Clinical Module 5: Ryerson (Newborn care modules 1-4 (birth trauma and hyperbilirubinemia) fully solved questions with 100% accurate solutions(Latest Update)

what is the "newborn" period

first 1-28 days of life

3 phases of psychological transition newborn goes through directly after birth

-First period of reactivity, lasting approximately 30 minutes after birth

-Period of decreased responsiveness or inactivity, lasting up to two hours

-Second period of reactivity, lasting two to eight hours

The physiological adjustments the newborn experiences during the 3 psych transition phases directly after birth include?

-Adapting to changes in the respiratory and circulatory systems

-Regulating body temperature during transition into new environment

-Initiating feeding for nutrients and to stimulate elimination of waste

when is newborn most vulnerable

first 6-8 hours after birth

the ballard scale is used to assess?

gestational age

areas assessed on the ballard scale

-Neuromuscular: posture, square window, arm recoil, popliteal angle, scarf sign, and heel to ear.

-Physical (anatomical) characteristics: skin, lanugo, plantar surface, breasts, eyes, ears and genitals.

newborns are typically _________ breathers until 3 months of age and have _____________ and ____________ breathing patterns

nose breathers, irregular and variable

more RR for a newborn

30-60 breaths per min at rest

signs of resp destress in a newborn include

nasal flaring, grunting, cyanosis, tachypnea, apnea, and retraction of chest (intercostalm subcostal or substernal muscles)

vernix

white cheese like coating on newborn after birth

where is the proper place to take small amount of blood for sample on new born

heel of foot

Which physiological characteristics of a newborn are found during the first period of reactivity transition phase?

Decreased motor activity

Heart rate increases rapidly to 160-180 beats per minute

Increased mucus production

Newborn is sleepy

decreased motor activity

What are the components of the APGAR score? Select all that apply.

Heart rate

Neurological reflex

Blood pressure measurement

Respiratory rate

Skin colour

heart rate, resp rate, skin colour

What are the signs of respiratory distress in a newborn?

A. Decreased respiration, tachycardia, and mouth breathing

B. Subclavicular retractions, tachypnea, and decreased blood pressure

C. Nasal flaring, intercostal retraction, and grunting

D. Acrocyanosis, seesaw breathing, and diaphoresis

Which action of the cardiovascular system causes a functional closure of the foramen ovale in a newborn?

A. Increasing pressure in the left atrium, decreasing pressure in the right atrium

B. Increasing pressure in the left atrium, decreasing pressure in the left ventricle

C. Increasing pressure in the right atrium, decreasing pressure in the left atrium

D. Increasing pressure in the right atrium, decreasing pressure in the right ventricle

A

Heat loss in the newborn occurs in four different ways. Which way is an example of radiation heat loss?

A. Heat loss from the newborn's body to a cooler ambient air

B. Heat loss from the newborn's body indirectly to a cooler surface

C. Heat loss from the newborn's body directly in contact with a cooler surface

D. Heat loss from the vaporization of liquid from the newborn's body

B

What are the characteristics of physiological jaundice?

A. Appears after 24 hours of birth and resolves without treatment

B. Begins at two to five days of age with breastfed newborns

C. Appears at birth and newborn is lethargic

D. Begins at four to tem days of age and etiology is unknown

A

What is the newborn's immunologic adaption dependent on?

Paternal immunity

Breastfeeding for a minimum of three months

Maternal immunity

Immunizations given in the first year of life

maternal immunity

how frequent should a nurse perform a resp assessment on a newborn

every 30 minutes for the first 2 hours of life

behavioural adjustments newborns experience include?

-Establishing a regulated physiological and behavioural state independent of their mother

-Developing sleep and wake patterns

-Self-regulating changes experienced in their environment by processing, storing and organizing various stimuli

-Establishing relationships through social interactions and engaging with caregivers (attachment)

The Brazelton Neonatal Behavioural Assessment Scale (NBAS) does what?

assesses 28 areas to identify a newborn's behaviour along a continuum and can determine if support is required.

mother says " when I hols my baby, her eyes seem to follow mine, I thought babies couldnt see very well?" how should nurse respond?

"A newborn is able to see objects as far as 50 centimetres away. When you hold your baby close, within 20 centimetres, she can see your face more clearly. "

"my baby jumps when there is a loud noise is this normal? how should nurse respond?

"Yes, this is a normal response for newborns when they hear high frequency noises. Your baby will respond with a startle by extending arms and legs out and then will relax again.This is called the Moro reflex and is a normal response in newborns up to 6 months of age. "

"My baby seems to sleep for long periods and only wakes to eat is this normal?" how should nurse respond?

"Yes this is normal behaviour. Your baby will sleep for most of the day during the first few days to recover from the birth experience. With each day, your baby will stay awake longer."

"my baby seems to cry often, is she in pain?" how should nurse respond?

"She may or may not be in pain. Crying is how your baby communicates to you about what she needs and can have various meanings, for example, hunger, wanting attention, responding to something in the environment, fussiness or pain.Responding each time your baby cries, will provide comfort and begin to build a bond between you and your baby. If you are unable to comfort your baby, then it's important to contact your health care provider. "

Which findings describe the quiet alert state of the sleep-wake cycle of a newborn?

A. The newborn smiles, vocalizes, follows faces and responds to auditory stimuli

B. The newborn's motor activity is increased, a high activity level and eyes open

C. The newborn has minimal motor activity and eyes are closed with REM

D. The newborn's eyes open and close, with slow, regular movements of extremities

A

Which newborn behaviour is a protective mechanism against overstimulation that allows the newborn to adapt to environmental stimuli, such as sounds and lights?

Orientation

Consolability

Motor activity

Habituation

Habituation

Newborns' sensory behaviour capabilities promote readiness for social interactions. Which sensory behaviours of the newborn function at an adult level from birth?

Vision

Touch

Hearing

Smell

Hearing

The Brazelton Neonatal Behavioural Assessment Scale is the most commonly used tool to determine a newborn's gestational age. T/F?

False

what trauma related injuries can happen to child at birth?

soft tissue injury, cranial nerve injury, brachial plexus injury, bone injury and intra abdominal injury.

birth trauma to newborn is common when?

when assistive devices such as a vacuum or forceps were used during delivery

soft tissue injury in newborn is considered what

injuries involving the head: Cephalhematoma, Caput succedaneum

Cephalhematoma

one of the most common injuries that a newborn may suffer, especially if forceps or vacuum is used. With soft tissue damage from mechanical trauma, blood will accumulate between the skull and the periosteum. The swelling will appear as a "squishy" or slightly hard lump on the newborn's head. Overtime, the blood will be reabsorbed and the swelling will go down

which soft tissue injury can lead to hyperbilirubinemia?

Cephalhematoma

Caput succedaneum

a condition that presents as swelling that crosses suture lines. During childbirth (especially when membranes have been ruptured and there is a long labour), there may be prolonged pressure from the dilated cervix or vaginal wall, which causes soft tissue injury and swelling.

most common newborn fracture

clavicle

how does newborn clavicle fracture occur

twisting and pulling by the clinician who is delivering the newborn.

fracture of the humerus or femur of newborn is associated with what

breech delivery

S&S of humerus or femur fracture in newborn

ecchymosis, hematoma, or hemorrhage at the site.

what signs are associated with newborn skull fracture

Swelling, bruising or a palpable step deformity will be present with a depressed skull fracture

risk factors for birth trauma

-Prolonged or rapid labour

-Prima gravida

-Large for gestational age (>4500 g)

-Vaginal breach delivery

-Instrumental deliveries, especially forceps or vacuum

-Abnormal or excessive traction during delivery

-Large fetal head

-Small maternal pelvis

What are the risk factors related to birth trauma?

Prima gravida

Cesarean section

Small for gestational age

Vaginal cephalic presentation birth

Prima gravida

During birth, which bone is the most common fracture from shoulder dystocia?

Skull

Pelvis

Clavicle

Scapula

Clavicle

what leads to Newborn Hyperbilirubinemia

the liver may not be mature enough to conduct conjugation, which can lead to an increase in unconjugated bilirubin

2 types of jaundice

physiologic and pathologic

Physiologic jaundice

A transient hyperbilirubinemia that is a normal finding, appearing after the first 24 hours of life, usually after day three, and is related to delayed elimination of bilirubin. If the level of bilirubin is high the newborn will require treatment to ensure the brain will not be harmed or affected.

Pathologic jaundice

also known as non-physiologic jaundice, appears within the first 24 hours of birth, and is related to increased production of bilirubin. Pathological jaundice requires further evaluation and treatment.

The most common cause of hyperbilirubinemia

is maternal-newborn blood group incompatibility

Jaundice is caused by elevated unconjugated bilirubinemia, with high serum bilirubin levels. T/F?

False

Which newborn is at greater risk of hyperbilirubinemia?

Pre-term newborn

Term newborn

Post-term newborn

Age is not a risk factor

Pre-term