OB Exam 5 & Terminology

ch. 23 (physiologic & behavioral adaptations of the newborn), ch. 24 (nursing care of the newborn & family), ch. 34 (nursing care of the high-risk newborn), ch. 35 (acquired problems of the newborn), ch. 36 (hemolytic disorders & congenital anomalies)

ch. 23 - birth to 28 days; involves physiologic transition to extrauterine life post-delivery and cord clamping

neonatal period

ch. 23 - begin by 12 weeks to develop respiratory muscles, regulate lung fluid, and decrease 24–36 hrs before true labor

fetal breathing movements (FBM)

ch. 23 - causes mild hypoxia and ↑CO₂, triggering medulla to start breathing

cord clamping

ch. 23 - expels lung fluid; recoil and crying draw in air, expand alveoli, and enhance fluid absorption and circulation

chest compression

ch. 23 - at birth trigger breathing by activating the newborn’s respiratory center

sensory stimuli (touch, light, noise, temperature)

ch. 23 - matures by 35–36 weeks to reduce alveolar surface tension; steroids given 24–34 weeks boost surfactant and reduce brain bleed risk

surfactant [(lecithin/sphingomyelin (L/S) ratio ≥2:1)]

ch. 23 - grunting, flaring, retractions, tachypnea, or cyanosis may signal distress needing oxygen support

abnormal respirations

ch. 23 - is brief distress after birth; risks: C-section, maternal conditions, macrosomia, male, poor perfusion, airway debris

transient tachypnea of the newborn (TTN)

ch. 23 - presents with tachypnea, mild cyanosis, grunting, flaring, and retractions; manage with pulse ox, blow-by O₂, NPO status, and CXR

TTN

ch. 23 - indicates fetal stool passed in utero; appears green, thin or thick, and signals possible fetal distress

meconium in amniotic fluid

ch. 23 - pallor, cyanosis, apnea, bradycardia, poor flexion, low APGARs, and hypotonia

signs of respiratory distress at birth

ch. 23 - increases systemic vascular resistance, aiding cardiac transition to neonatal circulation

cord clamping

ch. 23 - connects umbilical vein to IVC, delivering highly oxygenated blood

ductus venosus (fetal circulation)

ch. 23 - shunts oxygenated blood from RA to LA, bypassing lungs

foramen ovale (fetal circulation)

ch. 23 - links pulmonary artery to aorta, directing medium-oxygen blood away from lungs

ductus arteriosus (fetal circulation)

ch. 23 - flows via umbilical vein → ductus venosus → IVC (bypassing liver), then through ductus arteriosus → descending aorta (bypassing lungs)

placental blood

ch. 23 - ends placental and umbilical vein circulation

cord clamping

ch. 23 - newborn HR 110–160, BP ~80/50; murmurs and acrocyanosis common; BP rises then drops by 3 hrs

cardiovascular adaptations

ch. 23 - newborn blood volume ~300 mL (80–85 mL/kg); Hgb 14–24 (drops by 2 weeks), Hct 51–56%, WBC 9,000–30,000, platelets 150,000–300,000

hematopoetic adaptations

ch. 23 - HR >160/<100, central cyanosis, murmurs, poor perfusion, or abnormal BP may indicate cardiac defect

poor cardiac transition

ch. 23 - includes pulse ox, O₂ for central/circumoral cyanosis, 4-limb BP, NICU transfer, and cardiac workup

poor cardio transition management

ch. 23 - newborns lose heat easily; temp 97.6–99.5°F maintains balance and conserves O₂/glucose

thermoregulation

ch. 23 - heat loss to cooler surrounding air (e.g., drafts)

convection

ch. 23 - heat loss to nearby cooler surfaces without direct contact (e.g., window)

radiation

ch. 23 - heat loss as moisture on skin turns to vapor (e.g., after birth/bath)

evaporation

ch. 23 - heat loss via direct contact with cold surfaces (e.g., scale, mattress)

conduction

ch. 23 - newborns increase muscle activity, flexion, and vasoconstriction to reduce heat loss; raises metabolic rate and O₂/glucose use

thermogenesis

ch. 23 - uses brown fat to produce heat; preemies have less brown fat and are at higher risk for cold stress

non-shivering thermogenesis

ch. 23 - ↑RR, O₂ use, metabolism, risking hypoxia, acidosis, and glucose loss; hyperthermia (>99.5°F) is less common

hypothermia triggers cold stress

ch. 23 - prevent __________ with warm surfaces, skin-to-skin, blankets, hat, room ≥75°F, and regular temp checks

cold stress

ch. 23 - newborns have limited urine concentration ability; 90% void in 24 hrs, urine may appear straw-colored or with brick dust; assess if no void by __________.

24 hrs

ch. 23 - newborns digest simple nutrients; sterile gut colonizes in 1 week; reflux common; no solids until 6 months

GI adaptations

ch. 23 - newborns lose ≤10% of birth weight, regain it by 2 weeks; pass meconium by 24 hrs, followed by transitional (day 3) and milk stools (day 4)

more GI adaptations

ch. 23 - supports iron storage, glucose regulation, bilirubin conjugation, and clotting; immature but typically functions adequately after birth

newborn liver (40% of abdomen)

ch. 23 - newborns lack gut flora to produce __________, needed for clotting; a __________ shot is given at birth to prevent bleeding risk

vitamin K

ch. 23 - occurs as maternal glucose ends at birth; managed by prompt feeding and guided by protocols

hypoglycemia (<30–40 mg/dL in first 1–2 hrs)

ch. 23 - LGA, infant of a diabetic mother (IDM), cold stress, respiratory distress, prematurity, postmaturity, or IUGR

newborns at risk for hypoglycemia

ch. 23 - newborns produce ~8.5–10 mg/kg/day of __________ (2x adults) from RBC breakdown; excess unconjugated __________ causes jaundice

bilirubin

ch. 23 - insoluble, bound to albumin, from RBC breakdown; must be conjugated by the liver to be excretable

unconjugated (indirect) bilirubin

ch. 23 - water-soluble, excreted in bile into the duodenum, then eliminated via urine and stool after gut flora conversion

conjugated (direct) bilirubin

ch. 23 - common, appears after 24 hrs, peaks day 3–5, resolves by day 7–10; varies by age, race, and feeding; skin appears yellow

physiologic jaundice

ch. 23 - occurs within 24 hrs; often due to ABO incompatibility, liver disease, or enzyme issues; breastfeeding jaundice is usually benign

pathologic jaundice

ch. 23 - short RBC life, immature liver, low gut flora, poor intake, prematurity, LGA, maternal meds, ABO/Rh issues

hyperbilirubinemia risks

ch. 23 - manage __________ with feeds, phototherapy, and bilirubin checks to prevent kernicterus.

hyperbilirubinemia

ch. 23 - acute bilirubin encephalopathy (lethargy, seizures, coma), and kernicterus—irreversible brain damage causing cognitive and motor delays

jaundice complications

ch. 23 - with frequent feeds, bilirubin monitoring, phototherapy if needed, safe sunlight exposure, and early follow-up after discharge

manage jaundice

ch. 23 - relies on maternal IgG (3-month passive protection); fetus makes IgM by 8 weeks; IgA (from breast milk) protects mucosa; IgA/IgE/IgD production is limited

newborn immunity

ch. 23 - includes reflex checks, reactive periods, and sleep cycles; fontanels should be soft/flat, pupils reactive; delayed if delivery was difficult

neurologic adaptations

ch. 23 - eyes closed/semi-open, slowed HR/RR, slow reaction to stimuli

drowsy

ch. 23 - eyes open, minimal movement, fixates on faces/objects, slow to respond

quiet-alert

ch. 23 - eyes open, active limbs, reacts strongly to stimuli with increased movement

active-alert

ch. 23 - intense motor activity, signals needs, helps infant release energy and self-regulate

crying

ch. 23 - newborns fixate on faces, hear well, recognize voices, smell breast milk, respond to touch, and show rooting, sucking, and swallowing at birth

sensory adaptations

ch. 24 - includes APGAR scores at 1 & 5 mins, warming/drying/stimulating, and a quick gross exam

initial newborn assessment

ch. 24 - apply security bracelet after drying the newborn to ensure __________.

infant safety

ch. 24 - prepare with gloves, infant stethoscope, tape measure, and scale for __________.

newborn assessment

ch. 24 - uses the Ballard Score to estimate age based on physical maturity signs like skin, creases, and genitalia

GA assessment

box 24.2 - __________: more flexion of arms/legs indicates greater maturity; __________: wrist flexion measured; full flexion = score 4

posture; square window (maneuvers used in assessing GA)

box 24.2 - __________: after extension, brisk return to flexion = score 4; __________: angle <90° behind knee = score 5, indicating advanced maturity

arm recoil; popliteal angle (maneuvers used in assessing GA)

box 24.2 - elbow does not cross midline when arm pulled across chest = score 4

scarf sign (maneuvers used in assessing GA)

box 24.2 - closer foot is to ear with minimal resistance indicates less maturity; flexed knees and angle <10° = score 4

heel to ear (maneuvers used in assessing GA)

ch. 24 - birth weight between the 10th and 90th percentiles

appropriate for GA (AGA)

ch. 24 - birth weight above the 90th percentile

LGA

ch. 24 - birth weight below the 10th percentile

SGA

ch. 24 - temperature 97.6–100.4°F, heart rate 110–160 bpm, respirations 30–60 breaths/min

normal newborn vitals

ch. 24 - assess skin for color, rash (erythema toxicum), milia, and vernix caseosa

skin assessment

ch. 24 - assess newborn head for shape, sutures, molding, fontanels, and hair distribution

newborn head assessment

ch. 24 - soft scalp swelling present at birth, crosses suture lines, usually over occiput, resolves in 24–48 hrs

caput succedaneum

ch. 24 - blood collection over bone, does not cross sutures, often on parietal areas, painful, resolves in weeks to months

cephalohematoma

ch. 24 - assess face for color and symmetry; check eyes (sclera, hemorrhages), nose patency, lip alignment, and palate for cysts, teeth, and frenulum

face assessment

ch. 24 - assess ears for position (pinna aligned with eye canthus), note kidney anomaly risk; check neck for masses, clavicle integrity, and chest shape/breast buds

ear, neck, and chest assessment

ch. 24 - assess respirations for 1 min (irregular, abdominal, possible rales); auscultate heart for 1 min, noting any murmurs

respiratory and cardiac assessments

ch. 24 - assess abdomen for shape, bowel sounds, palpable liver, and umbilical cord status (falls off in 7–10 days)

abdominal assessment

ch. 24 - includes checking for bleeding, swelling, infection, and urine output within 6–8 hours

circumcision assessment

ch. 24 - __________: arms flail then pull in when startled; palmar/plantar reflex: fingers/toes curl when touched

Moro/startle reflex

ch. 24 - toes fan out when sole is stroked upward (reflex)

Babinski reflex

ch. 24 - mimics walking or crawling when held upright or on abdomen

stepping and crawling reflex

ch. 24 - turns head toward touch and sucks when cheek or mouth is stimulated

rooting and sucking reflexes

ch. 24 - assess urinary meatus placement; check for hypospadias, epispadias, cryptorchidism, and hydrocele

male genitalia assessment

ch. 24 - assess urethral opening, vulva for tags, mucus, redness, or swelling (may vary with delivery type)

female genitalia assessment

ch. 24 - assess extremities for tone, symmetry, palm creases, and signs of injury; breech may limit leg extension

extremities assessment

ch. 24 - screen for __________ using thigh/gluteal fold asymmetry, Barlow (adduction + posterior pressure), and Ortolani (abduction) maneuvers

congenital hip dysplasia

ch. 24 - assess back for skin color, palpate spine, check for sacral dimple, and inspect in prone position

back assessment

ch. 24 - within __________ of life: initiate first feeding, administer eye prophylaxis, and give vitamin K injection

1-2 hours

ch. 24 - done by audiology tech; RN ensures completion and documentation; physician notified of results

hearing screening

ch. 24 - pulse ox on right hand and foot at 24–48 hrs; pass = ≥97% with ≤3% difference

critical congenital heart disease (CCHD)

ch. 24 - administered shortly after birth per protocol

hepatitis B immunization

ch. 24 - blood collected via heel stick; venipuncture used for larger samples

newborn screening

ch. 24 - elective after 12 hrs and one void; monitor bleeding, urination, and give pain relief

circumcision

ch. 24 - are often childbearing-age females with a loss or infertility history; may pose as staff, scout units, act impulsively, and use stairs to flee

infant abductors

ch. 24 - teach families about abduction risks, monitor visitor behavior, stay alert to surroundings, and follow unit abduction protocols

staff education

ch. 24 - identify hospital staff, never leave baby unattended, verify staff before handing off baby, and limit photo sharing online or in media

mother instructions

ch. 24 - teach newborn care, safe sleep, and rear-facing car seat use in back seat

discharge teaching

ch. 24 - includes newborn care, safe sleep, dressing, cord care, car seat use, and scheduling follow-up visits

discharge teaching

ch. 34 - have underdeveloped systems, may face complications, require specialized immediate care, and often need prolonged, costly hospitalization

infants born before 37 weeks (preterm)

ch. 34 - LBW (<2500g), VLBW (<1500g), ELBW (<1000g); growth classifications include AGA (10ᵗʰ–90ᵗʰ percentile), SFD/SGA (<10ᵗʰ percentile), and LGA (>90ᵗʰ percentile)

weight-based classification

ch. 34 - preterm (<37 wks), late preterm (34–36⁶⁄₇ wks), early Term (37–38⁶⁄₇ wks), full term (39–40⁶⁄₇ wks), late term (41–41⁶⁄₇ wks), postterm (>42 wks)

GA classification

ch. 34 - affects cardiac, respiratory, thermoregulatory, and central nervous systems, leading to impaired physiologic function and increased risk of complications

prematurity

ch. 34 - preemies have __________ from low surfactant, causing ↑WOB, shallow breaths, and atelectasis risk.

non-compliant airways

ch. 34 - monitor HR, BP, O₂, perfusion, and ABGs in preemies to detect __________, shock, and early cardiac issues.

hypovolemia