LPN exam 1 Birth: Assessment and Stabilization of Neonate, Exams of Nursing

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LPN exam 1 Birth: Assessment and Stabilization of Neonate vital signs - Correct answer temperature: 96-99 F (35.5- 37 C); baby loses heat directly after birth DRY BABY Pulse: 120-160bpm; *may be irregular and responsive to stimuli Respirations: 30-60 breaths /minute; irregular BP: * 80/40 - 80/50; not usually measured weight, length, head and chest circumference - Correct answer 2500- 4300 grams (7-7 1/2 lbs.); girls usually smaller than boys; *5-10% of weight lost in first 2-3 days is normal (r/t estrogen and progesterone levels) usually regains in 5-7 days; 45-55 cm in length (18-22 inches); head circumference 33-35.5 cm (13-14 inches *head larger than chest; chest circumference 30 -33 cm ( 12-13 ") chest becomes equal or larger by 12 months head: fontanels - Correct answer head 1/4 the size of the body anterior fontanel: diamond shaped and closes approx.12-18 months posterior fontanel: triangle shaped and closes at 2-4 months molding - Correct answer asymmetry of the head due to pressure in the birth canal- disappears in approximately 72 hours *caput succedaneum - Correct answer edema of the soft tissue (crosses the suture line; subsides within a few days) *cephalohematoma - Correct answer swelling caused by bleeding into area between bone and periosteum (doesn't cross the suture line); absorbs in approximately 6 weeks head lag - Correct answer normal when pulling newborn into sitting position; newborn should be able to lift head just enough to turn to the side when laying on stomach acrocyanosis - Correct answer bluish color of the extremities; normal circumoral cyanosis - Correct answer not normal; bluish color around the mouth milia - Correct answer small, white blocked sebaceous glands around the nose, forehead, chin storke bites - Correct answer capillary hemanginomas; reddened area usually on the back of the neck vernix caseosa - Correct answer protective, cheesy substance found in creases of full term baby; disappears soon Mongolian spots - Correct answer bluish bruise like spots on the buttocks, back, and shoulders; typically found in Hispanic, Black, Slavic, Oriental; disappears in 2-4 years *erythemia toxicum neonatrum - Correct answer newborn rash; pimples; flea bites Vasculosus (strawberry mark) - Correct answer raised, red, rough surface; fades or disappears about school age flammeus (port wine stain) - Correct answer doesn't fade; reddish purple; usually on the face jaundice (icterus neonatorum) - Correct answer more serious if jaundice in first 24 hours after birth; excessive destruction of RBC's; *immature liver cant handle the excessive destruction of RBC's umbilical cord - Correct answer always check for *2 arteries 1 vein; clamped for 12-24 hours; clamp can come off in 12 hours if dry; wipe with alcohol every diaper change; sponge bath until cord falls off, approximately 10 days digestive system - Correct answer immature at birth; can metabolize nutrients except fats; *assess for patency, test feeding, with sterile water for first feeding meconium - Correct answer first bowel movement; black, tarry; should have first BM within 24 hours of birth stabilizing temperature - Correct answer temperature drops 3 degrees first hour after birth; stabilizes in 2-3 days convection - Correct answer loss of heat from newborn to surrounding air; air conditioners or drafts conduction - Correct answer transfer of body heat to a cooler object in contact with the baby radiation - Correct answer transfer of body heat to cooler object not in contact with baby evaporation - Correct answer loss of heat through vapor; dry baby to prevent heat loss this way vitamin K is administered because - Correct answer baby's gut is sterile and they are not making their own yet; helps with clotting; IM lateral thigh; start making their own after fed *blood glucose - Correct answer babies born to diabetic moms need a dextrose stick directly after birth; took away their sugar; should be 70-110 but cant be less than 40; baby may need 10% dextrose; don't usually need insulin but if they do it will be regular insulin *bilirubin - Correct answer jaundice is serious if in the first 24 hours; excessive breakdown of RBC's; either because of ABO or RH- incompatibility feedings: breast vs. bottle - Correct answer Breast: more stools, easier to digest, *more iron, antibodies, no allergies Bottle: stools fewer and firmer, babies iron is depleted by 3-4 months of age (needs supplemented), allergies more common, more difficult to digest key to successful breast feeding - Correct answer *completely empty breast; adequate rest; good diet; fluids; must be mom's decision colostrum - Correct answer precursor to milk; full of antibodies and nutrients bottle feeding/bubbling baby - Correct answer q 30 minutes after 1/2 oz. for first few days; position upright with head supported; make sure nipple is full to prevent sucking air; feed q 3-4 hours; never prop or microwave the bottle signs of dehydration - Correct answer sunken fontanels, squishy eyeball test, more than 12 hours without wet diaper preterm - Correct answer 38 weeks or less; weighing less than 5 1/2 lbs.; *occurs in 9-10% of births; *leading cause of death in infants in US; occurs in young moms/ poor prenatal care/ multiple births/ maternal diseases ect.. preemies: CNS - Correct answer weak, fragile, unstable, limp, weak reflexes/diminished preemies: circulatory system - Correct answer fragile capillaries, hemorrhage concern preemies: respiratory system - Correct answer *cyanosis r/t inadequate O2 to cells preemies: digestive system - Correct answer not mature until 4-6 months preemies: skin - Correct answer thin, lanugo, extra vernix preemies: renal system - Correct answer dehydrate easily, very immature preemies: immune system - Correct answer don't have IgG (risk for infection increased) preemies: head - Correct answer disproportionately large for body safe and effective care for preemies - Correct answer ABC's; ABG's on cord; help conserve energy (keep warm, may have to feed lavage); watch respirations-not over 80; *check blood glucose; prevent infection (no tape, turn baby); *use more concentrated formula 27 cal/oz. instead of the 20 cal/oz.; will lavage if 34weeks or less; teach mom effective behaviors post-mature baby - Correct answer baby born over 42 weeks gestation; desquamation (peeling); *check blood glucose; more respiratory distress; increased risk for birthing injuries (clavical most common); *light weight; *meconium stained amniotic fluid RDS most common in - Correct answer preemies; C-sections and babies born to diabetic moms; leading cause of death in infants in US; not enough surfactant to open up the alveoli in the lungs; hypoxia; cold stress signs of RDS - Correct answer *tachypnea (early sign); *nasal flaring;*retractions; *diminished breath sounds/wet; *cyanosis (late sign); *chest x-ray to determine which lobes are afffected care for RDS - Correct answer *may need trachea tube; *IV hydration; *antibiotics retrolental fibroplasias (retinopathy of prematurity) - Correct answer only in preemies and only because of prolonged oxygen exposure; can cause blindness if left exposed too long; decrease as soon as possible subconjunctival hemorrhage - Correct answer red spots in the sclera or around the cornea; rupture of capillaries in the eye; absorbs in about 5-7 days on it's own ecchymosis/ petechiae/ edema - Correct answer blood within tissues; usually resolves in 3-4 days; ecchymosis (bruising)/ petechiae (pinpoint spots)/ edema (swelling) treatment for clavicle injury - Correct answer swaddle tightly in alignment, resolves on it's own (most common injury to baby during birth Erb-Duchene (brachial paralysis) - Correct answer r/t crushed or severed nerves of the brachial plexus; caused from pressure in the birth canal; treatment includes splinting or physical therapy, can improve on it's own facial paralysis - Correct answer r/t forcepts used during birth; asymmetrical paralysis noted especially when crying; resolves on it's own CNS injuries cause/sx/treatment - Correct answer caused from large baby, dystocia (difficult labor), hypoxia, hypovolemia or prematurity; SX a tender uterus can be a sign of - Correct answer infection; * if membranes were ruptured 24 hours or more before birth there is an increased risk of infection Lochia - Correct answer rubra: dark red serosa: pink/brownish alba: white/cream colored *foul odor indicates infection menstruation for non-lactating women returns - Correct answer 7-9 weeks menstruation for lactating women returns - Correct answer 3-4 months; sometimes not till done lactating; breast feeding is not a form of birth control vagina, after birth - Correct answer returns to normal but never goes back to the same size as before as pre-pregnancy; refitted for diaphragm perineal care and exercise after birth - Correct answer ice packs for first 24 hours then sitz baths and heat will help; no sit ups 3-6 weeks after birth; kegels; early ambulation lactation - Correct answer SAP- Stimulates, Anterior pituitary, Prolactin; LOP- Lactation, Oxytocin, Posterior pituitary key to breastfeeding - Correct answer completely empty breast urinary tract - Correct answer a full bladder will push the fundus to the right, have mom void then massage fundus again; marked diuresis 8-12 hours after birth GI system discomfort/ (hemorrhoids, constipation)/ treatment - Correct answer may still be a problem after birth r/t effects of progesterone, relaxin, decreased fluids and decreased activity; treatment includes early ambulation and lots of fluid blood loss during C-section and vaginal delivery - Correct answer 500 cc loss in vaginal delivery= hemorrhage 1000 cc loss in C-section= hemorrhage care following delivery (mom) - Correct answer check BP,P and flow q 15 minutes for first hour then q 1 hr x 8 then q 8 hours till discharge. if anesthesia was given check gag reflex; offer food and fluids; encourage voiding within 8 hours of delivery; encourage bonding within first hour of birth check legs - Correct answer homans sign; assess for tenderness, pain, redness, and swelling. afterpains - Correct answer r/t to contraction of the uterus back into the pelvic cavity urination/ bowels - Correct answer may be unable to because of edema; early ambulation assess for signs of infection - Correct answer if temp is up 1st day = normal. If temp is up 2nd or 3rd day could indicate infection. If temp is elevated for two consecutive days patient most likely has an infection postpartum blues - Correct answer 75- 80% of women experience this; usually only lasts a couple of days postpartum depression - Correct answer *can last up to 6 months; * mom not interacting with baby, excessive crying, needs sensitive questioning and counseling vaccines for mom after delivery - Correct answer reubella; don't get pregnant for at least 3 months (live vaccine) breast feeding moms/ non breast feeding moms diet - Correct answer discourage dieting, * breastfeeding moms need 500 more calories/day (calcium, protein, fluids); non-breastfeeding moms need a balanced diet (simple carbs, low fat) baby's needs - Correct answer feedings q 2-3 hours (8-10x/day); 1-3 stools a day, more if breastfed immunizations for baby after birth - Correct answer Hepitis B and vitamin K(no clotting factor, sterile gut) PKU testing - Correct answer tests for inborn errors of metabolism and involves amino acids and proteins; checks for thyroid problems, sickle cell, ect... postpartum hemorrhage (early) - Correct answer muscle lacks tone; can be caused from multiple pregnancies, multiple birth, large baby, postpartum hemorrhage (late) - Correct answer muscle lacks tone; sub- involution; piece of placenta still in uterus (lochia turns from alba back to rubra) treatment for infection - Correct answer raise head of bed, antipyretics, methergan (to keep uterus contracted), antibiotics symptoms/ treatment for UTI - Correct answer low back pain, chills, fever; asogantricin and pyridium mastitis - Correct answer *cracked sore nipples and elevated temperature, caused by break in the skin; strep or staph from baby's mouth, clogged duct; usually Painful, hard breast, enlarged lymph nodes and is mostly unilateral; medication needed *contact HCP; Treatments- ice and pain relief sub- involution - Correct answer caused by a piece of placenta still in the uterus; boggy, foul odor, dragging sensation, continual lochia rubra; treatment is D&C; reassure the patient they will be ok. treatment for thrombophlebitis - Correct answer *bed rest, elevate legs, moist heat hematoma symptoms and treatment - Correct answer bruising and unrelieved pain; ice to area for first 24 hours then sitz baths