OB Test 2: The Newborn Flashcards
What is the first period of reactivity
First 30 minutes after birth.
Alert and hungry
Heart rate may go upto 180
Should allow this time for breast feeding and bonding
When is the neonatal transition period? Ad what are the periods?
- first 8 hours after birth
- first period of reactivity
- sleep period
- second period of reactivity
Sleep period
Heart rate and motor activity decrease as they sleep
Second period of reactivity
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
Why is the neonatal period so important
Go from intrauterine cardiopulmonary circulation to doing it themselves
What are the different indicators of respiration?
Surfactant Stimulation Periodic breathing Apnea Respiratory distress
What’s the most important initial step for a newborn
For the baby to start breathing
What is surfactant and what is the ratio?
Have to have stimulation to breath can be from chemical, CO2 increase and thermal stimulation
L:S ratio is 2:1
What is periodic breathing?
Irregular respirations
May have pauses upto 20 seconds, no color changes
What is apnea?
Pause longer then 20 seconds and requires stimulation
No neurological development
What is respiratory distress?
1 is tacipnea
30-60 respiratory rate
Look for nasal flaring as baby uses accessory muscles
What is the cardio pressure before birth? And after birth?
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
What is a foremen ovale?
Hole between atria of the heart that closes 1-2 hours post birth
Pressure increases on left side that closes due to pressure change
What is the ductus arteriosus?
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
What is the heart rate in cardiovascular transition
100-160
What is the blood pressure in cardiovascular transition
60-80/40-50mm Hg
What is a PDA murmer?
Common because it takes time for ductus arteriosus not closed
Happens between S1 and S2
What is the neonatal hemoglobin blood value?
80% blood cells carry this
Higher at 14-24 g/dL
What is the hematocrit neonatal blood value?
Higher than 44-64%
What is the WBC neonatal blood value?
18,000 at birth and 24,000 the next day.
Better indicator is a crp (c-reactive protein)
Don’t have good inflammatory response
What is neonatal blood value blood group and type
Established 4 months of gestation. Check rH factor.
What are the two types of thermogenesis
Non-shivering thermogenesis
Neutral thermal environment
What is non-shivering thermogenesis
Do not regulate temperature well
This is why we use radiant Warmers
Increase activity
Brown fat metabolism
What is brown fat metabolism
Newborns metabolize it for heat
By shivering up glucose and oxygen
When heat up fat end up with acidosis
What it NTE
Neutral thermal environment
T: 97.7 - 99.4 F
What is cold stress
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
What are the four heat loss mechanisms?
Evaporation
Conduction: cold touching warm skin
Convection: air current, maintain nursery temp at 80, keep away from window
Radiation: not in direct contact with
What are important milestons in the newborn renal system
First void within 24 hours
Pale urine
Document their first void
Kidney immature so not concentrated well
What is suck and swallow
Required for nutrient intake
What is the glucose for the GI system
Levels 50-60 and increase 60-70 as baby feeds
Do blood glucose at birth
If <45 have standing order for glucose water
Why is Vitamin K important in the GI system
Need for clotting factor and synthesized by factors in GI tract
What is meconium
Within 24-48 hours
Black, tarry, sticky bowel movement
Colostrum is slightly laxative
What are the different hepatic adaptations?
Iron storage, glycogen and bilirubin conjugation
How long can iron be stored in the hepatic systems?
Upto 6 months
What is bilirubin conjugation?
Fat soluble and not excreted .
If is fat soluble can cause jaundice
What are the different types of newborn immunity?
Weak inflammatory response
Maternal IgG and IgA
What is a weak inflammatory response?
When the newborn is ill and their temperature falls and if they have infection they do not have inflammation
What is maternal IgG and IgA?
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
When are newborn assessments done?
At birth Upon admission By physician APGAR done at 1 and 5 minutes Continuous throughout the day
What would be normal finding in the physical assessment and what are you looking for?
General appearance
Weight is 7.5 lbs, 34 g
What are the newborn vital signs that are expected?
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
What are expected newborn measurements?
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
What should you expect for head examination?
Open sutures
Fontanels open and flat
Fetal scalp electrode
What are findings of head trauma?
Molding
Caput succedoneum
Cephalhematoma
What is caput saccedoneum?
Swelling of the soft tissues in back. Soft, squishy, edema, move across sutures, increase risk of jaundice
Cephalhematoma, what is it?
Bleeding into periosteum of skull bones
Look carefully if delivered by forceps
What do you expect to find in a face examination?
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
What is the examination of the trunk?
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
What do you look for in female genitalia?
Labia: does labia major or labia minor
Discharge or vernix present
Pseudomenstration: due to mothers hormones
What do you look for in male genitalia?
Testes down, block inguinal to palate
Where urethra located, foreskin retractable, fluid filled
How do you test for developmental hip dysplasia?
Bend knee, fold thigh on abdomen and rotate hips out to see if it clicks
What are malformations of the legs, spine and hands?
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
What are normal finding you may see in newborn skin?
Lanugo: fine hair
Milla: pimples Round nose
Mottling: blue extremities
What is erythema toxicum?
Flat red rash with vesicles (fluid filled bump)
What is Telangiectic Nevi?
Stork bite on the back of the neck
What are Mongolian spots?
Dark spots on body
Document so doesn’t look like you bruised the baby
Fade
What are the neurological behaviors you expect to find?
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
What are the newborn sleep wake states?
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
What are the behavioral characteristics of newborn?
Habituation: get used to a stimuli
Orientation: attend and follow stimulus
Consolability: suck thumb
Cuddle
What is a newborns sensory ability?
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
