Ch23 study guide (physiologic/behavioral adaptations of the newborn)

Question 1

protein manufactured in type II cells of the lungs that reduces surface tension, thereby decreasing the pressure required to keep alveoli open with inspiration and preventing total alveolar collapse on exhalation
(alveolar stability is maintained)

Answer 1

surfactant

Question 2

maintenance of balance between heat loss and heat production

Answer 2

thermoregulation

Question 3

generation of heat

Answer 3

thermogenesis

Question 4

heat production process unique to the newborn accomplished primarily by brown fat metabolism and secondarily by increased metabolic activity in the brain, heart, and liver

Answer 4

nonshivering thermogenesis

Question 5

environment in which heat balance for the newborn is maintained
- it is at the temperature that allows the newborn to maintain a normal body temperature to minimize oxygen and glucose consumption

Answer 5

neutral thermal environment

Question 6

flow of heat from heat from the body surface to cooler ambient air
- two measures to reduce heat loss using this method are to keep the ambient air at 24*C and wrap the infant who is in an open bassinet

Answer 6

convection

Question 7

loss of heat from the body surface to a cooler, solid surface not in a direct contact but in relative proximity
- to prevent this type of heat loss, cribs and examining tables are placed away from outside windows and care is taken to avoid direct air drafts

Answer 7

radiation

Question 8

loss of heat that occurs when a liquid is converted to vapor

• in the newborn, heat loss occurs when moisture from the skin is vaporized
• this heat loss can be intensified by failure to dry the newborn directly after birth or by drying the newborn too slowly after a bath

Answer 8

evaporation

Question 9

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

• when admitted to the nursery, the newborn is placed in a warmed crib to minimize heat loss
• placing a protective cover on the scale when weighing the newborn will also minimize heat loss by this method

Answer 9

conduction

Question 10

high body temperature (37.5C) that develops more rapidly in the newborn than in the adult

• the newborn has a decreased ability to increase evaporative skin water losses because of a relatively large body surface and sweat glands that do not function sufficiently to allow the newborn to sweat
• it can cause neurologic injury and increased risk of seizures and (if severe) heat stroke and death

Answer 10

hyperthermia

Question 11

pinkish, easily blanched areas on the upper eyelids, nose, upper lip, back of the head, and nape of the neck
- they are also known as “stork bites”, “angel kisses”, or “salmon patches”

Answer 11

telangiectatic nevi (nevus simplex)

Question 12

overlapping of the cranial bones to facilitate passage of the fetal head through the maternal pelvis during the process of labor and birth

Answer 12

molding

Question 13

generalized, easily identifiable edematous area of the scalp, usually over the occiput

Answer 13

caput succedaneum

Question 14

collection of blood between skull bone and its periosteum as a result of pressure during birth
- it does not cross a suture line

Answer 14

cephalhematoma

Question 15

bluish-black pigmented areas usually found on back and buttocks

Answer 15

Mongolian spots

Question 16

bluish discoloration of the hands and feet, especially when chilled
- it is a normal intermittent finding over the first 10 days after birth related to vasomotor instability and capillary stasis

Answer 16

acrocyanosis

Question 17

white cheesecake substance that coats and protects the fetus’s skin while in utero

Answer 17

vernix caseosa

Question 18

white facial pimples caused by distended sebaceous glands

Answer 18

milia

Question 19

yellowish skin discoloration caused by elevated serum levels of unconjugated (indirect) bilirubin

Answer 19

jaundice

Question 20

nonpathologic unconjugated hyperbilirubinemia that occurs in approximately 60% of term newborns
- it appears after 24hrs of age and usually resolves without treatment

Answer 20

physiologic jaundice

Question 21

acute manifestations of bilirubin toxicity that occur during the first weeks after birth
- these can include lethargy, hypotonia, irritability, seizures, coma, and death

Answer 21

acute bilirubin encephalopathy

Question 22

irreversible, long-term consequences of bilirubin toxicity such as hypotonia, delayed motor skills, hearing loss, cerebral palsy, and gaze abnormalities

Answer 22

kernicterus

Question 23

hyperbilirubinemia that can be manifested by breastfed newborns

• early onset, which begins in the first 2-5days of age, is associated with ineffective breastfeeding
• the etiology of the late onset form, which can begin at age 5 or 10 days of age and persists up to 12 weeks, is uncertain but could be related to factors found naturally in breast milk

Answer 23

breast milk jaundice

Question 24

thick, dark green-black stool formed during fetal life and usually passed within 24hr of birth

Answer 24

meconium

Question 25

sudden, transient newborn rash characterized by erythematous macules, papules, and small vesicles found anywhere on the body

Answer 25

erythema toxicum | erythema neonatorium; flea bite dermatitis

Question 26

condition in which the urethral opening is located on the ventral side of the surface of the penis

Answer 26

hypospadias

Question 27

condition in which the urethral opening is located on the dorsal side of the surface of the penis

Answer 27

epispadias

Question 28

accumulation of fluid in the scrotum, around the testes

Answer 28

hydrocele

Question 29

small whitish areas found on the gum margins and at the juncture of the hard and soft palates

Answer 29

Epstein pearls

Question 30

head to rump development in the newborn

Answer 30

cephalocaudal development

Question 31

soft, downy hair on face, shoulders, and back

Answer 31

lanugo

Question 32

bruise

Answer 32

ecchymosis

Question 33

peeling of the skin that occurs in the term infant a few days after birth as vernix cases is removed - if present at birth, it may be an indication of postmaturity

Answer 33

desquamation

Question 34

vascular lesion visible at birth as pink and flat but darkens with time, becoming red or purple and pebbly in consistency - it varies in size, shape, and location, but it is usually found on the neck and face - it does not blanch under pressure or disappear

Answer 34

port-wine stain (nevus flammeus)

Question 35

birthmark consisting of dilated, newly formed capillaries occupying the entire dermal and subnormal layers with associated connective tissue hypertrophy - it is typically a raised, sharply demarcated bright or dark red, rough-surfaced swelling, usually found as a single lesion on the head

Answer 35

strawberry hemangioma (nevus vascularis)

Question 36

slightly blood-tinged mucoid vaginal discharge associated with an estrogen decrease after birth

Answer 36

psuedomenstruation

Question 37

foreskin

Answer 37

prepuce

Question 38

skeletal abnormality resulting in a hip that dislocates easily

Answer 38

developmental dysplasia of the hips (DDH)

Question 39

small, white, firm cysts seen at the tip of the foreskin

Answer 39

epithelial pearls

Question 40

missing digits

Answer 40

oligodactyly

Question 41

extra digits

Answer 41

polydactyly

Question 42

fused fingers or toes

Answer 42

syndactyly

Question 43

variations in the state of consciousness of a newborn infant

Answer 43

sleep-wake states

Question 44

the two sleep states

Answer 44

deep and light

Question 45

the newborn sleeps about ________ hours a day, with periods of wakefulness gradually _________

Answer 45

16-19 hours a day | increasing

Question 46

the four wake states

Answer 46

drowsy quiet-alert active-alert crying

Question 47

the optimum state of arousal in which the infant can be observed smiling, responding to voices, watching faces, vocalizing, and moving in synchrony with speech

Answer 47

quiet-alert

Question 48

ability of the newborn to respond to internal and external environmental factors by controlling sensory input and regulating the sleep-wake states, thereby making smooth transitions between states

Answer 48

state modulation

Question 49

protective mechanism that allows the infant to become accustomed to environmental stimuli - it is a psychologic and physiologic phenomenon in which the response to a constant or repetitive stimulus is decreased

Answer 49

habituation

Question 50

quality of alert states and ability to attend to visual and auditory stimuli while alert

Answer 50

orientation

Question 51

individual variations in a newborn's primary reaction pattern

Answer 51

temperament

Question 52

place infant in a supine position and apply pressure to soles of the feet with fingers when the lower limbs are semi-flexed - legs extend against examiner's pressure

Answer 52

magnet

Question 53

place infant supine on flat surface and make a loud abrupt noise - symmetric abduction and extension of the arms, fingers fan out, thumb and forefinger form a C - arms are then adducted into an embracing motion and return to relaxed flexion and movement

Answer 53

moro

Question 54

place finger in palm of hand or at vase of toes | - infant's fingers curl around examiner's finger or toes curl downward

Answer 54

grasp

Question 55

place infant prone on flat surface, run finger down side of back, first on one side and then down the other side 4-5cm lateral to spine - trunk flexes and pelvis swings toward stimulated side

Answer 55

truncal incurvation (Galant)

Question 56

tap over forehead, bridge of nose, or maxilla when eyes are open - blinks for first 4 or 5 taps

Answer 56

glabellar (Myerson sign)

Question 57

use finger to stroke sole of foot beginning at heel, upward along lateral aspect of sole, then across ball of foot - all toes hyperextend, with dorsiflexion of big toe ("positive response")

Answer 57

babinski (plantar)

Question 58

anal sphincter response to touch by opening and closing

Answer 58

wink reflex

Question 59

undescended testes

Answer 59

cryptorchidism

Question 60

touch infant's lip, cheek, or corner of mouth with nipple or finger - turns head toward stimulus and opens mouth ready to take hold and suck

Answer 60

rooting

Question 61

place sleepy infant in a supine position, then turn head quickly to one side - arm and leg on one side to which head is turned extend while opposite arm and leg flex

Answer 61

tonic neck (fencing)

Question 62

hold infant vertically, allowing one foot to touch table surface - infant alternates flexion and extension of feet

Answer 62

stepping (walking)

Question 63

touch or depress tip of tongue | - tongue is forced outward

Answer 63

extrusion

Question 64

place infant in a supine position, then extend one leg, press knee downward, and stimulate bottom of foot - opposite leg flexes, adducts, and then extends

Answer 64

crossed extension