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XIO > maternity 5-3 > Flashcards

maternity 5-3 Flashcards

1
Q

Physiologic, Anatomic & Behavioral Adaptations of the Newborn

A

Establish / maintain respirations
Circulatory changes
Thermoregulation
Regulate weight/blood glucose
Ingest, retain, digest nutrients
Arousal / sleep pattern
Establish relationship with caregivers & environment
Process multiple stimuli

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2
Q

Fetal Lung Function

A

largely bypasses lungs
Gas exchange via placenta
Lungs filled with fetal lung fluid

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3
Q

INITIATION OF BREATHING (CMTS breathes)

A

Chemical
Mechanical
Thermal
Sensory

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4
Q

Chemical (chemical chemos) and prostaglandin?

A

Activation of chemoreceptors in the aorta and carotid arteries by hypoxia/hypercapnia Prostaglandin level drops after cord clamping

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5
Q

Mechanical (mechanical thorax)

A

: increased thoracic pressure, lung
expansion with crying, expulsion/absorption of fetal lung fluid

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6
Q

initiate breathing - thermal (not thermal heat)

A

cold stimulation

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7
Q

sensory (sensory touch)

A

handling, suctioning

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8
Q

Factors in Neonatal Respiration - what can go wrong - when is surfactant produced?

A

Vaginal vs. C/S
Surfactant: lipoprotein prevents alveolar collapse
Age (lack of surfactant):
Produced at 24-28 weeks gestation
35 weeks usually full production
Meconium
Anatomical defects: congenital heart diaphragmatic hernia

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9
Q

Respiratory SystemNormal Newborn Respirations - what is normal rate and rhythm?

A

Normal rate 30-60 / min
Shallow and irregular

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10
Q

Abnormal Newborn Respirations

A

Bradypnea or tachypnea
Abnormal breath sounds
crackles, rhonchi, wheezes, expiratory grunt
Retractions: intracostal/subcostal (high intrathoracic pressure)
Nasal Flaring
Respiratory distress syndrome (RDS): Grunt, Flaring, Retracting***
Cyanosis, mottling
Low pulse oximetry value

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11
Q

CARDIOVASCULAR CHANGES - what conditions are normal? (just 2)

A

Shunts close
Pulmonary circulation
Normal HR 110-160
Dysrhythmias common - still tell someone even though they’re normal
Murmur - common
Extra RBC’s

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12
Q

Fetal Circulation -cheat sheet

A

Placenta: Site of gas/nutrient exchange

Umbilical Cord: 1 vein (high O2), 2 arteries (low O2)

Umbilical vein delivers O2 to fetus

Liver mostly bypassed: ductus venosis (shunt 1)

High O2 blood: inferior vena cava to R atrium

High O2 blood (majority): R atrium to L atrium via foramen ovale (shunt 2)

High O2 blood: L atrium to L ventricle to ascending aorta

Low O2 blood: R atrium, bypasses lungs via ductus arteriosus (shunt 3) and back to placenta via descending aorta/umbilical arteries.

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13
Q

Cardiovascular System:
Changes After Delivery - resistence?

A

Umbilical Vein
Cord clamped
High resistance

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14
Q

Fetal hemoglobin: - what happens to the cells?

A

Fetal hemoglobin:
RBC size larger than and adult’s
RBC: greater affinity for O2
After birth:
RBC count increase
RBC cell size decreases

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15
Q

Newborn hemoglobin and hematocrit levels

A

(H and H higher in baby than adult)
Hemoglobin (size decreases by # increases): 16-18 g/dL
Hematocrit: 46-68%
Higher after birth and then gradually decline
Destruction of RBCS = greater iron stores

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16
Q

DELAYED CORD CLAMPINGNew ACOG/AAP guidelines - hemoglobin?

A

Increases Hgb levels at birth
Improves iron stores

+

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17
Q

Assessment of NewbornTransition (think of the pic)

A

Inadequate perfusion: may be due to respiratory causes, cardiovascular, or both

Assess for: signs of respiratory distress/compromised cardiac function

Assess for: mottling, cyanosis

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18
Q

MOTTLING OF SKIN (4 things) this mottling is stressing me out

A

Stress
Respiratory
Cold
can be a sign of Sepsis

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19
Q

Acrocyanosis - and why does the body do this?

A

cyanosis in extremities as blood preferentially circulates to organs during extrauterine transition.

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20
Q

Perioral/Circumoral Cyanosis - associated w/ what? (the circle is transient)

A

Blue around mouth
In 1st 24 hours associated w/ Transient Tachypnea of the Newborn (TTN or TTNB).
TTNB (transient tachypnea) usually resolves in 24-48 hrs.
Facial bruising may be mistaken for perioral cyanosis

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21
Q

CENTRAL CYANOSIS - what causes it? (blue baby door)

A

Hypoxemia
Meconium Aspiration
Pneumonia

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22
Q

Polycythemia - what disorders cause it? (Poly hall)

A

Polycythemia can increase more with
delayed cord clamping, diabetes, IUGR, and maternal HTN

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23
Q

Physiological Jaundice - risk factor for jaundice - blood type (you know this one)

A

ABO and RH incompatability

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24
Q

THERMOREGULATION

A

when the baby is cold, it tries to take in more oxygen
* Immature regulation
ability
* Thin layer of SQ fat
* Blood vessels close to
surface of skin
* Larger “surface-to-body
ratio”

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25
Q

Newborn response to cold - what body position?

A

Crying
Flexed position
Increase muscle activity
Acrocyanosis (hands and feet)
Unstable blood glucose

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26
Q

Evaporation

A

Heat loss through evaporation of moisture on the skin.

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26
Q

Convection (convect the breeze)

A

Heat loss through cooler local air currents

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27
Q

Conduction (conduct my cat)

A

Heat loss through contact with cooler solid object in contact with the baby

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28
Q

Radiation (radiate towards me)

A

window pulls heat away. Transfer of heat from to a cooler object not in contact with the baby

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29
Q

AIRWAY/BREATHINGIf infant is crying or breathing on their own - 3 things

A

Skin to skin
Monitor vital signs
Bulb Suction PRN (suction mouth, don’t use this too much)

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30
Q

If infant is apneic or poor color - do what? (think cold color)

A

Radiant Warmer
Assess HR
Clear airway
Stimulate
Dry vigorously

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31
Q

Remove Secretions

A

Wipe nose and mouth with gauze to help get rid of excess fluids.

Use bulb syringe if neonate had meconium staining.

No apparent anomalies.

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32
Q

VS for newborns - how often? (vital signs 4 by 4)

A

Q30 for the first 2 hours, after 1st 30 min (don’t take vital signs in 1st 30 min), the once at 3 hours, and once at 4 hours

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33
Q

Indications for Oxygen (what about heart and cyanosis)

A
  • Increased respiratory
    effort
  • Respiratory distress with
    apnea
  • Tachycardia
  • Bradycardia
  • Central cyanosis
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34
Q

Oxygen and/or Positive Pressure Ventilation - HR? and what type of cyanosis?

A

Apnea
Gasping Respirations
HR <100
Persistent Central Cyanosis
No response
* CAUTION Retinopathy of Newborn

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35
Q

Newborn Initial Head-to-Toe Assessment

A

Integument: vernix, “stork bites”, vernix, milia, e. toxicum (normal NB rash), congenital dermal melanocytosis (Mongolian spots)
Head
Face: nose, mouth, eyes, ears
Neck, clavicles, and chest
Abdomen
Genitalia
Extremities and spine
Neurologic status: see Ricci 5th ed., 18.4 for reflexes

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36
Q

NEWBORN MEASUREMENTS - typical length?

A

Flat surface
Extend leg
Length range is 45-55 cm
(17.7—21.7 inches)
length measurement is not too accurate

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37
Q

BIRTH WEIGHT

A

< 2500: SGA
>4000: LGA
(this for a 40 week fetus)

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38
Q

how to ASSESS GESTATIONAL AGE

A

Maternal Record
LMP using Negele’s rule
Ultrasound, especially early in pregnancy it’s more accurate
Gestational Age Exam (Ballard Exam - looks at muscle tone, etc)

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38
Q

vernex

A

creamy substance on baby’s skin from in utero

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39
Q

first 24 hours, document

A

I/Os

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40
Q

copy slide

A

68

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41
Q

NEWBORN SCREENING (hearing, etc.)

A

Newborn screening Blood test
Newborn hearing screen
Congenital heart disease screening = “24 hour work-up” (put device on one extremity and the other - measure blood going to and from heart)
Blood test + TSB (total bilirubin) + Heart disease screening

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42
Q

hearing screening - Automated Auditory Brainstem Response (AABR) (in the name)

A

Automated Auditory Brainstem Response (AABR): Tests auditory nerve/brainstem pathways.

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43
Q

preimposed (not to pre-impose, but you’re the opposite)

A

post ductal - blood coming to the heart, deoxygenated blood

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44
Q

discharge teachings

A

ROUTINE INFANT CARE
SIDS
SHAKEN BABY
CIRCUMCISION CARE
WARNING SIGNS/DISCHARGE TEACHING
CPR

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45
Q

Discharge Teaching: Routine Care

A

Temperature
Respirations
Feeding
Pacifiers
Infant safety/Safe Sleep
Elimination
Rashes
Clothing
Cord Care
Bathing
Crying

46
Q

NEWBORN BATH - how long to delay?

A

WHO: Delay at least 24 hours if possible

Delayed bath: linked to higher rates of BRF

Vernix: keep on skin for moisturizing/antimicrobial properties

Give first bath after umbilical site healed

Never leave baby unattended in bath

47
Q
A
  • Check for bleeding
  • Void before DC: not required
  • Petroleum jelly on diaper
  • Clean with water
    (no wipes / no soap x 5-6 d)* Check for infection
  • Do not remove yellow
    Exudate
  • Comfort care
48
Q

SIGNS OF ILLNESS

A
  • Fever
  • Hypothermia
  • Poor feeding
  • Vomiting
  • Diarrhea
  • Decreased BM
  • Decreased urination
  • Breathing difficulties
  • Cyanosis
  • Lethargy
  • Inconsolable cry
  • Infected circumcision
  • Infected umbilical cord
  • Eye drainage
49
Q

Gut colonization/mucosal barrier - when does colonization occur? (We colonized in 6 months)

A

Gut colonization/mucosal barrier development takes 4-6 months
Immune system: “immature”

50
Q

Diaper Rash

A
  • Infrequent diaper changes
  • Change in diet
  • Breastfeeding mother eats
    certain foods
  • Use plain water / mild
    soap
  • Unscented baby wipes, no
    alcohol
  • Expose to air to heal
  • Zinc oxide ointment
  • Candida yeast Tx
51
Q

Medical Follow-Up - follow up when?

A

MD visit within 72
hours after DC
* Monitor weight gain
* Monitor hydration
* Monitor jaundice
* Prevent kernicterus

52
Q

Fetal lung fluid

A

removed via birth process/reabsorption
Gas exchange directly related to cardiovascular function/fetal structures

53
Q

normal newborn respirations - what sounds and apnea? (rally, that’s normal?)

A

Rales first hour common
Abdominal breathers
Nose Breathers
Short period of apnea < 10 sec “normal”

54
Q

fetal circulation - Umbilical Cord

A
55
Q

fetal circulation - liver

A
56
Q

fetal circulation - high 02 path

A
57
Q

fetal lung fluid is

A

filtered amniotic fluid

58
Q

birth process is

A

period of anoxia and hypercapnia

59
Q

when cord is clamped, what happens to pressure in baby’s body?

A

it goes from low pressure to high pressure

60
Q

what keeps shunts open?

A

Prostaglandin

61
Q
  • COLD STRESS - what is it?
A
  • COLD STRESS = 02 goes up (increased need for 02 consumption) trying to increase metabolic rate
62
Q

skin to skin regulates what?

A

RR in baby

63
Q

one way babies stay warm

A

Non-shivering thermogenesis:
Metabolism goes up – mainly of Brown Adipose Tissue

64
Q

immediate care of the newborn (3 things) (ABT)

A

airway, breathing, temp

65
Q

first 24 hours of life

A

very vulnerable time for baby

66
Q

newborn stomach size

A

10 -25 mL in the first 24 hours

67
Q

SIDS

A

is the leading cause of death among babies from 1 month to 1 year of age. higher w/ formula fed babies.

68
Q

what age is SIDS most common? (sid is young)

A

1 month to 4 months old

69
Q

changes after delivery - Ductus Venosus

A

Ductus Venosus= Not used

70
Q

changes after delivery - Foramen Ovale

A

Foramen Ovale = greater Pressure on the L>R, closes Ductus Arteriosus
umbilical artery = circulation stops
Contract in response to increase 02 and decrease prostaglandins

71
Q

delayed cord clamping - circulation?

A

Improve transitional circulation in preemies and reduces the need for blood transfusions

72
Q

delayed cord clamping - reduces what disease? (delay the death and hemorrhage)

A

necrotizing enterocolitis and intraventricular hemorrhage.

73
Q

central cyanosis - causes of it (PP causes CC at the blue baby door)

A

PPHN* (persistent pulmonary hypertension of a newborn- lungs aren’t inflating normally),
Cardiac dysfunction

74
Q

central cyanosis - early or late sign of distress?

A

Late sign of distress

75
Q

normal hematocrit

A

Normal HCT 51—56 %

76
Q

hearing screening - Otoacoustic Emissions (OAE) (acoustic hairs)

A

Tests functioning of outer hair cells.

77
Q

what happens with glucose initially?

A

it declines

77
Q

bilirubin is made of

A

heme

78
Q

colonization of gut

A

takes place in first 24 hours through oral intake

79
Q

newborn specific gravity (same)

A

low specific gravity (1.001 to 1.020)

80
Q

first period

A

reactivity (reflexes)

81
Q

second period

A

decreased responsiveness (sleep)

82
Q

second period of reactivity

A

baby wakes up again. may pass meconium.

83
Q

habituation (habit of vision and hearing)

A

newborn’s ability to process and respond to visual and auditory stimuli.

84
Q

fetal growth restriction - less than 28 weeks

A

symmetrical growth

85
Q

fetal growth restriction - more than 28 weeks

A

asymmetrical growth - brain anrd heart are big

86
Q

risk factors for Polycythemia (Poly plant)

A

newborns with jaundice and multiple births

87
Q

meconium aspiration - LGA or SGA

A

sga

88
Q

hyperbilirubinemia - LGA or SGA

A

LGA - bruising during birth trauma

89
Q

LGA newborns are more difficult to

A

arouse to a quiet alert state

90
Q

signs of hypoglycemia in LGA babies - what type of crying - and HR and breathing?

A

lethargy, irritability, tachypnea, weak crying, temperature instability, jitteriness, apnea, bradycardia, cyanosis, poor feeding

91
Q

preterm main problem

A

nutrition

92
Q

lanugo on preterms

A

Plentiful lanugo (soft, downy hair), especially over the face and back

93
Q

post-term babies - appearance

A

wasted look due to loss of muscle and fat

94
Q

post-term babies can have (2 things)

A

polythemia and jaundice

95
Q

square window (square wrists)

A

flex hands to wrist

96
Q

scarf sign

A

elbow to chest

97
Q

terms (start w/ late)

A

Late preterm—born 34 weeks 0/7days through 36 weeks and 6 days
Early term—born 37 weeks through 38 weeks and 6 days
Full term—born 39 weeks through 40 weeks and 6 days
Late term—born 41 weeks through 41 weeks and 6 days
Post-term—born 42 weeks and beyond

98
Q

stork bites

A

nape of neck, eyelids

99
Q

mongolian spots

A

blue lower back and buttocks

100
Q

Caput succedaneum

A

pressure from birth, prolonged labor

101
Q

babinski

A

stroking bottom of foot

102
Q

transient tachypnea - cause

A

from a lack of thoracic squeezing during c-section or CNS depressant for mom

103
Q

kernicterus

A

unconjugated bilirubin enters the brain

104
Q

hypoglycemia numbers

A

less than 30 mg/dL in first 72 hours of life

105
Q

how many calories for newborn?

A

110 to 120/kg of body weight

106
Q

when is sucking reflex developed?

A

32 weeks, so if they’re born before that, they have issues

107
Q

SGA - hematocrit and hemoglobin

A

hematocrit over 65%, hemoglobin over 20

108
Q

what color is skin of sga babies

A

ruddy - too many rbcs

109
Q

acidosis on fetal monitor strip (acid decreases my variability)

A

decreased variability

110
Q

polycythemia associated with what skills? (Poly has a Thick tongue and movement)

A

gross motor skills and speech delays

111
Q

polycythemia - more of a concern with LGA or SGA? (poly is large)

A

LGA

112
Q

behavior patterns

A

1st period of reactivity: alert and hungry
decreased responsiveness: sleepy
2nd period of reactivity: wakes up, temp and RR goes up

113
Q

blood volume

A

80-100 mL/kg

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