Study Guide Test 3 Flashcards
At birth the stomach holds __ml/kg
6ml/kg
Peristalsis in newborns is _______
rapid - twice as fast
Initial feedings should be about ____ ml and then increase very slowly
20 - 25ml
What is the main defining factors between Physiologic Jaundice vs Nonphysiologic Jaundice?
Nonphysiologic (pathologic) jaundice may occur in the first 24 hours while physiologic Jaundice never occurs before 24 hours
Which jaundice is considered normal.
Physiologic jaundice, also called nonpathologic or developmental jaundice, is a transient hyperbilirubinemia (excess bilirubin in the blood) and is considered normal.
The most common cause of jaundice in breastfed infants is _____________.
Insufficient intake
What kind of bilirubin can move into the tissues and cross the blood-brain barrier.
unconjugated
Bilirubin needs to be _______ by the liver in order to be excreted
conjugated
Assess for jaundice by ….
- blanching the infant’s skin on the nose or sternum.
- Assessment should be done in natural light
- Assess for jaundice every 8 to 12 hours along with vital signs.
- Determine how far down the body the jaundice extends.
- obtain transcutaneous or serum bilirubin measurements in any jaundiced infant.
Instruct parents to contact their care provider if they see an increase in jaundice when they are at home or if the infant is not eating well, voiding at least __times daily by the __ day, and producing stools appropriately (at least one stool per day for formula-fed infants and at least four stools daily for breastfeeding infants).
- 6
- 4
Jaundice becomes visible when the bilirubin is greater than __mg/dL
5
How can elevated fatty acids in the blood from Metabolism of glucose in the presence of insufficient oxygen or the metabolism of brown fat increasing the risk of jaundice?
Elevated fatty acids in the blood can interfere with transport of bilirubin to the liver, increasing the risk of jaundice
What 4 things can lead to hemolysis of RBC’s thus increasing the risk of increased bilirubin (jaundice)
- Bruising
- Cephalhematoma
- Physiologic destruction of RBCs
- Pathologic destruction of RBCs
________ is a very rare type of brain damage that occurs in a newborn with severe jaundice
Kernicterus
Physiologic jaundice is caused by ________ _____________
transient hyperbilirubinemia (excess bilirubin in the blood)
Factors that increase risk for increased bilirubin?
- Excess production
- Red blood cell life
- Liver immaturity
- Intestinal factors
- Delayed feeding
- Trauma can result in increased hemolysis of
red blood cells. - Fatty acids are released when brown fat is used
Methods of heat loss
- Evaporation
- Conduction
- Convection -
- Radiation
_________ is air-drying of the skin that results in cooling.
Evaporation
How does CONDUCTION work in heat loss
Movement of heat away from the body occurs when newborns have direct contact with objects that are cooler than their skin.
What occurs in convection?
Transfer of heat from the infant to cooler surrounding air
- NO DRAFTS
__________ is the transfer of heat to cooler objects that are not in direct contact with the infant.
Radiation
Thermoneutral zone in healthy, unclothed, full-term newborns, an environmental temperature of ______________ provides a thermoneutral zone. When the infant is dressed, the thermoneutral range is ___________
- 89.6° to 92.3°F
- 75.2° to 80.6°F
Manifestations of hyperthermia?
- metabolic rate rises, causing an increased need for oxygen and glucose and possible metabolic acidosis.
- peripheral vasodilation leads to increased insensible fluid losses.
- Tachypnea
What is Non shivering thermogenesis?
Metabolism of brown fat to produce heat
What are the hazards of cold stress?
- Increased oxygen need
- Decreased surfactant production
- Respiratory distress
- Hypoglycemia
- Metabolic acidosis
- Jaundice
What can be the result of Metabolism of brown fat ?
- Releases fatty acids which can result in metabolic acidosis
- Elevated fatty acids in the blood can interfere with transport of bilirubin to the liver, increasing the risk of jaundice
How should an infant be dressed to maintain proper thermoregulation
Dressed in an outfit with one more layer
How do thermal factors support respiration of a newborn at birth?
The temperature change that occurs with birth also stimulates the initiation of respirations.
How do the sensory factors help stimulate the first breaths ?
The stimulation of the light, sound, smell, and pain at delivery may also aid in initiating respirations
What role do Chemical factors play in initial respiration’s of a newborn?
Chemoreceptors in the carotid arteries and the aorta respond to changes in blood chemistry caused by the hypoxia that occurs with normal birth.
- A decrease in the oxygen and pH and an increase in carbon dioxide (Pco2) in the blood cause impulses from these receptors to stimulate the respiratory center in the medulla.
What are the 3 shunts in the fetal cardiovascular system and what do they do?
- Ductus Venosus- Directs blood away from liver to inferior vena cava
- Foramen Ovale - a flap valve in the septum between the right and left atria of the fetal heart. As blood flows into the right atrium, 50% to 60% crosses the foramen ovale to the left atrium
- Ductus Arteriosus - Connects the pulmonary artery and the descending aorta
What changes in blood flow occurs after the umbilical cord is clamped and the newborn takes its first breath?
- increase blood flow to the liver and lungs
- Decrease blood flow through the shunts
Clamping of the umbilical cord closes which shunt?
- Ductus Venosus
When does the foramen ovale’s flap valve close?
- when the pressure in the left atrium is higher than that in the right atrium.
Heat is produced in newborns by increased activity, flexion, and metabolism, vasoconstriction, and nonshivering thermogenesis. These factors increase _______ and ________ consumption and may cause respiratory distress, hypoglycemia, acidosis, and jaundice.
- Oxygen
- Glucose
Newborns receive passive immunity when _____ crosses the placenta in utero. After birth, IgM and IgA are produced to protect against infection.
IgG
What immunoglobulin is present in colostrum and breast milk?
IgA
What 6 behavioral states do Newborns progress through
- quiet sleep
- active sleep
- drowsy
- quiet alert
- active alert
- crying.
During what behavioral state is it a good time to increase bonding and continue to work on breast feeding?
Quiet Alert State
When does the first period of reactivity occur and how long does it last?
- Right after birth for about 30 min but can last for 2 hrs
During what period of reactivity should the mother begin breast feeding?
1st period of reactivity
Observing for signs of hypoglycemia is necessary throughout routine assessment and care. Early signs include
- jitteriness and other central nervous system signs
- signs of respiratory difficulty
- decrease in temperature
- poor feeding
Signs of neonatal hypoglycemia (more extensive list)
• Jitteriness, tremors • Poor muscle tone • Diaphoresis (sweating) • Poor suck • Tachypnea • Tachycardia • Dyspnea • Grunting • Cyanosis • Apnea • Low temperature • High-pitched cry • Irritability • Lethargy • Seizures - coma
RISK FACTORS FOR NEONATAL HYPOGLYCEMIA
- Prematurity
- Postmaturity
- Late preterm infant
- Intrauterine growth restriction
- Large or small for gestational age
- Asphyxia
- Problems at birth
- Cold stress
- Maternal diabetes
- Maternal intake of terbutaline
what are the hormonal changes at birth in relation to breast milk production?
- prolactin is secreted after the delivery of the placenta and it activates milk production
- oxytocin increases in response to nipple stimulation
What 3 hormones inhibit breast response to prolactin during pregnancy milk production in a pregnant woman?
- Estrogen
- Progesterone
- hCS
When is prolactin secreted at the highest levels with suckling?
During the night
_______ increases in response to nipple stimulation and causes the milk ejection reflex or let-down reflex
Oxytoncin
How to care for a circumcision?
- Observe the circumcision site at each diaper change, and check the amount of bleeding. Call the physician if more than a few drops of blood are present with diaper changes on the first day or any bleeding thereafter.
- Continue to apply petroleum jelly to the penis with each diaper change for the first 4 to 7 days or as directed by your pediatrician.
- If a PlastiBell ring was used, do not use petroleum jelly because it might make the ring fall off too soon.
- Keeping the circumcision site clean is important for healing. Squeeze warm water from a clean washcloth over the penis to wash it. Pat gently to dry the area.
- Fasten the diaper loosely to prevent rubbing or pressure on the incision site.
- Expect a yellow crust or scab to form over the circumcision site. This is a normal part of healing and should not be removed.
- The scab will fall off within 7 to 10 days. If a PlastiBell ring was used, the plastic rim will fall off in 10 to 14 days (AAP, 2011). If it does not fall off by that time or falls off sooner, notify your physician.
- Watch for signs of infection such as fever or drainage that smells bad or has pus in it. Call your physician if you suspect any abnormalities. The circumcision site should be fully healed in approximately 10 days.
After a circumcision an infant should be observed for at least ___ hrs before being released
2
Nursing interventions for an infant with excessive bleeding post circumcision? And what would she anticipate the physician to do?
- Apply pressure
- NOTIFY PHYSICIAN
- Apply Gelfoam, epinephrine or may suture the small blood vessel
If the infant goes home before voiding, after being circumcised, the mother is instructed to call the physician if the baby does not urinate within __ to __hours.
6 - 8
Signs of complications of circumcision include the following:
- Bleeding more than a few drops with first diaper changes
- Failure to urinate
- Signs of infection: fever or low temperature, purulent or foul-smelling drainage
- Displacement of the PlastiBell ring
During the APGAR test, The nurse scores the infant at __ minute and __minutes in each of five areas.
- 1
- 5
Blood sugars are monitored for babies below the ___ percentile and above the ___ percentile.
- 10th
- 90th
During APGAR scoring, the infant is assigned a score of ___ to ___ in each of the five areas, and the scores are totaled.
0
2
What are the 5 areas of assessed during an APGAR SCORE?
- Heart Rate
- Respiratory effort
- Muscle tone
- Reflex response
- Color
What do you do for APGAR score of 0 - 2
Infant needs resuscitation
APGAR scores from ___ to ___ don’t require any interventions
7 - 10
What do you do for APGAR score of 3 - 6
- Gently stimulate by rubbing infant’s back while administering oxygen.
- Determine whether mother received narcotics, which may have depressed infant’s respirations.
- Have naloxone (Narcan) available for administration.
What blood tests are done to screen for metabolic, hematologic, or genetic disorders ?
When are the tests performed?
- phenylketonuria
- hypothyroidism
- galactosemia
- hemoglobinopathies
- congenital adrenal hyperplasia
24 to 48hrs
<p>When should the hearing test be performed?</p>
within the first month
<p>How do pain and anxiety affect a woman's already high metabolic rate.</p>
Increase
Excessive pain can heighten a woman’s fear and anxiety, which stimulates an increased secretion of
Catecholamines
