate breast feeding?

1st 30 minutes

59

What are the first signs of hunger before crying?

Hand to mouth motions
Whimpering
Sucking
Rooting

60

How often should mother breast feed?

On demand - usually every 1 1/2 to 3 hours
8-10 feedings in 24 hours

61

What can "watching the clock" do to milk production?

Impair milk production

62

When should mother feed until?

Until signs of infant satiety - relaxes, falls asleep, slows down r stops sucking

63

When does Colostrum production begin and end?

Begins during pregnancy and ends a few days after birth?

64

What is colostrum high in?

Protein
Fat-soluble vitamins
Minerals
Antibodies

65

Transitional milk

Until about two weeks

66

What does transitional milk contain?

More fat,
lactose,
water-soluble vitamins
More calories than colostrum

67

What does mature milk contain?

Carbohydrates
Protiens
Fats
Water

68

What is foremilk and hindmilk in?

Mature milk

69

When assessing proper breastfeeding, feeding is appropriate if?

• 6 or more wet diapers/day
• adequate weight gain
• adequate bowel movements
• infant is satisfied

70

What can pacifiers help prevent?

SIDS

71

What helps assess for proper breastfeeding?

LATCH

72

What does L in LATCH stand for?

Latch

73

What does A in LATCH stand for?

Audible swallowing

74

What does the T in LATCH stand for?

Type of nipple

75

What does the C in LATCH stand for?

Comfort

76

What does the H in LATCH stand for?

Hold or positioning

77

What amount size should breast milk be stored in?

2-4 ounces

78

Refrigeration time for breast milk?

72 hours to 8 days

79

Freezer time for breast milk?

6 months

80

Whole milk should be used until when?

For the 1st to years of life

81

When is semi-solid foods be introduced?

At 4-6 months

82

What food seldom causes allergies when introduced at 4-6 months?

Rice cereal with iron

83

What foods can be introduced 6-8 months?

Vegetables and fruits

84

How should you introduce fruits and vegetables?

Introduce one new food at a time and then wait 3 days to introduce another

85

What foods can be introduced at 8-10 months?

Strained meats and proteins
Soft finger foods
Begins to use cup with a lid

86

What can be introduced between 10-12 months?

Eats soft table foods w/ family
Attempts to feed self with spoon
Eats 4x/day

87

What foods need to be delayed until 4 months?

Carrots
Beets
Spinach

88

What foods need to be delayed until 1 year?

Cow milk

89

What foods need to be delayed until 2 years?

Eggs

90

What foods need to be delayed until 3 years of age?

Peanuts
Nuts
Fish
Shellfish

91

What foods need to avoided to prevent choking?

Hot dogs
Hard vegetables
Candy
Whole grapes
Chunks of peanut butter

92

What food needs to be avoided to prevent botulism?

Honey

93

When can newborn have first tub bath?

After cord fall off

94

How should cord be taken care of?

Kept dry and exposed to air
Clean cord and skin with cotton ball 2-3 x per day. Alcohol 1-2 x per day.
Fold diaper below the cord

95

Following circumcision how often do you check for signs of bleeding or infection?

q 30 min X 2 hours

96

How should circumcision care be cared for?

Clean with Soap and water, rinse, pat dry

97

What does normal drainage look like after circumcision?

Light, sticky, and yello

98

If circumcision has a plastibell, when should it fall off?

In 8 days

99

If there is no plastibell placed after circumcision, what needs to be applied with each diaper change?

Petroleum jelly

100

When should head control be achieved by newborn?

3-4 months

101

How should newborn be positioned for sleeping?

On their backs

102

What things help reduce SIDS risk?

Sleep on back
Baby's head uncovered
Avoid overheating
Offer a pacifier for sleep

103

What does the AAP say about tummy time?

Recommends that when the infant is alert, he should be placed in his tummy for "play" sessions

104

If baby chokes, how should parents help?

Turn baby's head to the side to bulb suction

105

Where is the safest spot for the car seat?

Middle of the back seat

106

How long does the baby need to face the rear in the car?

Until 1 year-old or weighs 20 pounds

107

What temperature are signs of illness?

Above 101 R or 100.4 ax
Below 97 R or 97.8 ax