Ob-Study_Guide_Exam_2[Buy Quality]

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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

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 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

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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