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OB > OB Test 2: The Newborn > Flashcards

OB Test 2: The Newborn Flashcards

(60 cards)

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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
What it NTE
Neutral thermal environment | T: 97.7 - 99.4 F
25
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
26
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
27
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
28
What is suck and swallow
Required for nutrient intake
29
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
30
Why is Vitamin K important in the GI system
Need for clotting factor and synthesized by factors in GI tract
31
What is meconium
Within 24-48 hours Black, tarry, sticky bowel movement Colostrum is slightly laxative
32
What are the different hepatic adaptations?
Iron storage, glycogen and bilirubin conjugation
33
How long can iron be stored in the hepatic systems?
Upto 6 months
34
What is bilirubin conjugation?
Fat soluble and not excreted . | If is fat soluble can cause jaundice
35
What are the different types of newborn immunity?
Weak inflammatory response | Maternal IgG and IgA
36
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
37
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
38
When are newborn assessments done?
``` At birth Upon admission By physician APGAR done at 1 and 5 minutes Continuous throughout the day ```
39
What would be normal finding in the physical assessment and what are you looking for?
General appearance | Weight is 7.5 lbs, 34 g
40
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
41
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
42
What should you expect for head examination?
Open sutures Fontanels open and flat Fetal scalp electrode
43
What are findings of head trauma?
Molding Caput succedoneum Cephalhematoma
44
What is caput saccedoneum?
Swelling of the soft tissues in back. Soft, squishy, edema, move across sutures, increase risk of jaundice
45
Cephalhematoma, what is it?
Bleeding into periosteum of skull bones | Look carefully if delivered by forceps
46
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
47
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
48
What do you look for in female genitalia?
Labia: does labia major or labia minor Discharge or vernix present Pseudomenstration: due to mothers hormones
49
What do you look for in male genitalia?
Testes down, block inguinal to palate | Where urethra located, foreskin retractable, fluid filled
50
How do you test for developmental hip dysplasia?
Bend knee, fold thigh on abdomen and rotate hips out to see if it clicks
51
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
52
What are normal finding you may see in newborn skin?
Lanugo: fine hair Milla: pimples Round nose Mottling: blue extremities
53
What is erythema toxicum?
Flat red rash with vesicles (fluid filled bump)
54
What is Telangiectic Nevi?
Stork bite on the back of the neck
55
What are Mongolian spots?
Dark spots on body Document so doesn't look like you bruised the baby Fade
56
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
57
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
58
What are the behavioral characteristics of newborn?
Habituation: get used to a stimuli Orientation: attend and follow stimulus Consolability: suck thumb Cuddle
59
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 ```

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