Health and Illness IV: Lifespan - Exam 1 Review: Care of the Healthy Newborn

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165 Terms

1
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how does fetal oxygenation occur

transplacental gas exchange- at birth must establish lung function

2
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what causes spontaneous initiation of breathing at birth

-chemical

-mechanical

-thermal

-sensory

3
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chemical factors of spontaneous initiation of breathing at birth

clamping of cord decreases prostaglandins to increase respirations; surfactant released as lungs expand

4
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mechanical factors of spontaneous initiation of breathing at birth

compression of chest wall during birth

5
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thermal factors of spontaneous initiation of breathing at birth

lower temp stimulates respiration

6
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sensory factors of spontaneous initiation of breathing at birth

touch of MD/CNM/mother; bulb syringe, drying, lights

7
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breathing in newborn

mostly abdominal- chest and abdomen rise and move with respiration

-lung sounds are loud and lclear

8
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respiratory rate in newborn

30-60 per min

9
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what can breathing be after birth

shallow and irregular with periodic pauses/apnea

10
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when do CV changes occur after birth

with first breath

-lungs inflate and decrease pulmonary resistance

-causes functional closure of foramen ovale (permanent closure in 1st few months)

-ductus arteriosus closes at birth (permanently in 3-4 weeks)

11
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HR for newborn

120-160; can be irregular for 1st few hours

-listen for full minute

12
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HR for sleeping newborn

100

13
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HR for crying newborn

180

14
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heart sounds in newborn

higher pitch, shorter duration, S1>S2

15
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murmurs in newborns

-transient murmurs common in 1st few hours (usually form PDA)

-check for other signs of CV dysfunction

16
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s/s of CV dysfunction in newborn

-tachycardia

-bradycardia

-pallor

-cyanosis

-pulse ox reading

17
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normal color of newborn

acrocyanosis is normal in 1st 24 hours

18
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abnormal color of newborns

central cyanosis (lips and mucous membranes)

19
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BP for newborns

-routine BP not recommended

-if done, do a 2-4 extremity with doppler to note variation

-normal is based on fetal weight and age

20
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normal BP in 7-8 oz term newborn

60-80/40-50

21
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what is thermoregulation

maintenance of balance between heat loss and heat production

22
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thermoregulation for neonates

-have to adapt to lower external temp compared to in utero

-less adipose and SQ fat; blood vessels much close to skin surface (difficult adjusting to temp)

23
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neonatal response to cold

-increased muscle activity

-cannot generate heat by shivering

(thus use unique process of "brown fat" metabolism

24
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increased muscle activity in response to cold

crying, acrocyanosis, increased activity

25
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what is brown fat

unique adipose tissue found in neonates

-located in axilla, kidneys, and thoracic column

-lesser amounts in preterm

26
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what does brown fat do

-heat produced by metabolism of brown fat can increase heat production by 100%

27
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why do neonates need to use brown fat for thermoregulation

because they cannot generate heat by shivering

28
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what is brown fat (and thermoregulation) rapidly depleted by

cold stress

29
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cold stress in neonate

-Increased respiratory rate and oxygen consumption

-Oxygen consumption diverted from brain & cardiac fx

-Result if no intervention is metabolic acidosis & hypoglycemia

30
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when does the first void occur after birth

24 hours- expect one void on first day

31
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when does voiding increase

with increased intake

32
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voiding amount on 5th day after birth

6-8 wet diapers/day

33
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normal urine color for newborn

pale yellow/straw colored

-odorless

34
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pseudomenstruation

may cause red/pink stained diaper

-vaginal bleeding in newborn girls from removal of placental hormones

35
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uric acid crystals in newborn

may see pink urine in diaper

-dehydration

36
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mouth in newborn

normally pink and moist if well-hydrated

37
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what is sublingual frenulum

tongue-tied

38
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sucking as a newborn

mature at 34+ weeks

-assess

39
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what does coordination of suck-swallow-breath improve with

time/practice

40
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is emesis common in newborn

yes initiatelly

-don't overfeed!

41
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stomach size of newoborn

small (7-15 ml/day), increases with age

-more relaxed cardiac and pyloric sphincters

42
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meconium

first stool

-thick, tarry green/black

-by 24 hours of life

43
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what is transitional stool

2-3 day

green/brown

-less sticky

44
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what is milk stool

3-4th day

-yellow/gold and soft in breastfed infant

-pale yellow/light brown and odorous in formula fed infant

45
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meconium photo

knowt flashcard image
46
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milk stool photo

knowt flashcard image
47
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stool types

knowt flashcard image
48
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maternal factors that affect newborn behavior

-labor/birth

-pain meds

-pathology

-bonding

49
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newborn factors that affect newborn behavior

-pain

-physiologic factors

-meds

-bonding

-individual personality

-sleep-wake cycles

-sense

50
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nursing interventions for neonatal behavior

-teach parents to respond to their infants

-teach sleep-wake cycles, waking, calming, and personality and uniqueness of individual infant

51
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physical assessment of newborn

-Maintain temperature

-Undress only as needed - work quickly!

-Assessment requiring quiet first (cardiac, respiratory, bowel sounds)

-Invasive tasks last (temperature, reflexes)

52
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max apgar score

10

53
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apgar score components

-color

-respirations

-reflex irritability

-HR

-muscle tone

54
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apgar score chart

knowt flashcard image
55
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neonatal resuscitation

-initiated right after birth PRN

-nurses and RTs present at birth usually certified

56
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normal temp of newborn

97.7-99.6

57
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normal weight of newborn

2500 - 4000 g or 5 1/2 lb - 8 1/2 lb.

58
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normal length of newborn

45-55 cm (18-22 in)

59
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normal head circumference of newborn

33-35 cm (largest point)

60
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normal chest circumference of newborn

30-33 cm (nipple line)

61
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colors of newborn

pink, tan, jaundiced, cyanosis, circumoral cyanosis, pallor, ruddy, acrocyanosis (normal in the first 24 hours)

62
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acrocyanosis photo

knowt flashcard image
63
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lesions or rashes of newborns

Erythema toxicum (newborn rash); bruising, milia, blisters, petechiae, melanosis

64
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birthmarks of newborns

Mongolian spots (75-80% newborns of color), telangiectatic nevi ("stork bite marks"), hyperpigmentation, hemangiomas; skin tags

65
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hydration of newborns

vernix (white/cheesy), lanugo (soft hair), dry skin, turgor

66
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telangiectatic nevi (stork bite marks)

knowt flashcard image
67
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erythema toxicum (newborn rash)

knowt flashcard image
68
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vernix

knowt flashcard image
69
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mongolian spots

knowt flashcard image
70
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size and shape of head assessment

note molding, skull shape

71
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trauma head assessment

-palpate for caput or cephalohematoma

-bruising or lacerations on face or head

72
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suture lines assessment

palpate for overlaping

73
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fontanels assessment

palpate anterior and posterior for bulging (increased ICP) or depression

-should be flat

74
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mouth assessment

-rooting

-sucking

-tongue

-epstein's pearls

-teeth

-frenulum

-palpate

75
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nose assessment

-obligate nose breathers

-sound

-mucous

-abnormal shape/placement

76
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molding assessment

-shaping of the fetal head by overlapping of skull bones

-resolves within a few days

-creates smaller fontanels

77
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what do fontanels allow for

molding

78
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normal fontanels

flat

79
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bulging fontanels

ICP

80
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depressed fontanels

dehydration

81
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location of fontanels

-Larger anterior (2-5cm)

-Smaller posterior (1-2cm)

82
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how large is the newborn head

1/4 of body length

83
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eyes assessment

-Placement, discharge, sclera color, redness

-Can focus, fix & track

-Lids may be edematous

-Lacrimal glands non-functional for 2 - 3 months

-"Pseudostraubismus"

84
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ears assessment

-Abnormal placement, deformities, cartilage

-Newborn Hearing screen mandatory - (1 in 1000 have hearing loss)

85
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what are retractions and nasal flaring

ABNORMAL

-first sign of respiratory distress

-retractions can be substernal or intercostal

86
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retractions

knowt flashcard image
87
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breath sounds assessment

should be clear and vesicular A/P/L bilaterally

88
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adventitious sounds

-coarse

-rales/rhonchi

-stridor

89
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pulses assessment

femoral and brachial pulses should be equal and strong

90
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what are the pulse ox screen/SHINE test

screening for critical congenital cardiac disease that are mandatory in WI

91
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abdomen assessment

-Inspect cord - 3 vessel, drying, healing, discharge, odor

-Abdominal tone - rounded and protuberant but no distention in normal neonate

-Bowel sounds - active in all 4 quadrants within 1st hour

-Stools - assess frequency, color, consistency

92
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what are the newborn reflexes

-sucking

-rooting

-swallowing

-moro

-palmar grasp

-tonic neck (fencing)

-stepping

-babinski

93
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what is the sucking reflex

turn to suck when mouth/lip touched

94
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what is the rooting reflex

turn to open mouth and search for food with touch of lip/mouth/cheek

95
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swallowing reflex

swallows food

96
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moro reflex

startle; abduction and extension of arms, fingers fan out and form a C

97
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palmar grasp

curls fingers around object in palm

98
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tonic neck (fencing)

arm/leg extend on one side/flex on other

99
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stepping reflex

simulated walking

100
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positive babinski reflex

sole of foot stroked; toes fan out