Newborn Care and Jaundice Assessment
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What is the primary purpose of phototherapy in newborns with jaundice?

  • To stabilize body temperature in infants
  • To increase the production of red blood cells
  • To convert indirect bilirubin to direct bilirubin for excretion (correct)
  • To reduce respiratory distress in newborns

    • Which factor contributes to the increased levels of unconjugated (indirect) bilirubin in newborns?

  • Increased lifespan of red blood cells
  • Higher levels of maternal bilirubin
  • Increased maturity of the liver
  • Reduced ability of the newborn liver to conjugate bilirubin (correct)

    • When is the decision to treat hyperbilirubinemia typically made in newborns?

  • Immediately after birth regardless of bilirubin levels
  • Only after 48 hours of life
  • Between 24 to 120 hours of life using a bilirubin nomogram (correct)
  • Only if jaundice is visible without testing

    • Which newborn assessment should the nurse prioritize based on the presented conditions?

    <p>Baby with heart rate of 145 bpm and acrocyanosis</p> Signup and view all the answers

    What physiological change in newborns after birth can lead to an increased risk of jaundice?

    <p>Higher red blood cell mass and shorter lifespan of RBCs</p> Signup and view all the answers

    What is the first priority for the nurse caring for a 6-hour-old newborn with vital signs of 97.4°F, 122 bpm, and 36 breaths per minute?

    <p>Place the newborn skin to skin with mother.</p> Signup and view all the answers

    What is the expected frequency of voiding for a newborn after the fourth day of life?

    <p>6-8 times per day.</p> Signup and view all the answers

    What is the primary breathing method for newborns during the first week of life?

    <p>Nasal breathing.</p> Signup and view all the answers

    When should meconium be passed by a newborn?

    <p>Within 24-48 hours.</p> Signup and view all the answers

    What is a normal pattern for a newborn's breathing rate during the first month?

    <p>45-60 breaths per minute.</p> Signup and view all the answers

    What is the purpose of normal bacterial content developing in the intestines within the first week?

    <p>To produce vitamin K.</p> Signup and view all the answers

    What color is the newborn's first voiding typically expected to be?

    <p>Pale straw color.</p> Signup and view all the answers

    Which of the following is not a typical characteristic of newborn stool in the first few days of life?

    <p>Foul odor immediately after birth.</p> Signup and view all the answers

    What physiological process occurs to establish respiration in a newborn after birth?

    <p>First cries shift fluid out of the lungs</p> Signup and view all the answers

    What is the primary role of the placenta during intrauterine life?

    <p>To provide gas exchange and oxygenation</p> Signup and view all the answers

    Which of the following describes the adjustment from fetal to neonatal circulation immediately after birth?

    <p>The ductus arteriosus closes to redirect blood to the lungs</p> Signup and view all the answers

    Which of the following is NOT a physiological adaptation a newborn must make after birth?

    <p>Establishing a sleep pattern</p> Signup and view all the answers

    How is oxygenation changed in a newborn's body once they are born?

    <p>Lung expansion allows for gas exchange in the lungs</p> Signup and view all the answers

    In what order does the foramen ovale function after birth?

    <p>Closes within 1-2 hours after birth</p> Signup and view all the answers

    Which behavioral adaptation is essential for a newborn's development?

    <p>Processing stimuli</p> Signup and view all the answers

    What occurs immediately after birth regarding the lungs?

    <p>Blood flow to the lungs increases</p> Signup and view all the answers

    What percentage of weight loss is typically expected in a newborn during the first 3-5 days after birth?

    <p>5-10%</p> Signup and view all the answers

    How much time do newborns generally need to regain their lost weight after birth?

    <p>10-14 days</p> Signup and view all the answers

    What does SGA stand for in the context of newborn weight classification?

    <p>Small for gestational age</p> Signup and view all the answers

    Which of the following characteristics signifies a newborn being LGA?

    <p>Weight above the 90th percentile</p> Signup and view all the answers

    What is a common behavioral response to pain in newborns?

    <p>Crying and facial grimacing</p> Signup and view all the answers

    What anatomical feature defines the female newborn's genitalia?

    <p>Swollen labia</p> Signup and view all the answers

    Which period after birth is characterized by active alertness in newborns?

    <p>Second period of reactivity</p> Signup and view all the answers

    What is a sign of potential obstruction in a newborn's urinary function?

    <p>No urination in 24 hours</p> Signup and view all the answers

    What is a primary concern if primitive reflexes are absent in a newborn?

    <p>It may indicate neurological issues</p> Signup and view all the answers

    What term describes the classification of newborns who fall between the 10th and 90th percentiles for weight?

    <p>Normal for gestational age</p> Signup and view all the answers

    What is a characteristic of the light sleep state in infants?

    <p>Turning head as a sensitivity response</p> Signup and view all the answers

    Which statement about newborn cues is accurate?

    <p>Fussing usually signals hunger or discomfort</p> Signup and view all the answers

    What is the purpose of applying Vaseline to the penis after a circumcision using Gomco clamp?

    <p>To prevent adhering to the diaper</p> Signup and view all the answers

    In the PlastiBell circumcision method, which action is crucial?

    <p>Do not remove the rim until healing is complete</p> Signup and view all the answers

    What is indicated by the glans turning dark red post circumcision?

    <p>Normal healing progress</p> Signup and view all the answers

    How frequently should the diaper be changed after circumcision care?

    <p>At least every 4 hours</p> Signup and view all the answers

    Which of the following behaviors indicates a baby may be in deep sleep?

    <p>Falling asleep and breaking eye contact</p> Signup and view all the answers

    What measure should be provided to comfort the baby after circumcision?

    <p>Tylenol for pain relief</p> Signup and view all the answers

    What is the purpose of the ductus arteriosus in neonatal circulation?

    <p>To carry blood away from the lungs</p> Signup and view all the answers

    What condition is referred to as PDA when the ductus arteriosus does not close?

    <p>Patent Ductus Arteriosus</p> Signup and view all the answers

    Which medication is used to prevent eye infections in newborns?

    <p>Erythromycin ophthalmic ointment</p> Signup and view all the answers

    What is the recommended method for assessing a newborn's airway immediately after birth?

    <p>Bulb syringe suctioning</p> Signup and view all the answers

    Which APGAR score indicates minimal to no difficulty in a newborn's condition?

    <p>7-10</p> Signup and view all the answers

    What is the typical heart rate range for a newborn immediately after birth?

    <p>110-160 beats per minute</p> Signup and view all the answers

    When should the initial hepatitis B vaccine be administered to a newborn?

    <p>At birth</p> Signup and view all the answers

    What is the purpose of administering phytonadione (Vitamin K) to newborns?

    <p>To aid in blood clotting</p> Signup and view all the answers

    What is the common respiratory rate for a newborn?

    <p>30-60 breaths per minute</p> Signup and view all the answers

    What is advised in terms of bathing a newborn shortly after delivery?

    <p>Delayed bath for 12-24 hours</p> Signup and view all the answers

    What is a common sign of distress in newborns that requires immediate assessment?

    <p>Cyanosis or unusual color</p> Signup and view all the answers

    The Ballard Gestational Age Assessment is used to evaluate what aspect of a newborn?

    <p>Gestational age</p> Signup and view all the answers

    What is the correct sequence of actions to perform on a newborn immediately after birth?

    <p>Dry, stimulate, and then assess</p> Signup and view all the answers

    What aspect of a newborn's vital signs is typically not routinely measured unless a cardiac issue is suspected?

    <p>Blood pressure</p> Signup and view all the answers

    Study Notes

    The Newborn

    • Newborns transition from intrauterine to extrauterine life, requiring adjustments in physiology and behavior.
    • Physiological adjustments include establishing respirations, adjusting from fetal to adult circulation, temperature regulation, nutrient ingestion/retention/digestion, waste elimination, and weight regulation.

    Transition from Intrauterine to Life

    • Physiological:
      • Establish and maintain respirations.
      • Adjust from fetal to adult circulation.
      • Regulate temperature.
      • Ingest, retain, and digest nutrients.
      • Eliminate wastes.
      • Regulate weight.
    • Behavioral:
      • Establish a routine.
      • Process, store, and organize stimuli.
      • Establish relationships.

    Establishing and Maintaining Respirations

    • Intrauterine oxygenation:
      • The placenta provides gas exchange and oxygenates the fetus.
      • Fetal lungs are filled with amniotic fluid, and blood flow to the lungs is decreased.
    • Extrauterine (at birth) oxygenation:
      • First cries shift fluid out of the lungs.
      • Lungs expand with air, and blood flow to the lungs increases.
      • Gas exchange and oxygenation occur in the lungs.

    Adjusting from fetal to infant Circulation

    • Neonatal Circulation:
      • Shunts close, forcing blood to the lungs.
      • Normal neonatal circulation begins.
      • Change start immediately after birth.
    • Fetal Circulation:
      • Shunts blood (Foramen Ovale, Ductus Arteriosus).
      • Ductus venosus bypasses the liver

    Delivery Room Care

    • Review maternal records
    • Dry, stimulate, and assess
    • Obtain Apgar score.
    • Assess vital signs, weight, and measurements.
    • Cord care (3 vessels, clamp).
    • ID bands
    • Delayed bath.
    • Skin-to-skin.
    • Breastfeeding
    • Medications: erythromycin, vitamin K, hepatitis B.

    Immediate Assessment

    • ABC (Airway, Breathing, Circulation)
    • Clear airway (bulb syringe, mucus trap)
    • Crying
    • Color

    APGAR Scoring

    • Assess heart rate, respirations, muscle tone, reflex irritability, and color at 1 and 5 minutes after birth.
    • Scores range from 0 to 2 for each category, with a total score of 7-10 indicating minimal difficulty and 0-3 indicating severe distress.

    Gestational Age Assessment

    • Ballard Gestational Age Assessment Chart: a tool for assessing maturity based on physical and neuromuscular characteristics. It provides a scoring system to estimate gestational age.

    Vital Signs

    • Heart rate (110-160 bpm)
    • Pulses (brachial and femoral)
    • Blood pressure (not routine unless suspect cardiac issue)
    • Respiratory rate (30-60 breaths/min)
    • Irregular, short periods of apnea (<15 sec).
    • Nose and abdominal breathers.
    • Respiratory distress (lung/chest retractions, nasal flaring, grunting).
    • Temperature (axillary: 37°C or 98.6°F, range 36.5° - 37.5°C or 97.7° - 99.5°F).

    Thermoregulation

    • Increased muscle activity (crying, restlessness)
    • Brown fat metabolism (non-shivering thermogenesis)
    • Term infants have more brown fat stores than preterm infants.
    • Flexed position to conserve heat
    • Decreases the amount of exposed body surface.

    Hypothermia and Cold Stress

    • Pale and mottled appearance.
    • Cool extremities.
    • Cold stress can lead to metabolic acidosis, hypoglycemia, and hypoxia.
    • Rapid depletion of brown fat
    • Pulmonary vasoconstriction can jeopardize perfusion.

    Nursing Interventions

    • Maintain a neutral thermal environment (~75°F).
    • Keep newborns wrapped to maintain body heat.
    • Avoid overexposure.
    • Skin-to-skin contact with mom.
    • Use warm instruments and equipment around the infant.
    • Prevent dehydration

    Normal Labs and Screenings

    • Blood glucose (as needed; hypoglycemia = <40 mg/dl requiring treatment)
    • Newborn screening (heel stick after feeding)
    • Congenital heart disease / hearing testing
    • Bilirubin (jaundice monitoring).

    Teaching and Anticipatory Guidance

    • Teach parents to interact with the newborn and teach them how to care for the infant. Discharge teaching should include techniques such as: Bath, Bulb suction, Cord care and Circumcision care , Diapering, Swaddling, Taking temperature and Car seat safety.

    Safe Sleep

    • Sleep on back, tummy time (while awake)
    • Own sleeping space
    • Firm mattress.
    • No loose blankets, pillows or toys.
    • No smoking around baby.

    Danger Signs for Parents to Report

    • Hypothermia or hyperthermia
    • Refusal to eat for 2 consecutive feedings
    • Vomiting (more than once in 6 hours)
    • Diarrhea (green, watery, consecutive episodes)
    • Decreased bowel movements
    • Decreased urination
    • Difficulty breathing
    • Cyanosis
    • Lethargy
    • Bleeding
    • Inconsolable crying
    • Drainage from eyes

    Assessment Findings

    • Expected, Common Variation, or Unexpected findings in the newborn's assessment after 12 hours from birth

    Head and Face

    • Molding (sutures overlap)
    • Caput succedaneum
    • Cephalohematoma
    • Fontanels

    Integumentary System

    • Vernix
    • Lanugo
    • Milia
    • Grey slate nevus
    • Nevi (stork bite)
    • Erythema toxicum
    • Epstein pearls
    • Jaundice
    • Natal teeth (checking)

    Skeletal System

    • Observe throughout exam (ROM)
    • All extremities
    • Barlow test and Ortolani maneuver (especially in breech babies)
    • Spine

    Genitourinary

    • Female:
      • Anatomical features
      • Swollen labia
      • Vaginal discharge/pseudo-menses
    • Male:
      • Anatomical features
      • Descended testes
      • Swollen scrotum (hydrocele)
      • Assess location of testicles
      • Urination

    Reflexes and Periods of Reactivity

    • Primitive and protective reflexes.
    • Absence of reflexes is a cause for concern.
    • Periods of reactivity (first and second).

    Neonatal Pain

    • Physiological and psychological changes (vital signs, motor activity, facial expressions, behavioral pain responses).
    • Assessment (using pain scales—e.g., NIPS, FLACC.)
    • Management (nonpharmacological and pharmacological)

    Hepatic System—Physiologic Jaundice/Hyperbilirubinemia

    • After first 24 hours of life
    • Higher RBC mass, shorter lifespan of RBC
    • Reduced ability of newborn liver to conjugate.
    • Increased unconjugated bilirubin, which causes /displays/jaundice .
    • Phototherapy can convert indirect bilirubin.

    Newborn Nutrition

    • Breastfeeding (effective feeding, position, latch, duration, pumping and storage).
    • Formula feeding (timing, amount, preparation, holding).
    • Burping

    Blood Sugars (metabolism)

    • Transition to managing the amount of insulin production, and glucose availability.
    • Hypoglycemia = less than 40mg/dL.
    • Infants with a high risk for hypoglycemia:
      • Infants of diabetic mothers
      • Large-for-gestational-age (LGA) infants
      • Small-for-gestational-age (SGA) infants
      • Preterm infants
      • Infants with respiratory distress syndrome
      • Infants receiving maternal beta-blockers.

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    Description

    This quiz covers essential aspects of newborn care, focusing on the management and assessment of jaundice in newborns. Key topics include phototherapy, bilirubin levels, and vital signs monitoring. Test your knowledge on the physiological changes and care priorities for newborns in their first week of life.

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