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.