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Questions and Answers

Which of the following is NOT a characteristic or behavior typical of an abductor?

Pretend to be a healthcare provider

Visit the maternity ward to inquire about the layout

Encourage new parents to adopt a baby (correct)

Use the stairway to gain access

What is an appropriate bathing practice for newborns?

Bathe the baby weekly and use regular bath products

Bathe the baby daily and scrub their skin thoroughly

Bathe the baby every other day and use mild soap

Bathe the baby whenever they are dirty and do not scrub the skin (correct)

Which symptom would suggest that a newborn may have an infection?

Bright skin color

Increased appetite

Temperature instability (correct)

Consistent crying

What should parents ensure before leaving the hospital with their newborn?

They need proper identification and assurance of follow-up appointments Signup and view all the answers

Which immunization is typically administered in the hospital to newborns?

Hepatitis B vaccine Signup and view all the answers

What is a primary method to maintain body temperature in preterm infants?

Skin-to-skin contact Signup and view all the answers

What are the clinical signs of hypothermia in a preterm infant?

Pale, mottled skin and apnea Signup and view all the answers

Which option correctly describes a risk factor for central nervous system injury in preterm infants?

Breech delivery Signup and view all the answers

How does hypoxia affect the heart rate in a preterm infant?

It causes bradycardia Signup and view all the answers

What is the typical normal body temperature range for a newborn?

97.7 – 99.5 F Signup and view all the answers

What is a common respiratory sign associated with hyperthermia in infants?

Apnea or tachypnea Signup and view all the answers

Which of the following manifestations may indicate abnormal brain function in a preterm infant?

Decorticate posturing Signup and view all the answers

What effect does prematurity have on drug responses in infants?

Increased susceptibility to sedation Signup and view all the answers

At what gestational age does surfactant production peak during fetal lung development?

28-32 weeks Signup and view all the answers

What is considered a normal respiratory rate for a newborn?

30-60 breaths per minute Signup and view all the answers

Which of the following is NOT a sign of abnormal respirations in a newborn?

Coordinated breathing Signup and view all the answers

What major change in the cardiopulmonary system occurs immediately after birth?

Closure of the foramen ovale Signup and view all the answers

How can a newborn's heart rate appear immediately after birth?

160-180 beats per minute Signup and view all the answers

What is a common response of a newborn to sensory stimuli during birth?

Loud crying Signup and view all the answers

What condition is indicated by tachycardia in a newborn?

Heart rate above 160 beats per minute at rest Signup and view all the answers

Why is acrocyanosis considered acceptable in newborns?

It typically resolves shortly after birth Signup and view all the answers

What is the primary role of the liver regarding bilirubin?

To convert bilirubin into a water-soluble form Signup and view all the answers

Which type of jaundice occurs within the first 24 hours of life?

Pathologic jaundice Signup and view all the answers

What is the consequence of not effectively conjugating unconjugated bilirubin?

Potential toxicity from fat-soluble bilirubin Signup and view all the answers

Which factor is NOT associated with an increased risk of neonatal hypoglycemia?

Breastfeeding Signup and view all the answers

How is bilirubin primarily excreted from the body after conjugation?

Into bile ducts and duodenum Signup and view all the answers

What describes the typical presentation of physiologic jaundice in a newborn?

Increases after day 3-5 and resolves by day 7-10 Signup and view all the answers

What are common signs of hypothermia in a newborn?

Pallor and cool mottled skin Signup and view all the answers

What is the normal range for blood glucose in newborns?

70 to 90 mg/dL Signup and view all the answers

Which of the following findings would you expect in a newborn of a mother who abused drugs?

Constant crying Signup and view all the answers

What additional sign is consistent with fetal alcohol syndrome in a newborn exhibiting poor sucking reflex?

Abnormal palmar creases Signup and view all the answers

What is a common effect of substance abuse on infants that should be recognized?

Intrauterine growth restriction (IUGR) Signup and view all the answers

When would withdrawal symptoms from narcotics in utero typically appear after birth?

Between 48 to 72 hours Signup and view all the answers

Which drug is associated with craniofacial anomalies and mental retardation when abused during pregnancy?

Alcohol Signup and view all the answers

What is the typical timeframe for withdrawal symptoms from barbiturates following birth?

Between days 1 and 14 Signup and view all the answers

Which of the following is an expected consequence of maternal tobacco abuse during pregnancy?

Cleft palate/lip Signup and view all the answers

Which assessment finding is not typical for a newborn affected by drug exposure?

Calm and easy to console Signup and view all the answers

What is one of the major risks associated with preterm infants due to their immature systems?

They may require immediate healthcare personnel and equipment. Signup and view all the answers

Which maternal age groups are associated with an increased risk of preterm birth?

Under 17 and over 35 years Signup and view all the answers

What is the primary classification of infants who weigh less than 1500 grams at birth?

VLBW Signup and view all the answers

Which condition indicates an infant is Small for Gestational Age (SGA)?

Weight below the 10th percentile for gestational age Signup and view all the answers

What is a common cause of Intrauterine Growth Restriction (IUGR)?

Infections and chromosomal abnormalities Signup and view all the answers

How is surfactant administered in preterm infants?

By endotracheal tube in combination with oxygen and ventilation therapy Signup and view all the answers

What complication can arise from SGA or IUGR infants during birth?

Perinatal asphyxia Signup and view all the answers

What characteristic is commonly observed in postmature newborns?

Depleted subcutaneous fat and dry, cracked skin Signup and view all the answers

Study Notes

OB Exam 5 Tutoring

This material covers various aspects of newborn care, including physiologic responses, fetal respiratory system, fetal circulation, cardiopulmonary system, thermoregulation, hepatic adaptation, hypoglycemia, TTN, and hypothermia. Question time sections include case studies and exam-style questions.

Physiologic Responses of the NB to Birth

Newborn respiratory status assessed for regularity/irregularity, pauses, and apnea.
Normal heart rate (bpm) range at birth.
Count apical pulse.
Blood pressure normally rises after birth.

Fetal Respiratory System

Alveolar ducts present by 20-24 weeks.
Surfactant production peaks at 28-32 weeks, crucial for lung function.
Normal newborn respirations are assessed for regularity, pauses (apnea), rate (bpm), depth, and noise level.
Signs of abnormal respirations include grunting (especially at rest), nasal flaring, retractions, tachypnea, apnea, and cyanosis.

Fetal Circulation

Ductus venosus, foramen ovale, ductus arteriosus are crucial fetal structures.
Major changes in these structures occur after birth as the circulatory system transitions from fetal to neonatal.
Normal heart rate at birth can be up to 180 bpm.
Apical pulse x1 minute is important.
Blood pressure rises after birth.
Cardiac murmurs are usually assessed.

Cardiopulmonary System

Fluid-filled lungs at birth—the transition to air-filled lungs.
What prevents lung collapse?
Chemical stimuli like changes in partial oxygen (O2) and carbon dioxide (CO2) levels.
Sensory stimuli (auditory, tactile).
Abnormal cardiac patterns like tachycardia (heart rate over 160 bpm at rest).
Bradycardia (<100 bpm at rest, but not during sleep).

Thermoregulation

Maintaining a stable environment is critical to avoid heat loss and cold stress.
Newborns can't shiver as a primary source of heat.
Infants rely on nonshivering thermogenesis (increasing muscle activity) and brown adipose tissue.

Hepatic Adaptation

Liver functions like iron storage and glucose homeostasis important for the newborn.
Bilirubin—its metabolism and changes from fat-soluble (unconjugated) to water-soluble (conjugated) forms, crucial for excretion.
Jaundice--A result of bilirubin buildup and its potential causes and the conjugation processes.
How do babies excrete bilirubin?

Hypoglycemia, TTN, and Hypothermia

Normal newborn glucose range.
Signs and symptoms of hypoglycemia (e.g., jitteriness, lethargy, apnea, seizures).
Risk factors for hypoglycemia, e.g., macrosomia, premature infants, other maternal issues.
Interventions for hypoglycemia.
Identifying and managing hypoglycemia, TTN, and hypothermia.

Nursing Care of Newborn and Family

Nursing care of the newborn and family, focusing on essential aspects during the first 24 hours, like monitoring vital signs, Apgar scores, and other assessments, and ensuring the baby is in a thermoneutral environment.

Ballard Score- Physical Maturity

Assessment for gestational age based on physical features.
Skin appears thin and transparent in preterm infants; opaque in term infants.
Lanugo is present, prominent in preterm, decreasing throughout pregnancy.
Creases are unreliable beyond 12 hours.

Skin Assessment and Head Assessment

Cyanosis (blue-tinged skin) at rest but pink when crying—suspect choanal atresia or another structural issue.
Mottling, jaundice, and erythema toxicum.
Milia (white spots on the face) and how they should be explained to parents.

Simple Reflexes of the NB

Assessing newborn reflexes (e.g., sucking, rooting, Moro, tonic neck, palmar grasping, stepping).

Hyperbilirubinemia

Elevated bilirubin levels (physiological or pathological).
Causes of hyperbilirubinemia.
Risk factors.
Management (e.g., phototherapy).

Question Time! (Case Studies)

Multiple case studies with exam-style questions.
Important nursing actions and priorities for newborns with various conditions.

Acquired Problems of NB

Newborn injuries (e.g., brachial palsy, cephalohematoma, caput succedaneum).

Substance Abuse Neonatal Abstinence Syndrome (NAS)

Recognizing and managing NAS
Effects of drugs in the infant.

Nursing Care of the High-Risk Newborn

Care for high-risk newborns during the first 4 hours and beyond.
Specific considerations of critical aspects.
Interventions and priorities.

Alterations in Respiratory & Cardiac Function

Respiratory distress syndrome (RDS) and possible causes
Managing possible issues related to impaired cardiac function in premature infants.
Early recognition and management.

At-Risk Newborns

Assessment risk factors and classify high-risk infants based on gestation, weight, and other factors
Surfactant administration.

SGA/IUGR/LGA

Small for gestational age, Intrauterine Growth Restriction, and Large for Gestational Age
Complications and potential risks associated.

Postmature Newborns

Characteristics and possible complications.

Infants of Diabetic Mothers

Potential complications in infants of diabetic mothers
Risk factors.

Alterations in Thermoregulation

Factors leading to thermoregulation issues for premature and post-term newborns
Identifying and addressing specific thermoregulation concerns
Normal temperature range.

Circumsision

Procedure and post-procedure care.
What to monitor, concerns.
Daily hygiene.

Preparation for Discharge & Security

Preparing the newborn and parents for home.
Addressing safety before discharge
What to include in teaching.

Newborn Infections

Common newborn infections and signs/symptoms.

CNS Congenital Anomalies

Defects specific to the CNS including encephalocele, meningomyelocele, anencephaly, hydrocephalus, and microcephaly.

Respiratory Congenital Anomalies

Conditions affecting the respiratory system in infants.

Gastrointestinal Congenital Anomalies

Conditions affecting the gastrointestinal tract in infants (e.g., cleft lip/palate, esophageal atresia, TEF, omphalocele, gastroschisis).

Musculoskeletal Congenital Anomalies

Conditions affecting the musculoskeletal system in infants (e.g., hip dysplasia and clubfoot).

Urogenital Congenital Anomalies

Conditions affecting the urogenital system in infants (e.g., hypospadias, epispadias, hydrocele, cryptorchidism).

Metabolic Congenital Anomalies

Genetic disorders impacting metabolic processes.

Practice Questions

Multiple practice questions on various aspects of newborn care.

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