OB Test 2

_______________ soluble bilirubin is able to reach the GI tract and excreted via feces and some urine.

Water

Icteric. Normal? Definition:

Abnormal Build up of bilirubin Technical term for jaundice

Tonic reflex

"Fencer". Newborn's head is turned to one side; corresponding arm and leg extend away from body with hand partially open. Opposite hand clinches and knee bends.

Moro reflex:

"Startle" reflex. Knees flex, arms stretch out then return to chest.

How much vitamin K is administered?

0.5-1g

Acrocyanosis. Normal/abnormal? Definition:

Abnormal Persistent cyanosis of periperies. Mottled blue or red Coldness

Petachiae. Normal? Definition:

Abnormal Small, round, red spots on skin "Rash" Result of pressure on skin during birth

Nursing interventions immediately after delivery:

1. APGAR 2. Immunity (IgG, IgA, IgM, IgD, IgE) GAMDE

Foods to avoid with PKU

1. All meats 2. Eggs 3. Dairy 4. Nuts 5. Seeds 6. Legumes 7. Breads 8. Foods containing aspartame

Newborn reflex tests (8)

1. Babinski 2. Moro 3. Palmar grasp 4. Plantar grasp 5. Rooting 6. Stepping 7. Sucking 8. Tonic neck

Review: Traits of Newborn 2nd stage of sleep:

1. Decreased HR and RR 2. Difficult to awaken, esp for feeding. 3. Cardio-respiratory return to baseline expectations 4. Bowel sounds audible 5. Period of decreased responsiveness 6. Movements are less jerky and frequent 7. Muscles are relaxed and responsiveness to outside stimuli diminishes.

Review: 12 Nursing interventions for photo-therapy

1. Expose as much skin as possible 2. COVER GENITAL AREA AND EYES 3. Inspect eyes once per shift 4. Measure lamp output 5. Monitor skin temp 6. Expect loose, green stools and green urine (excreted bilirubin) 7. Assess skin color, lights off, every 4-8hrs 8. Assess for "bronze baby" syndrome 9. Reposition every 2hrs 10. Provide stimulation 11. Post treatment: Assess for rebound elevations. 12. Turn off lights before collection serum bilirubin specimen (light will break down bilirubin in samples).

Circumcision indications

1. Frank bleeding 2. Increased redness 3. Signs of infection 4. Anuria c/in 12hrs s/p circumcision

Erythromycin ointment

1. Mandated by law. 2. Prophylactic for ophthalmia neonatorum, caused by bacterium Neisseria Gonorrhoeae.

Jaundice appearing during the first 24 hrs. 1. Pathological 2. Physiological

1. Pathological "Pathogenic", "Acute"

Circumcision care

1. Petroleum jelly for 24hrs 2. Avoid friction with diaper 3. Do not wash yellowish mucous layer 4. Apply petroleum jelly to dressings to avoid sticking to skin.

Five interventions for Vitamin K useage

1. Protect med from sunlight 2. Administer during early newborn period 3. Administer IM; lateral aspect/middle third of vastus lateralis. 4. Monitor for bruising and/or bleeding at injection site and/or cord 5. Monitor for jaundice; vitamin k can cause hyperbilirubinemia.

Possible die effects of photo-therapy

1. eye damage 2. dehydration 3. sensory deprivation

Contraindications for vaginal delivery with active HSV

1. ↑ incidence of mortality and morbidity 2. 30-50% chance of newborn acquiring 3. Vaginal delivery contraindicated; c-section required

Normal newborn HR range

120-160bpm Can increase to 180 while crying.

Mother bladder before and during pregnancy

1300mL → 1500mL

Loss of heat due to water being converted to vapor

Evaporation.

How many veins and arteries in the cord?

2 arteries 1 vein (VAAAAAAA)

Newborns should be fed every ____________ hours

2-3

The postpartum nurse is providing instructions to the mother of newborn with hyperbilirubinemia who is being breast-fed. The nurse should provide which most appropriate instruction to the mother? 1. Feed the newborn less frequently 2. Continue to breast feed every 2-4hrs 3. Switch to bottle feeding the infant for 2 weeks 4. Stop breast feeding and switch to bottle feeding permanently

2. Continue to breast feed every 2-4 hrs. More eating = more pooping = more bilirubin excreted.

Jaundice appearing after the first 24hrs. 1. Pathological 2 Physiological

2. Physiological "Must not be a pathogen, must be physiological"

Apnea = cessation of breathing for greater than ______ seconds

20

93% of newborns urinate within ____________________ 100% of newborns urinate within ___________________

24hrs 48hrs (Otherwise notify physician)

Normal newborn weight

2500-4500g

_______________ soluble bilirubin is unable to be excreted from the body and builds up, resulting in jaundice.

Fat

Flap-like structure between the right and left atrium through which blood flows to bypass pulmonary circulation

Foramen Ovale (Forameno Valley)

INCORRECT method for strapping newborn into rear-facing car seat: 1. Crotch strap is adjusted per manufacturer's instruction 2. Straps are positioned at or below the level of the newborn's shoulders 3. Straps are positioned at or above the level of the newborn's shoulders 4. Straps are fasted at armpit level with the harness retainer clip

3.

Which nursing action is most effective in preventing heat loss by evaporation? 1. Warming the crib pad 2. Closing the doors to the room 3. Drying the infant with a warm blanket 4. Turning on the overhead radiant warmer

3. Drying the infant with a warm blanket.

Sleep phases of a newborn

30-120min of age, newborn enters 2nd stage of transition (aka sleep phase).

Normal newborn respiration range

30-60 breaths/min. Can increase while crying.

"Late pre-term" = _________________ weeks

34-37

Normal newborn temp range

36.5-37.5°C

Term = _______________ weeks

38-42

GDM

Gestational Diabetes Mellitus

GBS

Group B Stroptococcus

Complications of PKU deficiency

Phenylalanine accumulates in brain tissue, resulting in 1. Seizure 2. Microcephaly 3. Poor growth/development.

The nurse is preparing to care for a newborn receiving phototherapy. Which interventions should be included in the plan of care? Select all that apply. 1. Avoid stimulation 2. Decrease fluid intake 3. Expose all of newborn's skin 4. Monitor skin temperature closely 5. Repostition the newborn every 2 hours 6. Cover the newborn's eyes with eye shields or patches

4, 5, 6

Which statement, by family, indicates the need for further car seat safety instruction: 1. "Our rear seats belts have a ratchet locking mechanism, so we don't need a locking clip." 2. "We'll make sure to remind each other to put the carrying handle all the way back while the seat is in the car." 3. "I won't hang toys from the handle to entertain the bay while in the car." 4. "I'll turn the car seat to a front-facing position when the baby is 1 year old."

4. Must be 2yrs old or meet the height/weight requirements.

Post term = ________________ weeks

42+ and demonstrating signs of placental aging.

Average duration of contraction

45-60sec

Newborn initial stomach capacity

5-7mL

How long may a newborn be vitamin k deficient (until it produces vitamin k on it's own)?

5-8 days.

Newborn stomach capacity over time

50-60mL

Normal newborn blood pressure range

50-75 sys 30-45 dia

Normal newborn BP

50/30 - 75/45

Newborn initial bladder volume

6-44mL

Average number of daily voidings for a newborn

6-8

Pathological jaundice can be detected at _____mg/dl

6mg/dl

How many times should a newborn be fed per day?

8-10

Normal glucose for infants

>40

VEAL CHOP

Variable decelerations - Cord compression Early decelerations - Head compression Accellerations - Oxygenation Late decelerations - Placental Uterine Insuf.

Preferred method of assessing newborn's temp and why

Axillary. Rectal = possible bowel perforation.

Breech

BUTTOCKS towards cervix

Stepping reflex

Baby makes a stopping motion when held upright, feet on a flat surface.

Rooting reflex

Baby turns head towards stroked cheek.

Palmar grasp

Baby will grasp finger and tighten grip upon attempted removal

Gestational age assessment tool

Ballard/Dubowitz

Neonatal Abstinence Syndrome signs/symptoms

Blotchy skin, hyperactive reflexes, Diarrhea, increased muscle tone, Excessive or HIGH-PITCHED CRYING, Excessive sucking, irritability, poor feeding, Fever, rapid breathing, seizures, sleep problems, slow weight gain, stuffy nose, sneezing, sweating, tremors, vomiting

Erythromycin categorized as..

Broad-spectrum macrolide antibiotic

CSTS

Car Seat Tolerance Screening

Respiratory Distress Syndrome (RDS)

Caused by reduced or absent surfactant

Why is Cold Stress dangerous?

Causes oxygen and energy to be diverted from maintaining normal cell cardiac functions. Results in serious metabolic and physiological conditions.

Nicotine effects to neonate

Causes vasoconstriction = reduces uteroplacental blood flow = ↓birth weight, abortion, prematurity, abruptio placentae, or fetal demise.

Tx for Neonatal Abstinence Syndrome

Comfort and reduced stimulation. 1. Swaddling 2. Rocking 3. Pacifier 4. Reduced noise/lights 5. methadone/morphine for severe withdrawal

Loss of heat to cooler surfaces and objects in direct contact with newborn

Conduction.

Another name for water-soluble bilirubin

Conjugated

Loss of heat due to cool air currents

Convection.

Cold Stress effect on blood glucose

Decreases blood glucose.

Main concern for pre-term babies vs term babies, in regards to phototherapy

Dehydration

Conjugated bilirubin is also known as

Direct

What to do if car seat is expired, and/or does not meet current safety standards and family has no other means of transporting the baby?

Document education provided to family regarding risk; discharge the newborn

Vascular connection between the pulmonary artery and aorta

Ductus Arteriosus

State mandated heel-stick blood test performed 24hrs after 1st feeding. Used to detect PKU

Guthrie Blood Test

Vertex

HEAD towards cervix

Describe early decelerations

HR drops at START of contraction, returns to normal when contraction ends.

Describe late decelerations

HR drops in the MIDDLE of contraction, continues after contraction has ended.

Best way to have family demonstrate competency in appropriately securing the newborn in the car seat?

Have family install the car seat in the vehicle before leaving the facility.

Physical signs of jaundice appear in which order?

Head, thorax, ABD, extremities.

HSV

Herpes Simplex Virus

Physiological jaundice can be detected at ____ mg/dl

Higher than 15mg/dl

Describe accelerations

Increase in HR of 15+ for at least 15sec

Unconjugated bilirubin is also known as

Indirect

How to prevent heat loss resulting from Radiation

Keep newborn away from cold objects and outside walls.

How to prevent heat loss resulting from Evaporation

Keep newborn dry and well wrapped in blanket.

Preterm = _____________ weeks

Less than 37

Neonate hypoglycemia

Less than 40

Avoid ______________________ during third trimester to avoid premature closure of ductus arteriosus.

NSAIDs

A group of problems that occur in a newborn who was exposed to opiate drugs while in the womb

Neonatal Abstinence Syndrome

Sucking reflex

Newborn opens mouth and begins sucking motion when lips are stimulated.

Why is vitamin K administered?

Newborns are deficient in vitamin K and the injection prevents the newborn from bleeding.

Erythema toxicum. Normal? Definition:

Normal "Newborn rash" Small, red spots with white centers Looks like a pimple Build up of bilirubin and reacting Eosinophils

Telangiectatic Nevi. Normal? Definition:

Normal "Stork bite"

Molding. Normal/abnormal? Definition:

Normal Asymmetry of head d/t pressure in birth canal. Disappears w/in 72hrs Suture lines may overlap

Mongolian spots. Normal? Definition:

Normal Blue or purple splotches on lower back/buttocks Disappear within 4yrs

Cephalhematoma. Normal/abnormal? Definition:

Normal Collection of blood under scalp. Associated to molding. Does not cross subgaleal area

Caput Succedaneum. Normal/abnormal? Definition:

Normal Edema under scalp Onset w/in 24hrs, resolves 2-3 weeks Not limited by subgaleal area

Epstein pearls. Normal? Definition:

Normal Type of Milia but occurs in mouth and gums

Milia. Normal? Definition:

Normal Unopened sebaceous glands Usually found on nose, sometimes forehead/chin Disappear 2-4wks.

Why do newborns not produce enough vitamin K?

Not enough food digested = not enough flora to produce vitamin k.

A newborn with GA of 36 weeks is noted to have an SpO2 of 85% during a CSTS. What is the appropriate nursing response?

Notify the practitioner for further orders; possibly perform a repeat screening. Rationale: Practitioners should be notified, immediately, upon failure of CSTS. Also if: Apnea for more than 20sec SpO2 of less than 88% HR of less than 80bpm

When buying an infant car seat, the family should choose which seat?

One that fits the newborn and vehicle.

Noticeable "clunk" from hip while manipulating baby's legs

Ortolani's Sign

How to prevent heat loss resulting from Conduction

Perform all treatments on warm, padded surfaces.

A hereditary disease that is caused by lack of liver enzyme required to digest phenylalanine.

Phenylalanine Ketonuria

PKU

Phenylalanine Ketonuria

Other names for Vitamin K, medical and OB-specific.

Phytonadione OB = Aquamephyton

Loss of heat to cooler surfaces and objects NOT in direct contact with newborn

Radiation.

Preterm newborn reflexes, compared to term:

Reflexes may be absent or reduced.

What is NOT a general safety standard for infant car seats?

Registration card

How to prevent heat loss resulting from Convection

Shield Newborn from drafts.

Babinski reflex:

Stroke lateral sole of foot. Toes fan out. Up to 12mos of age.

Reason for placing newborns under radiant warmers

To prevent cold stress. Newborns lack the ability to shiver.

Plantar grasp

Toes curl if finger placed just below the toes.

Wet lung causes:

Transient Tachypnea of the Neonate, TTN

Another name for fat-soluble bilirubin

Unconjugated

Process of bilirubin breakdown

Unconjugated bilirubin (Fat Billy) → Turns skin yellow because fat (soluble) Billy makes people sick→ Billy "indirectly" catches a ride with Al (Albumin) to the liver gym→ Billy and Al get to the Liver gym where fat Billy works out and becomes conjugated. Becoming conjugated "directly" makes Billy get all sweaty (H2O soluble). Billy is "pooped" (excreted via feces).

How newborns create heat

Utilizing brown fat deposits.

When is a CSTS performed?

Weight less than 5.5lbs or GA less than 37 weeks.

When is erythromycin administered?

Within one hour after delivery

Inactive HSV okay for vaginal delivery?

Yes History of HSV is okay

Okay to breast feed with Hx of HSV, no active lesions?

Yes. Okay to breast feed.

Where, in the eye, is erythromycin administered?

conjunctival sacs

During 2nd sleep stage, a newborns HR and respirations _________________

decrease.

Vitamin K adverse effect:

hyperbilirubinemia (rare)

Infant bladder volume

kg x 7mL

How often to perform vitals during first 2hrs of life

q30mins

After the first two hours, how often to assess newborn's temp?

q8h until discharge.