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STUDY GUIDE EXAM 2 NURS 320
NEWBORN JAUNDICE
a. Jaundice
Physiologic Jaundice
1. Accelerated destruction of RBC’s
2. 60% full term, 80% preterm affected
3. NOTED ON THE 2ND OR 3RD DAY!!
Physiological jaundice after 24 hours of life
Pathologic jaundice is seen at birth or within first 24 hours
4. Causes
Impaired conjugation of bilirubin
Increased reabsorption of bilirubin form intestinal tract
Delayed intestinal motility
Proteins not available to bind to bilirubin
Complications (of pathologic jaundice)
1. Kernicterus (bilirubin goes into brain)
Risk factors
1. East Asian race
2. Sibling with Jaundice
3. Prematurity, stress at birth, hypothermia, hypoglycemia
4. ABO incompatibility
Assessment
1. Sclera – white or yellow
2. Progression in a cephalocaudal fashion – call physician
3. Urine and stool
4. Encourage early/frequent feedings
5. Lethargy
Treatment
1. Exposure to light, PHOTOTHERAPY
2. Monitor for bilirubin levels
3. ENCOURAGE FREQUENT FEEDINGS
CARE OF INFANT UNDERGOING PHOTOTHERAPY
a. Used to prevent hyperbilirubinemia
b. Bilateral eye patches are always used
c. Baby naked except for diaper
d. As much skin exposed as possible
e. Reposition every 2 hour
f. Ongoing monitoring – hydration, nutrition, temperature, improvement of jaundice
IMMEDIATE NURSING PRIORITIES POST-DELIVERY FOR NEWBORNS
a. Fetal breathing movements
Go from liquid filled –> gas filled
Lung expansion following birth – spontaneous
Marked increase in pulmonary circulation must occur
b. Surfactant
Alveoli type I: gas exchange
Alveoli type II: surfactant
1. 28-34 weeks gestation
2. Reduces surface tension of the fluid lining the alveoli, permitting
expansion
Necessary to breathe
Not large amounts in premature babies
c. Breathing
Chemical stimuli – pressure of first breath
, 2
Thermal stimuli – cold stimulates skin nerve endings causing newborn to
respond with a breath
1. Intervention: give warm blanket
Sensory stimuli – go from quiet, familiar space to noise, bright space
1. Intervention: rub baby with towel, flick feet
d. Cardiopulmonary
Closure of ductus arteriosus, foramen ovale, ductus venosus
Increased aortic pressure and decreased venous pressure
Increased systemic pressure and decreased pulmonary pressure
NORMAL NEWBORN CHARACTERISTICS AND NEWBORN ASSESSMENT
a. Respiratory
30-60 breaths per min
Shallow, diaphoretic, irregular
Periodic breathing – 5-15 second cessation of breathing
b. Cardiovascular
Apical pulse 110-160 beats/min… may be lower during sleep
Murmur is normal after delivery
c. Temperature
Axillary temp: 36.4-37.2 C
If temp decreases, blood sugar decreases
Thermoregulation
1. Less subcutaneous fat
2. Vessels close to skin
3. Flexed posture helps keep heat loss minimal
4. Smaller the infant the more controlled the environment must be
Heat loss:
1. Conduction – heat loss to a cooler surface by direct skin contact (chilled
hands, cold table)
2. Convection – heat loss due to cooler air currents (AC)
Place bassinet out of direct line of fan or AC vent, swaddle, and
keep head covered
3. Evaporation – heat loss due to water converting to vapor (dry the
newborn)
4. Radiation – heat transfers from heated body surface to cooler surfaces not
in direct contact (walls of room)
Keep newborn and examining tables away from window and AC
, 3
d. Liver
Iron storage – until needed to make RBC, newborn should have enough iron to
spare for 5 months
Carbohydrate metabolism – fuel sources are consumed fast due to temp,
activity, work of breathing
Conjugation of bilirubin – conversion of bilirubin into an excretable form,
unexcretable bilirubin is potentially toxic
1. Hyperbilirubinemia
Fetus has never had to conjugate bilirubin… mother did it
Conjugated bilirubin is excreted by stool and urine
i. Early/Frequent feeding increase stool and urine
Unconjugated bilirubin is formed when RBC’s are destroyed
Decreased ability to clear bilirubin occurs in breastfed babies and in
delayed bacterial colonization of the gut (use of antibiotics)
Coagulation - Vitamin K prophylaxis after birth… needed to start coagulation
factor
1. Phototherapy helps with difficult platelet aggregation function
e. Jaundice (see Newborn Jaundice page 1)
f. GI
Newborns typically pass a meconium stool within 8-24 hours
BS heard within 30-60 min
Breastfeed babies have seedy, no odor stools
Formula fed have mustard looking stools
g. Urinary
Lower GFR than adults
h. Neuro Sensory
Functioning
1. Sleep states
Deep/quiet – closed eyes, no eye movement, regular even
breathing, low HR (100-120)
Active/light sleep – REM, irregular respirations, minimal activity
2. Alert
Drowsy – open or closed eyes, semi dozing appearance, delayed
reaction to stimulus
Active – eyes open, high activity, alert
Quiet – baby focuses on fixed objects, delayed response
Crying – hunger, pain cues
Periods of reactivity
1. 1st period – baby is awake, active; high respirations, fast heart beat
2. Inactivity to sleep phase – baby quiets down, baseline RR, HR
3. 2nd period – baby awake again
Sensory
1. Baby can see 8-15 inches
2. Select mother by smell
3. Distinguish between sweet and sour
4. Reflexes
Survival reflexes – become voluntary (Sucking
i. Babinski – foot tickling
ii. Moro – loss of sudden support, arms fly back
Primitive reflexes disappear
5. Very sensitive – enjoy touch – skin to skin
NEWBORN VITAL SIGNS
a. RR – 30-60
b. HR – 110-160
c. Temperature – 36.4-37.2
d. BP – 70-50/ 45-30 at birth
STUDY GUIDE EXAM 2 NURS 320
NEWBORN JAUNDICE
a. Jaundice
Physiologic Jaundice
1. Accelerated destruction of RBC’s
2. 60% full term, 80% preterm affected
3. NOTED ON THE 2ND OR 3RD DAY!!
Physiological jaundice after 24 hours of life
Pathologic jaundice is seen at birth or within first 24 hours
4. Causes
Impaired conjugation of bilirubin
Increased reabsorption of bilirubin form intestinal tract
Delayed intestinal motility
Proteins not available to bind to bilirubin
Complications (of pathologic jaundice)
1. Kernicterus (bilirubin goes into brain)
Risk factors
1. East Asian race
2. Sibling with Jaundice
3. Prematurity, stress at birth, hypothermia, hypoglycemia
4. ABO incompatibility
Assessment
1. Sclera – white or yellow
2. Progression in a cephalocaudal fashion – call physician
3. Urine and stool
4. Encourage early/frequent feedings
5. Lethargy
Treatment
1. Exposure to light, PHOTOTHERAPY
2. Monitor for bilirubin levels
3. ENCOURAGE FREQUENT FEEDINGS
CARE OF INFANT UNDERGOING PHOTOTHERAPY
a. Used to prevent hyperbilirubinemia
b. Bilateral eye patches are always used
c. Baby naked except for diaper
d. As much skin exposed as possible
e. Reposition every 2 hour
f. Ongoing monitoring – hydration, nutrition, temperature, improvement of jaundice
IMMEDIATE NURSING PRIORITIES POST-DELIVERY FOR NEWBORNS
a. Fetal breathing movements
Go from liquid filled –> gas filled
Lung expansion following birth – spontaneous
Marked increase in pulmonary circulation must occur
b. Surfactant
Alveoli type I: gas exchange
Alveoli type II: surfactant
1. 28-34 weeks gestation
2. Reduces surface tension of the fluid lining the alveoli, permitting
expansion
Necessary to breathe
Not large amounts in premature babies
c. Breathing
Chemical stimuli – pressure of first breath
, 2
Thermal stimuli – cold stimulates skin nerve endings causing newborn to
respond with a breath
1. Intervention: give warm blanket
Sensory stimuli – go from quiet, familiar space to noise, bright space
1. Intervention: rub baby with towel, flick feet
d. Cardiopulmonary
Closure of ductus arteriosus, foramen ovale, ductus venosus
Increased aortic pressure and decreased venous pressure
Increased systemic pressure and decreased pulmonary pressure
NORMAL NEWBORN CHARACTERISTICS AND NEWBORN ASSESSMENT
a. Respiratory
30-60 breaths per min
Shallow, diaphoretic, irregular
Periodic breathing – 5-15 second cessation of breathing
b. Cardiovascular
Apical pulse 110-160 beats/min… may be lower during sleep
Murmur is normal after delivery
c. Temperature
Axillary temp: 36.4-37.2 C
If temp decreases, blood sugar decreases
Thermoregulation
1. Less subcutaneous fat
2. Vessels close to skin
3. Flexed posture helps keep heat loss minimal
4. Smaller the infant the more controlled the environment must be
Heat loss:
1. Conduction – heat loss to a cooler surface by direct skin contact (chilled
hands, cold table)
2. Convection – heat loss due to cooler air currents (AC)
Place bassinet out of direct line of fan or AC vent, swaddle, and
keep head covered
3. Evaporation – heat loss due to water converting to vapor (dry the
newborn)
4. Radiation – heat transfers from heated body surface to cooler surfaces not
in direct contact (walls of room)
Keep newborn and examining tables away from window and AC
, 3
d. Liver
Iron storage – until needed to make RBC, newborn should have enough iron to
spare for 5 months
Carbohydrate metabolism – fuel sources are consumed fast due to temp,
activity, work of breathing
Conjugation of bilirubin – conversion of bilirubin into an excretable form,
unexcretable bilirubin is potentially toxic
1. Hyperbilirubinemia
Fetus has never had to conjugate bilirubin… mother did it
Conjugated bilirubin is excreted by stool and urine
i. Early/Frequent feeding increase stool and urine
Unconjugated bilirubin is formed when RBC’s are destroyed
Decreased ability to clear bilirubin occurs in breastfed babies and in
delayed bacterial colonization of the gut (use of antibiotics)
Coagulation - Vitamin K prophylaxis after birth… needed to start coagulation
factor
1. Phototherapy helps with difficult platelet aggregation function
e. Jaundice (see Newborn Jaundice page 1)
f. GI
Newborns typically pass a meconium stool within 8-24 hours
BS heard within 30-60 min
Breastfeed babies have seedy, no odor stools
Formula fed have mustard looking stools
g. Urinary
Lower GFR than adults
h. Neuro Sensory
Functioning
1. Sleep states
Deep/quiet – closed eyes, no eye movement, regular even
breathing, low HR (100-120)
Active/light sleep – REM, irregular respirations, minimal activity
2. Alert
Drowsy – open or closed eyes, semi dozing appearance, delayed
reaction to stimulus
Active – eyes open, high activity, alert
Quiet – baby focuses on fixed objects, delayed response
Crying – hunger, pain cues
Periods of reactivity
1. 1st period – baby is awake, active; high respirations, fast heart beat
2. Inactivity to sleep phase – baby quiets down, baseline RR, HR
3. 2nd period – baby awake again
Sensory
1. Baby can see 8-15 inches
2. Select mother by smell
3. Distinguish between sweet and sour
4. Reflexes
Survival reflexes – become voluntary (Sucking
i. Babinski – foot tickling
ii. Moro – loss of sudden support, arms fly back
Primitive reflexes disappear
5. Very sensitive – enjoy touch – skin to skin
NEWBORN VITAL SIGNS
a. RR – 30-60
b. HR – 110-160
c. Temperature – 36.4-37.2
d. BP – 70-50/ 45-30 at birth
