OB Exam 3 NF

apgar scoring is the 1st newborn assessment done in the delivery room, it is performed at ____ minute(s) & ____ minute(s) of life

1 min & 5 min

5 components of apgar scoring

- Color

- Heart rate

- Reflexes

- Muscle tone

- Breathing

an apgar score of ____-____ indicates good condition; a score of

7-10 = good

apgar scoring results (0, 1, & 2 per category)

Appearance (color)

0 = pale or blue

1 = acrocyanosis (blue extremities/pink body)

2 = pink body/extremities

Pulse

0 = absent

1 =

what measurements are done at birth to provide a baseline for assessing growth & development and also compared with gestational age?

-weight

-length

-head & chest circumference

large for gestational age (LGA) fall above the ____ percentile & small for gestational age (SGA) fall below the ____ percentile

LGA = above 90%

SGA = below 10%

what 2 things does the ballard score assess? what is used for?

neuromuscular & physical maturity; helps gauge gestational age

when assessing an infant, ____ first if they are quiet; if they are crying, their vital signs may be ____; wait until quiets & reassess

listen; abnormal;

baby should be assessed every ____ whether in nursery or mom's room

hour

normal newborn vital signs (RR, HR, BP, temp, O2)

RR: 30-60

HR: 120-160

BP: 50/30 - 70/45 (not checked every assessment)

Temp: 97.7 (36.5) - 99 (37.2)

O2: 95-100%

the neonatal infant pain scale (NIPS) is based on what 6 things and when is it often used?

- facial expression (relaxed or grimace)

- cry (no cry, whimper, or vigorous)

- breathing patterns (relaxed, change in breathing)

- arm movements (relaxed/restrained, or flexed/extended)

- leg movements (relaxed/restrained, flexed/extended)

- state of arousal (sleeping/awake, fussy)

- used after circumcision

which method of checking temperature is preferred in healthy/normal newborns?

axillary (rectal only done if concern for thermoregulation issue)

why are infants at risk for heat loss?

-little subQ fat

-thin epidermis

-blood vessels close to skin

normal ____ ____ of infant conserves body temp by reducing amount of body surface exposed to environment

flexed position

strategies to dec. heat loss in infants

-keep dry

-swaddle

-use hats

-use radiant heat warmer

-warm objects in direct contact

-keep out of air drafts

-skin to skin

evaporation occurs when heat from body is lost from liquid to vapor, what is an example that could cause this type of loss in newborns?

failure to dry after birth or bath

convection occurs when heat from body is lost to cooler air, what is an example that could cause this type of loss in newborns?

(cooler) room temperature

radiation occurs when heat from body is lost to a cooler surface NOT in direct contact, what is an example that could cause this type of loss in newborns?

placing cold objects near incubator

conduction occurs when heat from body is lost to cooler surface that IS in direct contact, what is an example that could cause this type of loss in newborns?

stethoscope, scale

temperature should stabilize within ____ to ____ hours after birth; temp should be mont for every ____ minutes until stable for ____ hours; then assesses every ____ hours

8-12 hrs; 30 mins; 2 hours; 8 hours

what are the 2 classic signs of infection in newborn?

temp instability (usually too cold) & poor feeding

3 things inc. temp in newborn may indicate

-too many coverings

-room temp too hot

-dehydration

newborns have an altered ability to sweat, so what are signs of overheating instead?

-restlessness

-inc. RR & HR

-dec O2 sat

cold stress in an infant will begin to burn up their subcutaneous fat which leads them to need more ____ & use up more ____ leading to a ____ event because they have no other way to regulate their temperature

need more O2 & use up more glucose leading to a hypoglycemic event

the expected skin turgor is _______ and returns rapidly to original shape, the deviation would be __________

elastic, tenting

____ is bluish discoloration of the hands & feet that is usually present up to ____-____ hours after birth & can be normal for up to ____ hours

acrocyanosis; 2-6 hours; 24 hours

acrocyanosis is caused by poor peripheral ____ especially when exposed to ____

circulation; cold

____ is a lacy pattern of dilated blood vessels under the skin caused by general circulation changes; this is normal, can come & go, and can last hours to many weeks

mottling

____ ____ is a deep red color that develops over one side of the newborn's body while the other side remains pale; this can last up to ____ minutes

harlequin sign ("clown"); 20 minutes

harlequin results from a ____ disturbance where blood vessels on one side ____ and on the other side ____

vasomotor; dilate; constrict

____ ____ is characterized by macular erythema, papules, vesicles, and pustules; aka "newborn rash"

erythema toxicum

erythema toxicum comes & goes, leaves no ____, and there is no treatment

scars

____ is aka "baby acne" and presents as tiny white bumps that form from the sebaceous glands

milia

milia is most common on the ____, ____, & ____; it has no treatment and will disappear on its own

nose, chin, & cheeks

what is lanugo?

fine, soft, downy hair found on body of newborn, it sheds before birth but is often still present at birth; goes away on its own

vernix caseosa (aka "cheese") is a product of the sebaceous glands present on babies at birth that functions to ____ the ____

protect the skin

the amount of vernix caseosa ____ with gestational age & sheds off in the ____ ____; after birth it will come off naturally, don't try to scrub it off

decreases; amniotic fluid

____ ____ are a pigmentation discoloration that appear a steel blue-gray color with clear cut borders

mongolian spots

mongolian spots are common in ____ skinned ethnicities & never go away, but they can ____

darker; fade

port wine stain is caused by ____ blood vessels that create a ____-____ discoloration of the skin

swollen; reddish-purple

early port-wine stains are usually ____ & ____ in appearance

flat & pink

what treatment is there for port-wine stains?

laser therapy for cosmetic reasons

____ ____ are caused by a hemangioma or "dilated capillaries" & are raised & red

strawberry marks

strawberry marks grow, reaching full size by about ____ months of age & will ____ spontaneously usually by school-age

6 months; resolve

strawberry marks can be removed with ____ or ____ therapy

laser or prednisone therapy

stork bites/angel kisses are pale ____ or ____ spots on eyelids, nose, lower occipital bone, & nape of the neck; these are d/t to a stretching or ____ of certain blood vessels

pink or red; dilation

stork bites/angel kisses may becomes darker when the child ____ or the ____ changes; these are easily blanched & will fade

cries or the temperature changes

forceps or vacuum marks are reddened areas that usually disappear in 1-2 days, what is the big concern with these?

both inc. risk for bleeding;

forceps

-lacerations

-nerve damage

-intracranial bleeding

vacuum

-cephalohematoma leading to jaundice

____ ____ are vesicles that appear on the lips, fingers, or hands from vigorous sucking; they may be intact or ruptured

sucking blisters

sucking blisters treatment?

no treatment required

jaundice is a yellowing of the skin caused by higher levels of ____

bilirubin

pallor is a paleness of the skin that could indicate a ____ issue

respiratory

cyanosis is a purplish-blue discoloration of the skin caused by high levels of ____ hemoglobin in the blood near the surface of the skin

deoxygenated

____ is a ruddy, deep red-purple appearance of the skin associated with a high hematocrit often due to ____

plethora; polycythemia

____ is pinpoint flat round spots (bruising) that are reddened because they contain blood that leaked from the capillaries into the skin; they do not blanch when pressed

petechiae

____ is bruising that does not blanch when pressed & usually appears after birth trauma

ecchymosis

what is molding?

"cone head" when cranial bones overlap so head can fit through the birth canal

the anterior fontanelles should be soft & flat; bulging indicates what? depression indicates what?

bulging = inc. ICP

depression = dehydration

the muscle ____ in a newborns neck is not well developed so it is important to ____ their heads

tone; support

d/t the underdeveloped muscle tone in newborns neck, their head will ____ when pulled up from a supine position to a sitting position

lag

a cephalohematoma is caused by a collection of ____ under the skin & ____ cross suture lines

blood; doesn't

a cephalohematoma appears in about 2-3 days & disappears in ____-____ weeks; it is caused by use of a ____ during the birthing process

2-3 weeks; vacuum

to test for a cephalohematoma, press on the area, fullness will ____ & then immediately ____ when pressure is released

shift; refill

a caput succedaneum is caused by collection of ____ under the skin & ____ cross suture lines

fluid; may

caput succedaneum is caused by pressure on the presenting part making it ____ & the fluid is ____ within 12 hours to a few days

edematous; reabsorbed

to test for caput succedaneum, press on the area & release, it will ____ similar to ____ edema

indent; pitting

____ is an enlarged head due to an abnormal buildup of fluid in the brain

hydrocephalus

3 characteristics on hydrocephalus found on assessment

-enlarged or full fontanelles

-widened sutures

-head circumference >90% on growth chart

for newborns with hydrocephalus, assess head ____ daily & provide adequate ____ under the head

circumference; support

what color are newborns eyes?

blue, blue-gray, or dark (in darker skinned ethnicities)

infants eye color is established at ____ month(s) but can sometimes change up to ____ year(s)

3 months; 1 year

newborns eyelids may be ____ from birth

edematous

things to assess regarding eyes of newborn

-PERRL (accommodation is absent)

-symmetry in size & shape

-assess for discharge

a newborns ears should be in line with the eyes & symmetrical; what could low set ears indicate?

chromosomal abnormality

the auditory canal is not assessed immediately after birth because it is blocked with blood, vernix, & fluid; when is the hearing screen done?

hearing screen done before discharge (early intervention key to protect speech development)

preauricular skin tags are associated with ____ problems

kidney

newborns remove obstructions by ____ & if needed a ____ syringe can be used

sneezing; bulb

patency of a newborns nose is present if they can breathe easily with the ____ ____

mouth closed

asymmetrical movement of a newborns mouth could indicate facial nerve ____ & is associated with ____ use

palsy; forceps

choanal atresia is a blocked passageway between the ____ & the ____ which prevents newborns from coordinating the suck, swallow, breathe reflex

nose & pharynx

it is easiest to assess choanal atresia when the newborn is ____ because ____ difficulty will be seen; diagnosis is confirmed when attempting to insert a ____ ____

feeding; respiratory; feeding tube

____ are gray-white lesions on the gum

cysts

____ ____ are small glistening white specks/cysts found in the mouth that are hard to the touch

epstein pearls

____ is characterized by white patches in the mouth, typically on the tongue

thrush

thrush is caused by an overgrowth of ____ & is treated with ____; mom can also get this on her nipple & will also need treatment

yeast; nystatin (mycostatin)

____ ____ is a unilateral or bilateral visible birth defect that may involve the external nares, nasal cartilage, nasal septum, & alveolar process

cleft lip

____ ____ is a fissure connecting the oral & nasal cavity that may involve the uvula & soft palate, also may extend forward to nostril involving hard palate & maxillary alveolar ridge

cleft palate

infants with cleft lip/palate, there are specially designed bottles that have a ____ nipple & they should be fed lying on their ____

longer; side

____ ____ is paralysis of portions of the arm from trauma to the brachial plexus during a difficult birth (most often seen w/ should dystocia)

brachial palsy

____ ____ is damage to the upper arm that causes the arm to lie limp to the side, an inability to elevate the arm, and no moro reflex

erb's palsy

a newborns hips are assessed by an NP or MD with what 2 maneuvers?

barlow & ortolani maneuvers

____ is the presence of extra digits (fingers/toes) & ____ is fusion (webbing) of the fingers or toes

polydactyly; syndactyly

____ occurs when the foot is turned inward & will not return to midline position with gentle ROM

clubfoot

be sure to assess a newborns neurological "state" (ex: alert, quiet, sleeping, crying, lethargic, irritable) before ____ them

disturbing

a newborns expected cry is lusty, strong, vigorous; deviations include high-pitched, shrill, weak, or absent; what are some possible causes of a deviation in a newborns cry?

-neuro deficit

-hypoglycemia

-infection

if an infant does not cry during exam/assessment how should this be documented?

chart unable to assess, NOT absent

a newborns first period of reactivity lasts about ____ minutes after birth; during this the newborn is awake & active, appears ____, & has a strong ____ reflex; vital signs are elevated

30 minutes; hungry; sucking

what is often best to begin during the 1st period of reactivity?

breastfeeding

after the first period of reactivity (30 mins) the newborn's activity gradually ____; HR & RR decrease as the newborns enters sleep phase & they will be difficult to ____ & show no interest in ____

decreases; awaken; sucking

following the 1st period of reactivity, the sleep phase may last a few minutes up to ____ hour(s)

4 hours