Term
| What causes the foramen Ovale to close? |
|
Definition
| Increased pulmonary blood flow from the L side of the heart increases pressure in the L atrium, which causes functional closure. |
|
|
Term
| In a term infant, when should the ductus arteriosus close? |
|
Definition
| in the first few hours after birth, it should close. It will close permanently b/w 3-4 weeks. |
|
|
Term
| How can a patent ductus arteriosus be detected? |
|
Definition
| With auscultation of murmur. |
|
|
Term
| What is the normal heart rate for a term infant? |
|
Definition
| 100-160 bpm, 180 if crying. |
|
|
Term
| Where is the point of maximal intensity for a newborn's heartbeat? |
|
Definition
| 4th intercostal space L of midline. |
|
|
Term
| A mom is concerned because the nurse hear a murmur an hour after the baby is born. What do you say? |
|
Definition
| Transient murmurs are common during the 1st few hours of life. |
|
|
Term
| What is the normal hemoglobin range for the newborn? |
|
Definition
|
|
Term
| What is the normal hematocrit for a newborn? |
|
Definition
|
|
Term
| What is the normal WBC count for a newborn? |
|
Definition
|
|
Term
| What is the normal newborn temp range? |
|
Definition
|
|
Term
| What are the 4 modes of heat loss in the infant? |
|
Definition
| Convection, radiation, evaporation and conduction. |
|
|
Term
| What is nonshivering thermogenesis? |
|
Definition
| Metabolism of brown fat to produce heat in the newborn. |
|
|
Term
| When does brown fat appear and where? |
|
Definition
| 17-20 weeks gestation. In interscapular region, axillae, thoracic inlet, bertebral column, and around kidneys. |
|
|
Term
| What imbalance does cold stress lead to in infants? |
|
Definition
|
|
Term
| If newborn doesn't void in 1st 48 hours, what should we suspect? |
|
Definition
|
|
Term
| After the 4th day of life, how many voidings should the infant have per day? |
|
Definition
| 6-8 voidings of straw colored urine per day. |
|
|
Term
| On the 2nd day of life, mom is changing diaper and sees pink stains in the diaper, what do you tell her? |
|
Definition
| These are caused by uric acid crystals and are normal for the 1st few days of life, but if it happens later, it can mean baby is dehydrated. |
|
|
Term
| what are retention cysts? |
|
Definition
| Small whitish areas (epstein's pearls) found on gum margins and at juncture of hard and soft palate. They are normal. |
|
|
Term
| When should meconium be passed? |
|
Definition
| Within 1st 12 hrs of life, with almost all occuring by 24 hours. |
|
|
Term
| Where is the best place to palpate the infant's liver? |
|
Definition
| 1.3-5cm below R costal margin in midclavicular line. |
|
|
Term
| Jaundice appearing before ______ of age is considered pathologic. |
|
Definition
|
|
Term
| Where does jaundice usually get noticed first? |
|
Definition
| Usually in head 1st, especially sclera and mucus membrances, then progresses to thorax, abdomen, and extremities. |
|
|
Term
|
Definition
| Acute bilirubin encephalopathy, and the most serious complication of neonatal hyperbilirubinemia. Occurs when levels are >20 mg, and bilirubin is deposited in basal ganglia and brainstem, disrupting neuronal function and metabolism. |
|
|
Term
| Infant has been having abnormally high levels of bilirubin (around 17mg/dl). He is also hypoglycemic and premature. The nurse assessing the infant notices lethargy and poor suck reflex. What does the nurse suspect? |
|
Definition
|
|
Term
| What might the Dr. order soon after birth to prevent bleeding problems? |
|
Definition
|
|
Term
| What should be suspected if a newborn has fever? |
|
Definition
| Serious infection, because newborns usually do not exhibit fever. |
|
|
Term
| What are some of the main signs of infection in an infant? |
|
Definition
| Lethargy, irritability, poor feeding, vomiting, and diarrhea, with decreased reflexes and pale or mottled skin color. |
|
|
Term
| How long does normal acrocyanosis last in newborns and what causes it? |
|
Definition
| It's normal for the 1st 7-10 days and is caused by vasomotor instability, capillary stasis, and high Hgb levels. |
|
|
Term
| Baby has acute edema of the face and ecchymosis with petechiae. What might this be a result of? |
|
Definition
| Face presentation or forceps assisted birth. |
|
|
Term
| What is caput ceccedaneum and how long does it last? |
|
Definition
| Easily identifiable area of the scalp, most commonly found on the occiput. The pressure of the occiput against the cervix during birth. There's an increase in tissue fluids in the skin of the scalp and swelling develops. It goes away in 3-4 days. |
|
|
Term
| What can a large cephalohematoma lead to in babies? |
|
Definition
| Hyperbilirubinemia may occur after baby is home due to hemolysis of RBCs. |
|
|
Term
| When are the testes palpable in the scrotum? |
|
Definition
| After 40 wks. Rugae also cover the cac. |
|
|
Term
| What does a bluish color of scrotum suggest? |
|
Definition
| Testicular torsion. This requires immediate attention. |
|
|
Term
| Who is circumcision contraindicated in and why? |
|
Definition
| contraindicated in hypospadias since foreskin is used in repair of this anomaly. |
|
|
Term
| What is used to test for developmental hip dysplasia? |
|
Definition
-Barlow and orolani maneuver
-Gluteal folds should be equal and symmetric
-Hips inspected for symmetry |
|
|
Term
| When are transient tremors abnormal? |
|
Definition
| When they are observed while the infant is quiet, and beyond 1 month of age. |
|
|
Term
| When may you not be able to elicit the sucking/rooting reflex? |
|
Definition
| After the infant has been fed. |
|
|
Term
| How is swallowing reflex elicited? |
|
Definition
|
|
Term
| How do you do plantar and palmar reflexes? |
|
Definition
Palmar-place finger in palm of hand and infant curls fingers around yours
Plantar-Put finger at base of toes and infant curls toes downward. |
|
|
Term
| What is extrusion reflex? |
|
Definition
| Touch or depress tip of tongue and infant forces tongue outward. |
|
|
Term
| What is Glabellar (myerson's) reflex? |
|
Definition
| Tap over forehead, bridge of nose, or maxilla of newborn whose eyes are open. Newborn blinks for 1st 4 or 5 taps. Continued blinking with repeated taps is consistent with extrapyramical disorder. |
|
|
Term
| What is tonic neck or 'fencing'? |
|
Definition
| With infant falling asleep or sleeping, turn head quickly to one side. Opposite side arm and leg should flex and arm and leg on side face is turned should extend. Responses in legs are more consistent. After 6wk, persistent response is a sign of possible cerebral palsy. |
|
|
Term
|
Definition
| Asymmetric response may connote injury to brachial plexus, clavicle or humerus. |
|
|
Term
| Crossed extension reflex? |
|
Definition
Infant should be supine, extend one leg, press knee down, stimulate bottom of foot, observe opposite leg.
-Opposite leg flexes, adducts, and then extends. |
|
|
Term
| Babinski reflex (plantar) |
|
Definition
| Should be +. All toes hyperextend. |
|
|
Term
| Pull to sit (traction) reflex? |
|
Definition
| Pull infant up by wrists from supine position. Head will lag until infant in upright position. |
|
|
Term
| Trunk incurvation (galant) reflex? |
|
Definition
| Infant is prone, run finger down side of spine. Pelvis swings toward stimulated side. No response=transverse lesions. |
|
|
Term
|
Definition
| Infant in supine position, flex legs and apply pressure to feet. Both legs should extend against examiner's pressure. |
|
|
Term
| What are the 2 sleep states? |
|
Definition
| Deep sleep and light sleep. |
|
|
Term
| What are the 4 wake states? |
|
Definition
| Drowsy, quiet alert, active alert, crying. |
|
|
Term
| Newborns sleep approximately ______ hours a day. |
|
Definition
|
|
Term
| What is the least mature sensory system at term gestation? |
|
Definition
|
|
Term
| When does emotional tearing begin and when is it fully developed? |
|
Definition
| Begins at 3 weeks and is fully developed by 3 months |
|
|
Term
| What is an infants object color preference? |
|
Definition
|
|
Term
| Discuss the sensitivity of an infant's sense of smell. |
|
Definition
| Highly developed and can discriminate distinct odors. By the 5th day can recognize mom's smell, and breastfed infants can differentiate b/w mom's and another woman's breastmilk. |
|
|
Term
| When should gloves be worn when handling the newborn? |
|
Definition
| From birth-2hrs or until all blood and amniotic fluid are removed by bathing. |
|
|
Term
| What is the purpose of the APGAR scale? |
|
Definition
| Permits rapid assessment of need for resuscitation based on 5 signs that indicate physiologic state of the neonate. |
|
|
Term
| What is evaluated with the APGAR scale? |
|
Definition
| Heart rate, repiratory rate, muscle tone, reflex irritability and generalized color. |
|
|
Term
| APGAR score of 0-3 means what? |
|
Definition
|
|
Term
| APGAR score of 4-6 means what? |
|
Definition
| Moderate difficulty adjusting to exterauterine life. |
|
|
Term
| What does an APGAR score of 7-10 mean? |
|
Definition
| No difficulty adjusting to extrauterine life. |
|
|
Term
| What is erythromycin opthalmic ointment 5mg and why is it given? |
|
Definition
| It's a prophylactic agent mandatory in the US. It protects against opthalmia neonatorum (an inflammation of the eyes from gonorrheal and chlamydial infection). CDC says give ASAP after birth. |
|
|
Term
| What is the average cord separation time? |
|
Definition
|
|
Term
| When is the cord clamp removed? |
|
Definition
| Once the stump has started drying and is no longer bleeding. |
|
|
Term
| What is the standard lab value for reticulocytes? |
|
Definition
term=.4-.6%
preterm = up to 10% |
|
|
Term
| What is the standard lab value for fetal hemoglobin? |
|
Definition
Term=40-70%
Preterm=80-90% |
|
|
Term
| What is the standard lab value for RBCs? |
|
Definition
|
|
Term
| What is the standard lab value for platelet count? |
|
Definition
Term=150,000 to 300,000
Preterm= 120,000 to 180,000 |
|
|
Term
| What is the standard lab value for WBC count? /mcl |
|
Definition
Term= 9000 to 30,000
Preterm=10,000 to 20,000 |
|
|
Term
| What is the standard lab value for neutrophils? |
|
Definition
|
|
Term
| What is the standard lab value for eosinophils and basophils? |
|
Definition
|
|
Term
| What is the standard lab value for lymphocytes? |
|
Definition
|
|
Term
| What is the standard lab value for monocytes? |
|
Definition
|
|
Term
| What is the standard lab value for immature WBCs? |
|
Definition
|
|
Term
| Describe the characteristics of a newborn with normal posture. |
|
Definition
| Fists clinched, arms and legs in flexed flexion, resistance to having extremeties extended for exam. |
|
|
Term
| What will be the characteristics of a newborn with abnormal posturing? |
|
Definition
| Hypotonia (may be too relaxed d/t maternal meds) or hypertonia (may be d/t drug dependence) |
|
|
Term
| Why might a femoral pulse be weak? |
|
Definition
|
|
Term
| What is a normal HR and pulse? |
|
Definition
| 120-160 w/murmurs. Visible pulsations in 5th intercostals, apical pulse in fourth intercostals. |
|
|
Term
| What is the normal for respirations? |
|
Definition
| 30-50 breaths/min, shallow, irregular, apnea <15 seconds |
|
|
Term
| What is the normal for birth weight fluctuations? |
|
Definition
| Birth weight regained within 1st 2 wks, acceptable wt loss |
|
|
Term
| How is length measured and what is normal? |
|
Definition
| MEasured from top of head to heel. WNL=45-55cm. |
|
|
Term
|
Definition
| Measure at greatest diameter. WNL=32-36.8cm |
|
|
Term
|
Definition
| Measure at nipple line. WNL=2-3cm |
|
|
Term
|
Definition
| Not usually measured unless specific indication. WNL=Same size as chest. |
|
|
Term
|
Definition
| Check color, daylight provides best lighting. WNL=Pink, tangelectasias, stork bites, hemangiomas, etc. Check for Jaundice, Assess skin turgor, check vernix. |
|
|
Term
| Discuss assessment of head. |
|
Definition
| Palpate, inspect, and measure fontanels (not normal=full or bulging). Palpate the skin on the head (WNL=caput succedaneum, possibly with ecchymosis. Not normal=cephalohematoma (d/t birth related trauma). Palpate sutures. |
|
|
Term
|
Definition
| WNL=eyes and space b/w eyes each 1/3 the distance from outer to outer canthus. Check eyelids for size, movements, and blink (WNL=Edema if silver nitrate instilled). |
|
|
Term
|
Definition
| Not normal=copious drainage, flaring of nares (resp distress!) |
|
|
Term
|
Definition
| WNL= line drawn through inner and outer canthi of eyes reaching top notch of ears (at junction with scalp). |
|
|
Term
|
Definition
| WNL=Epstein pearls (whitish hard nodules on gums or roof of mouth). Not normal=teeth. |
|
|
Term
| How is the newborn usually placed after initial assessment to facilitate drainage? |
|
Definition
| In side lying position with a rolled blanket at back to facilitate drainage. |
|
|
Term
| What is the process for suctioning with bulb syringe? |
|
Definition
-Mouth is suctioned 1st to prevent infant from inhaling pharyngeal secretions by gasping as nares are touched.
-Bulb enters at side of mouth, center of mouth avoided b/c could stimulate gag reflex and increase risk of aspiration. |
|
|
Term
| What is the nasopharyngeal catheter with mechanical suction apparatus used for? |
|
Definition
| -Deeper suctioning
-Proper tube insertion and suctioning for 5seconds or |
|
|
Term
| What is the 1st thing you should try to relieve airway obstruction? |
|
Definition
| Reposition an suction the mouth and nose with a bulb syringe usually eliminates the airway problem. |
|
|
Term
| What does cold stress do in terms of the baby's oxygen and glucose? |
|
Definition
| Cold stress increases the need for O2 and may deplete glucose stores. |
|
|
Term
| Where should the thermistor probe be taped? |
|
Definition
| to the URQ of the abdomen just below the ribs (never over a bone) |
|
|
Term
| What is low birth weight? |
|
Definition
| Weight of 2500g or less. Commonly occurs with preterm birth. |
|
|
Term
| What is very low birth weight? |
|
Definition
| Birth weight below 1500g or less. |
|
|
Term
| What is low birth weight? |
|
Definition
| Weight of 2500g or less at birth. Preterm and LBW commonly occur together. |
|
|
Term
|
Definition
| Weight of 1500g or less at birth |
|
|
Term
| Intrauterine growth restriction |
|
Definition
| Term applied to fetus whose rate of growth doesn't meet expected norms. |
|
|
Term
|
Definition
| Born before 37 weeks gestation |
|
|
Term
|
Definition
| born b/w the beginning of week 38 and end of week 42. |
|
|
Term
|
Definition
| Born after completion of 42 weeks and showing effects of progressive placental insufficiency. |
|
|
Term
| When should a more detailed, thorough physical exam follow the initial assessment? |
|
Definition
| Within 12-18 hours after birth. |
|
|
Term
| What is the most common type of cranial injury in newborns and what is it associated with? |
|
Definition
| Cephalohematoma. It's associated with underlying skull fracture. |
|
|
Term
| What is caput succedaneum? |
|
Definition
| Diffuse swelling of soft tissue of the scalp and is a result of pressure of uterus or vaginal wall on the fetal head. |
|
|
Term
| What is the most common birth injury? |
|
Definition
| Fracture of the collarbone. |
|
|
Term
| What test can you use to differ cutaneous jaundice from skin color? |
|
Definition
| The blanch test. Apply pressure with the finger over a bony area for several seconds to empty all capillaries in that spot. |
|
|
Term
| Why is placing baby in sunlight not recommended for jaundice? |
|
Definition
| Because it is effective only if the infant is completely undressed; it presents danger in terms of hypothermia and risk of sunburn. |
|
|
Term
| Describe physiologic jaundice and when it becomes evident. |
|
Definition
Infant who is dx with physiologic jaundice appears to be otherwise well and shows signs of jaundice after age 24 hours.
-Jaundice is clinically visible when levels reach 5-7mg/dl |
|
|
Term
| When is jaundice considered to be pathologic? |
|
Definition
-When it appears before 24 hours of age.
-Rises more than .5 mg/dl/hr
-Peaks at >13mg/dl
-Associated with anemia and hepatosplenomegaly
-Always warrants immediate attention. |
|
|
Term
|
Definition
| An injection of Lidocaine Sub Q to each side of the shaft before circumcision. Wait 3-5 min. |
|
|
Term
| What is a dorsal penile nerve block? |
|
Definition
| Sub Q lidocaine at 2&10 o'clock at the base of the penis. Wait 3-5 min after inj before circumcising. |
|
|
Term
| How many calories does the baby need in the 1st 3 months? |
|
Definition
|
|
Term
| How many calories does the baby need from 3-6mo? |
|
Definition
|
|
Term
| How many cal does the baby need from 6-9 months? |
|
Definition
|
|
Term
| How many cal does the baby need from 9mo to 1yr? |
|
Definition
|
|
Term
| What is true of breast size in relation to breast production? |
|
Definition
| Size of breast is not an accurate indicator of its ability to produce milk. |
|
|
Term
| What hormone is responsible for the milk let-down reflex or Milk ejection reflex? |
|
Definition
|
|
Term
|
Definition
| Clear yellowish fluid that is more concentrated than mature milk and is extremely high in immunoglobulins. |
|
|
Term
| After mom gives birth, decrease in estrogen and progesterone triggers what? |
|
Definition
| Release of prolactin from anterior pituitary gland. |
|
|
Term
| What is prolactin's role during pregnancy? |
|
Definition
| It prepares the breasts to secrete milk. |
|
|
Term
| What is prolactin's role during lactation? |
|
Definition
| It synthesizes and secretes milk. |
|
|
Term
| What is a sign of a well-hydrated baby? |
|
Definition
| 6-8 wet diapers and 3-6 BM Q24 hours after day 4. |
|
|
Term
| How many calories should breastfeeding moms have? |
|
Definition
| 2700cal/day (500 more than usual) |
|
|
Term
| What type of breastfeeding hold is preferred for moms with a c-section? |
|
Definition
|
|
Term
| What type of breastfeeding hold works well for early feedings, especially with smaller babies? |
|
Definition
| The modified cradle or across lap hold. |
|
|
Term
| Which breastfeeding hold allows mom to rest while breastfeeding and is preferred by mom with perineal pain and swelling? |
|
Definition
|
|
Term
| What is the most common hold for infants who latch on easily? |
|
Definition
|
|
Term
| What is a sign that let down has occurred? |
|
Definition
| Mother feels a tingling sensation in the nipples (although many women never feel their milk let down). |
|
|
Term
| What is the average duration of feeding times? |
|
Definition
| 30-40min or approx 15-20min per breast |
|
|
Term
| How many times should a newborn breastfeed? |
|
Definition
| 8-12 times in a 24 hour period. |
|
|
Term
| What if it is time to breast feed baby and he is sleeping? |
|
Definition
| Feed every 3-4 hours even if you have to wake baby. They need 6-8 feedings per day. |
|
|
Term
| Why shouldn't a bottle be propped with a pillow or other item to feed baby? |
|
Definition
| Because it may result in choking and deprives baby of interaction with mother. It also causes tooth decay. |
|
|
Term
| When may boiling be needed? |
|
Definition
| When there is some question about the safety of the water supply, but it is otherwise not needed. |
|
|
Term
| How can we differentiate hemorrhagic areas from skin rashes and discolorations such as mongolian spots? |
|
Definition
| By blanching skin with 2 fingers. Petechiae and ecchymoses do not blanch. |
|
|
Term
| How can we diagnose a fractured clavicle bone? |
|
Definition
| Limitation of motion of arm, crepitus over bone, and absence of moro reflex seen on affected side and are diagnostic. |
|
|
Term
| What is Erb Duchenne palsy? |
|
Definition
| Brachial paralysis of the upper arm |
|
|
Term
| What is the most common type of paralysis associated with a difficult birth? |
|
Definition
| Erb Duchenne palsy/ Brachial plexus |
|
|
Term
| What does Erb Duchenne palsy result from? |
|
Definition
| Injury to upper plexus results from stretching or pulling the head away from the shoulder during a difficult birth. |
|
|
