HESI OB EXAM STUDY GUIDE
NEWBORN
HESI OB EXAM STUDY GUIDE
NEWBORN
Respiratory transition in the newborn
Respiratory function
• Established when cord is cut.
• Air inflates lungs with first breath.
• 4 factors influence the initiation of the 1st breath
Chemical factors: hypercar...
hesi ob exam study guide newborn respiratory transition in the newborn respiratory function • established when cord is cut • air inflates lungs with first breath •
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HESI OB EXAM STUDY GUIDE NEWBORN
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HESI OB EXAM STUDY GUIDE
NEWBORN
Respiratory transition in the newborn
➢ Respiratory function
• Established when cord is cut.
• Air inflates lungs with first breath.
• 4 factors influence the initiation of the 1st breath
➔ Chemical factors: hypercarbia, acidosis, and hypoxia which stimulate the resp center
in the brain toinitiate breathing.
➔ Sensory factors stimulate the first breath.
➔ Thermal factors are involved when the neonate exits the warm environment they have
been used to.
➔ Mechanical factors such as removal of fluid from the lungs and replacements of air
is the primarymechanical factor.
• The fetal chest compression that occurs during a vaginal birth increases
the intrathoracicpressure and helps push fluid out of the lungs.
Circulatory transition in the newborn
• Successful adaptation in the neonate involves five major changes and increased aortic
pressure
• Closure of the foramen ovale, the ductus arteriosus and the ductus venosus.
• Foramen ovale closes functionally 1-2 hrs anatomically 1-2 weeks
Hyperbilirubinemia in the newborn
• Unconjugated: fat soluble and toxic to body
• Normal bili = 4-6 mg/dl
• CONJUGATED: water soluble and nontoxic & conjugation happens in the liver
• Bili increases after birth r/t increased RBC
• Elevated bili = jaundice in the newborn - will rise over first 3-5 days and then decrease
• Total above 5 from unconjugated = yellowing of the skin, one of the most
common reasons fornewborn readmission
• Patho within 24 hours of life r/t polycythemia, blood incompatibilites, acidosis
• Physio after 24 hours of life r/t limitations and abnormalities of bili metabolism, r/t
increased bili loadbecause of polycythemia, shortened RBC lifespan, immature hepatic
uptake and conjugation process
- delayed passage of meconium
,puts at riskTemperature regulation
in the newborn Thermoregulation:
• Newborns have poor thermal stability due to excessive heat loss.
• It is closely related to rate of metabolism, oxygen consumption, amount of brown fat,
and amount ofsubcutaneous tissue.
• Increased metabolic demands and/or increased oxygen demands can quickly lead
to hypoglycemia(neonatal hypoglycemia is less than 40 mg/dl blood glucose
level).
• Infants produce heat by increasing their metabolic rate, increasing muscular activity, or
through
nonshivering thermogenesis (break down brown fat into heat).
• Four ways an infant loses heat:
▪ Convection: Air current blows heat away
▪ Radiation: Cold area, body radiates/loses heat
▪ Evaporation: When water evaporates it takes heat with it
▪ Conduction: If baby is put on cold surface it loses body heat to warm the surface
• Things you can do to help keep baby warm:
▪ Skin to skin contact, radiant warmer, wrap in warm blankets, use hats, monitor
temperature, drythem after a bath, heat oxygen and humidify (if on oxygen
therapy), teach family to keep them warm. You want their temp to stay around
98.6 but the normal range is 97.7-99.4.
Blood glucose changes in the newborn
• Normal BG
• 1-Day: 40-60 mg/dL
• >1-Day: 50-90 mg/dL
• Baby experiences an energy crunch @ the time of birth with the cutting of the
umbilical cord and resultant removal of the maternal glucose supply (baby’s BG <15
mg/dL lower than maternal BG)
• This is significant because baby needs adequate amount of glucose in order to
withstand the birthprocess and extrauterine life.
• Fuel sources are consumed at a faster rate because:
▪ The work of breathing
▪ Loss of heat when exposed to cold
▪ Activity
▪ Activation of muscle tone.
➢ Patho: As stores of liver and muscle glycogen and blood glucose decrease, the newborn
compensates bychanging form a predominantly carbohydrate metabolism to fat
metabolism.
▪ Energy is derived from fat and protein as well as from carbohydrates.
• Assessment:
• 1st and 2nd hour after birth: blood glucose declines
• 3rd hour after birth: blood glucose reaches a steady level
, Umbilical cord clamping and cutting
• Must use two clamps: one to cut off blood flow to placenta and one to keep baby form
bleeding out
• Placement should be closer to baby than placenta and an inch or two between both
clamps
• When cutting between two clamps: make sure clamps are tight enough and no blood is
being exploitedfrom umbilical cord
• After cutting: make sure two arteries and one vein are visible because baby may have
cardiac problemsif all vessels are not present
• Then cover with triple dye to increase time of closure and prevent infection
• It should be cleaned with alcohol swab each diaper change to prevent infection
Coagulation capabilities of the newborn
• Born without coagulation factors
• Given Vit K to initiate coagulation
• If not, bleeding is a risk
• The clinical presentation is often:
▪ Bruising
▪ Gastrointestinal blood loss or bleeding from the umbilicus and puncture sites.
▪ Intracranial hemorrhage is a severe presentation.
Modes of infection of the newborn
• Infants can acquire infection from uterus doting delivery
• Risk for infection increases the more premature the newborn is due to undeveloped
immune system
• Hep B is given with in the first 24 hours of birth
Behavioral states of the newborn
• Alert states:
• Drowsy: Fluttering eyelids, slow regular movements of extremities. Mild
startles from time totime.
• Quiet alert: Baby is alert and follows and fixates on attractive objects, faces or
sounds.
• Active alert: Eyes are open, motor activity is intense.
• Crying: Intense crying is accompanied by jerky motor movements. May be
signaling hunger orpain.
• Most active in the first 30 mins
• Sleep about 16-18 hours a day
Newborn teaching
Feeding/feeding cures, burping, spitting,
Positioning Bulb syringe, Bathing, nail care,
dress, cord care, rash Diaper changing,
Circumcision care, Newborn screenings
Hearing screen, Alert state--talk to, cooing, Sleeping back to sleep
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