NCM 107 PEDIATRICS

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This deck includes 103 flashcards covering apgar scale, apgar test, heart rate, and related concepts. Use it to review key Biology ideas, focus on weak cards, and prepare for your exam with StudyLess.

1. 01

   Essential newborn care includes, according to WHO:

   Immediate care at birth (delayed cord clamping, thorough drying, assessment of breathing, skin-to-skin contact, early initiation of breastfeeding), Thermal care, Resuscitation when needed, Support for breast milk feeding, Nurturing care, Infection prevention, Assessment of health problems, Recognition and response to danger signs, Timely and safe referral when needed.

2. 02

   Immediate care after birth for a healthy newborn:

   Umbilical cord is clamped and cut, mucous is suctioned, a cap is placed on the head to help prevent heat loss and stabilize body temperature.

3. 03

   Purpose of Vitamin K injection in newborns:

   To prevent any incidence of hemorrhagic disease (heavy bleeding).

4. 04

   Purpose of antiseptic ointment in newborn eyes:

   To prevent infections of the cornea that might result during vaginal delivery.

5. 05

   Purpose of the APGAR test:

   To determine quickly whether a newborn needs immediate medical care.

6. 06

   When is the APGAR test generally performed?

   At one and five minutes after birth, and may be repeated later if the score is, and remains, low.

7. 07

   Interpretation of APGAR scores:

   0-2: critically low or 'poor'; 3-7: 'fair' condition; 8-10: normal or 'good'.

8. 08

   What do the one-minute and five-minute APGAR scores indicate?

   One-minute scores indicate how well the baby tolerated the delivery. Five-minute scores indicate their adaptation to the new environment.

9. 09

   What does an APGAR score of '0' at both 1 and 5 minute intervals suggest?

   A stillborn baby.

10. 10

    What are the five components of the APGAR test?

    Appearance (skin color), Pulse (heart rate), Grimace (reflex irritability), Activity (muscle tone), Respiration (breathing).

11. 11

    APGAR Scale: Heart rate scoring

    Score 0: absent; Score 1: <100; Score 2: >100.

12. 12

    APGAR Scale: Respiration scoring

    Score 0: absent; Score 1: weak or irregular; Score 2: strong.

13. 13

    APGAR Scale: Muscle tone scoring

    Score 0: none; Score 1: some flexion; Score 2: active movement.

14. 14

    APGAR Scale: Reflex irritability scoring

    Score 0: no response to stimulation; Score 1: grimace/feeble cry when stimulated; Score 2: sneeze/cough/pulls away when stimulated.

15. 15

    APGAR Scale: Skin color scoring

    Score 0: blue all over; Score 1: blue at extremities; Score 2: normal.

16. 16

    Normal heart rate range for a newborn:

    120 to 160 beats per minute.

17. 17

    Common variations in newborn heart rate:

    Ranges from 100 when sleeping to 180 when crying. May be irregular with crying.

18. 18

    Normal respiration range for a newborn:

    30 to 60 breaths per minute.

19. 19

    Common variations in newborn respiration:

    Bilateral bronchial breath sounds. Moist breath sounds may be present shortly after birth.

20. 20

    Expected muscle tone in a newborn:

    Well-flexed, full range of motion, and spontaneous movements.

21. 21

    Reflex irritability is scored based on the infant's response to what?

    Stimuli, such as a mild pinch.

22. 22

    How is reflex irritability scored on the APGAR?

    No response to a pinch = 0 points. A grimace or feeble cry = 1 point. A lusty cry = 2 points.

23. 23

    Normal skin color of a newborn at birth and up to 24-36 hours:

    Reddish in color, smooth and puffy. After 24-36 hours, skin is flaky, dry, and pink.

24. 24

    What is acrocyanosis in a newborn?

    Blue colored fingers, toes, hands, and/or feet due to sluggish peripheral circulation.

25. 25

    What are Mongolian spots?

    Patches of purple-black or blue-black color distributed over the backside of infants of African-American or Asian descent. Resolves in time.

26. 26

    What is mottling in a newborn?

    Generalized red and white discoloration of the skin of chilled infants with fair complexion.

27. 27

    Signs of potential distress or deviations from expected findings in newborns:

    Posture limp, Persistent tremor, Twitching, Asymmetry of movement.

28. 28

    What is jaundice in a newborn?

    A yellow discoloration of the skin, mucous membranes, and eyes, caused by too much bilirubin.

29. 29

    What causes the yellowish appearance in jaundice?

    High levels of bilirubin circulating in the bloodstream dissolve in the subcutaneous fat, causing a yellowish appearance of the skin and the whites of the eyes.

30. 30

    Common reason for jaundice in newborns:

    An immature liver.

31. 31

    What is the purpose of bili lights therapy?

    To reduce elevated levels of bilirubin, which can cause permanent brain damage.

32. 32

    How do bili lights help the body?

    They allow the body to manufacture Vitamin D, similar to sunlight.

33. 33

    Average weight and length of a newborn infant:

    Weight: 7 pounds; Length: 20 inches.

34. 34

    Normal weight range for a newborn infant:

    2500-4000 gms (5 lbs. 8oz. - 8 lbs. 13 oz.)

35. 35

    Normal length range for a newborn infant:

    48 to 53 cms (19-21 inches).

36. 36

    Normal head circumference for a newborn:

    33 to 35 cm.

37. 37

    Expected relationship between newborn head and chest circumference:

    Head should be 2 to 3 cms larger than the chest. Chest circumference 30.5 to 33 cm.

38. 38

    What is molding of the head in a newborn?

    A temporary change in head shape due to pressure during birth, which may result in a lower head circumference measurement.

39. 39

    Expected finding for newborn fontanelles:

    Should be soft, firm, and flat.

40. 40

    What may bulging fontanelles indicate?

    Distress or deviation from normal.

41. 41

    When might head and chest circumference be equal in a newborn?

    For the first 24 to 48 hours of life.

42. 42

    Why are reflexes tested in infants?

    To evaluate neurological function and development.

43. 43

    What may absent or abnormal reflexes, or persistence of a reflex past the normal age, indicate?

    Problems with the nerve system.

44. 44

    Describe the Moro response/startle reflex:

    An automatic, involuntary reaction where the infant flings arms out sideways, palms up, and thumbs flexed (or drawn upward) when startled, feels like falling, or head drops back. A loud noise can also elicit it.

45. 45

    What is considered abnormal for the Moro reflex?

    Absence of the Moro reflex in newborn infants.

46. 46

    Describe the tonic neck reflex:

    When the baby's head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow (often called 'fencing').

47. 47

    When does the tonic neck reflex usually disappear?

    By the age of 4 months.

48. 48

    Describe the palmar grasp reflex:

    An automatic, involuntary grip where the infant's fingers close and hold onto an object when pressure is applied to their palm.

49. 49

    Describe the plantar grasp reflex:

    The toes curl inward when the sole of the foot is stimulated, as if to hold on.

50. 50

    Describe the step reflex:

    When the infant is held erect and the feet touch a surface, the infant makes step-like movements.

51. 51

    Describe the crawl reflex:

    When placed on their stomach, the infant automatically assumes a 'crawling' position.

52. 52

    When does the crawl reflex usually disappear?

    By 4 months.

53. 53

    Describe the sucking reflex:

    Allows the infant to ingest food from the nipple of a bottle or breast. Occurs when any nipple-sized object is placed on the baby's lips.

54. 54

    Describe the rooting reflex:

    When the corner of the baby's mouth is stroked, the tongue, mouth, and head follow the direction of the finger, and the mouth opens. Helps locate the nipple for feeding.

55. 55

    When does the rooting reflex usually disappear?

    By 3-4 months.

56. 56

    Describe the Babinski reflex:

    When the bottom of the baby's foot is stroked, the big toe flexes upward, the other toes fan out, and the leg extends outward.

57. 57

    When does the Babinski reflex usually disappear?

    By 9 months to 2 years.

58. 58

    Describe the blink reflex:

    The infant's eyes will open and close in response to touch on the face, bright light, loud sound, strong odor, or bitter taste. Protects the eyes.

59. 59

    Describe the pupillary reflex:

    The infant's pupils open automatically in response to weak light and contract in response to bright light. Protects the eyes and allows for better vision.

60. 60

    What is the primary goal of newborn thermoregulation?

    Maintaining a neutral thermal environment to reduce morbidity and mortality.

61. 61

    Define thermoregulation in newborns:

    The ability to balance heat production and heat loss to maintain body temperature within a normal range.

62. 62

    What is considered the average 'normal' axillary temperature for a newborn?

    37°C.

63. 63

    What range defines normal axillary temperatures according to AAP/ACOG/WHO?

    36.5°C to 37.5°C.

64. 64

    What range defines normal axillary temperatures according to ACORN?

    36.3°C-37.2°C.

65. 65

    Define hypothermia in newborns:

    Axillary temperature drops below 36.3°C (ACORN) or below 36.5°C (AAP/ACOG, WHO).

66. 66

    What characteristics put newborns at greater risk of heat loss?

    Large surface area-to-body mass ratio, Greater body water content, Immature skin, Poorly developed metabolic mechanism for responding to thermal stress, Altered skin blood-flow.

67. 67

    List the four ways a newborn loses body heat:

    Conduction, Convection, Evaporation, Radiation.

68. 68

    Describe heat loss by conduction:

    When the newborn is placed naked on a cooler surface (e.g., table, scale, bed).

69. 69

    Describe heat loss by convection:

    Exposure to cool surrounding air or drafts from open doors, windows, or fans.

70. 70

    Describe heat loss by evaporation:

    When amniotic fluid evaporates from the skin (greatest source of heat loss at birth).

71. 71

    Describe heat loss by radiation:

    When the newborn is near cool objects (walls, tables) without direct contact.

72. 72

    What are the mechanisms of heat production in newborns?

    Metabolic processes (oxidative metabolism of glucose, fat, protein) and Voluntary muscle activity (increased muscle activity, assuming a flexed position).

73. 73

    How is heat produced by metabolic processes?

    Oxidative metabolism of glucose, fat, and protein in the brain, heart, and liver.

74. 74

    How is heat produced by voluntary muscle activity?

    Increased muscle activity during restlessness and crying, and assuming a flexed position to decrease exposed surface area.

75. 75

    What is nonshivering thermogenesis?

    Heat production by metabolism of brown fat, stimulated by norepinephrine.

76. 76

    What are the consequences of hypothermia in newborns?

    Increased cellular metabolism leading to increased oxygen consumption (risk of hypoxia, cardiorespiratory complications, acidosis), and increased glucose consumption (risk of hypoglycemia).

77. 77

    Describe the effects of cold stress on a newborn:

    Activation of nonshivering thermogenesis, increased oxygen consumption, increased respiratory rate, pulmonary vasoconstriction, tissue hypoxia, peripheral vasoconstriction, anaerobic metabolism, metabolic acidosis, increased glucose use, depletion of glycogen stores, hypoglycemia.

78. 78

    List signs and symptoms of hypothermia in newborns:

    Acrocyanosis and cool, mottled, or pale skin, Hypoglycemia, Transient hyperglycemia, Bradycardia, Tachypnea, restlessness, shallow and irregular respirations, Respiratory distress, apnea, hypoxemia, metabolic acidosis, Decreased activity, lethargy, hypotonia, Feeble cry, poor feeding, Decreased weight gain.

79. 79

    Under what conditions should a newborn's temperature be monitored closely?

    Difficulty maintaining the 'warm chain', Low birth weight/ill newborn, Resuscitation required at birth, Suspicion of hypothermia or hyperthermia, With rewarming or cooling down, If the newborn has been re-admitted to hospital.

80. 80

    What are the ten steps of the 'Warm Chain'?

    1. Warm delivery room, 2. Immediate drying, 3. Skin-to-skin contact, 4. Breastfeeding, 5. Postpone weighing and bathing, 6. Appropriate clothing/blanket, 7. Mother and newborn together, 8. Warm transportation, 9. Warm assessment, 10. Training and raising awareness.

81. 81

    Procedure for Step 1: Warm delivery room:

    Temperature at least 25°C, free from drafts. Supplies for keeping newborn warm prepared.

82. 82

    Procedure for Step 2: Immediate drying:

    Immediately dry newborn with a warm towel/cloth to prevent heat loss from evaporation.

83. 83

    Procedure for Step 3: Skin-to-skin contact:

    Place newborn on mother's chest/abdomen while drying. Cover with a second towel and put on a cap. Keep covered and minimize uncovering during assessments.

84. 84

    When should breastfeeding be initiated?

    As soon as possible, preferably within one hour of birth.

85. 85

    When can weighing and bathing be done?

    Following the period of uninterrupted skin-to-skin contact and the first feed. Bathing soon after birth can cause a drop in body temperature.

86. 86

    Procedure for Step 6: Appropriate clothing/blanket:

    Dress newborn in loose clothing and blanket. After skin-to-skin, dress, apply a dry cap, and wrap in dry warm blankets.

87. 87

    Procedure for Step 7: Mother and newborn together:

    Keep mother and newborn together 24 hours a day (rooming-in) in a warm room (at least 25°C). Feed on demand. Skin-to-skin can be used to rewarm a newborn experiencing mild to moderate hypothermia.

88. 88

    Procedure for Step 8: Warm transportation:

    Keep newborn warm while waiting for transportation. Dress and wrap in blankets if a transport device is used.

89. 89

    Procedure for Step 9: Warm assessment:

    Lay on a warm surface in a warm room. Put under an additional heat source if necessary. Utilize servocontrol if on radiant warmer for >10 minutes.

90. 90

    Procedure for Step 10: Training and raising awareness:

    Alert health care providers and families to risks of hypothermia and hyperthermia. Teach the principle of thermal protection. Provide on-the-job training and supervised practice.

91. 91

    List signs and symptoms of hyperthermia:

    Tachycardia, tachypnea, apnea, Warm extremities, flushing, perspiration (term newborns), Dehydration, Lethargic, hypotonia, poor feeding, Irritability, Weak cry.

92. 92

    What are the consequences of hyperthermia?

    Hypotension and dehydration (due to increased insensible water loss), Seizures and apnea (due to high core temperature), Hypernatremia.

93. 93

    What is the usual approach to managing hyperthermia in a newborn?

    Adjust environmental conditions: move away from heat source, undress partially or fully. Lower incubator air temperature if applicable. Breastfeed frequently to replace fluids.

94. 94

    How should a newborn's temperature be monitored during cooling for hyperthermia?

    Every 15-30 minutes until stable.

95. 95

    What is hyperthermia defined as?

    Body temperature above 37.3°C or 37.5°C.

96. 96

    What are common causes of hyperthermia in newborns?

    Overheating from incubators, radiant warmers, or ambient environmental temperature; Maternal fever; Maternal epidural anesthesia; Phototherapy lights, sunlight; Excessive bundling or swaddling; Infection; CNS disorders (e.g., asphyxia); Dehydration.

97. 97

    What is the thermoregulation sequence?

    If temperature is <36.3°C or >37.2°C axillary, initiate thermoregulation sequence. If temperature is within 36.3°C to 37.2°C axillary, ensure the baby is in an environment where temperature can be controlled.

98. 98

    What actions are taken if a newborn has hypothermia (T < 36.3°C axillary)?

    Place in pre-warmed incubator OR Place on radiant warmer with servocontrol probe set to 36.5°C. Recheck temperature q15 to 30 minutes until stable.

99. 99

    What actions are taken if a newborn has hyperthermia (T > 37.2°C axillary)?

    Undress baby, Remove extra blankets, Decrease incubator/radiant warmer skin or air temperature setting by 0.5°C q15 minutes. Check temperature q15 to 30 minutes until stable.

100. 100

     What actions are taken if a newborn is normothermic (T 36.3°C to 37.2°C axillary)?

     Position baby skin-to-skin with mother, Provide warm hat and blanket, Maintain thermally controlled environment.

101. 101

     What is the treatment for mild hypothermia (body temperature 35-36.3°C)?

     Skin-to-skin contact in a warm room (at least 25°C), Place cap on newborn head, Cover mother and newborn with warm blankets.

102. 102

     What is the treatment for moderate hypothermia (body temperature 32-34.9°C)?

     Under a radiant heater, In a warmed incubator, In a heated water-filled mattress (i.e. KanBed). If no equipment or clinically stable, skin-to-skin contact in a warm room.

103. 103

     What is the treatment for severe hypothermia (body temperature below 32°C)?

     Using a warm incubator (set 1-1.5°C higher than body temp, adjusted as temp increases). If no equipment, skin-to-skin contact or warm room/cot.