NUR230 OB/PEDS FINAL EXAM NEWEST ACTUAL EXAM 2025 QUESTIONS AND CORRECT DETAILED ANSWERS, Exams of Nursing

Download NUR230 OB/PEDS FINAL EXAM NEWEST ACTUAL EXAM 2025 QUESTIONS AND CORRECT DETAILED ANSWERS and more Exams Nursing in PDF only on Docsity! NUR230 FINAL EXAM NEWEST ACTUAL EXAM 2024-2025 QUESTIONS AND CORRECT DETAILED ANSWERS| A+ GRADE which infants are at greatest risk of developing physiological jaundice? (SATA) a. 3 hour infant born at term b. 2 day old infant born at 35 weeks c. an 18 hour old SGA baby who is having difficulty breastfeeding d. 2 day old baby diagnosed with a cephalhematoma e. 2 hour old infant who is O- and the mother is B+ positive Correct Answer b. 2 day old infant born at 35 weeks c. an 18 hour old SGA baby who is having difficulty breastfeeding d. 2 day old baby diagnosed with a cephalhematoma an infant admitted to the neonatal intensive care unit (NICU) in exhibiting signs of neonatal abstinence syndrome. Which of the following behaviors would support this diagnosis? a. high pitched shrill cry b. hyper-dynamic precordium c. depressed fontanels d. excessive regurgitation Correct Answer a. high pitched shrill cry You are caring for a couple who has a baby with cleft lip and palate. Which statement, by the mother, displays that she understands priority interventions while feedings? a. we need to monitor for jaundice b. we need to monitor for pain c. we need to monitor for respiratory distress and aspiration d. we need to monitor for hypoglycemia Correct Answer c. we need to monitor for respiratory distress and aspiration which of the following is NOT a risk factor associated with mastitis? a. frequent feedings b. cracked nipples c. fatigue d. inadequate emptying of the breat Correct Answer a. frequent feedings rubin describes one of the phases of maternal postpartum adjustment as "Mothers focus attention on themselves and their recovery needs. Mothers are dependent on other to make decisions and to care for their newborns." Which phase is she describing? a. taking in b. letting in c. taking hold d. letting go Correct Answer a. taking in what is the purpose of giving newborns vitamin k/phytonadione? a. it helps newborns create intestinal bacteria b. given to prevent hemorrhage due to lack of vitamin k in gut c. aids in digestion of baby's first feedings d. given to enhance newborn immunity Correct Answer b. given to prevent hemorrhage due to lack of vitamin k in gut which of the following findings indicates respiratory distress in the newborn when all are present simultaneously? SATA a. RR - 70 b. apnea for 10 seconds c. intercostal retractions d. acrocyanosis e. grunting f. nasal flaring Correct Answer a. RR - 70 c. intercostal retractions What will happen if a postpartum patient is unable to eliminate all the extra fluid? Correct Answer it can lead to pulmonary edema and cardiac problems Why might a postpartum patient have tachypnea? Correct Answer fever or pain Why might a postpartum patient have bradypnea? Correct Answer respiratory compromise (pulmonary edema or if they were on meds/anesthesia) Why should you watch for respiratory fluid overload in a postpartum patient? Correct Answer We are given a lot of things that can cause fluid overload: - fluid bolus: typically given after epidural because it causes hypotension - pitocin: can lead to water intoxication - mag sulfate: can cause fluid to move into lungs What are some neurological problems that can occur in a postpartum patient? Correct Answer Headaches and visual changes (spots, blurring, bright lights) Why may a postpartum patient be experiencing a headache? Correct Answer - may result in fluid shifts in the first week after birth - leakage of CSF due to epidural or spinal (tylenol, IV fluids, caffeine, blood patch) - chronic or GHTN - preeclampsia - stress and fatigue (tylenol, motrin, rest!) If someone is experiencing a headache, what should you always ask about? Correct Answer Ask if they are having any visual changes What is a blood patch? what is it used for? Correct Answer When you take blood from where the CSF is leaking and put it in the epidural space - this is done to block/stop the CSF for leaking out What are some nutritional recommendations for postpartum patient? Correct Answer - encourage woman to eat foods high in iron - may need to continue taking prenatal vitamin - breastfeeding mothers increase intake by 300kcal - non-breasting mothers decrease intake by 200kcal postpartum changes in labs: WBC & blood loss Correct Answer - WBC: non-pathologic leukocytosis occurs in 1st week (25,000- 30,000) - Blood loss: 200-500ml (vag) and 700-1000 (C/S) --> 2-3% point drop = loss of 500ml When should blood values return to pre-pregnancy state by? Correct Answer end of the 6th week - plasma: return by 4-6 week - platelet: by 6th week When does menstruation and ovulation return for a non- breastfeeding mother? Correct Answer Menstruation: occurs in 7- 12 weeks Ovulation: occurs in 70-75 days When does menstruation return for a breastfeeding mother? Correct Answer Menstruation: may be delayed 3 months longer, depending on exclusively breastfeeding or not Is breastfeeding a reliable form of birth control? Correct Answer NO Postpartum weight changes? when do mom's typically return to pre-pregnant weight? Correct Answer - initial weight loss of 10- 12lb (baby, placenta, amniotic fluid) - postpartum diuresis: 5lbs - may return to pre-pregnant weight by 6th-8th week but DEPENDS on diet, exercise, and the patient BUBBLEHE Correct Answer Breasts Uterus Bladder Bowels Lochia Episiotomy Homan's Sign Emotional Status What should be assessed during a breast assessment? Correct Answer - size and shape - abnormalities, reddened areas, or engorgement - presence of breast fullness due to milk presence - assess nipples for cracks, fissures, soreness, or inversion What are some recommendations given to mother's who do not want to breastfeed? Correct Answer - well-fitting bra or ace wrap binder - cold compress/cabbage leaves (comfort) - anti-inflammatory medication - no warm shower on breast (back to shower) - no stimulation!! how often should mother's breastfeed? Correct Answer feeding pattern every 1.5-3hrs (8-12 times per 24hr period) What can plugged ducts lead too? Correct Answer mastitis What is mastitis? Correct Answer infection of the breast tissue What sort of bacterias cause mastitis? Correct Answer staph aureus, e. coli, candida albicans (yeast) What are the symptoms of mastitis? Correct Answer sudden onset: chills, fever (≥101F), malaise - reddened, painful, swollen areas on breast - possible discharge from nipples What are some treatment options for mastitis? Correct Answer - warm compresses - analgesics - 7-10 of antibiotics!!! What are some prevention measures for mastitis? Correct Answer - supportive bras to prevent milk stasis - good hand washing - prompt attention to blocked milk ducts - regular, complete emptying of breast - good positioning and latch - report flu-like symptoms What are some factors that associate with development of mastitis? Correct Answer - milk stasis! - actions that promote/multiply bacteria - breast/nipple trauma - obstruction of ducts - change in number of feedings/failure to empty breast - lowered maternal defenses (stress/fatigue) What is the main difference between mastitis and engorgement? Correct Answer mastitis usually only effects one breast where as engorgement effects both breast What are the symptoms of breast engorgement? Correct Answer breast are hard and painful due to fullness with a gradual onset - not associated with high fever What are some recommendations for breast engorgement? Correct Answer - don't miss feedings - hand express or pump to soften breast/nipples before feedings - warm compresses before feedings to help with "let down" - cold applications between feedings to slow milk production - well fitted bra 24 hours - cabbage leaves to reduce edema - breastfeed more often Weaning off of breastfeeding Correct Answer substitute one feed for one cup or bottle over a few days to a week - gradually increase bottle/cup feed as time goes on Why is slow method of weaning important? Correct Answer - prevents breast engorgement - allows infants to alter their own eating methods at their own rates - provides time for psychological adjustment What are some common things seen in an abdominal assessment for a postpartum patient? Correct Answer - abd is loose and flabby but will respond to exercise - uterine ligaments will gradually return to their pre-pregnant state - diastasis recti abdominis - stretch marks Abdominal assessment: assessing "after pains" Correct Answer after pains: intermittent uterine contractions associated with uterine involution - resting prone with pillow under will help keep uterus contracted - motrin (Ibuprofen) PRN for cramping (unless platelets are <70,000) involution of uterus Correct Answer - decrease in weight (100g) - spongy layer of decidua is sloughed off - basal layer differentiates into 2 layers (outer layer sloughs off and inner layer begins new endometrium) - placental site heals by exfoliation endometritis Correct Answer infection that involves the lining of the uterus symptoms of endometritis Correct Answer uterine tenderness, temperature spikes (104F), chills, foul smelling lochia What are some risk of endometritis? Correct Answer - C/S - PPROM - prolonged labor - multiple vag exams, especially with ROM - use of FSE/IUPC - instrument assisted deliveries - manual removal of the placenta - chorioamnionitis (chorion and amnion - PROM or PPROM) Fundal assessment Correct Answer - position of fundus related to umbilicus - position of fundus to midline - boggy or firm When will the fundus be at the level of umbillicus? Correct Answer 6-12 hours postpartum lochia serosa: pink (day 4-10) lochia alba: white (day 10-20 until cervix is closed) When will the uterus reach its prepregnant size? Correct Answer 5-6 weeks postpartum what are causes of postpartum hemorrhage? Correct Answer - uterine atony - lacerations of genital tract - episiotomy - retained placental fragments - vulvar, vaginal, or sub-peritoneal hematomas - uterine inversion - uterine rupture - problems of placental implantation - coagulation disorders (low platelet count, DIC) what are some signs of a postpartum hemorrhage? Correct Answer - excessive of bright-red bleeding - boggy uterus - abnormal clots - high temp - unusual pelvic discomfort or backache - rise in level of fundus - inc HR and dec BP What are some interventions to prevent postpartum hemorrhage? Correct Answer - uterine message: if soft or boggy - assess perineum for free flow bleeding or clots - encourage frequent voiding or cath the woman (we don't want them up and walking) - assess abnormalities in hematocrit levels (CBC repeated on 1st PP day) - encourage woman to eat food high in iron (make need supplement) What are some medications to prevent postpartum hemorrhage? Correct Answer - oxytocin (must give 10u IM if no IV) - methylergonovine maleate (methergine): DONT use for women with high BP - carboprost (hemabate): side effect, DIARRHEA - misoprostol (cytotec): flat tampon thing, may follow with oral doses Cervical changes in a postpartum patient Correct Answer - cervix is spongy, flabby, and may appeared bruised - external os may have lacerations and is irregular and closes slowly - shape of the external os changes to a lateral slit (diaphragm needs to be refitted if using this form of BC) Vaginal changes in a postpartum patient Correct Answer - may be edematous, bruised, with small superficial lacerations When does the vagina decrease in size and rugae start to reappear PP? Correct Answer 3-4 weeks When does the vagina return to prepregnant size? Correct Answer 6 weeks when does an episiotomy initially start to heal pp? completely heal? Correct Answer - initially: 2-3 weeks - completely: 6 months 1st Degree laceration of perineum Correct Answer only vaginal mucosa involved - sometimes repair 2nd Degree laceration of perineum Correct Answer Vaginal mucosa and into perineal muscle - must repair 3rd Degree laceration of perineum Correct Answer Mucosa, through perineal muscles, into anal sphincter 4th Degree laceration of perineum Correct Answer Mucosa, through perineal muscles, all the way through anal sphincter What should you assess when you assess the perineum? (REEDA) Correct Answer Redness Edema or swelling Ecchymosis or bruising Discharge Approximation (how well edges of incision repair together) What are some perineal care interventions done on a postpartum patient? Correct Answer - ice packs (after 1st 6 hours) - topical anesthetics - waffle cushions - surgigator - sitz bath Hemorrhoid care in a postpartum patient Correct Answer - comfort/healing: sitz bath, topical anesthetics, ointments, rectal suppositories, or which hazel pads - assume side-lying position when possible and avoid prolonged sitting - adequate fluid intake and stool softners Care after C/S birth Correct Answer - minimize respiratory complications (IS, deep breathing, ambulating） - Rest: between care of self and infant - pain management: Percocet, lortab, Motrin, Tylenol - minimize gas pains: ambulation, simethicone What are symptoms of postpartum blues? Correct Answer - mood swings: mild depression --> happy feelings - self-limiting - irritable/overly sensitive - episodic tearfulness without cause - difficulty sleeping - feeling of being let down - anxiety risk factors of postpartum blues Correct Answer - rapid hormone changes (estrogen, progesterone, and prolactin) - fatigue, discomfort, overstimulation, insecurity, anxiety - emotional letdown after birth - if C/S, grief in response of fantasizing vaginal birth nursing care management of postpartum blues Correct Answer - anticipatory guidance - validating feelings and reassurance - rest (quiet time) and good nutrition - parenting reference materials - support networks and the inclusion of the family - open visiting hours and rooming in Postpartum depression: occurrence? what does not occur? what else can occur? Correct Answer - greatest occurrence is around 4th week - depression: no characterized by mood swings! - can contemplate suicide as a way of escape and to protect the baby- dying seems more favorable than living risk factors for postpartum depression Correct Answer - primigravida - ambivalence towards pregnancy (mixed feelings) - history of previous PP depression or depression - lack of social support - dissatisfaction with self or body image - adolescence When is postpartum psychosis usually evident? Correct Answer first 1-3 months symptoms of postpartum psychosis Correct Answer - agitation - hyperactivity - insomnia - confusion - difficulty remembering or concentrating - delusions and hallucinations/illogical thinking - suicide risk/infanticide risk nursing care for postpartum depression Correct Answer - seek order for referral to mental health professional - help parents understand the lifestyle changes and role demands - provide anticipatory guidance - dispel myths about the perfect mother or the perfect newborn - educate about the symptoms of postpartum depression nursing care for postpartum psychosis Correct Answer - educate about the symptoms of postpartum psychosis - foster positive adjustments in the new family - assess maternal depression - teach families symptoms of depression - edinburgh postnatal depression scale screening tool and others - give contact information for community resources (depression after delivery (DAD) and postpartum support international) medical management of postpartum depression Correct Answer 1st line of defense: sertraline (Zoloft) 2nd line of defense: paroxetine (Paxil) Fluoxetine (Prozac): not recommended with breastfeeding medical management for postpartum psychosis Correct Answer - lithium - antipsychotics - electroconvulsive therapy with psychotherapy (to cause a "reset" of imbalances in the brain) - possible removal on infant - assess social support 3 ways of parent-infant attachment/bonding Correct Answer exploration of the newborn - intial fingertips - palms touching larger body surfaces - enfold in hand and arm (holding) En face - direct eye contact, face to face - maternal response Engrossment - absorption, interest, preoccupation - paternal response partent-infant attachment/bonding Correct Answer - incorperate family goals in care plan - may postpone eye prophylaxis for 1 hour after delivery - provide private time for family to become acquainted - encourage skin-to-skin contact - encourage mother to tell her birth story - encourage involvement of the sibling - prepare parents for potential problems with adjustment - initiate and support measures to minimize fatigue - help parents identify, understand, and accept feelings like im literally not remembering this:( If a postpartum client complains of extreme perineal pain, especially after having received pain medication, the FIRST action by the nurse should be: a. notify the provider b. apply an ice pack to the perineum c. assess the perineum d. check the client's vitals and fundus Correct Answer c. assess the perineum What suctions are used for non-meconium fluid vs meconium fluid? Correct Answer non-meconium: bulb suctioning meconium: suction catheter (deeper suctioning) When a baby comes out in meconium stain fluid, should you try and stimulate them? Correct Answer No! What should happen after suctioning the baby? Correct Answer cutting and clamping the cord What should you look for after cutting and clamping the cord? Correct Answer You should look for the 2 umbilical arteries and 1 vein What does it mean if the doctors milk the cord? Correct Answer rub the cord in a downward motion towards the baby to move as much blood to the baby as possible After cutting the cord, what should you do to the fetus (if there is not problems)? Correct Answer - dry and stimulate: you can stimulate them by slapping/flicking the bottom of baby's foot or rubbing their back - warm baby: kangaroo care, warmer, warm blankets, hats, completely dry off baby After drying, stimulating, warming baby, what should you do next? how? Correct Answer Identification - footprints - bracelets: mom and one other person and baby - infant security bracelet When should an APGAR score be taken? Correct Answer 1 and 5 minutes What are the 5 things APGAR scores? Correct Answer Appearance (Color) Pulse (HR) Grimace (reflex irritability) Activity (muscle tone) Respiration efforts What is the scoring of each of the 5 categories of APGAR? Correct Answer Color: pale blue (0), body pink, extremities blue (1), pink (2) HR: absent (0), below 100 (1), above 100 (2) Reflex irritability: none (0), grimace (1), vigorous cry (2) Muscle tone: flaccid (0), some flexion (1), active (2) Respiratory: absent (0), irregular (1), good cry (2) The nurse is performing a 1 minute APGAR assessment of a newborn infant. Appearance: body pink, blue hands Pulse: 118bpm Grimace: minimal Activity: some flexion Respiration: slow and irregular Whats the APGAR score? a. 8 b. 7 c. 6 d. 5 Correct Answer c. 6 newborn pulse? when sleeping? vigorous crying? Correct Answer 110-160 sleeping: as low as 80 vigorous crying: up to 180 newborn temp Correct Answer 97.7-99.5 axillary newborn respirations Correct Answer 30-60 breaths/min (count for full minute) What are the 4 changes that initiates respiration of a newborn? Correct Answer - mechanical changes - chemical changes - thermal changes - sensory changes initiation of respiration: mechanical change Correct Answer Occurs at time of delivery, 80-100mL of fluid remains in the lungs of full-term infant --> decreased production of lung fluid 2-4 days prior to delivery - during birth process, the fetal chest is compressed and squeezes fluid out initiation of respiration: chemical stimuli Correct Answer - first breath (gasp)- triggered by increased Pco2 and decreased pH and Po2 - triggers brain respiratory center - natural result of a normal vaginal birth initiation of respiration: thermal stimuli Correct Answer - decrease in environmental temp after birth --> respond with increased respiration - avoid prolonged exposure to cold - decreased pulmonary resistance - closure of foramen ovale - closure of ductus arteriosus/venosus When is it best to auscultate a newborns apical pulse? Correct Answer when they are sleeping What are the 2 common place to take newborn pulses? Correct Answer brachial and femoral 4 different types of heat loss Correct Answer 1. convection 2. radiation 3. evaporation 4. conduction convection heat loss Correct Answer the flow of heat from the body surface to COOLER AIR radiation heat loss Correct Answer is the loss of heat from the body surface to COOLER SOLID SURFACES NOT in direct contact but in relative proximity evaporation heat loss Correct Answer the loss of heat that occurs when a liquid is converted to a vapor conduction heat loss Correct Answer is the loss of heat from the BODY SURFACE to COOLER SURFACES in direct contact the nurse checks a newborn's axillary temperature after giving a bath. What type of heat loss may occur as a result? a. conduction b. convection c. radiation d. evaporation Correct Answer d. evaporation causes of heatloss Correct Answer - a large surface area-to-body mass ratio - little subq fat - high body water content - immature skin - won't keep heat in - poorly developed metabolic mechanism for responding to thermal stress (NO SHIVERING) - altered skin blood flow (peripheral cyanosis) Why are premature babies at even more risk for heat loss? Correct Answer - lack flexed posture for preserving heat - very thin skin with capillaries close to surface signs of hypothermia Correct Answer respiratory distress, apnea, hypoxemia, metabolic acidosis - acrocyanosis (centrally pink) and cool, mottled, or pale skin - hypoglycemia - transient hyperglycemia - bradycardia (try to conserve heat) - tachypnea, restlessness, shallow and irregular respirations - decreased activity, lethargy, hypotonia - feeble cry, poor feeding - decreased weight gain causes of hyperthermia Correct Answer - overheating from incubators, radiant warmers, or environmental temp - maternal fever - maternal epidural - phototherapy lights/sunlight - excessive bundling or swaddling - infection - CNS disorders - dehydration symptoms of hyperthermia Correct Answer - tachycardia and tachypnea (long periods can lead to apnea) - warm extremities, flushing, perspiration (term newborns) - dehydration - lethargic, hypotonia, poor feeding - irritability - weak cry consequences of hyperthermia Correct Answer respiratory distress - hypotension and dehydration (increased water loss) - seizures and apnea (high core temp) - hypernatremia (water loss) management of hyperthermia Correct Answer - usual approach is adjust environmental conditions - move away from heat, undress if necessary - if in incubator, air temp should be lowered - breastfed frequently due to water loss what is brown fat important for? Correct Answer used for energy and warmth When a newborn infants experience cold stress, they begin to metabolize brown fat stores. If the baby is no adequately warmed and the cold stress continues, which is NOT an anticipated outcome? a. hypoglycemia b. respiratory distress c. hypertension d. lethargy Correct Answer c. hypertension What is measured on a newborn? Correct Answer weight, length, head circumference, chest circumference - skin/skin variations - head - eye variations - ears and mouth - back - lanugo - breast bud - umbilical cord - genitals - extremities when your looking at the newborns back, what are you assessing? Correct Answer assess the spine: that it's in like and continuous and sign of a dimple-pit and even a tuff of hair sacral dimple (Pilonidal dimple) Correct Answer indention or "pit" at the base of the spine (sometimes with a tuff of hair) If the sacral dimple isn't closed, then we need to do an US to rule out what? Correct Answer 1. Spina Bifida Occulta: spine doesn't close properly around spinal cord 2. Tethered Cord Syndrome: tissue attached to the cord limits its movement- causes weakness, numbness and bladder and bowel problems how does lanugo change as gestational age increases? Correct Answer decreases as gestational age increases what should the breast bud be like at term? Correct Answer it should feel firm and measure between 0.5-1cm When assessing the umbilical cord, what should you look for? Correct Answer - 2 arteries and 1 veins - observe for umbilical hernia preterm vs term male genitals Correct Answer perterm: small scrotum, few rugae, testes are palpable in inguinal canal term: testes are generally in lower scrotum, which is pendulous and covered with rugue preterm vs term female genitals Correct Answer preterm: clitoris is prominent, labia majora are small and widely seperated (looks like an out-y vagina) term: labia majora cover the labia minora and clitoris (inny vagina) male genitalia variations Correct Answer - hypospadias - epispadias - phimosis - hydrocele - cryptorchidism hypospadias Correct Answer urinary meatus on the underside of the penis epispadias Correct Answer urinary meatus on the upper surface of the penis phimosis Correct Answer narrowing of foreskin so that it cannot be retracted over the glans penis- troubling with voiding hydrocele Correct Answer sac of clear fluid in the scrotum - happens in breech boys cryptorchidism Correct Answer undescended testicles female genital variation: pseudomenstruation Correct Answer vaginal bleeding from the newborn that can be due to withdrawal of the maternal hormones skin variations Correct Answer - vernix - milia - telangiectatic nevi (stork bites) - mongolian spots - nevus flammeus (port wine stain) - nevus vasculosus (strawberry mark) vernix caseosa: preterm vs term Correct Answer lubes and protects skin preterm: lots! term: only in the creases milia Correct Answer exposed sebatious glands on the skin telangiectatic nevi (stork bites) Correct Answer pink-red spots on the back of the neck - they go away in about 2 years monogolian spots Correct Answer Bluish gray or dark non - elevated pigmented on the butt - don't necessarily go away the skin will just get darker or change overtime why is it important to document mongolian spots? Correct Answer they look like bruises/abuse nevus flammeus (port wine stain) Correct Answer Reddish usually flat discoloration commonly on the face or neck - does not grow and does not fade. strawberry mark Correct Answer raised bright red area with well- defined borders - let it go and may fade or shrink - can do surgery if wanted extremity assessment on a newborn Correct Answer - fractured clavicle moro relex Correct Answer arms extend (at loud noise or you physically extending them and letting go) and come back together and make a C shape When does the Moro reflex disappear? Correct Answer 6mo rooting reflex Correct Answer stroke the side and they will turn towards if they are ready to eat when does rooting reflex disappear? Correct Answer 4 mo babinski reflex Correct Answer when the outside of the foot is stroked and their toes fanned out when and how does babinski change? Correct Answer it will change after a year and the toes will curl stepping reflex Correct Answer if you hold your baby up and put on if their feet down, they will put the other one down too When does the stepping reflex disappear? Correct Answer 3-4 mo When should all baby's have at least one void? Correct Answer 48 hours T or F: 93% of babies void by 24 hours after birth and 100% void 48 hours after birth Correct Answer true what is the initial bladder volume? Correct Answer 6-44mL When should you notify the physician if your baby hasn't voided? Correct Answer if they haven't within the first 48 hours after delivery how often should an infant be voiding? Correct Answer 5-25x/day most common: 6-8x/day What does meconium stool look like? Correct Answer thick, dark, sticky vibes What does a breast-fed baby stool look like? Correct Answer this. What does formula-fed stool look like? Correct Answer the second pic up top imperforate anus Correct Answer a congenital defect in which the rectal opening is missing or blocked. what are some factors that make neonates high risk? Correct Answer - low birth weight - low gestational age - decreased intrauterine growth - type and length of illness - environmental factors - maternal factors (health conditions) - maternal-neonatal separation at risk neonates Correct Answer - low socioeconomic status of mother - limited access to healthcare or no prenatal care - exposure to environmental dangers - pre-existing maternal conditions (GHTN, GDM) - medical conditions related to pregnancy (preecclampsia) - pregnancy complications (previa, abruption) preterm Correct Answer 20 - 36 6/7 late preterm Correct Answer 34-36 6/7 early term Correct Answer 37 - 38 6/7 full term Correct Answer 39 - 40 6/7 late term Correct Answer 41 0/7 - 41 6/7 post term Correct Answer 42 weeks < Low birth weight (LBW) Correct Answer <2500g (5.5lb) regardless of age Very low birth weight (VLBW) Correct Answer <1500 g (3.3lb) Extremely low birth weight (ELBW) Correct Answer <1,000g (2.2lb) small for gestational age (SGA) Correct Answer plot below 10th percentile appropriate for gestational age (AGA) Correct Answer plot between the 10th percentile and 90th percetile large for gestational age (LGA) Correct Answer >4000g - plot above 90th percentile intrauterine growth restriction (IUGR) Correct Answer rate of growth does not meet expected growth pattern symmetric vs asymmetric IUGR Correct Answer symmetric: weight, length, head, circumference behind (everything behind!) asymmetric: head normal but body smaller (<10th percentile) common causes of indicated preterm birth Correct Answer - diabetes (not well controlled and leading to DKA and acidotic states) - if you bath them a lot it can dry off skin periods of reactivity Correct Answer - first period of reactivity: first 30 minutes (very awakel need to feed, do kangaroo care) - sleep phase: typically after eating and last for a couple of hours (decreased RR and HR) - second period of reactivity: more awake (increased RR and HR: feed them) true or false: if a child if breastfeed, that's all they need for 6 months Correct Answer true what should you look for in a newborn in regards to nutrition? Correct Answer - assess for signs of readiness to feed (rooting/sucking) - assess infant physiologic status during feeding (awake/alart) - breast vs. formula feeding What do you need to do for a newborn who is breastfeeding? Correct Answer - place newborn on mother's chest - breastfeeding should begin in birthing room - supply and demand! (the mom will only produce the amount needed) when should you burp an infant? Correct Answer breastfeeding: burp when switching breast bottle fed: half way through the bottle - if a baby is spitting a lot or looks uncomfy daily care newborn assessments Correct Answer - vitals - weight - feedings - intake and output - caring of umbilical cord - observing skin color changes (pink, acrocyanosis, jaundice) jaundice Correct Answer yellow coloring of the skin or sclera due to increased levels of bilirubin from the breakdown of RBV (normal levels: 4-6 mg/dl before jaundice appears) pathological jaundice Correct Answer worried about this one! - occurs first 24 hours of life - possible use of phototherapy - possible blood transfusion physiological jaundice Correct Answer - occurs after 24 hours of life - increase feedings/breastfeeding 8-12 times in 24 hours (increase fluid to excrete bilirubin) - possible use of phototherapy How does phototherapy work? Correct Answer skin absorbs light and helps excrete billirubin nursing care of jaundice Correct Answer - keep infant warm: temp 97.7 or higher - monitor amount of stools - encourage early feedings - if phototherapy used: wear diaper, eye protection, monitor hydration, allow for bonding clinical manifestations of newborn withdrawal: neonatal abstinence syndrome (NAS) (CNS, GI, autonomic, cutaneous) Correct Answer Central Nervous System Signs - high pitched cry - hyperirritability - increase muscle tone - exaggerated reflexes - tremors - seizures GI Signs - excessive sucking - vomiting - poor weight gain - diarrhea Autonomic Signs - stuffy nose - yawning - tachypnea - swearing - hyperthermia Cutaneous Signs - excoriated buttocks, knees, elbows - facial scratches - pressure-point abrasions NAS complications Correct Answer - respiratory distress - jaundice - congenital anomalies - IUGR - behavioral abnormality - withdrawal what is the modified finnegan neonatal abstinence score sheet? Correct Answer - assessment tool - scores severity of withdrawal from OPIODS - monitors and documents infant's clinical response to withdrawal what are the key points in the scoring of the modified finnegan neonatal abstinence score sheet? Correct Answer - 21 most frequently observed symptoms - each symptom assigned a score - total score is determined by totaling the score assigned each symptom What are the different types of circumcisions/instruments? Correct Answer - gomco procedure - plastibell -mogen clamp What is it important to monitor for after a circumcision? Correct Answer make sure they void! - also look for signs of healing Are you allowed to do a circumcision when the urethral meatus is not in it's proper place? Correct Answer no Can you put petrolium jelly on a circumcised penis? Correct Answer YES; dont want it to dry and get stuck to the diaper what are the effects of prematurity on growth and development? Correct Answer - more mature the infant, the greater potential effect on the infants growth and development - preterm babies will not perform with the same ability as age level peers in areas of growth and development EXAMPLE: newborn born at 32 weeks on dec 1 is evaluated on jan 1 (would be considered 36 weeks gestation if still in utero) - the infants corrected age at 6 months after birth is now 4 months and responses would need to be evaluated by what a 4 month should be doing What critieria do preterm babies need to have to be discharged? Correct Answer 1. when tested for head lag, baby should raise head parallel to body when lifted from a prone position 2. ability to cry vigorously when hungry 3. appropriate amount and pattern of weight gain according to growth curves 4. neuro responses appropriate for corrected age (ex: should be able to focus on examiner's face and follow examiner with his/her eyes) signs of newborn illness Correct Answer - temp above 100.4 F or below 97.7 F- axillary (continual rise) - forceful and frequent vomiting - refusal of 2 feedings in a row - difficulty in awakening baby - cyanosis with or without feeding - absence of breathing longer than 20 seconds - inconsolable infant or continuous high-pitched cry - discharge or bleeding from umbilical cord, circumcision, or any opening - 2 consecutive green watery stools - no wet diapers for 18-24 hours - fewer than 6-8 wet diapers per day after 4 days of age - development of eye drainage