1
Q
bulb vs suction catheter after delivery?
- Mouth, then nose
- Non meconium substance
A
bulb suction
2
Q
bulb vs suction catheter after delivery?
- Meconium plugs
- Only used when infant comes out with no tone, pale, limp, no respiratory effort
A
suction catheter
3
Q
umbilical cord
___ arteries
___ veins
A
- 2 arteries
- 1 vein
4
Q
kangaroo care vs radiant warmer after delivery
- ________________ – option for stable infants
- ________________ – option for c/s infants, unstable infants, infants requiring close assessment
A
- Kangaroo care – option for stable infants
- Radiant warmer – option for c/s infants, unstable infants, infants requiring close assessment
5
Q
Neonatal resuscitation protocol
should nurse intervene?
- preterm baby, no tone, not breathing or crying
- Labored breathing or persistent cyanosis
- Apnea or gasping, HR <100
- HR <100
- HR <60
A
yes = intervene (warm, dry, stimulate, position airway, suction)
yes = intervene (position airway, suction, pulse ox, O2 or CPAP)
yes = = intervene (PPV, pulse ox, cardiac monitor)
yes = intervene
yes = intervene (chest compression, O2, epinephrine)
6
Q
Apgar score
A –
P –
G –
A –
R –
Apgar score taken at _____ min and ___ min
A
Apgar score
A – appearance (color)
P – pulse (HR)
G – grimace (reflex irritability)
A – activity (muscle tone)
R – respiratory effort
Apgar score taken at 1 and 5 minutes
7
Q
Apgar score
are all of these 0, 1, or 2 points?
- Pale blue color
- Absent HR/pulse
- Absent reflex irritability
- Limp muscle tone
- Absent respiratory effort
A
0
8
Q
Apgar score
are all of these 0, 1, or 2 points?
- Body pink, extremities blue in color
- HR/pulse is slow, under 100
- Grimace with reflex irritability
- Some flexion with muscle tone
- Slow, irregular respiratory effort
A
1 point (everything in between 0 and 2, not absent but not great either)
9
Q
Apgar score
are all of these 0, 1, or 2 points?
- Completely pink color
- HR/pulse above 100 bpm
- Vigorous cry with reflex irritability
- Active motion with muscle tone
- Good cry (respiratory effort)
A
2 points
10
Q
Newborn vitals
Pulse
- Normally _____-______ (when is best time to assess?)
- Sleep ______
- Vigorous cry __________
- locations to check pulse _________ and ____________
A
Newborn vitals
Pulse
- Normally 110-160 (at rest, best time to assess)
- Sleep 80
- Vigorous cry 180
- Brachial and femoral pulse
11
Q
new born Temp
- ______.7 F – _____.5 F
- location?
A
Temp
- 97.7 F – 99.5 F
- Axillary
12
Q
new born Respirations
- First 2 hours of life RR is increased – up to ______ breaths/min
- Normal respiratory _____ - _______ breaths/min
A
Respirations
- First 2 hours of life RR is increased – up to 70 breaths/min
- Normal respiratory 30-60 breaths/min
13
Q
- Normal = ___________ breathing – pauses in breathing up to 20 secs
- Abnormal = __________ breathing – pauses in breathing over 20 secs
A
- Normal = periodic breathing – pauses in breathing up to 20 secs
- Abnormal = apneic breathing – pauses in breathing over 20 secs
14
Q
new born BP
- Goes up or down after birth?
- Cap refill
A
BP
- Goes down after birth
15
Q
T/F
When crying vitals will be slightly low and that is normal?
Pulse ox reading screens for congenital heart disease in newborn?
A
F - Consider when crying – vitals will be slightly elevated and that is normal
T - Pulse ox reading screens for congenital heart disease in newborn – low O2 levels indicate heart issues
16
Q
- newborn Weight loss
- Term babies lose _______ of birth weight
- Preterm babies lose _______ of birth weight
- Weight gain
- Double birth weight by 6 mos
- Triple birth weight by 12 mos
A
Measure weight
- Weight loss
- Term babies lose 5%-10% of birth weight
- Preterm babies lose 15% of birth weight
- Weight gain
- Double birth weight by 6 mos
- Triple birth weight by 12 mos
17
Q
Measure length
- Head circumference
- Chest circumference
- Length head to toe
is head or chest circumference bigger in newborn?
A
- Head circumference bigger than chest circumference
18
Q
Skin color
-Completely ________ – desired
-Acrocyanosis – blue hands/feet or body/mouth
-Central cyanosis – blue hands/feet or body/mouth
A
Skin color
- Completely Pink – desired
- Acrocyanosis – blue hands and/or feet
- Central cyanosis – blue body and/or mouth
19
Q
newborn Resting posture
- Preterm – extended or flexed?
- Term – extended or flexed?
A
Resting posture
- Preterm – extended
- Term – flexed (helps preserve heat)
20
Q
newborn skin
- __________ – thin, transparent, veins prominent, smooth feet (no creases)
- ___________– opaque, no vernix, creases on feet
- ____________ – dry, peeling
post term, preterm, term
A
Skin
- Preterm – thin, transparent, veins prominent, smooth feet (no creases)
- Term – opaque, no vernix, creases on feet
- Post term – dry, peeling
21
Q
newborn Back
-Assess spine
-Sacral dimple (pilonidal dimple) - Closed/open indentation or pit at the base of spine
- If ________ must r/o
- Spina bifida occulta
- Tethered cord syndrome
A
Back
- Assess spine
- Sacral dimple (pilonidal dimple)
- Closed/open indentation or pit at the base of spine
- If open must r/o
- Spina bifida occulta
- Tethered cord syndrome
22
Q
T/F
Lanugo decreases as gestational age increases?
A
true
23
Q
observe umbilical for _________
A
hernia
24
Q
Term baby expected appearance T/F
- Creases on soles of feet
- Vernix only in skin creases
- Instant recoil to ears
- Prominent breast bud tissue
- Increased lanugo
A
- Creases on soles of feet
- Vernix only in skin creases
- Instant recoil to ears
- Prominent breast bud tissue
X - lanugo decreases as fetus matures, term baby would have little to none
25
lanugo vs vernix?
fine, downy hair that covers a fetus's body
white, cheesy substance that covers a baby's skin while in the womb
lanugo - fine, downy hair that covers a fetus's body
vernix - white, cheesy substance that covers a baby's skin while in the womb
26
Dubowitz ballard gestational age assessment = Looks at neuromuscular maturity and physical maturity
Lower/Higher score = higher gestational age
Lower/Higher score = lower gestational age
Higher score = higher gestational age
Lower score = lower gestational age
27
Male newborn genitals
-Term or Preterm?
- Small scrotum
- Few rugae (wrinkles)
- Testes are palpable in the inguinal canal
-Term or Preterm?
- Testes are lower in scrotum
- Rugae
Male genitals
-Preterm
- Small scrotum
- Few rugae (wrinkles)
- Testes are palpable in the inguinal canal
-Term
- Testes are lower in scrotum
- Rugae
28
Female newborn genitals
-Preterm/Term?
- Prominent clitoris
- Labia majora small and widely separates
-Preterm/Term?
- Labia majora covers labia minors and clitoris
Female genitals
-Preterm
- Prominent clitoris
- Labia majora small and widely separates
-Term
- Labia majora covers labia minors and clitoris
29
Genitalia variations for Male or Female?
-Hypospadias – urethral opening on underside of penis
-Epispadias - urethral opening on topside of penis
-Phimosis – cant retract foreskin
-Hydrocele – swelling in scrotum
-Cryptorchidism – teste(s) fail to descend
-Pseudo menstruation
Hold _______________ if hypospadias/epispadias is a concern
Male
- Hypospadias – urethral opening on underside of penis
- Epispadias - urethral opening on topside of penis
- Phimosis – cant retract foreskin
- Hydrocele – swelling in scrotum
- Cryptorchidism – teste(s) fail to descend
Hold circumcision if hypospadias/epispadias is a concern
Female
- Pseudo menstruation
30
Skin variations
- Vernix caseosa –
- Milia –
- Telangiectatic nevi –
- Mongolian spots –
- Nevus flammeus –
- Nevus vasculosus –
- Vernix caseosa – cheesy
- Milia – white bumps on face
- Telangiectatic nevi – stork bites
- Mongolian spots – birth marks, mistaken for bruises
- Nevus flammeus – port wine stain
- Nevus vasculosus – strawberry mark
31
resolves, fades, or permanent?
- Vernix caseosa – cheesy
- Milia – white bumps on face
- Telangiectatic nevi – stork bites
- Mongolian spots – birth marks, mistaken for bruises
- Nevus flammeus – port wine stain
- Nevus vasculosus – strawberry mark
- Vernix caseosa – cheesy, wash it off with newborn bath
- Milia – white bumps on face, resolves itself
- Telangiectatic nevi – stork bites, may fade
- Mongolian spots – birth marks, mistaken for bruises, permanent
- Nevus flammeus – port wine stain – permanent
- Nevus vasculosus – strawberry mark – may fade
32
- Birth injury
- Large baby
- Shoulder dystocia
- Difficult birth
can cause fracture of which bone?
Fractures clavicle
33
Erb’s palsy or Epstein’s pearls?
- type of brachial plexus injury that occurs most commonly during childbirth.
- The brachial plexus is a network of nerves that controls movement and sensation in the arm and hand.
Erb’s palsy
34
Polydactyly, Simian crease, or syndactyly?
Single line in palm – consider down syndrome
Webbing
Extra digits
Simian crease - Single line in palm – consider down syndrome
Webbing – syndactyly
Extra digits – polydactyly
35
Clubfoot
- To assess – move foot to midline, resistance = clubfoot
Sole plantar creases
- As gestation progresses, proceeds to heel
- Preterm or Term – creases?
- Preterm or Term – smooth?
- Term – creases
- Preterm – smooth
36
Hip dislocation - Ortolanis maneuver or Barlows maneuver?
- (dislocation maneuver) – if hip is dislocated, will feel femur move out of acetabulum, brings legs together
- (realignment maneuver) – if hip is dislocated, will hear hip click back into place (positive sign), brings legs apart
Hip dislocation
- Barlows maneuver (dislocation maneuver) – if hip is dislocated, will feel femur move out of acetabulum, brings legs together
- Ortolanis maneuver (realignment maneuver) – if hip is dislocated, will hear hip click back into place (positive sign), brings legs apart
37
Newborn head
- Larger or smaller than body?
- About 1/4 of body size?
- Contains 6 or 8 bones?
Newborn head
- Larger than body
- About ¼ of body size
- Contains 6 bones
38
Fontanelles –
- soft and flat =
- sunken =
- bulging =
Fontanelles –
-should be soft and flat
-sunken = dehydrated
- gather more information, ask mom about number of wet diapers and feeding sessions over last 24 hours
-bulging = ICP or crying
- SBAR provider about ICP concern
39
Caput succedaneum or Cephalhematoma?
Collection of blood between scalp and skull bone
- Doesn’t cross suture line
- Appears day 1-2
- Disappears weeks - months
Cephalhematoma
40
Caput succedaneum or Cephalhematoma?
Soft tissue swelling between scalp and skull bone
- Will cross suture line
- Appears at birth
- Disappears hours – days
Caput succedaneum
41
Caput succedaneum or Cephalhematoma?
Potential results of unresolved _______________
- Jaundice (high bilirubin)
- Anemia
- Hypotension
cephalhematoma - Collection of blood between scalp and skull bone
42
newborn Eye variation
Transient strabismus, Doll’s eye, Subconjunctival hemorrhage
______________– red sclera, resolves itself
_______________– cross eyed, normal up to 4 mos, resolves itself or may be treated later
________________– due to underdeveloped head/eye coordination, normal up to 12 weeks, resolves itself
Eye variation
Subconjunctival hemorrhage – red sclera, resolves itself
Transient strabismus – cross eyed, normal up to 4 mos, resolves itself or may be treated later
Doll’s eye – due to underdeveloped head/eye coordination, normal up to 12 weeks, resolves itself
43
newborn Ear variations
Placement of ears
- Low set
- Consider syndromes such as down syndrome or intellectual disabilities
Ear form and cartilage distribution
- Term or Preterm? – shapeless, flat, no recoil
- Term or Preterm? – cartilage, curving, good recoil
- Preterm – shapeless, flat, no recoil
- Term – cartilage, curving, good recoil
44
newborn Mouth variation
- Assess suck – finger glove in mouth
- Cleft lip and palate – risk for _________, monitor for _____________ and _____________ while feeding
- Precocious teeth
- Epstein’s pearls – harmless cysts, resolves itself
Mouth
- Assess suck – finger glove in mouth
- Cleft lip and palate – risk for aspiration, monitor for respiratory distress and aspiration while feeding
- Precocious teeth
- Epstein’s pearls – harmless cysts, resolves itself
45
Mechanical changes initiating newborn respiration
- Fetus knows to decrease production of lung fluid 2-4 days prior to delivery
- Still 80-100 mL of fluid in infant lungs at delivery
- During vaginal birth process, fetal chest is _____________________
- During vaginal birth process, fetal chest is compressed and squeezes fluid out
46
Babies more prone to having extra fluid still in lungs after delivery:
- Quick vaginal labor
- c/s delivery
- slow vaginal labor
- Quick vaginal labor
- c/s delivery
b/c during vaginal birth process, fetal chest is compressed and squeezes fluid out
47
Chemical changes initiating newborn respiration
increased or decreased CO2?
and
increased or decreased pH and O2?
triggers baby’s brain respiratory center to do first breath/gasp
increased Pco2 and decreased pH and Po2 = triggers baby’s brain respiratory center to do first breath/gasp
48
Thermal changes initiating newborn respiration
increase or decrease in environmental temp after birth triggers newborn RR to increase?
Thermal changes
- decrease in environmental temp after birth = newborn RR increase
- avoid prolonged exposure to cold = cold stress/apnea
49
Sensory changes initiate respirations in newborns SATA
- light
- sounds
- gravity
- touch
ALL
50
signs of respiratory distress SATA
- nasal flaring
- fever
- intercostal or xiphoid retractions
- expiratory grunting or sighing
- seesaw respirations
signs of respiratory distress
- nasal flaring
X- fever
- intercostal or xiphoid retractions
- expiratory grunting or sighing
- seesaw respirations
51
signs of respiratory distress SATA
- tachypnea RR 76
- RR 22
- RR 40
- Central cyanosis – blue body and/or mouth
- Circumoral cyanosis – blue mouth
signs of respiratory distress
- tachypnea
- RR outside of 30-60 breaths/min normal range
- Central cyanosis – blue body and/or mouth
- Circumoral cyanosis – blue mouth
52
T/F
- alveoli are the first to form during development of lungs?
- the younger the baby, the fewer alveoli, the more severe RDS is likely to be?
F - alveoli are the last to form during development of lungs
T - the younger the baby, the fewer alveoli, the more severe RDS is likely to be
53
which are RDS risk factors SATA
- Preterm infant
- c/s delivery
- maternal DM
- baby has an infection
- baby has hypothermia
- slow vaginal delivery
RDS risk factors
- Preterm infant – surfactant lacking
- c/s delivery – fluid doesn’t get squeezed out
- maternal DM – hyperinsulinemia and hyperglycemia reduce fetal surfactant production
- stress on baby – infection, cold stress, hypothermia
X- slow vaginal delivery
54
which ways can surfactant development in the alveoli be stimulated SATA
- giving mom betamethasone
- ROM
- oxygen therapy
- warming environment baby is born in
- giving mom betamethasone - steroid
- ROM – a sign to the body to get surfactant production going
X - oxygen therapy
X- warming environment baby is born in
55
Treatment for newborn with RDS - SATA
- Oxygen therapy
- CPAP
- Mechanical ventilation
- Surfactant admin
- Thermoregulation in incubator
- massage therapy
- ECMO - Heart/lung machine allows baby’s lungs to rest and heal
- Oxygen therapy
- CPAP
- Mechanical ventilation
- Surfactant admin
- Thermoregulation in incubator
X- massage therapy
- ECMO - Heart/lung machine allows baby’s lungs to rest and heal
56
progressive respiratory distress noted by at least 6 hours of age until 72 hours of age
transient tachypnea of the new born
57
causes of transient tachypnea of the new born -
SATA
- LGA
- SGA
- Late preterm infants
- Maternal over sedation
- Maternal bleeding
- Prolapsed cord
- Breech birth
- Maternal diabetes
- c/s birth
- LGA
X- SGA
- Late preterm infants
- Maternal over sedation
- Maternal bleeding
- Prolapsed cord
- Breech birth
- Maternal diabetes
- c/s birth
58
treatment of transient tachypnea of the new born
SATA
- chest xray
- oxyhood
- IV fluids
- Tube feed (if RR over 60, aspiration risk)
- ambulation
- chest xray
- oxyhood
- IV fluids
- Tube feed (if RR over 60, aspiration risk)
X- ambulation
59
Cardiopulmonary changes
-Closure of foramen ovale
-Increased systemic vascular resistance and decreased pulmonary vascular resistance
-Closure of ductus venosus
-Closure of ductus arteriosus
__________ = enhances perfusion of body systems
_________ = between atriums
__________ = blood flows from aorta to pulmonary artery
___________ = perfusion of liver
Cardiopulmonary changes
- Increased systemic vascular resistance and decreased pulmonary vascular resistance = enhances perfusion of body systems
- Closure of foramen ovale = between atriums
- Closure of ductus arteriosus = blood flows from aorta to pulmonary artery
- Closure of ductus venosus = perfusion of liver
60
convection, radiation, evaporation, or conduction?
The loss of heat from a newborn's body to the surrounding cooler air.
- Examples: Drafts, open windows, or air conditioning.
- Prevention: Keeping the newborn away from drafts, using radiant warmers, and maintaining a warm environment.
convection
61
convection, radiation, evaporation, or conduction?
The loss of heat from a newborn's body to a cooler solid surface nearby, without direct contact.
- Examples: Cold walls, windows, or equipment.
- Prevention: Placing the newborn away from cold surfaces, and using radiant warmers.
radiation
62
convection, radiation, evaporation, or conduction?
The loss of heat as water evaporates from the newborn's skin.
- Examples: Wet skin after birth, bathing, or diapering.
- Prevention: Drying the newborn immediately after birth, using warmed blankets, and minimizing bath time.
evaporation
63
convection, radiation, evaporation, or conduction?
The loss of heat from a newborn's body to a cooler solid surface through direct contact.
- Examples: Cold examination table, scale, stethoscope or clothing.
- Prevention: Warming equipment before use, using pre-warmed blankets, and avoiding direct contact with cold surfaces.
conduction
64
Newborns are at risk for cold/heat loss because of these issues with thermoregulation SATA
- Large surface area-to-body mass ratio
- high subq fat (low brown fat)
- low body water content
- Immature skin leading to evaporated water and heat loss
- Poorly developed metabolic thermal stress (cant shiver)
- Altered skin blood flow (peripheral cyanosis)
Newborns are at risk for cold/heat loss because
- Large surface area-to-body mass ratio
X- Low subq fat (more brown fat)
X- High body water content
- Immature skin leading to evaporated water and heat loss
- Poorly developed metabolic thermal stress (cant shiver)
- Altered skin blood flow (peripheral cyanosis)
65
- Preterm or Term newborns are at greatest risk for cold/heat loss?
- Preterm or Term newborns lack ability to do the flexed posture for preserving heat?
- Preterm or Term newborns have very thin skin with capillaries close to the surface that make them unable to preserve heat?
Preterm newborn – at even greater risk for cold/heat loss because
- Lack of flexed posture for preserving heat
- Very thin skin with capillaries close to the surface
66
- When infants experience cold stress, they begin to metabolize ____________ (brown fat or subq fat) stores
- if the baby is not warmed and the cold stress continues, s/s of ___________ (hypo or hyperthermia) appear
When infants experience cold stress, they begin to metabolize brown fat stores, if the baby is not warmed and the cold stress continues, s/s of hypothermia appear
67
68
s/s of hypothermia or hyperthermia?
- hypoglycemia
- transient hyperglycemia
- dehydration
- decreased activity
- lethargy
- hypotonia
- poor feed
- weak cry
hypo - hypoglycemia (using BS to warm up)
hypo - transient hyperglycemia
hyper - dehydration
both - lethargy
both - hypotonia
both - poor feed
both - weak cry
69
s/s of hypothermia or hyperthermia?
- bradycardia
- tachycardia
-tachypnea
- restless
- irritability
- shallow and irregular respirations
- respiratory distress
- apnea
- hypoxemia
- metabolic acidosis
hypo - bradycardia
hyper - tachycardia
both -tachypnea
hypo - restless
hyper - irritability
hypo - shallow and irregular respirations
hypo - respiratory distress
both - apnea
hypo - hypoxemia
hypo - metabolic acidosis
70
s/s of hypothermia or hyperthermia?
- tachycardia, tachypnea, apnea
- warm extremities, flushing, perspiration (term babies)
- dehydration
- lethargic, hypotonia
- poor feed
- irritability
- weak cry
hyperthermia
71
s/s of hypothermia or hyperthermia?
- Acrocyanosis
- Cool, mottled, pale skin
- Hypoglycemia – they are using blood sugar to warm up
- Transient hyperglycemia
- Bradycardia
- Tachypnea, restlessness, shallow and irregular respirations
- Respiratory distress, apnea, hypoxemia, metabolic acidosis
- Decreased activity, lethargy, hypotonia
- Feeble cry
- poor feed, Decreased weight gain
hypothermia
72
- overheating from incubators, radiant warmers, or environmental temp
- maternal fever
- maternal epidural anesthesia
- phototherapy lights, sunlight
- excessive swaddling
- infection
- CNS disorders – asphyxia
- Dehydration
can cause ___________
hyperthermia
73
consequences of newborn hyperthermia SATA
- Hypotension
- Dehydration
- Seizures
- Apnea
- Hypernatremia
- Respiratory distress
all
- Hypotension and dehydrations (from increased water loss)
- Seizures and apnea (from high core temp)
- Hypernatremia
- Respiratory distress
74
newborn under radiant warmer is showing signs of hyperthermia, which would be appropriate treatment options SATA
- Move away from heat
- Undress newborn
- lower room temp
- give newborn bath
- Move away from heat
- Undress newborn
- lower room temp when in incubator
X- give newborn bath
75
should the nurse suggest feeding newborn with hyperthermia frequently to replace fluids?
yes - Breastfeed newborn frequently to replace fluids
76
Tonic neck
Palmar and plantar grasp
Moro/startle
Rooting
Suck
Babinski
Stepping
these are all
reflexes born with
77
Should void by ________ hours, if not contact HCP
Stool
- meconium (1st stool) within ______ hours
- after that stool will appear different based on ___________
48 hours
24 hours
breastfeed vs formula feed
78
are neonates considered at-risk SATA
- Mom low socioeconomic status
- Limited access to healthcare
- No prenatal care
- Exposure to environmental dangers
- Pre-existing maternal conditions
- Medical conditions r/t pregnancy
- Pregnancy complications
- Average gestational age
- Mom low socioeconomic status
- Limited access to healthcare
- No prenatal care
- Exposure to environmental dangers
- Pre-existing maternal conditions
- Medical conditions r/t pregnancy
- Pregnancy complications
X- Average gestational age
79
Factors influencing the outcome of at-risk neonates
- Birth weight
- Gestational age
- time of delivery
- Intrauterine growth
- Type and length of illness
- Environmental factors
- Maternal factors
- Maternal-neonatal separation
- Birth weight
- Gestational age
X- time of delivery
- Intrauterine growth
- Type and length of illness
- Environmental factors
- Maternal factors
- Maternal-neonatal separation
80
Gestational age
- – 20 to 36 6/7 weeks
- – 34 to 36 6/7 weeks
- – 37 to 38 6/7
- – 39 to 40 6/7 weeks
- – 41 to 41 6/7 weeks
- – 42 weeks +
Full term, Late preterm, Early term, Late term, Preterm, Post term
Gestational age
- Preterm – 20 to 36 6/7 weeks
- Late preterm – 34 to 36 6/7 weeks
- Early term – 37 to 38 6/7
- Full term – 39 to 40 6/7 weeks
- Late term – 41 to 41 6/7 weeks
- Post term – 42 weeks +
81
T/F
SmallGA and IUGrowthRestriction infants are at greater risk of death?
true
82
newborn size
- _____________ = <5.5 lbs
- ______________ = <3.3 lbs
- ______________ = <2.2 lbs
Very low birth weight VLBW, Low birth weight LBW, Extremely low birth weight ELBW
- Low birth weight LBW = <5.5 lbs
- Very low birth weight VLBW = <3.3 lbs
- Extremely low birth weight ELBW = <2.2 lbs
83
newborn size
- Small for gestational age SGA = below ________ percentile
- Appropriate for gestational age AGA = between ______ and ______ percentile
- Large for gestational age LGA = above ________ percentile
- Small for gestational age SGA = below 10th percentile
- Appropriate for gestational age AGA = between 10th and 90th percentile
- Large for gestational age LGA = above 90th percentile
84
- Intrauterine growth restriction IUGR = rate of growth doesn’t meet _____________________
- Symmetric or Asymmetric IUGR = weight, length, head circumference all affected
- Symmetric or Asymmetric IUGR = head normal but body is disproportionately small below 10th percentile
- Increased risk of respiratory depression, sepsis, death is associated with symmetric or asymmetric IUGR?
- Intrauterine growth restriction IUGR = rate of growth doesn’t meet expected growth plan
- Symmetric IUGR = weight, length, head circumference all affected
- Asymmetric IUGR = head normal but body is disproportionately small below 10th percentile
- Increase risk of respiratory depression, sepsis, death
85
Common causes of indicated preterm birth SATA
- Diabetes
- pain
- Chronic HTN
- Pre-eclampsia
- Abruption
- Previa
- Gallbladder disease
- Diabetes
X- pain
- Chronic HTN
- Pre-eclampsia
- Abruption
- Previa
- Gallbladder disease
86
Common causes of indicated preterm birth SATA
- Heart disease
- VTE
- Asthma
- HIV
- active HSV
- convenience
- Obesity
- AMA
- Heart disease
- VTE
- Asthma
- HIV
- active HSV
X- convenience
- Obesity
- AMA
87
Common causes of indicated preterm birth SATA
- Fetal disorders
- IUGR
- Polyhydramnios
- oligohydramnios
- Hydrops
- Birth defects
- Multiple gestation
- Twin to twin transfusion syndrome TTTS – rare condition that affects identical twins in the womb where the blood supply of one twin moves to the other shared placenta
- striae
- Fetal disorders
- IUGR
- Polyhydramnios
- oligohydramnios
- Hydrops
- Birth defects
- Multiple gestation
- Twin to twin transfusion syndrome TTTS – rare condition that affects identical twins in the womb where the blood supply of one twin moves to the other shared placenta
X- striae
88
Effect of premature birth on g&d
T/F
- The more premature, the more risk for g&d problems
-Preterm babies can still perform the same as full term babies
-Age of all preemies are adjusted when development is evaluated
T- The more premature, the more risk for g&d problems
F- Preterm babies will not perform the same as full term babies
T- Age of all preemies are adjusted when development is evaluated
89
heal stick BS is warranted for babies with SATA
- Maternal DM
- LGA
- SGA
- baby is shivering
Bs level should be _____ or higher
heal stick BS is warranted for babies with SATA
- Maternal DM
- LGA
- SGA
- baby is shivering = hypoglycemia s/s
40 or higher
90
Hypoglycemia s/s
-Jittery/tremors/shivering
-Seizures
-Hypothermia
-Breathing problems
-asthma
-Jittery/tremors/shivering - remember baby cant shiver when cold so this would be a sign of something going on
-Seizures
-Hypothermia
-Breathing problems
X-asthma
91
Encourage breastfeeding in 1st hour to help regulate _______
blood sugar
92
Erythromycin
T/F
-Eye prophylaxis to prevent Hep B
-Caused by untreated chlamydia or gonorrhea in mom
-Can cause blindness in babies
-Give to newborns with positive moms
-Within 30 mins of birth
-Applied inner to outer eye
-Placed directly on eye
X - Eye prophylaxis to prevent conjunctivitis
- Caused by untreated chlamydia or gonorrhea in mom
- Can cause blindness in babies
X - Give to all newborns
- Within 30 mins of birth
- Applied inner to outer eye
- Placed directly on eye
93
Vitamin K shot
- Newborns lacking vitamin K in gut when born
- Vitamin K = clotting factor
- Risk of thrombosis
- Goes in vastus lateralis
- 90 degree
- Don’t aspirate
- Needle length smaller than 1.5 inches
- Dose 0.5 – 1.0 mL
Vitamin K shot
- Newborns lacking vitamin K in gut when born
- Vitamin K = clotting factor
X - Risk of bleeding/hemorrhage
- Goes in vastus lateralis
- 90 degree
- Don’t aspirate
- Needle length smaller than 1.5 inches
- Dose 0.5 – 1.0 mL
94
Newborn bath
______ hours or more after birth
Newborn bath
6 hours or more after birth
95
are these signs of readiness to feed?
- Rooting
- Sucking
- Bobbing head
- aware and alert
yes
96
breast vs formula feed?
- Feed Q 2-3 hours
- Burp in between each breast
- feed Q 3-4 hours
- burp after ½ formula
breast
- Feed Q 2-3 hours
- Burp in between each breast
Formula
- feed Q 3-4 hours
- burp after ½ formula
97
which Periods of reactivity is best for bonding and breastfeeding?
1st period of reactivity
- 30 mins after birth
Sleep phase
- 2-4 hours
2nd period of reactivity
- 4-6 hours
1st period of reactivity
- 30 mins after birth
- Good for bonding and breastfeeding
98
Umbilical cord care
- Clamp until _______
- Falls off 7-10 days usually, maybe more
Umbilical cord care
- Clamp until dried
- Falls off 7-10 days usually, maybe more
99
Yellow color of skin/sclera due to increased bilirubin levels from RBC breakdown
- Normal levels 4-6
jaundice
100
Pathological or physiological jaundice?
BAD
- r/t other condition/pathology
- Occurs within the first 24 hours of life
- Treatment - May use phototherapy or blood transfusion
Pathological jaundice = BAD
101
Pathological or physiological jaundice?
- Occurs after the first 24 hours of life
- Treatment – increase feedings 8-12 times/day, may use phototherapy
physiological jaundice
102
Examples of Infants at greatest risk of developing physiological jaundice or pathological jaundice?
- 2 day old infants born at 35 weeks
- 2 day old SGA baby who is having difficulty breastfeeding
- 2 day old baby diagnosed with a cephalhematoma
Examples of Infants at greatest risk of developing physiological jaundice
- 2 day old infants born at 35 weeks = preterm liver
- 2 day old SGA baby who is having difficulty breastfeeding = if they aren’t eating then they’re not pooping, and that’s how they get rid of excess bilirubin
- 2 day old baby diagnosed with a cephalhematoma = collection of blood
103
Nursing care for jaundice
T/F
- Keep baby warm 97.7 F +
- Monitor amount of stools
- Encourage early feedings
- Increase Frequency of feeding 8-12 x in 24 hours – stimulates gut to poop bilirubin out
- phototherapy
- Wear diaper
- Eye protection
- Monitor hydration
- Allow for bonding
all true
104
s/s of respiratory distress syndrome, Neonatal abstinence syndrome, or Newborn withdrawal?
- High pitched cry
- Hyperirritability, difficult to console
- Restlessness
- Increased muscle tone
- Exaggerated reflexes
- Tremors, jerks, shaking
- Seizures
- Sneezing, hiccups, yawning
- Short, unquiet sleep
NAS and Newborn withdrawal s/s
105
s/s of respiratory distress syndrome, Neonatal abstinence syndrome, or Newborn withdrawal?
- Vigorous, excessive suck
- Vomit
- Poor weight gain
- poor feed – doesn’t eat a good amount, takes longer than 30 mins to feed
- Sensitive gag reflex
- Diarrhea
NAS and Newborn withdrawal s/s
106
s/s of respiratory distress syndrome, Neonatal abstinence syndrome, or Newborn withdrawal?
- Stuffy nose
- Sneezing, yawning
- Mottled
- Tachypnea – greater than 60 breaths/min
- Fever, Sweating
- Hyperthermia
- Diaper rash
- Facial scratches
- Pressure-point abrasions
NAS and Newborn withdrawal s/s
107
NAS complications SATA
- Respiratory distress
- Jaundice
- Congenital anomalies
- IUGR
- Behavioral abnormality
- Withdrawal
- General complications from preterm birth (if it was necessary for fetal health)
all
108
Modified Finnegan neonatal abstinence score sheet
T/F
- Assessment tool
- Scores severity of withdrawal from opioids
- Monitors and documents infants clinical response to withdrawal
- 21 most frequently observed symptoms
- Each symptom assigned score, all symptoms observed during the scoring interval are added together for the total score
- Scoring is dynamic, not static
all true
109
which infant would get a finnegan score SATA
- All infants with maternal history suggesting narcotic/opioid use
- Infants exhibiting s/s of narcotic/opioid withdrawal
- All infants with low socioeconomic parents
- All infants with maternal history suggesting narcotic/opioid use
- Infants exhibiting s/s of narcotic/opioid withdrawal
X- All infants with low socioeconomic parents
110
when to do finnegan score
-baseline =___ hours after birth
-Continue scoring every 4 hours, before/after each feeding?
-Scores 8 or +
- Score every 2 hours until NAS meds started
- Score every 4 hours or after every feeding while on NAS meds
When to score
- 2 hours after birth for baseline
- Continue scoring every 4 hours, after each feeding
- Scores 8 or +
- Score every 2 hours until NAS meds started
- Score every 4 hours or after every feeding while on NAS meds
111
Nursing interventions & Nonpharmacological treatment: NAS and withdrawal SATA
- Skin to skin
- Swaddle
- Gentle waking
- Quiet, low light, minimal stimulation
- Calm music
- Massage therapy
- Cluster care
- Encourage parental involvement and rooming in
- Moms on methadone or buprenorphine should formula feed
- Finnegan scoring
Nursing interventions
Nonpharmacological treatment
- Skin to skin
- Swaddle
- Gentle waking
- Quiet, low light, minimal stimulation
- Calm music
- Massage therapy
- Cluster care
- Encourage parental involvement and rooming in
X - Moms on methadone or buprenorphine should be encouraged to breastfeed b/c it can delay the onset of and decrease severity of withdrawal symptoms, also decrease need for pharmacological treatment
- Finnegan scoring
112
Nursing interventions & pharmacological treatment: NAS and withdrawal SATA
- Depends on drug withdrawaling from
- Morphine and methadone most common 1st line meds
- Adjunctive use of phenobarbital or clonidine to treat opioid withdrawal
- Buprenorphine – prevents intrauterine fetal seizures and other withdrawal symptoms, mom heroin use
- May require NICU admission
- continued drug use may be encouraged
- Depends on drug withdrawaling from
- Morphine and methadone most common 1st line meds
- Adjunctive use of phenobarbital or clonidine to treat opioid withdrawal
- Buprenorphine – prevents intrauterine fetal seizures and other withdrawal symptoms, mom heroin use
- May require NICU admission
X- continued drug use may be encouraged
113
Moms on methadone or buprenorphine should be encouraged to breastfeed b/c SATA
- it can delay the onset of withdrawal symptoms
- decrease severity of withdrawal symptoms
- decrease need for pharmacological treatment
- it should not be encouraged b/c puts the baby at risk for exposure to teratogenic substance
- it can delay the onset of withdrawal symptoms
- decrease severity of withdrawal symptoms
- decrease need for pharmacological treatment
X- it should not be encouraged b/c puts the baby at risk for exposure to teratogenic substance
114
which is done Prior to d/c
- Hearing screening
- Vision screening
- Test for PKU (Guthrie blood test) after 24 hours of breast milk or formula feeding
- Hep B
- Hep B immunoglobulin
- Circumcision
- Parent education
- Hearing screening
X- Vision screening
- Test for PKU (Guthrie blood test) after 24 hours of breast milk or formula feeding
- Hep B – all babies
- Hep B immunoglobulin – baby’s with positive Hep B moms
- Circumcision
- Petroleum jelly with diaper change
- Parent education
- Swaddle infant
- Back to sleep
- Car seat safety
- Infant CPR
- Routine pediatric appointments
115
Hep B immunoglobulin or Hep B
______________– all babies
_____________ – baby’s with positive Hep B moms
- Hep B – all babies
- Hep B immunoglobulin – baby’s with positive Hep B moms
116
Preterm/Premature baby d/c
T/F
- Wait until 36-40 weeks gestation
- Look for Factors that predict normal g&d
- Head lag test - When lifted from prone position, babys head should hang below body
- baby is quiet and calm, even when hungry
- Appropriate amount and pattern of weight gain according to growth curves
- Neurologic responses appropriate for corrected age
- Wait until 36-40 weeks gestation
- Look for Factors that predict normal g&d
X- Head lag test - When lifted from prone position, baby should raise head parallel to body
X- Ability to cry vigorously when hungry
- Appropriate amount and pattern of weight gain according to growth curves
- Neurologic responses appropriate for corrected age
117
s/s of newborn illness SATA
- Temp above 100.4 F – axillary
- Temp below 97.7 F – axillary
- Continual rise in temp
- Forceful or frequent vomit
- excessive burping
- Temp above 100.4 F – axillary
- Temp below 97.7 F – axillary
- Continual rise in temp
- Forceful or frequent vomit
X- excessive burping
118
s/s of newborn illness SATA
- Refusal of 2 feedings in a row
- Drowsy infant, refusing to feed for 8 hours
- Difficulty waking baby
- Cyanosis w/ a feeding
- Cyanosis w/out a feeding
all
119
s/s of newborn illness SATA
- Absence of breath for 10 secs
- Inconsolable infant
- Continuous high pitched cry
- Discharge from umbilical cord
- Bleeding from circumcision
X- Absence of breath longer than 20 secs
- Inconsolable infant
- Continuous high pitched cry
- Discharge or bleeding from umbilical cord, circumcision, or any other opening
120
s/s of newborn illness SATA
- 2 green watery stools in a week
- No wet diapers for 18-24 hours
- Fewer than 6-8 wet diapers per day (after 4 days old)
- Eye drainage
X- 2 consecutive green watery stools
- No wet diapers for 18-24 hours
- Fewer than 6-8 wet diapers per day (after 4 days old)
- Eye drainage
121
s/s of hypothermia or hyperthermia?
- acrocyanosis
- warm extremities
- flushing
- perspiration (term babies)
- cool, mottled, pale skin
hypo - acrocyanosis
hyper - warm extremities
hyper - flushing
hyper - perspiration (term babies)
hypo - cool, mottled, pale skin
sav 332
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