http://www.ballardscore.com/Pages/videos.aspx, previous article in American Family Physician. b. This medication might cause your face to be flushed. Bruins Capital Reviews, are maifestations of fluid or A nurse is reinforcing teaching about home safety with a client who is postpartum. Copyright 2023 American Academy of Family Physicians. Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Principles of Environmental Science (William P. Cunningham; Mary Ann Cunningham), Give Me Liberty! Which of the following findings should the nurse expect? Place client in side-lying position -Tell the parents that a film of yellowish mucus can form over the glans by day two, and it is important not to wash it off This is a Premium document. Assist with Labor and Delivery,Active Learning Template: Medication) preferanly when the WebInterdependent letting-go phase focus on family as a unit Assess for positive responses from the sibling Interests and concern of the infant Increased independence Assess for adverse response from the sibling Indications of sibling rivalry and jealousy Regression in toileting and sleep habits stuffiness, epistaxis short periods of apnea (less Change the newborn's diaper at least every 4 hr, and clean the penis with warm water with each diaper change. Such disorders may be inherited, infectious, or caused by a medical problem of the mother. 45. -Hypoglycemia, Assessment and Management of Newborn Complications: Findings to Report (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 27), -Congenital anomalies Congenital heart disease occurs in approximately six out of 1,000 live births.38 Newborns with heart disease often exhibit tachypnea without retractions. WebUse standard precautions when handlingany tissue or sample of bodily fluidsthat samples are drawn and sent forprocessing promptlyIf results are outside ofnormal ranges, contact HCP immediately. Respirations less than 12/min acidosis can occur. Nutrition During Pregnancy: Teaching a Client Who Has Phenylketonuria (Active Learning Template - System Disorder, RM MN RN 10.0 Chp 5), -It is important for the client to resume the PKU diet for at least 3 months prior to pregnancy and continue the diet throughout pregnancy. Many factors affect test results. a nurse is collecting data from an antepartum client who reports taking ferrous sulfate twice per day for the past month. Renal ultrasonography should be performed only in patients with isolated ear anomalies, such as preauricular pits or cup ears, if they are accompanied by other malformations or significant family history. which of the following statement by the client indicates an understanding of the teaching? Subconjunctival hemorrhages from blood vessel rupture are also a common benign finding that may take weeks to resolve. Well-Being,Active Learning Template: Diagnostic Procedure) the left midclavicular line When a newborn takes the first breath, subsequent decreases in resistance in the pulmonary vasculature and increases in oxygen concentration result in eventual closure of the shunts, which allow the newborn to transition to adult circulation. A newborn's pulse is normally 120 to 160 beats per minute. assessment and management of newborn complications findings to report ati. -Fetal demise or Chorioamnionitis, Medical Conditions: Laboratory Values to Report (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 9), -Urinalysis for ketones and acetones (breakdown of protein and fat) is the most important initial laboratory test: Elevated urine specific gravity Which of the following actions should the nurse perform? -Sluggishness, hypotonic muscles, and hypoactivity, tremors from hypocalcemia place baby on warmer with no clothes if cold) Torticollis is primarily due to birth trauma to the sternocleidomastoid muscle that causes swelling or sometimes hematoma formation within the muscle. (RM MN RN 11 Chp 9 Medical Conditions,Active Learning Template: Used to rule out Down syndrome (low level) and neural tube defects (high level). Family-Centred Maternity & Newborn Care: National Guidelines 2000 Principles of Examination 1. A bifid uvula is often associated with a submucosal cleft. A nurse is caring for a client who is experiencing a postpartum hemorrhage. A newborn should have a thorough evaluation performed within 24 hours of birth to identify any abnormality that would alter the normal newborn course or identify a medical condition that should be addressed (eg, anomalies, birth injuries, jaundice, or cardiopulmonary disorders) [ 1 ]. -Encourage upright positions, application of warm/cold packs, ambulation, or hydrotherapy if not contraindicated to promote comfort, Labor and Delivery Processes: Indications of True Labor (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 11), -Contractions: can begin irregularly but become regular, stronger, longer, more frequent, felt in lower back, walking can increase contraction intensity, continue despite comfort measure -Chemistry profile revealing electrolyte imbalances (Sodium, potassium, and chloride reduced from low intake, Metabolic acidosis (secondary to starvation), Metabolic alkalosis due to excessive vomiting, Elevated liver enzymes, Bilirubin level) 1) A nurse is caring for a full-term newborn immediately following birth. The baby exhibited signs of torticollis. Maintenance: E. Laboratory Values (2 items) Newborn Nursing Care & Assessment ( Quiz 1: 25 Questions) 2. assessment of progression and a plan for delivery. Newborn Assessment: Eliciting Newborn Reflexes (Active Learning Template - Nursing Skill, RM MN RN 10.0 Chp 23) -Moro reflex: Elicit by allowing the head and trunk of the newborn in a semisitting position to fall backward to an angle of at least 30. Which of the following adverse effects should the nurse include in the teaching. which of the following statements should the nurse include? Macrocephaly (isolated head enlargement, greater than the 98th percentile or greater than two standard deviations above the mean) may be hereditary or the result of a central nervous system disorder (e.g., hydrocephalus, brain tumor), and imaging may be needed.3,4, After evaluating the overall size and shape of the head for asymmetry or gross structural abnormalities, the fontanelles and sutures should be palpated with the newborn in the upright position. A nurse is caring for a client who ins in preterm labor and is receiving betamethasone. WebA nurse is reinforcing teaching with a client who is at 30 weeks of gestation and has a prescription for nifedipine to treat preterm labor. Diagnostic echocardiography should be performed if screening results are positive (Table 6).40,41. WebNewborn Assessment: Findings to Report to the Provider (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 23) -Heart murmurs are documented and A client who is receiving continuous IV lidocaine and has a respiratory rate of 10min 32-Maternal Newborn Assessment 1. ADVANCE DIRECTIVES) Health Promotion and : an American History (Eric Foner), Psychology (David G. Myers; C. Nathan DeWall), Chemistry: The Central Science (Theodore E. Brown; H. Eugene H LeMay; Bruce E. Bursten; Catherine Murphy; Patrick Woodward), Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. OB ATI remediation 2 Flashcards | Quizlet Which of the following adverse effects should the nurse include in the teaching. Report at a scam and speak to a recovery consultant for free. The first description of sickle cell disease, published in 1910, 2 was followed by six decades of genetic, hematologic, pathologic, clinical and molecular observations. Newborn screening programs test babies for disorders that are often not apparent at birth. Routine screening tests to detect problems that cannot be seen during the physical examination are also done (see Screening Tests for Newborns ). Basic measurements include length , weight , and head circumference (see also Growth Parameters in Neonates ). The baby weight 3000 grams at birth 4. NURSINGN223 - Newborn Assessment.pdf - Course Hero risk factors are also the ones that associated with other STIs WebEarly Onset of Labor: Findings to Report to the Provider for a Client Who is Receiving Magnesium Sulfate. -Assess for orthostatic hypotension. Breathing rate. Chp 23 Newborn Assessment,Active Learning Template: Growth and 18. ii. Cleft lip and palate are the most common anomalies of the head and neck. murmurs are documented Steam is allowed to flow from the smaller tank, through the turbine, and into the larger tank until equilibrium is attained. A nurse is reinforcing discharge teaching with a parent of a newborn following a circumcision using the Plastibell technique. a. Urine output less than 30 mL/hr A nurse notes that a 6-hour-old neonate has cyanotic hands and feet. which of the following interventions should the nurse include in the plan of care? A nurse in a prenatal clinic is reinforcing nutritional teaching with a client who is at 10 weeks of gestation. iii. change in dose. Assessment and Management of Newborn Complications: Teaching fifth intercostal space at Hyperemesis Gravidarum mother regularly assessed for the When the baby's heel is pricked to collect a sample of blood for newborn screening. 4. lab 5:55 pm junho 7, 2022 . CONCEPT__Reportable The red reflex test is performed by using an ophthalmoscope, with the lens power set at 0 and the examiner standing approximately 18 inches away. STUDENT NAME______________________________________ Routine screening for congenital heart disease via pulse oximetry is recommended before discharge at 24 hours of life or later. -Promote diversional activities (e.g., TV, visits from family or friends, gentle exercise). which of the following instructions should the nurse include in the teaching? BUN 35 mg/dL Hgb 15 mg/dL Bilirubin 0 mg/dL Hct 37% 7. the procedure will determine if my baby's lungs are mature. Momandbaby ATIstudy 1 copy - 1. Assessment and Management A nurse is planning to administer phytonadione IM to a newborn shortly after birth. A nurse is assisting with the care of a newborn who has hyperbilirubinemia and is receiving phototherapy. I should increase my fluid intake while I am taking iron. reaches the maximum night and weight for the seat. Provides an estimation of gestational age and a baseline to assess growth and development. There, the staff runs laboratory tests looking for signs of certain serious conditions. A large anterior fontanelle may indicate increased intracranial pressure, Down syndrome, hypophosphatemia, trisomy, or congenital hypothyroidism. Which of the following conditions places the client at an increased risk for developing this condition? Induction of Labor (RM MN RN 11 Chp 15 Therapeutic Procedures to A detailed newborn examination should begin with general observation for normal and dysmorphic features. 36.5 C to 37.5 C with 37 C The normal hematocrit value for females\underline{females }females / males\underline{males }males is generally higher than that of the opposite sex. Table 1 shows the normal ranges for newborn vital signs at 40 weeks' gestation.24 The new Ballard score (http://www.ballardscore.com) was designed to assess a newborn's gestational age through a scoring system that combines physical characteristics with neuromuscular development.5 A video depicting this examination is available at http://www.ballardscore.com/Pages/videos.aspx. vii. Grunting and nasal flaring are clinical findings of respiratory distress. Which of the following statements should the nurse include? These include: Your sex, age and race. A nurse in an antepartum clinic is collecting data from a client who is at 28 weeks of gestation. The respiratory examination is important because the infant is transitioning from fetal to neonatal life. Which of the following actions should the nurse take? -Thyroid test indicating hyperthyroidism. place witch hazel pads on the client's perineum. A diagnosis of gestational diabetes requires two elevated blood-glucose readings x. use of IUDs Diaphoresis Management of Newborn Complications,Active Learning Template: If present, be prepared to administer an IV vasopressor such as ephedrine, position the client laterally, increase rate of IV fluid administration, and initiate oxygen, Complications Related to the Labor Process: Nursing Action for Shoulder Dystocia (Active Learning Template - Nursing Skill, RM MN RN 10.0 Chp 16), -Next, deliver the anterior shoulder located under the maternal symphysis pubis: next, the posterior shoulder; and then allow the rest of the fetal body to slip out (prevents shoulder dystocia) A diagnosis of gestational diabetes requires two elevated blood-glucose readings, Assessment and Management of Newborn Complications: Clinical Manifestations of a Macrosomic Newborn (Active Learning Template - System Disorder, RM MN RN 10.0 Chp 27), -Weight above 90th percentile (4,000 g) with a large head The nurse should identify that this medication is administered to prevent which of the following complications? Learning Template: Therapeutic Procedure) Reportable findings for a newborn.pdf - Course Hero the AP should have their photo identification badge displayed. pediatic stethoscope head - Genitalia of a male newborn should include rugae on the scrotum. A nurse is assisting with the admission assessment of a client whose labor is being induced. It can usually be corrected with physical therapy.36 If not corrected, torticollis can lead to plagiocephaly and ear misalignment. For which of the following findings should the nurse notify the provider? assessment and management of newborn complications findings to report atiblackadder goes forth bobblackadder goes forth bob Phone: (404) 327-7950. assessment and management of newborn complications findings to report ati. Pulse oximetry, or pulse ox, is a painless, non-invasive test that measures how much oxygen is in the blood. Urine output 22 mL/hr Which of the following laboratory results should the nurse report to the provider? can develop after your menstruation, miscarriage, abortion, pelvic -More than 2 minutes, longer than 10 indicates bradycardia, Prenatal Care: Glucose Testing (Active Learning Template - Diagnostic Procedure, RM MN RN 10.0 Chp 4), -Monitored in urine during every prenatal visit -When there is suspected rupture of membranes, the nurse should first assess the FHR to ensure there is no fetal distress from possible umbilical cord prolapse, which can occur with the gush of amniotic fluid a. Newborns with low-set ears should be evaluated for a genetic condition. Which of the following statements should the nurse include in the teaching? PE findings that impede breastfeeding - Nipple type or engorgement makes latch hard - Cracks or bleeding that causes too much pain to breastfeed 2. C. Potential for Complications of Diagnostic Tests/Treatments/Procedures (1 item) which of the following statements by the parent indicates an understanding of the teaching? Blood pressure should be 60 -Monitor the neonate for abstinence syndrome (withdrawal) and increased wakefulness using the neonatal abstinence scoring system, report if any symptoms are seen System Disorder) Screening for hypoglycemia should be performed in newborns who are large or small for gestational age, newborns of mothers with diabetes mellitus, and late preterm infants (34 to 36 6/7 weeks gestational age). Course Hero is not sponsored or endorsed by any college or university. A prematurely fused suture indicates craniosynostosis and occurs in one out of 1,000 newborns.8,9 Craniosynostosis limits growth of the skull in a direction perpendicular to the suture, while growth may continue in other directions. Cross), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), Educational Research: Competencies for Analysis and Applications (Gay L. R.; Mills Geoffrey E.; Airasian Peter W.), The Methodology of the Social Sciences (Max Weber), Forecasting, Time Series, and Regression (Richard T. O'Connell; Anne B. Koehler), Civilization and its Discontents (Sigmund Freud). CONSIDERATIONS Nursing Interventions (pre, intra, post) Pretest- Assessment of the patient to assist in determining precautions. Newborn babies may often lose 5 to 7 percent of their birthweight. Which assessment finding is important for the nurse to report to the hcp? Light should project onto both eyes simultaneously. -Instruct the client to thoroughly wash hands prior to breastfeeding. Sed quis, Copyright Sports Nutrition di Fabrizio Paoletti - P.IVA 04784710487 - Tutti i diritti riservati. A nurse is collecting data from a client who is 24 hr postpartum. than 15 seconds) occurring Which of the following information should the nurse include? A nurse is planning to perform a blood collection via heel stick on a newborn. agents are used Early detection, diagnosis, and intervention can prevent death or disability and enable children to reach their full potential. Sign for further assessment and monitoring of the client - Meconium should be passed within 24 hr after birth. Which of the following outcomes should the nurse expect from this medication? ii. findings for a newborn A nurse is reviewing the laboratory results of a client who is at weeks of gestation. -Administer calcium gluconate or calcium chloride as an antidote for magnesium sulfate toxicity, Prenatal Care: Education Regarding Rho(D) immune globulin (Active Learning Template - Medication, RM MN RN 10.0 Chp 4), -Administer RhO(D) immune globulin IM around 28 weeks of gestation for clients who are Rh-negative A nurse is caring for a client who is at 32 weeks of gestation and has a prescription for nifedipine. Part II, Skin, Trunk, Extremities, Neurologic, appears in this issue of AFP. WebA nurse is assessing four newborns. Which of the following findings should prompt the nurse to reassess the client. The highest score for each criterion is 2, and the lowest is 0. In general, small babies and very large babies are at greater risk for problems. Heart murmurs A Ballard score uses physical and neurologic characteristics to assess gestational age. v. Cardiac dysrhythmias is placed on the fourth or Cover the ears with gauze pads. Which of the following client statements indicates an understanding of the teaching? -Teach the parents to avoid using premoistened towelettes to clean the penis because they contain alcohol, Pain Management: Intervention for Hypotension Following Epidural Placement (Active Learning Template - Therapeutic Procedure, RM MN RN 10.0 Chp 12), -Administer a bolus of IV fluids to help offset maternal hypotension as prescribed Therefore, a fundal height of 25 cm is greater than the expected finding for 20 weeks of gestation. A technician or your doctor analyzes the test samples to see if your results fall within the normal range. which of the following manifestation should the nurse expect? It is caused by retained fluid in the lungs, which can result in alveolar hypoventilation.42 Treatment includes supportive respiratory care because the condition resolves within 48 hours. administer ampicillin via intermittent IV bolus. You should dress your baby in a one-piece sleeper at bedtime. v. Assessment after oxytocin every 30-60 minutes. The newborn will symmetrically extend and then abduct the arms at the elbows and fingers spread to form a "C", Expected Physiological Changes During Pregnancy: Quickening (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 3), -slight fluttering movements of the fetus felt by a woman, usually between 16 to 20 weeks of gestation, Contraception: Tubal Ligation (Active Learning Template - Therapeutic Procedure, RM MN RN 10.0 Chp 1), -The cutting, burning, or blocking of the fallopian tubes to prevent the ovum from being fertilized by the sperm, Newborn Assessment: Findings to Report to the Provider (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 23), -Heart murmurs are documented and reported, Baby-Friendly Care: Therapeutic Communication Concerning Role Transition (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 18), -Emphasize verbal and nonverbal communication skills between the client, caregivers, and the infant, Postpartum Infections: Teaching a Client Who Has Mastitis (Active Learning Template - System Disorder, RM MN RN 10.0 Chp 21). Regardless of red reflex findings, all newborns with a family history of retinoblastoma, cataracts, glaucoma, or retinal abnormalities should be referred to an ophthalmologist experienced in the examination of children because of the high risk of serious eye abnormalities.17, Dacryostenosis should be differentiated from ophthalmia neonatorum, which is conjunctivitis within the first four weeks of life (Table 3).18 With dacryostenosis, a blocked tear duct causes secretions to accumulate with a yellow sticky appearance while the rest of the eye appears normal.19 With conjunctivitis, however, there is often edema and conjunctival injection.18, Hearing should be evaluated in all newborns before one month of age, but preferably before discharge, using the auditory brainstem response or the otoacoustic emissions test.20 Assessing the size, shape, and position of the ears may reveal congenital abnormalities. A nurse is caring for a client who is in labor. Place the car seat ideally in the middle (away from airbags) to Maternal Newborn Assessment. Cyanosis is often present with severe disease.38 This appearance should be differentiated from acrocyanosis (isolated cyanosis of the hands and feet), which is normal in newborns. If a fracture is depressed or accompanied by neurologic symptoms, computed tomography should be performed to rule out intracranial pathology.12, Forceps use or a difficult delivery may also lead to a facial nerve palsy resulting in the inability to close the eye, loss of the nasolabial fold, drooping at the corner of mouth, or the inability to contract the ipsilateral lower facial muscles. Periodic breathing consising of 5- to 10-second respiratory pauses, followed by 10- to 15- second compensatory rapid respiraions. A suspected fracture should be confirmed with a radiograph. Respiratory distress, cyanosis multiple partners Report to the Provider (RM MN RN 11 Chp 27 Assessment and Varicose veins and lower-extremity edema, gingivitis, nasal If the causative factor occurred later in pregnancy (e.g., uteroplacental insufficiency), the head circumference will be preserved relative to other measurements.6 A newborn with a birth weight above the 90th percentile is considered large for gestational age. sponge bathe your baby until the umbilical stump has fallen off. More than 20% of cases are caused by specific single-gene mutations or chromosomal abnormalities and may be associated with conditions such as Crouzon, Apert, and Pfeiffer syndromes.10 A misshapen head may be caused by prenatal compressions rather than true synostosis. Table 5 summarizes important cardiac examination findings.38,39 Because of changes in vasculature immediately after birth, benign murmurs are common in the first hours of life.38,39 Routine screening for congenital heart disease via pulse oximetry is recommended before discharge at 24 hours of life or later, or shortly before discharge if earlier than 24 hours. Lethargy Pulse oximetry should be performed in a systematic fashion before discharge. The lowest overall score is 0, which indicates that there is no respiratory distress. Assume the constant velocity of the crate. Assessment As shown in figure, a turbine is located between two tanks Initially, the smaller tank contains steam at 3.0MPa3.0\ \mathrm{MPa}3.0MPa, 280C280^{\circ} \mathrm{C}280C and the larger tank is evacuated. -Have the client avoid foods that are high in sodium, alcohol and tobacco, and limit caffeine intake also instruct the client to drink six to eight 8-ounce glasses of water a day. Assessment of the newborn immediately starts the moment he or she is delivered, and there are a lot of standard assessments used to evaluate them rapidly. Fax: (404) 327-7919. Which of the following findings should the nurse report to the provider? We also searched POEMs (patient-oriented evidence that matters), Clinical Evidence, the Cochrane database, and Essential Evidence Plus. A nurse is reinforcing teaching with a client who is experiencing preterm labor and has a new prescription for nifedipine. Which of the following actions should the nurse include in the plan of care? ii. iii. What is the magnitude of the normal force acting on a crate as it slides across a horizontal floor, if the friction force acting on the box is Ffriction=0.49NF_\text{friction}=0.49\text{ N}Ffriction=0.49N and the coefficient of kinetic friction is K=0.25\mu_\text{K}=0.25K=0.25? RN 11 Chp 23 Newborn Assessment,Active Learning Template: System If heat transfer with the surroundings is negligible, determine the maximum theorctical work that can be developed, in kJ\mathrm{kJ}kJ. A nurse is caring for a newborn who is 24 hr old. For which of the following findings should the nurse intervene? Twitter page for Newborn Screening Program. which of the following statement by the guardian demonstrates in understanding of the teaching? List the four major divisions of Earth's history. - Apical pulse rate is Regardless of red reflex test results, all newborns with a family history of retinoblastoma, cataracts, glaucoma, or retinal abnormalities should be referred to an ophthalmologist who is experienced in the examination of children. which of the following statements by the client indicates an understanding of the instructions? A nurse is collecting data from a client who is at 36 weeks of gestation. presence of protein in the urine or any other signs of preeclampsia, Safety and Infection Control 66% (2 items) (The diet includes foods that are low in phenylalanine. ii. Which of the following statements should the nurse include in the teaching? -Irregular respirations, Cyanosis, Apnea, Medical Conditions: Educating Client Who Has Preeclampsia About Home Management (Active Learning Template - System Disorder, RM MN RN 10.0 Chp 9). newborn is sleeping. Diagnostic echocardiography should be performed if screening results are positive. Confirm that the fetus is engaged in the birth canal at minimum Medical Conditions: Priority Client to Assess (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 9), -Always assess patient with preeclampsia or eclampsia first, Infections: Treatment for Gonorrhea (Active Learning Template - System Disorder, RM MN RN 10.0 Chp 8), -administer Ceftriaxone IM and azithromycin PO: Broadspectrum antibiotic; bactericidal action, Prenatal Care: Auscultating for Fetal Heart Rate (Active Learning Template - Nursing Skill, RM MN RN 10.0 Chp 4), -The heartbeat can be heard by Doppler late in the first trimester, Therapeutic Procedures to Assist with Labor and Delivery: Indications for Amnioinfusion (Active Learning Template - Therapeutic Procedure, RM MN RN 10.0 Chp 15), -An amnioinfusion is indicated for cord compression, Expected Physiological Changes During Pregnancy: Documenting Ultrasound Findings (Active Learning Template - Basic Concept, RM MN RN 10.0 Chp 3), -Fetal heart tones are heard at a normal baseline rate of 110 to 160/min with reassuring FHR accelerations noted, which indicates an intact fetal CNS, Newborn Assessment: Eliciting Newborn Reflexes (Active Learning Template - Nursing Skill, RM MN RN 10.0 Chp 23), -Moro reflex: Elicit by allowing the head and trunk of the newborn in a semisitting position to fall backward to an angle of at least 30. There are five criteria to evaluate the newborn: chest movement, intercostals retraction, xiphoid retraction, nares dilatation, and expiratory grunt.