OB - Module 8 Flashcards
When is kidney function complete in the neonate? when is it functioning at the adult level?
35 weeks; 2 years
What eliminates waste from the fetus?
Placenta. Kidneys produce the urine
How much does a baby urinate after birth?
1-3 mg/kg/hr within the first 24 hours
Why are infants at risk for fluid loss?
Increased water loss, kidneys cannot handle fluid overload, and urine dilutes like an adult, but they only have half the ability of adults to concentrate urine
What is the normal intake of fluid for infants?
40-60ml/kg daily the first 2 days, and 100-150 ml/kg after.
How many times does an infant void?
atleast 1-2 during first 2 days, atleast 6 by the fourth day.
What is Mogan/Gomco?
Physician cuts the foreskin off, administering lidocain (anesthetic), and applying vaseline after cutting as well as cleaning.
Circumcision education
Change the gauze pad, apply more vaseline after diaper change, and REPORT bleeding greater than the size of a quarter.
What is Plastibell?
plastic ring is put over the penis that collects foreskin and a thin thread is tied that cuts off the foreskin in 7-10 days. the ring then falls off with little risk of bleeding
Acrocyanosis
Normal. Hands and feet are blue
Vernix
Normal. Protective cheesy stuff around the baby
What are mongolian spot\s
Bruise-like marks found on the back/buttocks that are NORMAL
What are Nevus simplex, flammeus, and vasculosus
Flat pink area located anywhere on the head as a result of capillary dilationl; permanent purple birthmark that can be removed by laser; Rough, red collection of capillaries that appears as a raised surface and disappears in time.
Cafe au lait spots
Permanent light brown spots found anywhere on the body. Report 6+ spots greater than 0.5 cm as it can indicate neurofibromatosis.
Lanugo
Fine, thin hair on the infants body that protect them and disappears. NORMAL
Milia
Tiny, white bumps that are immature sebaceous glands. NORMAL
Erythema toxicum
Short-lasting benign rash. NORMAL
Polydactyly
Extra digit
What is an indicatiion for down’s syndrome?
Simian crease. single crease across the palm
True club foot
cannot move foot into neutral position. requires extensive treatment.
Moveable club foot
can manipulate into place
Three immunoglubulins involved in the neonate immune system. Roles?
IgG - Passive immunity, given by mother
IgM - First one produced, does not cross placenta. high levels indicate infection in utero.
IgA - Does not cross placenta, but comes through breastmilk colostrum. protects from GI/respiratory infections
6 behavioral states
Quiet sleep, active sleep, drowsy, quiet alert, active alert, crying.
Sleep, drowsy, alert, crying. Infant moves to these states in THIS ORDER.
Best time to breast feed?
Quiet alert. Have to do before they reach crying stage.
Infant nutritional intake
110-120kcal/day and water. Average newborn takes in 19-21 oz/day. breastfeeding q2-3hrs, bottle fed q3-4hrs.
What is formula typically made of?
80% are made of cow’s milk others are of soy
Infant feeding education
NO MICROWAVE, don’t prop it up, head slightlyelevated
Does breastmilk cause allergies?
NO
When should a mother not breastfeed?
Active TB, Hepatitis B,C, HIV, or taking certain drugs as it passes through the breast milk.
Conditions for Newborn screening
Heel Stick, special card paper, no milk for 24 hrs prior, atleast 48 hrs old.
Blood volume of full term newborn
85-100 ml/kg, depending on time of cord clamp
Benefits of late and early cord clamping
Late - extra blood volume opens lungs, enriches iron stores, and increases pulmonary perfusion
Early - Extra blood volume from late increases heart workload and risk for jaundice
Newborn blood facts
More erythrocytes and higher hemoglocin and hematocrit (H&H) but shorter life span for RBCs.
Infant Hematocrit
> 65 indicates risk for respiratory distress and jaundice
What is given after birth?
Vitamin K 1 mg 1 hour after birth.
Pallor indicates
Hypoxia or anemia
Plethora
Ruddy skin color that indicates polycythemia. Confirmed by hematocrit >65 and at risk for jaundice.
When does the infant stomach empty? (poop)
2-4 hrs after feeding. Perstalsis is very rapid
Effect of long intestines in newborns
prone to water loss with diarrhea
When are bowel sounds present in newborns?
within 1st hr
Newborn digesion
Cannot digest complex carbs, no saliva production, but enzymes and saliva begin to appear by 36 weeks.
Function of liver in infant
Blood glucose maintenance (stored as glycogen in liver), conjugation of billirubin, iron storage.
Glucose for newborn
45-60. Hypo or Hyper is anything below or above.
Signs of hypoglycemia
Jitteriness. sweating, tachypnea, low temperature, HI PITCHED CRY, irritability, coma. Can also be asymptomatic.
Where to heel stick?
Very bottom of heal, farthest side.
Why are infants at risk for jaundice?
Liver is immature and cannot conjugate billirubin.
What happens when hematocrit is >65?
Hemolysis of excessive erythrocytes releasing billirubin. causes Jaundice!
Difference between Physiologic and Pathologic jaundice
Physiological: result of IMMATURE LIVER and RBC hemolysis. Normal in infants 1st 24 hours of life, 3-4 days after delivery. BEGINS IN THE FACE AND MOVES DOWN THE BODY.
Pathlogical: Occurs within 24 hours of life and the billirubin increases above physiological jaundice.
Breastfeeding jaundice
Occurs with inadequate intake, poor hydration, and delay in elimination.
True Breast milk jaundice
Occurs within 4-7 days from substances in brreast milk that interfere w/ conjugation. Treated by discontinuing breastfeeding, pumping milk, and phototherapy.
Thermoregulation interventions
Dry infant, radiant warmer, skin to skin
Medications given after birth
Eye (Erythromycin) antibiotic ointment, vitamin K injection in vastus lateralis to reduce risk of hemorrhagic disease
Normal vitals
Temp: 97.7-99.5 Pulse: 120-160 Resp: 120-160 BP: 70/45 (not usually taken) Glucose: 40-60
Normal measurements
Weight: 2500-4000gm, 5’8 oz - 8’13 oz
Length: 48-53 cm
Head: 33-35.5 cm
Chest: 30.5.33cm
LGA and SGA
Large/Small for gestational age. Large is above 90th percentile, Small is below 10th percentile
Surfactant role
Keeps alveoli open during first breath. produced after 22 weeks, lines and protects alveoli and reduces surface tension. By 34 weeks, there is enough to breath without difficulty
Respiratory assessment
COUNT FOR 1 FULL MINUTE. rapid, shallow, irregular respirations with pauses from 5-10 seconds are normal
Signs of respiratory distress
Tachypnea, retractions, flaring of nostrils, grunting, seesaw respiration (asymmetric chest), Central Cyanosis
Difference between Central and Acrocyanosis
Central involved the lips, tongue, and trunk while acro is only legs and feet.
What openings close after birth?
Ductus arteriosus and Ductus venosus, and foramen ovale
How often do you assess cardiovascular (heart sounds, pulses)?
q30 mins until stable for 2 hrs
How do infants lose heat?
Evaporation, Conduction (something cold touches skin), Convection (drafts, A/C) , Radiation (heat transferred to cooler objects without skin contact).
How do infants maintain heat?
Moving (flexion), oxidation of brown fat,
Effect of cold stress (hypothermia-ish)
Requires more o2/glucose, increased metabolism (to maintain heat), decreased Surfactant/glycogen/brown fat.
Effect of Hyperthermia
Requires more o2/glucose, causes vasodilation, water/fluid loss
How often is temperature assessed?
q30 mins until stable for 2 hrs
Babinski reflex
Stroke lateral sole of foot from heel to base and toes should flare out. Abnormal :No response
Moro reflex
Startle! Arms extends and it looks like a big hug.
Grasp reflex
Baby squeezes what’s in the hand or toes curl forward when on foot.
Difference between Seizure and Tremor.
Tremors (jitteriness) stops when baby is held or low glucose/calcium is fixed (feeding). It is a seizure if this persists with abnormal eye movements.
Chignon
Normal collection of fluid under the skin (looks like a bump on the head). Resolves itself within a few days
Caput succedaneum
Normal form of chignon that is a result of pressure from the cervix. Resolves itself within a few days
Cephalhematoma
Collection of blood under periosteum (bump on the head) that increases risk for jaundice. Resolves itself within a few days.
What vessels are in the umbilical cord?
2 small arteries and 1 large vein, If less or more, it’s abnormal!
What is the significance of Wharton’s jelly in a thin cord or it having a yellow-brown/green tinge
Thin cord = Poorly nourished
Yellow-brown/green tinge = Meconium release prior to birth.
