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Patient Evaluation

Assessment of the Infant

QuestionAnswer
Assessment of the Infant Perinatal History - mother's history history of pregnancy (age, smoking history, and substance abuse, nutrition, infections, previous pregnancy/outcome, hypertension. - mothers with diabetes are prone to have premature or large infants.
Assessment of the Infant Terminology/ Gestational Age - time since the estimated date of conception.
Assessment of the Infant Terminology/ Term Infant - born between 38 to 42 weeks of gestational age.
Assessment of the Infant Terminology/ Preterm Infant - (premature) born less than 38 weeks of gestational age.
Assessment of the Infant Terminology/ Post term Infant - more than 42 weeks gestational age.
Assessment of the Infant APGAR score - provides a clinical method for evaluating the infant immediately after birth. - Allows for a rapid appraisal of an infant in determine resuscitation.
Assessment of the Infant APGAR score/Routine - 1 minute predicts neonatal survival. - 5 minutes predicts neurological outcome.
Assessment of the Infant APGAR score/5 Factors Evaluated - color - heart rate - reflex irritability - muscle tone - respiratory effort
Assessment of the Infant APGAR score/APGAR scoring/Appearance (Color) - Appearance= 2pts=(Good) = completely pink - Appearance 1 pt. (Bad) = body pink Extremities = blue - Appearance 0 pt. (Real Bad) = Blue All Over = pale
Assessment of the Infant APGAR score/APGAR scoring/(Pulse) -Pulse = 2pts = (Good) = greater than 100 -Pulse = 1pt. = (Bad)= less than 100 -Pulse = 0pt. = (Very Bad) = absent No pulse
Assessment of the Infant APGAR score/APGAR scoring/(Grimace) - Grimace = 2pts = (Good) = cough or sneeze - Grimace = 1pt. =(Bad)= grimace - Grimace = 0 pt. = =(Bad)= no response
Assessment of the Infant APGAR score/APGAR scoring/(Activity) - Activity = 2pts =(Good) =active motion - Activity = 1pt = (Bad)= some flexion - Activity = 0pt.=(Very Bad)= no response
Assessment of the Infant APGAR score/APGAR scoring/(Respiratory Effort) - Respiratory Effort =(Good) = 2pts = regular strong cry. - Respiratory Effort=(Bad)= 1pts =slow, irregular, weak - Respiratory Effort =(Very Bad)= 0pts. = absent No cry
Assessment of the Infant APGAR score/Action based on score (0-3) -RESUSCITATE
Assessment of the Infant APGAR score/Action based on score (4-6) - SUPPORT -stimulate, warm, administer O2
Assessment of the Infant APGAR score/Action based on score (7-10) - MONITOR -routine care
Assessment of the Infant Transillumination/Recommended - recommended when pneumothorax is suspected.
Assessment of the Infant Transillumination/Equipment - a fiberoptic light is placed against the infants chest in a darkened room.
Assessment of the Infant Transillumination/Contact - normally a lighted halo is seen around the point of contact.
Assessment of the Infant Transillumination/Clinical - a pneumothorax or pneumomediastatinum will cause: the entire hemithorax to light up.
Assessment of the Infant Vital Signs/Temperature - infants lose body heat very quickly. - infants may need to be placed in a warm environment. - to maintain adequate body temperature.
Assessment of the Infant Vital Signs/Normal Temperature - 36.5 C
Assessment of the Infant Vital Signs/Maintain Temperature - servo controlled incubator and radiant warmers provide automatic adjustments of temperature.
Assessment of the Infant Sensors - a sensor is placed on the infant and feeds back information to the heating and cooling unit.
Assessment of the Infant Temperature Probes - if the temperature probe comes off the skin = the unit will over heat causing high temperature alarm and low skin temperature.
Assessment of the Infant O2 consumption - when an infant is kept warm oxygen consumption is reduced.
Assessment of the Infant Pulse/Heart Rate/Term Infant - Normal HR for term infant = 110-160 - Preterm faster rates
Assessment of the Infant Pulse/Heart Rate/Tachycardia - 170 bpm or greater
Assessment of the Infant Pulse/Heart Rate/Bradycardia -less than 100 bpm
Assessment of the Infant Pulse/Heart Rate/Measured - using the: - brachial pulse - femoral pulse - apical pulse
Assessment of the Infant Pulse/Heart Rate/Increased Cardiac Output - infants can increase cardiac output by increasing heart rate.
Assessment of the Infant Respirations/Normal - 30-60 breaths/min - higher in preterm
Assessment of the Infant Respirations/Respiratory Pause - apnea for 5-10 secs ,normal
Assessment of the Infant Respirations/Short Apnea - apnea 10-20 secs, normal
Assessment of the Infant Respirations/Long Apnea - apnea for longer than 20 secs , always abnormal
Assessment of the Infant Blood Pressure/ Term Infant - 60/40 mmHg
Assessment of the Infant Blood Pressure/ Pre-term Infant - 50/30 mmHg
Assessment of the Infant Birth Weight/ Term Infant - greater than 3000g - 3kg
Assessment of the Infant Birth Weight/ 28 week gestational age -1000g -1kg
Assessment of the Infant Birth Weight/ Low Birth Weight -low birth weight infants are at higher risk for respiratory problems.
Assessment of the Infant Cyanosis/Acrocyanosis - is bluish extremities and is not true cyanosis
Assessment of the Infant Cyanosis/How to Check - check mucous membranes of the mouth, tongue, nail beds
Assessment of the Infant Retractions - intercostal - subcostal - substernal - supraclavicular - retractions are signs of respiratory distress.
Assessment of the Infant Nasal Flaring - dilation of nasal opening also indicates respiratory distress for infants who must breath through their nose.
Assessment of the Infant Grunting - a sound heard at the end of exhalation that indicates respiratory distress (RDS) from decrease lung volume.
Assessment of the Infant Capillary Refill - blanching of the infants skin to see how long it takes for normal color to return. longer than 3 secs may indicate a decreased cardiac output
Assessment of the Infant Gestational Age/Dubowitz Method - assessment of the gestational ae is important to differentiate between a preterm infant and one that is small for their gestational age.
Assessment of the Infant Gestational Age/Dubowitz Method/Scoring - the higher the score the higher the gestational weeks.
Assessment of the Infant Gestational Age/Dubowitz Method/Scoring/Normal -40 corresponding to # of 40 weeks
Assessment of the Infant Gestational Age/Dubowitz Method/Scoring/>40 - post-term infant
Assessment of the Infant Gestational Age/Dubowitz Method/Scoring/<40 - preterm infant
Assessment of the Infant New Ballard - modified dubowitz scale - estimates gestational age of low birth weight babies - normal score = 40 weeks
Assessment of the Infant Pre-and Post Ductal Blood Gas Studies/R to L Shunt - if right to left shunt occurs across the ductus arteriosus = = Pa02 level obtained from ductal site (right arm)often exceeds the Pa02 level obtained from a post-ductal site (umbilical artery or a lower extremity vessel.
Assessment of the Infant Pre-and Post Ductal Blood Gas Studies>1 torr higher - if the pre- ductal (right artery) Pa02 is 15 torr higher than post- ductal (umbilical artery)Pao2 then the patient has patent ductus arteriosus with a right to left shunt
Assessment of the Infant Pre-and Post Ductal Blood Gas Studies/Evaluate - by transcutaneous monitoring - pulse Oximetry
Assessment of the Infant Pre-and Post Ductal Blood Gas Studies/Recommend - an echocardiogram to determine the cause of the shunt.
Assessment of the Infant Blood Glucose/Monitor - Blood glucose levels are important to monitor in infants
Assessment of the Infant Blood Glucose/Term - term infants have greater value greater than 30mg/dL
Assessment of the Infant Blood Glucose/Premature - premature infants should have values greater than 20 mg/dL
Assessment of the Infant Lung Maturity Information/Lecithin/Sphingomyelin(L/S) Ratio - A ratio of 2:1 or higher is good. -hyaline membrane - IRDS ratio approaches 0
Assessment of the Infant Lung Maturity/Ratio less than 2:1 - less than 2:1 indicates high risk of HMD/IRDS
Assessment of the Infant Lung Maturity/Ratio/Drops below 2 - incidence of HMD/IRDS range from - 40%-80% - lower ratio indicating higher risk.
Assessment of the Infant Lung Maturity/Incidence of false-negative - L/S ratio is from 20-25% and occurs when low L/S ratio is - - measured with no signs of distress (related to perinatal complications and maternal diabetes
Assessment of the Infant Phosphatidylglycerol PG - phospholipid appearing at about 36 weeks gestation and rising until term. - most reliable indicator of pulmonary maturity even with diabetes.
Assessment of the Infant Phosphatidylcholine PC PC(DPPC) - Phospholipid - lecithin makes up majority of the weight of surfactant - Indicator for lung maturity, and will rise as lungs mature
Created by: sukar