OB Newborn Assessment/Care

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OB Newborn Assessment/Care
2015-10-31 14:05:09
Exam 3
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  1. When is the very first newborn assessment performed and what is examined
    delivery room to make sure all parts are there
  2. When should a comprehensive newborn assessment be done
    within 24 hours after birth
  3. When performing a newborn assessment what should be examined first if baby is crying? If baby is silent?
    • Crying: everything that would aggravate the infant
    • Silent: things you need to listen to (heart, lungs)
  4. Name four primary symptoms of SGA babies, what do they weigh?
    • Hypoglycemia
    • Polycythemia
    • Hyperthermia
    • G&D delay
    • <2500 g
  5. Name 4 symptoms of LGA babies, what do they weigh?
    • Hypoglycemia
    • Poor Feeding
    • Traumatic Injury
    • Jaundice
    • >4000 g
  6. Describe the order of the five things you do at first glance for newborn assessment
    • Skin color
    • Muscle tone
    • Behavior
    • Take clothes off except diaper
    • Radiant warmer preferred
  7. What type of readings/labs are done to evaluate degree of jaundice
    Billi readings
  8. What must the billi read in order to see jaundice
  9. Where does jaundice begin and progress
    nose, downward
  10. What it the start of phototherapy treatment based on
    2 factors: Gestational age and age in hours
  11. When is phototherapy most effective
    First 24-48 hours of usage
  12. When do researchers recommend phototherapy be started
    Within the first 24 hours of life in high risk infants, VLBW, or severely bruised infants
  13. What is plethora
    Polycythemia (increased RBC)
  14. What is the bluish discoloration of hands and feet? Should it be reported to PCP?
    Acrocyanosis, doesn't need to be reported, this is normal
  15. What is a deep color that develops on one side of the body while the other side remains pale so that the skin resembles a clown suit
    Harlequin sign
  16. What are raised white spots on the face, especially across the nose? What should be done?
    Milia, nothing because it goes away within the first month
  17. What is a lacy pattern of dilated blood vessels under the skin that occurs as a result of general circulation fluctuations
  18. What may mottling be related to
    chilling, prolonged apnea, sepsis, hypothyroidism
  19. What is melanor pustulosis
    Similar condition to milia, usually with African heritage, leaves slightly pigmented spot when rubbed off
  20. What is an eruption of lesions in the area surrounding a hair follicle that are firm, vary in size 1-3 mm, and consist of a white or yellow papule or pustule with an erythema base
    Eruthema toxicum
  21. How does the rash of erythema toxicum appear
    Suddenly over trunk or diaper area and is widespread
  22. When does erythema toxicum appear and when does it not usually appear
    24-48 hours after birth, usually not after 5 days of life
  23. When should jaundice be reported to PCP
    If noticed before 24 hours of age
  24. What should you explain to the worried parents of a baby that was born using forceps who has reddened areas over cheek and jaw
    That it will go away in 1-2 days
  25. What occurs as a result of vigourous sucking in utero or after birth
    Sucking blisters
  26. What are pale pink or red spots frequently found on eyelids, nose, lower occipital bone, and nape of the neck
    Stork bite (telengietic nevi)
  27. What are macular areas of blue/black or gray-blue pigmentation commonly found in dorsal area and buttocks but may be anywhere on body
    Mongolian spots
  28. Who are mongolion spots common in
    Hispanic and Black
  29. When do mongolian spots usually disappear
    within the first year or 2 of life
  30. What is a capillary angioma directly below the epidermis
    Nevus Flammeus
  31. What is nevus flammerus also known as
    port whine stain
  32. What is it called if nevus flammerus is noted with involvement of 5th cranial nerve (convulsions/neuro)
    Sturge-Weber syndrome
  33. What is a capillary hemangioma that consists of newly formed and enlarged capillaries in the dermal and subdermal layers? (raised, clearly delineated, dark red, rough, commonly found in head region)
    Strawberry mark (Nevus vasculosus)
  34. What should be suspected for a baby who is cyanotic at rest and pink only with crying
    choanal atresia
  35. What should be suspected for a baby that has increased cyanosis with crying
    Heart or lung problems
  36. What should be suspected for very pale newborns
    anemia or hypovolemia
  37. What does >6 large cafe au lait spots indicate
  38. How large is the newborns head in comparison with the body
    1/4 the size
  39. What are changes in skull shape caused by an overriding of cranial bones during labor/birth
  40. What is an infants head that is mushy at first followed by a water balloon feeling an indication of
    Subgleal hemorrhage
  41. What should be done for an infant with suspected subgleal hemorrhage
    • Measure hct q 8-12 hours
    • Serial H&H
  42. What is a collection of blood resulting from ruptured blood vessels between the surface of the cranium bone (usually parietal) and periosteal membrane
  43. What does cephalohematoma feel like
    loose scalp that is slightly edematous
  44. What is a localized, easily identifiable soft area of the scalp, generally resulting from long and difficult labor or vaccum extraction (COLLECTION OF FLUID, EDEMATOUS SWELLING OF SCALP)
    Caput Succedaneum
  45. What are some key differences of cephalohematoma and caput succedaneum
    • Cephalo: doesn't cross sutures, disappears 2-3 weeks or could take months
    • Caput: cross sutures, fluid reabsorbed w/in 12 hours or a few days after birth
  46. What does a punched out look indicate? What is the term? (usually top of head)
    Trisomy 21, Cutis aplasia
  47. What are you looking for as a nurse when assessing the face
    • Symmetry
    • Facial movement during crying
    • Spacing between mouth
    • clefts
    • Also look for facial paralysis (usually disappears within a few days to 3 weeks)
  48. What are small glistening white specks that feel hard to the touch and often present on the hard palate or gums
    Epstein pearls
  49. How do babies breathe
    obligate nose breathers
  50. What are some common characteristics (NORMAL) of the newborns eyes
    • blue
    • clear drainage 1st day of life
    • Conjunctival hemorrgae
    • White/blue sclera
    • Strabismus
    • Eyelid edema
  51. What is hyperteiorism? Hypoteiorism?
    eyes far apart, eyes close together
  52. What should you evaluate if there are abnormalities of the ear
    Renal system
  53. What does a scaphoid abdomen almost always indicate
    Congenital diaphragmatic hernia
  54. Normal HR for newborn
  55. where should u try to listen to apical pulse
    4-5th ICS
  56. what does an absent S2 indicate
    severe congenital heart disease
  57. What does an active precordium indicate
    heart working overtime
  58. what pulse is best to assess for UE
  59. What pulse is best for LE
    femoral or posterior Tib
  60. What should occur if pulses of UE and LE are not equal
    Think heart disease and take immediate action
  61. What does weak pulses overall indicate? Absent pulses? No LE pulses? Bounding pulses?
    • Overall: shock, circulatory failure
    • Absent: Hypoplastic left Heart
    • LE: Coarction of Aorta
    • Bounding: Patent ductus arteriosus
  62. What are newborn respirations
    30-60 bpm
  63. What should be done if mass is detected in abdomen of newborn
  64. What does a high-pitched, shrill cry indicate
    abnormal: possible neuro or hypoglycemic
  65. What does crepitus of the clavicles indicate
  66. Where is the liver located in a newborn
    1-2 cm below RCM
  67. When does the umbilical cord fall off
    7-10 days
  68. What does clear drainage from cord indicate
  69. What does rust, brick colored urine indicate in girls
    nothing, its normal (uric acid crystals)
  70. If a boy has hypospadias what should the nurse do
    put in the chart in red (NO CIRCUMCISION), put note in crib, explain to mom and dad
  71. what is the most common cause of ambiguous genitalia in girls
    congenital adrenal insufficiency (life-threatening)
  72. Polydactyl on the thumb side indicates what? What if its on the pinky side?
    • syndrome or chromosome issue
    • familial (can be tied off)
  73. What is desquamization and when does it occur
    peeling of skin, few days after birth
  74. When should bowel sounds be present for newborn
    1-2 hr after birth
  75. When should meconium and urine be passed
    within 24 hr after birth
  76. How far away can a newborn see
    9-12 in away from face
  77. What is habitation
    Newborn easily adjusts to surroundings/environmental (noise, sights, anything that would startle it)
  78. What are the duties of the RN during admission of newborn/mom
    • Charting Hx and L&D record
    • Initial assessment
    • Patient/Infant interaction
    • weight
    • VS
    • Possible hct and glucose (high risk)
  79. How can the nurse maintain a thermal environment for newborn following delivery
    • Dry off and discard wet linens
    • Provide warmth, minimize air exposure
    • Skin to skin contact
    • Hat/sleeper
    • Radiant warmer
  80. Two things given to newborn to prevent substantial hemorrhage
    Vit K (immediately after birth) (AKA: Aquamephyton)
  81. How is Vit K (Aquamephyton) administered? What gauge needle? When is it given? How should it be stored?
    • IM thigh: vastus lateralis
    • 25 gauge
    • Always prior to CBC (within 1 hr of birth)
    • away from light
  82. What 3 things are observed for successful transition from utero to birth
    • Color
    • respiratory distress
    • Muscle tone activity
  83. When is the comprehensive assessment usually done
    Within the first 4 hours of birth
  84. When is the ideal time to Breast feed and why
    Right after birth because baby is most alert
  85. When is a formula fed baby usually fed after birth
    By about 5 hours of age (unless hypoglycemic)
  86. How should you instruct parents to dress baby
    In one more layer of clothing than adults comfortable at room temperature
  87. At what temperature should be go in radiant warmer
    97 degrees
  88. How much formula will a baby on bottle usually eat
    15-25 mL q 3 hrs in 1st 48 hrs
  89. When will first stool/meconium pass
    48 hrs
  90. How much weight loss should be expected for newborn
    no more than 10%
  91. When does spitting of clear mucus occur
    48 hrs
  92. What do you instruct parents to do regarding urine output/stool
    record it
  93. What does meconium look like? what does it look like after 48 hrs
    • sticky, thick dark green stools
    • Seedy green (bottle) or yellow seedy (breast)
  94. What should diaper wipes not contain
    alcohol, perfume, latex
  95. What should the nurse do with umbilical cord prior to discharge
    remove clamp with tool
  96. Describe umbilical cord care
    • keep clean and dry
    • Fold diaper to void urine contamination in boys
    • Alcohol, triple dye, or basic cleaning
  97. What are 3 danger signs of umbilical cord
    • bleeding
    • drainage (clear)
    • Redness around umbilicus (infection): foul smelling, deadly, induration
  98. What should be attached to baby in the delivery room for security (what does it entail)
    armband, name, dob, time, moms name
  99. Who is baby's last name under in hospital?
    MOMS, even if dad is on birth certificate
  100. What is circ care with the clamp method
    • First 48 hours:
    • wrap in vaseline gauze initially
    • apply vaseline to diaper to prevent raw glands from sticking
  101. What is circ care with plastibell method
    • keep clean and dry
    • no special care
    • allow bell to fall off on its own
  102. What is the care for an uncircumcised male
    • DO NOT retract foreskin
    • PCP will teach parents to slowly during bath
    • Once glans easily exposed, clean around base (usually completed 3-5 years of age)
  103. When does law mandated metabolic screening occur?
    • on full feedings, off IV fluids
    • (CAN'T leave hospital till done)
  104. When does metabolic screening results come in
    14 days after
  105. What should be scheduled following an abnormal hearing screening using either ABR or OAE method?
    BAER after discharge
  106. What 3 things MUST be done prior to discharge for mandated screenings
    • Metabolic screening
    • Hearing
    • Critical congenital heart disease
  107. When should critical congenital heart disease be conducted
    within 24 hours of birth, off oxygen
  108. How is critical congenital heart disease done? What should be done if abnormal
    • with pulse ox saturations
    • schedule ECHO
  109. How many stools are expected a day for neonate? voids?
    • Stool: 3-4x/day
    • Void: 6-10x/day after 4 days of life
  110. How many hours do newborn sleep at night?
    17 hr/day (4 hr at a time)
  111. when does temp stabilize to 98.6
    4 hours after birth
  112. what temp is considered hypothermia