OB exam 2 Newborn
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What is considered the neonatal period?
birth-28 days of life
What is the focus of nursing care in the newborn? How can this be done?
- to protect and support the newborn;
- maintaining body/ thermoregulation
- maintaining respiratory function
- decrease risk for infection
- assist parents in providing appropriate nutrition and hydration
- assist parents in learning care of infant
At birth lungs are filled with amniotic fluid; how much is forced out during birth? what happens to the remainder of the fluid? most fluid is absorbed withing how many hours? How many hours until all fluid absorbed?
- 30 mL is forced out at birth
- The remainder is absorbed through pulmonary circulation and lymphatic system
- Most is absorbed within two hours
- Completely absorbed within 12-24 hours
What causes the initiation of respiration?
- Mechanical stimuli: theory that labor process is primarily responsible for initial movement of fluids out of lungs
- Chemical stimuli: transitory asphyxia d/t cessation of placental gas exchange
- decreased PO2(mild hypoxia)
- increased PCO2 (hypercapnea)
- Decrease pH
- Stimulation of respiratory center in medulla
- stimulation of respirations
- Thermal Stimulation: Drop in environmental temperature
- Sensory Stimuli: Fetus leaves a dark, sound dampened, fluid filled environment
- experiences touch, light, sounds and gravity for first time
What are the two types of respiratory cells and what do they do? What are the two parts of surfactant?
- Type 1: Gas exchange
- Type 2: produces surfactant
- The two parts of surfactant are: x
What is a noraml L/S ratio? What does a normal level mean?
2:1 and denotes mature lungs with reduced incident of RDS
What is the pathway that the birth breath causes that leads to co2 and o2 exchange in the lungs?
- first breath
- increase in alveolar oxygen tension (PaO2) decrease in arterial pH
- increase in dilation of pulmonary arteries
- decrease in pulmonary vascular resistance
- increase in blood flow through pulmonary vessels
- increase in oxygen and carbon dioxde exchange in lungs
What are the manifestations of respiratory distress in the newborn?
- apnea > 15 seconds
- nasal flaring
What influences transition to neonatal circulation?
- the changes in the respiratory system
- decreased pulmonary vascular resistance --> and increase in pulmonary blood flow
- Increased systemic vascular resistance --> cardiovascular changes
Normal newborn loses how much the amount of heat as an adult? There is a need for balance between heat lost to environment and heat production. Heat production requires what two things? What is the relationship with subQ fat and heat loss? What position decreases heat loss? poor thermoregulation is due to what primarily?
- newborn loses 4x amt of heat
- Heat production requires both Oxygen use and increased metabolic rate(glucose consumption)
- The lesser the amount of Sub Q fate = increased heat loss
- The flexed position decreases heat loss
- poor thermo is due to heat loss rather than poor production
What are the two major routes of heat loss?
- inner core to body surface
- body surface to environment
How does the newborn respond to cold?
- increases metabolic rate
- increases muscle activity
- peripheral vascular resistance
- metabolism of brown adipose fat (BAT)
Why is a neutral thermal environment important?
- Maintains body temperature with minimal metabolic changes and oxygen consumption
- decreases possible complications
What is the process of thermoregulation in the newborn?
non-shivering thermogensis; unique heat production of newborns; they use stored brown adipose fat to produce heat; the do not shiver
When does BAT appear? How long does it grow for? Where is it located?
- BAT appears @ 26-30 weeks
- continues to grow until 2-5 weeks after birth unless it used early due to premature birth
- locate: midscapular, neck, axillas, trachea, esophagus, abdominal aorta, kidneys and adrenal glands
What is convection? Nursing interventions?
Body heat loss due to cooler air currents
What is evaporation? Nursing interventions?
Body heat loss when fluid evaporates off infants skin; via expired air when breathing
What is radiation? Nursing interventions?
Body heat transferred to cooler surfaces and objects not in direct contact with infant;
What is conduction? Nursing interventions?
body heat transferred to cooler surfaces and objects that are in direst contact with infant.
What is cold stress? Nursing actions?
excessive heat loss--> hypothermia --> increase in O2 consumption, depletion of glucose and a decrease in surfactant which --> respiratory stress
What is considered hemoconcentrated in newborns?
Hemoglobin 14-20gm/dL and hematocrit 43-63%
What does blood volume depend on?
- Age: term infant has ~ 80ml/kg; total amount of blood in infant after birth influenced by amount of placental transfusion after birth
- Cord clamping: increases amount of blood in infant if delayed until pulsing stops
- Milking of cord: increases amount of blood in infant
- Neonatal height: infant held below level of placenta after birth can increase amount of blood in infant
Metabolic system. There is a large amount of glucose stored by fetus before birth. When does glucose drop? stabilize?
- glucose levels drop within first hour of life
- glucose levels stabilize by 2-3 hours after birth
What is the optimal range for glucose? What is considered hypoglycemia?
- optimal range: 70-100 mg/dL
- hypoglycemia: <40
How much of the abdomen does the liver occupy in the newborn? What are the functions of the liver?
- liver occupies 40% of abdominal cavity.
- Functions include: x
- Carb metabolism
- amino acid and lipid metabolism
- synthesis of plasma proteins
- blood coagulation
- conjugation of bilirubin
- phagocytosis by Kupffer cells (macrophages)
- storgae of fat-soluble vitamins
The liver metabolizes carbs; what does it do with glucose?
converts excess glucose to glycogen; storage of glycogen is 2x that of an adult; converts glycogen to glucose when blood glucose levels are low
Liver stores fat soluable vitamins such as?
For how long is pancreatic amylase lacking? what does it do? When is GI system mature? Why are proteins easier to digest than fats? Why can anoxia cause meconium in amniotic fluid?
- 1st few months
- GI system is mature @ 36-38 weeks
- Proteins are easier digested than fats due to poor activity of pancreatic lipase
- anoxia stimulates peristalsis
What is the stomach capacity initially? By day 7? When can Bowel sounds be heard? how many calories a day does a newborn need to gain weight? What % of weight loss in first few days is considered normal?
- initially: 5-10mL
- by day 5: 60mL
- (cardiac sphincter is immature)
- Bowel sounds: 30-60 minutes
- in order to gain weight: 120/kcal/kg/day
- Weight loss: of 5-10% is considered normal in first few days of life
What is the GFR in newborns? Why is it matter? What are the newborns at risk for due to GFR? When do most infants void by? What is pseudomenstruation and what causes it?
- GFR in newborns: decreased
- Decreased GFR: newborn is less able to concentrate urine put him at risk for over hydration, dehydration and electrolyte imbalance
- Infants usually void by: 24 hours
- Pseudomenstruation: Bloody vaginal discharge of newborn caused by withdrawal of maternal hormones
How do babies receive IgG? IgA? IgM?
- IgG: Passive immunity; largest group which passes easily through placenta
- IgA: does not cross placenta; newborns produce after 4 weeks of age; colostrum is high in igA
- IgM: Active immunity; produced by fetus in response to antigen; elevated levels at birth may indicate exposure to an intrauterine infection
What are the implications to consider with immunologic adaption of the newborn?
- signs and symptoms may be subtle
- poor hypothalmic response to infection; therefore fever is not a reliable indicator
- hypothermia may actually indicate infection
neurologic/sensory adaption. When is eye movement present? Growth is_________ which means what? What objects can the infant see? What colors does the infant prefer? What reflexes are present? What kind of movements of the extremities are seen?
- Eye movements are present: at birth
- Growth is: cephalocaudal
- The infant is able to see: close objects
- the infant prefers: black and white as well as human faces
- The reflexes that are present: moro/startle, grasping, rooting, babinski, sucking, tonic neck
- Movements: are purposeless, uncooridnated bilateral movements of extremities
newborn senses. How far can the infant see? Can the infant her? feel pain? taste? Smell?
- Vision: 10-12 inches (orientation alert infant able to follow and fixate on complex visual stimuli)
- Hearing: able to hear
- Touch: feels pain
- Taste: able to differentiate taste by 1-2 days of life
- Smell: can pick out own mom by 1 week
What is lanugo? vernix caseosa? mongolian spots? milia? stork bites? Port-wine? Strawberry marks? Erythema toxicum?
- Lanugo: dawny hair
- Vernix: whitish substance to protect skin
- mongolian spots: bluish discoloration on buttocks (usually present in african americans)
- Stork bites:
- Strawberry marks: capillary hemangioma; raises, dark red rough surface; grows rapidly, reaching full size by 1-3 months and then begins to shrink and resolve spont
- erythema toxicum: Appear suddenly; 24-48 hours of age; no treatment needed
Head. molding from delivery process. What is caput succedaneum? What is a Cephalhematoma? What is the function of the fontanels? How big is the head?
- Caput succ: swelling of soft tissue of the scalp
- Cephalhematoma: a collection of blood beneath the periosteum of the cranial bone; does not cross suture line
- Fontanels: protect head during delivery and allow for further brain growth
- The head: is 1/5 pf the infants height
- The facial features are small
What is the tool used to determine gestational age? What is it based on?
Ballard scale; based on physical and neuromuscular characteristics
What is a circumcision? What is used for pain? What are the advantages to doing one? disadvantages? What is a gomco clamp? plastibell clamp? Mogen clamp?
- It is the removal of the foreskin of penis.
- Sucrose and a local anesthetic can be used for pain relief
- Advantages: possible prevention of cancer, fewer UTIs; fewer STDs
- Disadvantages: infection; hemorrage
- Gomco: a clamp used for the procedure; penis is wrapped with gauze; observe for bleeding, infection and trauma
- plastibell: foreskin is tied over a fitted plastic ring; rim falls off in 5-8 days
- mogen: used by trained rabbi
What are the aspects of newborn care?
- Inital assessment
- Routine assessments
- initiation of feeding: breast asap
- parent infant bonding
- infection prevention
What is the newborn discharge teaching?
- hearing test
- newborn screening
- bilirubin screening
- shaken baby
- car seat safety
What types are screening are state mandated?
screening for disorders that have therapy that can prevent many if not all of the disabilities that would result if let untreated;
Which screenings are required in PA?
- Congenital Adrenal Hyperplasia: defect in an enzyme that lead to dehydration, shock and death
- Congenital hypothyroidism: poor growth, mental dehydration
- Galactosemia: cannot digest part of a protein which leads to mental retardation and death
- Sickle cell and other hemoglobin diseases.
- (7/1/09 supplemental conditions mandate 22 additional conditions to be screened)
Newborn medications. What is phytonadione? what is it given for? Erythromycin? Hep B vaccine?
- Phytonadione (vit K):
- Erythromycin Opthalmic Ointment:
- Hep B: if exposed, Hep B vaccine and hepatitis immune globulin withn 12 hours of birth. 1st dose recommended before discharge; 2nd dose at 1-2 months of age; 3rd dose 6-18 months
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