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Neonatal/Pediatrics

Chapter 5 Examination and Assessment of the Neonate

QuestionAnswer
Once the baby is born, what three things should be checked for? If all things are present, the baby does not require resuscitation, and should be placed where? 1. is the baby breathing 2. is the baby crying 3. does the baby have good muscle tone *on the mother's chest to be kept warm and given gentle stimulation.
If the baby is not breathing, crying, or does not have good muscle tone, what steps should be taken? The baby should be brought to a preheated radiant warmer and resuscitation should begin.
Preventing _____ _____ is critical when caring for a newborn, because hypothermia increases _____ _____ and impedes effective resuscitation. heat loss, oxygen consumption
Drying off the baby quickly and removing wet blankets as soon as possible greatly reduces the risk of _____. hypothermia
The radiant warmer should be turned on before delivery, and a _____ should be used for all infants. hat
What position should the baby be in when placed under the warmer? sniffing, on his/her back
What should be initially used for suction the baby? a bulb syringe
In what order should the baby be suctioned? mouth first, then the nose
Why is a baby suctioned after birth? to clear secretions, blood, and/or meconium
What is the most effective means of stimulation for the baby? drying the baby with a warm, clean towel and flicking the bottom of the feet
List the components of the APGAR SCORE. HR, RR, skin color, reflex irritability, muscle tone
Of the 5 components of the APGAR SCORE, which is the most important? HR
How is APGAR measured? at 1 minute and 5 minutes
What is the normal APGAR score? 7
What are 3 main factors for gestational age and size assessment? 1. gestational age based on last menstrual period 2. prenatal ultrasound evaluation 3. postnatal Ballard assessment
A scoring system for the baby's gestational age. Ballard assessment
What are the 2 main areas of a Ballard assessment? 1. neuromuscular maturity 2. physical maturity
Birth weight that is considered small for gestational age. less than 10th percentile for gestational age
Birth weight that is considered large for gestational age. more than the 90th percentile for gestational age
A term neonate is approximately > _______. 3000g
A 28-week gestational age neonate is approximately ______g. 1000g
Prolonged rupture of membranes is considered how long? > 18 hours
Normal axillary (underarm) temperature ranges from _____ to _____degrees F. 97.5, 99.3 (36.5 - 37.4 degrees C)
What is normal heart rate for a neonate while awake? 120 - 160 BPM
What is normal heart rate for a neonate during deep sleep? 80 - 90
What is normal heart rate for a neonate when hungry or in pain? > 200
How is the heart rate of a neonate best assessed? by listening with a stethoscope for the apical beat over the precordium both in the delivery room and once admitted
HR > 170 tachycardia
HR < 100 bradycardia
Normal neonatal RR ranges between _____ and _____. 30 - 60 BPM
BP of a term infant is approximately _____/_____ mmHg. 60/40
BP of a pre-term is approximately _____/_____ mmHg. 50/30
How is adequate mean blood pressure (MPB) calculated? MPB = gestation age (weeks) + 5
Rates that exceed 60 breaths per minute but normalize over the next several hours may indicate _____ _____ _____ _____ _____. transient tachypnea of the newborn
An irregular pattern of intermittent respiratory pauses longer than 5 seconds but less than 20 seconds. periodic breathing
RR > 60 tachypnea
RR < 60 bradypnea
Pathologic condition in which breathing ceases for longer than 20 seconds. apnea
What scoring system is used to assess respiratory distress? Silverman Scoring System
In the Silverman Scoring System the _____ the score, the _____ the distress. higher, greater
In the Silverman Scoring System the higher the _____, the greater the _____. score, distress
What are some signs of distress in the Silverman Scoring System? nasal flaring, expiratory grunting, tachypnea, retractions
Occurs during inspiration when the muscles of the nasal passages contract, resulting in flaring of the alae nasi, widening of the nostrils, and reduction in airway resistance. nasal flaring
An audible expiratory noise caused by closure of the glottis during expiration in an attempt to provide increased positive end-expiratory pressure and to maintain lung volume (hold airways open). grunting
Represent thoracic and abdominal respiratory efforts that are not synchronous. "See-saw" effect that offen indicates severe respiratory distress. paradoxical respirations
Diminished, wheezes, stridor. abnormal breath sounds
Bowel sounds from the chest indicate a _____ _____ _____ congenital diaphragmatic hernia
Breath sounds for RDS will have rales, also known as _____. crackles
Pigeon chest, protruding xiphisternum or xiphoid process. pectus excavatum
Pectus excavatum is also known as _____. funnel chest
PMI point of maximal cardiac impulse
If the HR is persistently greater than 250 BPM, what recommendation should be made and why? an EKG, to rule out supraventricular tachycardia (SVT)
Soft to loud, harsh similar to forcible exhalation with the mouth open. cardiac murmur
True or False. Patent ductus arteriosus will have a heart murmur. TRUE
What could a weak pulse upon palpation indicate? low cardiac output states (shock, hypoplastic left-sided heart syndrome)
What could a bounding pulse upon palpation indicate? patient ductus arteriosus and left-to-right shunt
The use of a high-energy flashlight or fiberoptic device in a darkened room for a suspected pneumothorax. transillumination
What is transillumination used for? suspected pneumothorax
During transillumination, what will a pneumothorax look like? an excessively pink and illuminated area of light that is glowing
How should we palpate and auscultate the baby's abdomen? over all four quadrants
Where do we palpate/ascultate the baby's liver? 1-2 cm under the right rib margin
What does hepatomegaly indicate? congenital heart disease, infection, or hemolytic disease
How does a normal abdomen appear? flat
A congenital lack of abdominal musculature. prune-belly syndrome
A significant finding characterized by tightly drawn skin through which engorged subcutaneous vessels can easily be seen. distention
How does a scaphoid abdomen look? sunken or concave
What is a scaphoid abdomen a sign of? malnutrition
In children, with a large congenital diaphragmatic hernia, how will the abdomen appear? sunken (scaphoid)
What condition indicates a sunken anterior abdomen wall? congenital diaphragmatic hernia
When would we see a distended abdomen? sepsis, obstruction, ascites, necrotizing enterocolitis (NEC), pneumopericardium (air in the pericardial sac)
Air in the pericardial sac. pneumopericardium
A build up or excess abdominal fluid. ascites
A life-threatening emergency that happens when your body's response to an infection damages vital organs and, often, causes death. sepsis
A defect in the abdominal wall lateral to the midline with protrusion of the intestines externally to one side of the abdomen, not bound by a membrane. gastroschisis
On what side does gastroschisis usually appear? usually right-sided, not bound by a membrane
Protrusion of the membranous sac that encloses abdominal contents through an opening in the abdominal wall into the umbilical cord. omphalocele
The umbilical cord has how many blood vessels? What are they? 3, 1 vein, 2 arteries
What surrounds the vessels of the umbilical cord? Wharton's jelly
If the umbilical cord appears greenish yellow, what is indicated? meconium in the amniotic fluid
A newborn's first bowel movement. meconium
What does it mean if the umbilical cord is large and fat? the baby is large for gestational age and born to a diabetic mother
What does it mean if the umbilical cord is thin with little Wharton's jelly? intrauterine growth rstriction
Diffuse edema that crosses suture lines and usually resolves within 2-3 days. caput succedaneum
What are the common causes of scalp edema? caput succedaneum, cephalohematoma
Membrane covered spaces on an infant's skull where the bony plates of the skull have not yet joined. fontanels (soft spots)
A hemorrage of blood between the skull and the periosteum. cephalohematoma
How long does it take for cephalohematoma to resolve? several months
The leading cause of infant mortality in the post natal period. congenital anomalies
Incomplete opening into the nasopharynx as a result of membranous or bony structures. choanal atresia
A condition in which a person has an extra chromosome 13. Trisomy 13
A cleft lip and cleft palate are usually seen in _____ _____. Trisomy 13
Small mouth seen in Trisomy 18. microstomia
A small lower jaw with a receding chin. micrognathia
Characterized by a cleft palate, posteriorly displaced tongue, and micrognathia. Pierre Robin syndrome
Sacs of fluid (cysts) resulting from a blockage in the lymphatic system. hygroma
Congenital abnormality in which there is an abnormal connection between the esophagus and the trachea. tracheoesophageal fistula (TEF or TOF)
When a shoulder is broken in delivery by reluctance to move the shoulder. shoulder dystocia
The intrauterine environment often affects the extremities and musculoskeletal system. Many limb and toher deformations in the fetus result from _____ (fetal) or _____ uterine) factors. intrinsic, extrinsic
Neural tube defect of skin, bone, meninges and nerve tissue. spina bifida
A neural tube defect characterized by sac-like protrusions of the brain and the membranes that cover it through openings in the skull. encephalocele
How long should a normal capillary refill last? < 3 seconds
If a capillary refill lasts longer than 3 seconds, what does it indicate? decreased cardiac output
Blue hands and feet with decreased perfusion. acrocyanosis
Blue or dusky mucous membranes often most notable int he circumoral area. true cyanosis
Irregular areas of dusky skin alternating with areas of pale skin; uneven color, blotchy indicating decreased perfusion. mottling
Reddish-blue appearance. ruddy
An extremely pale or mottled neonate suggests _____ or _____. hypertension or anemia
A ruddy appearance is often associated with a high _____ value or _____. hematocrit, polycythemia
A yellow appearance. jaundice
Hyperbilirubinemia. jaundice
Discrete firm masses in subcutaneous tissue. subcutaneous fat necrosis
Red, flat areas. (Stork bites). telangiectatic nevi
Bleeding under the skin; pinpoint hemorrhagic areas. petechiae
Soft, fine, unpigmented hair that can be found on fetuses, newborns, and people with certain diseases. lanugo
Hardening of the skin. sclerema
Bruising. ecchymosis
Irregular areas of pale blue over sacrum and buttocks. congenital dermal melanocytosis
Congenital dermal melanocytosis it common in _____ and _____ neonates. black, asian
Bright red, flat spots 1-3 mm in diameter. strawberry hemangiomas
White papules < 1 cm on forehead, chin, and nose. milia
Whitish pink rash that commonly appears on newborns within the first week of life. erythema toxicum
Whitish gray, cheese-like substance that coats a fetus's skin during the last trimester of pregnancy. vernix caseosa
When a newborn infant grasps a finger placed in the palm of the hand. grasp reflex
Occurs when the head is allowed to fall back slightly. Moro reflex
List normal reflexes that are present in newborns. 1. grasp reflex 2. Moro reflex 3. shutting eyelids tight in response to bright light 4. turning toward unique sounds or sights 5. stepping reflex
Non pulmonary signs of respiratory distress. anxiety, fussiness, depressed level of consciousness or responsiveness, tachycardia
Pulmonary signs of respiratory distress. tachypnea, breathlessness, head bobbing, grunting, nasal flaring, retractions, desaturations < 90, cyanosis
Listening to the sounds of the heart, lungs, and gastrointestinal tract. auscultation
Vibrations of the chest resulting from movement of air through airways partially obstructed by mucus. bronchial fremitus
Grunting is associated with _____ _____ _____. respiratory distress syndrome
List adventitious breath sounds. 1. crackles 2. stridor 3. wheezes 4. stertor
Breath sounds that indicate fluid in the alveoli (normally shortly after birth). crackles
High-pitched monophonic, audible noise that may occur during inspiration or expiration, or my be biphasic. stridor
Extrathoracic airway obstruction (subglottic stenosis, croup, or thracheomalacia). inspiratory stridor
Iintrathoracic airway obstruction (mass or vascular compression of the trachea, tracheomalacia or bronchomalacia), expiratory stridor
Stridor that indicates a more severe degree of laryngeal or central airway obstruction (respiratory distress). biphasic stridor
Breath sounds that are often expiratory with airway narrowing. wheezez
What are the 2 types of wheezes? 1. polyphonic 2. monophonic
Wheezes associated with upper and central airway disorders and sounds similarly throughout the chest. monophonic wheezes
Wheezes associated with small airway disorders and sounds different. polyphonic wheezes
To distinguish stridor from wheezing, where should you place the stethoscope? over the neck area
How is does stridor sound compared to wheezing? upon auscultating, if the sound is louder over the neck than over the chest, it is most likely stridor
A low-pitched, wet sound similar to snoring. stertor
White blood cell count < 3500/mm3. leukopenia
White blood cell count > 25,000/mm3. leukocytosis
If the WBC greater than 25,000/mm3 suggests an _____. infection
True or False. Newborns tend to have decreased hemoglobin and hematocrit levels at birth. False. Newborns tend to have INCREASED hemoglobin and hematocrit levels at birth.
Created by: Respiratory22
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