Podcast
Questions and Answers
What is the primary purpose of phototherapy in newborns with jaundice?
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?
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?
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?
Which newborn assessment should the nurse prioritize based on the presented conditions?
What physiological change in newborns after birth can lead to an increased risk of jaundice?
What physiological change in newborns after birth can lead to an increased risk of jaundice?
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?
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?
What is the expected frequency of voiding for a newborn after the fourth day of life?
What is the expected frequency of voiding for a newborn after the fourth day of life?
What is the primary breathing method for newborns during the first week of life?
What is the primary breathing method for newborns during the first week of life?
When should meconium be passed by a newborn?
When should meconium be passed by a newborn?
What is a normal pattern for a newborn's breathing rate during the first month?
What is a normal pattern for a newborn's breathing rate during the first month?
What is the purpose of normal bacterial content developing in the intestines within the first week?
What is the purpose of normal bacterial content developing in the intestines within the first week?
What color is the newborn's first voiding typically expected to be?
What color is the newborn's first voiding typically expected to be?
Which of the following is not a typical characteristic of newborn stool in the first few days of life?
Which of the following is not a typical characteristic of newborn stool in the first few days of life?
What physiological process occurs to establish respiration in a newborn after birth?
What physiological process occurs to establish respiration in a newborn after birth?
What is the primary role of the placenta during intrauterine life?
What is the primary role of the placenta during intrauterine life?
Which of the following describes the adjustment from fetal to neonatal circulation immediately after birth?
Which of the following describes the adjustment from fetal to neonatal circulation immediately after birth?
Which of the following is NOT a physiological adaptation a newborn must make after birth?
Which of the following is NOT a physiological adaptation a newborn must make after birth?
How is oxygenation changed in a newborn's body once they are born?
How is oxygenation changed in a newborn's body once they are born?
In what order does the foramen ovale function after birth?
In what order does the foramen ovale function after birth?
Which behavioral adaptation is essential for a newborn's development?
Which behavioral adaptation is essential for a newborn's development?
What occurs immediately after birth regarding the lungs?
What occurs immediately after birth regarding the lungs?
What percentage of weight loss is typically expected in a newborn during the first 3-5 days after birth?
What percentage of weight loss is typically expected in a newborn during the first 3-5 days after birth?
How much time do newborns generally need to regain their lost weight after birth?
How much time do newborns generally need to regain their lost weight after birth?
What does SGA stand for in the context of newborn weight classification?
What does SGA stand for in the context of newborn weight classification?
Which of the following characteristics signifies a newborn being LGA?
Which of the following characteristics signifies a newborn being LGA?
What is a common behavioral response to pain in newborns?
What is a common behavioral response to pain in newborns?
What anatomical feature defines the female newborn's genitalia?
What anatomical feature defines the female newborn's genitalia?
Which period after birth is characterized by active alertness in newborns?
Which period after birth is characterized by active alertness in newborns?
What is a sign of potential obstruction in a newborn's urinary function?
What is a sign of potential obstruction in a newborn's urinary function?
What is a primary concern if primitive reflexes are absent in a newborn?
What is a primary concern if primitive reflexes are absent in a newborn?
What term describes the classification of newborns who fall between the 10th and 90th percentiles for weight?
What term describes the classification of newborns who fall between the 10th and 90th percentiles for weight?
What is a characteristic of the light sleep state in infants?
What is a characteristic of the light sleep state in infants?
Which statement about newborn cues is accurate?
Which statement about newborn cues is accurate?
What is the purpose of applying Vaseline to the penis after a circumcision using Gomco clamp?
What is the purpose of applying Vaseline to the penis after a circumcision using Gomco clamp?
In the PlastiBell circumcision method, which action is crucial?
In the PlastiBell circumcision method, which action is crucial?
What is indicated by the glans turning dark red post circumcision?
What is indicated by the glans turning dark red post circumcision?
How frequently should the diaper be changed after circumcision care?
How frequently should the diaper be changed after circumcision care?
Which of the following behaviors indicates a baby may be in deep sleep?
Which of the following behaviors indicates a baby may be in deep sleep?
What measure should be provided to comfort the baby after circumcision?
What measure should be provided to comfort the baby after circumcision?
What is the purpose of the ductus arteriosus in neonatal circulation?
What is the purpose of the ductus arteriosus in neonatal circulation?
What condition is referred to as PDA when the ductus arteriosus does not close?
What condition is referred to as PDA when the ductus arteriosus does not close?
Which medication is used to prevent eye infections in newborns?
Which medication is used to prevent eye infections in newborns?
What is the recommended method for assessing a newborn's airway immediately after birth?
What is the recommended method for assessing a newborn's airway immediately after birth?
Which APGAR score indicates minimal to no difficulty in a newborn's condition?
Which APGAR score indicates minimal to no difficulty in a newborn's condition?
What is the typical heart rate range for a newborn immediately after birth?
What is the typical heart rate range for a newborn immediately after birth?
When should the initial hepatitis B vaccine be administered to a newborn?
When should the initial hepatitis B vaccine be administered to a newborn?
What is the purpose of administering phytonadione (Vitamin K) to newborns?
What is the purpose of administering phytonadione (Vitamin K) to newborns?
What is the common respiratory rate for a newborn?
What is the common respiratory rate for a newborn?
What is advised in terms of bathing a newborn shortly after delivery?
What is advised in terms of bathing a newborn shortly after delivery?
What is a common sign of distress in newborns that requires immediate assessment?
What is a common sign of distress in newborns that requires immediate assessment?
The Ballard Gestational Age Assessment is used to evaluate what aspect of a newborn?
The Ballard Gestational Age Assessment is used to evaluate what aspect of a newborn?
What is the correct sequence of actions to perform on a newborn immediately after birth?
What is the correct sequence of actions to perform on a newborn immediately after birth?
What aspect of a newborn's vital signs is typically not routinely measured unless a cardiac issue is suspected?
What aspect of a newborn's vital signs is typically not routinely measured unless a cardiac issue is suspected?
Flashcards
Newborn Respiratory Transition
Newborn Respiratory Transition
The process of moving from intrauterine (in the womb) to extrauterine (outside the womb) oxygenation.
Fetal Circulation
Fetal Circulation
Blood circulation in the fetus, utilizing shunts to bypass the lungs.
Extrauterine Circulation
Extrauterine Circulation
Blood circulation in the newborn after birth.
Foramen Ovale
Foramen Ovale
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Ductus Venosus
Ductus Venosus
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Post-birth Circulation Changes
Post-birth Circulation Changes
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Importance of First Cries
Importance of First Cries
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Intrauterine Oxygenation
Intrauterine Oxygenation
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Ductus Arteriosus (DA)
Ductus Arteriosus (DA)
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PDA
PDA
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APGAR Score
APGAR Score
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APGAR Score Factors
APGAR Score Factors
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Erythromycin Ophthalmic Ointment
Erythromycin Ophthalmic Ointment
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Phytonadione (Vitamin K)
Phytonadione (Vitamin K)
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Hepatitis B Vaccine
Hepatitis B Vaccine
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Vital Signs Assessment
Vital Signs Assessment
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Cord Care
Cord Care
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ID Bands
ID Bands
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Skin-to-Skin Contact
Skin-to-Skin Contact
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Breastfeeding
Breastfeeding
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Immediate Assessment (ABC)
Immediate Assessment (ABC)
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Acrocyanosis
Acrocyanosis
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Ballard Gestational Age Assessment
Ballard Gestational Age Assessment
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Newborn vital signs (V.S.)
Newborn vital signs (V.S.)
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Priority for a newborn (6 hours old)
Priority for a newborn (6 hours old)
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Newborn feeding (Day 1)
Newborn feeding (Day 1)
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Newborn breathing at a week
Newborn breathing at a week
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Stomach capacity in newborns
Stomach capacity in newborns
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Intestinal bacteria in newborns
Intestinal bacteria in newborns
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First urine characteristics
First urine characteristics
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Meconium stool
Meconium stool
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Normal Weight Loss
Normal Weight Loss
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Hypoglycemia in Newborns
Hypoglycemia in Newborns
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Effective Breastfeeding
Effective Breastfeeding
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Formula Feeding Timing and Amount
Formula Feeding Timing and Amount
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Burping Newborns
Burping Newborns
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Neonatal Pain Assessment
Neonatal Pain Assessment
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Neonatal Pain Management
Neonatal Pain Management
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Physiological Jaundice
Physiological Jaundice
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Indirect Bilirubin
Indirect Bilirubin
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Phototherapy
Phototherapy
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Nomogram
Nomogram
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What causes physiological jaundice in newborns?
What causes physiological jaundice in newborns?
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Newborn Sleep-Wake States
Newborn Sleep-Wake States
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Purposeful Newborn Behaviors
Purposeful Newborn Behaviors
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Interpreting Newborn Cues
Interpreting Newborn Cues
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Comfort Measures For Circumcision
Comfort Measures For Circumcision
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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.
