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maternal child health RN > Powerpoints Test 2 Module 5 > Flashcards

Powerpoints Test 2 Module 5 Flashcards

1
Q

When does the transition from intrauterine to extrauterine life begin?

A

Once the umbilical cord is clamped and the infant takes the first breath….. the transition from intrauterine to extrauterine life begins.

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2
Q

Newborns Thermogenic Adaptation

A

Cold stress
Large body area
Limited subcutaneous fat
Limited ability to shiver
Thin skin and blood vessels close to surface
Non-shivering thermogenesis uses brown adipose tissue

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3
Q

How soon to start the apgar scoring?

A

At 1 minute and 5 minutes

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4
Q

Immediate nursing care at birth includes?

A

Mother–infant identification

•Infection/injury prevention
Eye prophylaxis
Vitamin K injection
Hepatitis B vaccine (parental consent required)

  • Assess blood glucose
  • Hematocrit and hemoglobin
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5
Q

Skin assessment of the neonate

Mongolian Spots

Erythema Toxicum

Lanugo

Milia

A

Dark spots on back

Red dry areas on face

Fine thin hair

White pustules

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6
Q

Assessment of the Infant’s Head

eyes?

Ears?

Lips?

Chin?

A

Symmetry of head

Eyes: shape, size, placement, coordinated lid movement; red reflex; gross vision

Ears: shape, size, placement, hearing

Lips: movement, color

Chin: appropriate size

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7
Q

How to assess Head: Fontanels

A

Estimate size
•Fullness without bulging: normal
•Bulging and tense with large head circumference: increased intracranial pressure
•Sunken: dehydration

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8
Q

Head-

Diffuse edema, crosses suture lines, disappears in few days

A

Caput succedaneum

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9
Q

Subperiosteal hemorrhage
Does not cross suture lines
Persists for weeks

A

Cephalhematoma

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10
Q

Newborn mouth and neck assessment

A

Mouth

Epstein pearls
Teeth
Ability to suck
Hard and soft palate

Neck
Torticollis

Facial features

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11
Q

Respiratory system assessment newborn

A
  • Symmetry in chest movement
  • Breast tissue
  • Nasal patency
  • Respiration rate, pattern, and use of accessory muscles
  • Auscultate lungs, anterior and posterior
  • Abdominal movements should be synchronous with the chest movements
  • Skin color
  • Capillary refill
  • Signs of distress
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12
Q

Cardiovascular system assessment of newborn

A 
Inspection and auscultation
Point of maximum impulse
Heart rate
Capillary refill
Peripheral pulses
Auscultate all areas: murmurs
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13
Q

GI system assessment

A

Abdominal inspection, including umbilical cord
Auscultate bowel sounds, upper abdomen for gastric bubble, and heart sounds of the abdominal aorta
Palpation

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14
Q

usually passes within the first 8-24 hours of life

  • Absence of this by 72 hours of life may be indicative of an obstructive bowel problem
  • Consists of particles found in amniotic fluid such as vernix, skin cells, hair and cells that have been shed by the intestinal tract

•Greenish-black and viscous at first
•Gradually change to transitional stools:
-thinner and greenish-brown to yellowish brown
-1-10 times over a 24 hour period

A

Meconium

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15
Q

Conditions that warrant further assessment in newborns in GI

A

Abdominal distention
Absence of bowel sounds
Discharge from umbilical cord/site
Abdominal mass

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16
Q

Urinary system assessment in newborn

A 
Hips abducted
Palpate and inspect scrotum, testes, and penis
Male: retract foreskin
Palpate and inspect female genitalia
Anus and anal wink reflex
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17
Q

Common findings in male newborns

A

Scrotal swelling
Smegma
Hypospadias-ventral
Epispadias-dorsal

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18
Q

What to assess in newborns urine

A

Nursing assessments
•Careful monitoring of I/O
-Normally void 2-6 times in a 24 hour period during the first 2 days of life
-by fourth day of life, output should increase to more than 6 voids in a 24 hour period
•Assess appearance of urine
•Rusty colored urine can be normal with first voiding and is related to the kidneys having difficulty removing waste products from the blood
-Small amounts of protein and glucose are present in the urine
-Urate crystals: pink-red in color are excreted in urine.
-Disappear after the first few days of life
-Can be mistaken for blood

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19
Q

Common findings in female newborns

A

Hymenal tags
Vernix caseosa on labia
Pseudomenstruation

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20
Q

Conditions that warrant further assessment in perineal area newborn

A 
Undescended testicles
Micropenis
Ambiguous genitalia
Imperforate hymen
Imperforate anus
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21
Q

Musculoskeletal system assessment in newborn

A

Observe infant’s movements in crib
Inspect for differences in extremity length and size
Assess muscle tone and symmetry
Gentle passive ROM to assess joint rotation
Assess head lag
Skin folds on thighs

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22
Q

Musculoskeletal issues that warrants further assessment

A

Fractured clavicle- Palpate for separation of bone ends and for crepitus.
-bruising/swelling/pain
•Polydactyly- Extra digits
•Syndactyly- Webbing
•Simian crease- Single, straight crease in the middle of the palm of one or both hands.
-Down’s syndrome

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23
Q

Neurological assessment in newborn?

A 
Reflexes-
Breathing and Blinking
Swallowing
Stepping
Babinski
Grasping
Moro
Startle
Galant
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24
Q

Neurological issues that warrant further assessment

A

Erb’s palsy
•brachial plexus injury
•

Cerebral palsy
•

Spina bifida

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25
Newborn care
``` Newborn metabolic screening tests Circumcision Ensuring optimal nutrition Discharge planning for the infant and family Child care ```
26
Jaundice in babies - complications Normal biliruban? Tx?
Jaundice (cont’d) Complications Bilirubin encephalopath ? Light phototherapy Cover eyes and genitals No lotion
27
Car seat safety
Middle Rear facing in car Remove heavy outerwear of infant prior to placing and buckling Buckle Harness fastened and placed at infants armpit level.
28
Newborn Metabolic Screening Tests
cystic fibrosis sickle cell anemia phenylketonuria (PKU) A lack of proper conversion results in a buildup of toxic blood levels of phenylalanine, a condition that causes central nervous system damage
29
High risk newborns Gestational age?
``` Gestational age (GA): length of time in utero •Preterm (delivered at or before the completion of 37 weeks’ gestation) •Term (delivered any time from 38 to 41 completed weeks’ gestation) •Post-term (newborn delivered on or after 42 weeks’ gestation) ```
30
High risk newborns Birth weight?
Birth weight: Low birth weight (LBW) (< 2,500 g) Very low birth weight (VLBW) (< 1,500 g) Extremely low birth weight (ELBW) (< 1,000 g)
31
High risk newborns Small for gestational age infants
SGA newborns are those born at any GA with a birth weight that falls below the 10th percentile on the growth charts
32
High risk newborns Large for gestational age newborns
Infants born > 90th percentile on the growth chart Can be genetically large More commonly, exposed to imbalance of nutrients in utero Example: newborn who weighs 3,750 g (8 lb 4 oz) at 40 weeks’ gestational age
33
High risk new born Premature
Prematurity classified by weeks of gestation: Severe prematurity: birth at 23 to 26 weeks Moderate prematurity: birth at 26 to 34 weeks Late preterm: birth at 34 to 37 weeks
34
High risk infants Respiratory distress Cause? S/s
Developmental respiratory disorder Affects preterm newborns (what is given prior to delivery to help present?) Due to lack of lung surfactant ``` Signs and symptoms Expiratory grunting Nasal flaring Cyanosis in room air Rapid breathing (tachypnea) Labored breathing (retractions) Decreased breath sounds, often with rales ``` Note: Beractant (Survanta) lowers minimum surface tension and increases pulmonary compliance and oxygenation in preterm newborns
35
high risk Neonatal absence syndrome NAS S/s Nursing care? How often to score infant?
``` signs and symptoms IRRITABLE TREMORS LOOSE STOOLS SNEEZING INCESSANT CRYING ``` ``` Nursing care Provide quiet and dark environment Provide comfort measures Gently rock and hold infant Some infants prefer not to be held ``` Score infant every 3 hours using neonatal abstinence scoring tool
36
High risk SIDS Sudden infant death syndrome Prevention?
Prevention: Recommendations from American Academy of Pediatrics for safe sleep environment include: “Back to sleep” for every sleep Firm mattress Keep newborn in parent room; NOT in parent’s bed Remove all soft objects and loose bedding from crib Decrease smoking in pregnancy and in the house of a newborn Offer pacifier at nap time and bedtime Do not let newborn get overheated
37
Amniotic fluid supports newborns respiratory system how?
Supports fetal lung development
38
Intrapulmonary fluid supports newborns respiratory system how?
Reduce his pulmonary resistance to bloodflow Initiation of air breathing
39
Surfactant supports newborns respiratory system how?
Lung expansion stimulates surfactant Decreases surface tension within alveoli 34-36 weeks gestation production supports enough for alveolar stability Reduced production in diabetics mothers
40
Pulse within 30 minutes beats how many bpm? Newborn
110-160
41
Newborn capillary refill should be?
Less than 3 seconds Adequate Greater than 4 seconds, possible underlying problem
42
Ph issues with newborn exposure to cold Increases respiration’s — vasoconstriction—-decreases o2 to tissues ——increases glucose—— decreases po2 —-=
Metabolic acidosis
43
Mechanisms for neonatal heat loss
17-8 in book
44
Fetal hgb carries how much more oxygen than adults ? What vitamin infants have none of 17-2 lab values for infants Increase 12 hours after birth
20-50% Vitamin k - risk for bleeding issuesn
45
Establish airway how?
Suction - mouth then nose 18-1
46
Provide warmth how?
Dry infant Place on mother abdomen , heated blankets Place beneath radiant heater Cap
47
The immediate neonatal assessment
Establish airway first Provide warmth Observe respiratory effort, color , muscle tone Stimulate neonate to breathe deeply and cry Assess heart rate, temperature Note obvious abnormalities Check and record number of umbilical cord vessels
48
S/s of neonatal distress
``` Cyanosis Tachycardia above 160 Tachypnea greater than 70 Sternal or rib retractions Grunting Nasal flaring ```
49
Later neonatal assessment
Body positioning 18-3 Skin color Body size Level of reactivity Measurements and determination of gestational age - Ballard tool 18-13
50
Normal newborn findings WT Head and chest circumstance Skin Movement
2500-4000gram - loses 5-10% of weight in first 3 days Head and chest aprox the same Skin may have acrocyanosis Normal spontaneous movement bilat extremities
51
What to teach parents about newborn care? 18-38 and 18-39
Temperature assessment - axillary Bathing Nail care and unbelical cord care Clothing Diapering - below umbilical cord stump Attachment
52
Hyperbilirubinemia risk factors Physiologic jaundice Pathologic jaundice Breastfeeding Breast milk jaundice 17-2
Appears 25-48 hits after birth At birth - 24 hours 2-4 days 10 days
53
Jaundice tx
19-18 and 19-19
54
Fetal lung maturity is determined by the ?
L/S ratio and PG values
55
At birth 3 fetal shunts ? | close and promote circulation to accommodate oxygen intake by the lungs
DFD Ductus arteriosus, foramen ovale, ductus venosus
56
The neurological system including the pns, sns are what at birth?
Underdeveloped
57
Term used to denote a lack of intrauterine fetal growth Usually results in a small for gestational age newborn
Intrauterine growth restriction
58
S/s or characteristics of a SGA small for gestational age newborn?
Wasted muscle tissue Lack of brown fat Abdominal is often sunken in or scaphoid Eyes appear large with a wise old man look Fingernails are often long Meconium stained thin cord is often present 19-4
59
Conditions affecting the SGA newborn
Cold stress such as prolonged hypothermia Pain Hypoglycemia (preterm or high risk are considered hypoglycemic when bs 50-60 Polycythemia (elevated hemocrit) greater or equal to 65%
60
Newborns large for gestational age risks
Newborns with a diabetic mother TTN (transient tachypnea of newborn) delayed clearance of fetal lung fluid Hypocalcemia Hypo-magnesia Birth injuries Brachial plexus injuries 19-8 Fractures
61
Normal newborn calcium levels Low calcium can produce what in newborns? May also have low what?
Greater than 7.5 or 8 in prematures Seizures Low bs 19-5
62
Ballard assessment?
?
63
RDS- resp distress syndrome in newborn Priority intervention
Airway maintenance and oxygenation
64
Types of oxygen therapy for newborn
Humidifier oxygen continuous positive airway pressure (cpap)

maternal child health RN (15 decks)

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