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Normal Newborn
Child Health Test#1
| Question | Answer |
|---|---|
| The most critical and immediate physiologic change required of the neonate | Breathing |
| Stimuli that initiates breathing | -biochemical changes-thermal stimuli-tactile stimuli???? |
| When can fetal breathing movements be detected? | 11weeks, by ultrasound (very irregular) |
| What do the fetal breathing movements involve? | the diaphragm and intercostal muscles |
| How long before the newborns first breath? | 1 minute |
| Describe newborn respirations within the first 15 minutes | -60-80/min-irregular-crackles-nasal flaring and chest retractions-brief periods of apnea |
| When does the open mouth breathing reflex occur? | 3 weeks (strictly nose breathers before than) |
| Normal Respirations for newborn | 30-60/minshallowirregularshort periods of apnea <15 secs |
| See-saw respirations | chest and stomach rise simultaneouslyABNORMAL |
| Transition from fetal circulation involves: | Closure of......-foramen ovale-ductus arteriosus-ductus venosus |
| What dilates the pulmonary vessels? | inspired oxygen from expanding lungs |
| What happens to the pressure in the left atrium after birth? | it increases r/t increase in pulmonary blood flow |
| What happens to the pressure in the right atrium after birth? | it decreases r/t removal of placental circulation |
| What causes the foramen ovale to become plastered to the septum? | greater pressure in the left atrium than the right |
| How does the ductus arteriosus close? | 1st- a constriction of the vessels during the first 12hrs of birth2nd- anatomical closure by fibrosis (usually by third month) |
| What causes the constriction of the ductus arteriosus? | a decrease in prosaglandins and increase in oxygen (creates vasospasms) |
| Which shunts eventually becomes a ligament? | Ductus Arteriosus, Ductus Venosus |
| When does the ductus venosus close? | within 1-3 hours of birth |
| How is the ductus venosus seal off? | by closing of a spincter at the umbilical cord |
| What happens to the umbilical vessels once they are clamped? | -the vessels constrict-cease to pulsate within 5-10 min |
| Transitory heart murmur in neonates | can be heard in some neonates-dissappear within a few days -evidence of delayed closure -caused by leackage of blood |
| Convection | the flow of heat fromthe body surface to cooler surrounding air |
| Conduction | the transfer of body heat to a cooler solid object in contact with the body |
| Radition | the transfer of body heat to a cooler solid object not in contact with the body, but in relative proximity |
| Evaporation | the losst of heart that occurs when a liquid is converted to vapor |
| Non-shivering thermogenesis | increase in metablism of primarily brown fat and rate of oxygen consumption |
| Brown fat | -adipose tissue unique to neonates-richer vascular and nerve supply that ordinary fat |
| Hemoglobin | 14.5-22.5 (70-80% is fetal hgb) |
| Hematocrit | 44-75% |
| RBC | 4.0-6.6 |
| WBC | at birth-18,000first day- 23,000 |
| What happens after the initial peak of WBC | they decrease to 11,500 and become less efficient at phagocytosis (lower resistance to infection) |
| Is drooling common within the first few hours | Yes |
| stomach capacity | 30-90mls |
| stomach emptying | 1-24 hrsinfluenced by:-time/volume-type of feeding-psychic stress-physical state-maturity |
| Regurgitation | may occur r/t cardiac sphincter and nrevous system control of the stomach are immature |
| Changing stool pattersn | 1. meconium2. transitional stool3. milk stool |
| Meconium | -first stool-sticky, greenish black, sterile-composed of intrauterine debri-usually passed within 24hrs |
| Transitional Stool | -by third day of life-thin, slimy, green brown, yellow seedy, less sticky |
| Milk Stool | by fourth day of life |
| Breastfeed Stools | -yellow-golden color-pasty consistency-non-irritating-many stools |
| Formula Stools | -Pale, yellow to light brown-firmer consistency-more offensive odor-irritating |
| When is the elimination pattern established? | by the second week |
| Why do newborns have a low level of vitamin k? | because of the absence of intestinal flora bilirubing is not broken down to stercobilin and urobiligen |
| When are newborns at risk for hemorrhage? | between the second and fith day of life |
| Vitamin K | Aquamehyton1mg for full term0.5 for premature infants |
| What is the major function of the liver? | breakdown of bilirubin |
| What breaksdown bilirubin before the liver? | the placenta |
| What is the lifespan of a newborns RBS | 70-90 days |
| When does physiologic jaundice occur? | After 24 hours |
| Pathologic jaundice | occurs before 24 hours. Indicates pathologic process regardless of bili serum level |
| How does jaundice occur | cephalocaudally |
| When does jaundice dissappear? | at one week |
| Bilirubin levels should not exceed______ | 20mg. Can cause brain tissue staining "kernicterus" |
| What carries out the kidneys function prior to birth? | the kidneys-urine formed becomes part of the amniotic fluid |
| Why cant they concentrate urine? | short loop of henle |
| At what age is renal function mature? | 2 years-puts newborns at high risk for electrolyte imbalance |
| How long before a newborn may void? | 12-24 hours |
| What is considered average adequate fluid intake? | 6-10 voidings of pale straw colored urine |
| By 10 days of age, what is the usual urine output? | 50-300mls |
| What are the 3 stages of immediate care after birth | -Immediate care-transitional period-routine newborn care |
| What postition should the newborn be in after birth? | slight trendelenburg |
| What does the APGAR assess? | -Muscle Tone-Heart Rate-Reflex Irritability-Color-Respirations |
| How close should the cord clamp be? | 1 inch from abd |
| What information should be on the id band? | mothers name, date and time of delivery, doctors name, and special id number |
| How often should you get vitals on newborns? | -q 15 min for 1hr-q 1 hr for 4 hrs-q 8 hrs until discharge |
| How should you take a blood pressure? | once all extremities and compare upper to lower to ruleout a cardiac defect |
| When should scoring of gestational age be performed? | 2-8 |
| What does the prophylactic eye ointment prevent? | -gonorrheal neonatorum-ocular chlamydial infections |
| What is the drug of choice for prophylactic eye treatment? | Erythromycin |
| What should formula feed infants receive for their first feeding? | 1/4 - 1/2 oz. (burp after 1/2 oz) |
| How long before umbilical cord falls off? | 7-10days |
| Surgical circumcision | a "Gomco" or Mogen" clamp is used to pinch of nerve endings and blood supply and skin is cut off |
| Non-surgical circumcision | Plastibell is a plastic ring tied around the foreskin, skin falls off in 5-8 days |
| Newborn circumcised on day of discharge_____ | cannot not go home til he has voided |
| If jaundice is visible what are the bili levels | they exceed 4-6mg |
| Methods to reduce jaundice | -sunlight-phototherapy-bili-blanket-bilibed |
| Neonatal Screening Tests | law- must be done before discharge-needs to be after 48 hrs for metabolic test to be accurate-tests 34 diseases |
Created by:
jas067
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