neonate.pdf

‫‪Care of the Newborn‬‬ ‫مستر احمد السيد‬ ‫‪0402233050‬‬ ‫احمد السيد ‪0402233050‬‬ Preterm Newborn An infant born before 37 weeks of gestation term Newborn An infant born between 37-40 weeks of gestation Post term Newborn Infant born after 42 weeks of gestation (dry and cracked)skin without La...

‫‪Care of the Newborn‬‬ ‫مستر احمد السيد‬ ‫‪0402233050‬‬ ‫احمد السيد ‪0402233050‬‬ Preterm Newborn An infant born before 37 weeks of gestation term Newborn An infant born between 37-40 weeks of gestation Post term Newborn Infant born after 42 weeks of gestation (dry and cracked)skin without Lanugo Small for Gestational Age Newborn who is plotted at or below the 10th percentile on the intrauterine growth curve Appropriate for Gestational Age Newborn who is plotted between the 10th- 90th percentile on the intrauterine growth curve Large for Gestational Age Newborn who is plotted at or above the 90th percentile on the intrauterine growth curve Assessment 1. Observe or assist with initiation of respirations. 2. Assess Apgar score. Routinely assessed and recorded at 1 minute and 5 minutes after birth 0402233050 ‫احمد السيد‬ APGAR score intervention The Ballard Scale may be used for gestational age Assessment Vital signs Heart rate resting 120 to 160 beats/minute sleeping 80 to 100 beats/minute crying up to 180 beats/minute Respirations: 30 to 60 breaths/minute HEAD 0402233050 ‫احمد السيد‬ Molding Asymmetry of the head resulting from pressure in the birth canal usually disappears in about 72 hours Masses from birth trauma Caput succedaneum Edema of the soft tissue over bone (crosses over suture line) It subsides within a few days. Cephalhematoma a minor condition that occurs during the birth process. Pressure on the fetal head ruptures small blood vessels when the head is compressed against the maternal pelvis during labor or pressure from forceps or a vacuum extractor used to assist the birth It usually is absorbed within 6 weeks with no treatment. Skin Vernix caseosa a cheesy white substance, on entire body in preterm newborns, May be absent after 42 weeks of gestation 0402233050 ‫احمد السيد‬ Lanugo hair fine body hair, might be seen, especially on the back. Milia small white sebaceous glands, appear on the forehead, nose, and chin Acrocyanosis (peripheral cyanosis of hands and feet) is normal in the first few hours after birth Mongolian spots Bluish black pigmentation On lumbar dorsal area and buttocks Polydectayl Extra finger in the new born hands Syndectayl Two digits are fused together 0402233050 ‫احمد السيد‬ Pseudo menstruation Caused by the withdrawal of the maternal hormone estrogen,is possible (blood-tinged mucus). First voiding should occur within 24 hours. Immune system Receives passive immunity via the placenta (immunoglobulin G). and from colostrum (immunoglobulin A) Stomach capacity  (less than 10 mL at birth, increasing to about 90 mL by day 10)  Breast-feeding should be done every 2 to 3 hours  Position the newborn on the right side after Feeding  the side-lying position is not recommended for sleep because this position makes it easy for the newborn to roll to the prone position (prone position is contraindicated because the prone position increases the risk of sudden infant death syndrome). Meconium stool  greenish black with a thick, sticky, tarlike consistency  usually is passed within the first 24 hours of life. phenylketonuria [PKU]) newborn should be on formula or breast milk for 24 hours before screening. Prevent heat loss resulting from; Evaporation keeping the newborn dry and well wrapped with blanket. radiation keeping the newborn away from cold objects and outside walls. convection  shielding the newborn from drafts. Conduction  Avoid direct contact with cold object 0402233050 ‫احمد السيد‬ 1.Sucking and rooting  Touch the newborn’s lip, cheek, or corner of the mouth with a nipple The newborn turns the head toward the nipple  usually disappears after 3 to 4 months, but may persist for 1 year. Moro reflex (startle reflex) occurs when a baby is startled by a loud sound or movement. Babinski sign: Plantar reflex  occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot Serious lung disorder caused by immaturity and inability to produce surfactant, resulting in hypoxia and acidosis Surfactant: Substance produced by the alveolar epithelium reduces the surface tension and helps in establishing respiration.  Surfactant secreted in lung at gestation age 24weeks  Surfactant complete in lung at gestation age 28weeks signs and symptoms  tachypnea, nasal flaring, expiratory grunting,  retractions,seesaw respirations, decreased breath sounds,and apnea 0402233050 ‫احمد السيد‬ treatment surfactant replacement therapy (instilled into the endotracheal tube) to a newborn physiological jaundice Appears after the first 24 hours in full term newborns and after the first 48 hours in premature newborns peaks on about the fifth day of life indirect bilirubin levels 6 to 7 mg/dL Feed early to stimulate intestinal activity and to keep the bilirubin level low. Pathological jaundice Jaundice occurring during first 24 hours Indicate early hemolysis of red blood cells Hyperbilirubinemia Elevated serum bilirubin greater than 12 mg/dL in a term newborn. The appearance of jaundice during the first day of life indicates a pathological process. Therapy is aimed at preventing kernicterus, which results in permanent neurological damage Interventions  Keep the newborn well hydrated to maintain blood volume.  frequent feeding to hasten passage of meconium and encourage excretion of bilirubin.  Prepare for phototherapy (use of light to reduce serum bilirubin levels in the newborn.)  Cover the genital area, and monitor the genital area for skin irritation or breakdown.  Cover the newborn’s eyes with eye shields or patches  Reposition the newborn every 2 hours  monitor the newborn closely during the treatment.  monitor the newborn closely. Hypoglycemia, hyperbilirubinemia, respiratory distress syndrome, hypocalcemia, birth trauma, Excessive size and weight as a result of excess fat and glycogen in the tissues(macrosomia) 0402233050 ‫احمد السيد‬ Sudden Infant Death Syndrome (SIDS)  unexpected death of an apparently healthy infant younger than 1 year usually occurs during sleep periods affects infants 2 to 3 months of age High-risk conditions for SIDS  Prone position  Use of soft bedding, sleeping in a noninfant bed such as a sofa. Prevention and interventions  Infants should be placed in the supine position for sleep. Measles vaccine administration route? A. Intramuscular B. Subcutaneous C. Intradermal D. Intravenous What of the following disease are prevented by MMR vaccine? A. Mumps-measles-Scarlet fever B. Mumps-measles-rotavirus C. Mumps-measles-rabies D. Mumps-measles-germen- measles A 6-year-old child is scheduled to have measles, mumps, and rubella (MMR) vaccine. Which of the following routes will you expect the nurse to administer the vaccine? A. Intramuscularly in the vastus lateralis muscle. B. Intramuscularly in the deltoid muscle. C. Subcutaneously in the gluteal area. 0402233050 ‫احمد السيد‬ D. Subcutaneously in the outer aspect of the upper arm. Which of the following routes is used to administered Diphtheria, Tetanus and pertussis DTP vaccine? A. Oral B. Intramuscular C. Subcutaneous D. Intradermal An infant with a patent ductus arteriosus is admitted to the pediatric unit ward. The nurse anticipates which of the following medications will be given to the infant? A. Prednisone B. Ibuprofen C. Penicillin D. Albuterol 9 month vaccine : A. MCV4 B. Hepatitis A C. Hib D. MMR Five minutes post-birth, a neonate has a heart rate of 98, irregular breathing, actively moves all extremities, but has bluish hands and feet, as ll as a weak and timid cry. Which is the correct APGAR assessment score? A. 9 B. 8 0402233050 ‫احمد السيد‬ C. 7 D. 6 A nurse is performing physical examination on the new born she notes that the baby has cephalhetoma this baby is risk developing which of the following? A. Sudden death B. Pathological jaundice C. Infected umbilical cord D. Increased intracranial pressure While a nurse is assessing vital signs of newborn infant first hour of delivery. HR 170 RR 70 TEM 36 . the nurse would interpret these finding as in the discharge instruction A. Anemia B. Cold distress . C. Heart defects D. Hyperglycemia Toddler is admitted to the pediatric room with several episodes of diarrhea 3 days . the child is diagnosed with gastroenteritis. Which organism is responsible about the most diarrhea episodes in children? A. Rota B. Bacillus magissterium C. Shigella D. Staphylococcus 0402233050 ‫احمد السيد‬ 3 month-old infant is admitted to the Emergency Department (ED) with fractured arm. The mother indicated that while the child was crawling fell down the stairs and broke his arm. Which of the following observation would lead the nurse to suspect that this is a victim of abuse? A. Age inappropriate injury B. Pattern and shape of the injury C. Child is appearing malnourished D. Improper explanation of the cause of injury A nurse in the newborn nursery is assessing a 2-hour old newborn. She observed that the newborn has a caput succedaneum. Which intervention has the highest nursing priority ? A. Activate code blue immediately B. Turning on the radiant warmer C. Do nothing, it will resolve in 3-4 days D. Administer oxygen by nasal cannula While a nurse is assessing the head of a newborn at the first hour after delivery , she observed a soft edema over the vertex which crosses the suture line. Which of the following would be the proper nurses interpretation? A. Cephalohematoma B. Hydrocephaly C. Large head D. Caput succedaneum 0402233050 ‫احمد السيد‬ When the nurse on duty accidentally bumps the bassinet. the neonate throws out its arms. hands opened. and begins to cry. The nurse interprets this reaction as indicative of which of the following reflexes? A. Startle reflex B. Babinski reflex C. Grasping reflex D. Tonic neck reflex Neonate is near to cold window what is the type of heat loss A.radiation B .Convection C.Conduction D. Evaporation A nurse in a delivery room is assisting with the delivery of a newborn infant. After the delivery, the nurse prepares to prevent heat loss in the newborn resulting from evaporation by: A. Warming the crib pad B. Turning on the overhead radiant warmer C. Closing the doors to the room D. Drying the infant in a warm blanket A nurse in the newborn nursery is monitoring a preterm newborn infant for respiratory distress syndrome. Which assessment signs if noted in the newborn infant would alert the nurse to the possibility of this syndrome? 0402233050 ‫احمد السيد‬ A. Hypotension and Bradycardia B. Tachypnea and retractions C. Acrocyanosis and grunting D. The presence of a barrel chest with grunting A nurse in a newborn nursery is performing an assessment of a newborn infant. The nurse is preparing to measure the head circumference of the infant. The nurse would most appropriately: A. Wrap the tape measure around the infant’s head and measure just above the eyebrows. B. Place the tape measure under the infant's head at the base of the skull and wrap around to the front just above the eyes C. Place the tape measure under the infant's head, wrap around the occiput, and measure just above the eyes D. Place the tape measure at the back of the infant’s head, wrap around across the ears, and measure across the infant’s mouth. A30week gestational preterm admitted to NICU 2hours ago the neonate starts to have grunting ,nasal flaring which of the following the nurse recognize regarding signs and symptoms A. Neonate has RDS B. It is normally in the first 24 hours of birth C. This is not significant unless become cyanosis D. Neonate has hypoglycaemia 0402233050 ‫احمد السيد‬ A nurse on the newborn nursery floor is caring for a neonate. On assessment the infant is exhibiting signs of cyanosis, tachypnea, nasal flaring, and grunting. Respiratory distress syndrome is diagnosed, and the physician prescribes surfactant replacement therapy. The nurse would prepare to administer this therapy by: A. Subcutaneous injection B. Intravenous injection C. Instillation of the preparation into the lungs through an endotracheal tube D. Intramuscular injection 30weeks of gestational age preterm is admitted to the neonatal intensive care unit 2 hours. the neonate starts to have grunting tachypnea, and nasal flaring. Which of the following is responsible factors for diagnosis of the premature A. Bronchial spasm B. Immature bronchioles C. Lack of surfactant D.Pulmonary overload A baby born at 38 weeks of gestation with birth weight 1800 gram which of the following is the classification of this infant A. Low birth weight B. Very low birth weight C. Appropriate for gestational age D. Small for gestational age 0402233050 ‫احمد السيد‬ A nurse prepares to administer a vitamin K injection to a newborn infant. The mother asks the nurse why her newborn infant needs the injection. The best response by the nurse would be: A. “Your infant needs vitamin K to develop immunity.” B. “Vitamin K will protect your infant from having jaundice.” C. “Newborn infants are deficient in vitamin K, and this injection prevents your infant from abnormal bleeding.” D. “Newborn infants have sterile bowels, and vitamin K promotes the growth of bacteria in the bowel.” A nurse in a newborn nursery receives a phone call to prepare for the admission of a 43-week-gestation newborn with Apgar scores of 1 and 4. In planning for the admission of this infant, the nurse’s highest priority should be to: A. Connect the resuscitation bag to the oxygen outlet B. Turn on the apnea and cardiorespiratory monitors C. Set up the intravenous line with 5% dextrose in water D. Set the radiant warmer control temperature at 36.5* C (97.6*F) A nursing instructor asks a nursing student to describe the procedure for administering erythromycin ointment into the eyes of a neonate. The instructor determines that the student needs to research this procedure further if the student states: A. “I will cleanse the neonate’s eyes before instilling ointment.” B. “I will flush the eyes after instilling the ointment.” C. “I will instill the eye ointment into each of the neonate’s conjunctival sacs within one hour after birth.” D. “Administration of the eye ointment may be delayed until an hour or so after birth so that eye contact and parent-infant attachment and bonding can occur.” 0402233050 ‫احمد السيد‬ the primary critical observation for Apgar scoring is the: A. Heart rate B. Respiratory rate C. Presence of meconium D. Evaluation of the Moro reflex When performing a newborn assessment, the nurse should measure the vital signs in the following sequence: A. Pulse, respirations, temperature B. Temperature, pulse, respirations C. Respirations, temperature, pulse D. Respirations, pulse, temperature Intrauterine growth curves were used to classify a 32-week-old preterm new-born. Birth weight and gestational age shows the infant's growth rate falls below the 10th percentile. What is the priority nursing diagnosis for anew-born with small for gestational age A. Risk for injury related to impaired gluconeogenesis B. Risk for impaired gas exchange related to meconium aspiration C. Risk for ineffective thermoregulation related to lack of subcutaneous fat D. Risk for altered nutrition less than body requirement related to increased metabolic needs 0402233050 ‫احمد السيد‬ After assessment of new-born nurse instruct parent to use kangaroo roll which of the following should be useful A. Heart rate 150 B. Respiration 55 C. Temperature 34.5 D.blood presure 100/60 Within three (3) minutes after birth the normal heart rate of the infant may range between: A. 100 and 180 B. 130 and 170 C. 120 and 160 D. 100 and 130 The expected respiratory rate of a neonate within three (3) minutes of birth may be as high as: 50 60 80 100 The nurse is aware that a healthy newborn’s respirations are: 0402233050 ‫احمد السيد‬ A. Regular, abdominal, 40-50 per minute, deep B. Irregular, abdominal, 30-60 per minute, shallow C. Irregular, initiated by chest wall, 30-60 per minute, deep D. Regular, initiated by the chest wall, 40-60 per minute, shallow A4 days old baby diagnosed with physiological jaundice . his father is distressed and wants to know why he has this condition . what the nurse should the nurse tell the about the most prominent physiological jaundice A. Immature hepatic function B. Decrease milk intake C. Rh incompatibility D. Red blood cell enzyme defects To help limit the development of hyperbilirubinemia in the neonate, the plan of care should include: A. Monitoring for the passage of meconium each shift B. Instituting phototherapy for 30 minutes every 6 hours C. Substituting breastfeeding for formula during the 2nd day after birth D. Supplementing breastfeeding with glucose water during the first 24 hours A newborn has small, whitish, pinpoint spots over the nose, which the nurse knows are caused by retained sebaceous secretions. When charting this observation, the nurse identifies it as: A. Milia B. Lanugo 0402233050 ‫احمد السيد‬ C. Whiteheads D. Mongolian spots When newborns have been on formula for 36-48 hours, they should have a: A. Screening for PKU B. Vitamin K injection C. Test for necrotizing enterocolitis D. Heel stick for blood glucose level Which action a nurse needs to include when caring for a newborn receiving phototherapy? A. Expose all surfaces B. Prevent stimulation C. Cover the eyes with shield D. Change position every four hourly Which action best explains the main role of surfactant in the neonate? A. Assists with ciliary body maturation in the upper airways B. Helps maintain a rhythmic breathing pattern C. Promotes clearing mucus from the respiratory tract D. Helps the lungs remain expanded after the initiation of breathing While assessing a 2-hour old neonate, the nurse observes the neonate to have acrocyanosis. Which of the following nursing actions should be performed initially? 0402233050 ‫احمد السيد‬ A. Activate the code blue or emergency system B. Do nothing because acrocyanosis is normal in the neonate C. Immediately take the newborn’s temperature according to hospital policy D. Notify the physician of the need for a cardiac consult The nurse is aware that a neonate of a mother with diabetes is at risk for what complication? A. Anemia B. Hypoglycemia C. Nitrogen loss D. Thrombosis A client with group AB blood whose husband has group O has just given birth. The major sign of ABO blood incompatibility in the neonate is which complication or test result? A. Negative Coombs test B. Bleeding from the nose and ear C. Jaundice after the first 24 hours of life D. Jaundice within the first 24 hours of life A client has just given birth at 42 weeks’ gestation. When assessing the neonate, which physical finding is expected? A. A sleepy, lethargic baby B. Lanugo covering the body C. Desquamation of the epidermis 0402233050 ‫احمد السيد‬ D. Vernix caseosa covering the body The most common neonatal sepsis and meningitis infections seen within 24 hours after birth are caused by which organism? A. Candida albicans B. Chlamydia trachomatis C. Escherichia coli D. Group B beta-hemolytic streptococci When teaching umbilical cord care to a new mother, the nurse would include which information? A. Apply peroxide to the cord with each diaper change B. Cover the cord with petroleum jelly after bathing C. Keep the cord dry and open to air D. Wash the cord with soap and water each day during a tub bath A mother of a term neonate asks what the thick, white, cheesy coating is on his skin. Which correctly describes this finding? A. Lanugo B. Milia C. Nevus flammeus D. Vernix 1 year vaccine : A. Opv 0402233050 ‫احمد السيد‬ B. Hib C. DTap D. Hepatitis A and varicella The neonate is delivered by cesarean section the baby should be transported to NICU. Which type of baby incubator should be used? A. Closed box incubators B. Portable incubators C. Double - walled incubators D. Servo - control incubators When performing nursing care for a neonate after birth, which intervention has the highest nursing priority? A. Obtain a dextrostix B. Give the initial bath C. Give the vitamin K injection D. Cover the neonates head with a cap Which of the following would the nurse in charge do first after observing a 2-cm circle of bright red bleeding on the diaper of a neonate who just had a circumcision? A. Notify the neonate's pediatrician. B. Check the diaper and circumcision again in 30 minutes. C. Secure the diaper tightly to apply pressure on the site. D. Apply gentle pressure to the site with a sterile gauze ped 0402233050 ‫احمد السيد‬ What are the symptoms of the BCG vaccination side effect? A. Diarrhea B.SCAR C. no symptoms D. Seizure The nurse wants to assess growth of baby 9 month what is the most appropriate measure? A. Weight B. Height C. Development D. Vital Signs The nurse wants to assess nutritional status of baby 9 month what is the most appropriate measure? A. Head circumference B. Arm circumference C. Chest circumference D. Abdomin circumference Mother asked the nurse that while she was changing the diaper for her female newborn, she noticed a brick red stain on it. What is the best response by the nurse? A. It is a sign of low iron excretion. B. It is expected in female newborn. 0402233050 ‫احمد السيد‬ C. It is due to medication given to the mother. D. it due to medication given to the newborn A newborn’s mother is alarmed to find small amounts of blood on her infant girl’s diaper. When the nurse checks the infant’s urine it is straw colored and has no offensive odor. Which explanation to the newborn’s mother is most appropriate? A. “It appears your baby has a kidney infection” B. “Breast-fed babies often experience this type of bleeding problem due to lack of vitamin C in the breast milk” C. “The baby probably passed a small kidney stone” D. “Some infants experience menstruation like bleeding when hormones from the mother are not available” Vacciine refrigator temerature is ? A. 0-3 B. 1-5 C. 2-8 D. 3-9 The immunity system of the child reaches normal full mature level, at age. A. 10 years B. 9 years C. 12 months D. 15 years 0402233050 ‫احمد السيد‬ The nurse hears the mother of a 5-pound neonate telling a friend on the telephone, “As soon as I get home, I’ll give him some cereal to get him to gain weight.” The nurse recognizes the need for further instruction about infant feeding and tells her: A. “If you give the baby cereal, be sure to use Rice to prevent allergy.” B. “The baby is not able to swallow cereal, because he is too small.” C. “The infant’s digestive tract cannot handle complex carbohydrates like cereal.” D. “If you want him to gain weight, just double his daily intake of formula.” Infant 2 months with patent ductus arteriosus. What are the expected signs and symptoms for infant? A. Acrocyanosis B. Central cyanosis C. Tachycardia and tachypnea D. Tachypnea New born stomach capacity A. 6ML B. 12ml C. 28ml. If full term infant weight 3 kg at birth, approximately should the infant weight be at 12 months old? A. 7 kg B. 9 kg C. 11kg 0402233050 ‫احمد السيد‬ D. 13kg A client who is breastfeeding her newborn requests assistance from the lactation nurse. Which reflex does the nurse explain in order to assist with latching on A. Extrusion reflex B. Rooting reflex C. Swallowing reflex D. Tonic neck reflex Vitamin k dose in newborn . A. 0.25 mg B. 0.5mg C. 1 mg D. 2mg 0402233050 ‫احمد السيد‬ ‫احمد السيد ‪0402233050‬‬