question

Immediately after birth, newborn care starts and focuses on what?

answer

Stabilizing the newborn's condition (page 643)

question

Immediately after birth, who has primary responsibility for the baby?

answer

The nurse. (643)

question

Because of the transmission of viruses such as Hepatitis B and HIV via maternal blood and amniotic fluid, how should the nurse handle the baby?

answer

Until proved otherwise, the newborn should be considered a potential contamination source and should be handled with gloves until proved otherwise. (643)

question

As part of standard precautions, nurses should do what when handling a newborn?

answer

Wear gloves until blood and amniotic fluid are removed by bathing. (643)

question

When and how is the first assessment of the newborn done?

answer

Immediately after birth using an Apgar score (Table 25-1) and a brief physical exam (Box 25-1). A more comprehensive physical exam is done within 24 hours of birth. (643)

question

What permits rapid assessment of the new born's transition to extrauterine existence based on 5 signs signs that indicate his or her physiologic state?

answer

Apgar Score

question

What are the 5 signs used for Apgar assessment?

answer

1. heart rate. 2. respiratory rate 3. muscle tone. 4. reflex 5. general skin color

question

How is the heart rate assessed for the Apgar score?

answer

Based on auscultation with a stethoscope or palpation of the umbilical cord.

question

How is the respiratory rate assessed for the Apgar score?

answer

Based on observed movement of the respiratory efforts.

question

How is the muscle tone assessed for the Apgar score?

answer

Based on the degree of flexion and movement of extremities

question

How is the reflex irritability assessed for the Apgar score?

answer

Based on response to bulb or catheter inserted in nasopharynx.

question

How is the generalized skin color assessed for the Apgar score?

answer

Generalized skin color is described as pallid, cyanotic, or pink.(643)

question

When are Apgar evaluations performed?

answer

At 1 and 5 minutes after birth by the nurse or birth attendant. (644)

question

What do Apgar scores predict?

answer

Apgar scores are useful for describing the newborn's transition to the extrauterine environment, but do not predict future neurologic outcome. (644)

question

What is important to teach parents about the results of Apgar scores?

answer

Because infants often do not receive the maximum score of 10, parents need to know that scores of 7 to 10 are within normal limits.

question

What are the 4 immediate duties of the nurse responsible for the care of the newborn immediately after birth?

answer

1. verify that respirations have been established. 2. dry infant thoroughly. 3. assess temperature. 4. place identical id bracelets on mom and baby (646)

question

Immediately after birth, babies can be placed on the mother's abdomen. What are 2 benefits?

answer

1. Maintain optimum temperature & 2. to promote bonding through skin-to-skin contact (646)

question

How soon after birth will the newborn be placed at the mother's breast to start the breastfeeding process?

answer

Within the first 30 minutes to 1 hour after birth.

question

Do all assessments need to be immediate?

answer

Initial exam can be done while drying and wrapping the infant. If no threatening anomalies or risk factors are noted, further assessment can be delayed until after interaction with parents. (646)

question

Do normal term infants born vaginally have difficulty clearing the airway?

answer

No, most secretions are brought by the cough reflex to the oropharynx and either drained or swallowed.

question

What can the nurse do to promote a clear airway for the newborn?

answer

Initially the infant may be placed in the side-lying position, with the head stabilized but not in Trendelenburg position, until secretions are cleared and then placed supine. (646)

question

What should the nurse do if the infant has excess mucus in the respiratory tract?

answer

The mouth & nasal passage may be gently sucgtioned with a bulb syringe. Routine chest percussion & suctioning of healthy term and near-term infants are avoided.

question

What should the nurse do for an infant who is choking on secretions?

answer

The infant should be supported with his or her head to the side. The mouth is suctioned first to prevent inhaling pharyngeal secretions as the nares are touched. (646-47)

question

How should the infant's mouth be suctioned?

answer

Bulb should be compressed then inserted into one side of the infant's mouth. The center of the infant's mouth is avoided because it could stimulate the gag reflex. Bulb needs to be kept in crib. Parent's should be taught how to use the syringe and give a return demonstration (647)

question

As part of airway maintenance, the nurse should auscultate the infant's respirations to determine the presence of what?

answer

Crackles, rhonchi, or inspiratory stridor. Fine crackles may be auscultated for several hours after birth. (647)

question

What can be used if a bulb syringe does not clear mucus interfering with respiratory effort?

answer

Mechanical suction. If the obstruction is not cleared with suctioning, further investigation is needed (647)

question

What are 4 signs of newborn breathing distress?

answer

1, Bradypnea- respirations less than 30 breaths per minute. 2. Tachypnea-respirations of 60 breaths per minute or more. 3. Abnormal breath sounds - crackles, other than fine crackles may be heard in first few hours, wheezing, rhonchi, expiratory grunting, stridor, diminished or absent air movement. 4. Respiratory distress - nasal flaring, retractions, labored breathing, apnea lasting 20 seconds or long (box 25-2 p 648)

question

If wall suctioning is performed, what should the pressure be adjusted to?

answer

Less than 80 mm Hg. (648)

question

What are 4 conditions essential for maintaining an adequate oxygen supply?

answer

1. a clear airway. 2. effective establishment of respirations. 3. adequate circulation, adequate perfusion, and effective cardiac function. 4. adequate thermoregulation (648)

question

What does the exposure to cold stress do to a newborn?

answer

Increases oxygen and glucose needs. (648)

question

How may the infant react to cold exposure to cold?

answer

By increasing the respiratory rate and may become cyanotic. (648)

question

4 Ways to stabilize the newborn's body temperature include what?

answer

1. placing infant directly on mother's abdomen & covering with a warm blanket. 2. drying & wrapping newborn in warmed blankets. 3. keeping the head well covered. 4. keeping ambient temperature at 22-26 degrees Celsius. Allowing the vernix caseosa to remain on the infant's skin has not been associated with a decrease in axillary temperature within the first hour after birth. (648)

question

If newborn does not remain with mother during the first 1-2 hours after birth, how does the nurse assist with regulating body temperature?

answer

place the thoroughly dried newborn under a radiant warmer or in an incubator until the body temp stabilizes (648)

question

When using a warmer with a servocontrolled mechanism's control panel should be set at what temp?

answer

between 36 and 37 degrees Celsius, to maintain the healthy term infant's skin temperature around 36.5 to 37 degrees Celsius. It will adjust the warmer temp to maintain the infant's temp at a preset range. (648)

question

Where is a thermistor probe, automatic sensor, usually placed on a newborn and why?

answer

On the upper quadrant of the abdomen immediately below the right or left costal margin, never over a bone. This will ensure detection of minor temperature changes. The sensor should be checked periodically to ensure that it is securely attached to the infant's skin. (648)

question

How often is the newborn's axillary temperature checked?

answer

Every hour or more often as needed, until his or her temperature stabilizes. (648)

question

How long does it take to stabilize an maintain body temperature?

answer

The time required to stabilize a newborn's temperature varies. Care should be individualized (648)

question

When should the newborn be given it's first bath?

answer

After his or her temperature has stabilized.(648)

question

Because heat loss must be avoided or minimized, where should examinations and activities for the newborn take place?

answer

Under a heat panel. (648)

question

What can cause newborn hypothermia?

answer

1. Birth in a car on the way to the hospital. 2. A cold birthing room. 3. inadequate drying and wrapping immediately after birth. (648)

question

What are effects of rapid warming?

answer

Apnea and acidosis. Warming is monitored to progress slowly over a period of 2-4 hours. (648)

question

What are Interventions that may be delayed for an hour or two in order to provide uninterrupted maternal-infant bonding to occur?

answer

1. Eye prophylaxis. 2. Vitamin K Prophylaxis

question

Why is eye prophylaxis mandatory in the United States?

answer

to precaution against opthalmia neonatorum, which is an inflammation of the eyes from gonorrheal or chlamydial infection. Erythromycin, tetracycline and are often used, but for chlamydial infection only erythromycin for 14 days by mouth can treat. (648-49)

question

Where should Vitamin K be administered?

answer

Intramuscularly, in a single injection of 0.5 to 1.0 milligrams to prevent hemorrhage. Vitamin K may be delayed until after first breast feeding in delivery room. (649)

question

When are newborns able to produce their own Vitamin K?

answer

By day 8. (649)

question

Is Vitamin K ever given I V?

answer

Always given IM except in some cases of a preterm infant with no muscle mass. In this case, medication must be diluted and given over 10-15 minutes. Monitor infant closely with cardiorespiratory monitor. Rapid bolus may cause cardiac arrest.

question

Today's childbirth practices strive to promote what as the focus of care?

answer

Family (649)

question

Why is early contact between mother and baby important?

answer

It can be important in developing future relationships. It also has a positive effect on the duration of breastfeeding. Oxytocin and prolactin levels (physiologic benefits) rise in the mother, and suckling activity is activated in the infant. (649)

question

When does the development of the neonate's active immunity begin?

answer

As the infant ingests flora from the mother's colostrum (649)

question

What allows the infant to remain with the parents after the birth?

answer

Single room maternity care, SRMC, or mother-baby, couplet, care.(649)

question

Nurses who work in an SRMC unit, or labor, deliver, recovery or postpartum unit, must be educated in what?

answer

Intrapartum, neonatal, and postpartum nursing care. (650)

question

What can be done to decrease pain after administration of a Vitamin K injection to a new born?

answer

After removing the needle, rub gently on the injection site with a dry gauze. (650 Med guide)

question

Why is assessment of gestational age is important?

answer

Because perinatal morbidity and mortality rates are related to gestational age and birth weight. (650)

question

What is used to assess six external physical and six neuromuscular signs?

answer

The Ballard scale. Each sign has a number score, and cumulative score total correlates with a maturity rating from 20 to 44 weeks gestation.

question

When can the new simplified Ballard scale be used?

answer

With newborns as young as 20 weeks gestation. (650)

question

When should the gestational age assessment of newborns with a gestational age of 26 weeks or less?

answer

At a postnatal age of less than 12 hours. (650)

question

When should the gestational age assessment of newborns with a gestational age of more than 26 weeks?

answer

Up to 96 hours after birth, but recommended within the first 48 hours for accuracy (650)

question

What are 6 techniques used in assessing gestational age?

answer

1. Posture, 2. Square window. 3. Arm recoil. 4. Popliteal angle. 5. Scarf sign. 6. Heel to Ear (651 Box 25-3)

question

What is a more satisfactory method for predicting mortality risks and providing guidelines for management of the neonate?

answer

Classification of infants at birth by both birth weight and gestational age. Weight, length & head circumference are plotted on standard graphs that identify normal values. (651)

question

What is recommended to the reader of results of classification of infants at birth by both weight and gestational age?

answer

Because head circumference, weight, and length vary according to race and gender, it is recommended that the reader access and use the most current chart specific to the population being evaluated. (651)

question

What is a large for gestational age, LGA?

answer

Above the 90% (651)

question

What is small for gestational age, SGA?

answer

Below the 10% (651)

question

How does birth weight influence mortality?

answer

The lower the birth rate, the higher the mortality. (651)

question

Which neonates are considered late pre-term infants?

answer

Born 34 to 36 weeks 6 days of gestation, often the size and weight of term infants, and may be admitted to and treated as healthy newborn infants (651)

question

What are risk factors of late pre-term infants?

answer

1. development of respiratory distress. 2. temperature instability. 3. hypoglycemia. 4. apnea. 5. feeding difficulties. 6. jaundice. 7. hyperbilirubinemia (651)

question

What is the goal of umbilical cord care?

answer

Prevention and early detection of hemorrhage or infection. (651)

question

What are the AWHONN recommendations for cord care?

answer

Initial cleaning with sterile water and subsequent cleanings with water. (652)

question

What reduces colonization and infection in the cord?

answer

A one time application of triple dye. (652)

question

Why is alcohol not recommended for cord care?

answer

It s associated with prolonged cord drying and separation. (652)

question

The cord should be assessed for what and how often?

answer

the stump and base of the cord should be assessed for erythema, edema, and drainage with each diaper change. (652)

question

Is odor an indication of omphalitis, or infection of the umbilical stump?

answer

No. the stump deteriorates through the process of dry gangrene. (652)

question

What influences cord separation time, and when should it separate?

answer

1. type of cord care. 2. type of delivery. 3. other perinatal events. Average cord separation time is 10-14 days (652)

question

When is the cord clamp removed?

answer

Once the stump has started drying and is no longer bleeding, typically within 24 hours and prior to discharge from the hospital. (652)

question

What is any physical injury sustained by a newborn during labor an birth?

answer

Birth trauma (652)

question

What are maternal factors that predispose an infant to birth trauma?

answer

Uterine dysfunction that leads to prolonged or precipitous labor, preterm or postterm labor, and cephalopelvic disproportion. (652)

question

What are fetal factors that predispose an infant to birth trauma?

answer

Dystocia caused by fetal macrosomia, multifetal (652)

question

What intrapartum events that can cause birth trauma?

answer

Use of intrapartum monitoring of fetal heart rate and fetal scalp blood sampling. (652)

question

What birth techniques can cause birth trauma?

answer

forceps birth, vacuum extraction, external version and extraction, and cesarean birth. (652)

question

What to teach parents about retinal and subconjunctival hemorrhages?

answer

Caused by increased pressure during birth, usually clear within 5 days, and present no further problem (652)

question

Are petechiae or pinpoint hemorrhagic areas, acquired during birth which may extend over the trunk and face serious?

answer

If they disappear within 2 or 3 days they are benign. (652)

question

Ecchymoses and petechiea may be signs of what?

answer

More serious disorders like thrombocytopenic purpura. To differentiate between these and a skin rash, apply pressure to skin with two fingers. Ecchymoses and petechiea don't blanch. (652)

question

What are common trauma marks from forceps?

answer

Linear marks across both sides of he face in the shape of the blades of the forceps. Keep affected areas clean to reduce risk of infection. Padded forceps have reduced this occurrence. (652)

question

What may be the cause of bruises over the face?

answer

Face presentation (652)

question

What may cause bruising and selling over the buttocks or genitalia?

answer

Breech presentation (652)

question

What may cause the skin over the entire head to be ecchymotic and covered with petechiae?

answer

A tight nuchal cord (653)

question

What trauma may result from cesarean birth?

answer

Accidental laceration, usually superficial, most often on the scalp, buttocks, and thighs. (653)

question

What causes jaundice?

answer

Unbound bilirubin leaves the vascular system and permeates other extravascular tissues, like the skin, sclera, and oral mucous membranes. (653)

question

Why does neonatal jaundice occur?

answer

because the newborn has a higher rate of bilirubin production than does an adult and the absorption of the bilirubin from the neonate small intestine is considerable. (653)

question

What are levels of bilirubin in full term infants?

answer

African American & Causcasian infants gradually increase to 5-6 mg/dl by 60 to 72 hours of life, then decrease to a plateau of 2-3 mg by the 5th day. Asian and Asian-Americans peak 10-14 mg around day 3-5, and fall to 2-3 mg by day 7-10. After 12-14 more days, levels will decrease for all to the normal level of 1 mg (653)

question

What are levels of bilirubin in preterm formula-fed infants?

answer

10-12 mg/dl at 5-6 days of life and decrease slowly over 2-4 weeks. (653)

question

In term infants physiologic jaundice appears after ______ and disappears by the end of the ____ day.

answer

24 hours and 7th day (654)

question

In preterm infants, physiologic jaundice is evident after ___ hours and disappears by the ___ or __ day.

answer

48 hours and 9th or 10th day. (654)

question

Pre-discharge, an neonate with physiologic jaundice, must have a total serum bilirubin must fall where?

answer

below the 95th percentile on the hour-specific nomogram (654)

question

In physiologic jaundice, serum concentration of unconjugated bilirubin does not exceed what?

answer

Term = 12 mg / dl. Preterm = 15 mg/dl (654)

question

In physiologic jaundice, direct bilirubin does not exceed what?

answer

1-1.5 mg/dl (654)

question

In physiologic jaundice does not increase by more than what?

answer

5 mg per dl per day (654)

question

What does the appearance of jaundice during the first 24 hours of life or persistence beyond the ages covered by physiologic jaundice usually indicate?

answer

A potential pathologic process that requires further investigation. (654)

question

What is a primary mechanism in physiologic jaundice?

answer

Enterohepatic circulation or shunting. (654)

question

How do you assess and differentiate jaundice from normal skin color?

answer

Apply pressure over a bony area, like nose, forehead, or sternum, for several seconds to empty all capillaries in that spot. If jaundice, the blanched area will look yellow before capillaries refill. Best to use natural light (654)

question

How can you assess jaundice in darker skinned infants?

answer

The conjunctiva and buccal mucosa. (654)

question

what is the most common therapy used to treat high or rapidly rising serum bilirubin?

answer

Phototherapy (654)

question

What determines the degree of jaundice?

answer

Serum bilirubin levels. Normal values of unconjugated bilirubin are 0.2 to 1.4 mg/dl. (655)

question

It is important to note that eval of jaundice is not based solely on bilirubin levels, but also on what?

answer

The timing of the appearance of clinical jaundice, gestational age at birth, age in hours since birth, family history including maternal Rh factor, evidence of hemolysis, feeding method, physiologic status and the progression of serum bilirubin levels (655)

question

What is the yellow staining of the brain cells that may result in bilirubin encephalopathy?

answer

Kernicterus. Damage occurs when bilirubin reaches toxic levels. The exact level needed to cause damage is unknown. (655)

question

Signs of bilirubin encephalopathy are?

answer

CNS depression or excitation. (655)

question

Survivors of bilirubin encephalopathy may eventually show what?

answer

Evidence of neurologic damage, such as cognitive impairment, cerebral palsy, ADD or ADHD, delayed or abnormal motor movement, behavior disorders, perceptual problems, or hearing loss. (655)

question

What is transcutaneous bilirubinometry, TcB?

answer

Noninvasive monitoring of bilirubin via cutaneous reflectance measurements, within 2-3 mg accuracy. They are used to screen clinically significant jaundice and decrease need for serum measurements. (655)

question

When is TcB not useful as a screening tool?

answer

After phototherapy has been initiated. (655)

question

What is the official recommendation for monitoring healthy neonates at 35 weeks gestation or greater before discharge from the hospital?

answer

Hour-specific serum bilirubin levels to predict term newborns at risk for rapidly rising levels. (655)

question

What are risk factors for hyperbilirubinemia?

answer

Gestation age less than 38 weeks, breastfeeding, a sibling who had significant jaundice, and jaundice appearing before discharge (656)

question

When does breatfeeding-associated jaundice appear?

answer

2 to 4 days of age, probably related to caloric and fluid intake before milk supply is well established (656)

question

The presence of decreased caloric intake, less milk, weight loss of more than 5 to 7% in the first 5 days of life, increasing serum bilirubin levels, decreased stooling, and increased jaundice is sometimes referred to as what?

answer

Starvation jaundice or nonbreastfeeding jaundice. To prevent this, initiate breastfeeding within the first few hours of life, and encourage continuous rooming in with feedings 10-12 times per day, no supplements, and recognition and response to hunger cues.(656)

question

At birth, the maternal source of glucose is cut off with what?

answer

Clamping of the cord (656)

question

Infants who are asphyxiated or have other physiologic stress may experience what?

answer

Hypoglycemia as a result of decreased glycogen supply, inadequate gluconeogenesis, or overutilization of glycogen stored during fetal life. (656)

question

Insulin does not cross the placental barrier, this predisposing some infants to what?

answer

Low glucose levels as a result insulin activity. of increased

question

In healthy newborn full term infants, born after an uneventful pregnancy and delivery, what are the recommendations to monitor glucose?

answer

Only in the presence of risk factors or with clinical manifestations of hypoglycemia. (656)

question

New born plasma glucose levels below ___ require immediate intervention?

answer

45 (656)

question

What is recommended for Infants at risk for altered metabolism related to maternal illness factors, or newborn factors?

answer

Close observation and monitoring of glucose within 2 to 3 hours of birth. (657)

question

what is recommended if newborn glucose level is below 36

answer

breast or bottle feeding; if levels remain low start IV dextrose. treatment should be aimed to maintain glucose above 45 mg / dl. (657)

question

Should blood glucose be monitored in asymptomatic healthy term neonates?

answer

No (657)

question

Signs of hypoglycemia include:

answer

jitteriness, irregular respiratory effort, cyanosis, apnea, weak, high-pitched cry, feeding difficulty, lethargy, twitching, eye rolling, and seizures. These signs may be transient but recurrent. (657)

question

What is considered hypocalcemia in infants?

answer

Less than 7.8 to 8 in term and 7 in preterm. Early onset may be 24 to 48 hours after birth (657)

question

Signs of hypocalcemia are?

answer

Jitteriness, tremors, twitching, high-pitched cry, irritability, apnea, laryngospasm, although some infants are asymptomatic. (657)

question

What is the treatment for most cases of hypocalcemia?

answer

feeding fortified human milk or a preterm infant formula (657)

question

How do you treat hypocalcemia in extremely low birth weight, medically unstable infants?

answer

IV elemental calcium and phosphorus (657)

question

Because jitteriness is a symptom of both hypoglycemia and hypocalcemia, how do you treat?

answer

Hypocalcemia must be considered if therapy for hypoglycemia is ineffective. (657)

question

How can most lab tests for newborn screening be obtained?

answer

Heel puncture, including tests for bilirubin levels, blood glucose, PKU, hypothyroidism, sickle cell disease, and galactosemia. (657)

question

Things to remember when performing a heel stick:

answer

1. Loosely wrapping a cloth soaked in warm water around the foot 5 to 10 minutes helps to dilate blood vessels.2. wear gloves when collecting specimen. 3. Spring-loaded automatic puncture device causes less pain and requires fewer punctures than manual lance blades, so avoid manual lance blades. 4. It is important to fill all circles on metabolic screening form with blood. (659)

question

What is the most serious complication of infant heel stick?

answer

Osteochondritis from lancet penetration of the bone. To prevent, penetrate outer aspect of heel and should be no deeper than 2.4 mm. (659)

question

After specimen has been collected from heel stick, what should be done?

answer

Pressure is applied with a dry gauze square. Band Aid. No further skin cleanser should be applied because it will cause the site to continue to bleed. (659)

question

A heel stick is traumatic for an infant and causes pain. How do you reassure the infant and promote feelings of safety?

answer

The neonate should be cuddled and comforted when the procedure is complete. Admin of oral sucrose, 2 minutes prior if possible. Nonnutritive sucking. Mother's holding decreases stress, music decreases pain response. (659-60)

question

Can cord blood be used for newborn screening and genetic studies?

answer

No. Only venous or capillary blood samples can be used for newborn or genetic studies. (660)

question

Examination of urine should take place how close to collection time?

answer

within one hour of collection (660)

question

How should you attach urine collecting bags?

answer

Start at the bridge of skin separating the rectum from the vagina and work upward for girls. The penis, and scrotum depending on size of collection bag, should be tucked through the opening of the collector before removing adhesive. Replace diaper and check frequently.(661)

question

What can be used by nurses on inpatient cases and modified at discharge to ensure the infant receives appropriate care and screenings?

answer

Critical Path Case Management (661)

question

What provision is basic to the care of the newborn?

answer

A protective environment. (661)

question

What are some environmental factors that must be maintained when providing a protective environment?

answer

Adequate lighting, elimination of fire hazards, safety of electric appliances, adequate ventilation, controlled temperature, warm an free of drafts, and 40-60% humidity. (662)

question

What are measures to control infection when providing a protective environment?

answer

Adequate space to position bassinets at least 3 feet apart in all directions, hand washing, and areas for cleaning and storing equipment.(662)

question

What is the single most important measure in the prevention of neonatal infection?

answer

Hand washing between handling infants, and after contact with inanimate objects. Inanimate objects should be cleaed with appropriate bactericidal solution. (662)

question

Who should be excluded from contact with or take special precautions with newborns?

answer

Persons with upper respiratory tract infections, gastrointestinal tract infections, and infectious skin conditions. (662)

question

What are some safety factors to implement when providing a protective environment?

answer

matching ID bracelets, bands a with transmitters that set off alarms if threshold is crossed, footprints or ID pictures taken before removal from mother's side, conduction of periodic unit drills, photo ID required for all personnel caring for newborns, educating parents on measures to prevent abduction from hospital room and at home. (662)

question

What are the factors of providing a protective environment?

answer

Environmental factors, infection control, & safety (662)

question

Why are assessment of family & community resources an essential component of care?

answer

The family's ethnic & cultural background is important in determining the health status, genetic or familial risk factors, and social support available to the woman throughout pregnancy and in the postpartum period. (662)

question

Which cultural groups delay breastfeeding and why?

answer

Some Asians, Hispanics, Eastern Europeans, and Native Americans delay breastfeeding because they think colostrum is bad. (663)

question

What is basic to the development of a mutually satisfying parent-child relationship?

answer

Caregiver's sensitivity to the infant's social responses. Sensitivity increases over time. (662)

question

What presents the best time for infant and family interaction?

answer

the activities of daily care during the neonatal period. You can caress, cuddle, massage, and talk to and engage in arousal and smiling. (662)

question

When should stimulation of the newborn be avoided?

answer

immediately after feedings or just before a sleep period (662)

question

How often should newborns be fed?

answer

Newborns are placed on demand feeding schedules and are allowed to feed when they awaken and demonstrate typical hunger cues, regardless of time lapsed from previous feeding. Usually every 2 to 3 hours during the day and only when the infant awakens during the night. However, the newborn should not be allowed to sleep more than 4 to 5 hours during the night to ensure adequate fluid intake and weight gain. (663)

question

Why are breastfed babies nursed more often than bottle fed babies?

answer

Breast milk is digested faster than formulas made from cow's milk and the stomach empties sooner as a result. (663)

question

Why are water and dextrose supplements not recommended in the newborn period?

answer

They have the tendency to decrease breastfeeding. (663)

question

When should Hep B vaccine be given to an infant?

answer

If mother is Hep B positive or if the mother's Hep B status is unknown, both the Hep B vaccine and the hepattis B immune globulin, HBIG, should be given within 12 hours of birth in separate sites. If the mother is Hep B negative the first dose of the vaccine should be given at birth or at one month of age, with parental consent. (663)

question

What size needles should be used to give Hep B vaccines and Vitamin K injections and where should they be given?

answer

25 gauge, 5/8 or 7/8 inch. the preferred injection site for newborns vastus lateralis. The dorsogluteal & deltoid muscles are not recommended. Recommended doses should not exceed 0.5 ml per I M injection (663)

question

What is an important factor in preventing and minimizing local reaction to I M injections?

answer

Adequate deposition of the fluid deep within the muscle; therefore muscle size, needle length, and amount of medication injected should be carefully considered. (663)

question

How should you give an immunization shot to a newborn?

answer

Stabilize leg, wear gloves, cleans site, insert in vastus lateralis at 90 degree angle, aspirate, inject, withdraw quickly, & maintain pressure to minimize pain. If when aspirating, you have blood return, remove needle and injection is given at another site. (665)

question

What is the best therapy for hyperbilirubinemia & what is the goal of treatment?

answer

Prevention by providing early feeding, which simulates passage of meconium. The goal of treatment is to help reduce the newborn's serum levels of unconjugated bilirubin. (665)

question

What are two ways to reduce unconjugated bilirubin levels?

answer

Phototherapy & exchange of blood transfusion (665)

question

How is the most effective phototherapy achieved?

answer

With lights 400 to 550 nanometers, and a blue-green light spectrum is most efficient. (665)

question

How is the decision to discontinue phototherapy made?

answer

Based on definite downward trend in serum bilirubin values.

question

What precautions must be taken for the infant during phototherapy?

answer

1. eyes must be protected by an opaque mask, which should cover eyes but not occlude the nares. 2. Close eyes gently before applying mask to prevent abrasion of the corneas. 3. mask should be removed periodically and during infant feedings so that the eyes can be checked and cleansed with water & parents can have visual contact with infant (666)

question

What should you monitor the infant for while undergoing phototherapy treatment?

answer

Temperature change, insensible water loss which may cause a fluid and electrolyte imbalance, urine output, number and consistency of stools, skin integrity of butt. (666)

question

How should infant hydration be maintained?

answer

With human milk or infant formula; there is no advantage or benefit to administering oral glucose or plain water. (666)

question

What & how should parents be taught regarding bilirubin in the newborn?

answer

It will continue to rise for 5 days after birth, and written instructions should be provided for assessing an infant's condition. (667)

question

What are the opinions of the American Academy of Pediatrics regarding circumcision?

answer

despite scientific evidence of potential medical benefits of circumcision, the data are not sufficient to recommend routine circumcision, but if performed analgesia should be used (667)

question

What are some reasons parents decide to have their newborn circumcised?

answer

Hygiene, religious conviction, tradition, culture, or social norms. Regardless of the reason, parents should be given unbiased information and the opportunity to discuss the benefits and risks. (667)

question

When should information regarding circumcision be discussed with parents?

answer

During the prenatal period. Because of the stress of the intrapartum period, this isn not an ideal time to broach the topic of circumcision. (667)

question

What are the procedures regarding circumcision?

answer

Remove foreskin, or prepuce, of the glans, before discharge, and not immediately following birth because of clotting factors and cold stress, withhold feeding 2-3 prior, use Gomco clamp to make almost bloodless operation, apply small petroleum jelly gauze dressing or a generous amount of petroleum or A&D ointment. (668)

question

What are advantages of using PlastiBell for circumcision?

answer

Applies constant, direct pressure to prevent hemorrhage during procedure and protects against infection, keeps site from sticking to diaper, and prevents pain with urination. Plastic rim remains in place for about a week, and then falls off once heeling has taken place. Petroleum is not usually needed (668)

question

What are some forms of pain management for circumcision?

answer

Nonpharmacologic methods, as well as anesthesia and analgesia (668) Following procedure, infant may be fussly for hous and have disturbed sleep wake patterns, as well as disorganized feeding behaviors. Oral acetaminophen may be given PRN q4h for a max of 5 doses in 24 hours of 75 mg/kg/day (669)

question

What should a nurse do if bleeding is noted from the circumcision site?

answer

apply gentle pressure to the site with a folded sterile gauze or sprinkle powdered gel foam. If bleeding is not easily controlled, a blood vessel may need to be ligated, one nurse notifies physician and prepares equipment while another nurse maintains intermittent pressure (669)

question

What should you teach parents regarding care for an infant following circumcision?

answer

1. The glans, normally dark and red during healing, becomes covered with a yellow exudate in 24 hours, this is normal, not an infection and will persist for 2 to 3 days; 2. fanfold diaper to keep from pressing on circumcised area. 3. encourage to change diaper q4h to prevent sticking. 4. avoid wipes and use water on a soft cloth to clean. 5. apply petroleum jelly around glans after each diaper change (669)

question

What does the nurse use to set priorities for teaching regarding infant care activates?

answer

Parental cues. Deficient knowledge should be identified before beginning to teach. (669)

question

What teaching topics should be included in discharge planning with parents?

answer

Normal growth and development and the infant's changing needs (669)

question

Which position should the infant be placed in? What position should be avoided?

answer

Supine to prevent SIDS. Prone position has been associated with an increased risk of SIDS. Side lying position is not recommended for sleep because anatomically the newborn's shape make it easy to roll from the side to prone position (671)

question

What should parents be taught regarding car seat use?

answer

Use a rear-facing car seat from birth to 9 kg, 20 pounds, and to 1 year of age. If the infant reaches weight limit before the first birthday, the rear-facing position should still be used. Rear facing seats should not be placed in the front seat unless the air bag has been deactivated. (673)

question

What special intervention should be used for infants born at less than 37 weeks gestation and with a birth weight less than 2500 g?

answer

They should be observed and monitored for apnea, bradycardia, and a decrease in oxygen saturation in a car sea for a period of 90-120 minutes prior to discharge. If carseat test is failed, a car bed may be used to provide safe transportation. (673)

question

What is the infant's chief pleasure?

answer

Sucking (673)

question

Benefits of nonnutritive sucking are:

answer

1. increased weight gain in preterm infants, 2. increased ability to maintain an organized state, and 3. decreased crying. (673-74)

question

Should a child be restrained to prevent thumbsucking?

answer

Not unless it persists past 4 years of age, when permanent teeth erupt. (674)

question

What are purposes for bathing, cord care, and skin care?

answer

1. cleansing, 2. observing infant's condition, 3. promoting comfort, & 4. parent-child-family socializing. (674)

question

The newborn's skin pH falls from 6.4 to the bacteriostage range less than 5.0 within 4 days of birth. What should u teach parents?

answer

Avoid Alkaline soaps, like Ivory, oils, powders, and lotions because they alter the acid mantle thus providing a medium for bacterial growth. ***"use Dove soap", as per JC

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