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Flashcards in OB Week 2 Deck (64)
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1

Back and Buttocks

-Straight Spine
-Spina Bifida Occulta-dimple or tuft of hair
-Meningocel (sac with fluid only)
-Meningomyelocele (sac with fluid and spinal cord)

(FOLIC ACID DEFICIT)

2

Neuroligic S x S- 1 A

Reflexes which can dissapear at certain intervals.
-Balinsky
-Plantar/Palmars grasp
-Moro-
-Rooting
-sucking
-reflexes disappear at certain intervals
-Galant reflex-back stroke move hips toward the side
-Tonic Neck Reflex
-Stepping reflex

3

Neurologic Sx S 2 A

-Sensory
- Do eyes track?
-Does infant respond to sound?
-Habituation
-Seizures
-Difficult to recognize because of many extraneous movements
-Maybe caused by acute or chronic conditions (hemorrhage, trauma, infection, brain malformation...)

4

Gestational Exam

EDD is not alway correct only accurate 75-85% of the time.
-Performing a genstation exam helps the nurse evaluate for potential age-related problems. Should be done in the first 4 hours of life.
-Gestation age tools have 2 components:phhysical maturity and neuromuscular maturity.
Most common tool is the New Ballard Score

5

Lab Assessments

-Blood Gluclose->40 mg/dl is normal
-Bilirubin Level-< 12 is normal, Peeks on 3rd day of life
-Newborn Screening Test (NBS)- State required test:
-Phneylketonuri (PKU)
-Hypothyoidism
-Galactosemia
-Hemoglobinopathies

6

Medications

-immediatly after birth;
-Vitamin K injections
-Erythromycin ophthalmic ointment
-Hepatitis B
-CDC recommendations
+All newborns be immunized forHepatitis B
+Neonates who have been exposed to Hep B during birthing should also recive HBIG.

7

Initiation and Maintenance of Respirations

-Lung Development-as a fetus nears birth, fluid begins to move to interstitial space.
-Production of surfactant by 34-36 weeks.
-It's a mixture of lipoproteins
-It reduces surface tension in the alveoli, which promotes lung expansion after birth.
-It keeps alveoli of lungs from collapsing when exhalation occurs.

8

Factors that initiate Respiration
Chemical Factors

DROP in O2 and RISE in CO2 causes impulses to stimulate the respiratory center in the medulla of the brain.

9

Factors that initiate Respiration
Thermal Factors

Abrupt temperature change sends impulses impulses fromskin recepotors to the brain's respiratory center.

10

Factors that initiate Repiration

Mechanical Factors: Fetal chest is compressed during birth, forcing fluid out. Plus, suctioning, holding, sounds, and lights.

11

Factors that maintain respirations

surfactant & functional residual capacity (both the thorax and lung are very complaint, so that the FRC is very small)

12

Cardiovascular Adaption
FETAL CIRCULATION

A combination of structures/vessels that are present only during the fetal period, helps shunt the the highest oxygenated blood to the liver, brain, and heart.

13

ICLICKER
42 WEEKS of gestational age

AT RISK FOR INJURY DURING BIRTH

14

THREE MAIN STRUCTURS of Cardio

-Ductus Arteriosus (Pulmonary Atery to Aorta)
-Foramen Oval (Right Atrium to Left Atrium)
-Ductus VEnosus (Umbilical Vein to interior Vena Cava)

15

Cardiovascular Adaption 2 A

At birth, after the first few breaks, the following cardiovascular changes occur:

16

Cardio
Ductus Arteriosus

Closes in response to INCREAS o2 and DECREASE to resistance in the LUNGS (PDA Murmurs)

17

Pulmonary blood vessels -Cardio

Dilate in response to demand in lungs

18

Foramen Ovale- Cardio

Is forced to close because of increased pressure in the left side of the heart.

19

Ductus Venosis- Cardio

Constricts when umbilical cord is clamped
-Reversal of blood flow:from aorta to pulmonary artery (in the fetus, blood flow: from aorta to pulmonary artery (in the fetus, blood is shunted from the pulmonary artery to the aorta through the patent ductus arteriosus)

20

Apgar Scoring

-Dr. Virtginia Apgar (1909-1974) develop the first scoring system of the Newborn
-The Apgar score description the condition of the newborn infant immediatly after birth.
-scoring is done at 1 minute and 5 minutes of age.
-The Apgar is affected by gestational age, maternal medications, resuscitation, and cardiorespiratory and neurologic conditions.
-There is a need for professional to be consistent in assigning an Apgar score during a resuscitation."

21

Neurologic Adaptation:Thermoregulation

-The maintenance of body temperature is a major task for the NB infant (normal temperatur is 97.7-99.1)

22

Neurologic Adaptation: 1A

Their skin is thin and blood vessels areclose to the surface.
-They have little SQ fat to serve as a barrier to heat loss.
-Their surface area in proportionto body mass is 3x that of adults
-Preterm infnats are especially susceptible to heat loss because their tone is poor and they have even less fat and thinner skin than full term babies.
-Signs of inadequate thermorgulation p 694
-There are 4 ways of Heat loss...

23

Effects of COLD STRESS
Non-Shivering Thermogensis

Initial response, metabolism of Brown fat. This leads to increased production of free fatty acids, which can lead to metabolic acidosis and jaundice.

24

Cold Stress
INCREASE METABLOIC RATE

Leads to INCREASE use of glucose and decrease production of Surfactant. This can lead to hypoglycemia and respiratory distress.

25

Cold Stress
Vasoconstriction

Leads to pale, mottled skin and shut down of pulmonary vessels, which may lead to repiratory distress (fetal ciruclatory patterns)

26

Nuetral Thermal Envirc (NTE)

-NTE helps to prevent heat loss in newborns
- Maintains stable temp without an increase in oxygen or metabolic rate.
-In health unclothed NB's an environmental temp of 89.6 to 92.3 (32'-33.5'C) provides a thermoneutral zone; 24'-27'C if infants is dressed.

27

Hematologic Adaptation
BLOOD VALUES

RBC's NEWBORNS have a higher # of RBC's than adults, and their RBC's than adults, and their RBC's are larger in order to recive adequate O2 to cells.
-Fetal hemoglobin carries 20% - 50% more O2 than adult hemoglobin.

28

POLYCYTHEMIS

.65% is a higher RBC count. It increases risk for jaundice and brain infarct

29

Hematocrit

-Higher than in the adult: 48% -69% is normal when by a heel stick and 65% in venous blood.

30

Hermatologic Adaptation Cont. 1A

WBC- ave is 15,000 mm3 (9,000-30,000/mm3) at birth
-Elevation is normal, because the stress of birth increases production.
-Infection can cause abnormal WBC with large # of immature WBC's (bands)