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Neonatal Assessment

What is conduction? direct heat loss to a cooler surface with body surfaces
What is convection? heat loss to cooler surrounding air
What is radiation? loss of heat to a cooler solid surface that are not in contact with the body such as a wall
What is evaporation? loss of heat when a liquid such as body fluid becomes a gas
5 things assessed for APGAR score HR, Respiratory effort, muscle tone, reflex response, and color
APGAR score for HR Absent-0, Slow(below 100)-1, Over 100-2
APGAR scoring for Respiratory effort Absent-0, Weak cry/hypoventilation-1, Good strong cry-2
APGAR scoring for muscle tone limp-0, some flexion of extremeties-1, well flexed-2
APGAR scoring for reflex response cath in nose or footslap no respone- 0, grimace-1, cough/sneeze/cry/foot withdrawl-2
APGAR scoring for color blue/pale-0, body pink extremities blue-1, completely pink-2
6 criteria assessed for neuromuscular maturity on Ballard scoring system posture, square window wrist, arm recoil, Popliteal angle, Scarf sign, and heel to ear
6 areas assessed for physical maturity on Ballard scoring skin, lanugo, plantar surface, breast, eye/ear, genitals
When is APGAR scored? at 1 minute and 5 minutes
What is the maximum APGAR score? 10
APGAR ___-__ = severe asphyxia 0-3
APGAR __-__= moderate asphyxia 4-6
APGAR __-__= no asphyxia 7-10
What are the 2 scoring systems for gestational assessment? Duobowitz(11/10 signs) and Ballard (6/6 signs)
The Dubowitz can be performed within __ days and is accurate up to __ weeks; The higher the score then ____ the gestational age 2;2;greater
Once the gestational age is determined, what 3 things do you plot on graph to determine size for gestational age weight, length, and head circumference
SGA indicates what? intrauterine malnutrition
6 major reasons for SGA placenta, infection, maternal htn, toxemia, multiple births, and smoking
A newborns anatomy is different. Tongue is proportionally ______ and larynx is more ___ larger; anterior
Why is there no need for cuffed ET tubes? cricoid ring is limiting diameter
Tubes are cuffles to what size? 4.0
If a leak is heard what do you need? a bigger ET tube
D/t their large tongue, babies are what? obligate nose breathers, plugging can cause resp distress
3 additional differences in neonatal anatomy? breathing is diaphragmatic, compliant/non calcified rib cage(retractions readily seen), and immature resp muscles(fatigue faster)
Clinical color: Acrocyanosis means decreased perfusion
Clinical color:Pale= ___, Mottled= ____, Ruddy= ___ anemia; septic; reddish/blue (high Hct)
Where to you check for meconium staining? nail beds and cord
Neonates often appear _____ after the first day jaundice
Normal neonate RR 40-60 breaths per minute
First sign of respiratory distress in neonate? tachypnea
What causes tachypnea in a neonate? decreased PaO2 or increased CO2
What causes bradypnea in a neonate? fatigue
What is primary apnea? around 20 seconds long and you can stimulate them to make them breathe
What is secondary apnea? 30-40 seconds long, HR and BP decrease, cannot stimulate to breathe, must bag them
Periodic breathing = normal
4 signs of abnormal respiratory function retractions, grunting, nasal flaring, Seesaw effect
What is the scoring system that quantifies degree of respiratory distress called Silverman Anderson
Retractions are commonly seen in diseases that reduce alveolar ventilation, usually from atelectasis
Where do retractions occur? in any muscle group of or attached to thorax
Common site of retractions in neonates intercostal (most common) and substernal
What is grunting and what neonate population is it commonly seen in? a physiologic response to increase lung volume to improve alveolar gas exchange (mimic natural CPAP), common in babies with RDS
What causes grunting and when is it heard? caused by infant breathing against a closed or partially closed glottis heard at the end of a breath
What is the Seesaw effect? asynchronous breathing during increased RR d/t soft cartilage of rib cage
The expansion or rising abdomwn pushing up on the diaphragm during seesaw effect causes what? reduced volume bc diaphragm is unable to descend effectively
4 possible causes of Diminished BS ET tube problem, RDS, PIE, atelectasis
What is PIE? Pulmonary interstitial edema
Asymetrical chest rise could be d/t ET too low, unilateral disease such as pneumonia or aspiration, pneumothorax
Rhonchi are ____ and heard where? coarse from lg bronchi
Rales are ___ and heard where? fine, in smaller airways
What is pectus caritnatum? malformation of chest with protruding xyphoid process
What is pectus excavatum? funnel chaped chest malformation
What can cause asymmetry of the chest? enlarged heart, Diaphragmatic hernia, pneumothorax
PMI: Why seen and what is it? easily seen d/t thin, compliant chest wall close to sternal border (prominent fetal R ventricle)
Normal HR 120-160
Tachycardia= >160 and caused by ___, ____ activity, meds
Bradycardia: <100 caused by ___, _____ vagal stim, hypoxemia
If a neonate is bradycardic what do you do? start bagging!
What do weak pulses suggest? low CO states such as shock or hypoplastic left heart
Bounding pulses are seen with PDA- Patent Ductus Arteriosus
Brachial and Femoral pulses should be ____, if not suspect Coarctation of Aorta equal
Abdominal abnormalities associated with Respiratory distress Scaphoid( caused by DH), Distended(sepsis, obstruction, tumors, ascites NEC), Omphalocele (bowel into cord), Gastrochisis (bowel outside abd wall)
Abnormalited of the head, lips, oral cavity are usually associated with what? syndromes
A cleft palate is associated with what syndrome? Pierre Robin (small chin, large tongue)
What is Choanal atresia? blockage of 1 or both nares
Normal Temperature of Neonate? 36.5 degrees celcius
2 things thermoregulation is important for? minimal oxygen consumption and metabolic demands
Lower weights require __ thermal temp higher
Neonates cant _____ and have limited fat for energy shiver
4 responses to cold stress increased RR, signs of resp distress, Hypoglycemia, Metabolic acidosis
6 ways to minimize heat loss dry with warm blankets, avoid cold surfaces, keep under warmer, use double walled isolettes, heat inspired gases, keep head covered
Created by: Dabi2