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Flashcards in Test 3 Blueprint (3) Deck (57):
1

How much weight is normal for an infant to lose on day 3 or 4?

5-10%

2

Macrosomic means...
Microsomic means...

above 90th percentile
below 10th percentile

3

How many kcal/day is normal for a newborn?

110 kcal/kg/day

4

What do you suction first? Why?

mouth before nose, removes the substances from the mouth/throat area so they won't be aspirated when the nose is suctioned

5

Localized swelling of the soft tissues of the scalp caused by pressure on the head during labor. An expected finding that may be palpated as a soft edematous mass and may CROSS OVER THE SUTURE LINE.

Caput succedanum

6

Caput succedneum usually resolves in ___ to ___ days. Does it require treatment?

3 to 4 days
doesn't require treatment

7

Extravasation of blood from ruptured vessels between a skull bone and its external covering, the periosteum. Swelling is limited by the margins of the cranial bone affected (usually parietals).

cephalhematoma

8

Explain:
AGA
SGA
LGA

AGA: appropriate for gestational age --> btwn 10th & 90th percentile
SGA: small for gestational age --> below 10th percentile; grown at restricted rate during intrauterine life
LGA: large for gestational age --> more than 90th percentile; grown at accelerated rate during intrauterine life

9

What are the 4 ways a baby loses heat?

Evaporation
Conduction
Convection
Radiation

10

What is evaporation?

conversion of liquid to vapor
(ex/ infant covered with amniotic fluid, wet gown)

11

What conduction?

directed contact with objects cooler than skin
(ex/ infant place on cold scale)

12

What is convection?

transfer of body heat to air surrounding infant
(ex/ uncovered in cool room)

13

What is radiation?

heat loss to cooler objects not in direct contact with body
(ex/ walls of nursery near bed or warmer)

14

Characteristics of neonate that lead to heat loss:

- little subQ fat
- thin epidermis/blood vessels close to surface
- body mass (heat-producing tissue such as muscle/adipose) --> small in relation to surface area
- position of extension contributes to rapid heat loss
- cannot shiver to generate heat

15

Characteristics of neonate that encourages thermoregulation:

- flexed position --> conserves heat
- nonshivering thermogenesis from metabolism of brown fat & metabolic activity of brain, heart, liver

16

What are the 2 types of infant jaundice?

physiologic & pathologic

17

Describe physiologic jaundice:

Benign, appears after 24 hrs of age
From normal newborn physiology of increased bilirubin production due to the shortened lifespan and breakdown of fetal RBCs and liver immaturity

18

Describe pathologic jaundice:

Result of underlying disease, appears BEFORE 24 hrs of age or is persistent after day 7
Usually caused by a blood group incompatibility or an infection, but may be the result of RBC disorders

19

How can we treat jaundice?

Feed early & often...helps with excretion of bilirubin in urine & feces
Phototherapy...breaks down bilirubin into an excretable form

20

Phenylalanine is an essential ____ ____.

amino acid

21

What does an infant need before the PKU test can be performed?

adequate amounts of milk (24 hrs)

22

Accumulations of phenylalanine can result in what?

severe mental retardation (but early treatment can avoid this)

23

Education for mother who is receiving the rubella vaccine:

- receive vaccine after birth and again 1 month following
- don't get pregnant for 1 month after vaccination
- may cause rash
- safe for breastfeeding
- made from duck eggs, allergy my develop hypersensitivity to rubella vaccine

24

Normal HR of a newborn:

120-140

25

Where can you best hear the neonate's heart sounds immediately after birth?

midline

26

Where can you best hear the neonate's heart sounds 24 hours after birth?

PMI is found at 4th ICS to left MCL day after delivery

27

Normal RR of newborn?

30-60/min

28

What is characteristic of a newborn's breathing?

- shallow, irregular breathing
- short periods of apnea (

29

What is normal cord blood bilirubin level?

30

Skin staining may be noticed with serum bilirubin levels of ___ to ___ mg/dl.

4 to 6 mg/dl

31

Number one cause of infant stress...

cold

32

Moro reflex:

Strike flat surface that newborn is lying on, or allow head and trunk to fall back to an angle of 30 degrees. Arms and legs extend then abduct, fingers spread to form a "C".

33

Root reflex:

Stroke cheek or edge of mouth, newborn turns to that side and starts to suck.

34

Babinski's reflex:

Stroke outer edge of sole of foot, moving up toward toes. Toes will fan upward & out.

35

Characteristics of gestational newborn maturity (length, weight, L/S ratio):

Length: 17.7 - 21.7 in
Weight: 5.5 - 8.8 lb
L/S ratio: 2:1

36

Characteristics of FIRST PERIOD OF REACTIVITY:

- lasts up to 30 min after birth
- HR increased at first but gradually falls back to btwn 100-120
- RR high = 60-80/min
- Audible grunting, nasal flaring, chest contraction can be present (should clear within one hour)
- may have fine crackles
- infant is alert

37

Characteristics of SECOND PERIOD OF REACTIVITY:

- starts 2-8 hrs after birth, lasts 10 min to several hrs
- tachycardia, tachypnea
- increased muscle tone...really jumpy
- increased mucus production...watch for gag & choking
- meconium usually passed during this time

38

What is considered a normal APGAR score? What is indicative of a need for resuscitation?

7-10 normal
3-4 needs resuscitation

39

APGAR heart rate scores:

0 - absent
1 - 100

40

APGAR respiratory rate:

0 - absent
1 - weak, irregular
2 - good, crying

41

APGAR muscle tone:

0 - flaccid
1 - arms & legs flexed
2 - well flexed

42

APGAR reflex irritability:

0 - no response
1 - grimace
2 - cough or sneeze

43

APGAR skin color:

0 - blue, pale
1 - hands & feet blue
2 - completely pink

44

What can cold stress result in?

- hypoxia (cold stress uses up O2)
- hypoglycemia (glucose depleted in efforts to raise core temp)
- metabolic acidosis
- bilirubin level increased r/t excessive fatty acids released and displace bilirubin from binding sites

45

How can hypoxia lead to metabolic acidosis?

hypoxia --> hypoglycemia --> metabolic acidosis

46

How can cold stress increase bilirubin level?

because fatty acids are released and displace bilirubin from binding sites --> jaundice and potential for kernicterus

47

What nursing interventions are done when baby is too cold?

- dry quickly, put on cap
- attach transistor probe over upper quadrant of abdomen to keep infant's temp 36.5-37 C
- position crib away from walls or windows
- perform exams/procedures under heat panel
- delay bath until temp is stable (36.5/97.7)
- skin to skin with mother, cover with blanket
- swaddle in double warm blankets
- radiant warmer
- observe for resp. distress
- observe for signs of hypoglycemia

48

What is bigger, the head or the chest? By how much?

Head, by approx. 0.5in

49

What type of cry may be noted in a baby with hypoglycemia?

shrill, high-pitched cry

50

What should be done for a hypoglycemic baby?

- check glucose (

51

Diffuse swelling that crosses suture lines on the neonate's head.

caput succedaneum

52

Swelling confined to an area between suture lines:

cephalhematoma

53

How does cephalhematoma contribute to increased bilirubin level?

Blood between skull and periosteum, blood pools under skull and not getting to liver to remove toxins

54

Normal bilirubin levels:
serum...
cord blood...

serum: 0-1 mg/dl
cord:

55

Signs of Down Syndrome?

- small, low set ears
- simian hand crease; broad hands; 5th finger with only 1 flexion crease
- oblique palpebral fissures or upward slant of eyes; epicanthal folds
- flat facial profile with depressed nasal bridge and small nose
- protruding tongue
- hyperflexibility; hypotonic muscles

56

3 ways to determine the presence of congenital hip dislocation of newborn:

1) positve Ortoloni sign
2) unsymmetrical gluteal folds
3) uneven level of knees (Allis sign)

57

Characteristics of POSTTERM newborn:

- wasted appearance, beginning to lose brown fat
- leathery cracked skin
- meconium staining under nails
- long nails
- alertness equal to 2 wk old
- meconium aspiration...difficulty establishing respirations
- macrosomia
- hypoglycemia due to insufficient glycogen stores