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Peds1.2
Neonatal Assessment
| Question | Answer |
|---|---|
| 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
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