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2021 OB > normal newborn > Flashcards

normal newborn Flashcards

1
Q

stages of transition to extrauterine life

A
  • first period of reactivity
  • period of decreased responsiveness
  • second period of reactivity
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2
Q

first period of reactivity

A
  • lasts up to 30 min after birth
  • HR = 160-180 bpm
  • RR = 60-80/min
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3
Q

period of decreased responsiveness

A
  • lasts 60-100 min
  • sleepiness and ↓ motor activity
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4
Q

second period of reactivity

A
  • 2-8 hr after birth
  • ↑
    • HR
    • RR
    • muscle tone
    • mucus production
  • may have meconium
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5
Q

meconium

A
  • first stool neonate passess within 24-48 hr of birth
  • dark black
  • sticky
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6
Q

changes in fxn of resp system after birth

A
  • infant must clear fluid that filled lungs in utero, aided by
    • squeezing of chest during labor
    • hormonal changes during labor
  • alveoli collapsed at birth, must be expanded
    • surfactant necessary for expansion
  • resp irregular at birth
  • RR = 30-60/min
  • babies are nose-breathers
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7
Q

acrocyanosis

A
  • normal bluish discoloration of baby’s extremities
  • lasts up to 48 hr
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8
Q

CV changes at birth

A
  • fetal openings that must close
    • foramen ovale
    • ductus arteriosus
    • ductus venosus
  • if not closed, surgical correction needed
  • can lead to complications later in life if not fixed
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9
Q

foramen ovale (RA-LA)

A
  • purpose in utero
    • send high-O2
    • diverts blood from fluid-filled lungs
  • closes soon after birth 2/2
    • ↑ pulmonary blood flow from left side of heart
    • ↑ pressure in left atrium
  • crying can temporarily reverse flow and cause cyanosis
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10
Q

ductus arteriosus (aorta-PA)

A
  • allows OP from RV to bypass lungs
  • closes 24 hr after birth
    • permanent closure within 2-3 mo
    • can reopen before 2-3 mo because of hypoxia, asphyxia, prolonged crying, and pathological problems
  • patent ductus arteriosus: unclosed DA
    • “washing-machine” sounding heart murmur
    • prostaglandin inhibitors: ibuprofen, indomethacin
    • surgery if still not closed
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11
Q

ductus venosus (umbilical vein-IVC)

A
  • allows blood flow from UV to bypass liver and GI tract
  • closes when cord is clamped and converts to ligament by 2-3 mo
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12
Q

RA

A

right atrium

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13
Q

LA

A

left atrium

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14
Q

PA

A

pulmonary artery

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15
Q

RV

A

right ventricle

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16
Q

LV

A

left ventricle

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17
Q

IVC

A

inferior vena cava

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18
Q

UV

A

umbilical vein

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19
Q

neonate normal VS

A
  • HR: 110-160 bpm
    • murmur abnormal if accompanied by
      • poor feeding
      • sweating
      • apnea
      • cyanosis
      • pallor
  • BP: 80/40
    • MAP = GA
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20
Q

MAP

A

mean arterial pressure

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21
Q

normal neonate blood volume

A

80-100 mL/kg

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22
Q

delayed cord clamping (DCC)

A
  • cord clamped 15-45 sec after birth
  • benefits
    • ↑ circulating blood
    • ↑ BP
    • ↓ risk for intravascular hemorrhage, necrotizing enterocolitis
  • can ↑ polycythemia and hyperbilirubinemia
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23
Q

polycythemia

A

excess RBCs

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24
Q

hematologic changes at birth

A
  • ↑ RBCs
    • shorter lifespan, ↓ O2 storage
    • possible anemia @ 4-6 mo
  • ↑ WBCs
    • rapidly ↓ and stabilize
    • limited ability to fight certain bacteria
    • ↑ risk of infection
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25
Q

heat loss

A
  • convection
    • body → ambient air
    • keep away from drafts, vents, foot traffic (any moving air)
  • radiation
    • body → cooler nearby surface
    • keep away from cold exterior walls, windows
    • preheat warmer if using
  • evaporation
    • body → evaporating moisture
    • dry baby well with warm blankets (esp. head)
    • remove wet linen
    • put warmed hat on baby
  • conduction
    • body → cooler surface in contact
    • skin to skin on mom
    • dry with warmed blankets
    • warm stethoscope and hands
    • warm blanket on scale before weighing
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26
Q

neutral thermal environment

A

balance of maintaining appropriate temperature for infants to avoid cold stress, heat stress, hypothermia, and hyperthermia

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27
Q

thermogenesis

A
  • infants’ response to cold
  • burns brown fat
  • babies can’t shiver
  • limited brown fat stores = risk for cold stress
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28
Q

hypothermia in infants

A
  • temp < 97.7F
  • more common than hyperthermia
  • →
    • vasoconstriction: pale and mottled skin
    • ↑ RR to produce heat
    • ↓ O2 to brain
    • respiratory distress
    • hypoglycemia: burning everything to stay warm
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29
Q

hyperthermia in infants

A
  • temp > 99.5F
  • cause: environment or sepsis
  • sweat glands inadequate
  • signs
    • flushed skin
    • warm hands/feet (overheated)
    • cold hands/feet (sepsis)
    • extended posture
  • → neuro injury, sz, heatstroke, death
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30
Q

renal changes at birth

A
  • must record UOP, I/O
    • babies lose body weight after birth
    • times voided = days old
    • check for abd masses
  • immediate follow-up for lack of voiding, masses
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31
Q

GI changes at birth

A
  • gut flora built in first week
    • meconium: first stool, mostly amniotic fluid swallowed in utero; different color, consistency
    • as flora build, color → green, brown, yellow
  • LES immature → risk for GER
    • avoid overfeeding
    • burping important
    • position with head slightly elevated (controversial in NICU)
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32
Q

green emesis

A

indicates volvulus, twisting of bowel

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33
Q

volvulus

A
  • twisting of bowel, usually in sigmoid and ileocecal areas
  • predisposing cause: prolapsed mesentery
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34
Q

projectile vomiting

A

pyloric stenosis

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35
Q

pyloric stenosis

A
  • constriction or narrowing of the pyloric opening
  • nausea, projectile vomiting, dehydration, wt loss, malnutrition
  • happens by about 1 mo
  • firm, round mass in abd palpated, confirmed by US
  • Tx: pyloromyotomy
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36
Q

pyloromyotomy

A

incision of the pyloric sphincter to treat (infantile hypertrophic) pyloric stenosis

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37
Q

hepatic changes at birth

A
  • immature infant liver ↑ risk for hyperbilirubinemia
  • hyperbilirubinemia = > 1.5x normal for age, jaundice
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38
Q

hyperbilirubinemia

A
  • excess of bilirubin in the blood
  • immature liver can’t conjugate bilirubin after breakdown of short-lived RBCs
  • unbound bilirubin crosses BBB → kernicterus
  • monitored if mild-moderate, phototherapy if severe
39
Q

immune system changes at birth

A
  • ↓ circulation Igs
  • ↑ infection risk
  • sources of Igs
    • breastmilk: IgA
    • placenta: IgG
      • immunity for 3 mo
      • ↓ time in utero = ↓ IgG
40
Q

galactosemia

A
  • autosomal recessive disorder
  • inability to metabolize galactose r/t congenital absence of one of two enzymes needed to convert galactose to glucose
41
Q

nursing actions directly after delivery

A
  • dry and stimulate
    • warm blanket/towel
    • replace wet linen with dry
    • apply warm hat
  • physical assess. and APGAR
  • for central cyanosis, dyspnea, lack of vigor
    • reposition head
    • suction with bulb syringe or neo-yankauer
    • supplementary O2
    • call for peds
42
Q

APGAR

A
  • done at 1 and 5 min of life
  • Appearance
  • Pulse
  • Grimace
  • Activity
  • Respirations
43
Q

newborn initial assessment equipment

A
  • sulb syringe: suction mouth, then nose
  • stethoscope: heart and lungs
  • thermometer
  • BP cuff: check for equal in arms and legs
  • scale
  • tape measure
    • cm for charting, inches for parents
    • length
    • head circumference
  • clean gloves
44
Q

neonate initial skin assessment

A
  • color: acrocyanosis normal
  • peeling
  • birthmarks
  • foot/hand creases
45
Q

newborn initial torso assessment

A
  • chest
    • RR
    • breathing effort, symmetry
    • HR/sounds (S1, S2)
    • breath sounds
    • breast tissue
  • abd
    • rounded
    • umbilical cord: AVA
    • palpate for massess
46
Q

newborn initial HEENT assessment

A
  • nose
    • patency
    • alignment
  • head
    • palpate fontanels: soft, open
    • palpate sutures
    • hair: abnormal swirls or patterns (genetic disorders)
  • eyes
    • hemorrhage
    • bruising
    • discharge
    • abnormal epicanthal folds
  • facial symmetry
    • eye/ear alignment
  • mouth
    • color
    • moisture
    • integrity of hard and soft palates
    • sucking/rooting reflex
    • frenulum
    • distinct chin
  • neck: midline with thyroid not palpable
47
Q

newborn initial neuro assessment

A
  • muscle tone
  • reflexes
    • Moro
    • Babinski
    • sucking and rooting
    • palmar/plantar grasp
48
Q

New Ballard Score

A
  • done in first 24-48 hr of life
  • used to assess physical, neuromuscular maturity
49
Q

neonate female genitalia assessment

A
  • integrity
  • may be swollen 2/2 hormones from mom’s blood
50
Q

neonate male genitalia assessment

A
  • intact foreskin
  • palpable testes
  • conditions such as hypospadias
51
Q

hypospadias

A
  • misplaced urethra opening
  • can cause trouble urinating
52
Q

normal newborn VS

A
  • HR: 110-160/min
  • RR: 30-60/min
  • BP: 80/40 (MAP = GA)
  • temp: 97.7F - 99.5F (36.5C - 37.5C)
53
Q

AGA

A

appropriate for gestational age

54
Q

LGA

A

large for gestational age

55
Q

SGA

A

small for gestational age

56
Q

post-term

A

42 wks

57
Q

post-mature

A
  • > 42 wks
  • placenta fails: ↓ O2 and nutrients
  • ↓ wt
  • skin dry and cracked
58
Q

milia

A

small, raised pearly white spots on nose, chin, or forehead

59
Q

Mongolian spots

A

areas of blue, brown, gray, or black pigmentation

60
Q

talngiectatic nevi

A
  • stork bites
  • flat pink or red marks
  • on neck, nose, upper eyelids, forehead
  • go away by 2nd year of life
61
Q

nevus flammeus

A
  • port wine stain
  • capillary angioma below skin
  • red or purple
  • usually on face
  • does not resolve on its own
  • usually only removed if obvious and could cause psychosocial issue
62
Q

erythema toxicum

A
  • newborn rash
  • pink
  • appears suddenly in 1st 3 wks of life
  • anywhere on body
  • resolves on its own
63
Q

cephalohematoma

A
  • collection of blood between periosteum and skull bone
  • doesn’t cross midline
  • from birth trauma
64
Q

caput succedaneum

A
  • localized swelling of soft tissue of scalp
  • crosses midline
  • from birth trauma
65
Q

molding

A
  • normal process
  • newborn skull is flexible
  • molds to fit birth canal
  • gradually regains proper shape
66
Q

subconjunctival and retinal injuries

A
  • caused by ↑ ICP at birth
  • benign
  • will heal in 10-14 days
  • reassure parents
  • report if not healing after a couple of wks
67
Q

bruising

A
  • breech presentation: lower extremities
  • trauma in difficult birth
68
Q

petechiae

A
  • seen in nuchal cord, trauma from squeezing
  • benign of disappear in 48 hr
69
Q

forceps injury

A
  • linear bilateral marks from placement of forceps in assisted birth
  • reassure family
  • usually heal on their own
70
Q

lacerations

A
  • causes
    • scalpel in C/S or episiotomy
    • internal fetal monitoring
  • usually found on
    • scalp
    • butt
    • thighs
71
Q

newborn normal blood counts

A
  • RBC: 4.8-7.1 x 106
  • Hgb: 14-24 g/dL
  • Hct: 44-64%
  • WBC: 9,000-30,000/mm3
  • Plt: 150-300k/mm3
72
Q

normal newborn BG

A

40-60 mg/dL

73
Q

normal newborn bilirubin

A
  • 24 hr: 2-6 mg/dL
  • 48 hr: 6-7 mg/dL
  • 3-5 days: 4-6 mg/dL
74
Q

newborn meds and labs at birth

A
  • vitamin K (IM)
  • erythromycin (ophthalmic ointment)
  • cord blood type and screen
75
Q

newborn meds, labs, and procedures within 24 hr of life

A
  • bathe: leave vernix on for 24 hr
  • labs: draw blood via heel stick or venipuncture
    • PKU
    • glucose
    • Hct
    • bilirubin
  • Hep B vaccine/immune globulin
  • hearing screen
  • CHD screen
76
Q

PKU

A

phenylketonuria

77
Q

phenylketonuria

A

rare inherited disorder that causes an amino acid called phenylalanine to build up in the body

78
Q

CHD

A

congenital heart dz

79
Q

PKU screen

A
  • tests for 35 congenital dz and disorders
  • required by law
  • disorders include
    • PKU
    • cystic fibrosis
    • sickle cell dz
    • galactosemia
    • congenital hypothyroidism
80
Q

circumcision

A
  • ensure consent is signed
  • gather supplies
  • provider performs procedure, nurse assists
  • try to keep newborn calm
  • local anesthesia in groin area
  • Gomco or Plasti-Bell
  • document voiding and teach parents about post-circumsion care
81
Q

types of circumcisions

A
  • Gomco
    • metal clamp and bell stabilize foreskin and glans while provider removes foreskin with scalpel
    • post-care: apply petroleum jelly to area to keep diaper from sticking; check hourly x12 for bleeding
  • Plasti-Bell
    • plastic bell placed over glans, separating it from foreskin; string tied tightly over bell and foreskin occludes blood flow; distal part of foreskin dies and falls off with plastic bell as remaining portion heals
    • post-care: check frequently for infection or oozing; diaper loosely
  • monitor for and report excess bleeding or s/sx of infection
82
Q

criteria for postpartum discharge

A
  • parents can feed and diaper every 3 hr
  • parents can tend to baby when something is wrong/changed
  • normal physical exam, VS, screenings
  • baby fed successfully on regular schedule
  • passed urine/stool
  • no excess bleeding for circumcision site
  • no significant jaundice (follow-up if borderline)
  • 48-hr stay for vaginal delivery
  • 96-hr stay for C/S w/o complications
83
Q

parent education

A
  • check car seat for recalls
    • proper installation/use
    • rear-facing in back seat
  • breast- or bottle feeding
  • temp or signs to bring baby in
  • importance of follow-ups
  • bathing
  • bulb syringe
  • diapering
  • signs of pain
  • CPR
84
Q

bathing education

A
  • sponge bath until cord falls off (10-14 days)
    • keep cord clean and dry
    • check for redness, oozing, bleeding
  • universal precautions
  • be aware of temp and thermoregulation
  • safety precautions
85
Q

feeding education

A
  • breastfeeding: check for appropriate latch, suck, and expression of breastmilk (EBM)
  • bottle feeding
    • if mom not producing, can get consent for donor EBM
    • check respirations, stress cues, ability to express milk from nipple
  • infant is well-fed when
    • sleeping after feed
    • gaining wt
    • 6-8 soiled diapers/day
86
Q

EBM

A

expression of breastmilk

87
Q

kangaroo care

A
  • skin-to-skin contact with baby, which enhances
    • thermoregulation
    • breasfeeding
    • VS regulation
    • ↓ LOS
88
Q

LOS

A

length of stay

89
Q

contraindications for breastfeeding

A
  • HIV/AIDS
  • galactosemia
  • active TB
90
Q

calorie content of breastmilk

A

20 kcal/oz

91
Q

calorie content of formula

A

20-24 kcal/oz

92
Q

galactosemia

A
  • “galactose in the blood”
  • rare, inherited dz in which galactose cannot be broken down, and undigested sugars build up in the blood
  • untreated children who do survive usually fail to grow, are mentally retarded, and have cataracts
93
Q

normal newborn caloric intake

A

110 kcal/kg/day

94
Q

preterm newborn caloric intake

A

150 kcal/kg/day

2021 OB (9 decks)

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