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Women's Health > 09/02/2015 Lecture > Flashcards

09/02/2015 Lecture Flashcards

1
Q

When is the neonatal period?

A

first 28 days of life

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2
Q

What are the two major systems that have to adapt during the neonatal period?

A

1) Respiratory System
2) Cardiovascular system

  • most transitions happen within first 6-10 hours
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3
Q

Where is the site of gas exchange for the fetus? for the newborn?

A

1) fetus - placenta

2) newborn - lungs

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4
Q

What happens to the newborn’s circulatory system after birth?

A

3 shunts close up (ductus venosis, foramen ovale, ductus arteriosis), umbilical arteries/vein gone

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5
Q

what does the ductus venosis do? foramen ovale (why is this important)? ductus arteriosis?

A

1) bypass the liver
2) puts blood directly into left atrium to circumvent pulmonary circuit (blood then goes into left ventricle and into left aorta) -> allows blood to get to baby’s body as efficiently as possible b/c lungs don’t work yet
3) connects pulmonary artery to aorta allowing blood to bypass pulmonary circuit

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6
Q

What is the umbilical vein?

A

carries o2 blood from placenta to fetus

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7
Q

what is PDA?

A

patent ductus arteriosis, means it never closed when transition cardiovasc system from fetal to newborn

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8
Q

what will HR be for first half-hour of life?

A

160-180 HR

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9
Q

Newborn heart rate should be how many BPM? What should you be able to palpate in newborn?

A

at LEAST 100, should be able to palpate PMI at 3rd or 4th intercostal space and left of midclavicular line; pulses 2+ is normal

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10
Q

Is it normal to have a transient normal in newborn?

A

yes, wooshing sound from foramen ovale still closing off and you’re hearing the result of that

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11
Q

What is blood volume dependent on in newborn

A
  • amount transferred from placenta at birth

- when the physician clamps the umbilical cord (early, 3 minutes

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12
Q

is late or early cord clamping beneficial?

A

late, anemia precention, increased BP, improve cardiopulmonary adaptation, improved o2 transport and RBC flow

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13
Q

What is nature’s first stem cell transplant?

A

cord blood, can potentiate into any cells the body needs

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14
Q

Newborn Blood values

A 
Hg: 17-23 gm/dL
Hct: 46-86%
Platelets: 100k - 350k
RBC: 4.5-7.0
WBC: 10-30k (elevation from trauma of going through birth)
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15
Q

What are the respiratory system adaptations?

A

1) surfactant: lipoprotein that will keep alveoli from collapsing
2) initiation of respirations: adjusting from flui-filled intrauterine enviro to gaseous extrauterine

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16
Q

Who has the most trouble making initial respirations?

A
  • premature babies, baby’s not delivered vaginally
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17
Q

How does a vaginal birth help with respiratoins?

A
  • coming out the baby’s lungs get squeezed and when outside of the uterus, the lungs naturally expand and suck in air and help to initiate first breath
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18
Q

What are environmental stimuli that help kickstart the baby’s systems?

A
  • lighting
  • sound
  • temperature
  • wet to dry
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19
Q

what’s the measurement of blood gases in the newborn like?

A

higher CO2 level and lower O2 concentration of blood

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20
Q

What are the signs of resp distress in the newborn?

A

1) nasal flaring
2) Intercostal or subcostal retractions
3) Grunting: a little bit more like a sigh/small fart sound/laboured exhale
4) Chest and abdomen not moving together with breathing (See-saw respirations)

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21
Q

How do we classify apnea in the newborn?

A
  • periods of apnea have to be greater than 15 seconds, because the newborn has very abnormal breathing patterns which is normal (called periodic breathing)
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22
Q

What’s the normal respiratory rate for the newborn?

A

30-60 breaths/minute

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23
Q

how do newborns thermoregulate?

A

heat production: primarily through non-shivering thermogenesis
heat loss: caused by lots of factors
- thin skin with vessels close to surface
- little subQ fat
- can’t change posture

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24
Q

can newborns shiver?

A

not really, limited stores of metabolic substrates

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25
Q

do newborns have a large body surface area? what does that mean?

A

yes, large SA in terms of body weight, means lots of heat loss

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26
Q

what are the 4 mechanisms of heat loss for the newborn?

A

1) conduction (contact)
2) Convection (air)
3) evaporation (water evaporation, why we dry babies)
4) radiation (cold exterior spaces like cold walls/windows)

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27
Q

what can hypothermia in the baby cause in a newborn?

A

cold stress

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28
Q

What can cold stress cuase?

A

1) respiratory distress: to produce heat there’s an increase in need for O2 to raise body temp, so increased RR, pulmonary vasoconstriction can occur and blood pH goes down
2) exacerbate hyperbilirubinemia: more anaerobic glycolysis leads to increase production of acids which displace bilirubin from albumin-binding sites
3) hypoglycemia: anaerobic glycolysis uses more blood glucose which depletes them

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29
Q

what is brown fat?

A

specialized type of fat in babies that is very vasculature and can help boost heat BUT there’s very little of it so can be burnt through quickly

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30
Q

To create heat what do babies need to put into their bodies? what does this cause?

A

O2, higher RR

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31
Q

What’s the best way to maintain temperature in a newborn?

A

skin-to-skin with mom or dad (can then cover baby with a blanket)

*** if mom or dad not there put them under radiator warmer in nursery

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32
Q

what is thermogenesis

A
  • an attempt to generate heat
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33
Q

<p>what are the two causes of hypothermia ***need to look up if it's hyperthermia on slides***(s/s?)</p>

A

<p>1) environmental cause - skin vessel dilate and appears flushed - skin is warm to touch - infant's posture is of extension 2) sepsis causation - skin vessel constrict and baby appears pale - hands and feet are cool to the touch</p>

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34
Q

so when the placenta is lost at birth, the maternal glucose supply is cut off (baby’s glucose = 70-80% of mom’s), what organ compensates for this in the first 24 hours of life?

A

the liver releases glucose from glycogen stores

- initiate early feeding assistance

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35
Q

What are the three different ways jaundice can happen in newborn?

A

1) overproduction of bilirubin
- RBCs being broken down very fast in newborn release heme groups resulting in increased levels of bilirubin
2) decreased conjugation
- not being made into form that the body can excrete, indirect or fat-soluble bilirubing needs to be made into a form that’s water-soluble to be excreted
3) impaired exretion

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36
Q

for how long can a newborn’s iron stores last for?

A

4-6 months

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37
Q

What’s do we do to combat jaundice? how can you tell if they’re getting jaundice other than color?

A

1) we start feeding them more and bilirubin then excreted through stool
2) baby gets really sleepy

38
Q

how often does visible jaundice occur in newborns? when does jaundice peak?

A

in more than half of healthy newborns; day 3 or day 4 of life

39
Q

what AE can jaundice in a newborn cause?

A

neuro damage

40
Q

what can bilirubin overproduction be caused by?

A

RH or ABO incompatibility, drugs , trauma at birth, polycythemia, delayed cord clamping, and breast milk jaundice

41
Q

what can decreased bilirubin conjugation be caused by?

A
  • physiologic jaundice, hypothyroidism, and breastfeeding
42
Q

what can cause impaired bilirubin excretion?

A
  • biliary obstruction, sepsis, chromosomal abnormalities (Turner syndrome, Trisomy 18, 21), and various drugs
43
Q

how much do we need to initially feed a newborn?

A

30-90 mLs and first day just 30mL

44
Q

does the gut have normal flora? what does this mean?

A

no, can’t form vitamin K which prevent clotting, so with eyes and thighs that’s the thigh part where we give a shot of vitamin K into thigh

45
Q

how can we test for drug abuse in mother?

A

can test the first meconium passage

46
Q

What’s meconium and what does it look like?

A

first stool of newborn, sticky

47
Q

Stool paterns of breast-fed and forumla-fed newborns?

A

breast-fed: yellow-gold, loose, stringy to pasty, sour-smelling

formula-fed: yellow, yellow-green, loose, pasty or formed, unpleasant odor

48
Q

what stool would a nurse expect to find a 1-week old newborn?

A

yellow-gold loose stool

49
Q

within which timeframe should first void occur?

A

within 24 hours after birth

50
Q

until what age do the kidneys have a limited ability to concentrate urine?

A

until about 3 months of age

51
Q

how many voids do you expect with a newborn?

A 
1st day- 1 void
2nd- 2 void
3rd day - 3 voids
etc etc
then from 6th and on 6-8 voids a day
52
Q

Purposeof immune system in newborn

A

1) defense
2) homeostasis
3) surveillance

53
Q

Do babies have natural immunity?

A

yes some

54
Q

What are the immunoglobulins from acquired immunity

A

IgG: 80% of circulating antibodies - crosses placenta, fights bacteria, bacterial toxins and viruses
IgA: 2nd most abundant (what we see in breast-milk)
IgM: in blood and lymp-fluid, help against bloodborne pathogens

55
Q

What is the integument of a newborn like?

A

thin (eg we don’t use bandaids b/c can cause damage to skin)

56
Q

When do sweat glands become fully functional?

A

2-3 years of life

57
Q

What direciton does development go in newborn?

A

cephalocaudal, proximal -> distal

58
Q

What’s the least developed sense in the newborn?

A

vision, can only focus on things 7-12 inches away

59
Q

What is the period of reactivity?

A

birth to 30 minutes after life

  • newborn is alert and moving and may appear hungry
  • RR and HR elevated
60
Q

what is the period of decreased responsiveness

A

30 min to 120 min of age

- sleep or decreased activity

61
Q

What is the period between 2-8 hours of life?

A

Second period of reactivity

  • shows interest in environment
  • HR and RR increase
  • peristalsis increases and may pass first meconium
  • interaction encouraged
62
Q

what is orientation and what is habituation?

A

1) oreintation:

2) habituation: ability to hear things and tune them out

63
Q

some other newborn behavioral responses are

A

motor maturity, self-quieting ability (consolability), social behaviors (cuddling/snuggling)

64
Q

What does the first and second assessments include after birth?

A

1st

  • in birthing room
  • vital signs, APGAR, length/weight, and eyes/thighs

2nds

  • must be within first 24 hours
  • head to toe, gestational age assessment, anthropometric measurements, and reflex testing
65
Q

Signs of prblem during initial newborn assessment

A
  • generalized cyanosis (acrocyanosis is normal, when extremities bluish)
  • don’t want to see flaccid body posture
  • abnormal vitals
  • nasal flaring
66
Q

look up Apgar score

A

lkljlkj

67
Q

what is lanugo?

A

fine downy hair grown inutero, usually gone when they’re born so if baby has lanugo then probably pre-term

68
Q

how do we measure temp in the newborn?

A
  • axillary, rectal can be tricky b/c lining is sensitive
69
Q

what is HR of newborn

A

120-160

70
Q

what’s the BP of newborn

A

50-75 systolic and 30-45 diastolic, usually not part of assessment and only performed when ordered

71
Q

how and when do we measure pulse ox in the newborn

A

r hand and either foot, after 24 hours of life

72
Q

know the new ballard score system: physical maturity

A

there’s ano`wther new ballard we don’t need to know just fyi

73
Q

what is recoil

A

when you pull pinna and it snaps back, in pre-term baby there’s a lack of recoil (look up)

74
Q

what is the role of the nurse during delivery?

A

1) maintain airway
2) ensure proper identification
3) admin prescribes meds (vitamin K, eye prophylaxis)
4) maintaining thermoregulation - dry off right away, wrap
5) newborn assessment

75
Q

what does the eye prophylaxis do?

A

prevents opthalmia neonatorum which can cause neonatum blindness

76
Q

how do you want to give the vitamin K shot to the baby?

A

STRAIGHT down into the vastus lateralis b/c no adipose tissue in newborn so at an angle will cause it to hit the bone

77
Q

look up how to do a newborn asessment on slides

A

too much info

78
Q

what is group B strep?

A

normal flora that some women have and some do not and can cause sepsis in the newborn

79
Q

what’s the expected length for a full-term baby

A

19-21 inches

80
Q

know differences between LGA AGA and SGA

A

LGA: weight >90%
AGA: 10% 90%
SGA: less than 10th percentile

81
Q

if baby’s legs are spread in the air, what does that mean?

A

was a breached baby and legs were like that in utero

82
Q

what is vernix caseosa

A
  • formed by secretions of fetus’ oil glands, need not be removed entirely, thick white cheasy looking substance, usually seen more on premie baby
83
Q

what are milia

A

unopened sebaceous glands, mostly on nose chin and forehead

84
Q

what is erythema toxicum

A

known as newborn rash
70% of newborns develop it
- some speculate occurs in healthy newborns b/c it’s an immune response to being touched

85
Q

what is nevus simplex

A

also known as stork bites or salmon patches, concentration of immature blood vessels

86
Q

nevus flammeus

A

“port wine stain” most often on face, permanent lasers to lighten should be done in first year of life to have best results

87
Q

nevus vasculosus

A

or strawberry hemangioma

- benign capillary hemangioma`

88
Q

if you have a lot of cafe au lait or a really big one what oculd that be associated with

A

neuro disorder

89
Q

does a cephalhematoma cross sutures?

A

no, a caput succedaneum does

90
Q

what’s the rule of thirds

A

from outer canthus to inner canthus should be one third the width of face (?)

Women's Health (9 decks)

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