11/19/23, 9:30 AM Exam 2 Study Guide - Summary Maternity and Pediatric Nursing
Exam 2 Study Guide
Chapter 17
Cardiovascular System Changes:
KNOW REFLEXES AND WHEN THEY GO AWAY
SPINA BIFIDA (2 DIMPLES?)
GALLANT REFLEX
SKIN TO SKIN BENEFITS
DEHYDRATED BABY= SUNCK IN FONTANELS
ACROCYANOSIS
WHEN FEET ARE MORE BLUE THAN HANDS BABY IS COLD
HEART RATE: 120-160
SLEEPING BABY: HEART RATE COULD DROP AS LOW AS 100
SKIN TAGS ARE NORMAL BUT SHOULD PROMPT FURTHER INVESIGATION
BILIRUBIN: TRAUMA, BLOOD COMPENTS, CONJUGATION
IGA, IGG, IGM
SKIN: FIRST LINE OF DEFENSE, TEMPERATURE, PREVENTS DEHYDRATION
BLACK WOMEN CAN HAVE WHITE BABIES
108 KCAL DAY OPTIMAL DIET FOR NEWBORN
-The umbilical vein carries oxygenated blood from the placenta to the fetus
-The ductus venous allows for the majority of the blood to bypass the liver and merge with blood moving through
the vena cava bringing it to the heart sooner. The foramen ovale allows the blood from the right atrium to move to
the left atrium which bypasses the pulmonary circulation (lungs).
-The ductus arterioles connects the pulmonary artery to the aorta which also skips the pulmonary circuit (lungs)
-Only a small amount of blood goes to the lungs for perfusion purposes
-At birth the newborn circulation and placental oxygen exchange must switch to pulmonary gas exchange (lungs)
-The changes must include increased pulmonary blood flow, removal of the placenta, closure of the foramen ovale
(the opening between the right and left atrium) and closure of the venous ductus and ductus arterioles
-The stresses of birth release catecholamine’s that are critical for the transition into extrauterine life.
- The increased levels of epi and norepi stimulate increased cardiac output and contractility; stimulate surfactant
release (needed for oxygen and gas exchange) and promotion of lung fluid clearance
about:blank 1/30
,11/19/23, 9:30 AM Exam 2 Study Guide - Summary Maternity and Pediatric Nursing
Fetal to neonatal Circulation Changes:
-Circulation changes as soon as the fetus separates from the placenta
-When the cord is clamped is when the first breath is taken and lungs begin to function
-Systemic vascular resistance increases and blood return via inferior vena cava decreases
-Decrease in pulmonary vascular resistance and increase in pulmonary blood flow
-Foreman ovale closes with a decrease in pulmonary vascular resistance decreasing right sided heart pressures. It
closes when left atrial pressure increases and right atrium pressure decreases. Normally functionally closes at birth
and permantantly closes in several weeks.
-The ductus arterioles and venous ductus are no longer needed and turn into ligaments over time.
-With closure of the foramen ovale oxygenated blood and deoxygenated blood now become separated
-During fetal life the ductus arterioles protected the lungs from circulatory overload by shunting blood right to left
into the descending aorta to the rest of the body
-Patency of the ductus arterioles is protected by prostaglandins E2 during fetal life
-Ductus arterioles functionally close a few hours after birth and its closure depends on increased oxygenation
resulting from aeration of the lungs after birth
-The venous ductus closes within a few days after birth because it’s shunting of blood is no longer needed with the
activation of the liver. The liver now takes over the function of the placenta
-The umbilical vessels (1 vein, 2 arteries) begin to constrict and are no longer needed, also becoming ligaments
(One aretery is associated with renal and GI abnormalities)
Heart Rate:
-During first few minutes after birth the infant’s heart rate is between 110-160 but then decreases to an average of
120-130.
-The newborn is dependent on the heart rate for maintance of cardiac output and blood pressure.
-BP normally plateaus a week after birth
-Cardiac defects can be determined through a thorough physical assessment of the newborns cardiovascular
system. The nurse should be able to identify any abnormalities because this could lead to early detection and
treatment.
-A transient functional cardiac murmur may be heard during the neonatal period as a result of cardiovascular
changes.
-Fluctuations of heart rate and blood pressure mimic baby’s behavioral state. (If baby is agitated the heart rate and
blood pressure will be elevated)
-Tachycardia may be found as a result of fluid volume loss, cardio respiratory disease, drug withdrawal and
hyperthyroidism.
-Bradycardia is found with apnea and hypoxia
about:blank 2/30
, 11/19/23, 9:30 AM Exam 2 Study Guide - Summary Maternity and Pediatric Nursing
Blood volume:
-The amount of blood the baby has depends on the amount of blood transferred to the infant from the placenta at
birth.
-Late clamping (after 3 minutes) is better than early clamping (30-40 seconds). Late clamping improves the infants
cardiopulmonary adaption, prevents iron deficient anemia without increasing risk of hypervolemia, increases
blood pressure, improves oxygen transport, and increases red blood cell flow.
-Cord blood “nature’s first stem cell transplant”
Blood Components:
-Fetus has more red blood cells at birth. They are larger in size and have a greater affinity for oxygen. After birth the
RBC count increases and the RBC decreases in size. This is due the RBC now living in an environment where there is
much more pulmonary oxygenation.
-An infant’s hemoglobin initially declines as a result of a decrease in neonatal red blood cell mass
-Leukocytosis (increased white blood cell count) is present after birth due to the trauma of birth.
-The newborns platelet aggregation and platelet count are the same as adults
-Blood test results of the newborn re dependent of where the blood is drawn from, capillary blood has higher
levels of hemoglobin and hematocrit compared to venous blood, placental transfusion (early vs. late cord
clamping), gestational age (increased age is associated with increased RBC and hemoglobin)
NORMAL NEWBORN BLOOD VALUES
Hemoglobin- 16-18
Hematocrit- 46-68%
Platelets- 150,000-350,000
RBC 4.5-7.0 (1,000,000)
WBC 10-30000
Respiratory System Adaptations:
-Lung aeration leads to the establishment of functional residual capacity allowing for gas exchange to begin
-The first breath results in the lungs filling increasing pulmonary pressure which pushes the diaphragm down
-While the mom is in labor she is breathing rapidly (hypercapnia), hypoxic, and acidodic, all of these help initiate
the baby to breath
-Inspiration of air and expansion of lungs increase tidal volume
-Surfactant prevents alveolar collapse at the end of expiration and loss of lung volume
-Normal lung function depends on surfactant which permits a decrease in surface tension at the end of expiration
to prevent atelectasis
-The newborns chest wall is floppy due to the high cartilage content and poorly developed musculature
about:blank 3/30
Exam 2 Study Guide
Chapter 17
Cardiovascular System Changes:
KNOW REFLEXES AND WHEN THEY GO AWAY
SPINA BIFIDA (2 DIMPLES?)
GALLANT REFLEX
SKIN TO SKIN BENEFITS
DEHYDRATED BABY= SUNCK IN FONTANELS
ACROCYANOSIS
WHEN FEET ARE MORE BLUE THAN HANDS BABY IS COLD
HEART RATE: 120-160
SLEEPING BABY: HEART RATE COULD DROP AS LOW AS 100
SKIN TAGS ARE NORMAL BUT SHOULD PROMPT FURTHER INVESIGATION
BILIRUBIN: TRAUMA, BLOOD COMPENTS, CONJUGATION
IGA, IGG, IGM
SKIN: FIRST LINE OF DEFENSE, TEMPERATURE, PREVENTS DEHYDRATION
BLACK WOMEN CAN HAVE WHITE BABIES
108 KCAL DAY OPTIMAL DIET FOR NEWBORN
-The umbilical vein carries oxygenated blood from the placenta to the fetus
-The ductus venous allows for the majority of the blood to bypass the liver and merge with blood moving through
the vena cava bringing it to the heart sooner. The foramen ovale allows the blood from the right atrium to move to
the left atrium which bypasses the pulmonary circulation (lungs).
-The ductus arterioles connects the pulmonary artery to the aorta which also skips the pulmonary circuit (lungs)
-Only a small amount of blood goes to the lungs for perfusion purposes
-At birth the newborn circulation and placental oxygen exchange must switch to pulmonary gas exchange (lungs)
-The changes must include increased pulmonary blood flow, removal of the placenta, closure of the foramen ovale
(the opening between the right and left atrium) and closure of the venous ductus and ductus arterioles
-The stresses of birth release catecholamine’s that are critical for the transition into extrauterine life.
- The increased levels of epi and norepi stimulate increased cardiac output and contractility; stimulate surfactant
release (needed for oxygen and gas exchange) and promotion of lung fluid clearance
about:blank 1/30
,11/19/23, 9:30 AM Exam 2 Study Guide - Summary Maternity and Pediatric Nursing
Fetal to neonatal Circulation Changes:
-Circulation changes as soon as the fetus separates from the placenta
-When the cord is clamped is when the first breath is taken and lungs begin to function
-Systemic vascular resistance increases and blood return via inferior vena cava decreases
-Decrease in pulmonary vascular resistance and increase in pulmonary blood flow
-Foreman ovale closes with a decrease in pulmonary vascular resistance decreasing right sided heart pressures. It
closes when left atrial pressure increases and right atrium pressure decreases. Normally functionally closes at birth
and permantantly closes in several weeks.
-The ductus arterioles and venous ductus are no longer needed and turn into ligaments over time.
-With closure of the foramen ovale oxygenated blood and deoxygenated blood now become separated
-During fetal life the ductus arterioles protected the lungs from circulatory overload by shunting blood right to left
into the descending aorta to the rest of the body
-Patency of the ductus arterioles is protected by prostaglandins E2 during fetal life
-Ductus arterioles functionally close a few hours after birth and its closure depends on increased oxygenation
resulting from aeration of the lungs after birth
-The venous ductus closes within a few days after birth because it’s shunting of blood is no longer needed with the
activation of the liver. The liver now takes over the function of the placenta
-The umbilical vessels (1 vein, 2 arteries) begin to constrict and are no longer needed, also becoming ligaments
(One aretery is associated with renal and GI abnormalities)
Heart Rate:
-During first few minutes after birth the infant’s heart rate is between 110-160 but then decreases to an average of
120-130.
-The newborn is dependent on the heart rate for maintance of cardiac output and blood pressure.
-BP normally plateaus a week after birth
-Cardiac defects can be determined through a thorough physical assessment of the newborns cardiovascular
system. The nurse should be able to identify any abnormalities because this could lead to early detection and
treatment.
-A transient functional cardiac murmur may be heard during the neonatal period as a result of cardiovascular
changes.
-Fluctuations of heart rate and blood pressure mimic baby’s behavioral state. (If baby is agitated the heart rate and
blood pressure will be elevated)
-Tachycardia may be found as a result of fluid volume loss, cardio respiratory disease, drug withdrawal and
hyperthyroidism.
-Bradycardia is found with apnea and hypoxia
about:blank 2/30
, 11/19/23, 9:30 AM Exam 2 Study Guide - Summary Maternity and Pediatric Nursing
Blood volume:
-The amount of blood the baby has depends on the amount of blood transferred to the infant from the placenta at
birth.
-Late clamping (after 3 minutes) is better than early clamping (30-40 seconds). Late clamping improves the infants
cardiopulmonary adaption, prevents iron deficient anemia without increasing risk of hypervolemia, increases
blood pressure, improves oxygen transport, and increases red blood cell flow.
-Cord blood “nature’s first stem cell transplant”
Blood Components:
-Fetus has more red blood cells at birth. They are larger in size and have a greater affinity for oxygen. After birth the
RBC count increases and the RBC decreases in size. This is due the RBC now living in an environment where there is
much more pulmonary oxygenation.
-An infant’s hemoglobin initially declines as a result of a decrease in neonatal red blood cell mass
-Leukocytosis (increased white blood cell count) is present after birth due to the trauma of birth.
-The newborns platelet aggregation and platelet count are the same as adults
-Blood test results of the newborn re dependent of where the blood is drawn from, capillary blood has higher
levels of hemoglobin and hematocrit compared to venous blood, placental transfusion (early vs. late cord
clamping), gestational age (increased age is associated with increased RBC and hemoglobin)
NORMAL NEWBORN BLOOD VALUES
Hemoglobin- 16-18
Hematocrit- 46-68%
Platelets- 150,000-350,000
RBC 4.5-7.0 (1,000,000)
WBC 10-30000
Respiratory System Adaptations:
-Lung aeration leads to the establishment of functional residual capacity allowing for gas exchange to begin
-The first breath results in the lungs filling increasing pulmonary pressure which pushes the diaphragm down
-While the mom is in labor she is breathing rapidly (hypercapnia), hypoxic, and acidodic, all of these help initiate
the baby to breath
-Inspiration of air and expansion of lungs increase tidal volume
-Surfactant prevents alveolar collapse at the end of expiration and loss of lung volume
-Normal lung function depends on surfactant which permits a decrease in surface tension at the end of expiration
to prevent atelectasis
-The newborns chest wall is floppy due to the high cartilage content and poorly developed musculature
about:blank 3/30
