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N113 Neonatal

N113 - Neonatal transition

QuestionAnswer
Why is erythromycin used? For prevention of opthalmia neonatorum, neisseria gonorrhea & chlamydial infections. Given within 1 hour of birth.
Why is a vitamin K injection given? Promotes liver formation of clotting factors (prevent hemorrhage). Newborn gut does not contain bacteria required to produce vitamin K until several days (bottle fed) to several weeks (breast fed).
Which babies are at risk for developing hypoglycemia? Babies born to diabetic mothers, babies small for gestational age, premature babies.
Why is hypoglycemia a concern in newborns? Brain depends on glucose. Too little glucose can impair function, can lead to seizures or brain injury.
What are the symptoms of hypoglycemia? Symptoms may include: jitteriness, cyanosis, apnea, hypothermia, poor body tone, poor feeding, lethargy, seizures.
How is a newborn treated for hypoglycemia? May be as simple as giving glucose/water mixture or formula. Baby may require a glucose IV. Glucose levels are closely monitored after treatment for recurrence.
What is considered a low glucose level in newborns? In most cases 40 mg/dl, some will go as low as 20 mg/dl.
What is APGAR scoring? It assess 5 characteristics of the newborn: appearance-color, pulse-heart rate, grimace-irritability, activity-muscle tone, and respirations-respiratory effort.
How often is APGAR scoring done? At 1 and 5 minutes. If problems continue, can be done again at 10 minutes.
How is the central nervous system assessed in a newborn? Moves extremities, symmetric features & movements, reflexes intact & appropriate, anterior fontanel soft & flat, spinal column completely closed
How is the cardiovascular system assessed in a new born? Heart rate strong & regular - 120-160, as low as 100 when sleeping, as high as 180 when crying, no murmurs, pulses strong/equal bilaterally, cord with 2 arteries & 1 vein, color overall pink.
How is the respiratory system assessed in a newborn? Lungs clear to auscultation, no retractions or nasal flaring, rate 30-60 breaths per/min, chest expansion symmetric, no upper airway congestion.
How is the genital/urinary system assessed in a newborn? Male - urethral opening at tip of penis, testes descended bilaterally. Female - vaginal opening apparent.
How is the GI system assessed in a newborn? Abdomen is soft, no distention, cord attached & clamped, anus patent - 1st meconium stool
How is the ears, nose & throat assessed in a newborn? Eyes clear, palates intact, nares patent, symmetry, top of ears align with outer canthus of eyes.
How is the integument system assessed in a newborn? Color - pink or acrocyanotic, no lesions or abrasions, no peeling, birthmarks, caput/molding, vacuum 'cap', forceps marks
When are the alveolar ducts developed? Between 20-24 weeks, determines viability and ability for newborn to breathe.
At what age do the type 1 & type II cells differentiate? Between 24-28 weeks, type I - respiratory gas exchange, type II - provide synthesis & storage of surfactant.
What is surfactant? A group of surface-active phospholipids - lecithin & spingomyelin, critical for alveolar stability.
What mechanical events take place in the respiratory tract? 1/3 of fluid is squeezed out by movement through the birth canal by chest compression. Remaining fluid must be suctioned out. All fluid is suctioned with C-section babies.
What chemical events take place in the respiratory tract? First breath is an inspiratory gasp, triggered by the cord being clamped off. CO2 increases which stimulates the aortic & carotid chemoreceptors.
What is the ductus venosus? It is a shunt that bypasses the liver, shunting blood directly to the inferior vena cava.
What is the foramen ovale? It bypasses the lungs, it is an opening between the right & left atrium.
What is the ductus arteriosis? It bypasses the lungs also, it is an opening between the pulmonary artery & aorta.
When does the ductus venosus close? It closes with clamping of cord, permanently fibroses in 1 week.
When does the foramen ovale close? Closes when pressure in LA becomes higher than RA. Permanently closed by 3 months.
When does the ductus arteriosis close? Constricts within minutes of birth, complete closure in 10-15 hours. Permanently closes by 3 weeks.
What hematologic differences occur in a newborn? Infant has increased RBC's and increased H&H which enables cells to receive enough O2. Newborn RBC's have shorter life span and breakdown releases bilirubin causing jaundice.
What factor can impact fetal blood volume? Delayed cord clamping can cause an increase in fetal blood volume.
What are the liver functions after birth? Maintenance of blood glucose levels, production of clotting factors, iron storage, metabolism of drugs.
What is conjugated bilirubin? Conversion of yellow lipid-soluble pigment into water-soluble pigment.
What is unconjugated bilirubin? A breakdown product derived from hemoglobin that is released primarily from destroyed RBC's - NOT an excretable form and potential toxin.
What are sources of bilirubin? Physiologic destruction of RBCs - normal & pathologic destruction of RBCs - abnormal
What is physiologic jaundice? Never present during first 24 hrs of life, appears on 2nd or 3rd day. Considered normal if level doesn't get too high.
What is breastfeeding jaundice? Develops due to insufficient intake during first few days. Meconium not eliminated, which is high in bilirubin.
What is pathologic jaundice? Always abnormal. Occurs during first 24 hours, clinical significance depends on age. Major contributing factor is incompatibilities between mother & infant blood type.
How are jaundice levels read? Jaundice levels increase corresponding to the newborns age. A higher level in a 3 day old is acceptable when the same level would be unacceptable in a 2 day old.
What digestive enzyme is a newborn lacking? Pancreatic lipase, which is used to digest fats. Lipase is found in breast milk. The fats in breast milk are easier to digest than those in formula.
What can difficulty coordinating suck/swallow signify? May indicate cardiac abnormality or tracheoesophageal fistula - may drool.
What is conductive heat loss? Heat transferred from a heat source (neonate) to an object that is colder when the two are in contact.
What is convective heat loss? Loss of heat by air movement - open door, air conditioning vent
What is evaporative heat loss? Heat loss related to moisture on skin, wet linens or clothes.
What is radiant heat loss? Heat loss between a warm surface (neonate) and cold room.
How will a newborn combat cold stress? Metabolic rate will increase. Increased metabolism leads to increased heat produced in body. Oxidation of brown fat, reserves are normally available for several weeks.
What position will conserve heat loss in newborn? Flexed position, arms and legs drawn up under abdomen.
What happen during cold stress? Increased metabolic rate increases demand for O2. O2 & energy are diverted from normal function. If demand for O2 can't be met, respiratory distress syndrome can occur.
When does a fetus begin producing urine? At 12 weeks gestation, by 2nd half of pregnancy - fetal urine is major source of amniotic fluid.
When are the kidneys completely developed? By 35 weeks gestation. Still more difficult for newborn to concentrate urine (high levels of H2O in urine), may lead to dehydration, acidosis & over hydration.
What happens during the 1st period of reactivity? Occurs during 1st 30 minutes after birth. Best time for bonding & breast feeding. Infant is alert, startles easy, cries, exploratory behavior. Respirations are irregular, possible grunting & nasal flaring.
How long does the period of inactivity last? Can last anywhere from 60-100 minutes, decrease in motor activity. Baby will likely sleep.
What happens during the 2nd reactivity phase? Occurs during 4th to 8th hour after birth. Lasts from 10 minutes to several hours. Increase in muscle tone, skin color & mucus production. Meconium is frequently passed at this time.
What is deep sleep? Baby is very quiet with very little movement, no facial or eye movement. Breathing is smooth & regular, very difficult to awaken.
What is light sleep? Active sleep, eye fluttering & body movements. Breathing is shallow & irregular. Baby may make crying or fussing sounds. Baby may console self back to sleep. Babies spend most of their sleep time in this state. Can be aroused easily.
What is the quiet alert state? Time when baby is still and ready for interaction. May smile and follow objects with eyes. Best time for parent interaction - talking, singing, playing
What is habituation? Ability to process and respond to stimuli - neonatal defense mechanism.
What is orientation? Ability to be alert, follow and fixate on visual stimuli.
What is IgG? Only immunoglobulin to cross placenta, active against bacterial toxins.
What is IgA? Does not cross the placenta and not adequate until 4 to 6 weeks of age. Present in colostrum & breast milk. Protects the respiratory & GI systems. This is the reason infants are susceptible to respiratory & GI infections.
What is IgM? Produced by gram negative enteric organisms & some viruses. Does not cross the placenta, produced by fetus at 10-15 weeks gestation. If elevated, may indicate intrauterine exposure to bacteria.
What is active acquired immunity? Formation of antibodies in response to an illness or immunization.
What is passive acquired immunity? Results when IgG antibodies are passed from mother to fetus. Very active against bacterial toxins, passed in 3rd trimester.
What antibodies are found in breast milk? IgA, IgG & IgM are all found in breast milk, the most important one is IgA.
What is congenital adrenal hyperplasia (CAH)? Defect in an important enzyme, can cause dehydration, shock or even death. Early treatment can prevent medical problems.
What is congenital hypothyroidism? Babies lack a thyroid hormone. Can cause poor growth or mental retardation, can be treated medically.
What is galactosemia? Babies cannot digest galactose. Galactose is a simple sugar found in breast milk & many formulas. Can cause eye damage, liver or brain damage. Baby must be given milk-free formula.
What is maple syrup urine disease? Babies cannot digest part of a food protein. Can cause severe mental retardation or even death. Babies require a special formula & diet.
What is phenylketonuria? Babies cannot digest a different part of food protein. Can cause nerve & brain cell damage and lead to mental retardation. Babies get special formula and diet.
Created by: jrb265