Newborn Care and Respiratory Distress

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Questions and Answers

What causes the closure of the foramen ovale shortly after birth?

Increase in pulmonary vascular resistance

Presence of surfactant in alveoli

Closure of ductus venosus

Increase in left atrium pressure due to decreased systemic vascular resistance (correct)

What is the main consequence of persistent pulmonary hypertension in newborns?

Increased pulmonary vascular resistance (correct)

Decreased right ventricular hypertrophy

Improved systemic circulation

Increased oxygenation of tissue

How soon does the ductus arteriosus typically close after birth in term neonates?

2 weeks

96 hours

30 minutes

15 hours (correct)

Which condition is most likely to contribute to hypoxemia in term or near-term neonates?

Low levels of surfactant Signup and view all the answers

What is a primary goal in treating persistent pulmonary hypertension of the newborn?

Correct hypoxia and acidosis Signup and view all the answers

What is the first intervention the nurse should implement for a neonate assessed at 30 minutes of age with concerning signs?

Complete the New Ballard Tool for a specific gestational age assessment Signup and view all the answers

Which intervention should be prioritized to prevent skin breakdown in a 29-week gestation infant admitted to the NICU?

Place the premature on a gel mattress inside a double-walled incubator Signup and view all the answers

What is a sign of respiratory distress in a newborn?

Nasal flaring and expiratory grunting Signup and view all the answers

Which complication is commonly associated with Respiratory Distress Syndrome (RDS) in newborns?

Hypoglycemia Signup and view all the answers

What action should the nurse take next when a newborn displays respiratory distress signs like tachypnea and grunting?

Suction the airway with a bulb syringe Signup and view all the answers

What symptom indicates potential patent ductus arteriosus in a newborn?

Cyanosis and weak pulse Signup and view all the answers

How can preterm infants minimize skin breakdown during care?

Limit tape use with frequent position changes Signup and view all the answers

What finding is NOT expected in a newborn with respiratory distress?

Calm and controlled breathing Signup and view all the answers

What indicates a suspected right-to-left shunting in a neonate?

A difference of 15 mm Hg or more between preductal and postductal PaO2, with preductal higher Signup and view all the answers

Which medication is primarily used to decrease right-to-left shunting in neonates?

Dopamine Signup and view all the answers

Which assessment finding in a 28-week gestation infant suggests possible intraventricular hemorrhage?

Anterior fontanel is full and tense Signup and view all the answers

What finding increases a neonate's risk for pathological jaundice?

Mother’s blood type O-, newborn A+ Signup and view all the answers

Which type of medication is controversial for neonates who resist ventilation?

Paralyzing agents Signup and view all the answers

In assessing a 3-day-old neonate with abdominal distention, what likely diagnosis should the nurse suspect?

Necrotizing enterocolitis Signup and view all the answers

Which statement indicates a need for immediate intervention when a newborn is receiving phototherapy?

The infant is being held by a parent during treatment Signup and view all the answers

What difference in pulse oximetry would raise concern for right-to-left shunting?

A difference of 5% or greater between pre- and postductal saturation Signup and view all the answers

What is the term used for neonates whose weight is below the 10th percentile for gestational age?

SGA Signup and view all the answers

Which practice is NOT recommended for caring for a neonate who is SGA?

Keeping the room temperature below 74°F Signup and view all the answers

Which finding increases a neonate's risk for infection?

Small laceration on the scalp Signup and view all the answers

What is the priority nursing action for a 36-week gestation neonate whose mother had no group B streptococcal culture collected prenatally?

Assess the newborn for signs of infection Signup and view all the answers

Which action should be performed to identify complications of neonatal abstinence syndrome in a newborn?

Assess using a neonatal abstinence scoring tool Signup and view all the answers

What is a common sign that indicates a newborn is suffering from neonatal abstinence syndrome?

High-pitched cry Signup and view all the answers

Which of the following components is NOT part of the APGAR scoring system?

Gestational age Signup and view all the answers

At what time intervals is the APGAR score typically obtained after birth?

1 minute and 5 minutes Signup and view all the answers

Study Notes

Newborn Care

SATA: Everything but 150pbm, failing hearing test, and anemia
Preterm Newborn (3qs): Nurse assesses a 30-minute-old infant presenting with a frog-like position, translucent skin, lanugo, apnea, weak cry/suck, and undescended testicles.
Interventions: First actions include completing the New Ballard Tool and placing the infant on a gel mattress inside a double-walled incubator to prevent skin breakdown.
29-week gestation: Admitted to NICU, initial plan to prevent skin breakdown includes placing the infant on a gel mattress in a double-walled incubator. Don't use alcohol and limit tape with frequent position changes
Respiratory Distress (4qs): Newborn displays a respiratory rate of 70 breaths/min, circumoral cyanosis, flaring nostrils, intercostal retractions, sputum, and grunting. Pulse 160 bpm, temp 36.5°C (97.7°F). Next action is to suction the airway with a bulb syringe.

Patent Ductus Arteriosus (2qs)

Heart Murmur: A nurse assessing for patent ductus arteriosus should expect an increase in systemic vascular resistance (SVR) and left atrium (LA) pressure.
Closure: The ductus venosus shunt, ductus arteriosus, and foramen ovale close within certain timeframes (ductus venosus within 2 weeks, ductus arteriosus within 15 hours term/ 96 hours all neonates), and the presence of surfactant is important. Low surfactant levels and severe hypoxemia lead to an increase in pulmonary vascular resistance and prevent dilation.

Persistent Pulmonary Hypertension of the Newborn (1q)

Newborn presents with elevated pulmonary vascular resistance, high pulmonary pressure, and right-to-left shunting through the foramen ovale and ductus arteriosus.
Result: Hypoxia, reduced cardiac output, systemic hypotension, and metabolic acidosis worsen due to pulmonary vasoconstriction.
Causes: Issues like hypoxia, asphyxia, RDS, meconium aspiration, sepsis, or congenital lung anomalies like diaphragmatic hernia are common causes.
Goal: Correct hypoxemia and acidosis. Preductal and postductal blood gases and continuous pulse oximetry will show a difference in PaO2 (15 mm Hg or more) and preductal will be higher. Pulse oximetry shows a difference of 5% or greater between pre- and postductal oxygen saturation.

Medications

Vasopressors: Dopamine decreases right-to-left shunting by maintaining systemic vascular pressure above pulmonary vascular pressure
Vasodilators: Sildenafil and prostaglandins are used to promote pulmonary artery dilation
Other: Sedatives and analgesics (like midazolam/Versed and morphine); antibiotic therapy to decrease infection risk

Necrotizing Enterocolitis (1q)

Assessment findings: Abdominal distention, vomiting in a 3-day-old neonate born at 34 weeks' gestation, most likely NEC.
Intraventricular Hemorrhage: A full and tense anterior fontanel is an assessment finding associated with intraventricular hemorrhage in a 28 week premature infant with RDS.

Hyperbilirubinemia (4qs)

Risk Factor: Mother's blood type O-, newborn A+
Intervention: The statement "You must stop breastfeeding and substitute formula since your baby is jaundice and is not getting enough nutrition from your breastmilk" requires intervention.

SGA/LGA (2qs)

SGA: Term used for neonates whose weight is below the 10th percentile for gestational age. (Dry immediately; skin to skin; warm room, warm hands and equipment, infant hat)
LGA: Term used for neonates whose weight is above the 90th percentile for gestational age.

Neonatal Infection/GBS (2qs)

Risk Factor: A small laceration on the scalp noted from electrode use during labor increases the risk of infection for a 36-week gestation newborn. The priority action is for the nurse to assess the newborn for signs of infection.

Neonatal Abstinence (2qs)

Assessment: Use a neonatal abstinence scoring tool to assess and report increasing scores.
Symptom: High-pitched cry is a sign of neonatal abstinence syndrome.

Discharge Planning (1q)

Transition to Extrauterine Life: Transition to extrauterine life (APGARS) is assessed in 3qs.

Newborn Assessment (8qs)

Vitals: Heart Rate (110-160 bpm), rate may increase with crying, temperature (97.7°F-99°F axillary; abnormal >38°C or <36.6°C), Respiration (30-60), irregular with pauses up to 15 seconds.
Concerns: The absence of bowel sounds warrants further investigation.

Newborn Nutrition (8qs)

Instruction: Prepare the formula according to the directions on the label.
Effective Teaching: I will hold my baby during a feeding with his head higher than his body.

Newborn Discharge Teaching (3qs)

Successful Breastfeeding: At least 6-8 wet diapers, several stools per day.
Concerned Mother: "It takes time for both of you to learn, let us review signs he is getting enough milk."
Solid Food: The statement "My mother tells me I should put cereal in a bottle with his milk at night" requires intervention; no cereal in the bottle. Risks of choking and aspiration. Contraindications for breastfeeding include HIV, chemotherapy, active herpes, lesions on breast, tuberculosis, illicit drugs, and galactosemia (rare hereditary disorder).

Sibling Adaptation (1q)

Sibling Rivalry: "Even though the older children seem to love their new siblings. We won't leave the baby alone with them." This statement is important for preventing injury.

SIDS (1q)

Safe Sleep: The Safe Sleep Initiative addresses Sudden Infant Death Syndrome (SIDS).

Discharge Education (8qs)

Diaper Dermatitis: "I will apply baby powder to help keep the area dry with every diaper change," requires teaching; instead use a barrier ointment and powder should not be used.

Colic (1q)

Colic: Crying for at least 3 hours, 3 days per week, for at least 3 weeks. Mom should take steps to see a doctor and assess infant, particularly when colic is experienced.

Bonding/Attachment (1q)

Skin-to-Skin Contact: "There are many benefits for you and your baby with skin-to-skin care."

Medication (3qs)

Intervention: Invite parents to comfort the infant by stroking their head or hands is a nonpharmacological method.
Injection Site: Vastus lateralis.
Hepatitis B: Hepatitis B immune globulin and hepatitis B vaccine within 12 hours of birth

MedMath (5qs)

Percentage Calculation: Divide the part by the whole and multiply by 100. Example: 1,000mcg = 1mg.

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Description

This quiz covers essential knowledge in newborn care, focusing on interventions for preterm infants and management of respiratory distress. Test your understanding of the assessment and intervention strategies for newborns, including the use of the New Ballard Tool and recognizing respiratory complications. Prepare to delve into critical care practices for neonatal patients.