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51 Cards in this Set
- Front
- Back
- 3rd side (hint)
newborn
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Infant within the first few hours after birth.
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40.6
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neonate
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Infant within the first month after birth.
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40.6
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Antepartum (Before Birth) Risk Factors
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-Multiple gestation
-Pregnant woman's age <16 or >35 years -Post-term (>42 week's) gestation -Toxemia, HTN, diabetic -Polyhydramnios (excessive amount of amniotic fluid) -Premature rupture of the membrane and fetal malformation -In adequate prenatal care -History of perinatal morbidity or mortality -Use of drugs or medications -Fetal anemia Oligohydramnios (decreased volume of amniotic fluid during a pregnancy) |
40.6
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Intrapartum (During Birth) Risk
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-Premature labor
-Rupture of membranes >24 hours before delivery -Abnormal Presentation -Prolapsed cord -Chorioamnionitis -Meconium-stained amniotic fluid -Use of narcotic within 4 hours of delivery -Prolonged labor or precipitous delivery -Bleeding -Placenta previa |
40.6
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In utero (ie, in the pregnant woman's womb) the fetus receives oxygen from the _________.
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placenta
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40.7
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Describe the fetus lungs
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Collapse and filled with fluid, and most of the fetal blood flow is diverted away from the lungs.
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40.7
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Fetal transition
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A rapid series of events which happen at birth enabling the baby to breathe. Lungs expand with air, the pulmonary pressure drops and blood begins to flow to the lungs, picking up oxygen.
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40.7
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Causes of Delayed Transition in Newborns
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-Main cause being hypoxia
-Meconium or blood aspiration -Acidosis -Hypothermia -Pneumonia -Hypotension |
40.7
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premature
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An infant delivered at less than 37 weeks.
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40.7
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term
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An infant born at 38 to 42 weeks of gestation.
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40.7
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post-term
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An infant born after 42 weeks of gestation.
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40.7
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Key questions for delivery or post delivery
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Mother's age, length of pregnancy (in weeks), the presence and frequency of contractions, the presence or absence of fetal movement, whether there have been any complications (diabetes, HTN, Fever), whether membranes have ruptured including time and makeup (clear, meconium stained, or bloody), and medications taken.
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40.8
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Minimum equipment needed for birth
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Warm dry blankets, bulb syringe, two small clamps or ties, and a pair of clean scissors.
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40.8
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Baby positioning during birth
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Keep baby below the placenta, at level with mother, with head slightly lower than body.
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40.8
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Normally newborns are ________ at birth.
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cyanosis
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40.9
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Neonates max suction time is
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10 seconds
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40.9
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APGAR
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Develop in 1953 by Dr. Virgina Apgar to help determine the need for and effectiveness of resuscitation.
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40.9
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When should APGAR be determined?
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Within 1 to 5 minutes after birth. A score of <7 should be reassessed every 5 mins till 20 mins after birth.
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40.9
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Positioning of baby immediately after birth
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Hold the baby with the head slightly lower than the body to facilitate drainage of secretions.
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40.9
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First A in APGAR
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Appearance-skin color
2 is completely pink 1 is Body pink, extremities blue 0 is central blue, pale |
40.10
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P in APGAR
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Pulse rate
2 is >100 1 <100 but not 0 0 is Absent |
40.10
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G in APGAR
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Grimace-irritability
2 is cries 1 is grimaces 0 is no response |
40.10
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Second A in APGAR
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Activity-muscle tone
2 is Active motion 1 is some flexion of extremities 0 is Limp |
40.10
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R in APGAR
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Respiratory-effort
2 is strong cry 1 is slow and irregular 0 is Absent |
40.10
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acrocyanosis
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Centrally pink, blue hands and feet.
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40.10
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Newborn Resuscitation
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First 30 seconds warm and assess, if apneic for 20 seconds or longer respiratory pause or has a pulse rate less than 100 bpm begin PPV-positive pressure ventilation via BVM.
After min is pulse is < than 60 bpm, begin CPR. |
40.10
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Blow-by oxygen flow
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Set of 5 lpm and do not blow directly into newborns eyes.
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40.10
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Reasoning for BVM if pulse is < 100 bpm
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Hypoxia is the main cause of bradycardia.
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40.10
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Signs that require BVM
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Periodic breathing, intercostal retractions (sucking in between the ribs), nasal flaring, grunting on expiration.
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40.12
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Normal tidal volume for an infant
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5 to 8 mL/kg.
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40.12
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Note about first few breaths with neonate
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With BVM it may require higher pressure and you may need to cover the spring-load pop valve with your fingers because the lungs are collapse.
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40.12
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What is correct timing for ventilations in newborns?
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40 to 60 breaths/min
Use breath two-three, breath two-three |
40.12
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Newborn intubation blade size
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No 1 for full term infants, No 0 for premature infants
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40.13
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ET size for new born
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2.5 to 4.0 mm
Full term 4.0 mm 34 to 38 weeks 3.5mm 28 to 34 weeks 3.0 mm before 28 weeks 2.5 |
40.13
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How to determine NG size in baby
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Bottom of the earlobe to tip of nose and halfway between xiphoid process and umbilicus.
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40.15
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Average baby weight
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Full term 6.5 to 9 lbs (3 to 4 kg)
At 28 weeks 2.5 lbs (1 kg) |
40.17
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Epi in newborn
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After 30 seconds of ventilations and 30 seconds of CPR if bradycardia does not improve move onto epi at 0.1 to 0.3 mg/kg of 1:10,000 IV equal to 0.01 to 0.03 mg/kg. No IV consider 0.3 up to 1mL/kg ET, repeat in 3 to 5 mins, with persistent bradycardia. Usually requires med con.
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40.17
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A fluid bolus in an infant consist of:
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10mL/kg of NS given over 5 to 10 mins
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40.18
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Signs of hypovolemia include
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Pallor, delay capillary refill, weak pulse despite a good pulse rate or high quality chest compressions.
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40.18
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Sodium Bicarbonate in newborns:
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After a duration of ventilations and chest compressions you may suspect acidosis. Medical control may suggest an initial dose of 2 mEg/kg of 4.2% solution (0.5 mg/mL) IV over 5 to 10 minutes. Rapid administration changes pH rapidly increasing the risk of bleeding into the brain.
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40.18
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Narcan in newborns
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Do not give to newborn of a drug-addicted mother as it has been proven to cause seizures that often lead to death, just bag pt. Only use if it is an acute narcotic exposure with med con at 0.1mg/kg
May be give IV or IM |
40.18
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Dangers of Meconium Aspiration
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If the newborn inhales the meconium-stained amniotic fluid either in utero or at delivery, their airway may become plugged and hypoxia may ensue. Significant increase in dangers of meconium aspiration after 42 weeks of gestation.
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40.19
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What to do when a baby is born through meconium-stained amniotic fluid?
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Assess the newborn, if crying and virgours, continue with standard interventions. If depressed intubate at once, do not dry or stimulate the baby. Attach the moconium aspirator to the ET tube and suction while withdrawing the tube from the trachea. Repeat as needed. After suctioning is complete start drying and stimulating. Be prepared for PPV. Without ET sucess, start resuscitation guidelines.
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40.19
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Diaphragmatic hernia
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An abnormal opening in the diaphragm, commonly left sided. Has an incidence of 1 in 2,500 live births. Increases chance of respiratory distress. Signs are heart sounds shifted to the right, decrease breath sounds on Lt, sunken abdomen as contents are in chest cavity. Pt will need an OG tube to minimize intestinal distention, may not have appropriate size tube in field.
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40.19
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Apnea in newborns
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At first during primary apnea warm and stimulate baby. If this does not stimulate breathing, move on to secondary apnea and provide PPV.
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40.19
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What is low birth weight? Common cause?
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< 5.5 lbs
Most common cause is premature (before 37 weeks) birth. |
40.20
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Premature infants are at high risk for resiratory distress because deficiency in ________. Define
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Surfactant
The substace formed in the lungs that helps keep the small air sac or alveoli from collapsing and sticking together. |
40.21
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Define seizure clinically
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A paroxysmal alteration in neurologic function, behavior and/or autonomic function.
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40.21
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Dextrose via IV in infants
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A 10% dextrose solution may be given at 2 mL/kg.
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40.24
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Complications from a delay in clamping the umblical card
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A delay in clamping the umbilical cord and keeping the infant below the placenta may allow blood to flow into the infant, which can in turn lead to polycythemia.
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40.8
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What is the most common seizure type in newborns?
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Clonic
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