Care Management OB Final Study Guide
New Material:
Nursing Care Newborn
APGAR at 1 and 5 minutes of life
*remember that G (grimace) is with stimulation
· 2 points for: pink, pulse >100, cries and pulls away, active movement, strong cry
· 1 point for blue extremities, pulse<100, grimaces or weak cry, arms and legs flexed,
slow and/or irregular breathing
· 0 points for blue or pale, no pulse, no response to stimulation, no movement, no
breathing
-Score >7 indicates little to no difficulty adjusting to extrauterine life
-Score 4-6 indicates moderate difficulty
-Score 0-3 indicates severe distress
Need to know normals:
· Weight 2500-4000g
· Head circumference 32-38cm
· Chest circumference 2-3cm smaller than head
· Length 45-55cm
· Temp 97.7 - 99.5 (axillary; NO rectal temp d/t risk of perforation and infant stress)
· Pulse newborns HR increases from 160 to 180 for first 30 minutes after birth then
slows to 100-140 but Egan said just remember 110-160 (count for full minute); could
decrease to 70 when sleeping or 170 when crying or very active
,· RR 30-60 (count for full minute)
· BP (not part of newborn exam) 60-80/40-50
SGA < 10%
LGA > 90%
Priority immediately after birth is effective respirations
Immediate interventions:
· Airway maintenance
-Clear the airway/ excess mucus with a bulb syringe
- newborns are nasal breathers until 2-6 months old so Egan said avoid suctioning the
nose to not obstruct it but the book says to suction the mouth and nose
-Fine crackles may be heard several hours after birth
-Mechanical suction may be used (but not too often; “usually they let them work it out
on their own” - Egan)
· Maintain adequate oxygen supply
· Eye prophylaxis
-Prevents opthalmia neonatorium or neonatal conjunctivitis
-Erythromycin 0.5% opthalmic ointment
-should be applied within 1 hour of birth
· Vitamin K prophylaxis
(they do not produce their own vit K because it is produced in the stomach and they
don’t have any gut bacteria yet)
-0.5-1 mg of Vitamin K (Phytonadione) given IM in vastus lateralis (muscle of leg)
-Prevents vitamin K deficiency bleeding and hemorrhagic disease of the newborn
, -given within first 6 hours of birth
· Promoting parent-infant interaction
*Skin to skin and/ or breastfeeding within 1-2 hours of birth
Common newborn problems:
Birth injuries
· Most are minor and resolve without treatment
· Erythema, ecchymoses, petechiae, lacerations, edema
Physiologic Problems
· Hyperbilirubinemia
- Total serum bilirubin level >5 mg/dL resulting in jaundice
- Physiologic vs pathologic causes:
-Pathological jaundice –
· Also known as significant hyperbilirubinemia (should be reported to primary care
provider)
· Referring to the development of jaundice within the first 24 hours of life
· Conditions that can alter production, transport, metabolism and excretion of bilirubin
can cause significant hyperbilirubinemia. These conditions include polycythemia,
hemolysis due to RH isoimmunization, or ABO incompatibility
-Physiologic jaundice–
· After the first 24 hours of life
· Benign (also known as benign neonatal hyperbilirubinemia)
· This can be caused by dehydration, poor feeding, and not enough output
New Material:
Nursing Care Newborn
APGAR at 1 and 5 minutes of life
*remember that G (grimace) is with stimulation
· 2 points for: pink, pulse >100, cries and pulls away, active movement, strong cry
· 1 point for blue extremities, pulse<100, grimaces or weak cry, arms and legs flexed,
slow and/or irregular breathing
· 0 points for blue or pale, no pulse, no response to stimulation, no movement, no
breathing
-Score >7 indicates little to no difficulty adjusting to extrauterine life
-Score 4-6 indicates moderate difficulty
-Score 0-3 indicates severe distress
Need to know normals:
· Weight 2500-4000g
· Head circumference 32-38cm
· Chest circumference 2-3cm smaller than head
· Length 45-55cm
· Temp 97.7 - 99.5 (axillary; NO rectal temp d/t risk of perforation and infant stress)
· Pulse newborns HR increases from 160 to 180 for first 30 minutes after birth then
slows to 100-140 but Egan said just remember 110-160 (count for full minute); could
decrease to 70 when sleeping or 170 when crying or very active
,· RR 30-60 (count for full minute)
· BP (not part of newborn exam) 60-80/40-50
SGA < 10%
LGA > 90%
Priority immediately after birth is effective respirations
Immediate interventions:
· Airway maintenance
-Clear the airway/ excess mucus with a bulb syringe
- newborns are nasal breathers until 2-6 months old so Egan said avoid suctioning the
nose to not obstruct it but the book says to suction the mouth and nose
-Fine crackles may be heard several hours after birth
-Mechanical suction may be used (but not too often; “usually they let them work it out
on their own” - Egan)
· Maintain adequate oxygen supply
· Eye prophylaxis
-Prevents opthalmia neonatorium or neonatal conjunctivitis
-Erythromycin 0.5% opthalmic ointment
-should be applied within 1 hour of birth
· Vitamin K prophylaxis
(they do not produce their own vit K because it is produced in the stomach and they
don’t have any gut bacteria yet)
-0.5-1 mg of Vitamin K (Phytonadione) given IM in vastus lateralis (muscle of leg)
-Prevents vitamin K deficiency bleeding and hemorrhagic disease of the newborn
, -given within first 6 hours of birth
· Promoting parent-infant interaction
*Skin to skin and/ or breastfeeding within 1-2 hours of birth
Common newborn problems:
Birth injuries
· Most are minor and resolve without treatment
· Erythema, ecchymoses, petechiae, lacerations, edema
Physiologic Problems
· Hyperbilirubinemia
- Total serum bilirubin level >5 mg/dL resulting in jaundice
- Physiologic vs pathologic causes:
-Pathological jaundice –
· Also known as significant hyperbilirubinemia (should be reported to primary care
provider)
· Referring to the development of jaundice within the first 24 hours of life
· Conditions that can alter production, transport, metabolism and excretion of bilirubin
can cause significant hyperbilirubinemia. These conditions include polycythemia,
hemolysis due to RH isoimmunization, or ABO incompatibility
-Physiologic jaundice–
· After the first 24 hours of life
· Benign (also known as benign neonatal hyperbilirubinemia)
· This can be caused by dehydration, poor feeding, and not enough output
