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Exam 3: Maternity

Newborn Care

The three major fetal shunts that close at birth are the ductus venosus, foramen ovale, & ductus arteriosis
this closes with clamping and cutting of cord ductus venosus
this closes when increased pulmonary blood returns to left atrium: pressure increases in the left atrium (permanent closure takes several months) foramen ovale
constricts as oxygen level increases in the arterial blood: permanent closure starts at approximately 3-4 weeks of age ductus arteriosus
what becomes the organ of gas exchange at birth? the lungs
an increase in _____ clears the lungs by decreasing secretion of lunch fluids and increasing their absorption through the lymphatic system catecholamines
APGAR stands for appearance, pulse, grimace (reflex irritablity), activity, & respiratory efforts
in utero, RBCs are approximately _____ r/t low oxygen saturation 5-7.5 million
After birth, RBCs _____ until 8-10 weeks of age decrease
hemoglobin level after adaptation 15-20 grams
hematocrit level after adaptation 43-61%
platelet level after adaptation 100,000-200,000
WBCs after adaptation 10,000-30,000
the ability to produce heat and maintain body temperature thermoregulation
process of heat generation includes the following 4 things: vasoconstriction, increased metabolic rate, increased muscular activity, & non-shivering thermogenesis
this is accomplished by brown fat & increased metabolic activity in the brain, heart, & liver: heat produced by intense lipid metabolic activity: brown fat appears 26-30 wks gestation & lasts for 5 weeks after birth non-shivering thermogenesis
location of brown fat shoulders, axilla/thorax, lumbar area, & kidneys
heat loss when water is converted to vapor is called _____ (wet body @ birth, bathing) evaporation
transfer of heat to cooler surface not in contact with skin is called _____ (walls of isolette. placing a cold object in isolette, equipment in crib) radiation
transfer of heat from body to cooler surface through direct contact is called _____ (cool scales, hands, mattress, blankets) conduction
flow of heat from body to cooler air (A/C, unheated oxygen, unstable room temp) convection
an immature liver hinders _____ coagulation
the gut is _____ at birth sterile
______ is given at birth vitamin K
glucose levels should be between _____ 50-60 mg
neonatal stress depletes _____ glycogen stores
respiratory distress, apnea, lethargy, tremors, hypothermia, bradycardia, death results of low glucose
water soluble, converted form, which is secreted by colon and kidneys conjugated bilirubin
fat soluble, unconverted form, derived from the breakdown of RBCs unconjugated bilirubin
produces jaundice and can cause kernicterus: value at birth less than 3mg, 4-13 mg within 3 days bilirubin
golden yellow and sweet smelling, passes within 4 days of age breast fed stool
soft, pale yellow, & malodorous, irritating to the skin, passes within 4 days of age formulated fed stool
what percent body weight is extracellular fluid? 40%
what percentage of total body weight is excreted each day? 20%
immunoglobulin that crosses placenta, immunity against bacterial toxin, lasts weeks to months IgG
elevation of this immunoglobulin indicates exposure to TORCH infection IgM
this immunoglobulin is found in colostrum, protects respiratory & GI tract IgA
perform physical assessment in a _____ manner cephalocaudal
respirations should be between ______ 30-60/min
heart rate should be between _____ 120-160 (100-100: sleeping, 180: crying)
temperature should be between _____ 97.7-98.6 F (axillary)
blood pressure should range between _____ 60-80/40-50
maneuvers used during the physical exam to assess the hips for dysplasia Ortolani and Barlow maneuvers
dorsal surface opening on male genitalia epispadius
ventral surface opening on male genitalia hypospadius
very still with regular breathing & strong stimuli needed to awaken deep or quiet sleep
some movement, irregular breathing, and easier to arouse but returns to sleep REM sleep
occasional eye opening with glazed appearance, irregular breathing, and easy to arouse drowsy state
optimum state of arousal alert state (quiet alert)
very active, may be fussy and irritable, and increased sensitivity to disturbing stimuli active state (active alert)
increased motor activity, eyes tightly closed, grimaces present, extreme response to unpleasant stimuli crying state
what test is performed after first breast milk or formula feeding: a state mandated screening test usually done @ discharge PKU (phenylketonuria)
how many calories should the newborn get per day? 110
how much fluid should the newborn get per day? 80-100 ml
how much protein should the newborn get per day? 2-2.5 grams
how much iron should the newborn get per day? 6 mgs
how much urine output should the newborn put out per hour? 1 cc (ml)
how long does a breast feeding usually last? and how often should you breast feed? usually 3-5 minutes (sometimes up to 10 minutes): every 2-3 hours on demand
how long does a bottle feeding usually last? and how often should you bottle feed? usually give 30 ml, then burp: every 3-4 hours on demand
caused by cord compression &/or poor placental perfusion: maternal hemorrhage perinatal asphyxia: intrauterine hypoxia
signs and symptoms of perinatal asphyxia: intrauterine hypoxia include low apgar scores, hypotonia, slowed HR and respirations, poor skin color, abnormal ABG
treatment of perinatal asphyxia: intrauterine hypoxia oxygen supplement, parenteral nutrition, antibiotics, blood/blood products
caused by retained pulmonary fluids transient tachypnea of the newborn (TTN)
signs and symptoms of transient tachypnea of the newborn include rapid RR, grunting, flaring, retractions
treatment of transient tachypnea of the newborn closely monitor, oxygen via hood, prophylactic abx, blood cultures, gavage feedings
caused by in-utero stress (hypoxia) meconium aspiration syndrome
signs and symptoms of meconium aspiration syndrome include meconium suctioned at delivery, x-ray confirmation
treatment of meconium aspiration syndrome ET suction until clear, asessment of respiratory function, oxygen support, abx
caused by lung immaturity and underdevelopment, surfactant deficiency, less than 30 wks gestation age and/or less than 1200 grams respiratory distress syndrome (RDS)
signs and symptoms of respiratory distress syndrome include apnea due to fatigue, hypoxia, chest x-ray whited out
treatment of respiratory distress syndrome oxygen supplement, positive and expiratory pressure, exogenous surfactant, nutritional support
caused by prolonged mechanical ventilation, high oxygen with PEEP or continuous positive airway pressure (CPAP) bronchopulmonary dysplasia (BPD)
signs and symptoms of bronchopulmonary dysplasia include ventilator dependency, prolonged oxygen requirement, increased WOB/air hunger, cor pulmonale, irritability
treatment of bronchopulmonary dysplasia wean oxygen, prevent infection, adequate nutrition, bronchodilators and diuretics, family support
caused by asphyxia, hypoxia, mechanical obstruction(meconium aspiration) persistent pulmonary hypertension of the newborn (PPHN)
signs and symptoms of persistent pulmonary hypertension of the NB include deteriorating respiratory function, oxygen and ventilator required, DA and FO reopens, lung infiltrates present, falling oxygen levels and BP
treatment of persistent pulmonary hypertension of the NB NTE & little stimulation, sedate & paralyze, high O2 level, rapid ventilatory rate, maintain pH at 7.45-7.55, BP support with dopamine and dobutamine, pulmonary vasodilators
stress results in the release of _____ norepinephrine
_____ leads to acidosis hypoxia
pathologic jaundice occurs in first 24 hrs of life
physiologic jaundice occurs after the first 24 hrs of life
herniation of the abdominal contents into the umbilical cord or failed closure of the abdominal wall omphalocele & gastroschisis
excess CSF in the cerebral ventricles & impaired circulation of CSF hydrocephalus
caused by hypoxia and respiratory distress syndrome, pulmonary edema, and CHF patent ductus arteriosis
signs and symptoms of patent ductus arteriosus include murmur, visible pulsation, bounding pulses, tachycardia, tachypnea, pulmonary edema
treatment of patent ductus arteriosus adequate oxygenation, restricted fluids, digoxin, diuretics, indomethacin, surgery
caused by fragility or germinal matrix, fluctuating pO2 and BP, fluid volume changes, coagulopathy, ventilator pressure, vagal response to startle reflex intraventricular hemorrhage
signs and symptoms or intraventricular hemmorhage include lethargy, bradycardia, apnea, declining Hct, rising bG, full, tense fontanelles, seizures possible
treatment of intraventricular hemorrhage monitor pO2 &pCO2, monitor platelet status, decrease stimulus, decrease BP variations, treat seizures, limit excessive motor activity
caused by iatrogenic damage to developing retinal vasculature, oxygen status changes, sepsis, & vitamin E deficiencies retinopathy of prematurity
signs and symptoms of retinopathy of prematurity include ID by eye exam
treatment of retinopathy of prematurity opthamology follow up
Created by: jennk4