exam 3 - fetal circulation/newborn assessments
A woman presents to the Family Birth Place in labor. By her dates and abdominal measurement, she is 32 weeks pregnant. After a short labor she delivers a female weighing 1400 g. The Ballard score confirms the gestational age. The infant's weight falls between the 10th and 90th percentiles. 1.How would you classify this infant by weight?
1) Is less than 2500 grams; is low birthweight (LGA)
What are two components of the ballard tool?
1) external physical characteristics 2) neuromuscular characteristics
What are 4 types of jaundice in the newborn?
1) physiological jaundice 2) pathological jaundice 3) breastfeeding jaundice 4) breastmilk jaundice
4 major actions of cardiopulmonary adaption after birth: 1) increased systemic vascular resistance and decreased vascular resistance
1. Increased systemic vascular resistance and decreased pulmonary vascular resistance. a) Due to the loss of the placenta, the systemic vascular resistance increases causing a greater systemic pressure. b) Pulmonary blood flow is increased and pulmonary vessels dilate. c) The combination of vasodilation and increased pulmonary blood flow decreases the pulmonary vascular resistance. d) This allows the pulmonary vascular beds to open, systemic vascular pressure to increase, thus enhancing perfusion to the other body systems.
A woman presents to the Family Birth Place in labor. By her dates and abdominal measurement, she is 32 weeks pregnant. After a short labor she delivers a female weighing 1400 g. The Ballard score confirms the gestational age. The infant's weight falls between the 10th and 90th percentiles. 5.What would you estimate the neonate's blood volume to be?
1.4 kg x 85 = 119
What percentile is AGA?
10th-90th percentile
What is the normal heart rate range for a newborn? Where is this best assessed? For how long?
110-160 bpm; ausculation is performed over the entire heart region (precordium, below left axilla and below the scapula) Listen for a full minute b/c babies can have irregular heart rates, preferably when infant asleep.
4 major actions of cardiopulmonary adaption after birth: 2. Closure of the Foramen Ovale
2. Closure of the Foramen Ovale a) The foramen ovale closes due to the changing arterial pressures. b) In utero, the pressure in the right atrium is greater than pressure in the left atrium, which allows the blood to flow from the right atrium to the left atrium. c) Once the pressure changes, the left atrium has greater pressure which causes the foramen ovale to close with in 1-2 hours after birth. Anatomic closure occurs within 30 months. Becomes the fossa ovalis
At what age can baby's distinguish b/n sweet and sour?
3 days
When do newborns reach a peak in bilirubin levels?
3-5 days
4 major actions of cardiopulmonary adaption after birth: 3. Closure of the ductus arteriosus.
3. Closure of the ductus arteriosus. a) An increase in PO2 triggers the ductus arteriosus to constrict. b) Functional closure of the ductus arteriosus starts within 18 hours after birth. c) Anatomic closure occurs within 2 to 3 weeks after birth. Becomes the ligamentum arteriosum
What is the normal rate of respirations for a newborn?
30-60 respirations per minute.
What is the average chest circumference?
32 cm (12.5"); range 30-35 cm (12-14")
What is average head circumference of a newborn? How much larger than chest circumference?
33-35 cm (13-14"); range 32-37 cm (12.5-14.5") 2 cm larger than chest circumference
4 major actions of cardiopulmonary adaption after birth: 4. Closure of the ductus venosus.
4. Closure of the ductus venosus. a) Closure is related to the mechanical pressure changes from severing the cord, redistribution of blood, and cardiac output. b) Occurs within 2 months and becomes known as the ligamentum venosum.
When do preterms reach their peak bilirubin levels?
5-7 days
What is average length of a newborn? Growth rate?
50 cm (20"); range is 46-56 cm (18-22"); growth of 2.5 cm (1") per month for 6 mos.
In a baby that is 8 lbs - how much blood volume?
8/2.2 kg x 85 mL=306 ml blood volume
What is blood volume of a term infant estimated to be?
85 mL/kg of body weight
How soon do most newborns urinate after birth? What is the bladder volume of a newborn?
90% of newborns void 24 hours after birth; 99% void by 48 hours after birth; if no void in 48 hours, assess fluid intake, bladder distension, restlessness, and syptoms of pain. Initial bladder volume for a newborn is 6-44 ml of urine.
A woman presents to the Family Birth Place in labor. By her dates and abdominal measurement, she is 32 weeks pregnant. After a short labor she delivers a female weighing 1400 g. The Ballard score confirms the gestational age. The infant's weight falls between the 10th and 90th percentiles. 3.How would you classify this infant by both weight and gestational age?
AGA - weight falls within the normal range for gestational age
What are characteristics of baby during active or light sleep?
Active or light sleep (Rapid-Eye Movement [REM] sleep): respirations are irregular, irregular sucking motions, minimal activity, irregular movement of extremities. Environmental and internal stimuli may initiate a startle reaction and a change of state.
Physical assessments of Ballard: breast
Areolae/Breast tissue: the tissue is measured. Term gestation should measure between 0.5 and 1 cm. Absence or decreased breast tissue indicates premature or SGA (small for gestational age) newborn
When does surfactant increase?
Around week 35.
What does clamping the cord do for fetal circulation?
As placenta is detached, prostaglandins are released, which causes the ductus arteriosis to close off
How can you tell a baby is looking at something?
As the object comes into vision, eyes get wide, limbs become still and they stare
What is average weight of a newborn? growth rate?
Average: 7lb, 8oz (3405 g); range 2500-4000g (5lb 8 oz-8lb 13oz); growth is 7 oz (198g) per week for first 6 mos.
A woman presents to the Family Birth Place in labor. By her dates and abdominal measurement, she is 32 weeks pregnant. After a short labor she delivers a female weighing 1400 g. The Ballard score confirms the gestational age. The infant's weight falls between the 10th and 90th percentiles. 2.How would you classify this infant by gestational age alone?
Baby is less than 37 weeks; is Preterm
When should newborn's hearing be tested?
Before they leave the hospital
what is breastfeeding jaundice?
Breastfeeding jaundice occurs in 12.9% of breastfeeding newborns in the first days of life, with a bilirubin level greater than 12 mg/dL. Is associated with poor feeding practices, such as inadequate fluid intake and dehydration. Peaks around day 3 as enteral intake increases, then resolves.
What is breastmilk jaundice?
Breastmilk jaundice occurs in 2% - 4% of term newborns between days 4 to 7. True cause is unknown. It is thought to be caused from the breast milk promoting increased bilirubin reabsorption from the intestine. This is because some women's breast milk contains higher levels of certain free fatty acids that compete with bilirubin for binding sites on albumin. This prevents conjugation, which increases the enterohepatic circulation of bilirubin.
What is the primary source of heath in the newborn?
Brown adipose fat (increases in fetus at about 25-30 weeks gestation; increases until 3-5 weeks after birth of full term newborn.
Where is brown adipose tissue found in the newborn?
Brown adipose fat is deposited in the midscapular area, around the neck, and in the axillas. Also found around the trachea, esophagus, abdominal aorta, kidneys, and adrenal glands.
How can the nurse use tactile capacity to soothe the newborn?
By swaddling, placing hand on abdomen, or holding arms to prevent a startle reflex (all soothing methods for newborn)
What is the characteristics of the baby during deep or quiet sleep?
Deep or quiet sleep: characterized by closed eyes. No eye movements, regular breathing. May have jerky motions or startles. Startles are suppressed.
What is a transcutaneous bilirubin risk assessment tool?
Device that can be placed on the baby's chest to measure bilirubin; if greater than 6, will do a blood test of bilirubin
A female infant weights 2200 g (4 lb 14 oz) at birth. The mother has had not prenatal care and does not know the date of her last menstrual period. She smokes 20 cigarettes per day. The infant has loose, wrinkled, skin. The infant scores at 42.5 weeks on the Ballard score. When plotted on a weight for gestational age chart, the infant falls below the 10th percentile. 2. Why was it important to score this infant?
Don't know when her LMP was and she had no prenatal care
Physical assessments of Ballard: eye/ear
Ear form and cartilage: less than 34 weeks, ear is flat and shapeless; has little cartilage. The ear will fold over and remain in that position. By term, pinna is formed, stands away from head, and springs back quickly
What is fetal circulation before delivery?
Fetal Circulation (before delivery). →Oxygenated bloods enters the umbilical vein from the placenta. →Enters ductus venosus (bypasses liver) and then passes through to the inferior vena cava. →Enters the right atrium, goes through the foramen ovale into the left atrium. →Passes through the left ventricle into the ascending aorta to supply nourishment to the brain and upper extremities. →Returns to the heart through superior vena cava and enters the right ventricle. →Small amount of blood enters the pulmonary artery with some blood flow going to lungs. →Majority of blood flows through the ductus arteriosus. →Enters descending aorta (some blood goes to the lower extremities) →Returns to the placenta through the umbilical arteries.
What kind of state is the newborn in the first 30-60 minutes after birth? What should the nurse encourage during this time?
First Period of Reactivity Approximately first 30 to 60 minutes after birth, newborn is awake, active, may appear hungry, and have a strong sucking reflex. Important to encourage bonding and to initiate breastfeeding at this time.
When is Hep B vaccine usually given to baby
First day after birth
Physical assessments of Ballard: genitals
Genitals: males are evaluated for size of scrotal sac, presence of rugae and descent of testes. The female's genitals depend of the amount of subcutaneous fat deposition which relates to the nutritional status of the fetus. As fetus increases in gestational age, clitoris becomes more prominent, labia majora increase in size.
What non-invasive nursing intervention can be done immediately following birth that could help cardiopulmonary adaptations
Getting the baby to cry brings in more oxygen into the baby's developing lungs and clears out more fluid.
A female infant weights 2200 g at birth. The mother has had not prenatal care and does not know the date of her last menstrual period. She smokes 20 cigarettes per day. The infant has loose, wrinkled, skin. The infant scores at 42.5 weeks on the Ballard score. When plotted on a weight for gestational age chart, the infant falls below the 10th percentile. 5. Why is it important to identify this infant as being both underweight for gestational age and wasted (atrophy)
Identify baby's needs and what his risks are (meconium aspiration, hypothermia (small); hypoglycemia (under 2500g); organ damage from placental deficiency or hypoxia.
What type of immunoglobulin is colostrum high in?
IgA (starts to be produced in intestinal mucosa at 4 weeks)
What are three types of immunoglobulins involved in immunity for newborns that are passed by moms? When are they transferred to fetus?
IgG - crosses placenta and active against bacterial toxins IgA IgM These are transferred primarily in the third trimester. (Preterm more susceptible to infection)
How does jaundice progress?
In a cephalocaudal patter; first seen in the face then travels down the trunk
A female infant weights 2200 g (4 lb 14 oz) at birth. The mother has had not prenatal care and does not know the date of her last menstrual period. She smokes 20 cigarettes per day. The infant has loose, wrinkled, skin. The infant scores at 42.5 weeks on the Ballard score. When plotted on a weight for gestational age chart, the infant falls below the 10th percentile. 1. What is the explanation for the appearance of this infant's skin?
Inadequate food supply in the last couple of weeks of pregnancy; baby is not gaining adipose tissue.
A woman presents to the Family Birth Place in labor. By her dates and abdominal measurement, she is 32 weeks pregnant. After a short labor she delivers a female weighing 1400 g. The Ballard score confirms the gestational age. The infant's weight falls between the 10th and 90th percentiles. 4.What problems is this infant at high risk of in the first few weeks of life?
Jaundice, necrotizing enteric disease; poor breathing; poor feeding, infection, retinopathy of prematurity, anemia, intraventricular hemorrhage, patent ductus arteriorosis
Physical assessments of Ballard: Lanugo
Lanugo: fine hair that is on the body of the newborn. Decreases as gestational age increases. The amount is greatest at 28 to 30 weeks. Most abundant over back; however may be seen of face, legs, and arms. Disappears first from face, then from trunk and extremities.
What percentile is LGA?
Large for gestational age: above 90th percentile
A female infant weights 2200 g (4 lb 14 oz) at birth. The mother has had not prenatal care and does not know the date of her last menstrual period. She smokes 20 cigarettes per day. The infant has loose, wrinkled, skin. The infant scores at 42.5 weeks on the Ballard score. When plotted on a weight for gestational age chart, the infant falls below the 10th percentile. 4. How would you classify this infant by weight for gestational age?
Low birth weight
What factors may affect accuracy of the ballard test?
Maternal: preeclamsia, diabetes, maternal analgesia/anesthesia, hypertension Baby: magnesium sulfate messes up neuromuscular measures; maternal analgesia may cause respiratory depression
What to do with breast milk jaundice?
May need to temporarily stop breastfeeding if levels reach 20 mg/dl and let it clear.
What is meconium? When does it pass?
Meconium is thick, tarry, dark green poo formed in utero from the amniotic fluid and its components, intestinal secretions, and shed mucosal cells. Usually passes w/in 8-48 hours after birth.
A female infant weights 2200 g at birth. The mother has had not prenatal care and does not know the date of her last menstrual period. She smokes 20 cigarettes per day. The infant has loose, wrinkled, skin. The infant scores at 42.5 weeks on the Ballard score. When plotted on a weight for gestational age chart, the infant falls below the 10th percentile. 7. What is the probable cause of this infant being underweight for gestational age?
Mom's heavy smoking.
Is fever a reliable indicator of infection in a newborn?
No
A female infant weights 2200 g at birth. The mother has had not prenatal care and does not know the date of her last menstrual period. She smokes 20 cigarettes per day. The infant has loose, wrinkled, skin. The infant scores at 42.5 weeks on the Ballard score. When plotted on a weight for gestational age chart, the infant falls below the 10th percentile. 6. Are all posterm infants wasted or underweight for gestational age
No - but are often wasted or underweight for gestational age
What should be expected of the newborn from 2-4 hours after birth?
Period of Inactivity to Sleep Phase The newborn's activity will gradually decrease and will enter the sleep phase. The sleep phase may last from a few minutes to 2 to 4 hours. Newborn may be difficult to awaken and will have no interest in feeding.
Physical assessments of Ballard: overview
Physical characteristics usually include sole creases, amount of breast tissue, amount of lanugo, cartilaginous development of the ear, testicular descent and scrotal rugae in the male, and labial development in the female. These are objective clinical criteria that are not influenced by labor and birth and do not change significantly within the first 12 hours of birth.
What is physiologic jaundice? When does it develop?
Physiologic jaundice: nonpathologic unconjugated hyperbilirubinemia. This means that there is no pathological reason for the increased levels, but a natural biological response of the newborn. Develops after the first 24 hours postnatally which differentiates it from Pathological jaundice which is seen at birth or within the first 24 hours of postnatal life.
What are possible causes of high bili levels?
Possible causes: 1) The lifespan for RBCs are considerably shorter for a newborn; therefore, they have a 2 to 3 times greater production or breakdown of the bilirubin. 2) Bruising from a delivery can increase the amount of bilirubin that must be processed through the liver. 3) Newborns can have a low volume and inadequate caloric intake from their initial feedings. This can increase the reabsorption of bilirubin from the aggravation caused from the decrease of GI activity.
A female infant weights 2200 g (4 lb 14 oz) at birth. The mother has had not prenatal care and does not know the date of her last menstrual period. She smokes 20 cigarettes per day. The infant has loose, wrinkled, skin. The infant scores at 42.5 weeks on the Ballard score. When plotted on a weight for gestational age chart, the infant falls below the 10th percentile. 3. How would you classify this infant by gestational age alone?
Post term (42.5 weeks)
What kind of "breathers" are babies?
Primarily diaphragmatic (noted with rising and falling of abdomen).
Physical assessments of Ballard: Resting posture
Resting posture: assess as the baby lies undisturbed on a flat surface
What is the benefit of having a settled newborn?
Settled newborn is able to interact with the environment.
Physical assessments of Ballard: skin
Skin: preterm newborns skin appears thin and transparent, with veins prominent over the abdomen. Term newborns skin appears opaque because of the increase in subcutaneous tissue. Vernix caseosa disappears on postmature newborns (42 weeks and those with signs of placental insufficiency) and promotes skin desquamation (peeling skin).
What percentile is SGA?
Small for gestational age: below 10th percentile
Physical assessments of Ballard: plantar surface
Sole (plantar) creases: most reliable of gestational age in first 12 hours. Development of creases begins at the top (anterior) portion of the sole and then proceeds to heel as age progresses. Plantar creases may vary with race.
What are advantages of delaying cord clamping for the term newborn? (3)
Term: →Newborns can receive approx. 80 mL (after 1 min) and 100 mL (after 3 min) of extra blood; →Delay may assist in transition from fetal circulation to newborn circulation →Newborns have significantly higher levels of hemoglobin than ferritin than newborns with cord clamped immediately.
•What does the newborn's initial breathes do?
The Initiation of Respiration includes: Chemical: the first breath is an inspiratory gasp triggered by increased PCO2 & decreased PH levels and PO2. This triggers aortic and carotid chemoreceptors that trigger the brain's respiratory center. Thermal: the newborn will experience a significant change in temperature after birth which will stimulate the newborn's nerve endings which causes the newborn to respond with a rhythmic respiration.
Why do bili levels tend to increase after birth?
The bili levels will tend to increase after birth because there is 1) an increased bilirubin production, 2) a delay in bilirubin elimination, and/or 3) there is a recirculation of bilirubin.
What is bilirubin?
The breakdown of the heme portion of hemoglobin causes the production of a yellow pigment (bilirubin)
What does the foramen ovale become after birth?
The fossa ovalus
What does the ductus arteriosus become after birth? How long does this take?
The ligamentum arteriosum. At birth, the prostaglandin (PGE) levels fall and the ductus arteriosus constricts and occludes the ductus arteriosus lumen. This allows the blood to flow to the neonatal lungs. This remodeling process (the ductus arteriosus turns into the ligamentum arteriosum) supports the change from a fetal circulation to a neonatal circulation where gas exchange is able to occur in the lungs. This happens within minutes of being born.
Why might a newborn have problems conjugating bilirubin? What helps prevent jaundice?
The longer the direct bilirubin stays in the newborn's gut, the higher the chance it has of becoming deconjugated and reabsorbed in the body -The sooner the newborn establishes gut motility and active stooling through early and frequent feeding, the less likely they are to develop physiologic jaundice. -The newborn liver has less activity in the first few weeks than an adult liver and this makes it hard for the newborn to keep up with a relatively large bilirubin amount (this decreases the liver's ability to conjugate the bilirubin).
What is thermogenesis? When does it occur?
The production of heat; can include basal metabolic rate, muscular activity, and chemical thermogenesis (aka non-shivering thermogenesis) This occurs when skin receptors perceive a drop of temperature in the environment. The newborn responds by transmitting sensations to stimulate the sympathetic nervous system.
What do newborns depend upon for immunity?
Their mother's immunity passed on to them b/c they lack immunulogic memory (fetus does not make own antibodies)
What is the purpose of finding out whether baby is large or small for gestational age?
There are protocals for babies that fall outside of AGA (Appropriate for Gestational Age) such as blood glucose monitoring.
Describe a newborn baby's visual capacity
They are nearsighted with a visual distance of 8-15".
What is a baby's auditory capacity?
They can respond to auditory stimulation; heart rate rises and may see minimal startle reflex; if the sound is appealing (mom or dad voice) newborn will search for it.
What kind of objects do newborns prefer?
They prefer human faces, eyes, and high contrast objects and patterns. (Black and white toys good)
What is the Agpar scoring system used for?
To evaluate the physical condition of the newborn at birth.
What is the most important of all senses for the newborn?
Touch. Newborn is sensitive to touch, cuddling, and being held.
How often do baby's have BMs?
Varies; usually 2-3 times a day; may be as frequent as 10 per day. Baby not consitpated if stool is soft.
When should the cord be clamped?
WHO and ACOG represent delaying the clamping of the cord. ACOG: 30-60 seconds after birth.
What is the sequence of events that occurs when the neonate takes its first breaths?
When the neonate takes it's first breaths, a sequence of events are initiated. •The fluid in the lungs is emptied. •Volume and lung function is established. •Causes the fetal circulation to convert to neonate circulation •Air entering the lungs which increases the oxygen content in the alveoli and stimulates a relaxation of the pulmonary arteries. •With the increased oxygenated pulmonary blood flow and loss of placenta, systemic blood flow increases. •The foramen ovale closes directing the blood flow from the right atrium to the right ventricle. •The patent ductus arteriousus (PDA) begins to close directing the blood to flow from the right ventricle into the pulmonary artery. •These events leads to a decrease in pulmonary vascular resistance which allows complete vascular flow to the lungs.
What are the main features of fetal circulation (3)
While the fetus is still in the womb, the placenta is the organ that controls the gas exchange. In utero, the fluid-filled lungs have a higher vascular resistance while the placenta has a lower vascular resistance. This results in four different shunts that assist in fetal circulation. 1.Highly oxygenated blood flows from the placenta, through the umbilical vein, and through the ductus venosus. This shunt allows the majority of the oxygenated blood to flow into the inferior vena cava towards the right atrium while a small amount perfuses the liver. 2.Oxygenated blood mixes with deoxygenated blood from the superior and inferior vena cavas into the right atrium. During the fetal circulation, the pressure is higher in the right atrium compared to the left atrium. The foramen ovale, an opening in the septum between the atriums, allows oxygenated blood to flow into the left atrium, which then travels to the left ventricle and then to the ascending aorta so that it can deliver oxygenated blood better to the myocardium and brain. 3.A small amount of blood travels from the right ventricle into the pulmonary arteries. The fluid-filled lungs have a higher vascular resistance which causes more than 60% of the blood from the right ventricle to bypass the lungs and pass through another shunt, the ductus arteriosis. This is an opening between the pulmonary artery and the descending aorta. The blood then travels to the lower extremities and returns to the placenta through the umbilical artieries. At the placenta, carbon dioxide and waste products are released and oxygen and nutrients are collected.
Can baby select and differentiate mother thru smell?
Yes.
What are the following special structures that support fetal circulation? Fetal arteries a) carries unoxygenated blood from fetus to placenta b) connects right and left atrium to allow oxygenated blood to supply brain, heart and kidneys c) Carries oxygenated blood from umbilical vein to inferior vena cava bypassing the fetal liver and continuing on to heart. d) connects the pulmonary artery and the descending aorta and carries oxygenated blood which mostly bypasses the fetal lungs. e) where gas exchange takes place during fetal life. f) Carries oxygenated blood from placenta to fetus.
a) carries unoxygenated blood from fetus to placenta
What are mechanisms of heat loss in a baby? radiation a) loss of heat thru the air to a cooler surface (not in direct contact with neonate) b) heat loss as water evaporates from the skin c) transfer of heat to surface the newborn is lying on d) transfer of body heat to the surrounding air.
a) loss of heat thru the air to a cooler surface (not in direct contact with neonate) example: placing cold objects near incubator
What is normal temperature in a newborn? Axillary? rectal? continuous?
axillary: 36.4-37.2 c (97.5-99 f) rectal: 36.6-37.2 (97.8-99 f) continuous skin probe: 36-36.4 (96.8-97.5)
What are the following special structures that support fetal circulation? Foramen Ovale a) carries unoxygenated blood from fetus to placenta b) connects right and left atrium to allow oxygenated blood to supply brain, heart and kidneys c) Carries oxygenated blood from umbilical vein to inferior vena cava bypassing the fetal liver. d) connects the pulmonary artery and the descending aorta and carries oxygenated blood which mostly bypasses the fetal lungs. e) where gas exchange takes place during fetal life. f) Carries oxygenated blood from placenta to fetus.
b) connects right and left atrium to allow oxygenated blood to supply brain, heart and kidneys
What are mechanisms of heat loss in a baby? Evaporation a) loss of heat thru the air to a cooler surface (not in direct contact with neonate) b) heat loss as water evaporates from the skin c) transfer of heat to surface the newborn is lying on d) transfer of body heat to the surrounding air.
b) heat loss as water evaporates from the skin (e.g., drying of amniotic fluid)
What are the following special structures that support fetal circulation? Ductus Venosus a) carries unoxygenated blood from fetus to placenta b) connects right and left atrium to allow oxygenated blood to supply brain, heart and kidneys c) Carries oxygenated blood from umbilical vein to inferior vena cava bypassing the fetal liver. d) connects the pulmonary artery and the descending aorta and carries oxygenated blood which mostly bypasses the fetal lungs. e) where gas exchange takes place during fetal life. f) Carries oxygenated blood from placenta to fetus.
c) Carries oxygenated blood from umbilical vein to inferior vena cava bypassing the fetal liver.
What are mechanisms of heat loss in a baby? conduction a) loss of heat thru the air to a cooler surface (not in direct contact with neonate) b) heat loss as water evaporates from the skin c) transfer of heat to surface the newborn is lying on d) transfer of body heat to the surrounding air.
c) transfer of heat to surface the newborn is lying on (example: cold stethoscope)
What are the following special structures that support fetal circulation? Ductus Arteriosus a) carries unoxygenated blood from fetus to placenta b) connects right and left atrium to allow oxygenated blood to supply brain, heart and kidneys c) Carries oxygenated blood from umbilical vein to inferior vena cava bypassing the fetal liver. d) connects the pulmonary artery and the descending aorta and carries oxygenated blood which mostly bypasses the fetal lungs. e) where gas exchange takes place during fetal life. f) Carries oxygenated blood from placenta to fetus.
d) connects the pulmonary artery and the descending aorta and carries oxygenated blood which mostly bypasses the fetal lungs.
What are mechanisms of heat loss in a baby? convection a) loss of heat thru the air to a cooler surface (not in direct contact with neonate) b) heat loss as water evaporates from the skin c) transfer of heat to surface the newborn is lying on d) transfer of body heat to the surrounding air.
d) transfer of body heat to the surrounding air. (example: cold delivery room or removal from incubator)
What are the following special structures that support fetal circulation? Placenta a) carries unoxygenated blood from fetus to placenta b) connects right and left atrium to allow oxygenated blood to supply brain, heart and kidneys c) Carries oxygenated blood from umbilical vein to inferior vena cava bypassing the fetal liver and continuing on to heart. d) connects the pulmonary artery and the descending aorta and carries oxygenated blood which mostly bypasses the fetal lungs. e) where gas exchange takes place during fetal life. f) Carries oxygenated blood from placenta to fetus.
e) where gas exchange takes place during fetal life.
What are the following special structures that support fetal circulation? Umbilical vein (1) a) carries unoxygenated blood from fetus to placenta b) connects right and left atrium to allow oxygenated blood to supply brain, heart and kidneys c) Carries oxygenated blood from umbilical vein to inferior vena cava bypassing the fetal liver and continuing on to heart. d) connects the pulmonary artery and the descending aorta and carries oxygenated blood which mostly bypasses the fetal lungs. e) where gas exchange takes place during fetal life. f) Carries oxygenated blood from placenta to fetus.
f) Carries oxygenated blood from placenta to fetus.
How does muscle tone progress?
from caudocephalad (tail-to-head) progression
What does the ballard score assess?
gestational age by assessing the maturity of the newborn (especially if don't know). Max score of 50 corresponds to 44 week gestation.
What is a strong sign of infection in newborns?
hypothermia; other signs and symptoms of infection are nonspecific
What is the poop of breastfed babies like?
more frequent, liquid consistency stools; mushy, golden yellow, often after feeding, odor similar to sour milk.
What are signs of respiratory distress in a baby?
nasal flaring, intercostal or xiphoid retraction (chest sucks in), expiratory grunt or sign, seesaw respirations (abdomen lifts and chest sinks and reverses when diaphragm relaxes) or tachypnea (greater than 60 breaths per minute)
What is orientation?
newborn's ability to be alert to, follow, and fixate on appealing objects.
What is poop of bottle fed babies like?
pale and thicker consistency; firm, pasty, yellow-brown, strong odor
What neuro assessments are included in the ballard test?
posture; square window sign; popliteal angle, leg and arm recoil, popliteal angle, scarf sign, heel-to-ear extension, ankle dorsiflexion, head lag, ventral suspension, major reflexes
When does pathologic jaundice occur?
seen at birth or within the first 24 hours of postnatal life.
What are physical characteristics included in the ballard test?
sole (plantar) creases; breast tissue; lanugo; cartilage development of ear; testicular descent and scrotal rugae in male; labial development in female
What is kernicterus? what can it cause?
type of brain damage that can result from high levels of bilirubin. -Can cause cerebral palsy and hearing loss. -Can lead to problems with vision, teeth and learning disabilities
What is the total bili (combo of both types) at birth?
usually less than 3 mg/dl at birth
When should the Ballard tool be completed?
within the first 12 hours of birth
What is the difference b/n breastfed and bottle fed sucking?
•Breastfed newborns suck in bursts with frequent regular pauses •Bottle fed newborns suck at a regular rate with infrequent pauses.
What is conjugated bilirubin?
•Conjugation is the conversion of unconjugated bilirubin (indirect) into the water soluble pigment (excretable, direct) conjugated bilirubin. •The newborn's liver must then begin to conjugate bilirubin after birth.
What is unconjugated bilirubin?
•Unconjugated bilirubin is fat soluble and is NOT in an excretable form = potentially toxic. (excreted by the placenta in utero)
How can newborn calm himself?
•Uses non-nutritive sucking as a self-quieting activity which assists in development of self-regulation. (soothing and relaxing)
What are advantages of delaying cord clamping for the preterm newborn? (2)
→Fewer babies required blood transfusions for anemia and/or low blood pressure; →Reduction in the incidence of intraventricular hemorrhage and less risk of necrotizing enterocolitis
How to prevent breastfeeding jaundice?
→Frequent breastfeedings (every 2 to 3 hours). →Avoid supplementing. →Seek lactation consultation.
Why might newborns have varying amounts of blood?
→Gestational blood: more blood volume with greater gestational age →Prenatal and perinatal hemorrhage decreases hemocrit level and causes hypovolemia →Site of sample blood: the hemoglobin and hematocrit are higher in capillary blood than in venous blood; therefore, venous blood sites are more accurate that capillary sites.
What are CONS of delayed cord clamping for term and preterm newborns?
→Higher need for phototherapy due to jaundice (b/c more blood→ more RBC to breakdown; the liver is not working as well, results in jaundice) →Could hinder resuscitation efforts in a timely manner for neonates that are asphyxiated or with cardiopulmonary failure or other medical reasons.
How to transfer blood from placenta to NB? Does placing baby skin-to-skin with mom hinder transfusion?
→Hold newborn at or below level of placenta →Can place skin to skin with mom - new research has shown does not alter transfusion
What are major risk factors for hyperbilirubinemia in full term newborns?
→Jaundice within first 24 hours after birth. →A sibling who was jaundiced as a neonate. →Unrecognized hemolysis such as ABO blood type incompatibility or Rh incompatibility. →Nonoptimal sucking/nursing →.Deficiency in glucose-6-phosphate dehydrogenase, a genetic disorder. →Infection. →Cephalohematomas/bruising. →East Asian or Mediterranean descent.
What are nursing interventions for prevention and/or treatment of jaundice? (4)
→Keep newborn temp above 36.5/97.8. If newborn gets too cold, the stress results in acidosis which can cause elevated unconjugated bilirubin levels. →Encourage breastfeedings q 2 to 3 hours. Frequent feedings promote intestinal elimination and bacterial colonization and promote caloric intake. →Provide emotional support to the parents. Explain the condition to them and help them understand. →Phototherapy: If the bilirubin levels are getting too high, may be necessary to place baby "under the lights." Special flurolescent lights that help breakdown the bilirubin to decrease jaundice
What are the five adaptations of fetal circulation?
→Placental vein →ductus venosa (bypasses liver, dumps into inferior vena cava →foramen ovale (allows blood to cross from right atrium to left atrium) →ductus arteriosus (allows shunt of blood from pulmonary artery to aorta) →umbilical artery (blood flows back to the placenta (which is low pressure compared to the fetal lungs)
