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maternity > test 4 > Flashcards

test 4 Flashcards

1
Q

neonate period

A

first 30 days. Baby has to adjust to extrauterine life.
They need to complete this list

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2
Q

physiological adjustments baby needs to make after birth

A

establishing and maintaining respirations
adjusting to circulatory changes
regulating temp
ingesting, retaining, and digesting nutrients
eliminating waste
regulating weight

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3
Q

first period of reactivity

A

first 30 mins of life
stabilization of HR, RR
alert, responsive, usually hungry
golden hour- Use this time to do skin to skin and get baby breast feed. Allows bonding before baby goes to sleep

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4
Q

sleep phase

A

after first period of reactivity

may last from minutes to hours, difficult to awake

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5
Q

second period of reactivity

A

2-8 hours after birth
peristalsis increases

first meconium may occur, gagging, spiting up

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6
Q

when are babies weighed

A

they are weighed every 24 hours

not weighed right after birth typically

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7
Q

what gets suctioned first if needed

A

mouth before nose!

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8
Q

what causes initiative of breathing

A

chemical- increased co2
mechanical- Negative thoracic pressure, baby cries and draws air into lungs
thermal- cold environment
sensory- drying baby off, suctioning

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9
Q

normal new born breathing

A

nose breathers- not mouth
chest and abdomen rise synchronously
shallow and irregular pattern with pauses lasting under 20 secs
30-60 breaths/min

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10
Q

abnormal newborn breathing

A

grunting
nasal flaring
retractions- skin is retracting with ribs
seesaw respirations
persistant cyanosis
tachypnea >60
gasping

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11
Q

newborn resp distress

A

around 120 breaths per minute. Intubation needed

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12
Q

TTN (transient tachypnea of newborn)

A

baby isn’t transitioning as well as should. Encourage more skin to skin or if its bad then possibly nursery

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13
Q

2 cardio changes that occur with birth

A

Foramen ovale - closes quickly after baby starts breathing
Ductus arteriosus- doesn’t shut for 24-48 hours.

Murmur could be heard as ductus arteriosus is closing

If ductus doesn’t close- cardio symptoms may occur

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14
Q

acrocyanosis

A

bluish discoloration of hands and feet
normal if within first 24 hours bc of extrauterine circulation transition.
does not occur in all babies

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15
Q

why are babies at risk for heat loss

A

Blood vessels are closer to skin, don’t have much fat, they don’t shiver

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16
Q

how can baby warm up

A

We want a thermo environment that is warm - skin to skin, hat, blankets, flexion of muscles, metabolize brown fat

thermogenesis- baby makes own heat by moving

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17
Q

4 heat loss mechanisms

A

conduction- occurs if touching something cold- heat transfers to it
convection- from air moving toward them like fan
evaporation- could occur if wet
radiation- heat transfer from one object to another without physical contact. ex- cold wall near by

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18
Q

brown fat

A

only in newborns
amount increases with gestational age

usually present for several weeks unless cold stress

Once it is burnt off its gone.
Metabolized, could warm a infant, but calories and oxygen will be burned to do this

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19
Q

what could happen when a baby is cold

A

hypoglycemia- due to a increased metabolic rate to produce heat

acidosis- Brown fat converted to heat and fatty acids, fatty acids lower pH

Hypoxia- requires extra o2 to produce heat

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20
Q

desired temp for baby

A

36.5 to 37.5 C
(97.7 to 99.5 F)

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21
Q

what can cause hyperthermia in newborns

A

they dont sweat, too much heat/clothes

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22
Q

what should 24 hour bilirubin be

A

under 7

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23
Q

bilirubin in babies

A

Unconjugated bilirubin- cant be excreted. Must go to liver to get conjugated to get excreted by stool.

if bilirubin to high in baby, could cause kernicterus (neuro issues)

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24
Q

Why are all babies at risk for elevated bilirubin

A

there RBC have a shorter life, and there livers are immature

this would be physiologic hyperbilirubinemia

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25
Q

what puts babies at even more risk to develop elevated bilirubin

A

Coombs positive, breast feeding if not effective, prematurity, family history

this would be pathologic hyperbilirubinemia

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26
Q

when should baby have first stool and pee

A

first day of life

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27
Q

harlequin sign

A

half of babys face turns red

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28
Q

petechiae in newborn

A

could be from traumatic birth or sign of menigitis

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29
Q

mottling

A

purple rings occur when baby is cold

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30
Q

vernix caseosa

A

waxy white substance found on newborns.
more common in preterm

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31
Q

desquamation

A

newborn peeling skin. more common in post term

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32
Q

nevus vasculosus or “strawberry mark”

A

raised red bits on newborn. they go away with time

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33
Q

nevus flammerus “port wine stain”

A

red mark on newborn face. Skin will not blanch with this and it does not go away

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34
Q

caput succedaneum

A

edema of scalp. goes away on its own

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35
Q

subgaleal hemorrhage

A

collection of blood between skull and periosteum. goes away on its own

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36
Q

cephalohematoma

A

bleeding under scalp, treatment is needed

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37
Q

if newborns are tremoring at rest, what may the issue be

A

NAS, hypoglycemia, neuro issue

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38
Q

newborn reflexes

A

sucking and rooting
swallowing
grasp
extrusion
glabellar
tonic neck
moro
stepping
babinski

39
Q

what sense is not fully developed when baby is born

A

vision

40
Q

six sleep-wake states

A

deep sleep
light sleep
drowsy
quiet alert
active alert
crying

41
Q

APGAR meaning

A

activity
pulse
grimace
appearance
respiration

best score is a 10

42
Q

0 points for APGAR

A

activity absent
pulse absent
grimace floppy
appearance blue
respiration absent

43
Q

1 point APGAR

A

flexed arm and leg
pulse below 100 bpm
grimace- minimal response to stimulation
appearance- blue extremities pink body
respirations slow and irregular

44
Q

2 point APGAR

A

Active activity
pulse over 100
grimace- prompt response to stimulation
pink appearance
vigorous cry (respirations)

45
Q

what to worry about for LGA babies

A

BG

46
Q

where is head circumference measured at

A

above eyebrows

47
Q

where should babys ears line up

A

eye length

48
Q

what to assess in umbilical cord

A

number of vessels
hernia
sign of infection

49
Q

hydrocele

A

fluid in scortal sac

50
Q

what on hand may be a indication of down syndrome

A

simian crease

51
Q

what do you need to know to graph bilirubin

A

hours of age
lab result (TSB)
gestational age
risk factors

52
Q

phototherapy

A

for jaundice

baby needs eye protection, skin care, turned q2, monitor temp

53
Q

how are infants lab drawn

A

by heel

54
Q

when should umbilical cord fall of

A

2 weeks

do sponge bath until its off

55
Q

what is common find for labia in newborns

A

edema
there also may be some discharge or pink stains in diaper

56
Q

what can u do for baby hip dysplasia

A

ortolani maneuver

57
Q

scale that estimates baby’s gestational age

A

Ballard scale

58
Q

benefits of skin to skin

A

faster and easier transition
better temp, resp and glucose reg
lower stress levels
breastfeed longer
improved maternal bonding
less anxiety for mother

59
Q

meds for newborn

A

vitamin K for clotting
hep B vaccine
eye prophylaxis for gonorrhea as it may cause blindness

60
Q

circumcision care

A

monitor for bleeding
monitor for infection
don’t bathe until circumcision looks normal
wrap penis with Vaseline and gauze until healed to prevent scab from falling off

61
Q

what hormone prepares mom for milk

A

prolactin

62
Q

what are breast feeding moms at lower risk for

A

postpartum hemorrhage

63
Q

what can occur when breast feeding early on

A

after pains

64
Q

how many feeds should newborns have in 24 hours

A

8-12 feedings
should be done every 2-4 hours but as baby is hungry

65
Q

how many pee/poos should baby have on day one

A

one pee and one poo
day 2- two pee , two poo
day 3- three pee, three poo

66
Q

by day 5 of life, how much should baby pee/poo

A

they should have 3 stools and 6-8 wet diapers

67
Q

how long is breast milk good for

A

room temp - 5 hours
refrigerator - 5 days
freezer- at least 5 months

dont microwave breast milk!

68
Q

how much should babys eat

A

day 1-2 - 15-30 mL per feeding
then should be increased 5-10 mL per day and should be 90-150 mL by end of second week

69
Q

newborn birth injuries

A

skull fractures- linear or depression
fractured clavicle
peripheral nervous system injury
facial paralysis
neuro injury (such as from o2 injuries, blood flow issues, etc)

70
Q

fractured clavicle signs and symptoms

A

crepitus over the area
absence of moro reflex on that side
feeling of dislocation

immobilize arm by swaddling them
when dressing baby- use affected arm first, and when taking clothes off use nonaffected arm

71
Q

peripheral nervous injury

A

also called erbs palsy
nerve injury- branchial plexus
could heal in 3-6 months if not permanent

avoid pulling on arms
do PROM exercises in a week or 2. baby cant move arm
teach parents how to dress and undress
do not immobilize

72
Q

facial paralysis care

A

cant close mouth so may need to be tube feed at first
eye may dry out wince one cant close so we will need to prevent this

73
Q

Hypoxic ischemic brain injury (HIE)

A

Brain injury due to lack of oxygen

74
Q

what puts babies more at risk for neuro injuries

A

the lower the gestational age, the higher the risk

75
Q

examples of neuro injury problems

A

cerebral palsy
seizures
hydrocephalus

76
Q

therapeutic hypothermia

A

used for hypoxic ischemic brain injury

we cool them because it slows the neurological damage

77
Q

early onset sepsis in newborns

A

acquired in perinatal period

from direct contact with GI/GU tracts- UTI, frequent cervical checks, meconium stained fluid

most common organisms- GBS, E coli
usually manifests within 72 hours of birth

high morality- 3-40%
progresses rapidly

78
Q

late onset neonate sepsis

A

acquired in hospital/community

most common cause- Staph. could also be E coli, enterobacter cloacae, canida

usually occurs at 7-30 days of age
mortality rate 2-20%

79
Q

signs of neonate sepsis

A

apnea, bradycardia
tachypnea
grunting
nasal flaring, retractions
tachycardia
hypotension
temperature instability
irritability
seizures
lethargy
decreased perfusion
jaundice
pallor
feeding intolerance
abdominal distention
petechiae

80
Q

TORCH acronym

A

5 infectious diseases
these are harder diseases to identify

Toxoplasmosis
Other (like hep B, HIV, syphilus)
Rubella (german measles)
Cytomegalovirus (CMV)
Herpes simplex virus (HSV)

81
Q

signs of withdrawl in newborns from substance abuse

A

irritability
hyperactivity
exaggerated moro reflex
high pitched cry
tremor
fever
diaphoresis
mottled skin
poor feeding
frantic uncoordinated suck
dehydration
V/D
disrupted sleep patterns
temp instability

82
Q

how to drug test baby

A

urine sample of baby and mom tells what mom took recently
meconium of baby tells us a bigger picture

83
Q

common congenital defects

A

congenital heart disease
abdominal wall defects
imperforate anus
neural tube defects
cleft lip or palate
club foot
developmental dysplasia of hip

84
Q

preterm infant risk factors

A

previous preterm
maternal infections
multiple gestation
htn
placental issues
diabetes
heart disease
kidney disease
smoking
drug use
poor nutriton
weakened cervix
younger than 17 or older than 35
conceiving via IVF
multiple miscarriages/abortions

85
Q

nursing care for substance abuse

A

cluster care
decrease stimuli
NAS scoring
skin care
swaddle tight
encourage breastfeeding
bonding
hydration

86
Q

if mom is RH- and baby is RH+ what needs to be done

A

rho-gam within 72 hours of delivery in case of another future pregnancy

if mom gets pregnant again, rho-gam will need to be given again at 26-28 weeks

if we don’t do this, moms antibodies will attack future baby

baby will most likely need phototherapy

87
Q

when is indirect vs direct coombs test given

A

indirect when mom is pregnant

direct when mom is post partum

88
Q

infants of diabatic mother issues

A

congenital abnormalities
RDS
extreme prematurity
macrosomia
hypoglycemia

mom needs to maintain euglycemic status to prevent these!

89
Q

high risk problems related to preterm infants

A

thermoregulation
hypoglycemia
hyperbilirubinemia
sepsis
resp function
cognitive and motor delays

90
Q

why is RDS common in premies

A

they dont have surfuctant yet

91
Q

necrotizing enterocolitis (NEC)

A

The most common neonatal intestinal emergency, characterized by intesntinal ischemia. could lead to bowels spilling into perineum

Goals: Stabilize infant, treat infection, rest intestinal tract

needs to be treated with abx. discontinue feedings, NG tube for abdomen depression, Initiate IV fluids. monitor vitals.
encourage mom to breast pump and freeze

92
Q

s/s of NEC

A

*not tolerating feeds, poor perfusion, mottled skin, bilious vomiting, grossly bloody stools, abdominal distention, decreased UO, hypotension, lethargy, jaundice, unstable body temp

93
Q

care of high risk infant

A

assess
resp suport
thermoregulation
protect from infection
hydration
nutrition

maternity (4 decks)

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