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Neonatal/Pediatrics
Chapter 5 Examination and Assessment of the Neonate
Question | Answer |
---|---|
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. |