APGAR
Name what each letter in APGAR stands for
Appearance: Baby's color
Pulse: Heart Rate
Grimace: Reflex Irritability
Activity: Muscle tone
Respirations
Healthy term newborns can tolerate the stress of labor with contractions resulting in a decrease in fetal _______ and pH and increased ______ _______.
What is a decrease in fetal oxygen
Increased carbon dioxide
What to report to the provider:
A. Baby's respirations are 68 at 45 minutes old.
B. Baby's respirations are 24 at four hours old.
Answer: B. Normal respiratory rate is 30 to 60. Below 30 is bradypnea
A does not need to be reported. Mrs. Miller specifically said that we could tolerate up to 70 resps per minute within the first two hours of life.
Babies have a thinner epidermis and less subcutaneous ______ which can make them susceptible to fluctuations in body temperature
What is fat
Other reasons include large body surface in relation to body mass, less developed vasomotor control, and blood vessels that are located closer to the skin.
Baby's temperature is 99.8. Initial course of action is to:
A. Remove excess blankets.
B. Evaluate for sepsis
C. Put a hat on the baby's head
D. Continue to monitor, retake temperature in 30 minutes
Correct: A
Hyperthermia usually caused by environment (too many blankets or coverings)
With sepsis, will see subnormal temperatures that do not resolve with actions to warm baby.
At one minute, baby has a strong cry and is actively flexing limbs. Heart rate is 120 bpm and the only cyanosis noted is in baby's hands and feet. Baby pulls away when stimulated
Appearance: 1 for blue extremities
Pulse: 2 for over 100
Grimace: 2 for response when stimulated
Activity: 2 for active movement
Resps: 2 for strong cry
Total: 9
Changes in blood chemistry, thermal stimulation of birth into a ______ environment, and the recoil of the chest after compression in the vaginal canal stimulates the _____ breath.
What is cooler and first
Changes in blood chemistry are decreased oxygen, increased CO2 and decreased pH
What to report to the provider:
A. Baby has a period of apnea of 20 seconds
B. Baby has irregular and shallow breathing with a respiratory rate of 36
A: Periods of apnea should be less than 15 seconds
B does not need to be reported to the provider because its okay for babies to have irregular and shallow breathing as long as it is unlabored and symmetrical. Also, RR is WNL
Normal temperature range of a baby in fahrenheit and celcius
F: 97.8 to 99.4
C: 36.5 to 37.4
Hypoglycemia in the newborn is defined as a blood glucose of less than ___.
40
40 to 60 is normal
At five minutes, baby is pink all over, crying vigorously, actively flexed limbs, and has a heart rate of 140
Appearance: 2 for no blue coloration
Pulse: 2 for greater than 100
Grimace: 2 for crying (in ATI book). Miller's reference says 2 for sneezing, coughing, pulling away when stimulated
Activity: 2 for active movement, well-flexed
Resps: 2 for strong cry
Total: 10
How much lung fluid is squeezed out of the baby's lungs during the second stage of labor?
What is 1/3rd
Total 80 to 100ml of lung fluid
Rest is reabsorbed through the lymph system
What to report:
A. Baby's SPO2 in both hand and foot is 95%
B. Baby's SPO2 is 99% in right hand and 95% in left foot.
B. Should be less than a 3 point difference in SPO2 in hand and foot
Miller says evaulate if less than 95%, so A does not need to be reported.
Placing a cold stethoscope directly on the baby's chest will result in which kind of heat loss?
A. Evaporation
B. Conduction
C. Convection
D. Radiation
B. Conduction: Direct contact with a cooler surface (in this case, the stethoscope)
Glycogen is stored in the liver for ____ hours
24 hours
At one minute, baby grimaces but does not cry when stimulated and extremities are partially flexed. Cyanosis is noted in hands and feet. Pulse is 105 and resps are slow and irregular
A: 1 for acrocyanosis
P: 2 for greater than 100
G: 1 for grimace
A: 1 for some flexion of extremities/some movement
R: 1 for slow and irregular
Total: 6
Functioning alveoli depends on production of surfactant. Surfactant production can be measured prenatally by obtaining a _________ - ___________ ratio.
Lecithin-sphingomyelin ratio. Respiratory stability indicated by a greater than 2:1 L-S ratio.
Surfactant synthesis begins at 24 to 28 weeks
At 28 to 32 weeks the ratio is equal at 1:1
What to report to the provider:
A. Hematocrit of 66%
B. WBC of 15,000
A. Normal hematocrit is between 44 to 64%
B does not need to be reported as it falls within normal range (9000 to 30,000)
Which of the following is an example of heat loss through convection?
A. Baby is placed on a cold exam table
B. Baby is placed close to an exterior wall
C. Baby is not dried after a bath
D. Baby is placed in the direct line of air flow from a fan
Correct: D
A is conduction, B is radiation, C is evaporation
Which to report:
A. Bilirubin of 5 at 12 hours
B. Bilirubin of 10 at 24 hours
B. Report bilirubin of greater than 8 at 24 hours
Would only need to report a bilirubin of greater than 6 at 12 hours
At one minute, baby is limp and has no movement. Weak grimace is noted with stimulation, HR is 80 and resps are slow and irregular. Baby has an overall pallor and cyanosis
A: 0 for overall cyanosis
P: 1 for less than 100
G: 1 for grimace
A: 0 for no movement/limp
R: 1 for slow and irregular
Total: 3
Increase in aortic pressure
Decrease in venous pressure
What to report to provider:
A. Baby's heart rate increases to 162 with movement but returns to 150 when still
B. Respiratory rate of 45, noted chest rise on right side only.
B. Asymmetrical chest risk could indicate a pneumothorax
A does not need to be reported as it is expected for baby's heart rate to increase with movement. Tachycardia is a heart rate above 160 for 10 minutes or greater.
Long term cold stress (which can begin at temperatures of 97.2) can lead to these two complications.
What is hypoxia and metabolic acidosis
Indirect bilirubin level measures which type of bilirubin?
Unconjugated
Measured by a transcutaneuous bili meter