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BC3- maternity newborn lecture

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Question
Answer
respiratory   lungs continually develop throughout fetal life  
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Surfactant in fetus   by week 35, enough surfactant is in alveoli of lungs to prevent collapse.  
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surfactant   compromised of surface active pphospholipids, lecithin, the most important for stability  
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lung maturation   35-36 weeks generally  
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lecithin/sphingomyelin ratio   2:1 lungs are developed enough to function properly at birth know through amniocentesis  
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diabetes mother lecithin/ sphingomyelin ratio   d/t complications of diabetes, a 3:1 ratio is necessary to evidence lung maturity for babies of diabetic mom  
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fetal breathing in utero   occur in utero as early as 11 weeks gestation, good development of chest wall muscles lead to good external adaption  
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initiation of breathing   the first breath  
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chemical events of first breath newborn   PCO2 goes up, PH, PPO2 goes down, stimulates respiratory center of medulla  
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Thermal Stimuli/ related to first breath   decreases in temp. around fetus 98.6 down to 70 deg. (cold stress)  
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physical stimuli of first breath   thouroughly drying infant stimulates respirations and prevents excessive heat loss  
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mechanical events of first breath   exchange of fluid in lung to gasses, air replaces fluid  
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secretion of lung fluids in utero   drop 48 hours before birth  
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Lung fluids at delivery   1/3 of fluid is squeezed out durring delivery  
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successive breaths after birth   each successive breath leads to more lung expansion  
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pulmonary vascular resistance at birth   decreases, pulmonary blood flow increases and more fluid is absorbed in blood stream  
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s/s of respiratory distress   retraction, nasal flaring, grunting, high resp rate >60  
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transiant ticipnea   in c sections, respiratory distress  
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PDA   patent ductus arteriousis, hear a murmur  
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functional closure of foramen ovale   from changing arterial pressures (total closure takes from several weeks to 1 year) opening between atria of the heart  
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closure/ constriction of ductus arteriosus   as a result of increased PO2 after air enters the lungs (functional closure within 15 hours) ductus eventually occludes and becomes a ligament.  
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ductus arteriosus   channel between main pulmonary artery and aorta of the fetus  
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closure of ductus venosis   immediate closure of umbilical vein and arteries, from clamping and cutting of cord  
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peripheral circulation of newborn   sluggish, causing acrocyanosis  
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acrocyanosis   blue extremities of newborn  
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newborn BP   78/42  
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heartrate of newborn   120-160  
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HGB newborn   14.5- 22.5  
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hct of newborn   44- 72  
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RBC's newborn   5- 7.5  
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WBC's of newborn   18,000  
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blood sugar of newborn   40 - 60 < 40 is concern  
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take infant blood sugar if ...   large baby, small baby, low temp, moms diabetic, gittery baby, symptomatic  
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urine in utero   forms in kidneys by 4th month gestation and is excreted to amniotic fluid  
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mature kidney function of newborn   not established until 2nd year of life: has narrow margin of safety in chemical balance  
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newborn voids?....   12- 24 hours after birth  
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Brick Dust   pinkish stains on diaper formed by newborns kidney, is normal  
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baby weight   record in lbs. and grams  
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newborn length   crown to rump, rump to heal  
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newborn GI system   newborn is capable of swallowing, digesting, metabolizing, absorbing proteins, simple carbs, and limited ability to digest fats. NO cow milk until after 1 year  
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Mucous membrane of newborn mouth   moist and pink, no saliva for ....  
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Epsteins pearls in mouth   common, white cysts on gums and palate  
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stomach capacity of newborn   30- 90 mls, emptying time is variable 1-24 hours regurgitation is normal: burp baby  
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Bowel sounds newborn   heard within one hour of birth  
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bacteria not in bowel at birth   but... soon enter. Normal intestinal flora synthesize vit.K, folic acid, and biotin  
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Meconium at birth   sticky, sterile, substance usually passed within 24 hours of life.  
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breast fed babies stools   soft golden yellow, non irritating to babies skin  
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bilirubin   yellow pigment derived from hgb. resulting from breakdown of RBC's and myoglobin in muscle cells.  
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unconjugated bilirubin or indirect bilirubin   unsoluble in water and causes jaundice in skin, sclera, and oral mucous membranes  
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circulating indirect bilirubin   newborns can have a high amount d/t normal newborn jaundice, physiological jaundice, occurs in 50% newborns, 80% of preemies  
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physilolgical jaundice is defined as   jaundice occuring after 24 hours and can be caused by: delayed clamping of cord, delayed emptying of intestine, maternal prebirth ingestion of certian drugs (sulfa, aspirin) and cold stress  
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normal pattern of bilirubin following birth   2 mg at birth. Increases to 6 mg by 72 hours, receeds to 5 mg by day 5 and should never exceed 12 mg  
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pathological jaundice   appears before 24 hours, exceeds 12 mg at any time  
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kernicterus   levels of bilirubin over 20 mg. the distruction of braincells resulting in mental retardation or cerebral palsy  
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phototherapy   treatment for 12-15 mg level of bilirubin  
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bilirubin level 20 mg. treatment   an exchange transfusion  
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rhogam   drug used to give rh negative moms to prevent severe hemolytic disease  
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Breast milk jaundice   occurs after first week of life , related to enzyme present in the milk of some women, which inhibits the conjugation of bilirubin  
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newborn integumentary appearence   plump, pink , blotchy  
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acrocyanosis   normal, bluish color of extremities  
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lanugo   fine hair covering shoulders and back, keeps them warm  
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caput succadaneum   edematous area of scalp, crosses suture lines , disappears in 3-4 days, from vacuum extraction  
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cephalohematoma   collection of blood between a skull bone and its periostem. appears from about 3 hours after birth to 3 days old. does not cross suture lines, dissolves in 3-6 weeks  
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mongolian spots   fade gradually over months / years go away between 4-7 years  
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stork bites   pink, easy to blanch, appear on eyelids, nose ,lower occiput bone, upper lip, neck, usually disappear in 1-2 years  
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erythema toxicum   normal newborn rash, pink area with white pustual center for 2 months, goes away on its own, dont treat.  
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reproductive organs   swelling normal, and darkened scrotum area  
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sensory and development   capable of social interacction  
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brain size newborn   1/4 size of adult  
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coordination of newborn   uncoordinated, labile in temp and startles easily  
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reflexes   moro (startle), stepping, rooting, sucking, grasp, babinski pos. up to 6 mos  
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temperature regulation   only bathe when temp is up  
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thermoregulation in newborn   closely related to metabolic rate and oxygen consumption  
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newborns require a higher enviornmental temp....   to maintain internal body temp  
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newborn at risk for heat transfer because....   limited supply of body fat and large surface area in relation to body weight.  
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brown fat   most important source of heat in a cold stressed newborn  
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conduction   surface heat loss  
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convection   drafts, vents, air conditioner, dont bathe near vent  
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evaporation   loss of heat through excess moisture, dry thorough  
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radiation   heat transfers from heated body to cool surface  
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