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Newborn 5

Ch. 29 Study Guide

Substance in the alveoli that reduces surface tension Surfactant
Tool to evaluate the degree of respiratory distress Silverman-Andersen index
Holding an infant skin-to-skin Kangaroo care
Chronologic age minus weeks born prematurely Corected age
Formula in the stomach before a gavage feeding Residual
Classify the following physical traits as Preterm(pt), term(t) or postmature(pm). Some may have more than one answer
underdeveloped flexor muscles pt
Abundant hair on the head t or pm
Loose skin pm
Little or no lanugo pm
Poor muscle tone pt
Long fingernails pm
Visible blood vessels on the abdomen pt
Long, thin body pm
Creases covering the entire sole t or pm
Alert & wide eyed pm
Little subcutaneous fat Pt or pm
Dry & peeling skin t or pm
"frog leg" position pt
Meconium staining pm
Abundant bernix caseosa pt
Full areola 5-10mm t or pm
Soft, flexible ears pt
Labia majora covering clitoris & labia minora t or pm
Explain newborn classifications of gestational age & birth-weight for late preterm. Born between 34 0/7 and 36 6/7 weeks of gestation
Explain newborn classifications of gestational age & birth-weight for preterm born before the 38th week of gestation begins
Explain newborn classifications of gestational age & birth-weight for low birth-weight birth-weight 2500g (51b, 8oz) or less
Explain newborn classifications of gestational age & birth-weight for very low birth-weight birth-weight 1500 g (3 lb. 5 oz) or less
Explain newborn classifications of gestational age & birth-weight for extremely low birth-weight birth-weight 1000 g (2 lb. 3 oz) or less;
Explain newborn classifications of gestational age & birth-weight for IUGR birth-weight and growth less than expected for duration of gestation
List at least 5 problems common to later preterm infants. Respiratory distress syndrome, transient tachypnea of the newborn, apnea of prematurity, inadequate thermoregulation, hypoglycemia, hyperbilirubinemia, kemicterus, seizures, feeding difficulties, neurodevelopmental disorders, rehospitalization after disch
Distinguish periodic breathing from apneic spells. Periodic breathing is lack of breathing for 5 to 10 seconds without cyanosis or bradycardia, which may be followed by rapid respirations for 10 to 15 seconds. Apneic spells usually last 20 seconds or longer along with cyanosis or bradycardia.
Why is prone position not advised for normal newborns, but good for the preterm infant? Prone position associated w/ increased incidence of SIDS. It reduces energy used for respirations, increases oxygenation, enhances respiratory control, and improves mechanics & volume. Preterm infants should be moved to prone as soon as they can tolerate
Describe 5 major disadvantages the preterm infant has in regulating temp. Thin skin with little insulating fat; accumulation of less heat-producing brown fat; poor flexion to reduce exposed body surfaces; proportionally more body surface area than full-term infant; immature temperature control center in the brain
List common measures to help the preterm infant maintain thermoregulation. Radiant warmers, incubators, warmed oxygen, measures to reduce air currents, transparent plastic blanket over the radiant warmer bed, keeping portholes of incubators closed as much as possible, hats and heated blankets when out of the incubator or radiant
What factors make fluid & E'lyte balance difficult in preterm infant? Greater water loss through the thin, permeable skin; nonflexed positioning & large surface area increases insensible losses; drying effects of outside heat sources; rapid respiratory rate & use of oxygen; poor ability of kidneys to concentrate/dilute urin
Describe measures to evaluate fluid status in preterm infant. Calculating intake and output: weigh diapers to determine difference between dry weight and wet weight; collecting urine with cotton balls at perineum to check specific gravity; weighing unclothed infant daily/twice daily on same scale at same time of da
List signs of dehydration. Dehydration: urine output <1 mL/kg/hr; increased urine specific gravity; excessive weight loss; dry skin or mucous membranes; sunken fontanel; poor tissue turgor; increased blood sodium, protein, and hematocrit; hypotension.
List signs of overhydration. Overhydration: urine output >3 mL/kg/hr with decreased specific gravity; edema; too-rapid weight gain; bulging fontanel; decreased blood sodium, protein, and hematocrit; moist lung sounds; dyspnea.
How can the nurse reduce trauma to the preterm infant's skin? Avoid adhesive tape. use gauze wraps or easy to remove products, pectin or hydrocolloid barriers, transparent semipermeable dressings, hydrogel or silicone-based adhesives, or hydrocolloid sheet dressings; avoid cleansing products that are traumatic and r
What factors typically increase a preterm infant's risk for infection? Maternal infection, incomplete passive antibody transfer from the mother, immature immune response, invasive therapeutic procedures that damage delicate skin, exposure to organisms in the hospital
How can the nurse help an infant during painful procedures? Use pain scale to assess pain level, use containment and facilitated tucking; provide rest periods before, during, and after procedures; use pacifiers, sucrose, soft talking, and ordered medication.
What are the possible reasons that a preterm inant may need gavage feedings instead of nipple feedings? Poor suck, swallow, and breathing coordination; rapid respirations; immature gag reflex; high expenditure of energy for sucking
List 4 mehtods to identify intestinal complications. Check residual before beginning feedings, measure abdominal circumference to identifr distention, test stools for reducing substance and occult blood, observe for vomiting or diarrhea.
What in the purpose of given an infant a pacifer when gavage feeding? Association of the comfort of fullness with sucking and oral stimulation; preparation for nipple feeding; decreases behavior changes during feedings; brings infant to an alert state
What advantages do breastfeeding & breast milk have for the preterm infant? Has immunologic benefits; more easily digested; provides enzymes, hormones, and growth factors; helps prevent infections and necrotizing enterocolitis; causes less stress bc baby can better regulate respirations and suckling; moms body keeps baby warm.
What signs suggest development of respiratory distress syndrome? cyanosis, rales or decreased breath sounds, acidosis with hypoxemia; chest x-ray films show “ground glass” appearance or atelectasis
What signs of necrotizing enterocolitis should the nurse report to MD? Increased abdominal girth r/t distention (rather than growth), increased or bile-stained gastric residuals, decreased or absent bowel sounds, bowel loops seen through the abdominal wall, vomiting, abdominal tenderness, signs of infection, blood in stools
What is one possible consequences for a fetus who is postmature? Placental deterioration with chronic hypoxia, malnutrition, oligohydramnios, cord compression, meconium passage into the amniotic fluid, asphyxia at birth, higher perinatal mortality.
What is the other possible consequence for a fetus who is postmature? Continued placental function, with continued growth that increases the risk for birth injury or cesarean birth.
Why is the postmature infant likely to have problems with hypoglycemia & thermoregulation? Poor glycogen stores at birth; little insulating subcutaneous fat
Created by: L.moore