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OB FINAL > Newborn > Flashcards

Newborn Flashcards

1
Q

The First Breath

A

Intrapulmonary fluid absorbed
Reduces pulmonary resistance to blood flow
Facilitates initiation of air breathing

Surfactant
Decreases surface tension within alveoli

Lungs that have fluid dissipate out of tissues when baby is turning in cardinal movements

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2
Q

Cardiopulmonary Transition

A

Increased pulmonary blood volume
Conversion from fetal to neonatal circulation
Skin color
Respiratory rate
Breathing pattern – suction mouth and then nose
Change in pressure from circulatory system

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3
Q

Immediate Newborn Assessment

ABC

A 
ABCs
  Establish airway
  Stimulate neonate to breathe deeply and cry
     Observe respiratory effort, color, muscle tone
     Provide warmth
  Assess heart rate
     Check umbilical cord vessels
     Note obvious abnormalities
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4
Q

APGAR

A 
Activity
Pulse
Grimace
Appearance
Respiration
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5
Q

When a baby is born…

A 
Cord Clamped
Vessels
Vital Signs
Weight
Identification
Measurements
SGA, AGA, LGA
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6
Q

Baby receives two things when they are born…

A

Erythromicin ointment both eyes
Prevents STI’s and other infections baby can get while going through the birth canal

Vitamin K IM Vastus Lasteralis – cannot synthesize in intestines without bacterial flora –> increased risk for hemorrhagic disease

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7
Q

Injuries during delivery (6)

A
  1. Laceration
  2. Fractured clavicle
  3. Shoulder dystocia
  4. Brachial plexus injury – nerves from spine/shoulder are stretched, compressed
  5. Erb’s palsy – hands are turned out
  6. Torticollis – neck muscles contract causing head to turn to one side
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8
Q

Heelstick blood sugar
Indications (4)

Symptoms of hypoglycemia (6)

A 
Pre or Post term
IDM
LGA, SGA, IUGR
Delivery:
   Decelerations
   Nuchal cord
   Meconium-stained amniotic fluid

Sx? jitteriness, hypotonia, irritability, apnea, lethargy, temperature instability

Babies are ALWAYS at risk for Hypoglycemia with diabetic mom

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9
Q

Psychosocial Adaptation

3 periods

A

First period of reactivity – mouth open, moving around, some sounds, turn to breast, quiet and alert, interested, en face position, may latch, moving arms and legs

Period of inactivity/sleep – sleeping for 2 hours, decrease in RR and HR, meconium, bowel sounds

Second period of reactivity – shorter with quiet alert stage, feed, regurgitate

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10
Q

Bonding vs. Attachment

A

Bonding – initial attraction to baby after delivery as parents meet and identify their newborn; e/b talking to baby and gentle touch and enhanced by skin-to-skin

Attachment – establishment of relationship between parent and baby; reinforced through interactions and experiences – reciprocated

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11
Q

Bonding Delayed (6)

A

Using negative terms describing newborn
Discussing newborn in impersonal terms
Failing to call newborn by name – check culture
Refusing to hold newborn
Lack of eye contact with newborn
Increasing length of time of newborn in the nursery

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12
Q

Feeding
How often?
How Long?
Is it enough?

A

How often? 8 to 12 times per day

How long? As long as vigorously sucking, then burp ( switch breast) until too drowsy to suck

Is it enough? For the first week, each day should have one more than the day before, half with stool

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13
Q

Immunological Adaptation

A

Mom vaccinated or exposed
Mom antibodies – active acquired immunity
Baby passive acquired immunity

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14
Q

Initial Assessment

Bathed

A

In first 2 hrs by nursery/postpartum nurse
After assessment, if temp is stable, then baby is bathed (ideally ~6 hr), and double-wrapped in blankets until temp returns to normal x2
Precautions maintained until after the bath.

Baby needs to thermoregulate

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15
Q

Newborn Challenges

A

Hypoglycemia
Hypothermia
Hyperbilirubinemia

Complications
Respiratory Distress
Infection

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16
Q

Gestational Age determined by

A

Ballard score
Dubowitz

Neuromuscular and physical characteristics

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17
Q

Conditions Affecting LGA (8)

A

Large for Gestational Age
Infants over the 90th percentile on the growth chart

Chronic hyperglycemic state 
Transient tachypnea of the newborn
Hypoglycemia 
Hypocalcemia
Hypomagnesemia
Birth injuries
Brachial plexus injuries & Erb’s palsy
Fractures - clavicle
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18
Q

Risk for Unstable Blood Glucose Level (11)

A 
Risk factors:
Infant of diabetic mother (IDM)
LGA 
SGA
Post-term 
Preterm
Hypothermia
Neonatal infection
Respiratory distress
Neonatal resuscitation
Birth stress or trauma
Intrauterine growth restricted (IUGR)
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19
Q

Symptoms of LOW sugar (7)

A 
Jitteriness
Hypotonia
Irritability
Apnea
Lethargy
Temperature
Instability
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20
Q 
Nursing Interventions
Blood sugar (10)
A

Assess blood glucose
Assess vital signs (temperature, RR, HR)
Assess neurological status—observe for tremors, seizures, and specific characteristics in her crying pattern
Initiate early feedings (within the first hour)
Plan interventions to enhance conservation of infant’s energy
Maintain a neutral thermal environment
Administer glucose, calcium, and magnesium as prescribed
Reassess (blood glucose, abnormal vs or other findings)
Monitor calcium and magnesium levels if ordered
Teach normal newborn care

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21
Q

Learning Needs for low blood glucose

A

Provide the family with information about the relationship between gestational diabetes and neonatal risk factors.

Teach the family about the special needs of their baby.

Encourage family to participate in their baby’s care.

Discuss normal family coping and provide anticipatory guidance as to normal responses to expect when dealing with a baby with high risk factors.

Provide information about effective coping techniques.

Give the family information about support groups and additional resources.

22
Q

Thermogenic Adaptation

4 Reasons why newborns are susceptible to cold stress

A

Newborns are homeothermic
Neutral thermal environment (first day might need 2 blankets and 2,3 days might need one, then Tshirt)

Large body area
Limited subcutaneous fat
Limited ability to shiver
Thin skin and blood vessels close to surface

23
Q

Heat loss mechanisms
Convection
Conduction

A

Convection - flow of heat from the body surface to cooler surrounding air
Eliminating drafts such as windows or air conditioning, reduces convection

Conduction – the transfer of body heat to a cooler solid object in contact w baby
Covering surfaces with a warmed blanket or towel helps minimize conduction heat loss

24
Q

Heat loss mechanisms
Radiation
Evaporation

A

Radiation – the transfer of heat to a cooler object not in contact with the baby
Cold window surface or air conditioning; moving as far from the cold surface, reduces heat loss

Evaporation – loss of heat through conversion of a liquid to a vapor
Form amniotic fluid; NB should be dried immediately

25
Q

More prone to Hypothermia… (3)

A

Calorie intake restricted
Infection
Stressors

Cold Stress

26
Q

Conditions Affecting SGA/IUGR

4

A

Hypothermia
Hypoglycemia
Polycythemia – increased erythrocyte count
Pain

27
Q

Risk for Imbalanced Body Temperature: “Cold Stress”

Risk Factors (6)

A

Hypothermia = axillary temperature below 97.7° F

Prematurity
SGA
Hypoglycemia
Prolonged resuscitation 
Sepsis
Neurological, endocrine, or cardiorespiratory anomalies
28
Q

Risk for Imbalanced Body Temperature: “Cold Stress”

Symptoms (9)

A 
Cool skin
Lethargy
Pallor
Tachypnea
Hypoglycemia
Jitteriness
Hypotonia
Irritability
Weak suck
29
Q

What does stress lead to in newborns?

A

In newborns, every stress leads to
hypoglycemia and hypothermia
and then results in respiratory distress

30
Q 
Hyperbilirubinemia
Physiologic
Pathologic
Breastfeeding jaundice
Breastmilk
A

Physiologic jaundice
onset 2 to 3 days after birth; transient
normal hemolysis of RBCs
bruising increases hyperbilirubinemia

Pathologic jaundice
present at birth or within 24 hours
Rh hemolytic, ABO incompatibility

Breastfeeding “jaundice” (dehydration)
onset 2 to 4 days

Breast milk jaundice
onset 7-10 days; peaks at 2 wks – 3 wks

31
Q

Unconjugated vs. Conjugated

A

Unconjugated bilirubin (fat soluble) formed by the normal breakdown of RBCs is unready for excretion.

Conjugated bilirubin (water soluble) has been converted in the liver and is ready for excretion in stool and urine.

50% (term) -> jaundice
≈ 5% elevated enough -> tx

32
Q

Hyperbilirubinemia

Assessment

A

Visual assessment is subjective and unreliable

Assessment
all babies should be assessed with transcutaneous bilimeter
If transcutaneous bili is too high (based on hospital policy) a total serum bilirubin should be drawn
prevent Kernicterus

If transcutaneous bilimeter is not available,
jaundice is assessed during blanching on mid-forehead

Phototherapy bili lamps, bili blanket

33
Q

Pathologic Jaundice

Hemolytic Disease of the Newborn

A 
Rh Antibodies (mom negative, dad positive, positive baby)
ABO incompatibility (type O mom, type A, B, or AB baby)

At risk for development of
Etythroblastosis fetalis
all red blood cells are destroyed

Hydrops fetalis
multi-system failure – anemia that causes HF and edema – babies anemic from destruction of RBCs

34
Q

Breastfeeding Jaundice

Breast milk jaundice

A

Breastfeeding “jaundice” (dehydration)
Onset 2 to 4 days
May need to supplement with formula

Onset 7 days
Peaks at 10-14 days
Reduced production of diphosphoglucuronic acid (UDPGA)glucuronyl transferase inhibits conjugation of bilirubin
Substances in breastmilk may increase absorption of bilirubin from intestine and interfere with conjugation

35
Q

Neonatal Abstinence Syndrome

Behavioral
Feeding
Respiratory
Other signs

A 
Behavioral
Irritability
Jitteriness, tremors
Increased muscle tone
Restlessness
Exaggerated, startle reflex
Prolonged high-pitched cry
Difficult to console
Feeding
Excessive suck 
Uncoordinated suck and swallow
Frequent regurgitation or vomiting
Diarrhea

Respiratory
Nasal stuffiness, sneezing
Tachypnea
Apnea

Other signs
Poor sleeping patterns
Yawning
Seizures
Diaphoresis

Narcan? NO – can result in seizure of baby

36
Q

Nursing Interventions for neonatal abstinence syndrome
Assess for sx of drug withdrawal

Interventions

A

opiates – 48-72 hours
cocaine – 2-3 days
alcohol – within 3-12 hours

Obtain meconium and urine for drug screen
Feeding – more difficult may need to gavage
Rest – keep stimulation to minimum, reduce noise and lights, calm, slow approach
Promote bonding
Teach measures for frantic crying: rock, coo, dark room, avoid stimulation
Finnigan score to wean off medication

High risk for if mom is using
SGA
Preterm

37
Q

Circumcision

Normal signs and symptoms post op

A

What influences the parents’ decision to have their newborn circumcised?

“Pending circumcision”
Surgical procedure - consent
Pre-op
   Stable VS
   NPO 
Pain management
Post-op complications
    Exudate with no scab; purulent drainage = HCP
Teaching
38
Q

Health Promotion & Disease Prevention (7)

A

What needs to be done?

Car Seat Challenge
Hearing Screening
LATCH
Newborn Screening (ex. PKU)
Pulse Oximetry
Transcutaneous Bilimeter
Vaccination: Hepatitis B
39
Q

Newborn Teaching

Family centered

A 
Newborn care	
Dressing/Clothing
Diapering, Circumcision care
Bathing
Feeding and diet
Solid foods
Bottle feeding
Safety
Back to Sleep
Vaccinations
Car seat
Normal growth & development
Safety
Normal appearance and activity
Signs and management of illness
Prevention
Temperature
Treatments
40
Q

SIDS

A

“Crib Death” Sudden Unexpected Infant Death (SUID)

Unexplained death of infant >1 month

41
Q

Decreasing the Risk of SIDS (7)

RISK FACTORS

A 
Maternal smoking during pregnancy
Use of soft bedding
Sleeping prone
Sibling w/SIDS
Infections
Prematurity
Low birth weight

Back to sleep prone to play

42
Q

Encourage…

A

Role model

Plagiocephaly

43
Q

Purpose of Well-Child Visit

A 
Immunizations
Anticipatory Guidance
Assessment of Growth
Assessment of Developmental 	Milestones achieved
SAFETY
44
Q

Breastfeeding

Contraindications (chronic diseases, meds, newborns)

A

Chronic disease
HIV positive
Active Tb, leprocy
Herpes lesions on breasts

Meds
Chemo, nuclear dx testing, lithium, prozac, celexa, drugs

Contraindication
Newborn with PKU

Talk to moms – need to keep their weight up; not the time to lose weight

45
Q

Hazards of Cold Stress (6)

A 
Increased oxygen need
Decreased surfactant production
Respiratory distress
Hypoglycemia
Metabolic acidosis
Jaundice
46
Q

Kernicterus

A

Bilirubin crosses into brain and stains brain tissue
No tests to verify
Causes CP and inability to form emotional attachments

47
Q

Caput Succedaneum

A

Area of localized edema that appears over vertex or head as a result of pressure against moms cervix – crosses sutures

48
Q

Cephalhematoma

A

Bleeding between periosteum and skull as the result of pressure during birth – clear edges at end of suture lines

49
Q

Vernix caseosa

A

Thick, white and covers body

50
Q

Milia

A

Tiny white bumps that commonly appear on a baby’s face.

51
Q

Lanugo

A

fine, soft hair, especially that which covers the body and limbs of a human fetus or newborn.

OB FINAL (8 decks)

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