maternity 5-3 Flashcards by Amanda S.

Physiologic, Anatomic & Behavioral Adaptations of the Newborn

Establish / maintain respirations
Circulatory changes
Thermoregulation
Regulate weight/blood glucose
Ingest, retain, digest nutrients
Arousal / sleep pattern
Establish relationship with caregivers & environment
Process multiple stimuli

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Fetal Lung Function

largely bypasses lungs
Gas exchange via placenta
Lungs filled with fetal lung fluid

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INITIATION OF BREATHING (CMTS breathes)

Chemical
Mechanical
Thermal
Sensory

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Chemical (chemical chemos) and prostaglandin?

Activation of chemoreceptors in the aorta and carotid arteries by hypoxia/hypercapnia Prostaglandin level drops after cord clamping

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Mechanical (mechanical thorax)

: increased thoracic pressure, lung
expansion with crying, expulsion/absorption of fetal lung fluid

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initiate breathing - thermal (not thermal heat)

cold stimulation

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sensory (sensory touch)

handling, suctioning

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Factors in Neonatal Respiration - what can go wrong - when is surfactant produced?

Vaginal vs. C/S
Surfactant: lipoprotein prevents alveolar collapse
Age (lack of surfactant):
Produced at 24-28 weeks gestation
35 weeks usually full production
Meconium
Anatomical defects: congenital heart diaphragmatic hernia

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Respiratory SystemNormal Newborn Respirations - what is normal rate and rhythm?

Normal rate 30-60 / min
Shallow and irregular

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Abnormal Newborn Respirations

Bradypnea or tachypnea
Abnormal breath sounds
crackles, rhonchi, wheezes, expiratory grunt
Retractions: intracostal/subcostal (high intrathoracic pressure)
Nasal Flaring
Respiratory distress syndrome (RDS): Grunt, Flaring, Retracting***
Cyanosis, mottling
Low pulse oximetry value

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CARDIOVASCULAR CHANGES - what conditions are normal? (just 2)

Shunts close
Pulmonary circulation
Normal HR 110-160
Dysrhythmias common - still tell someone even though they’re normal
Murmur - common
Extra RBC’s

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Fetal Circulation -cheat sheet

Placenta: Site of gas/nutrient exchange

Umbilical Cord: 1 vein (high O2), 2 arteries (low O2)

Umbilical vein delivers O2 to fetus

Liver mostly bypassed: ductus venosis (shunt 1)

High O2 blood: inferior vena cava to R atrium

High O2 blood (majority): R atrium to L atrium via foramen ovale (shunt 2)

High O2 blood: L atrium to L ventricle to ascending aorta

Low O2 blood: R atrium, bypasses lungs via ductus arteriosus (shunt 3) and back to placenta via descending aorta/umbilical arteries.

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Cardiovascular System:
Changes After Delivery - resistence?

Umbilical Vein
Cord clamped
High resistance

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Fetal hemoglobin: - what happens to the cells?

Fetal hemoglobin:
RBC size larger than and adult’s
RBC: greater affinity for O2
After birth:
RBC count increase
RBC cell size decreases

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Newborn hemoglobin and hematocrit levels

(H and H higher in baby than adult)
Hemoglobin (size decreases by # increases): 16-18 g/dL
Hematocrit: 46-68%
Higher after birth and then gradually decline
Destruction of RBCS = greater iron stores

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DELAYED CORD CLAMPINGNew ACOG/AAP guidelines - hemoglobin?

Increases Hgb levels at birth
Improves iron stores

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Assessment of NewbornTransition (think of the pic)

Inadequate perfusion: may be due to respiratory causes, cardiovascular, or both

Assess for: signs of respiratory distress/compromised cardiac function

Assess for: mottling, cyanosis

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MOTTLING OF SKIN (4 things) this mottling is stressing me out

Stress
Respiratory
Cold
can be a sign of Sepsis

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Acrocyanosis - and why does the body do this?

cyanosis in extremities as blood preferentially circulates to organs during extrauterine transition.

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Perioral/Circumoral Cyanosis - associated w/ what? (the circle is transient)

Blue around mouth
In 1st 24 hours associated w/ Transient Tachypnea of the Newborn (TTN or TTNB).
TTNB (transient tachypnea) usually resolves in 24-48 hrs.
Facial bruising may be mistaken for perioral cyanosis

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CENTRAL CYANOSIS - what causes it? (blue baby door)

Hypoxemia
Meconium Aspiration
Pneumonia

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Polycythemia - what disorders cause it? (Poly hall)

Polycythemia can increase more with
delayed cord clamping, diabetes, IUGR, and maternal HTN

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Physiological Jaundice - risk factor for jaundice - blood type (you know this one)

ABO and RH incompatability

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THERMOREGULATION

when the baby is cold, it tries to take in more oxygen
* Immature regulation
ability
* Thin layer of SQ fat
* Blood vessels close to
surface of skin
* Larger “surface-to-body
ratio”

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Newborn response to cold - what body position?

Crying Flexed position Increase muscle activity Acrocyanosis (hands and feet) Unstable blood glucose

Evaporation

Heat loss through evaporation of moisture on the skin.

Convection (convect the breeze)

Heat loss through cooler local air currents

Conduction (conduct my cat)

Heat loss through contact with cooler solid object in contact with the baby

Radiation (radiate towards me)

window pulls heat away. Transfer of heat from to a cooler object not in contact with the baby

AIRWAY/BREATHINGIf infant is crying or breathing on their own - 3 things

Skin to skin Monitor vital signs Bulb Suction PRN (suction mouth, don't use this too much)

If infant is apneic or poor color - do what? (think cold color)

Radiant Warmer Assess HR Clear airway Stimulate Dry vigorously

Remove Secretions

Wipe nose and mouth with gauze to help get rid of excess fluids. Use bulb syringe if neonate had meconium staining. No apparent anomalies.

VS for newborns - how often? (vital signs 4 by 4)

Q30 for the first 2 hours, after 1st 30 min (don't take vital signs in 1st 30 min), the once at 3 hours, and once at 4 hours

Indications for Oxygen (what about heart and cyanosis)

* Increased respiratory effort * Respiratory distress with apnea * Tachycardia * Bradycardia * Central cyanosis

Oxygen and/or Positive Pressure Ventilation - HR? and what type of cyanosis?

Apnea Gasping Respirations HR <100 Persistent Central Cyanosis No response * CAUTION Retinopathy of Newborn

Newborn Initial Head-to-Toe Assessment

Integument: vernix, “stork bites”, vernix, milia, e. toxicum (normal NB rash), congenital dermal melanocytosis (Mongolian spots) Head Face: nose, mouth, eyes, ears Neck, clavicles, and chest Abdomen Genitalia Extremities and spine Neurologic status: see Ricci 5th ed., 18.4 for reflexes

NEWBORN MEASUREMENTS - typical length?

Flat surface Extend leg Length range is 45-55 cm (17.7—21.7 inches) length measurement is not too accurate

BIRTH WEIGHT

< 2500: SGA >4000: LGA (this for a 40 week fetus)

how to ASSESS GESTATIONAL AGE

Maternal Record LMP using Negele’s rule Ultrasound, especially early in pregnancy it's more accurate Gestational Age Exam (Ballard Exam - looks at muscle tone, etc)

vernex

creamy substance on baby's skin from in utero

first 24 hours, document

I/Os

copy slide

NEWBORN SCREENING (hearing, etc.)

Newborn screening Blood test Newborn hearing screen Congenital heart disease screening = “24 hour work-up” (put device on one extremity and the other - measure blood going to and from heart) Blood test + TSB (total bilirubin) + Heart disease screening

hearing screening - Automated Auditory Brainstem Response (AABR) (in the name)

Automated Auditory Brainstem Response (AABR): Tests auditory nerve/brainstem pathways.

preimposed (not to pre-impose, but you're the opposite)

post ductal - blood coming to the heart, deoxygenated blood

discharge teachings

ROUTINE INFANT CARE SIDS SHAKEN BABY CIRCUMCISION CARE WARNING SIGNS/DISCHARGE TEACHING CPR

Discharge Teaching: Routine Care

Temperature Respirations Feeding Pacifiers Infant safety/Safe Sleep Elimination Rashes Clothing Cord Care Bathing Crying

NEWBORN BATH - how long to delay?

WHO: Delay at least 24 hours if possible Delayed bath: linked to higher rates of BRF Vernix: keep on skin for moisturizing/antimicrobial properties Give first bath after umbilical site healed Never leave baby unattended in bath

* Check for bleeding * Void before DC: not required * Petroleum jelly on diaper * Clean with water (no wipes / no soap x 5-6 d)* Check for infection * Do not remove yellow Exudate * Comfort care

SIGNS OF ILLNESS

* Fever * Hypothermia * Poor feeding * Vomiting * Diarrhea * Decreased BM * Decreased urination * Breathing difficulties * Cyanosis * Lethargy * Inconsolable cry * Infected circumcision * Infected umbilical cord * Eye drainage

Gut colonization/mucosal barrier - when does colonization occur? (We colonized in 6 months)

Gut colonization/mucosal barrier development takes 4-6 months Immune system: “immature”

Diaper Rash

* Infrequent diaper changes * Change in diet * Breastfeeding mother eats certain foods * Use plain water / mild soap * Unscented baby wipes, no alcohol * Expose to air to heal * Zinc oxide ointment * Candida yeast Tx

Medical Follow-Up - follow up when?

MD visit within 72 hours after DC * Monitor weight gain * Monitor hydration * Monitor jaundice * Prevent kernicterus

Fetal lung fluid

removed via birth process/reabsorption Gas exchange directly related to cardiovascular function/fetal structures

normal newborn respirations - what sounds and apnea? (rally, that's normal?)

Rales first hour common Abdominal breathers Nose Breathers Short period of apnea < 10 sec “normal”

fetal circulation - Umbilical Cord

fetal circulation - liver

fetal circulation - high 02 path

fetal lung fluid is

filtered amniotic fluid

birth process is

period of anoxia and hypercapnia

when cord is clamped, what happens to pressure in baby's body?

it goes from low pressure to high pressure

what keeps shunts open?

Prostaglandin

* COLD STRESS - what is it?

* COLD STRESS = 02 goes up (increased need for 02 consumption) trying to increase metabolic rate

skin to skin regulates what?

RR in baby

one way babies stay warm

Non-shivering thermogenesis: Metabolism goes up – mainly of Brown Adipose Tissue

immediate care of the newborn (3 things) (ABT)

airway, breathing, temp

first 24 hours of life

very vulnerable time for baby

newborn stomach size

10 -25 mL in the first 24 hours

SIDS

is the leading cause of death among babies from 1 month to 1 year of age. higher w/ formula fed babies.

what age is SIDS most common? (sid is young)

1 month to 4 months old

changes after delivery - Ductus Venosus

Ductus Venosus= Not used

changes after delivery - Foramen Ovale

Foramen Ovale = greater Pressure on the L>R, closes Ductus Arteriosus umbilical artery = circulation stops Contract in response to increase 02 and decrease prostaglandins

delayed cord clamping - circulation?

Improve transitional circulation in preemies and reduces the need for blood transfusions

delayed cord clamping - reduces what disease? (delay the death and hemorrhage)

necrotizing enterocolitis and intraventricular hemorrhage.

central cyanosis - causes of it (PP causes CC at the blue baby door)

PPHN* (persistent pulmonary hypertension of a newborn- lungs aren't inflating normally), Cardiac dysfunction

central cyanosis - early or late sign of distress?

Late sign of distress

normal hematocrit

Normal HCT 51—56 %

hearing screening - Otoacoustic Emissions (OAE) (acoustic hairs)

Tests functioning of outer hair cells.

what happens with glucose initially?

it declines

bilirubin is made of

heme

colonization of gut

takes place in first 24 hours through oral intake

newborn specific gravity (same)

low specific gravity (1.001 to 1.020)

first period

reactivity (reflexes)

second period

decreased responsiveness (sleep)

second period of reactivity

baby wakes up again. may pass meconium.

habituation (habit of vision and hearing)

newborn’s ability to process and respond to visual and auditory stimuli.

fetal growth restriction - less than 28 weeks

symmetrical growth

fetal growth restriction - more than 28 weeks

asymmetrical growth - brain anrd heart are big

risk factors for Polycythemia (Poly plant)

newborns with jaundice and multiple births

meconium aspiration - LGA or SGA

sga

hyperbilirubinemia - LGA or SGA

LGA - bruising during birth trauma

LGA newborns are more difficult to

arouse to a quiet alert state

signs of hypoglycemia in LGA babies - what type of crying - and HR and breathing?

lethargy, irritability, tachypnea, weak crying, temperature instability, jitteriness, apnea, bradycardia, cyanosis, poor feeding

preterm main problem

nutrition

lanugo on preterms

Plentiful lanugo (soft, downy hair), especially over the face and back

post-term babies - appearance

wasted look due to loss of muscle and fat

post-term babies can have (2 things)

polythemia and jaundice

square window (square wrists)

flex hands to wrist

scarf sign

elbow to chest

terms (start w/ late)

Late preterm—born 34 weeks 0/7days through 36 weeks and 6 days Early term—born 37 weeks through 38 weeks and 6 days Full term—born 39 weeks through 40 weeks and 6 days Late term—born 41 weeks through 41 weeks and 6 days Post-term—born 42 weeks and beyond

stork bites

nape of neck, eyelids

mongolian spots

blue lower back and buttocks

Caput succedaneum

pressure from birth, prolonged labor

babinski

stroking bottom of foot

transient tachypnea - cause

from a lack of thoracic squeezing during c-section or CNS depressant for mom

kernicterus

unconjugated bilirubin enters the brain

hypoglycemia numbers

less than 30 mg/dL in first 72 hours of life

how many calories for newborn?

110 to 120/kg of body weight

when is sucking reflex developed?

32 weeks, so if they're born before that, they have issues

SGA - hematocrit and hemoglobin

hematocrit over 65%, hemoglobin over 20

what color is skin of sga babies

ruddy - too many rbcs

acidosis on fetal monitor strip (acid decreases my variability)

decreased variability

polycythemia associated with what skills? (Poly has a Thick tongue and movement)

gross motor skills and speech delays

polycythemia - more of a concern with LGA or SGA? (poly is large)

LGA

behavior patterns

1st period of reactivity: alert and hungry decreased responsiveness: sleepy 2nd period of reactivity: wakes up, temp and RR goes up

blood volume

80-100 mL/kg

maternity 5-3 Flashcards

(116 cards)