The Normal Newborn (1)

Question 1

what is necessary for fetus lung compliance?

Answer 1

surfactant (lecithin and sphingomyelin)
(open alveolar sacs in lungs so oxygenation can take place)

Question 2

what is the ideal ratio of lecithin adn sphingomyelin (surfactant)

Answer 2

2:1 or greater lecithin:sphingomyelin

Question 3

what are fetal breathing mvmts

Answer 3

breathing mvmt in the amniotic fluid

Question 4

describe a babys first breath

Answer 4

inspiratory gasp from CNS response to mechanical, reabsorptive, chemical, thermal, and sensory changes

Question 5

what are the mechanical events of respiration before/during birth

Answer 5

• lung fluid decreases prior to onset of labor
• chest compression during labor
• higher intrathoracic pressure leads to absorption of lung fluid

Question 6

what do chemical stimuli do for the resp system

Answer 6

stimulate chemoreceptors that stimulate the respiratory center

Question 7

what are examples of cemical stimuli

Answer 7

• transitory asphyxia (HR decelerations, less o2=inc. resp)
• elevation of PCO2 (inc. co2=inc. resp)
• decrease in pH
• clamping umbilical cord, dec. prostaglandins

Question 8

what is thermal stimuli

Answer 8

cold stimulates sensory receptors

Question 9

what is sensory stimuli

Answer 9

tactile, auditory, visual, and painful stimuli stimulate receptors

Question 10

what is the normal respiratory rate for newborns?

Answer 10

30-60

Question 11

describe newborn breathing

Answer 11

• irregular breathing pattern
• obligatory nose breathers

Question 12

what are some potential signs of respiratory distress?

Answer 12

• inc. resp rate
• grunting
• retracting
• flaring
• color change

Question 13

what part of fetal circulation allows blood from the umbilical vein to bypass the liver and enter the right atrium

Answer 13

ductus venosis

Question 14

what part of fetal circulation allows blood flow from right atrium to left atrium

Answer 14

foramen ovale

Question 15

what part of fetal circulation allows blood flow from pulmonary artery to aorta

Answer 15

ductus arteriosis

Question 16

when will the ductos venosis close?

Answer 16

when blood supply from umbilical venous return is closed off

Question 17

when will closure of the extra fetal circulation pathways take place?

Answer 17

when blood starts going to the lungs

Question 18

how long does it take for the ductus venosis to close

Answer 18

4 weeks

Question 19

how long does it take for the foramen ovale to close

Answer 19

30 months

Question 20

how long does it taje for the ductus arteriosis to close

Answer 20

2 months

Question 21

normal newborn heart rate is ____ following delivery, ____ in full term newborn, and ____ during deep sleep

Answer 21

180, 110-160, 80-100

Question 22

what is turbulent blood flow through narrow opening

Answer 22

presence of murmur

Question 23

what can happen if the cardiovascular ducts don’t close?

Answer 23

-mix of oxyegnated and nonoxygenated blood, can lead to color changes and poor feedings

Question 24

what is a normal fetal pulse ox?

Answer 24

50%

Question 25

describe hemoglobin levels in newborns

Answer 25

levels rise initially , get additional hgb from placenta, atransient dehydration

Question 26

describe physiologic anemia of the newborn

Answer 26

cell life is shorter, cells die off faster than they can reproduce, peaks @ 3 mo., iron supplements given

Question 27

who does Rh incompatibility effect?

Answer 27

people that are Rh- (negative blood type)

Question 28

describe Rh incompatibility

Answer 28

rh- mother is not effected during the first pregnancy, but antibodies are made that will attack subsequent pregnancies

Question 29

what works to prevent antibody (rh) formation against subsequent pregnancies

Answer 29

rhogam

Question 30

when is rhogam given

Answer 30

-during pregnancy -postpartum -after abortions

Question 31

what blood type does Rh incompatibility effect?

Answer 31

-

Question 32

what is heat loss from air current

Answer 32

convection

Question 33

what is heat lost when the surface around baby is colder

Answer 33

radiation

Question 34

what is heat lost when the body is moise with dry air?

Answer 34

evaporation

Question 35

what is heat lost when baby loses heat to a cold surface (like a scale)

Answer 35

conduction

Question 36

what is a normal baby temp

Answer 36

36.4-37.2

Question 37

describe relation of gestation/brownfat/flexed position

Answer 37

full-term babies have more brown fat and can flex better

Question 38

what allows for optimal oxygen use, metabolism, and internal temp because of thermal balance?

Answer 38

neutral thermal environment

Question 39

what helps thermogenesis

Answer 39

increased BMR, muscular activity, nonshivering thermogenesis

Question 40

what are interventions for baby hypothermia

Answer 40

* verift reading * double wrap and hat * kangaroo care (skin/skin) * warmer or isolette

Question 41

what is the role of the liver in a newborn

Answer 41

iron storage, carbohydrate metabolism, conjugation of bilirubin

Question 42

is jaundice a normal biologic response?

Answer 42

yes

Question 43

what is jaundice from?

Answer 43

increased bilirubin levels

Question 44

physiologic jaundice occurs after low long?

Answer 44

after the first 24 hours

Question 45

interventions for physiologic jaundice

Answer 45

-notify pediatrician -well hydrated -phototherapy (maximum skin, exposure cover eyes, monitor diapers)

Question 46

where does bilirubin go if theres too much?

Answer 46

brain

Question 47

what is long term irreversible permanent brain damage

Answer 47

kernicterus

Question 48

what is breast feeding jaundice associated with

Answer 48

poor feeding and inadequate fluid intake

Question 49

what are interventions for breast feeding jaundice

Answer 49

frequent feedings and lactation support

Question 50

when does breast milk jaundice begin

Answer 50

after day 7

Question 51

what is breast milk jaundice r/t

Answer 51

breast milk itself

Question 52

what results from breastmilk causing reabsorption of bilirubin from the intestine. free fatty acids from BM comoete for binding sites on albumin and inhibit coagulation

Answer 52

breast milk jaundice

Question 53

when is swallowing and peristalsis initiated?

Answer 53

in utero

Question 54

when does the first BM normally occur, and what is the goal time

Answer 54

within 48 hours, goal of 8-24 hr

Question 55

what is 1st BM called?

Answer 55

meconium

Question 56

what is the implication and function of vitamin k in newborns

Answer 56

since the GI tract is sterile, there is limited vitamin k. it is used for clotting

Question 57

what is the normal BM frequency

Answer 57

vary, 1 BM every 2-3 days up to 10 per day

Question 58

what kind of stool is greenish "raspberry seed" appearance, lasts 1-2 days

Answer 58

transitional stool

Question 59

is breastfed or formula stool more formed?

Answer 59

formula

Question 60

how long does it take for most babies to void, and nearly 100% void by when?

Answer 60

most within 24 hr, 100% 48 hr

Question 61

do babies have a higher or lower GFR than adults

Answer 61

lower

Question 62

when can babies fully concentrate urine?

Answer 62

3 months

Question 63

pain relief for circumcision

Answer 63

lidocaine @ site prior tylenol after

Question 64

what is the pain assessment tool for newborns?

Answer 64

NIPS (neonatal infant pain score)

Question 65

what pain meds are used in infants?

Answer 65

local, emla (cream numb), tylenol, sweetease (sucrose solution)

Question 66

what is the normal appearance of the penis after circumcision?

Answer 66

beefy red and raw (no swelling/active bleeding)

Question 67

should petroleum jelly be used after circumcision?

Answer 67

yes!!!! liberally

Question 68

what kind of immunity is where the pregnant woman forms antibodies from exposure

Answer 68

active acquired immunity

Question 69

what kind of immunity is where IgG antibodies are transferred to teh fetus? (fetus gets from mom)

Answer 69

passive acquired immunity

Question 70

between IgG and IgM, which crosses the placenta?

Answer 70

IgG

Question 71

where is IgA found?

Answer 71

colostrum

Question 72

what is seen in the first period of reactivity in newborn neurological function

Answer 72

Hr and RR are elevated alert from time of birth-30 mins

Question 73

what is seen during the period of inactivity in newborn neuro function

Answer 73

Hr and RR decrease may sleep up to 4 hours

Question 74

what is seen in the second period of reactivity in newborn neuro

Answer 74

HR and RR may increase awake/alert for 4-6 hr

Question 75

what sleep state for newborns has eyes closed, no eye movement, regular resps, and HR 100-120

Answer 75

deep sleep

Question 76

what sleep state in newborns has irregular resps, rapid eye mvmt, irregular sucking

Answer 76

light sleep (REM)

Question 77

what newborn alert state has open/closed eyes w/ fluttering eyelids

Answer 77

drowsy/awake

Question 78

what newborn alert state has the baby alert, may fixate on attractive object

Answer 78

quiet alert

Question 79

what newborn alert state has eyes open and motor activity quite intense

Answer 79

active alert

Question 80

what newborn alert state is an intense state

Answer 80

crying

Question 81

what is the visual capability of newborns

Answer 81

faces, bright colors, and patterns

Question 82

what is the auditory capability of newborns

Answer 82

can hear, conduct hearing test

Question 83

what is the olfactory capability of newborns

Answer 83

identify people through smell

Question 84

what is the taste capability of newborns

Answer 84

can respond to taste

Question 85

describe the grasping reflex

Answer 85

holding a placed finger

Question 86

describe the rooting reflex

Answer 86

stroke face, it turns with attempt to suck

Question 87

when does teh rooting reflex disappear

Answer 87

4 mo.

Question 88

when does the stepping reflex disappear

Answer 88

4-8 weeks

Question 89

describe the babinsky reflex

Answer 89

stroke sole of foot, fans/extends toes

Question 90

describe the tonic neck reflex

Answer 90

turns head to one side when laying on back, arm extended on baby side faces, flexed on opposite side