During the first ___ hours after birth, newborns go through a ___ between intrauterine and extrauterine life.
6 to 8
transition period
The most critical adjustment a newborn makes at birth is ___.
establishing respirations
Signs of respiratory distress include ___, ___, and ___.
nasal flaring
intercostal or subcostal retractions
grunting with respirations
The newborn’s average systolic blood pressure is ___ millimeters of mercury (mm Hg); the average diastolic pressure is ___ mm Hg.
60 to 80
40 to 50
In the newborn, heat loss results from ___, ___, ___, and ___.
convection
radiation
evaporation
conduction
At birth, the lower intestine is filled with meconium, which is formed from ___, ___, and ___.
It is ___, i.e. it contains no ___.
amniotic fluid and its constituents
intestinal secretions including bilirubin
cells shed from the mucosa
sterile
microorganisms
At birth, a protective covering, called ___, is fused with the epidermis. However, in full-term infants, it is found primarily in the ___ and ___.
vernix caseosa
axilla
perineal area
An indication of the degree to which an infant is ___ is that a greater proportion of the integument will be covered with vernix caseosa.
pre-term
Baseline measurements taken during the first ___ hours of an infant's life include ___, ___, and ___.
24
weight
head circumference
body length
A healthy infant must accomplish ___ and ___ tasks to develop normally.
behavioral
biologic
___ is a protective mechanism that allows the infant to become accustomed to environmental stimuli.
Habituation
What would be a warning sign of ineffective adaptation to extrauterine life if noted when assessing a 24-hour-old breastfed newborn before discharge?
A. Apical heart rate of 90 beats/min, slightly irregular, when awake and active.
The heart rate of a newborn should range from 120 to 140 beats/min, especially when active. The rate should be regular with sharp, strong sounds.
Acrocyanosis is ___, and is a normal finding in a newborns that may persist for ___.
peripheral cyanosis - blue color hands and feet in most infants at birth
7 to 10 days
A harlequin sign is characterized as ___. It is a ___ finding related to the ___ of a newborn.
a cutaneous condition seen in newborn babies characterized by momentary red color changes of half the child, sharply demarcated at the body's midline
normal
immature neurologic system
A ___% weight loss is acceptable in the newborn.
5
When caring for a newborn, the nurse must be alert for signs of cold stress, including:
B. Increased respiratory rate.
An increased respiratory rate is a sign of cold stressin the newborn.
An increased respiratory rate is a sign of ___ in the newborn.
cold stress
Hypoglycemia OR Hyperglycemia would occur with cold stress.
Hypoglycemia
Newborns are unable to shiver as a means of increasing heat production; they ___.
increase their activity level instead
The nurse helps a breastfeeding mother change the diaper of her 16-hour-old newborn after the first bowel movement. The mother expresses concern because the large amount of thick, sticky stool is very dark green, almost black in color. She asks the nurse if something is wrong. The nurse should respond to this mother's concern by:
A. Explaining to the mother that the stool is called meconium and is expected of all newborns for the first few bowel movements.
At this early age, this type of stool (meconium) is typical of both bottle-fed and breastfed newborns.
When weighing a newborn, the nurse should:
C. Weigh the newborn at the same time each day for accuracy.
T/F: When weighing a newborn, the nurse should leave its diaper on for comfort.
F: The baby should be weighed without a diaper or clothes.
T/F: When weighing a newborn, the nurse should place a clean scale paper on the scale for infection control.
T: Clean scale paper is acceptable; it does not need to be sterile.
T/F: When weighing a newborn, the nurse should keep a hand above the newborn's abdomen for safety.
T: The nurse’s hand should be above, not on, the abdomen for safety.
Vitamin K is given to the newborn to:
B. Enhance ability of blood to clot.
Newborns have a deficiency of vitamin K until intestinal bacteria that produce vitamin K are formed. Vitamin K is required for the production of certain clotting factors.
The nurse notes that, when the newborn is placed on the scale, he immediately abducts and extends his arms and his fingers fan out with the thumb and forefinger forming a "C." This response is known as a:
D. Moro reflex.
___ refers to the "fencing posture" a newborn assumes when he is supine and turns his head to the side.
Tonic neck reflex
Tonic neck reflex refers to the ___.
"fencing posture" a newborn assumes when he is supine and turns his head to the side
The ___ refers to retraction of testes when chilled.
cremasteric reflex
The cremasteric reflex refers to ___.
retraction of testes when chilled
The ___ refers to the flaring of the toes when the sole is stroked.
Babinski reflex
The Babinski reflex refers to ___.
the flaring of the toes when the sole is stroked
A newborn male, estimated to be 39 weeks of gestation, would exhibit:
D. Testes descended into scrotum.
full-term male infant will have both testes in his scrotum and rugae on his scrotum.
T/F: A newborn male, estimated to be 39 weeks of gestation, would exhibit extended posture when at rest.
F: The newborn’s good muscle tone will result in a more flexed posture when at rest.
T/F: A newborn male, estimated to be 39 weeks of gestation, would exhibit a moderate amount of lanugo over his entire body.
F: The newborn will exhibit only a moderate amount of lanugo, usually on his shoulders and back.
During human development, the lanugo grows on fetuses as a normal part of gestation, but is usually shed and replaced by vellus hair at about 33 to 36 weeks of gestational age. As the lanugo is shed from the skin, it is normal for the developing fetus to consume the hair with the fluid, since it drinks from the amniotic fluid and urinates it back into its environment. Subsequently, the lanugo contributes to the newborn baby's meconium. The presence of lanugo in newborns is a sign of premature birth.
A hypothesis, according to the NHS, is that the lanugo of human fetuses has to do with temperature regulation.
A newborn would OR would nothave the ability to move his elbow past midline.
would not
While examining a newborn, the nurse notes uneven skinfolds on the buttocks and a click sound when performing the Ortolani maneuver. The nurse recognizes these findings as a sign that the newborn probably has:
A. Hip dysplasia.
The Ortolani maneuver is used to detect the presence of hip dysplasia.
The Ortolani test or Ortolani maneuver is part of the physical examination for developmental dysplasia of the hip, along with the Barlow maneuver. It relocates the dislocation of the hip joint that has just been elicited by the Barlow maneuver. It is performed by an examiner first flexing the hips and knees of a supine infant to 90 degrees, then with the examiner's index fingers placing anterior pressure on the greater trochanters, gently and smoothly abducting the infant's legs using the examiner's thumbs. A positive sign is a distinctive 'clunk' which can be heard and felt as the femoral head relocates anteriorly into the acetabulum. Specifically, this tests for posterior dislocation of the hip. This is part of the standard infant exam performed preferably in early infancy; it usually becomes negative after 2 months of age. It is performed with the Barlow maneuver and inspection of the hip joint and legs.
___ is the presence of extra digits.
Polydactyly
Polydactyly is ___.
the presence of extra digits
Clubfoot (talipes equinovarus) is a deformity in which the ___.
foot turns inward and is fixed in a plantar-flexion position
Webbing, or ___, is ___.
syndactyly
a fusing of the fingers or toes
A patient feels too warm and asks for a fan in her room for her comfort. The nurse enters the room to assess the mother and her infant and finds the infant unwrapped in his crib with the fan blowing over him on “high.” The nurse instructs the mother that the fan should not be directed toward the newborn and the newborn should be wrapped in a blanket. The mother asks why. The nurse’s best response is:
C. “Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him.”
___ is the loss of heat from the body surface to cooler surfaces, not air, in direct contact with the newborn.
Conduction
Evaporation is loss of heat that occurs when ___. In the newborn, heat loss by evaporation occurs as a result of vaporization of moisture from the skin.
a liquid is converted into a vapor
All of these statements describe the first phase of the transition period except:
A. It may involve the infant suddenly sleeping briefly.
The first phase is an active phase in which the baby is alert. Decreased activity and sleep mark the second phase.
T/F: The first phase of the transition period lasts at least 30 minutes.
F: The first phase is the shortest, lasting less than 30 minutes.
Expected behaviors of the first phase of the transition period are ___, ___, ___, and ___.
Spontaneous tremors
crying
head movements
spontaneous startle reactions
are expected exploratorybehaviors in the first phase..
In the first phase of the transition period, a period of ___, in addition to passing ___, the newborn also produces ___. This first phase is also called the ___.
less than 30 minutes
meconium (may be...)
saliva
first period of reactivity
The shivering mechanism of heat production is rarely functioning in the newborn. Nonshivering ___ is accomplished primarily by metabolism of brown fat, which is unique to the newborn, and by increased metabolic activity in the brain, heart, and liver.
thermogenesis
Hypothermia from excessive heat loss is a common and dangerous problem in neonates. The newborn infant's ability to produce heat (thermogenesis) often approaches that of the adult; however, the tendency toward rapid heat loss in a cold environment is increased in the newborn and poses a hazard.
Brown Fat
Source of heat unique to neonates that is capable of greater thermogenic activity than ordinary fat; deposits are found around the adrenals, kidneys, and neck; between the scapulae; and behind the sternum for several weeks after birth
caput succedaneum
Swelling of the tissue over the presenting part of the fetal head caused by pressure during labor.
cephalhematoma
Extravasation of blood from ruptured vessels between a skull bone and its external covering, the periosteum; swelling is limited by the margins of the cranial bone affected (usually parietals)
cold stress
Excessive loss of heat that results in increased respirations and nonshivering thermogenesis to maintain core body temperature
Erythema toxicum
Innocuous pink papular neonatal rash of unknown cause, with superimposed vesicles appearing within 24 to 48 hours after birth and resolving spontaneously within a few days.
habituation
Psychologic and physiologic phenomenon whereby the response to a constant or repetitive stimulus is decreased.
jaundice
Yellow color of skin due to increased level of bilirubin in body tissues.
meconium
Greenish black, viscous first stool formed during fetal life from the:
amniotic fluid and its constituents
intestinal secretions (including bilirubin)
cells (shed from the mucosa)
milia
Small, white sebaceous glands, appearing as tiny, white, pinpoint papules on the forehead, nose, cheeks, and chin of the neonate
mongolian spots
Bluish gray or dark nonelevated pigmented areas usually found over the lower back and buttocks that are present at birth in some infants, primarily nonwhite, usually fading by school age
surfactant
Phosphoproteinnecessary for normal respiratory function that prevents alveolar collapse (atelectasis)
thermoregulation
Control of temperature; a balance between heat loss and heat production
transition period
Period from birth to 4 to 6 hours later in which the infant passes througha period of reactivity, sleep, and a second period of reactivity
vernix caseosa
Protective gray-white fatty substance of cheesy consistency covering the fetal skin
The phases of instability that in the first ___ to ___ hours after birth are called the ___.
6 to 8
transition period
During the ___ or the first 30 minutes of life or less, the newbon's heart rate increases rapidly to ___ to ___ before falling to their baseline rate of ___ to ___.
first period of reactivity
160 to 180
100 to 160
During the ___ of the transition period, the RR will also be irregular and between ___ and ___, which is again higher than baseline rate of ___ to ___. All of the signs of repiratory distress: ___, ___ and ___ may be noted as well, but these should cease within the first ___ of birth.
first period of reactivity
60 and 80
30 to 60
nasal flairing
intercostal & subcostal retractions
grunting with respirations
hour
A period of ___ follows the first period of reactivity. During this ___ to ___ period, the newborn may either ___ or have ___.
unresponsiveness
60 to 100 minutes
sleep
a marked decrease in motor activity
The second period of reactivity occurs roughly between ___ and ___ and lasts from ___ to ___.
4 and 8 hours
10 minutes to severfal hours
Tachypnea may result from ___ or ___.
inadequate clearance of lung fluid
newborn respiratory distress syndrome
The second period of reactivity is characterized by ___ of ___, and ___, associated with increased ___, ___, and ___. ___ is also commonly seen.
brief periods
tachycardia and tachypnea
muscle tone
skin color
mucous production
Passing meconium
Most healthy newborms experience a second period of reactivity regardless of ___ or ___. Very preterm infants do not because of ___.
gestational age
type of birth
physiologic immaturity
Seesaw or paradoxical respirations (exagerated rise in abdomen, with respirations, as chest falls) instead of abdominal respirations are ___.
abnormal and should be reported
Apneic periods longer than ___ are an indication of a pathologic process such as ___, ___, ___, and ___. These should be thoroughly eval'ed.
20
rapid rise in temp
hypothermia
hypoglycemia
sepsis
At rest RR outside of ___ to ___ must be eval'ed. This can be caused by ___ and ___.
30 to 60
anesthetics and analgestics to mom during birth
Atelectasis
defined as the collapse or closure of the lung resulting in reduced or absent gas exchange. It is a condition where the alveoli are deflated.
If within the first week of life, the baby's urine stains their diaper pink or orange ("brick dust"), this is cause by ___ and is an indication of ___.
uric acid crystals
insufficient intake
If warmer is used for baby they should be wearing
hat and diaper only
Male babies must pee within ___ hours and cannot be ___ circumsized until they do.
24
Best time to start breast feeding
First period of reactivity
During the first ___ opf life ___ continue to remove largwe amounts of fluid. This is also a result of the ___ between ___, ___ and ___.
hour
pulmonary lymphatics
pressure gradient
alveoli
ISF (interstitial fluid
Author
TomWruble
ID
183758
Card Set
NUR114 CH16
Description
Physiologic and Behavioral Adaptations of the Newborn
