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Questions and Answers
What is the recommended frequency for breastfeeding on demand?
What is the recommended frequency for breastfeeding on demand?
What is a suggested method for relieving engorgement in non-breastfeeding clients?
What is a suggested method for relieving engorgement in non-breastfeeding clients?
What should be done to ensure complete breast emptying during breastfeeding?
What should be done to ensure complete breast emptying during breastfeeding?
Which is the correct way to assess a newborn's heart rate?
Which is the correct way to assess a newborn's heart rate?
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What is the normal range for a newborn's axillary temperature?
What is the normal range for a newborn's axillary temperature?
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What is the primary role of fetal lung fluid during birth?
What is the primary role of fetal lung fluid during birth?
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At what gestational week is surfactant typically detectable?
At what gestational week is surfactant typically detectable?
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Which factor is NOT associated with the baby's first breath during vaginal delivery?
Which factor is NOT associated with the baby's first breath during vaginal delivery?
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What occurs to the patent foramen ovale after birth?
What occurs to the patent foramen ovale after birth?
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What characterizes the first hour after birth, known as the golden hour?
What characterizes the first hour after birth, known as the golden hour?
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Which of the following bypasses is responsible for connecting the two atria in fetal circulation?
Which of the following bypasses is responsible for connecting the two atria in fetal circulation?
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What does an APGAR score of 4-6 indicate for a newborn?
What does an APGAR score of 4-6 indicate for a newborn?
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What is the purpose of performing the APGAR score at 1 and 5 minutes after birth?
What is the purpose of performing the APGAR score at 1 and 5 minutes after birth?
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What is NOT a characteristic of the period of relative inactivity following birth?
What is NOT a characteristic of the period of relative inactivity following birth?
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Why is vitamin K administered to newborns within the first hour of birth?
Why is vitamin K administered to newborns within the first hour of birth?
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What is the main purpose of the ductus venosus in fetal circulation?
What is the main purpose of the ductus venosus in fetal circulation?
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Which assessment is NOT typically included in the head-to-toe assessment performed on a newborn?
Which assessment is NOT typically included in the head-to-toe assessment performed on a newborn?
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What does acrocyanosis in a newborn indicate?
What does acrocyanosis in a newborn indicate?
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How often should vital signs be monitored in a newborn during the initial 24 hours?
How often should vital signs be monitored in a newborn during the initial 24 hours?
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What is the primary focus of evaluations during the first 24 hours before discharge?
What is the primary focus of evaluations during the first 24 hours before discharge?
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When is the newborn metabolic screening typically performed?
When is the newborn metabolic screening typically performed?
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What is a key characteristic of a cephalohematoma?
What is a key characteristic of a cephalohematoma?
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Which statement is true regarding voiding patterns in newborns?
Which statement is true regarding voiding patterns in newborns?
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What is the typical stool appearance for a breastfed infant?
What is the typical stool appearance for a breastfed infant?
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What is significant about assessing jaundice in newborns?
What is significant about assessing jaundice in newborns?
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What is the initial bladder volume of a newborn?
What is the initial bladder volume of a newborn?
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What describes the stool of a formula-fed infant?
What describes the stool of a formula-fed infant?
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When promoting stooling in newborns, which of the following is crucial?
When promoting stooling in newborns, which of the following is crucial?
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What risk is associated with cephalohematoma in newborns?
What risk is associated with cephalohematoma in newborns?
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What is the peak bilirubin level typically reached in physiologic jaundice before it begins to decrease?
What is the peak bilirubin level typically reached in physiologic jaundice before it begins to decrease?
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Which group of newborns is at a higher risk of developing physiologic jaundice?
Which group of newborns is at a higher risk of developing physiologic jaundice?
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Which factor is a significant contributor to early onset breastfeeding jaundice?
Which factor is a significant contributor to early onset breastfeeding jaundice?
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What is the primary intervention for managing late onset breastfeeding jaundice?
What is the primary intervention for managing late onset breastfeeding jaundice?
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What is true about pathologic jaundice in newborns?
What is true about pathologic jaundice in newborns?
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What factor can cause late onset breastfeeding jaundice?
What factor can cause late onset breastfeeding jaundice?
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Which is NOT a common cause of pathologic jaundice?
Which is NOT a common cause of pathologic jaundice?
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What is the possible consequence if a newborn's total serum bilirubin levels are dangerously high?
What is the possible consequence if a newborn's total serum bilirubin levels are dangerously high?
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Which treatment for jaundice involves the use of special blue light?
Which treatment for jaundice involves the use of special blue light?
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Passive immunity for infants mainly comes from which source?
Passive immunity for infants mainly comes from which source?
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What is considered a more reliable indicator of infections in infants rather than fever?
What is considered a more reliable indicator of infections in infants rather than fever?
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At what age does solitary play typically occur?
At what age does solitary play typically occur?
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What is the term for the onset of breast development in females during puberty?
What is the term for the onset of breast development in females during puberty?
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What occurs about 2-6 months after thelarche during puberty?
What occurs about 2-6 months after thelarche during puberty?
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Which type of play involves children playing together with rules and possibly a winner?
Which type of play involves children playing together with rules and possibly a winner?
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What is the role of breastfeeding in relation to passive immunity in infants?
What is the role of breastfeeding in relation to passive immunity in infants?
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Study Notes
Newborn Transition
- Normal Findings: Pulse range is 120-160 bpm, but may be as low as 100 bpm during sleep and up to 180 bpm during crying. Apical pulse is counted for a full minute. Respiratory rate is 30-60 breaths per minute, primarily diaphragmatic, but synchronous with abdominal movements. Brief periods of apnea, less than 15 seconds, are normal. Axillary temperature is 36.4-37.2°C (97.5-99°F), and skin temperature is 36-36.5°C (96.8-97.7°F). Blood pressure at birth is 90-60/50-40 mmHg, rising to 100/50 mmHg by day 10. Blood glucose should be at least 40mg/dL and hematocrit should be less than 65-70% in central venous sample.
Normal Newborn Rashes
- Congenital Dermal Melanocystosis: Bluish-black pigmentation; common on back or buttocks. Usually fades over a year and more common in darker skin tones.
- Nevus Simplex: Also called salmon patches. They are salmon-colored patches on the face, neck, and eyelids caused by superficial capillary defects. Fades in the first 1-2 years of life but facial patches may remain into adulthood.
- Erythema Toxicum Neonatorum: Transient rash appearing in the first 24-72 hours and lasting up to 3 weeks. It appears anywhere on the body as red dots. It is an inflammatory response and generally resolves without treatment.
- Hemangioma: New, dilated capillaries, usually superficial raised lesions. Appear bright red and grow in size until about 6 months, then start to fade and usually don't require treatment unless they are a significant size or internal.
- Milia: Small, white sebaceous glands; commonly found on the face and are considered normal.
Infant Feeding
- Feeding Cues: Rapid eye movement under eyelids, suckling movements, hand-to-mouth movements, body movements, small sounds, rooting, and crying (last hunger cue).
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Types of Milk:
- Colostrum: First 2-3 days, yellow, thick, high in protein, fat-soluble vitamins, and immunoglobulins.
- Transitional Milk: Between days 3-4 and 2 weeks, higher concentration of fat, lactose, and water-soluble vitamins.
- Mature Milk: After 2 weeks, 10% carbs, protein, and fat, and 90% water. Foremilk is higher in water, vitamins, and protein, while hind milk is higher in fat.
Breastfeeding
- Breast Milk Production: Colostrum development begins between 12-16 weeks, and milk is produced in the alveoli of the breasts, most notably during infant sucking. The hormones prolactin and oxytocin are crucial to milk production.
- Supply and Demand: Negative feedback is triggered if milk isn't removed from the breasts.
Breastfeeding Benefits
- Infant Benefits: Breast milk is tailored to the infant's specific needs and is easily digestible, reducing constipation while promoting healthy portion control and avoiding reliance on clean water. Breast milk also reduces allergies, infections, and may lower the risk of various diseases.
- Mother Benefits: Oxytocin release can enhance uterine involution, reduce blood loss, and delay the return of menses and ovulation.
Discharge Teaching
- Breastfeeding: Wear comfortable non-binding bras, breastfeed on demand (8-12 times per day), offer both breasts during each feeding session, utilize warm compresses before feeding and cold compresses after feeding, and ensure complete breast emptying.
- Non-Breastfeeding: Use supportive bras continually for 72 hours, avoid breast stimulation, and employ cool compresses or fresh cabbage leaves to alleviate engorgement. Analgesics or anti-inflammatories may be used to address pain.
Normal Newborn Transition (Vitals)
- Heart Rate: 120-160 BPM (apical pulse), checked for a full minute.
- Respiratory Rate: 30-60 breaths per minute.
- Temperature: Axillary 36.4-37.2°C (97.5-99°F), skin temperature 36-36.5°C (96.8-97.7°F).
- Blood Pressure: 60-90/40-50 mmHg (apical, which is often easier than brachial) but typically may reach 100/50 mmHg by day 10.
APGAR Scoring
- APGAR scoring: Assesses newborns at 1 and 5 minutes after birth by evaluating color, heart rate, reflex irritability, muscle tone, and respiratory effort. A score of 0-3 is considered critical, 4-6 below normal, and 7-10 normal. Perform every 5 minutes for up to 20 minutes if initial score is less than 7.
- Clinical Follow-up: Repeat the APGAR test or evaluate other factors if the initial APGAR score is low
Other
- Jaundice: Assessing for jaundice every 8-12 hours, with both visual assessments (universal predischarge screening) and serum testing (blood test through a heel stick), or transcutaneous testing when appropriate.
- Types of jaundice: Evaluating possible causes, whether physiologic or pathological.
- Elimination: Evaluating stool consistency, frequency, and color. Breastfed infants' stool should be yellow, gold, soft, or mushy (seedy). Formula-fed stools are generally pale yellow to light brown, formed, and pasty.
Newborn Reflexes
- Reflexes: Summarized description of newborns' common reflexes like blinking, Babinski, grasping, Moro, rooting, stepping, sucking, swimming, and tonic neck reflex. Describes when these reflexes typically disappear.
Newborn Genitalia
- Normal: Description of normal genitalia and potential abnormalities (e.g., hypospadias, epispadias, undescended testicles, etc) including when to watch for these potential issues and seek healthcare
- Voiding: Assessing for voiding within 24 hours as a baseline for normal fluid intake and appropriate kidney function
Types of Play
- Categories of play: Description of types of play categorized by unoccupied, solitary, onlooker, parallel, associative, and cooperative play in infants. The different periods described are typically linked to their specific age group.
Puberty
- Growth and Development: Description of typical puberty changes in boys and girls (breast development, pubic and axillary hair, menarche, spermarche, etc.).
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Description
This quiz covers the vital signs and normal findings during the newborn transition period, including pulse, respiratory rates, and blood pressure. Additionally, it explores common newborn rashes like congenital dermal melanocystosis and nevus simplex. Test your understanding of these essential newborn health aspects.
