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OB Exam 2
OB chapter 17
| Question | Answer |
|---|---|
| jaundice | Failure of the liver cells to break down and excrete bilirubin can cause an increased amount of bilirubin in the bloodstream causes yellowing skin and sclera |
| meconium | evolution of a stool pattern begins with a newborn’s first stoo |
| meconium is composed of | amniotic fluid, shed mucosal cells, intestinal secretions, and blood |
| meconium appearance | greenish black, has a tarry consistency, and is usually passed within 12 to 24 hours of birth |
| Neutral thermal environment | An environment in which body temperature is maintained without an increase in metabolic rate or oxygen use |
| Neutral thermal environment promote | growth and stability and allow the newborn body to conserve energy for basic bodily functions |
| Periodic breathing | cessation of breathing that lasts 5 to 10 seconds without changes in color or heart rate |
| Periodic breathing may be observed in | newborns within the first few days of life and requires close monitoring |
| surfactant | a surface tension–reducing lipoprotein found in the newborn’s lungs that prevents alveolar collapse at the end of expiration, prevents lung atelectasis, and loss of lung volume |
| when does surfactant production start | at about 26 weeks’ gestation and reaches maturity levels at approximately 35 weeks |
| Surfactant provides | the lung stability needed for gas exchange |
| thermoregulation | the process of maintaining the balance between heat loss and heat production in order to maintain the body’s core internal temperature |
| ways to maintain thermoregulation | Drying the newborn and providing warmth to prevent heat loss by evaporation Placing the newborn under a radiant heat source and putting on a cap will further reduce heat loss after drying |
| Neonatal Period | the first 28 days of life |
| Successful Transition | for transition to extrauterine life to be successful, adaptations MUST occur in 4 interdependent areas |
| critical areas for successful transition from inutero to outside world | Circulatory Respiratory Thermoregulation Glucose stabilization |
| initiation of breathing | chemical factors mechanical factors thermal factors sensory factors |
| chemical factors of breathing | cumulative hypoxic effect of labor |
| mechanical factors of breathing | Labor SQUEEZE of chest through the birth canal Crying |
| what does the squeeze of the chest through birth canal do | helps to remove fluid from the lungs |
| thermal factors of breathing | cold environment stimulates respiratory center in brain |
| sensory factors of breathing | handling & drying stimulate respiratory center |
| Respiratory System Adaptations | Gas exchange moves from placenta to LUNGS |
| if newborn is in respiratory distress, they will exhibit | cyanosis |
| After respirations are established in the newborn | they are shallow and irregular, ranging from 30 to 60 breaths per minute, with short periods of apnea (less than 15 seconds) |
| Signs of respiratory distress | central cyanosis, tachypnea, expiratory grunting, sternal retractions, and nasal flaring |
| Characteristics of newborn respirations according to BJB | RR 30-60 nose breathers - suction if fluid/secretions irregular |
| what is common in respiratory system adaptations | periodic breathing |
| Transient Tachypnea of Newborn (TTN) | delayed fluid clearance from lungs, resp rates >60 |
| Before the newborn’s lungs can maintain respiratory function, the following certain events must occur: | Initiation of respiratory movement Expansion of the lungs Establishment of functional residual capacity (ability to retain some air in the lungs on expiration) Increased pulmonary blood flow Redistribution of cardiac output |
| minimal breathing in utero, amount of fluid is decreased as baby is squeezed through the birth canal, so | if c section baby then there is more mucus, bubbling, and maybe tachypneic because less is squeezed out |
| TTN is the result of | a delay in clearance of fetal lung liquid leading to ineffective gas exchange, respiratory distress, and transient pulmonary edema |
| Cardiovascular Adaptations: closures | closures happen gradually, not suddenly |
| A couple of points to remember for Cardiovascular Adaptations | gas exchange occurred through the placenta rather than the lungs There was mixing of oxy & deoxy blood Shunts/ducts allowed blood to move throughout the circuit |
| Rewiring of shunts occur in response to | resistance changes |
| how does process of rewiring of shunts | 1 Blood flow to lungs increases as fluid is cleared 2 Placenta is removed 3 Ducts close |
| Changes in Resistance: 1 | First breath & reabsorption of lung fluid causes decrease in pulmonary resistance, encouraging blood flow to the lungs |
| Changes in Resistance: 2 | Umbilical cord clamped causes increased systemic resistance = increased pressure L side of heart |
| Changes in Resistance: 3 | Foramen ovale closes because of decreased pulmonary vascular resistance, which = decreased pressure in R heart |
| Changes in Resistance: 4 | Ductus venosus closes which increases aortic pressure and closes PDA |
| normal HR range | 110-160bpm |
| causes of tachycardia TB | fetal hypoxia, maternal fever, maternal dehydration, amnionitis, drugs, maternal hyperthyroidism, maternal anxiety, fetal anemia, prematurity, fetal infection, chronic hypoxemia, congenital anomalies, fetal heart failure, and fetal dysrhythmia |
| causes of bradycardia TB | fetal hypoxia, placental abruption, cord prolapse, prolonged umbilical cord compression, maternal hypoglycemia, hypothermia, and maternal hypotension |
| causes of tachycardia BJB | respiratory distress, fever, overwarming |
| causes of bradycardia BJB | respiratory distress, results of drugs mom was given |
| Blood volume depends on | the amount of blood transferred from the placenta at birth |
| Blood volume varies depending on | when clamping of the umbilical cord occurs |
| Recommendation to delay cord clamping for | 1 min to promote benefits in newborn |
| benefits from delaying cord clamping for 1 min | higher hemoglobin levels, preventing iron-deficiency anemia at 3 to 6 months of age, improved myelin brain volume to 12 months of age, and improved neurodevelopmental outcomes at 4 years of age |
| clamping of cord is known as | natures first stem cell transplant |
| blood components: RBCs | after birth, RBC size decreases as the count increases Hgb levels are higher in newborn first few hours of life than in adults |
| blood components: WBCs | number is elevated after birth due to stress and trauma (leukocytosis) |
| blood components: plts | count and ability to aggregate is the same as adults, stabilizes after their born |
| Nonshivering Thermogenesis is the primary method of | heat production |
| Nonshivering Thermogenesis is the process by which | brown fat (adipose tissue) is oxidized in response to cold exposure |
| brown fat is | heat burning so it helps baby maintain their body temp |
| BAT is a unique tissue that can | convert chemical energy to heat |
| BAT is | finite so once it's used, it is gone |
| when is BAT produced | in the 3rd trimester, so preterm infants have less BAT |
| storage of BAT is reduced by | 3-5 weeks |
| babies do not have a | shivering mechanism |
| Thermoregulation is the process of | maintaining a body temp between hot & cold in order to maintain the body’s internal core temperature |
| newborns depend on their | BAT in order to help maintain their body temp |
| Compared to adults, newborns tolerate a | narrower range of environmental temperatures and are more vulnerable to cold and heat |
| On average, normal newborn temperature is | 97.9-99.7 |
| first line of treatment for hypothermia | skin to skin |
| skin to skin should be | initiated after birth regardless but is helpful for unstable temps |
| why are babies so prone to heat loss pt 1 | Thin skin and blood vessels close to surface Increased permeability to water Can’t shiver (until 3 months old) Limited metabolic substrates – glucose, glycogen, fat (breaking these down creates energy, which creates warmth) |
| why are babies so prone to heat loss pt 2 | Limited voluntary muscle activity (can’t jump up and down!) Large SA to body mass ratio Lack subQ fat (for insulation) Lack ability to conserve heat by fetalizing! (changing posture) Can’t adjust own clothing or ask for blankets! (communication) |
| Right after birth, newborn temperature can | drop 3 to 5 degrees within minutes |
| Heat exchange with environment occurs through | 4 mechanisms of heat loss |
| Mechanisms of Heat loss | conduction convection evaporation radiation |
| conduction involves the | transfer of heat from one object to another when the two objects are in direct contact with each other |
| conduction refers to | heat fluctuation between the newborn’s body surface when in contact with other solid surfaces, such as a cold mattress, scale, or circumcision restraining board |
| Heat loss by conduction can also occur when | touching a newborn with cold hands or when the newborn has direct contact with a colder object such as a metal scale or a cool mattress, blanket, or clothing |
| convection involves the | flow of heat from the body surface to cooler surrounding air or to air circulating over a body surface |
| Examples of convection-related heat loss would be | a cool breeze that flows over the newborn, a cool room, cool corridors, or outside air currents |
| evaporation involves | the loss of heat when a liquid is converted to vapor. |
| Evaporative loss may be | insensible (such as from skin and respiration) or sensible (such as from sweating) |
| evaporation examples | When the baby is born, the body is covered with amniotic fluid. The fluid evaporates into the air, leading to heat loss. Heat loss via evaporation also occurs when bathing a newborn. |
| radiation involves the | the loss of body heat to cooler, solid surfaces that are in proximity but not in direct contact with the newborn |
| The amount of heat loss from radiation depends on | the size of the cold surface area, the surface temperature of the newborn’s body, and the temperature of the receiving surface area |
| radiation examples | when a newborn is placed in a single-wall isolette next to a cold window, heat loss from radiation occurs. A newborn will become cold even though they are in a heated isolette |
| Cold stress is | excessive heat loss that requires a newborn to use a compensatory mechanism to maintain core body temperature |
| Preterm newborns are at highest risk for | cold stress, particularly within the first 12 hours of life |
| Signs of Cold Stress | skin is cool to the touch skin appears mottled central cyanosis appears decreased responsiveness, lethargy jittery because hypoglycemia tachypnea |
| consequences of Cold Stress | Depleted brown fat stores, Increased oxygen and glucose consumption = Respiratory distress & Hypoglycemia, Increased risk of jaundice, failure to gain weight |
| newborns are prone to | overheating d/t limited insulation and limited sweating ability |
| Body temp control occurs through | a complex negative feedback system |
| what is the complex negative feedback system for body temp control | Heat production Heat gain Heat loss Feedback is controlled by hypothalamus, which is immature in the newborn |
| newborns cannot reduce | heat which can lead to increased fluid loss, the respiratory rate, and the metabolic rate |
| NTE promotes | balance and good environment for baby |
| NTE conserves | energy |
| NTE minimizes | heat loss |
| Nursing Care to Promote Neutral Thermal Environments | Prewarming blankets and hats Keeping isolette warmed and charged Drying newborn after birth Skin to skin Promote early breastfeeding to provide fuel When using oxygen, heat & humidify Always use radiant warmers Defer bathing till medically stable |
| Maternal iron intake during pregnancy affects | the iron stores available for use during the first 6 months of the infant's life |
| the amount of iron a mother gets during pregnancy helps determine | how much iron her baby has stored in their body after birth |
| After birth, placental source of glucose is | cut off |
| After birth, placental source of glucose is cut-off so | newborns must learn to regulate their blood glucose hypoglycemia is one of the most frequent problems encountered early feedings help stabilize blood glucose levels |
| Bilirubin Conjugation | Bilirubin is the byproduct of RBCs breakdown Newborn production of bilirubin is more than twice the rate of adults |
| indirect (unconjugated) | Form released by RBC breakdown fat-soluble Converted to direct in liver can stay in skin |
| direct (conjugated) | Processed in liver water-soluble Excreted in feces & urine |
| Jaundice | Failure of liver to break down and excrete bilirubin Bilirubin is high in the blood Yellowing of skin, sclera, mucous membranes |
| physiologic types of jaundice | after 24 hours considered "normal" mild, usually requires no tx Increased production, decreased excretion (d/t immature liver) |
| pathologic types of jaundice | before 24 hours underlying medical condition - involve PCP moderate to severe, requires tx |
| Mucosal Barrier Develops so it | Protects infant during gut microbiome development |
| Stomach & Digestion: BS begin | shortly after birth (w/in 1 hour) |
| For the first 24 hours, stomach is | small and holds 30cc |
| since stomach is small, | burp between feedings |
| Relaxed/immature cardiac sphincter = | if you feed too much, they will spit up |
| Bowel Elimination – early feeding = early elimination | 1st meconium (tarry green) should occur within 1st 24 hours Meconium is passed for 1-2 days before stool changes Transitional stools depending on feeding method |
| Weight Gain | Will lose weight after birth bc void/excrete Goal is ≤10% weight loss within first couple of days |
| Kidneys are what at birth | immature |
| since kidneys are immature at birth | Decreased GFR Decreased ability to concentrate urine --> Leads to Decreased GFR Decreased ability to concentrate urine --> Leads to both dehydration and fluid overload |
| Looking for the 1st void within | the first 24 hours of life (93% of infants do) 99% void within 48 hours |
| newborn urine appearance | Odorless straw color Variations include slightly blood-tinged, uric acid crystals, dehydration |
| Teaching for urination is | # of voids = # of days of life |
| Newborn skin is important | But, it's vulnerable to injury and infections Most important job is to provide protection and maintaining body temperature |
| Other functions of skin | Limits water loss Prevents absorption of harmful agents Protects thermoregulation & fat storage Shields against physical trauma |
| Many skin variations are considered wnl | Birthmarks Coloring Rashes |
| neuro adaptations | Immature and continues development until 1 year of life |
| development follows a | cephalocaudal (head-to-toe) and proximal–distal (center-to-outside) pattern |
| hearing | well developed at birth, responds to noise by turning to sound |
| taste | ability to distinguish between sweet and sour by 72 hours old |
| smell | ability to distinguish between birthing parent’s breast milk and breast milk from others |
| touch | sensitivity to pain, responds to tactile stimuli pain sensitive, respond to touch Face, hands, soles of feet are most sensitive |
| vision | incomplete at birth; maturation is dependent on nutrition and visual stimulation. Newborns can focus only on close objects (6 to 10 in away) with a visual acuity of 20/640 They demonstrate a preference for looking at faces |
| newborn reflexes | Moro Reflex Rooting Reflex Babinksi Reflex Palmar / Plantar Grasp Tonic Neck |
| First Period of Reactivity | birth to 30 minutes alert, moving, eyes open may appear hungry |
| Period of Decreased Responsiveness | 30 minutes to 2 hours sleepy, disengaged decreased activity |
| Second period of Reactivity | 2 hours to 8 hours of life awake, interested in things/stimuli |
| orientation | sensory response to environmental stimuli movement of head and eyes to "track" stimulus. prefer faces and shiny objects. |
| habituation | measure of how well infant responds to environment. Ability to block out external stimuli after the newborn is accustomed to the activity |
| motor maturity | depends on gest age. Eval of posture, tone, coordination, and movements. Good motor organization = rhythmic and spontaneous movements (e.g., bringing hand to mouth) = CNS working |
| consolability | ability to console selves or be consoled 5 "Ss"** |
| Social behaviors - Variable! | Cuddliness Irritability - lower sensory threshold? Crying - language! amount and tone is unique |
| 5 S's of consolability | swaddling, side/stomach positioning while awake and supervised, shushing, swinging, and sucking |
Created by:
leh195