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Transition to extrauterine life: ___________: Most critical and immediate
respiration
Initiation of respiration:
a.
b.
c.
a. chemical factors
b. thermal factors
c. physical compression
Initiation of respiration:
Chemical factors:
-Decreased ___ and ___
-Increased ___
Stimulates the respiratory center of _________
O2/pH
CO2
Medulla
Initiation of respiration:
Thermal Factors: sudden _______ stimulates respiration
chilling
Initiation of respiration:
Physical compression: fluid in lungs. _______ is squeezed during NSD forcing _____ out and ___enters to take its place.
Thorax
fluid
air
_____ may need extra respiratory support
c-section
when sufficient fluid isn't forced out of lungs during delivery:
transient tachypnea of the neonate (TTN)
The first breath:
requires a great deal of energy
________-developed at the end of pregnancy and excreted by the lungs causes decreased surface tension and therefore lung expansion.
role of surfactant
within ____ have developed adequate residual volume
10m
within ___-___ have established neonatal VC
10-12h
with the first breath, ____% of blood goes to the lungs causing _______ which decreases _____pressure and ______resistance, resulting in inflation of the lungs
100
vasodilation
thoracic
pulmonary
Thermoregulation: Large surface area tempered by a ___ ___, which helps to reduce the surface area
flexed state
Thermoregulation: neonates has a thing layer of ______ _____
squamous fat
Thermoregulation: inability to _______
shiver
Thermoregulation: this source of heat is unique to infants:
brown fat
Thermoregulation: Brown fat is richer is _______ and ____ _____ than ordinary fat.
vascular
nerve supply
Thermoregulation: Brown fat can cause a _______% increase in heat production when metabolized.
100
Thermoregulation: how long is brown fat present?
several weeks after birth
Thermoregulation: once brown fat is gone, can it come back?
NO, once it's gone, it's gone.
Thermoregulation: supplies of brown fat are severely reduced with ____ ____
cold stress
Thermoregulation: ________ don't have as much brown fat as ____ ____
preemies
term infants
Thermoregulation: why do preemies have less brown fat then term infants?
b/c it is produced at the end of pregnancy.
Thermoregulation: heat is also produced with increased metabolic activity of the ______, _______ and ______
brain heart liver
Thermoregulation: Temperature generally stabilizes within ____-____
1.5-2h
Thermoregulation: Nursing considerations:
-Maintain neutral thermal environment: there is minimal O2 consumption and calorie expenditure when air temp is ____C greater than abdominal temp.
1.5
What are three things that keep neonates body at the right temp?
radiant warmer
isolette
bassinet with cotton blankets
Thermoregulation: Nursing considerations:

The radiant warmer has ServoControl which:
sets upper and lower limits of temp.
what is the best way to take a neonate's temp?
axillary
why don't we do rectal temps on neonates?
-rectal T only drops when baby's reached max effort to preserve heat
-risk for anal perforation
Periods of reactivity: the first period of reactivity is from ______ to _______
birth / 30 mins
First period of reactivity:
(birth to 30 min)
1. Color:
2. Temp
3. Heart rate:
4. Respirations:
5. Activity:
6. Responsiveness to stimuli:
7. Mucous:
8. Bowel sounds:
1. acrocyanosis (extremities blue)
2. begins to drop from intrauterine of 100.6
3. rapid 160-180
4. irregular, 60-80, occasional retractions, nasal flaring
5. alert, watching
6. reacts vigorously
7. visible in mouth, production of saliva
8. heard after 15 mins, passage of meconium
Periods of reactivity:
Period of decreased responsiveness (___-___mins)
60-100
Period of reactivity:
Period of decreased responsiveness:
1. Color:
2. Temp:
3. heart rate:
4. respirations:
5. activity:
6. responsiveness to stimuli:
1. stabilizing, pink all over
2. stabilizes at ~99
3. slows to 100-120
4. slows to 30-50
5. sleeps
6. difficult to arouse
Period of reactivity:
Second period of reactivity: (___-___h)
4-8
Period of reactivity:
Second period of reactivity:
1. Color:
2. Temp:
3. Heart Rate:
4. Respirations:
5. Activity:
6. Responsiveness:
7. Increased ___, ___, ___
8. Bowel Sounds:
1. quick color changes c crying or movement
2. increases to 99.6
3. wide swings in rate with activity
4. b/c irreg c activity
5. awake
6. becomes responsive again
7. muscle tone, skin color, mucous production
8. Often passes meconium stool
V/S of newborn: do what first? then what?
resp's
temp
How should one obtain neonates pulse?
apical, 1 minute
Do nurses take baby's B/P along with vitals?
initially, then only if there is a problem.
Sleeping Patterns- Behavioral states.
1.Sleep states:
a.
b.
a. deep sleep
b. light sleep
in a deep sleep, the baby will be ____.
1. What about their eye movements?
2. respiratory status?
3. Threshold to stimuli?
still
1. none
2. smooth respiratory status
3. high threshold to stimuli
Light Sleep:
1. movement?
2. Eye movements?
3. respirations?
4. threshold to stimuli?
1. body movements
2. REM
3. irregular resps
4. more responsive to stimuli
Sleeping Patterns: Awake states:
a.
b.
c.
d.
a. drowsy
b. quiet alert
c. active alert
d. crying
In this awake state, there is minimal activity, wide eyed, interested look on face, regular respirations, attentive to stimuli. (also enc. to eat)
quiet alert
In this awake state, there is some movement, eyes open/close occasionally and are heavy lidded, irregular respirations, delayed response to stimuli.
drowsy
In this awake state, there is increased activity, eyes closed or open, irregular respirations, crying to unpleasant stimuli.
crying
In this awake state: very active, eyes open but face not as bright, irregular respirations, becoming more sensitive to disturbing stimuli.
active alert.
creamy cheeselike covering
vernix
fine, thin hair
lanugo
edema on: (4)
eyes, face, scrotum, labia
distended sebaceous gland: white papules on cheeks, nose, and chin.
milia
when does milia disapper?
2-4wks
is milia normal?
yes, and it will disappear
ecchymosis/petechiae r/t:
birth trauma
dryness and peeling of the skin due to post maturity (born late)
desquamation
when lying on side, bottom half is pinkish/purple and top half is pale
harlequin color change
irregular areas of deep bluish pigment generally found in sacral region
mongolian spots
mongolian spots are common among:
people of color
when do mongolian spots disapper?
generally fade by age 2
flat/deep pink areas:
stork bites
what's another name for stork bite?
telangiectatic nevi
where are stork bites commonly found?
nose, eyelid, back of neck
do stork bites go away?
generally fade by 2nd bday
raised rough-surfaced sharply demarcated and bright red, resembling a strawberry.
strawberry mark
What is another name for a strawberry mark?
nevus vasculosus
does the strawberry mark disappear?
yes, generally by school age
non elevated sharply demarcated red-purple dense area of capillaries common on face
port wine stain
what's another name for a port wine stain?
nevus flammeus
pink papular rash with vesicles
erythema toxicum
what is another name for erythema toxicum?
flea bite rash
where does erytema toxicum appear? (4)
buttocks, abd, thorax, back
when does erythema toxicum appear? Do is disappear?
it may appear 24-48hr and disappear in several days
yellow appearance to skin
jaundice
contusion on face
forcep marks
when do forcep marks disappear?
2-3days
forcep marks are accompanied by:
edema
assess baby for any:
bruising
weighing the neonate: ranges b/n ____ and ____ G
2500-4000
weighing the neonate: ranges b/n ____ and ____ (Lbs/Oz)
5lb 8oz and 8lb 8oz
what is the average neonate weight in G?
3400G
what is the average neonate weight in lbs/oz?
7lb 8-11oz (7.5lbs)
the neonate will gain approximately ___oz weekly
7
Weighing the neonate: ___-___% of weight is water
70-75
In percent, what is the expected weight loss due to fluid shifts?
5-10%
Weight loss due to fluid shifts can be as much as ___% in preterm.
15
Measuring height and length: average is ____-___in (___-___cm)
19-21 in
45-55cm
to measure the height and length of the neonate, you must:
extend the legs
measuring head circumference: should be ____ of total body
1/4
what is the normal head circumference in inches? in cm?
13-14 inches
32-37 cm
The head should be ___inch (__cm) > chest circumference.
1
2
asymmetry as bones overlap
molding
when does molding return to normal ?
within days
openings at junction of cranial bones
fontanels
what shape is the anterior fontanel?
diamond
how many cm long and wide is the anterior fontanel?
3-4cm long
2-3cm wide
when does the anterior fontanel close?
18 months
what shape is the posterior fontanel?
triangular
when does the posterior fontanel close?
8-12wks
the fontanels should not appear:
edematous or depressed
If the fontanel seems edematous, this means:
too much fluid
If the fontanel seems depreseed, this means:
dehydrated
compression of blood vessels causing edema under periosteum often due to vacuum extraction or prolonged labor
caput succedaneum
caput succedaneum:
overrides sutures
caput succedaneum is present at birth and fluid is reabsorbed in:
12h to several days
collection of blood from ruptured blood vessels between parietal bone and periosteal membrane.
cephalohematoma
cephalohematoma:
doesn't cross sutures
cephalohematoma arises when?
2-3 days after birth
cephalohematoma disappears in:
2-3 wks or several months
Eyes: color will be established by:
3-12months
what color will the eyes of a caucasion infant be?
blue or blue gray
what color will the eyes be of an infant of color?
darker
Eyes: neonate may have transient (temporary):
strabismus
Eye: tearless cry:

cry is usually tearless until ________
2 months
why does the neonate have a tearless cry?
immature lacrimal ducts
What is the neonate able to see?
shapes, objects, colors, faces 9-12" away
Eyes: ______ is seen best
black and white
The neonate has ______ vision
peripheral
milk curd like white patches on tongue and inside cheeks that bleed if removed.
thrush
what 4 things should you check for in the neonate's mouth?
palate
precocious teeth
thrush
sucking blister
what is the nurse checking the palate for?
intactness
how is the palate checked?
with a gloved hand
What is another name for precocious teeth?
natal teeth
precocious teeth are rare...what happens when a neonate has precocious teeth?
generally pulled if loose to prevent aspiration
Measuring chest circumference: The chest should be ____-____" and _______
12-13 cylindrical
What should the neonate's chest circumference be in cm?
30-33
Chest: Neonate may have ______ ______
accessory nipple
Chest: ____ ____ (male or female) may occur due to maternal hormones
engorged breasts
how long may a neonate's breast be engorged?
can last for 2 wks
Respirations: Normal range is ___-___. They may be ____ and ______.
30-60
shallow
irregular
Respirations: May have short ______ episodes
apneic
Respirations are diaphragmatic: observe:
rise and fall of abd
neonates are obligatory ____ breathers
nose
the neonate: _____/____ reflex present
coughing/sneezing
The following are signs of resp. distress:
-nasal flaring
-intercostal/xyphoid retractions
-expiratory grunt/sigh
-tachypnea (>60)
-see saw resps
Cry should be ____,____ and of ____ ____
strong
lusty
medium pitch
_____ is abnormal and indicates neurological or resp. problem/drug exposure
shrill
Heart rate: normal range is ____-___ with accelerations to ____
120-160
180
what is heart rate influenced by? (4)
activity
crying
wakefullness
temp
heart rate: _____ and _____ are common
irregularities
murmurs
what size should the abdomen be?
same size as chest
observe abd for ____ and ____ ____
distention
bowel sounds
umbilical cord/umbilical stump: Observe for:
3 vessels (2arteries/1vein)
the umbilical cord/stump can initially be used to feel ____
HR
the umbilical cord/stump shouldn't ____ once clamped
bleed
observe for signs of ___ of the umbilical stump
infection
when will the umbilical stump fall off?
within 2 weeks
The umbilical stump begins to dry. ___ ___/___ may or may not be used- institutional policy.
triple dye/ETOH
Female genitalia may have ___ ___
vag. discharge
If the vaginal discharge is blood tinged:
pseudomenstruation
cheese-like substance under labia
smegma
male genitalia: check urinary orfice for :
hypospadius
epispadius
meatus on ventral surface:
hypospadius
meatus on dorsal surface:
epispadius
_____: foreskin can't be retracted
phimosis
examine scrotum for ____ ____
undecended testicle
check for fluid around the testes which is called:
hydocele
check voiding pattern. may not void for ___-___ and then will void __-__x daily
12-24h
6-10
what color urine indicates adequate nutrition?
pale/straw colored
check anus for _____ gently with a glove
patency
the stool passed in the first 24 hrs is called:
meconium
meconium is: (4)
sticky
tar like
blackish green
odorless
______ stool: until 4th day
transitional
transitional stool is: (3)
thin
slimy
brown/green
If a neonate is being breast fed, it may have a BM how often?
q feeding or 3-4/day
Breast milk stool: by 4th day: (4)
1. light golden yellow (mustard)
2. sweet smelling
3. loose
4. non irritating to skin
If urine is lightly brick stained, this may be:
uric acid
Formula stool occurs how often by 4th day?
daily to bid
Characteristics of formula fed stool?
1. formed
2. soft
3. pale yellow
4. irritating to skin
5. fecal smelling
extra digits
polydactyly
webbed fingers/toes
syndactyly
Single transverse palmar crease is found with:
down's syndrome
trauma to brachial plexus
brachial plexus palsy
Most common type of brachial plexus palsy:
Erb-Duchenne
Erb-Duchenne brachial palsy:

-arm is ____
-elbow is in _____
-forearm _____; can't be elevated independently
- limp
- extension
- pronated
Rx for Erb-Duchenne brachial palsy:
passive ROM or may splint with more severe
Prognosis of Erb-Duchenne depends on:
extent of damage
legs are bowed and short
bow legged
sole of foot is flat
flat feet
check for congenital dislocation of hip (aka...)
congential hip dysplasia
flex/abduct legs and listen for:
click
____ ___: abduct the thighs and apply gentle pressure forward over the greater trochanter
ortoloni sign
When doing ortoloni's sign, a clunking sensation indicates:
a dislocated femoral head moving into the acetabulum
With ortoloni's sign, a hip click may be heard, but is:
usually normal
this test is when you adduct the hips and apply gentle pressure down and back with the thumbs.
Barlow test
with the Barlow test, if the child has hip dysplasia, the examiner can feel:
the remoral head move out of the acetabulum.
Legs/Feet: Note the symmetry of:
gluteal and thigh creases
clubbed foot is aka
congential talipes equinovarus
check for clubbing of feet: with true clubbing, there is
resistance when foot is moved to the midline
what position should the baby be in when checking for gluteal folds?
on belly
This reflex is when you stroke face and the baby turns head in that direction
rooting reflex
This reflex is when the baby sucks when lips/mouth is touched
sucking reflex
This reflex is when the baby pushes out any substance placed on anterior tongue
extrusion
This reflex is when you place baby on back with head turned and arm/leg will extend in direction of head while opposite side with flex
tonic neck/fencer reflex
This reflex is when arms straigthen and move outward, knees flex and fingers form a "C"
moro/startle reflex
This reflex is when baby grasps when palm stimulated
palmar grasp reflex
This reflex is when baby grasps when base of toes in touched
plantar grasp
This reflex is when you stroke sole of foot and toes fan out
babinski reflex
This reflex is when the baby is held upright with 1 ft touching surface and will appear to walk.
stepping reflex
standard precautions when providing care:
1.
2.
1. wash hands
2. wear gloves
clip your fingernails short to prevent:
-scratching newborns skin
-harboring bacteria under nails
Wear gloves when assessing or providing care which might cause you to:
come into contact with body fluids
Thermoregulation:
1. Ensure ______ thermal environment
2. Take _____ T-digital best
3. Place under ____ ___ after birth
4. Wrap in ____ ___ and ___
1. neutral
2. axillary
3. radiant warmer
4. warm blankets/cap
Always keep cap on because
head loses most heat
Check thermoregulation q shift. If T is <97.5 do what?
double wrap, recheck in 20 mins. If still low put in warmer
always support:
head and neck of newborn
what are four ways of holding newborn?
football
horizontal
shoulder
across lap
newborn's bed should have no:
pillows
if baby is gassy:
put on abd and rub back
how should the baby be positioned for bed?
What is best?
side lying or back

back is best
when transporting the baby is hospital, place crib
flat
after eating, head of bed should be
elevated
Nasal/Oral suctioning: baby's are obligatory ____ breathers
nose
to suction the baby, position head to:
side
Oral suctioning, compress bulb syringe and insert____________. ____ contents of mouth.
-b/n cheek and gum
-aspirate
Oral suctioning: Do not insert bulb syringe
into back of throat
How do you do nasal suctioning?
compress bulb, insert into nostril, allow reinflation, expel into tissue
To prepare for bathing: gather _____ and _________
supplies, turn off phone
What is the order in which you wash a baby?
head to toe, perineal last
shampoo with:
baby shampoo
For a baby with cradle cap:
wash hair more freq and use soft hairbrush
Should you use sulfur shampoo with cradle cap?
discuss use with pediatrician
wash face and ears with:
water only
wash underarms, back, neck and behind ears with:
mild soap and water
When washing chest, be sure to:
not get cord wet.
During bath, check fingers for:
threads that may be wrapped around them.
wash perineal are last including:
all creases
wash female perineal area:
front to back, including any discharge
Do not use what things during a bath because it can cause an allergy: (4)
powder
oil
lotion
perfumed soaps
when can you brush teeth with toothbrush?
end of first year
when should the baby be dried?
How?
-after you wash each area.
-pat dry with towel
how often should you wash face/skin folds?
daily
what does the umbilical cord look like after birth?
white
translucent
shiny
in hospital the umbilical cord may be painted with:
purple antimicrobial dye
Cord clamp is usually present on umbilical cord. This is removed when?
in 24h
What should you teach mother to do with umbilical cord?
-assess for infection
-keep dry
-fold diaper under
-no tub bath until it falls off
how often should the mother assess the umbilical cord?
q diaper change
teach the mother the following sx of umbilical cord infection:
-foul odor
-redness
-purulent drainage
When is circumcision generally performed?
when baby is at least 12h old and recovered from stress of birth
Circumcision: removal of foreskin which covers the ____ ____
glans penis
What are 3 popular reasons for doing circumcision?
religious, cultural, social
What 3 things do you assess for after circumcision?
infection, bleeding, 1st urination
what is the clamp called that is used for circumcisions?
gumco clamp
Circumcision care: ____, _____ to head of penis; cover with ______ _______
bacitracin
vaseline
light dressing
Circumcision care: how often do you change the dressing ?
q urination
Circumcision care: when baby urinates: _________ and repeat with ample vaseline and new gauze
drizzle with warm water
Circumcision care: _____ _____ forms in 2-3 days
yellow granulation
Circumcision care: teach parents what about granulation?
don't wash it off, it's normal
Circumcision care: when will the plastibell fall off? What should you not use if a plastibell is used?
5-8 days
vaseline/petroleum jelly
___ ______-prepuce is slit, placed over cone device, clamp is applied around penis to crush bld vessels in the prepuce, excessive prepuce or foreskin is cut
gumco clamp
apply ample amt of vaseline or bacitracin on the head of the penis to prevent:
diaper from sticking
you should clean and bathe an uncircumcised baby with
soap and water
In an uncircumcised baby, the foreskin is attached to the glans so
avoid retracting
In an uncircumcised child, when will the foreskin mature and separate?
3 yrs
when is it safe to retract the foreskin on an uncircumcised penis?
when MD tells you
Nails: how often should you trim the baby's fingernails?
1-2x/week
why is it important to trim the baby's nails?
so baby won't scratch self
with an active baby, trim nails
while sleeping
Nails: Safety in care: use what three things to maintain short nails?
emory board
scissors with blunt tip
baby nail clippers
what grows more slowly, toe or finger nails?
toe
Dressing: Unless in hot weather, baby should be dressed
in several layers
Rule of thumb about dressing baby?
dress in one more layer than you are wearing
If putting baby in one piece, what part do you dress first?
legs first then arms
baby may struggle with dressing. When changing upper half:
hold on lap
baby may struggle with dressing. When changing lower half:
lay on bed
how many times is normal for baby to void/day?
6-10
If painful urination:
notify MD
4 types of stool?
meconium
transitional
bottle fed
breast fed
bottle fed baby will have how many stools/day?
1-2
how many years ago were disposable diapers introduced?
35 yrs ago
How does the cost of disposable diapers compare to cloth diapers?
equivalent
What are the environmental issues that are looked at when comparing cloth or disposable diapers?
solid waste vs. energy, air and water pollution
It is difficult to keep ______ diapers from leaking. This is a health problem especially in group settings. Generally speaking day care center require use of _________ diapers
cloth
disposable
Excessuvely wet skin and contact with urine and stool can cause diaper rash. If using cloth, should change freq. and use disposables for:
nighttime
outings
How many hrs of sleep does neonate get per day?
16h
If baby naps more then ___ hrs in the afternoon, wake and play.
4
keep nighttime feeding as _______ as possible
subdued
90% of ___mo old babies sleep thru the night (6-8) h
3
sleeping position-APP recommends that healthy infants be placed how? (this is due to evaluation of SIDS data-discuss with primary care provider
on backs
process by which parent/child come to love and accept eachother motivation for decades of care
attachment
________________ (___)-proposed that immediately after birth, close contact with infants was essential for optimum development
klaus and kennell 1976
Klaus and kennel revised their proposal in 1982. They realized it:
took longer than a few hrs to form a relationship
IM at birth-prevents bleeding
vit k
ointment to eyes immediately following birth:
erythromycin
IM given b4 leaving hosp
hep B
There are several purposes for crying including: (3)
1. means of communication
2. helps release tension
3. helps shut out sensations that are too intense
What might this cry mean? short, rises and falls.
hunger
a turbulent cry means:
anger
You cannot spoil a baby by giving too much attention. you must respond quickly in the:
first few months
If baby is crying check for:
warmth
diaper
feeding
If baby is crying, and you've checked the baby for warmth, diaper and feeding, calm by: ______. Gently ____ ___, ___ ___ or ____. what are some other ways to calm a baby? brsstww
rocking
stroke head
pat back or chest
-burp, rock, sing, swaddle, talk, walk, warm bath
Signs and symptoms of illness:
1. Temperature:
axillary or rectal elevated or low
Signs and symptoms of illness:
2. vomiting:
>1 forceful vomiting, freq vomiting over 6 hours
Signs and symptoms of illness:
3. LLD
lethargy, listless, difficulty walking
Signs and symptoms of illness:
4. Crying:
inconsolable or high pitched
Signs and symptoms of illness:
5._______ without feeding
cyanosis
Signs and symptoms of illness:
6. breathing:
absense of breathing >15 secs
Signs and symptoms of illness:
7. abdominal distention:
when trying to pass stools or absence of stools after stool pattern established
Signs and symptoms of illness:
8. stool:
2 consecutive green, watery stools
Signs and symptoms of illness:
9. urine:
no wet diapers for 8-12 hrs or less than 6 wet diapers a day
Signs and symptoms of illness:
10. skin
increasing jaundice of skin.
Signs and symptoms of illness:
call health care provider with:
length of time since onset
related activities
or
specific problems
Don't give ______. C virus, taking this causes Reye's syndrome and death
aspirin
Tests and Medications: ____given b/c neonate lacks enzyme to convert amino acid phenylalanine to tyrosine
PKU
Parent's must be competent to take home baby. They must demonstrate:
holding, bathing, diapering and infant.