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OB > OB Test 2: The Newborn > Flashcards

OB Test 2: The Newborn Flashcards

0
Q

What is the first period of reactivity

A

First 30 minutes after birth.
Alert and hungry
Heart rate may go upto 180
Should allow this time for breast feeding and bonding

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1
Q

When is the neonatal transition period? Ad what are the periods?

A
  • first 8 hours after birth
  • first period of reactivity
  • sleep period
  • second period of reactivity
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2
Q

Sleep period

A

Heart rate and motor activity decrease as they sleep

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3
Q

Second period of reactivity

A 
4-8 hours post birth
Baby awake and ready to feed
If bottle fed, this is the first feeding
May pass meconium
Active body parts
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4
Q

Why is the neonatal period so important

A

Go from intrauterine cardiopulmonary circulation to doing it themselves

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5
Q

What are the different indicators of respiration?

A 
Surfactant
Stimulation
Periodic breathing
Apnea
Respiratory distress
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6
Q

What’s the most important initial step for a newborn

A

For the baby to start breathing

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7
Q

What is surfactant and what is the ratio?

A

Have to have stimulation to breath can be from chemical, CO2 increase and thermal stimulation

L:S ratio is 2:1

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8
Q

What is periodic breathing?

A

Irregular respirations

May have pauses upto 20 seconds, no color changes

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9
Q

What is apnea?

A

Pause longer then 20 seconds and requires stimulation

No neurological development

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10
Q

What is respiratory distress?

A

1 is tacipnea

30-60 respiratory rate
Look for nasal flaring as baby uses accessory muscles

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11
Q

What is the cardio pressure before birth? And after birth?

A

High pulmonary vascular resistance: lungs full of water
Low systemic vascular resistance: little resistance to blood leaving heart
Pressure in heart is right to left

Low pulmonary vascular resistance: full of air so not much resistance
High systemic vascular resistance
Pressure is left to right

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12
Q

What is a foremen ovale?

A

Hole between atria of the heart that closes 1-2 hours post birth
Pressure increases on left side that closes due to pressure change

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13
Q

What is the ductus arteriosus?

A

Connects aorta to pulmonary vein so it goes to across the aorta before in the lungs
Close within 15 hours of birth due to high oxygen levels

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14
Q

What is the heart rate in cardiovascular transition

A

100-160

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15
Q

What is the blood pressure in cardiovascular transition

A

60-80/40-50mm Hg

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16
Q

What is a PDA murmer?

A

Common because it takes time for ductus arteriosus not closed
Happens between S1 and S2

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17
Q

What is the neonatal hemoglobin blood value?

A

80% blood cells carry this

Higher at 14-24 g/dL

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18
Q

What is the hematocrit neonatal blood value?

A

Higher than 44-64%

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19
Q

What is the WBC neonatal blood value?

A

18,000 at birth and 24,000 the next day.
Better indicator is a crp (c-reactive protein)
Don’t have good inflammatory response

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20
Q

What is neonatal blood value blood group and type

A

Established 4 months of gestation. Check rH factor.

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21
Q

What are the two types of thermogenesis

A

Non-shivering thermogenesis

Neutral thermal environment

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22
Q

What is non-shivering thermogenesis

A

Do not regulate temperature well
This is why we use radiant Warmers
Increase activity
Brown fat metabolism

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23
Q

What is brown fat metabolism

A

Newborns metabolize it for heat
By shivering up glucose and oxygen
When heat up fat end up with acidosis

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24
Q

What it NTE

A

Neutral thermal environment

T: 97.7 - 99.4 F

25
Q

What is cold stress

A

Can be fatal
Increased CO2 levels
Hyper bilirubin causes jaundice
Size and amount of adaptor tissue, gestational age and birth weight determine how he thermoregulates

26
Q

What are the four heat loss mechanisms?

A

Evaporation
Conduction: cold touching warm skin
Convection: air current, maintain nursery temp at 80, keep away from window
Radiation: not in direct contact with

27
Q

What are important milestons in the newborn renal system

A

First void within 24 hours
Pale urine
Document their first void
Kidney immature so not concentrated well

28
Q

What is suck and swallow

A

Required for nutrient intake

29
Q

What is the glucose for the GI system

A

Levels 50-60 and increase 60-70 as baby feeds
Do blood glucose at birth
If <45 have standing order for glucose water

30
Q

Why is Vitamin K important in the GI system

A

Need for clotting factor and synthesized by factors in GI tract

31
Q

What is meconium

A

Within 24-48 hours
Black, tarry, sticky bowel movement
Colostrum is slightly laxative

32
Q

What are the different hepatic adaptations?

A

Iron storage, glycogen and bilirubin conjugation

33
Q

How long can iron be stored in the hepatic systems?

A

Upto 6 months

34
Q

What is bilirubin conjugation?

A

Fat soluble and not excreted .

If is fat soluble can cause jaundice

35
Q

What are the different types of newborn immunity?

A

Weak inflammatory response

Maternal IgG and IgA

36
Q

What is a weak inflammatory response?

A

When the newborn is ill and their temperature falls and if they have infection they do not have inflammation

37
Q

What is maternal IgG and IgA?

A

IgG: cross over to fetus in third trimester but preterm baby does not get it
IgA: transmitted through breast milk and good against respiratory tract infection

38
Q

When are newborn assessments done?

A 
At birth
Upon admission
By physician 
APGAR done at 1 and 5 minutes
Continuous throughout the day
39
Q

What would be normal finding in the physical assessment and what are you looking for?

A

General appearance

Weight is 7.5 lbs, 34 g

40
Q

What are the newborn vital signs that are expected?

A

Heart Rate: 110-160, listen for full minute, listen for murmur, up to 180 If crying
Blood pressure: done once
Respirations: 30-60 and irregular
Temperature: stabilizes at 12 hours, worry about cold stress, auxiliary preferred over rectal

41
Q

What are expected newborn measurements?

A

Length: 16-22 inch
Body size: 1/3 of it is head circumference which is 12 and half and 14 and half
Abdominal measurements done at level of umbilicus

42
Q

What should you expect for head examination?

A

Open sutures
Fontanels open and flat
Fetal scalp electrode

43
Q

What are findings of head trauma?

A

Molding
Caput succedoneum
Cephalhematoma

44
Q

What is caput saccedoneum?

A

Swelling of the soft tissues in back. Soft, squishy, edema, move across sutures, increase risk of jaundice

45
Q

Cephalhematoma, what is it?

A

Bleeding into periosteum of skull bones

Look carefully if delivered by forceps

46
Q

What do you expect to find in a face examination?

A

Eyes: check for conjunctival hemmorages, red reflex, blink reflex
Ears: low set indicates retardation
Nose: newborns obligate nose breathers, some have coanal atrichia (can’t breathe)
Mouth: look for teeth or Epstein pearls

47
Q

What is the examination of the trunk?

A

Neck: can be webbed, head lag
Clavicles: fraction is common birth injury
Chest: symmetrically, round nipples, bowel sounds, palate masses, clamped cord
Abdomen: hernia is umbilicus pouches out

48
Q

What do you look for in female genitalia?

A

Labia: does labia major or labia minor
Discharge or vernix present
Pseudomenstration: due to mothers hormones

49
Q

What do you look for in male genitalia?

A

Testes down, block inguinal to palate

Where urethra located, foreskin retractable, fluid filled

50
Q

How do you test for developmental hip dysplasia?

A

Bend knee, fold thigh on abdomen and rotate hips out to see if it clicks

51
Q

What are malformations of the legs, spine and hands?

A

Legs: curved in
Spine: spinedabifida is dimple at spinal base or small patch of hair, risk for meningitis
Hands: polydectomy is extra digits,
symdactemy: digits fused together

52
Q

What are normal finding you may see in newborn skin?

A

Lanugo: fine hair
Milla: pimples Round nose
Mottling: blue extremities

53
Q

What is erythema toxicum?

A

Flat red rash with vesicles (fluid filled bump)

54
Q

What is Telangiectic Nevi?

A

Stork bite on the back of the neck

55
Q

What are Mongolian spots?

A

Dark spots on body
Document so doesn’t look like you bruised the baby
Fade

56
Q

What are the neurological behaviors you expect to find?

A

Moro reflex: startle, hands come into “c”
Tonic reflex:turn head in direction you turn they should stretch sides. Fencing look
Rooting reflex: touch cheek to side and open mouth
Babinski reflex: toes fan out, if in adult they have brain damage

57
Q

What are the newborn sleep wake states?

A

Deep sleep: have no response
Calm/alert: good time for breathing and learning
Active alert: good time for breathing and learning
Screaming: not good time to learning

58
Q

What are the behavioral characteristics of newborn?

A

Habituation: get used to a stimuli
Orientation: attend and follow stimulus
Consolability: suck thumb
Cuddle

59
Q

What is a newborns sensory ability?

A 
Vision: prefer faces, see shape and colors, exhibit crossed eyes
Hearing: 12-2; hours post birth
Smell: moms breast milk
Taste: suck harder in sweeter things
Touch

OB (10 decks)

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