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Midwifery > Care of the Newborn and Family > Flashcards

Care of the Newborn and Family Flashcards

1
Q

When are the two assessments for the APGAR score?

A

Immediately following birth and again 5 minutes later

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2
Q

List the SEVEN points in the APGAR score procedure

A
  • Ensure adequate lighting
  • Note time of delivery (first score at 1 minute)
  • Act promptly and appropriately to the score
  • Repeat score at 5 minutes
  • Repeat again at 10 minutes and 15 minutes if active resuscitation is in progress
  • Document findings
  • Discuss with parents
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3
Q

List the FOUR aspects of the midwife’s examination of the newborn head

A
  • Look for signs of caput and moulding / Does the head appear asymmetrical?
  • Observe for visible signs if trauma
  • Feel along suture lines and fontanelles. Are they normal size and appearance?
  • Measure head circumference
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4
Q

List the FIVE aspects of the midwife’s examination of the newborn face

A
  • Eyes - 2, general shape and size, cloudy may be cataracts, discharge may be infection
  • Nose - shape and size, note if flaring and react
  • Mouth - symmetrical? Inside should be viewed
  • Ears - 2, formed and in correct position, skin tags noted
  • Milia - pin head sized whited spots
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5
Q

List the FIVE aspects of the midwife’s examination of the newborn neck

A
  • Examine for symmetry
  • Feel to detect presence of swelling
  • Head should be able to move from side to side
  • Webbing can be unusual - react
  • Feel both clavicles to ensure they are intact
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6
Q

List the FIVE aspects of the midwife’s examination of the newborn arms and hands

A
  • Arms should be the same length
  • Arms should both move freely, lack of movement may denote underlying trauma
  • The number of digits should be counted. Polydactyly (extra digits) or syndactyly (webbing) should be noted
  • Palm should be straightened and creases examined
  • Look at the nails
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7
Q

List the SIX aspects of the midwife’s examination of the newborn chest

A
  • Examine for symmetry
  • Sternal recession should be reported immediately
  • Nipples and areola should be well formed, accessory nipples noted
  • Breasts may appear enlarged, not a concern if no signs of infection
  • Heart rate should be 110 - 160 bpm
  • Respiration rate should be 40 - 60 breaths per minute
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8
Q

List the THREE aspects of the midwife’s examination of the newborn abdomen

A
  • Should be rounded and move in synchrony with the chest
  • Inspect and gently palpate for swelling
  • Umbilical cord should be securely clamped with no signs of haemorhage
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9
Q

List the TWO aspects of the midwife’s examination of the newborn genitalia

A
  • BOYS, length of penis should be around 3 cm, position of urethral meatus confirmed, do not retract foreskin, palpate scrotum for presence of two testes
  • GIRLS, examine for presence of clitoris, urethral and vaginal orifices, Mucoid discharge may be present
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10
Q

List the FIVE aspects of the midwife’s examination of the newborn legs

A
  • Assess symmetry, length
  • Both legs should move freely
  • Shape of feet noted
  • Count toes
  • Look for polydactyly and syndacyly
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11
Q

List the TWO aspects of the midwife’s examination of the newborn feet

A
  • Positional talipes - contraction of muscles and tendons related to positioning in utero
  • Ankles should move freely
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12
Q

List the THREE aspects of the midwife’s examination of the newborn spine

A
  • Look for obvious signs of swelling or dimpling or hairy patches (could indicate abnormality of the spine)
  • Assess curvature by running fingers lightly over the spine
  • Gently part cleft of buttocks to look for any dimples, sinuses and to confirm the presence of the anal sphincter
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13
Q

List the THREE aspects of the midwife’s examination of the newborn skin

A
  • General condition should be observed
  • Obvious swelling or spots should be recorded
  • Mongolian blue spot may be present and should be differentiated from bruising
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14
Q

What THREE things should be measured following the birth?

A
  • Weight in kilograms
  • Length in centimetres
  • Occipital Frontal Circumference (OFC) - normal range 32-37cm
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15
Q

List EIGHT danger signs in newborns

A
  • Poor feeding
  • Lethargy
  • Convulsions (staring and lip twitching or limb twitches)
  • Cold body temperature (less than 35.5 degrees)
  • Hot body temperature (more than 37.5 degrees)
  • Chest indrawing
  • Fast breathing (more than 60 is too fast)
  • Jaundice
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16
Q

Which vessel carries oxygenated blood from the placenta to the fetus?

A

Umbilical vein

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17
Q

What is the foramen ovale?

A

The hole in the neonate’s heart between the right and left atria

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18
Q

What is the ductus arteriosus?

A

The vessel which allows the blood to bypass the pulmonary arteries and flow in to the aorta

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19
Q

What is the ductus venosus?

A

The vein which allows most of the oxygenated blood to enter directly in to the inferior vena cava, bypassing the liver

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20
Q

What is surfactant?

A

A substance produced in the lungs, which encourages the alveoli to stay open in the newborn

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21
Q

What is non-shivering thermogenesis?

A

The generation of heat in the newborn, by increasing the cellular metabolic rate in skeletal muscle and the breakdown of brown fat

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22
Q

What are the TWO types of urinary incontinence and describe each

A

Stress incontinence
Pelvic floor is weakened, sudden increase in abdominal pressure occurs and external urinary sphincter fails to contract

Urge incontinence
Sudden and uncontrollable urge to urinate

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23
Q

What can be used as a preventative strategy for incontinence?

A

Pelvic floor exercises

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24
Q

List FOUR benefits of skin to skin contact

A
  • Prolactin is released (stimulates milk production and bonding)
  • Stimulation of oxytocin to calm the mother
  • Baby is calmed
  • Increased duration of exclusive breastfeeding
25
Q

List the NINE stages of instinctive newborn behaviour

A
  • Birth cry
  • Relaxation
  • Awakening
  • Activity
  • Crawling
  • Resting
  • Familiarisation
  • Suckling
  • Sleeping
26
Q

How long should skin to skin contact last for?

A

Until after the first breastfeed

27
Q

What is jaundice?

A

Yellow discolouration of the skin caused by a raised level of bilirubin in the circulation, a condition known as hyperbilirubinaemia

28
Q

Why is most neonatal jaundice harmless?

A

The fetal circulation has a greater number of red blood cells with a shorter lifespan so the increased breakdown levels causes a build up of bilirubin

29
Q

When is jaundice normal (physiological jaundice)?

A

Appears at day 2, peaking at 3-7 days of age with bilirubin levels up to 80 umol/l

30
Q

List SIX possible causes of physiological jaundice

A
  • Infection
  • Concealed haemorrhages
  • Dehydration
  • Increased enterohepatic circulation
  • Impaired liver function
  • Metabolic disorders
31
Q

List THREE possible causes for pathological jaundice

A
  • Blood group incompatibility
  • Infection
  • Trauma and bruising
32
Q

When is jaundice considered pathological (not normal)?

A

Appears at less than 24 hours old
Bilirubin levels rise more than 85 umol/l per day or 5mmol/l per hour
Sick infant

33
Q

What treatment can be given for jaundice?

A

Phototherapy

34
Q

How does phototherapy work?

A

Detoxifies bilirubin by converting it in to a water-soluble form which can be excreted by the kidney

35
Q

What is the consequence of a vitamin k deficiency?

A

An impaired production of coagulation factors by the liver

36
Q

What does VKDB mean?

A

Vitamin K Deficiency Bleeding

37
Q

What are the THREE types of VKDB and when do they occur?

A

Early VKDB - within 24 hours of birth
Classic VKDB - between day 1 and 7 of life
Late VKDB - between week 2 and week 12 of life

38
Q

List FIVE gastro intestinal tract problems of the newborn

A
  • Cleft lip and or palate
  • Oesphageal atresia
  • Tracheal Oesphageal fistula
  • Gastro-Oesphageal reflux
  • Pyloric stenosis
  • Intestinal obstruction
39
Q

What is Oesphageal Atresia?

A

A congenital abnormality in which there is a blind ending oesophagus

40
Q

What is pyloric stenosis?

A

The muscles of the pylorus are thickened which prevents the stomach from emptying into the small intestine

41
Q

What are the signs of a bowel obstruction?

A
  • Failure to pass meconium
  • Progressive abdominal distention
  • Poor feeding
  • Bilious vomits
42
Q

What is an imperforate anus? (4 abnormalities)

A
  • The absence of an anal opening
  • The anal opening in the wrong place
  • A connection joining the intestine and the urinary system
  • A connection joining the intestine and vagina
43
Q

What is Hirschsprungs’s disease?

A

The nerves are missing from part of the bowel which then cannot push material through and causes a blockage

44
Q

What is necrotising enterocolitis?

A

Portions of the bowel undergo necrosis (tissue death)

45
Q

Which class of antibodies do neonate’s have at birth?

A

Immunoglobin G (IgG)

46
Q

By how many weeks gestation are maternal and infant IgG levels equal and when are the infants IgG levels greater?

A

Equal at 33 weeks

Greater at 40 weeks

47
Q

What FIVE types of antibodies are found in breast milk?

A 
GAMED
IgG
IgA
IgM
IgE
IgD
48
Q

Describe passive immunity in relation to pregnancy and birth

A

Maternal antibodies passed to the fetus through the placenta and through breast milk

49
Q

Describe natural acquired immunity

A

Immunity present at birth, which is exposed to different antigens in an environment

50
Q

Describe induced active immunity

A

Immunity gained from deliberate antigen exposure such as vaccinations

51
Q

Why does the newborn body require a higher demand for glucose than an adult?

A

The newborn has a higher brain-to-body weight ratio and the brain uses glucose almost exclusively for its energy needs

52
Q

Describe the TWO changes to energy sources that occur in a neonate following birth

A

Changes from continuous supply to intermittent

Changes from high carb and low fat to low carb and high fat

53
Q

What is hypoglycaemia?

A

A deficiency of glucose in the blood stream

54
Q

What TWO reasons make detecting and treating neonatal hypoglycaemia very important?

A
  • It deprives the brain of its primary source of metabolic fuel and can lead to brain damage and seizures
  • It is a presenting feature of numerous endocrine disorders and inborn errors of metabolism
55
Q

List FOUR things that may cause a neonate to be more at risk of developing hypoglycaemia

A
  • Prematurity
  • Hypothermia
  • Perinatal asphyxia
  • Sepsis
56
Q

List SIX clinical features that would indicate that a neonate should have its blood glucose checked

A
  • Jitteriness
  • High-pitched cry
  • Seizure activity
  • Lethargy
  • Poor feeding
  • Apnoea
57
Q

What FIVE things does the blood spot test screen for?

A 
PKU - Phenylketonuria
CHT - Congenital hypothyroidism
CF - Cystic fibrosis
SCD - Sickle cell diseases
MCADD - Medium chain acetyl CoA dehydrogenase deficiency
58
Q

What is the puerperium?

A

The time immediately following childbirth which lasts approximately 42 days during which anatomical and physiological changes brought about by childbirth resolve

59
Q

How soon following birth should the mother have passed urine and opened her bowels?

A

Urine - 6 hours

Bowel - 3 days

Midwifery (37 decks)

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