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Newborn 2
Ch. 20 Study guide
| Question | Answer |
|---|---|
| Grating sensation during palpation | Crepitus |
| "Crossed" eyes | Strabismus |
| Bluish color of hands & feet | Acrocyanosis |
| Sunken appearance | Scaphoid |
| Scrotal skin creases | Rugae |
| Pinkish color on a wet diaper | Brick dust stain |
| Cord around fetal neck | Nuchal cord |
| Abnormality of nasal septum causing obstruction | Choanal atresia |
| The 2 immediate newborn assessments after birth are for.... | Respiratory problems; obvious anomalies |
| Molding (Causes, Characteristics & teaching) | See p.469-470 |
| Caput succedaneum (Causes, Characteristics & teaching) | See p.469-470 |
| Cephalhematoma(Causes, Characteristics & teaching) | See p.469-470 |
| Explain possible signifance of 2-vessel umbilical cord | Associated with other anomalies; assess infant carefully. |
| Explain possible signifance of simian crease or line | Single palmar crease that often occurs in infants who have chromosomal abnormalities such as Down syndrome. |
| Explain possible signifance of unequal gluteal creases | Suggests one leg is shorter than the other; often associated with developmental hip dysplasia. |
| Explain possible signifance of hair tuft on lower spine | May indicate spina bifida occulta, or failure of one or more vertebrae to close fully. |
| Explain possible signifance of ears below level of outer canthi of the eyes | Associated with chromosomal disorders. |
| Explain possible signifance of drooping of one side of the mouth | Indicates facial nerve injury during birth resulting in paralysis. |
| Normal measurements & possible cause for deviations | See p. 462 (Table 20-1) |
| List normal ranges for term neonatal VS & describe correct assessment technique for each | See p.467-468 & Procedure 20-1 |
| Why should RN avoid taking rectal temp on newborns? | Taking a rectal temperature on newborns may irritate the mucosa or perforate the rectum, which turns at a right angle 3 cm (1.2 inches) from the anal sphincter. |
| List at least 5 signs that suggest neonatal respiratory distress. | tachypnea (sustained); retractions that continue after the first hour; nasal flaring after the first hour; cyanosis involving the lips, tongue, and trunk (central cyanosis); grunting; seesaw respirations; asymmetry of chest expansion |
| List signs that suggest neonatal hypoglycemia. | Jitteriness, poor muscle tone, sweating, respiratory signs (dyspnea, apnea, cyanosis, tachypnea, grunting), low temperature, poor suck, high-pitched cry, lethargy, seizures, eventually coma; some show no signs of hypoglycemia |
| Descibe normal assessment of female genetalia. | Labia majora darker than surrounding skin and completely covering the clitoris and labia minora; white mucous discharge or pseudomenstruation; hymenal or vaginal tags; patent urinary meatus and vagina. |
| Descibe normal assessment of male genetalia. | Pendulous scrotum that is darker than surrounding skin and covered with rugae; testes palpable in the scrotal sac; meatus centered at the tip of the glans penis; prepuce covering the glans and adherent to it. |
| State possible significance of ruddiness on skin. Is any special care needed? | Suggests polycythemia; may cause higher bilirubin levels as the excessive erythrocytes break down, so observe for more severe jaundice and emphasize to parents. ( |
| State possible significance of green-tinged discoloration of skin & vernix. Is any special care needed? | Indicates meconium passage in utero; observe infant for associated respiratory difficulties resulting from aspirated meconium. |
| State possible significance of red,blotchy areas w/ white or yellow papules in center on skin. Is any special care needed? | Erythema toxicum; differentiate from infection; teach parents that rash is self-limiting. |
| State possible significance of Blue-black marks over the sacral area on skin. Is any special care needed? | Mongolian spots; more common in dark-skinned infants; most disappear during early years; teach parents who are unfamiliar with these. |
| State possible significance of flat, purplish area that does not blanch w/ pressure on skin. Is any special care needed? | Nexus flammeus (port-wine stain); permanent; large or obvious ones can later be removed by laser surgery. |
| State possible significance of red, raised, rough lesion on head. Is any special care needed? | Nevus vasculosus (strawberry hemangioma); grows larger for 5 to 6 months, then gradually disappears. |
| State possible significance of light brown spots on skin. Is any special care needed? | Café-au-lait spots; 6 or more spots or spots larger than 0.5cm are associated with neurofibromatosis and should be reported to the physician. |
| What facial marks may be present if infant had a nuchal cord? | Petechiae on the face or upper body are often present when the infant had a nuchal cord at birth. |
Created by:
L.moore
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