Untitled Quiz

OB Exam 5 Tutoring

• This material covers various aspects of newborn care, including physiologic responses, fetal respiratory system, fetal circulation, cardiopulmonary system, thermoregulation, hepatic adaptation, hypoglycemia, TTN, and hypothermia. Question time sections include case studies and exam-style questions.

Physiologic Responses of the NB to Birth

• Newborn respiratory status assessed for regularity/irregularity, pauses, and apnea.
• Normal heart rate (bpm) range at birth.
• Count apical pulse.
• Blood pressure normally rises after birth.

Fetal Respiratory System

• Alveolar ducts present by 20-24 weeks.
• Surfactant production peaks at 28-32 weeks, crucial for lung function.
• Normal newborn respirations are assessed for regularity, pauses (apnea), rate (bpm), depth, and noise level.
• Signs of abnormal respirations include grunting (especially at rest), nasal flaring, retractions, tachypnea, apnea, and cyanosis.

Fetal Circulation

• Ductus venosus, foramen ovale, ductus arteriosus are crucial fetal structures.
• Major changes in these structures occur after birth as the circulatory system transitions from fetal to neonatal.
• Normal heart rate at birth can be up to 180 bpm.
• Apical pulse x1 minute is important.
• Blood pressure rises after birth.
• Cardiac murmurs are usually assessed.

Cardiopulmonary System

• Fluid-filled lungs at birth—the transition to air-filled lungs.
• What prevents lung collapse?
• Chemical stimuli like changes in partial oxygen (O2) and carbon dioxide (CO2) levels.
• Sensory stimuli (auditory, tactile).
• Abnormal cardiac patterns like tachycardia (heart rate over 160 bpm at rest).
• Bradycardia (<100 bpm at rest, but not during sleep).

Thermoregulation

• Maintaining a stable environment is critical to avoid heat loss and cold stress.
• Newborns can't shiver as a primary source of heat.
• Infants rely on nonshivering thermogenesis (increasing muscle activity) and brown adipose tissue.

Hepatic Adaptation

• Liver functions like iron storage and glucose homeostasis important for the newborn.
• Bilirubin—its metabolism and changes from fat-soluble (unconjugated) to water-soluble (conjugated) forms, crucial for excretion.
• Jaundice--A result of bilirubin buildup and its potential causes and the conjugation processes.
• How do babies excrete bilirubin?

Hypoglycemia, TTN, and Hypothermia

• Normal newborn glucose range.
• Signs and symptoms of hypoglycemia (e.g., jitteriness, lethargy, apnea, seizures).
• Risk factors for hypoglycemia, e.g., macrosomia, premature infants, other maternal issues.
• Interventions for hypoglycemia.
• Identifying and managing hypoglycemia, TTN, and hypothermia.

Nursing Care of Newborn and Family

• Nursing care of the newborn and family, focusing on essential aspects during the first 24 hours, like monitoring vital signs, Apgar scores, and other assessments, and ensuring the baby is in a thermoneutral environment.

Ballard Score- Physical Maturity

• Assessment for gestational age based on physical features.
• Skin appears thin and transparent in preterm infants; opaque in term infants.
• Lanugo is present, prominent in preterm, decreasing throughout pregnancy.
• Creases are unreliable beyond 12 hours.

Skin Assessment and Head Assessment

• Cyanosis (blue-tinged skin) at rest but pink when crying—suspect choanal atresia or another structural issue.
• Mottling, jaundice, and erythema toxicum.
• Milia (white spots on the face) and how they should be explained to parents.

Simple Reflexes of the NB

• Assessing newborn reflexes (e.g., sucking, rooting, Moro, tonic neck, palmar grasping, stepping).

Hyperbilirubinemia

• Elevated bilirubin levels (physiological or pathological).
• Causes of hyperbilirubinemia.
• Risk factors.
• Management (e.g., phototherapy).

Question Time! (Case Studies)

• Multiple case studies with exam-style questions.
• Important nursing actions and priorities for newborns with various conditions.

Acquired Problems of NB

• Newborn injuries (e.g., brachial palsy, cephalohematoma, caput succedaneum).

Substance Abuse Neonatal Abstinence Syndrome (NAS)

• Recognizing and managing NAS
• Effects of drugs in the infant.

Nursing Care of the High-Risk Newborn

• Care for high-risk newborns during the first 4 hours and beyond.
• Specific considerations of critical aspects.
• Interventions and priorities.

Alterations in Respiratory & Cardiac Function

• Respiratory distress syndrome (RDS) and possible causes
• Managing possible issues related to impaired cardiac function in premature infants.
• Early recognition and management.

At-Risk Newborns

• Assessment risk factors and classify high-risk infants based on gestation, weight, and other factors
• Surfactant administration.

SGA/IUGR/LGA

• Small for gestational age, Intrauterine Growth Restriction, and Large for Gestational Age
• Complications and potential risks associated.

Postmature Newborns

• Characteristics and possible complications.

Infants of Diabetic Mothers

• Potential complications in infants of diabetic mothers
• Risk factors.

Alterations in Thermoregulation

• Factors leading to thermoregulation issues for premature and post-term newborns
• Identifying and addressing specific thermoregulation concerns
• Normal temperature range.

Circumsision

• Procedure and post-procedure care.
• What to monitor, concerns.
• Daily hygiene.

Preparation for Discharge & Security

• Preparing the newborn and parents for home.
• Addressing safety before discharge
• What to include in teaching.

Newborn Infections

• Common newborn infections and signs/symptoms.

CNS Congenital Anomalies

• Defects specific to the CNS including encephalocele, meningomyelocele, anencephaly, hydrocephalus, and microcephaly.

Respiratory Congenital Anomalies

• Conditions affecting the respiratory system in infants.

Gastrointestinal Congenital Anomalies

• Conditions affecting the gastrointestinal tract in infants (e.g., cleft lip/palate, esophageal atresia, TEF, omphalocele, gastroschisis).

Musculoskeletal Congenital Anomalies

• Conditions affecting the musculoskeletal system in infants (e.g., hip dysplasia and clubfoot).

Urogenital Congenital Anomalies

• Conditions affecting the urogenital system in infants (e.g., hypospadias, epispadias, hydrocele, cryptorchidism).

Metabolic Congenital Anomalies

• Genetic disorders impacting metabolic processes.

Practice Questions

• Multiple practice questions on various aspects of newborn care.