Low Risk Neonatal PPT Exam 33 Questions with Verified Answers,100% CORRECT, Study notes of Nursing

Download Low Risk Neonatal PPT Exam 33 Questions with Verified Answers,100% CORRECT and more Study notes Nursing in PDF only on Docsity!

Low Risk Neonatal PPT Exam 33 Questions with Verified

Answers

Respiratory Transition - CORRECT ANSWER Respirations begin and continue effectively fluid is cleared from airways; transition made from fluid to gas Respiratory Transition: prenatal preparation - CORRECT ANSWER fetal lung development: -surfactant --begins 28 wks, peaks at 35 wks --maintains alveolar stability --enables the establishment of functional residual capacity respiratory transition: fetal breathing movements - CORRECT ANSWER essential for developing chest wall muscles and the diaphragm what factors induce respirations - CORRECT ANSWER mechanical: -fetal chest compression and recoil chemical: -chemoreceptor stimulation -decreased PO2 and increased PCO Thermal: -sudden cooling stimulates sensory receptors sensory: handling and drying; tactile stimulation Hormonal: -Increased norepinephrine & epinephrine stimulate cardiac output, surfactant release and promotion of pulmonary fluid clearance

Newborn respiratory patterns: expected assessment findings - CORRECT ANSWER nose breathers shallow and irregular short periods of apnea count full minute for neonate rate 30- airway noises common -> still clearing fluid out, upper airway noises c section babies -> no opportunity to have labor process compression their chest, vulnerable to airway noises signs of respiratory distress - CORRECT ANSWER persistent nasal flaring retractions expiratory grunting increased use of intercostal muscles tachypnea cyanosis Circulatory transition - CORRECT ANSWER goals: systemic vascular resistance must increase blood must circulate through the lungs --dilation of the pulmonary artery --pulmonary vascular resistance must decrease fetal shunts must close --dependent on a decrease in PVR Circulatory transition to extrauterine life - CORRECT ANSWER placental circuit shut off when the umbilical cord is clamped ductus venosus: closes by 3 days, liver takes over placental functions

foramen ovale: closes as the pulmonary blood flow from the left side of the heart increases pressure in the left atrium ductus arteriosus: constricts as pulmonary circulation & arterial oxygen tension increases -spontaneous closure: 90% newborns by 48 hrs of age; -permanent anatomic closure by 3 weeks to 3 months Thermoregulatory transition - CORRECT ANSWER newborns tolerate a narrower range of environmental temperatures and are extremely vulnerable to both under and overheating will attempt to regulate via flexed position, peripheral vasoconstriction, increased metabolic rate, and metabolism of brown fat Factors that predispose a newborn to heat loss - CORRECT ANSWER thin skin with vessels close to surface shivering mechanism rarely operable limited stores of glucose, glycogen, fat large body surface area relative to body weight lack of subcutaneous fat limited voluntary activity or ability to change posture can't communicate 'too hot', 'too cold' Consequences of cold stress - CORRECT ANSWER oxygen consumption and energy will be diverted from maintaining normal brain/cardiac function to thermogenesis for survival Depleted brown fat stores, increased oxygen needs, increased glucose consumption leading to hypoglycemia, metabolic acidosis, jaundice, hypoxia and decreased surfactant production

overheating - CORRECT ANSWER limited ability to sweat immature CNS system large body surface Newborn thermoregulation: expected findings - CORRECT ANSWER newborn temperature will remain between 36.5-37.2 (97.7-99.4) axillary balance achieved between heat loss and heat generation nursing interventions that prevent cold stress: EBP Benefits of skin-to-skin contact (SSC) - CORRECT ANSWER Minimizes crying, HR surges stabilizes temp improves interaction increases rate of BF initiation promotes uterine involution improves infant neurobehavioral development and self regulation Feeding - CORRECT ANSWER ability to take nourishment from breast or bottle coordinated sucking, swallowing and breathing Elimination renal: - CORRECT ANSWER void within 24 hours (93%) average # diapers = # days old By 4 days of age, 6-8 voids/ 24 hours Elimination: stools - CORRECT ANSWER most passed within 8-24 hours meconium

-dark and tarry transitional stool -greenish after meconium passed milk stool great variation in frequency Immune system adaptation - CORRECT ANSWER immature immune system & lack of exposure to organisms make the newborn vulnerable to infection -immature leukocyte function immunoglobulins contribute passive immunity -IgG: passed to fetus from mom via placenta, protects newborn against infections via mom's antibodies IgA: does not cross placenta; present in colostrum IgM: does not cross placenta, if elevated in NB, may indicate intrauterine infection (TORCH) Physical assessment of the newborn - CORRECT ANSWER immediate post delivery -anticipate and prepare --maternal history, intrapartal history -caregiver trained in neonatal resuscitation available for all births ongoing assessments following stabilization Nurturing and attachment: psychosocial adaptation - CORRECT ANSWER periods of reactivity newborn behavioral and sensory capabilities --visual, auditory, olfactory, taste, tactile newborn temperament neonatal pain parent/newborn attachment

Identification bands - CORRECT ANSWER time of birth, mother's name, birthdate, matching numbers for mom and baby medical ID number for baby Safety in the hospital setting - CORRECT ANSWER matching bands 'hugs' tags visitor ID and check in; closed units rolling bassinet parent education postpartum care Expected assessment findings: weight - CORRECT ANSWER 5Ib 8oz - 8Ib 13 oz Expected assessment findings :length - CORRECT ANSWER 45-53cm (19-21 inches) Expected assessment findings: head - CORRECT ANSWER 33-35.5cm (13- inches) Expected assessment findings: chest - CORRECT ANSWER 30.5-33cm (12- inches) newborn medications - CORRECT ANSWER Erythromycin ointment -prevention of gonococcal opthalmis neonatorum and chlamydial conjunctivitis mandated in most states vitamin K -given to prevent vitamin-k dependent hemorrhagic disease of the newborn newborns at risk first week or life due to immature liver and sterile GI tract

vitamin K stimulates liver to synthesize factors II, VII, IX, X hepatitis B vaccine Physical exam - CORRECT ANSWER within first 2 hours after birth -skin, head, neck, respiratory, cardiovascular, abdomen, musculoskeletal, genitalia neurogolical (reflexes) transitional period: -TPR, skin color, LOC, muscle tone, activity level evaluated and documented at least once q 30 minutes until stable for 2 hrs Hyperbilirubinemia (neonatal jaundice) - CORRECT ANSWER occurs in as many as 60% of newborns, more severe in preterm physiologic (non pathologic) appears 2-3 days after birth; pathologic <24 hrs after birth caused by presence of unconjugated bilirubin released with the breakdown of RBCs -increased fetal RBC's with a shortened life span -liver immaturity Bilirubin: pigment derived from breakdown HgB Concern: -acute bilirubin encephalopathy: neurological dysfuntion associated with elevated levels of bilirubin -Kernicterus: chronic manifestation of ABE Assessing jaundice - CORRECT ANSWER bilirubin: -appears in cephalocaudal manner -visual assessment has been found to be unreliable and leads to under-detection of hyperbilirubinemia, particularly in darkly pigmented infants Bilirubin screening - CORRECT ANSWER hour specific bilirubin nomogram

-findings should be interpreted according to the infant's age in hours Bilirubin levels -should peak at 5-8 mg/dl at 72 hrs of age Management of hyperbilirubinemia - CORRECT ANSWER appropriate follow up based on time of discharge and risk assessment phototherapy -interaction of light with bilirubin causes photochemical change that facilitates excretion -eyes must be covered to prevent retinal damage Exchange transfusion Infants at risk for severe hyperbilirubinemia - CORRECT ANSWER TcB levels in high risk zone jaundice with the first 24 hours after birth ABO incompatibility gestational age between 35-36 weeks Previous sibling who received phototherapy cepalhematoma or significant bruising east asian sub optimal breastfeeding (inadequate intake and dehydration that slows bilirubin elimination)