OB Exam 3 Review - newborn nursing care, medications, and complications - PDF

**OB Exam 3 review** A close-up of a form AI-generated content may be incorrect. **[Newborn nursing care ]** - Nursing interventions - Maintain airway patency - Maintain thermoregulation - Administer prescribed meds - Ensure proper identification - Airway patency...

**OB Exam 3 review** A close-up of a form AI-generated content may be incorrect. **[Newborn nursing care ]** - Nursing interventions - Maintain airway patency - Maintain thermoregulation - Administer prescribed meds - Ensure proper identification - Airway patency - Bradypnea - Resp less than 30/min - Tachypnea - Resp greater than 60/min - Abnormal breath sounds - Grunting, crackles, wheezes - Respiratory distress - Nasal flaring - Retractions - Grunting and labored breathing - Nursing interventions for stabilization and resuscitation of airway (airway patency) **(2 questions)** - Routine suction of mouth then nasal passage - Mechanical suctioning IF wipe and bulb syringe do not work - **Bulb syringe** ONLY IF NEEDED - Keep with newborn at ALL TIMES - Educate family on how to use - Have family teach back - Compress away from baby and insert into side of mouth (cheek) - 1 -\> use towel to wipe secretions - 2 -\> suction with bulb to remove fluids from mouth THEN nose - 3 -\> mechanical suction - 4 -\> initiate NRP (baby CPR) - Thermoregulation - Maintaining balance between heat loss and heat production - Nursing priority - Ensure normal body temp - Nursing action - No contact with cold surfaces - BEST METHOD to maintain temp is skin to skin with mom - 4 mechanisms - Conduction - Heat loss from DIRECT CONTACT - Interventions - Preheat radiant warmer - Warm stethoscope - Place warm cover on scale - Convection (air AROUND the body) - Heat from body to cooler environment - Interventions - Place crib away from open door or air vent - Swaddle - Keep head covered (especially in first 24 hours) if outside - Keep room at 72-78 degrees - Evaporation (baby being wet) - Surface liquid is converted to vapor - Interventions - Dry baby IMMEDIATELY after birth with warm blanket - Check temp before bathing - Expose one body part at a time while bathing - Radiation (being next to a window) - From body surface to cooler solid surface - Interventions - Keep baby and tables away from windows, air vents, and open doors - Nursing interventions **(3 questions)** - Skin to skin with mom - Hat on newborn immediately after birth - Dry newborn immediately after birth - Wrap in warm blanklets - Use a warm cover for scale - Warm stethoscope and hands - Avoid drafts and vents - Delay bathing until temp is stable - Avoid placing cribs near outer walls - Newborn medications **(2 questions)** - **Vitamin K** - Given to help clot bc baby has no clotting factors - **Promotes blood clotting** - Bowel is sterile - Produced in intestine after first feeding - Administered 1-2 hours after birth - IM injection (vastus lateralis muscle) - 25 gauge 5/8 needle - Hold leg firmly - **Erythromycin** - Prevents hyperacute conjunctivitis - Required for vaginal and c section babies - Contracted during birth from **chlamydia and gonorrhea** infection - Eyelids become swollen, red, and have purulent drainage - Do not touch tip to eye - Wipe off excess after 1 minute - **Hepatitis B** - Protects against hep B - Informed consent needed - **Vitamin K and hep B given in DIFFERENT thighs** - Newborn care **(5 questions)** - Discharge teaching begins on admission - The nurse's responsibility - Assess current knowledge - Anticipate the learning needs of parents - Assess their readiness for learning - Provide education - Assess learning - Metabolic screening - Newborn screening is state mandated - Requires a few drops of blood taken from heel stick - Screens for PKU - Congenital hypothyroidism, galactosemia, sickle cell anemia - Can only be done AFTER baby is 24 hrs old - Critical congenital heart disease (CCHD) - Life threatening - O2 sensor on right hand and either foot - Screening done AFTER 24 hrs old - Looking for a large differential between hand and foot - Large differential = bad - Transcutaneous bilirubin - Measures how much bilirubin is in the blood - Done at 24 hr mark - Uses a bilirubinometer (noninvasive) - Need at least 1 meconium in first 24 hrs - Hearing screen - Most common birth disorder - Screened prior to discharge - Vaginal delivery = 6 hrs after birth - c/s delivery = 24 hrs after birth - screening NOT diagnostic - Crying - Quieting techniques **(6 S's)** - Skin to skin - Swaddling - Sucking (breast or pacifier) - Breast feeding should happen at LEAST 8 times daily - Shushing - Swaying - Side lying - Family education - Babies cry when... - Hungry - Offer BOTH breasts at feeding - Wake bby every 2-3 hrs to feed - Dirty - cold/hot - need to burp - overstimulated - Sleep-wake cycle - Newborns sleep approximately 16-19 hrs/day - NBs develop their own sleep patterns, initially having day and night reversed - Sleep safety - **Place baby on back** - Do NOT bed share - **Use a firm surface** - No additional items in sleeping area - **SIDS** - Sudden unexpected death of a child younger than 1 year during sleep - Most common around 4 months - Factors - Sleeping on stomach/side - Sleeping on soft surface - Sharing a bed - [Overheating ] - Male gender - Second hand smoke - vaping - Bathing (at hospital) - Wear gloves before bby's first bath - Skin to skin or radiant warmer to stabilize temp after bath - **Bathing (at home)** - **No submersion until umbilical cord has fallen off** - Do not leave infant unattended - Water should be 100.4 - NO BABY POWDER!!! - No oils or lotions until told by provider (wait 2-3 weeks) - No Q-tips - Umbilical cord care - Clamp is removed before discharge - Keep the cord dry - **Observe for redness, drainage, or foul odor (signs of infection)** - **Let cord fall off naturally** (takes 14-17 days) - **Keep diaper below cord stump** - Elimination - Voids - Void within 24 hrs of birth - Urate crystals in first 3 days of life are normal - Reddish orange stain diaper - Babies should generally have 6 pees a day after 6 days of life - Day 1 = 1 pee - Day 2 = 2 pees - Day 3... - Day 7 = 6 pees - Stools - Meconium withing 24 hrs of birth - Meconium lasts 1-3 days - Transitional stools (looser greenish to yellow) - Car seat safety - Keep infant in rear-facing car seat - **45-degree** angle in the car seat - **Chest clip at armpit level**/nipple line - Nurses are NOT car seat certified - **Head should be 1 inch below top of carseat** - Signs of illness to report - Temp \> 100.4 - Dec wet diapers - **Circumcision** - Surgical removal of foreskin - Contraindications - Did not receive vitamin K - No voids in life - Less than 12 hrs old - Hypospadias - Urinary meatus on UNDERSIDE of penis - Common - Epispadias - Urethra on TOP or SIDE rather than tip of penis - Rare - Family education - Yellowish exudate over the glans by day 2 - Do NOT try to wash off - No tub baths until healed **Newborn nutrition** **(3 questions)** - Nutritional needs - Breastmilk or formula is the only nutrition an infant needs for the first 6 months of life - Solids should be given after 6 months to avoid allergy development - **Feeding readiness cues**  A baby with a purple shirt AI-generated content may be incorrect. - Crying is a LATE sign - Weight loss - **Loss of 5-10% after birth** - Breastfeeding - Recommended exclusively for first 6 months of life - **Perform every 2-3 hrs** - Breastfeed **at least 8 times/day** - Colostrum - Contains IgA (passive immunity) - Nursing interventions **\*\*\*\*** - Skin to skin on moms chest - Demonstrate breastfeeding positions - Show how to break a latch to prevent nipple trauma - Consult lactation - **Pt education for breastfeeding \*\*\*\*** - Nose, cheeks, and chin should touch the breast - Hunger cues (rooting, tongue thrusting, lip smacking) - Breastfeed at least 15-20 min on each breast - Offer BOTH breasts at feeding - Observe for fullness (sleeping, sucking slows) - Burp after each breast - Uterine cramping is normal - Avoid nipple confusion - Wait to use pacifier (10 days) - Supplement using syringe (not bottle) - Formula feeding - **Feed every 3-4 hrs** - **Minimum of 6 times a day** - Pt education for formula feeding - baby will have less frequent BM - feed at 45 degree angle - nursing interventions for nutrition complications - **newborn is too sleepy \*\*\*\*** - **unwrap** the newborn - place **skin to skin** - **change diaper** - hold newborn upright - **talk** with baby - massage hands and feet - apply a cool cloth to face - failure to thrive - evaluate position and latch - massage the breast - determine feeding patterns - allergy to cow milk (formula feeding) **Newborn assessment** - Physiological response to birth **(1 question)** - **Resp function is established when the umbilical cord is cut and clamped \*\*\*** - Air inflates the lungs with the first breath **\*\*\*** - Pushing fluid out of the alveoli **\*\*\*** - Three shunts needed for fetal circulation - Close during newborn's transition +-----------------------+-----------------------+-----------------------+ | | **Fetus** | **Newborn** | +=======================+=======================+=======================+ | Resp system | Fluid filled, high | Air filled, low | | | pressure through duct | pressure | | | | | | | | Closure of duct | +-----------------------+-----------------------+-----------------------+ | Gas exchange | Placenta | Lungs | +-----------------------+-----------------------+-----------------------+ | Circulation through | Pressure in the right | Pressure in the left | | heart | atrium | atrium | | | | | | | Blood flow through | Foreman ovale closure | | | foreman ovale | | +-----------------------+-----------------------+-----------------------+ - Initial newborn assessment **(1 question)** - **Signs that indicate a problem** - Nasal flaring - Chest retractions - Grunting - Generalized cyanosis - Abnormal resp rates - Tachypnea (\>60 breaths) - Bradypnea (\15 seconds)** - Abnormal heart rates - Tachycardia (\>160 bpm) - Bradycardia (\ fully flexed hips and knees - Skin - Color - Pink - Turgor - Texture - Dry, soft, smooth, and warm - Vernix - More abundant in preterm - White cheesy covering - Lanugo - More abundant in preterm - Fine, downy hair - Found on ears, forehead, and shoulders - **Acrocyanosis** - Blueish color on hands and feet - Resolves in 24-48 hrs after birth - **Milia** - Small raised white spots - EDUCATE parents to not squeeze spots - **Mongolian spots** - Flat, congenital mark - Usually located on buttocks and lower back - EDUCATE -\> normal - DOCUMENT - **Stork bites** - Normally fade by age 2 - Flat pink/red marks that easily blanch - Port wine stain - Less common - Found on face and does NOT blanch or disappear - **Newborn rash** - Pink rash that appears suddenly anywhere on the body - No treatment required - Head - Shape -\> round or molding - Should be 2-3 cm larger than chest circumference - Fontanels -\> soft and flat - [Problems]: - Sunken = dehydration - Bulging = ICP - Sutures -\> palpable - May be separated/overriding - [Problem]: - Fused sutures - **Caput** succedaneum -\> "cone head" - Localized swelling of the soft tissues - **Caused by prolonged pushing** - Usually resolves in 3-4 days - No treatment required - **Cephalohematoma** - Collection of blood between periosteum and skull bone - r/t any kind of trauma delivery - Does NOT cross suture line - **Higher risk for jaundice!!!!** - Eyes - Symmetrical in size and shape - No drainage - [Normal variation]: eye movements may be random, jerky or cross - Ears - Low set ears = chromosome abnormality - Cartilage should be firm - Inspect ears for skin tags - Indicates kidney problems - Nose - Midline, flat, and broad - Newborns are obligatory nose breathers - EDUCATE - Sneezing to clear passage is normal!!! - Mouth - Lips and mouth should be symmetrical, pink, and moist - Assess for strong suck - Saliva should be scant - Excess saliva is abnormal - [Normal variation]: sucking blister - Epstein's pearls - Small whitish-yellow cysts found on gums and palate - Disappear in a few weeks - Precocious tooth - Can be dangerous is loose - Neck - Short, thick, surrounded by skin folds - Absence of head control can indicate prematurity or Down's syndrome - Chest - Barrel shaped - Respirations are diaphragmatic - Use diaphragm and abdomen to breathe - Clavicles intact - Retractions absent - Abdomen - Soft, round, dome shaped and non-distended - Bowel sounds present a few minutes after birth - Anogenital - Void within 1^st^ 24 hrs - [Expected findings]: Uric crystals produce a rust color - Meconium should be passed within 1^st^ 24 hrs - Boys - Rugae on scrotum - Testes should be present - Urinary meatus at penile tip - Girls - Labia majora covering labia minora - Edematous - Pseudomenstration - [Normal variation]: Blood tinged discharge - Extremities - Assess for full ROM - Gluteal folds should be symmetrical - [Normal variation]: extra digits - Spine - Straight, flat, midline - Possible problems - Sacral dimples - Hair tufts -\> spina bifida - Pain - Pain scales - NPASS - NIPS - Physiologic responses to pain - Inconsolable crying - VS changes - Newborn reflex assessment **(2 questions)** - Sucking - Rooting  - Palmar grasp - Plantar grasp Close-up of a baby\'s feet AI-generated content may be incorrect. - Moro reflex  - Tonic neck A baby lying on a white blanket AI-generated content may be incorrect. - Babinski  - Stepping A person holding a crying baby AI-generated content may be incorrect. **Newborn complications** - Preterm/post-term newborn **(2 questions)** - Preterm -\> any baby **before 37 weeks** - Late preterm -\> between 34 and 36 weeks - Complications - Resp distress syndrome (RDS) -\> dec surfactant - Aspiration -\> no intact gag reflex - Apnea -\> immature neurological and chemical mechanisms - Risk factors - GHTN - Closely spaced pregnancies - Lack of prenatal care - PPROM - **Expected assessment findings** - Low birth weight - Lack of creases on palms/feet - Abundant lanugo - Abundant vernix - Inability to coordinate suck and swallow - Nursing interventions - Maintain thermoregulation - Assess ability to feed - Observe for signs of dehydration - Dry mucous membranes - Sunken/depressed fontanels - Insufficient wet diapers - Cluster care - Minimize stimulation - Encourage skin to skin - Use standard precautions - Problem: thermoregulation - Skin is thinner - Heat easily lost from internal organs to skin - Post term -\> born **AFTER 42 weeks** - Most common in 1^st^ pregnancy - Neonatal risk factors - Placental degeneration and uteroplacental insufficiency - Inc risk of meconium aspiration - Continued growth in utero - Birth trauma - **Expected assessment findings** - **Macrosomia** - More than 4000 grams - Absence of lanugo - Overgrown nails - Peeling, cracked, and dry skin - Hypoglycemia - Cold stress - Nursing interventions - Monitor VS - Thermoregulation with skin to skin - Early and frequent feedings - Treat birth injuries - SGA/LGA **(2 questions)** - SGA - **Less than 10^th^ percentile** - Common complications - **Hypoglycemia r/t inadequate glycogen stores** - Body temp instability - Feeding difficulties - Maternal risk factors - Hypertension/preeclampsia - **Diabetes mellitus** - Smoking, drug, or alcohol use/abuse - Nutrition (malnutrition or obesity) - **Expected assessment findings** - Thin umbilical cord - Temp instability - Jitteriness (hypoglycemia) - Wide skull sutures (inadequate bone growth) - Scaphoid abdomen (sunken, not well rounded) - Hypotonia - **Nursing interventions** - VS - Stabilize temp (room, skin to skin, hat) - BG check - Early and frequent feedings - Cluster care - LGA - **Greater than 90^th^ percentile** - **Common complications** - Shoulder dystocia - Clavicle fracture - C-section brith - Hypoglycemia - Polycythemia - Erb-duchenne paralysis - Risk factors - Posterm newborn - Maternal diabetes - Maternal obesity - Multiparity - Male fetus - Genetics - Expected assessment findings - Large body - Plump - **Hypoglycemia** - Poor motor skills - Birth injuries - Nursing interventions - Monitor VS - BG checks - Early and frequent feedings - Treat birth injuries - Cold stress **(2 questions) tutor said know everything about this** - Excessive heat loss - **Focus on preventative measures** - Compensatory mechanisms - **Non shivering thermogenesis** - **Brown fat is oxidized in response to cold exposure** - tachypnea - Complications - **Resp distress** - **Hypoglycemia** - Metabolic acidosis - **Jaundice** - Hypoxia, cyanosis - **Lethargy** - **Feeding intolerance** - Brown fat - Develops during 3^rd^ trimester - Nursing interventions - Dry baby after birth - Warm blankets and hats - Skin to skin - Promote early breastfeeding - Defer bathing - **When taking temp place over liver for accurate reading** - Hypoglycemia **(6 questions)** - **BG \< 40** - Risk factors - Maternal DM - Preterm baby - LGA or SGA - Stress at birth (cold stress, hypoxia) - **Expected findings** - Poor feeding - Jitteriness (tremors) - Hypothermia - Lethargy - Weak cry - Flaccid muscle tone - Cyanosis - Apnea - Seizures and coma - **Nursing interventions** - **Early and frequent feedings** - BG checks (heel stick) - Prevent heat loss - Skin to skin - Hyperbilirubinemia **(8 questions)** - Also called jaundice - Bilirubin is the by-product of RBC breakdown - Bilirubin is neurotoxic - Physiologic jaundice - Due to shortened RBC lifespan - Inc 3-5 days after birth - Pathologic jaundice - Occurs within 1^st^ 24 hrs - Elevated bilirubin can cause permanent neurological damage - Educate - s/s of elevated bilirubin - lethargy - hypotonic (seizures) - **risk factors** - Rh incompatibility - Prematurity - Oxytocin during labor - Maternal diabetes - Genetics - Lab tests - **TcB** --\> noninvasive - **Serum bilirubin** -\> invasive, more accurate - Direct coombs test -\>