OB test 2

Normal newborn weight changes

gain of 110-200g / week for first 3 months

newborn calorie requirements

100-110 cals/kg/day (milk and formula are 20 cals/oz)

This also equals 45-50 cals/lb

breastfeeding timing

every 2-3 hours / Q8-12 hours

breastfeeding rotation

feed 15-20 minutes each breast

burp when alternating breasts

begin next feeding on the breast you stopped on last time

breastfeeding education

place on back after feeding

dont microwave

dont leave out and still use

can refrigerate fresh milk but not half drank milk

Colostrum

IgA, high protein, high fat, high nutrients

2nd milk

Transitional milk: still IgA but less protein, still high fat and calorie

3rd milk (2 types)

mature milk: at 7-10 days.

Foremilk: first let down. like skim, protein, thin, watery, quenches baby thirst (hydration). First half of feeding

Hind: higher fat and calories, creamier. 2nd half of the feeding

4th type of milk

let down. higher fat and calories. Impacted by maternal health

prolactin

stimulates milk production, highest at night

oxytocin

causes let down reflex

signs of infant problem feeding

falling asleep less than 5 minutes after feeding, refusal, tongue thrusting, smacking sounds, dimpling of cheeks, choppy jaw motions, no audible swallowing.

LATCH score

Latch

Audible swallowing

type of nipple

Comfort

Hold

0-2 for each

APGAR

appearance

pulse

grimace (reflex)

Activity (muscle tone)

Respiration

0-3 = severe stress. 4-6 = moderate difficulty. 7-10 = minimal or no difficulty

Initial fetal assessments

apgar, skin color, peeling, birthmarks, foot creases, breast tissue, nasal patency, meconium, ease of breathing, auscultation, quality of heart tones, lung auscultation, abdomen for rounding, cord, muscle tone, reflex, fontanels and sutures

ballard score

newborn maturity rating

Normal fetal vitals and labs

RR: 30-60 - breathless periods can be normal

HR: 110-160

BP: 97.7-99.5

HgB: 14-24

platelets: 150,000-300,000

HcT: 44-64

Glucose: increase 40-45

RBC: 3.9 - 6 (x10 ^9)

bilirubin: 1-12

WBC: 9,000-30,000

Newborn screenings

metabolic

endocrine

hemoglobin

genetic disorders

capillary heel stick

hearing

congenital heart disease

Conduction

heat loss via direct contact with cool surfaces (putting them on a cold scale)

convection

flow of heat from body surface to cool environment (a draft from a window)

radiation

loss from close proximity to a cold object

evaporation

loss of surface liquid from converting to vapor (wet baby)

Normal fetal voiding

likely only once within the first 24 hours. Then 6-8 voids a day

Cord clamping normal and care

clamp stays for 24-48 hours, clean the cord, assess stump, don’t let diaper rub it, shouldn’t submerge it

Fetal meds: erythromycin

prophylactic eye care

Fetal meds: vitamin K

prevent hemorrhage as newborns don’t have their own natural Vitamin K (a clotting factor)

Fetal meds: Hep B vaccine

to prevent contraction of Hep B as they have very weak livers

Normal fetal sleep and safe sleep patterns

16-19 hours

Supine, dark quiet room

with parents

crib with nothing else

firm mattress

bathe before bed

last feeding 2300

normal bath safety

100 degrees

don’t soak cord

keep room warm - no draft

don’t force back foreskin

when to report abnormality

temp above 100.4 or below 97.7

poor feeding

forceful vomit

decreased urination

decreased bowel movement

diarrhea

labored breathing

nasal flare

absence of breathing > 15 second

jaundice

cyanosis

lethargy / difficulty waking

inconsolable crying

bleeding of cord or circumcision

eye drainage

biochemical receptor development

clamp cord > decreased PaO2 and decreased pH, increased PaCo2 > aortic and carotid chemoreceptors

sensory receptor development

sound, light, touch, smell > auditory, visual, tactile, olfactory chemoreceptors

Thermal receptor development

cold > thermal receptors

Pressure/stretch receptor development

Chest compression from birth > causing gasp of amniotic fluid > stretch receptors

C-section babies don’t get this

Factors assisting fetal respiration

surfactant, lung expansion, nose breathers, tongue, lumens, suctioning, alveoli (sensitive)

Hypothermia leads to (cycle)

*Hypoglycemia, respiratory depression*

Why do babies have impaired thermoregulation

no shivering, lack of subcutaneous fat, blood vessels are close to the surface, immature hypothalamus, limited metabolism stores, cant put on clothes when cold

What does help babies thermoregulate

flexed body position, vasoconstriction, increased metabolic rate, non shivering thermogenesis

Hazards of cold stress

Increased O2 needs, decreases surfactant, respiratory distress, hypoglycemia, metabolic acidosis, jaundice

All connected

Jaundice in newborns

normal process for first 2-8 days

due to newborn shorten RBC lifespan and slower uptake of bilirubin in immature liver

can’t just diagnose from looks, need a transcutaneous bilirubin number

signs of fetal hypoglycemia

jitters, tremors, poor muscle tone, tachypnea, grunting, cyanosis, apnea, low temp, high cry, diaphoresis, not feeding, lethargy, irritability, seizure/coma

risk factors for fetal hypoglycemia

premature, postmature, intrauterine growth restriction, large or small size

asphyxia (oxygen deprivation), cold stress, birthing complications, maternal diabetes, maternal intake of terbutaline (med for premature labor)

2 types of immunoglobulins newborns have

IgA from colostrum

IgG because it can cross the placenta

Newborn GI system

limited digestion of fats, decrease musculature, unpredictable cardiac sphincter = spit up, air pockets = burping, irregular peristalsis, neutral gastric content,

Normal stool

First meconium, then transitional stool, then milk stool

Integumentary function

limits water loss, prevent harmful absorption, protects thermoregulation and fat storage, protects from trauma

Neuro newborn function and development

develops from proximal to distal

acute sense of smell taste hearing. Adaption of other systems represents neuro function, such as reflexes

Behavior of the newborn

first reactivity from birth-30 minutes - alert, moving, hungry, increased HR RR

decreased responsiveness from 30-120 minutes - sleep, decreased activity, decreased HR and RR

2nd reactivity between 2-8 hours

six states of newborns

deep sleep, light sleep, drowsy, awake/alert, alert/fussy, crying

normal body measurements

Head: 33-35 cm, 13-14 inches

Chest: 30-33 cm, 12-13 in

length 48-50 cm, 19-20 in

weight: 7.2-7.6 lb, 3.2-3.3 kg

Risk factor for SGA

malnutrition, anemia, smoking, alcohol, drugs, placental insufficiency, preeclampsia, hypertension, multiple gestations

complications of SGA

hypoglycemia, poor thermoregulation, respiratory distress, feeding difficulty

LGA risk factors

diabetes, maternal obesity, excessive weight gain, previous LGA

complication of LGA

birth injury, hypoglycemia, respiratory distress, c-section, jaundice

First latent stage

0-4-6 cm, infrequent mild-moderate contraction every 5-30 minutes lasting 30-45 seconds

scant brownish discharge, pale pink mucus

follows directions, may be apprehensive

First active stage

4/6-10 cm

regular moderate + strong contractions every 2-5 minutes lasting 45-90 second

contractions more painful, N/V, rectal pain, increased blood, most difficult part

Second stage of labor

full dilation and pushing, fetal descent, birth

Third stage of labor

placental delivery

recommended delayed cord clamping 30-60 seconds

fourth stage of labor

maternal stabilization of vital signs - homeostasis

5 P’s impacting labor

Passenger, passageway, powers (contractions), position, physiology

Tocotransducer

over fundus to measure uterine contractions

Labor precentations/cardinal movements

engagement: head passes into pelvic inlet

Descent: progression of head through pelvis

Flexion: when fetal head meets resistance of cervix

Internal rotation: fetal occipital rotates lateral anterior

Extension: occipital under symphysis pubis > extension of chin away from head - head is born

external rotation/restitution: born head aligns with body / quarter turn

premonitory signs of labor

lightening, cervical changes, increased energy level, bloody show, increased discharge, braxton hix, membrane rupture

true labor

rhythmic regular contractions, felt in abdomen and back, unaffected by position change, increase in duration frequency and intensity, cervical changes*

False labor

braxton hicks, more at night, short irregular not changing contractions, felt in abdomen and groin, relieved with change of position/ambulation/sleep, no cervical change*

Fetal attitude

How are the baby’s body parts position

the degree of flexion (or extension)

fetal lie

How is the spine aligned

Longitude: babys spine runs parallel to mom (vertex or breech presenting)

Transverse: baby lies sideways, perpendicular to mom (shoulder presenting)

Fetal position

Where is the presenting part facing in moms pelvis

LOA: Left occiput anterior - back of head faces moms front and towards the left

OP: occiput posterior - baby’s head is down, back of head faces moms back

Fetal presentation

What part comes out first. Cephalic (vertex is a type of head first): head first. Shoulder: shoulder first. Breech: feet or butt first.

fetal station

How far the baby’s presenting part has descended into mothers pelvis in relation to ischial spine

-5 - -1: head is above ischial spine

0: at ischial spine

+1-+5: below ischial spine

crying baby 5 S’s

swinging, shushing, swaddling, sucking, side/stomach position

caput succedaneum

a benign, superficial swelling of a newborn's scalp caused by pressure on the head during a vaginal delivery

Cephalhematoma

head bruising

Newborn screenings

PKU, hearing, CCHD, pulse, oximetry, metabolic

When to do intermittent auscultation

latent: hourly

Active: 15-30 minutes

Second phase: 5-15 minutes

When can we consider FHR to be tachy or brady

out of range for 10 minutes on 2 occasions

Causes of fetal bradycardia

uterine/placental insufficiency, umbilical cord prolapse, maternal hypotension, prolonged cord compression, fetal congenital heart block, anesthetic meds, viral infection, maternal hypoglycemia, fetal HF, maternal hypothermia

Causes of fetal tachycardia

infection, fetal anemia, fetal dysrhythmias, cocaine, caffeine, maternal dehydration, fever, hyperthyroidism

reasons for decreased FHR variability

medications depressing CNS, fetal hypoxemia, fetal metabolic acidemia, fetal sleep cycle, congenital abnormalities, fetal neuro compromise

early decelerations

slowing of FHR aligning with contractions. Caused by head compression (contraction, fundal pressure) No intervention required

Late decels

Slowing of FHR after contractions. From uteroplacental insufficiency and inadequate oxygenation. Intervention required

Variable decelerations

transitory abrupt slowing of FHR 15 or more below baseline for at least 15 seconds. Caused by cord compression. Not always concerning depending on shape and timing

Prolonged Decels

any type of decels lasting >30 seconds

*shape outweighs timing

Effacement vs dilation

thinning and stretching of the cervix

dilation opening of cervix 0-10 cm

how to tell if theres meconium

greenish amniotic fluid

IUPC

intrauterine pressure catheter, measures contractions. Membranes need to have ruptured. Could cause infection or injury.

Contraction timing: peak/acme, frequency, duration, interval

peak/acme: when it peaks

interval: relaxation in between

frequency: start of 1 to start of the next

duration: from start to end of one

guidlines for FHR monitoring

initial 10-20 minutes continuous FHR assessment

4 categories of baseline variability

Absent: no fluctuation detected

Minimal: fluctuation at least <5 beats per minute

moderate/normal: fluctuation range from 6-25 bpm

Marked: >25 BPM fluctuation

cause of variability

push and pull of natural parasympathetic and sympathetic NS. healthy CNS

periodi vs non periodic/episodic variability

periodic: FHR changes with contraction

NP: FHR changes not related to contraction

normal accelerations

they’re all good and normal but normal is considered increase of 15 beats for 15 seconds

nursing interventions for decels

POOF

position changes

oxytocin OFF

oxygen

fluids (IV)

Pudendal block

local anesthetic transvaginally

Provides regional anesthesia

given during second stage

Clients can’t bear down

-caine

Epidural/spinal regional

Fentanyl and sufentanil, short acting opioid > motor

Client can bear down

epidural block

local anesthetic and analgesic injected into the epidural space

Eliminates pain from umbilicus - thighs

can still feel pressure

usually started at 3-4 cm

spinal block

local anesthetic injected into subarachnoid space into spinal fluid. Eliminates all sensation from nipples-feet

often for C sections

opioid

decrease pain perception, can cause fetal respiratory depression

Fentanyl most commonly

butorphanol, stadol, nalbuphine, nubain, meperidine, demerol, sublimaze

external cephalic version

Manually turning baby in utero if they’re breech

37ish weeks

risky and painful