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SEM 1 > W6: Newborn Assessment > Flashcards

W6: Newborn Assessment Flashcards

1
Q

3 components of physiologal adjustments for newborns

A
  • establishing and maintaining respirations
    -adjusting to circulatory changes
  • regulating temperature
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2
Q

Chemical factors of establishing respirations

A

activation of chemoreceptors on carotid arteries & aoorta d/t fetal hypoxia
contraction temporarly decreases uterine blood flow and gas exchange = transient fetal hypoxia
dec PO2, inc PCO2, dec blood pH
stimulation of respiration centre

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3
Q

thermal factors of establishing respirations

A

cold extrauterine environment
stiumulates receptors in the skin resultng in stimulation of the respiratory centre in the medulla
(cold stress important for initializing breathing)

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4
Q

mechanical factors of establishing respirations

A

changes in intrathoracic pressure from compression of the chest during vaginal breath
relieve of the perssure results in negatice intrathoracic pressure which helps draw air into lungs
crying of baby (increases air distribution in lung, + pressure keeps alveoli open)

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5
Q

sensory factors of establishing respirations

A

handling or drying, lights, sounds, smells stimulate respiratory centre
pain associated w/ birth

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6
Q

cirulatory changes after birth

A

expansion of lungs increases BP –> dec in pulmonary pressure –> dec shunting of blood to ductus arterious and closure of ductus arteriosus

in pressure in LA of the heart & low pressure in RA cause foramen ovale to close

faliure of closure = patent foramen ovale = surgical repair

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7
Q

physiological: why are newborns at tisk of heat loss-hypothermia

A

larger body surface to body weight
less adipose tissue & fat in newborns
underdeveloped sweating and shivering mechanisms
blood vessels closer to skin surface = heat loss

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8
Q

Newborn Heat-Loss: Evaporation

A

loss of heat when water evaporates from the skin &b resp tract

  • falling completely dry after bathing
  • dry baby quickly and remcoe we towels/blankets
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9
Q

Newborn Heat-Loss: Conduction

A

heat loss from the body surface to cooler surface in direct contact

-prewarm incubator/radiant warmer to ensure warm matress
-cover x-ray plates & scales
- prewarm hands, blankets, equipments
- weighing the newborn should have a protective cover to minimize conductive heat loss

  • skin to skin!!
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10
Q

Newborn Heat-Loss: radiation

A

heat loss to surrounding colder solid objects (not in direct contact)

keep incubator, table, cots away from outside walls
dress baby
avoid exposing direct air

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11
Q

Newborn Heat-Loss: convection

A

heat loss from the body surface to cooler ambient air

  • temp should be 22-26
    -cover baby head
    -wrap/dress baby
    -warm o2
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12
Q

describe cold stress

A

cold
–> oxygen consumption inc –> pulmonary + peripheral vasoconstriction –> decreasing oxygen uptake by the lungs & oxygen to tissues –> aerobic glycolysis —> dec pO2 + pH –> metabolic acidosis

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13
Q

What are the components of APGAR

A

apperance
pulse
grimace
activity
respiration

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14
Q

APGAR: Apperance

A

0 = pale/blue
1= extremeties blue
2= pink

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15
Q

APGAR: Pulse

A

0 = no pulse
1 = <100 bpm
2 = >100 bpm

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16
Q

APGAR: Grimace

A

0= no response to stimulation
1 = grimaces or weak cry
2 = cries and pulls away

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17
Q

APGAR: Activity

A

0 = no movement
1= arms, legs flexed
2= active movement

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18
Q

APGAR: Respiration

A

0= no breathing
1= slow irregular
2= strong cry

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19
Q

Interpreting APGAR Score

A

0-3 = severe distress
4-6 = moderate difficulty
7-10 = minimal-no difficulty

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20
Q

when do you reassess APGAR scores

A

is the score is less than 7 @ 5 mins, you reassess at 10-20 mins

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21
Q

when is APGAR score done?

A

1-5 mins after birth

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22
Q

PA: Respiratory System

A

observe for 1 full min
auscultate

normal = 30-60 bpm
shallow & irregular
apneic periods of 5-10 secs as fluid is absorbed/expelled
possible crackles (1st hour PP)
acrocyanosis - normal during transition

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23
Q

Signs of Respiratory Distress

A

chest retractions
grunting w/ expirations
increase use of intercostal msucles
nasal flaring
respiration rate <30 / >60

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24
Q

PA: Cardiovascular System

A

110-160 bpm
- <110/160< = reeval after 30m-1hr
heart murmurs for first 6 mo
BP: 60-80/40-50
Fetal Hb: 14-24g/dl
Blood volume: 300mls

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25
Q

PA: Cardiovascular Abnormal

A

persistent tachy (>160)
persistent brady (<100)
anemia
hypovolemia
hyperthermia
sepsis
congenital heart block
hypoxemia
normal sinus brady
hypothermia
unrqual/absent pulses
dec./inc. BP

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26
Q

How long does anterior fonatel take to close?

A

18 months

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27
Q

how long does it take porterior fonatel take to close

A

8-12 months

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28
Q

Widely spaces sutures =

A

hydrocephaly

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29
Q

premature closer of sutures =

A

craniocynostosis

30
Q

Signs of Fonatel Concerns

A

full bulging (tmor, hem, infection)
large, flat, soft (malnutrition, hydrocephaly, delayed bone age, hypothyroidism)
depressed = dehydration

31
Q

Cephalhematome

A

d/t pressure of L&D, forceps
largest on 2nd-3rd day (boggy, edemous)
does not cross suture lines
resolves in 3-6 weeks
not aspirated d/t risk of infection
increase risk of jaundice

32
Q

capcut succedaneum

A

localized edematous area of the soft tissue of scalp (compression of vessels, slow venous return)
extends beyond suture lines
disappears spontaneously within 3-4 days

33
Q

PA: Mouth

A

lips symmetrical
pink, moist lips + mucosa
suckling blisters (from breastfeeding latch)
saliva not excessive
intact hard + soft palate
freely moving tongue
tongue not protuding
sucking pads inside cheeks
uvula midline
anatomical groove in palate to accomadate nipple (gone by 3-4 years)

34
Q

epstein’s pearls

A

small, firm, white cysts on gyms, resolve on its own during 1st weeks

35
Q

PA: Common Conditions of the Mouth

A

thrush: white plaque, similar to milk curds, not easilt scraped off
precocious= teeth at birth
cleft lip/palate
short lingual frenlum (tongue-tie)
asymmetry in movement of lips (seventh cranial nerve paralysis)
cyanosis, circumoral pallor (resp distress, hypothermia)

36
Q

PA: Female genitalia

A

labia: size, labia not fused, ambiguous genitalia
milky vaginal discharge (m. hormones)
psuedomenses d/t hormones
vaginal tag (hymenal tag), disappears in a couple weeks
swelling of breast tissue (male & femle) d/t hyperestrogenism, some d/c

37
Q

PA: male genitalia

A

hypospadias - circumcision contraindicated
epispadias
phimosis
tight prepuce
hydrocele
discolouration of testes - testicular torsion
crepitus of groin or scrotal sac = hernia
cryptochidism

38
Q

hypospadias

A

hole on bottom

39
Q

epispadias

A

hole on top

40
Q

phimosis

A

foreskin cannot fully retract

41
Q

hydrocele

A

fluid around testes

42
Q

cryptochidism

A

undescended testes

43
Q

PA: Skin

A

pink, perfused
capilary refill <2secs
good skin turgor
skin is soft, dry
acrocyanosis (6-8 hrs pp)
post-mature: dry skins, cracking on hands + feet
pre-mature: loosse, wrinkled skin
mottling: due to temp

44
Q

PA: Abnormal Skin

A

mottling: due to temp instability, overstimulation,

tense, shiny, tight skin = edema, cold, shock, infection

45
Q

PA: Extremeties

A

assess ROM of arms & shoulders
leg length symmetrical gluteal crease
club foot = talipes equinovrus
back: straight & flexible
pilondial dimple: cleft base of sacrum, benign

digitd:
extra: polydactyly
webbind= syndactyly

46
Q

Suckling Reflex

A

sucking when anything placed in mouth OR touches lips

47
Q

Rooting Reflex

A

infant turns head when side of mouth/cheek is stimulated
present for 3-4 months
for latching

48
Q

Moro Reflex

A

startling infant
symmetrical extending of arms out, knee flex
lasts 6mo
sensitive neurological ass.

49
Q

Babinski refelx

A

hyperextension of toes when sole is stroked from heel up to ball of foor
gone by 1 yr

50
Q

Prophylactic & Screening Measures

A

0.5% erythromycin eye ointment within 1 hr (gonnocacal)
vit k injection 1 hr (hem)
heb B at birth, HBIG 12 hrs after (active m hep b)
blood glucose, basleine @2hr
- GDM,LGA, SGA= 30m-1hr
heel prick (bilirubin, pku, sickle cell, hypothyroidism)
screening for congenital heart disease (O2)
- repeat is >3% diff between two reading, or <94%
- right hand + foot
hearing loss

51
Q

Pain in Newborns: oxygentation

A

inc satutation
dec arterial saturation

52
Q

Pain in Newborns: Skin

A

pallor
flushing
diaphoreis
palmar sweating

53
Q

Pain in Newborns: vocalization

A

crying
whimpering
groaning

54
Q

Pain in Newborns: Facial Expression

A

grimace
brow furrow
chin quivering
eyes closed
mouth open- squarish

55
Q

Pain in Newborns: body movements & posture

A

limb withdrawal
thrashing
rigidity
flaccidity
fist clenching

56
Q

Pain in Newborns: changes in state

A

changes in sleep-wake cycle
feeding behaviours
activity levels
fussiness
irritability

57
Q

Pain Management

A

not-nutritive sucking on paciifer
oral sucrose in small amounts
skin-skin contact (kangaroo)
breastfeeding, breast milk
swaddling wrapping
touch, massaging, rocking, holding, environmental modification

58
Q

High Risk: Jaundice

A

hyperbilirubinemia (340mcmol/L) for first 28 days

cause: increase bilirubin level
short lifespan of RBC
immature liver
heaptic obstruction

59
Q

Physiologcal Jaundice

A

appears 24 hrs of age, resolves w/o tx

60
Q

pathological jaundice

A

appears within 24 hrs
untreated = bilirubin neurotoxic to brain
>100mcmol/24hrs
bilirubin encephalopathy (lethargym seizure, death, poor sucking, irritability)

61
Q

kernicterus

A

irreversivle long term consequences of bilirubin toxicity

hypotonia
delayed motor skils
cerebral palsy
hearing loss
gaze abnormalitiess

62
Q

phototherapy

A

reduced level of circulating unconjugated bilirubin to keep it from increasing

levels begin to decrease within 4-6 hours

63
Q

Phototherapy precautions

A

newborn’s eyes protected by shield (retinal damange)
temperature should be closely monitored q2hr
possibility of heat loss and dehydration
feeding is critical
no ointments (heat absorption & cause burns)
maintain skin integirty - loose stool due to bilirubin breaskdown

64
Q

ELBW

A

<1000g

64
Q

Preterm Risk

A

repiratory distess
thermal instability
hypoglycemia
jaundice
feeding difficulties
neurodevelopment issues
infection

65
Q

Preterm Complication

A

RDS
patent ductus ateriosus
periventrical-intraventricular hemorrhage
nectrotizing entercolitis

66
Q

NC: Nutrition & Hydration

A

breastfeeding
gavage feeding (nasogastric, orogastric tube)
gastrostomy feeding (tube)
supplemental parenteral fluids

67
Q

NC: skincare

A

use skin products with caution
rinse with waters afterwards
minimal use of adhesive tape - delayed removal

68
Q

LGA

A

higher incidence of birth injuries
asphyxia
congentical anomalies

69
Q

Causes of LGA

A

maternal DM
maternal obsesity
hx of LGA babies
geentic anomalies
excessive weightgain during pregnancy

70
Q

Infants of diabetic mothers

A

higher risk of hypoglycemia
high maternal blood sugar levels during fetal life, leads to hyperinsulnism
removal of newborn glucose supply = hyperinsulnism –> neurological damage, death

71
Q

clincal signs: infant of mother w/ DM

A

macrosomia/LGA
plump, full faced
abundant vernix caseosa
plethora
listless, lethargic
meconium stained
hypotonia

SEM 1 (11 decks)

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