Low Risk Neonatal PPT Exam 33 Questions with Verified Answers
Respiratory Transition - CORRECT ANSWER Respirations begin and continue
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fluid is cleared from airways; transition made from fluid to gas
Respiratory Transition: prenatal preparation - CORRECT ANSWER fetal lung development:
-surfactant
--begins 28 wks, peaks at 35 wks
--maintains alveolar stability
--enables the establishment of functional residual capacity
respiratory transition: fetal breathing movements - CORRECT ANSWER essential for developing chest wall muscles and the diaphragm
what factors induce respirations - CORRECT ANSWER mechanical:
-fetal chest compression and recoil
chemical:
-chemoreceptor stimulation
-decreased PO2 and increased PCO2
Thermal:
-sudden cooling stimulates sensory receptors
sensory:
handling and drying; tactile stimulation
Hormonal:
-Increased norepinephrine & epinephrine stimulate cardiac output, surfactant release and promotion of pulmonary fluid clearance
Newborn respiratory patterns: expected assessment findings - CORRECT ANSWER nose breathers
shallow and irregular
short periods of apnea
count full minute for neonate
rate 30-60
airway noises common -> still clearing fluid out, upper airway noises
c section babies -> no opportunity to have labor process compression their chest, vulnerable to airway noises
signs of respiratory distress - CORRECT ANSWER persistent nasal flaring
retractions
expiratory grunting
increased use of intercostal muscles
tachypnea
cyanosis
Circulatory transition - CORRECT ANSWER goals:
systemic vascular resistance must increase
blood must circulate through the lungs
--dilation of the pulmonary artery
--pulmonary vascular resistance must decrease
fetal shunts must close
--dependent on a decrease in PVR
Circulatory transition to extrauterine life - CORRECT ANSWER placental circuit shut off when the umbilical cord is clamped
ductus venosus: closes by 3 days, liver takes over placental functions
foramen ovale: closes as the pulmonary blood flow from the left side of the heart increases pressure in the left atrium
ductus arteriosus: constricts as pulmonary circulation & arterial oxygen tension increases
-spontaneous closure: 90% newborns by 48 hrs of age;
-permanent anatomic closure by 3 weeks to 3 months
Thermoregulatory transition - CORRECT ANSWER newborns tolerate a narrower range of environmental temperatures and are extremely vulnerable to both under and overheating
will attempt to regulate via flexed position, peripheral vasoconstriction, increased metabolic rate, and metabolism of brown fat
Factors that predispose a newborn to heat loss - CORRECT ANSWER thin skin with vessels close to surface
shivering mechanism rarely operable
limited stores of glucose, glycogen, fat
large body surface area relative to body weight
lack of subcutaneous fat
limited voluntary activity or ability to change posture
can't communicate 'too hot', 'too cold'
Consequences of cold stress - CORRECT ANSWER oxygen consumption and energy will be diverted from maintaining normal brain/cardiac function to thermogenesis for survival
Depleted brown fat stores, increased oxygen needs, increased glucose consumption leading to hypoglycemia, metabolic acidosis, jaundice, hypoxia and decreased surfactant production
overheating - CORRECT ANSWER limited ability to sweat
immature CNS system
large body surface
Newborn thermoregulation: expected findings - CORRECT ANSWER newborn temperature will remain between 36.5-37.2 (97.7-99.4) axillary
balance achieved between heat loss and heat generation
nursing interventions that prevent cold stress: EBP
Benefits of skin-to-skin contact (SSC) - CORRECT ANSWER Minimizes crying, HR surges
stabilizes temp
improves interaction
increases rate of BF initiation
promotes uterine involution
improves infant neurobehavioral development and self regulation
Feeding - CORRECT ANSWER ability to take nourishment from breast or bottle
coordinated sucking, swallowing and breathing
Elimination renal: - CORRECT ANSWER void within 24 hours (93%)
average # diapers = # days old
By 4 days of age, 6-8 voids/ 24 hours
Elimination: stools - CORRECT ANSWER most passed within 8-24 hours
meconium
-dark and tarry
transitional stool
-greenish after meconium passed
milk stool
great variation in frequency
Immune system adaptation - CORRECT ANSWER immature immune system & lack of exposure to organisms make the newborn vulnerable to infection
-immature leukocyte function
immunoglobulins contribute passive immunity
-IgG: passed to fetus from mom via placenta, protects newborn against infections via mom's antibodies
IgA: does not cross placenta; present in colostrum
IgM: does not cross placenta, if elevated in NB, may indicate intrauterine infection (TORCH)
Physical assessment of the newborn - CORRECT ANSWER immediate post delivery
-anticipate and prepare
--maternal history, intrapartal history
-caregiver trained in neonatal resuscitation available for all births
ongoing assessments following stabilization
Nurturing and attachment: psychosocial adaptation - CORRECT ANSWER periods of reactivity
newborn behavioral and sensory capabilities
--visual, auditory, olfactory, taste, tactile
newborn temperament
neonatal pain
parent/newborn attachment
Identification bands - CORRECT ANSWER time of birth, mother's name, birthdate, matching numbers for mom and baby
medical ID number for baby
Safety in the hospital setting - CORRECT ANSWER matching bands
'hugs' tags
visitor ID and check in; closed units
rolling bassinet
parent education
postpartum care
Expected assessment findings: weight - CORRECT ANSWER 5Ib 8oz - 8Ib 13 oz
Expected assessment findings :length - CORRECT ANSWER 45-53cm (19-21 inches)
Expected assessment findings: head - CORRECT ANSWER 33-35.5cm (13-14 inches)
Expected assessment findings: chest - CORRECT ANSWER 30.5-33cm (12-13 inches)
newborn medications - CORRECT ANSWER Erythromycin ointment
-prevention of gonococcal opthalmis neonatorum and chlamydial conjunctivitis
mandated in most states
vitamin K
-given to prevent vitamin-k dependent hemorrhagic disease of the newborn
newborns at risk first week or life due to immature liver and sterile GI tract
vitamin K stimulates liver to synthesize factors II, VII, IX, X
hepatitis B vaccine
Physical exam - CORRECT ANSWER within first 2 hours after birth
-skin, head, neck, respiratory, cardiovascular, abdomen, musculoskeletal, genitalia neurogolical (reflexes)
transitional period:
-TPR, skin color, LOC, muscle tone, activity level evaluated and documented at least once q 30 minutes until stable for 2 hrs
Hyperbilirubinemia (neonatal jaundice) - CORRECT ANSWER occurs in as many as 60% of newborns, more severe in preterm
physiologic (non pathologic) appears 2-3 days after birth; pathologic <24 hrs after birth
caused by presence of unconjugated bilirubin released with the breakdown of RBCs
-increased fetal RBC's with a shortened life span
-liver immaturity
Bilirubin: pigment derived from breakdown HgB
Concern:
-acute bilirubin encephalopathy: neurological dysfuntion associated with elevated levels of bilirubin
-Kernicterus: chronic manifestation of ABE
Assessing jaundice - CORRECT ANSWER bilirubin:
-appears in cephalocaudal manner
-visual assessment has been found to be unreliable and leads to under-detection of hyperbilirubinemia, particularly in darkly pigmented infants
Bilirubin screening - CORRECT ANSWER hour specific bilirubin nomogram
-findings should be interpreted according to the infant's age in hours
Bilirubin levels
-should peak at 5-8 mg/dl at 72 hrs of age
Management of hyperbilirubinemia - CORRECT ANSWER appropriate follow up based on time of discharge and risk assessment
phototherapy
-interaction of light with bilirubin causes photochemical change that facilitates excretion
-eyes must be covered to prevent retinal damage
Exchange transfusion
Infants at risk for severe hyperbilirubinemia - CORRECT ANSWER TcB levels in high risk zone
jaundice with the first 24 hours after birth
ABO incompatibility
gestational age between 35-36 weeks
Previous sibling who received phototherapy
cepalhematoma or significant bruising
east asian
sub optimal breastfeeding (inadequate intake and dehydration that slows bilirubin elimination) [Show Less]