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ob class
test 5
| Question | Answer |
|---|---|
| To live independently from the mother, how must the newborn must adapt? | breathe quickly/maintain RR; replace fluid n lungs w/air;open up pulmonary circulation/ close fetal shunts;allow pulmonary blood flow 2 increase/cardiac output (blood volume)redistributed;provide energy 2 maintain body temp/support metabolic processes; |
| To live independently from the mother, how must the newborn must adapt? cont'd | dispose of waste products produced by food absorption and metabolic processes; and detoxify substances entering from the external environment. |
| What is surfactant, and what is its purpose | surfactant s produced by mature lungs in a full-term fetus. It reduces the force between the moist surfaces of the alveoli, thereby preventing them from collapsing with each expiration, and thus promotes lung expansion.surfactant promotes lung compliance |
| With regards to the respiratory rate of the newborn, why is it necessary to keep the infant warm? | Excessive cooling increases the need for oxygen and can produce acidosis. A lack of oxygen (hypoxia) at the tissue level depresses respirations rather than stimulate them |
| Why is the infant who is delivered by cesarean birth at greater risk of respiratory distress than the infant delivered vaginally? | The infant who is delivered by cesarean birth does not experience chest compression followed by chest recoil, which causes air to be drawn into and out of the lungs. Thus the infant is at greater risk for respiratory distress |
| Name the three fetal shunts | ductus arteriosus, foramen ovale, and ductus venosus |
| Compare prenatal and postnatal respiratory functions | respiratory functions before birth: Lungs filled w/fluid. no air n lungs,Surfactant s present n mature fetuses. no movement of air n lungs. rate s slower. Gas s xchanged thru fetoplacental unit. Temp s warm & stable. Resp funct after birth:fluid s removed |
| Why do newborns have a greater transfer of heat to the external environment than do adults? | 7. Newborns are prone to heat loss because they have a large body surface area in relation to their weight. Their skin is thin, blood vessels are close to the surface, and there is little subcutaneous fat for insulation |
| Explain nonshivering thermogenesis | Nonshivering thermogenesis,complx process ↑metabolic rate & O2 rate consumption n newborn,uses metabolism of brown fat(brown adipose tissue)4 heat prod. wen newborn infant s subjected 2 cold stress.Cold stress leads 2 ↑O2 consumption →leads 2 acidosis |
| Compare prenatal and postnatal respiratory functions cont'd | by chest being squeezed during vaginal delivery & absorbed by the lymphatic system. Air s pulled n w/1stst breath 2 open alveoli &establish functional residual capacity w/ help of surfactant,which keeps alveoli open. Baby begins 2 breathe w/n 30secPowerfl |
| Compare prenatal and postnatal respiratory functions cont'd | stimuli (cold,touch,clamping of cord)help initiate breathing.Resp rate ↑ 30-60 bpm bcuz >need 4 O2.Neonate must breathe on own 2 get O2.Newborn s @ risk 4 hypothermia&hyperthermia til thermoregulation stabilizes.newborn bcoms chilled (cold stress)O2↑ |
| Why is newborn cry so important to assess? | Their way to communicate needs, such as feeling wet,hugry, or too warm |
| When does the nurse begin to observe the infan't vital signs & how often does he/she measure them? | Begins while the mother & infant are bonding in the delivery room, measured 15-30 min 1st hour then every 4-8hours after infant is stable |
| Summarize the normal respiration patterns of the newborn. | movement of chest & abdomen should b synchronized.range typically from 30-60 bpm.breaths should be clear over most area,but sounds of moisture mite b heard n lungs during 1st few hrs after birth. |
| Describe the difference between molding & caput seccedaneum. | Molding-overlapping of bones of the head due to head compession@ birth. The skull bones override each other for the head to fit through the vaginal canal, but this resolves within 2 or 3 days |
| Describe the normal appearance of the anterior fontanelle, and explain the conditions that may cause abnormalities of this fontanelle. | newborn is quiet,anterior fontanelle shudn't b elevated but shud b level w/cranial bones.size of anterior fontanelle @ birth s between 3.6 & 6 cm (1.4 & 2.4 in.).size of the fontanelles n preterm & term newborns s same once the preterm newborn reaches ter |
| caput seccedaneum | s localized swelling of soft tissues of the scalp that s caused by pressure on the head during labor.It can be palpated as a soft, fluctuant mass that may cross over the suture lines.caput succedaneum is absorbed in a few days and requires no intervention |
| Neonatal period | as the first 28 days of life,but the first 24 hrs. of life can be the most precarious. |
| Umbilical cord clamped | the first breath is taken and the lungs begin to function |
| nursing mgmt during theimmediate newborn pd. | The period of transition 4m intruterine to extrauterine life occurs during the 1st several hrs after birth. Neonates temp., resp.,& cardiovascular dynamics stabilize during dis period.Problems that occur during dis critical time can have a lifelong impact |
| initial newborn assessment signs that might indicate a problem | nasal flaring,chest retractions,grunting on exhalation,labored breathing,generalized cyanosis,abn. breathing sounds:rhonci,crackles,wheezing,stridor |
| APGAR SCORES | is used to evaluate newborns @ 1 & 5 minute assessmentAn additional Apgar assessment is done @ 10 minutes if the 5 min. score is less than 7 pts. 5 min assessmt provides a clearer of nb overall cns. |
| Five parameters assed with Apgar scores | A-appearance (color) P-pulse (heart rate) G-grimace (reflex irritability) A-activity (muscle tone) R-respiratory (respiratory effort) |
| Apgar scoring for newborns | Heart rate(ausculation of apical heart for 1 full min.)respiratory effort(observation of the volume & vigor of the nb's cry;auscultation of depth & rate of respirations) |
| Apgar scoring for newborns cont'd | Muscle tone(observation of extent of flexion in the newborn's extremities & newbornsresistance when the extremities are pulled away from the body)reflex irritability(flicking of the soles of the feet or suctioning of the nose w/a bulb syringe) |
| Apgar scoring for newborns cont'd | skin color (inspection of trunk & extremities w/the appropriate color for ethnicity appearing within minutes after birth) Usually a low score |
| Birth weight | less than 10% or more than 90% on a growth chart r outside the normal range & need further investigation.NB's typically lose approximately 10% of their initial birth wt. by 3-4 days of age 2ndary loss of meconium,xtra cellular fluid & limited fluid intake |
| Vital signs | Apical pulse for 2 full min.;NB respiratory rate 30-60 bpm assessed every 30 minutes until stable 2 hrs after birth;axillary temp.36.5-37.5C (97.9-99.7F);Rectal are no longer taken bcus of risk of perforation |
| Maintaining Airway Patency | immediately after birth, nb is suctioned to remove fluids & mucus from the mouth & nose.NB's mouth is suctioned 1st w/bulb syringe to remove debris & then nose .Suctioning helps prevent aspiration of fluid into lungs by unexpected gasp. |
| What is to be kept near newborn in case he/she develops sudden choking or a blockage in the nose. | Bulb syringe |
| Ensuring proper identification | mother and newborn, possibly the father, receive matching identification bracelts. the newborn receive 2 id bracelets, one on a wrist & 1 on ankle |
| Gestational age assessment | is important because it allows the nurse to plot growth parameters& to anticipate problems related to prematurity, postmaturity,and growth abnormalities. (intrauterine growth retardation (restriction)) |
| Administering Prescribed medications | 2 meds. 1)vit K-blood clotting,takes 1 week to be produced to prevent vit.K dificiency bleeding 2)eye prophylaxis w/either erythromycin or tetracycline-prevent opthalmia neonatorum,causes neonatal blindness-caused by chlamydia |
| Obtaining thermoregulation | maintaining body temp.is crucial *remember the potential for heat loss in Nb, & perform all nursing interventions in a way that minimizes heat loss & prevents hypothermia. |
| head circumference | average newborn head circumference is 32-38 cm (13-15 in).Head circumference may need to be remeasured @ a later time if the shape of the head is altered from birth. |
| Chest circumference | generally equal to or about 2-3 cm less than the head circumference. |
| Skin condition and color | Nb's skin often appears blotchy or mottled,especially in the extremities. Persistent cyanosis of fingers, hands, toes, and feet w/mottled blue or red discoloration & coldness acrocyanosis. |
| Vernix caseosa | thick white substance that protects the skin of the fetus. |
| Stork bites | salmon patches are superficial vascular areas found on the nape of the neck on the eyelids,& between the eyes & upper lip |
| Milia | are unopened sebaceous glands frequently found on a newborn's nose. |
| Mongolian spots | blue/purple splotches that appear on the lower back & buttocks of newborns |
| Erythemia toxicum | newborn rash |
| nevus flammeus | port wine stain,appears on the newborn's face or other body areas *doesn't grow in area or size, its permanent & will not fade *may be associated w/structural malformations, bony or muscular overgrowths, and certain cancers |
| nevus vasculosus | strawberry mark or strawberry hemangioma, benign capillary hemangioma in the dermal & subdermal layers *hemangiomas tend to resolve by age 3 w/o any treatment. |
| molding | the elongated shaping of the fetal head to accommodate passage through the birth canal |
| caput succedaneum | localized edema on the scalp that occurs from the pressure of the birth process.Swelling will gradually dissipate in about 3 days without any treatment. |
| cephalhematoma | localized effusion of blood beneath the periosteum of the skull *swelling doesn't cross suture lines & is firmer to the touch than an edematous area *usually appears on 2nd or 3rd day after birth & disappears w/n wks or mos. *3 weeks to heal |
| microcephaly | associated with infections (cytomegalovirus) & symdromes such as trisomy 13 & 18 & fetal alcohol syndrome |
| neck | also inspect the clavicles, which should be straight and intact. **Crepitus(crackling sound,broken clavicle)** |
| chest | *fine crackles can be heard on inspiration soon after birth as a result of clearing amniotic fluid from the lungs.*PMI* |
| Point of maximal impulse (PMI) | lateral to midclavicular line located @ 4th intercostal space. a displaced PMI may indicate tension pneumothorax ro cardiomegaly. Accumulation of air & doesn't let lung expand final dx= x-ray |
| umbilical cord | correct amount of blood vessels (two arteries & 1 vein)Evidence of only a single umbilical artery is associated w/renal & Gastrointestinal anormalies, inspect for signs of bleeding,infection,granuloma, or abnormal communciation w/intra-abdominal organs. |
| genitalia | underneath=hypospadius,above=epispadious;check position of the uringary meatus;it should be in the midline @ the glans tip. it it on the ventral surface of the penis,hypospaidas is present, if is is on dorsal surface of the penis, it is termed epispadias |
| pseudomenstration | vaginal discharge composed of mucus mixed w/blood may also be present during the 1st few weeks of life,requires no treatment. |
| Genitalia | Inspect anus both male/female NB's for psition & patency. if meconium isn't passed, lubricated rectal be performed to determine patency. Abnormal findings would include anal fissures or fistulas & no meconium passed within 24 hrs after birth. |
| extremities & back | note any extra digits (polydactyly) or fusing of two or more digits (symdactyly)*Inspect the feet for clubfoot (a turning-inward position). |
| extremities & back | Perform Ortolanie & barlow maneuvers to identify hip dislocation,developmental dysplasia of the hip (DDH)=click or cluck sound*back inspection spine should appear straight & flat & should be easily flexed when the baby is held in a prone position. |
| back inspection | observe for the presence of a tuft of hair, a pilonidal dimple in th emidline,a cyst, or a mass along the spine |
| Rooting reflex | nb turns to side being stroked |
| sucking reflex | nb open mouth and begin a sucking motion |
| moro reflex | startling motion |
| stepping reflex | walking motion |
| tonic neck reflex | baby's head is faced the same side the extended are is out. |
| babinski reflex | stroking bottom of foot and toes fold inward |
| palmar grasp | fingers grasp |
| plantar grasp | toes grasp fingers |
| Bathing | sponge bath until umbilical cord falls off and navel area is healed completely. |
| elimination | urine light amber in color, soaking 6-12 diapers a day=adequate hydration, stools can change in color,texture,& frequency w/out signaling a problem. meconium passed 1st 48 hrs.stools =thick,tarry,sticky, and dark green. |
| stools | breastfed-seedy mustard-colored soft stool formula fed-yellow-brown, formed stool w/a pasty consistency |
| cord care | umbilical cord begins drying within hours after birth & is shriveled & blackened by the 2nd or 3rd day. any cord drainage is abnormal & generally caused by infection. |
| circumsicion care | circumsicion surgical removal of all or part of the foreskin (prepuce of hte penis), @ removal penis is covered with petroleum jelly-coated gauze to keep the wound from sticking to diaper,squeeze soapy water over area. |
| car safety | use rear-facing car seats for infants until they are @ least 1 yr old & weigh 20 lbs. |
| screening test | PKU, galactosemia |
| pku | autosomal recessive inherited deficiency;mental & motor retardation, seizures |
| Transient tachypnea of Newborn | appears soon after birth,occurs when fetal liquid in the lungs is removed slowly or incompletely |
| Transient tachypnea of Newborn-nursing intervention | providing supportive care (gvn O2,ensuring warmth, observing respiratory status frequently,& allowing time for the pulmonary capillaries & lymphatic to remove the remaining fluid,clinical course relatively benign,but to new parents can be frightening |
| physiologic jaundice | common in newborns, w/yellowish skin,mucous memranes, and sclera within 1sr 3 days of life,results 4m deposition of unconjugated bilirubin pigment in skin & membranes,excreted through feces |
| bilirubin | removed by liver from blood and changes it to form in which it can be excreted. As RBC breakdown continues at a fast pace, the newborn's liver cannot keep up w/bilirubin removal. |
| prevention & management of hyperbilirubinemia | promotion & support of successful breast-feeding practices to make sure the newborn is well hydrated & stooling frequently to promote elimination of bilirubin |
| assessing for juandice in NB | pressing gently w/a fingertip on the bridge of the nowe, sternum, or forehead. If jaundice is present, the blanched area will appear yellow before the capillary refill |
| Reducing risk of juandice | expose to sunlight, provide breastfeeding on demand-promotes eliminationthrough urine & stooling, & avoiding glucose water supplementation,which hinders elimination. If or when levels of unconjugated serum bilirubin increase use phototherapy. |
| phototherapy | exposing the nb to UV light, which converts unconjugated bilirubin into products that can be excreted through feces & urine. |
| hypoglycemia | affects as many as 40% of all full-term nb. it defined as a blood glucose level of less than 35mg/dL or plasma concentration of less than 40 mg/dL |
| s/s hypoglycemia | nonspecific & include jitteriness,lethargy,cyanosis,apnea, seizure, high-pitched or weak cry, and poor feeding. |
| prevent hypoglycemia | early feeding,if persist notify PHP for orders of IV therapy w/dextrose solutions. |
| feeding newborns | Newborns should be fed on demand whenever they seem hungry.Most newborns give clues about hunger by crying,placing thier fingers or fist in their mouth, rooting around, & sucking. formula fed usually feed evry 3-4 hrs finishing bottle in 30 min. or less. |
| Releasing air | upright position,not strength of the patting or rubbing, that allows the newborn to release air accumulated in the stomach. |
| feedings | time for closeness & sharing, for baby's emotional pleasure as his/her physical well-being,encourage eye contact,soft communication between parent/baby for comfort,security,and closeness |
| breast milk changes | colostrum-thick & yellow,hi fat & minerals hi protein, rich in IgA (protects gi tract against infections,natural laxative helps rid of meconium |
| formula | correct preparation is critical in newborns health & development. mistakes in dilution may result. |
Created by:
yvettep119
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