NURS 306 – OB Week 4 Study Guide 2023 Exam

NURS 306 – OB Week 4 Study Guide 2023 Exam. Chapter 15 - Neonatal period o From birth through the first 28 days of life - Focus of nursing care o Maintaining body heat o Maintaining respiratory function o Decreasing risk of infection o Assisting parents in providing appropriate nutrition and hydration o Assisting parents in learning to care for their newborn - Transition to extrauterine life: Respiratory system o THE ESTABLISHMENT OF EXTRAUTERINE RESPIRATION IS THE MOST CRITICAL CHANGE THAT OCCURS IN THE TRANSITION FROM FETUS TO NEONATE  AIRWAY AND BREATHING IS PRIORITY (ABC) o Mechanical Stimuli  Loss of amniotic fluid from lungs + delivery of chest (negative pressure – passive inspiration of air – first breath)  entry of air into alveoli replacing the expelled amniotic fluid  neonate crying (stimulate baby to cry) intra thoracic positive pressure  alveoli remain open  Good strong cry will help with respirations  EX: c section doesn’t have much mechanical stimuli o Chemical Stimuli  Cessation of placental blood flow  Decreased O2 Mild hypoxia  Increase CO2  Acidosis  Stimulation of respiratory center in medulla  Stimulation of respirations o Internal stimuli  Chemical changes o External stimuli  Sensory, thermal, mechanical changes - Importance of surfactant o Pulmonary surfactant is a complex mixture of specific lipids, proteins and carbohydrates, which is produced in the lungs by type II alveolar epithelial cells. The mixture is surface active and acts to decrease surface tension at the air–liquid interface of the alveoli. o Protective against pulmonary diseases  Premature babies don’t have surfactants - Newborn assessment – signs of respiratory distress o Tachypnea o Cyanosis  Oral cyanosis or trunk o Nasal flaring  Widening of the nares o Expiratory grunting  Sounds like “singing” o Retraction of the chest wall o Cyanosis, abnormal respiratory patterns (apnea/tachypnea), retractions of the chest wall, grunting, flaring of nostrils, hypotonia (flobby)  Transition period is 1-2 hours after birth.  Signs of respiratory distress will persist past this normal time frame o Anything that causes stress for baby – MOST COMMON IS C SECTION BIRTH BECAUSE AREN’T HAVING THE MECHANICAL STIMULATION SO WHEN THEY COME OUT THEY HAVE A LOT OF SECRETIONS  Cord prolapse  Low APGAR  Meconium staining  IF WATER BREAKS AND IS GREEN = BABY IS STRESSED  Prematurity  Post maturity  Small for gestational age  Breech birth  Chest, heart or respiratory tract anomalies  Maternal history of diabetes  Hypoglycemia can cause respiratory distress  Premature rupture of membranes  Maternal use of barbiturates or narcotics close to birth  < 9cm is bad  Non-reassuring fetal monitoring strip  Acidotic - Cardiopulmonary adaption o Increased aortic pressure and decreased venous pressure o Increased systemic pressure and decreased pulmonary pressure o Closure of foramen ovule, ductus arteriosus, and ductus venosus o Drying or clamping of the umbilical cord and stimulation of cold receptors  increased PCO2, decreased PO2 and increased acidosis  first breath  decreased pulmonary artery pressure - Newborn circulation o Ductus Venosus-  Blood flow stops when cord is clamped.  Closes by Day 3 of Life  Becomes a ligament o Foramen Ovale-  Opening between right and left atrium  Closes when left atrial pressure is higher than right atrial pressure  First couple of hours o Ductus Arteriosus  Closes within 15 hours post birth  Will remain open if lungs fail to expand or PaO2 levels drop - Thermoregulatory system o Physiological changes o Neutral thermal environment (NTE)  An environment that maintains body temperature with minimal metabolic changes and or/oxygen consumption o Brown fat: Highly dense and vascular adipose tissue  “No shivering thermogenesis” – babies don’t shiver  If cold  they burn through their brown fat which causes shiver  Shivering baby  hypoglycemia not because they’re cold  Preterm babies have very little brown fat o Factors that negatively affect thermoregulation  Decreased subcutaneous fat – IGR/premature baby increased risk  Decreased brown fat in preterm infants  Large body surface  Thin skin and blood vessels close to skin  Loss of heat from convection, radiation, conduction, and/or evaporation - Mechanism of heat loss o Can be unstable. o Guard against loss due to:  Convection – the baby is at home and you place them by a fan – air conditioner (DRAFT)  Conduction – direct skin contact such as warm blankets should be ready to go/or on mom  Radiation – indirect objects such as a cold wall  Evaporation- loss of heat the occurs when water on neonates skin is converted to vapors, during bathing or directly after birth o Dry immediately with warm blankets - Thermoregulation: cold stress o Drop in environmental temperature  Decrease in body temperature  Increased heart and respiratory rates  Increased O2 consumption, depletion of glucose, and decreased surfactant  Respiratory distress o Can delay the transition from fetal to neonatal circulation o Leads to hypoglycemia, hyperbilirubemia, etc o Nursing action  Actions to decrease risk  Actions when neonate displays signs of cold stress  Risk factors: prematurity, small for gestational age, hypoglycemia, prolonged resuscitation efforts, sepsis, neurological/endocrine, cardioresp problems  S&S: Axillary temp below 36.5, cool skin, lethargy, pallor, tachypnea, grunting, hypoglycemia, hypotonia, jitteriness, weak suck  Nursing action: dry baby immediately after birth to decrease heat loss, remove wet blankets, place stocking cap on head, skin to skin contact, use prewarmed blankets, swaddle blankets, delay initial bath - Metabolic system o *Large amounts of glycogen stored by fetus during pregnancy in preparation for energy requirements after birth. o Neonate then becomes independent of mother’s metabolism and must balance insulin production and glucose availability. o IF MOTHER IS DIABETIC AUTOMATICALLY CHECK GLUCOSE LEVEL AFTER BIRTH  Hypoglycemia  S&S lethargy, poor feeding, jitteriness, asphyxia (SOB/deprived of oxygen), irregular temp, apnea, weak/high pitched cry, restlessness, seizure, pale/bluish skin, TACHYPNEA, TACHYCARDIA  Hypoglycemia with clinical sign is a medical emergency  TREATMENT IS TO FEED BABY COLOSTRUM OR EVEN FORMULA  Treatment of hyperinsulinism prevents long term neurological damage  Usually defined as blood glucose <40 o Was the baby fed colostrum or formula? o Traumatic birth?  Common in transition time (1-2 hours after birth) o Especially in infants of diabetic mothers - Hyperbilirubinemia o Liver produces substances essential for clotting of blood o Stores needed iron for the first few months  Preterm and small infants have lower iron stores than full term o Physiologic jaundice  After 24-48 hrs of age do to increased breakdown of RBC’s and immature liver functioning  Lasts for about 14 days, peaks around 7-9  Liver is starting to mature and break down the bilirubin  Disappears without treatment  < 5mg / dL  Yellow discoloration of the infants skin and sclera of eye  Baby’s liver is immature SO IT’s NORMAL o If baby has a traumatic birth (hemorrhagic birth) it’s most like physiologic jaundice o Pathological Jaundice o Occurs before 24 hours or after 7 days – something is really up with the liver o Lasts for MORE THAN 14 DAYS o > 15 mg/dL o Needs treatment for the cause o Risk factors for hyperbilirubinemia  ↑ RBC breakdown (cephalohematoma, extensive bruising from birth trauma)  Rh or ABO incompatibility  Ineffective breastfeeding & dehydration  If not getting enough intake (breastmilk) bilirubin can’t bind to anything to get excreted  Certain medications (aspirin, tranquilizers, and sulfonamides)  Maternal enzymes in breast milk- fairly uncommon  Hypoglycemia  Hypothermia  Decreased liver function  Anoxia  EXCLUSIVELY BREAST FED BABIES ARE AT RISK FOR HYPERBILIRUBEMIA – SO WE USE FORMULA o Nursing assessment of hyperbilirubinemia  Darker baby- blanching the skin  Yellowish tint to skin, sclera and mucus membranes--observe by window – NATURAL SUNLIGHT  Note time of jaundice (integral in differentiating between physiologic and pathologic jaundice)  Treatments: early feedings, phototherapy, exchange transfusion  Phototherapy: results in photoconverting bilirubin molecules to water soluble isomers that can be excreted by urine or stool  Exchange transfusion: when phototherapy isn’t effective. About 85% of neonate’s RBC are replaced with donor cells- reduces bilirubin, removes RBC, corrects anemia o Testing for bilirubin levels  TCB – transcutaneous bilirubin (on forehead or neck)  Chest, forehead  < 20 < 24 hours (pathological) – blood drawn, etc  Clinical jaundice  measure bilirubin  bilirubin > 12 AND <24 hours  Coombs Test  Clinical jaundice  measure bilirubin  bilirubin <12 mg OR infant < 24 hours  Follow bilirubin o Treatment for bilirubin  Either feed the baby and retest it or  Phototherapy involves shining fluorescent light from the bili lights on bare skin. A specific wavelength of light can break down bilirubin into a form that the body can excrete through the urine and stools. - GI system o Physiological changes  Stomach and digestive enzymes o Bacterial colonization once starts eating o • Vitamin K produced  Hemorrhagic disease due to vitamin k deficiency so we give an injection of vitamin K o Intestinal peristalsis o Characteristics of stools  Meconium  Begins to form during the 4th gestational month and is the first stool eliminated by the neonate, thick, sticky, black and odorlessfirst passed within 24-48 hours  Transitional  Begins around the 3rd day and can continue 3-4 days- black to greenish black, to greenish brown, to greenish yellow  Breastfed stool- yellow and semi formed  Formula fed stool- drier and more formed than breastfeed stools- paler yellow or brownish yellow unpleasant odor  Breast vs. Bottle - Signs and symptoms of dehydration o Sunken fontanelle from malnutrition and dehydration - Renal system o Kidney function  If renal system isn’t hydrated well – sunken frontal o Nursing assessments  Careful monitoring of I/O  Assess appearance of urine  Signs dehydration or increased ICP  Bulging frontal is a sign of ICP  Signs of dehydration – looking at the diaper and sunken frontal head