Patty Hanks Shelton School of Nursing

CBCR Spring 2015

Pre-Clinical Preparation Assignment: Nursery
Please review Unit 5: Chapters 15 and 16 in your Maternal-Newborn Nursing
textbook. These chapters and table relate directly to the Nursery clinical experience
scheduled for you.
Textbook: Chapman, L, Durham, R. (2014). Maternal-Newborn Nursing. The Critical
Components of Nursing Care. Philadelphia: F.A. Davis Company
Completing the medication cards and answering pre-clinical questions will provide a
better learning experience and allow you to function more safely in the environment
with greater confidence.
Medication cards may be pre-typed or pre-printed. The expectation is for the
student to be familiar with these medications. Medication cards should include
the following: name, classification, action, therapeutic uses, adverse
reactions, contraindications/precautions, interactions, nursing
considerations and patient education
Medications:

Erythromycin Ophthalmic Ointment

Hepatitis B Vaccine
Narcan
Survanta
Vitamin K
EMLA Cream
Lidocaine
Sweeties

Definitions (short answer in your own legible handwriting)

Physiologic jaundice:
Jaundice related to breastfeeding:
Phototherapy:
Transient Tachypnea:
Molding as it relates to newborns:
Caput as it relates to newborns:
Normal Bilirubin level:
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Patty Hanks Shelton School of Nursing

CBCR Spring 2015
Pre-Clinical Preparation Assignment: Nursery

Discussion Questions (in your own legible handwriting):

1. Describe Group B Streptococcus (GBS) and its cause.

Group B streptococcus also called group B strep is a common bacterium often

carried in the intestines or lower genital tract. Although group B strep is usually harmless
in adults, it can cause complications during pregnancy and serious illness in newborns. If
you're pregnant, your health care provider will likely recommend a group B strep test
during the third trimester.

During a group B strep test, your health care provider will swab your vagina and rectum
and send the samples to a lab for testing. In some cases, you might be given instructions
on how to collect the samples yourself. Because you can test positive at certain times and
negative at other times, you'll need to repeat the group B strep test each time you're
pregnant. If the group B strep test is negative, no action is needed. If the group B strep
test is positive, you'll be given antibiotics during labor to prevent group B strep disease in
your baby.

2. What are the risks/complications of not treating GBS?

The mother carries group B strep in her body

The baby is born prematurely (earlier than 37 weeks)

The mother's water breaks 18 hours or more before delivery

The mother has an infection of the placental tissues and amniotic fluid (chorioamnionitis)

Group B strep bacteria have been detected in the mother's urine (Bacteriuria) during
pregnancy (either her current pregnancy or previous pregnancies)

The mother's temperature is greater than 100 F (38 C) during labor

The mother previously delivered an infant with group B strep disease

3. What are the normal vital sign parameters for newborns?

Normal ranges for vital signs:
Heart Rate: 100 to 160 beats per minute (bpm)
Respiration (breaths): 0 to 6 months 30 to 60 breaths per minute (bpm)
Blood Pressure: 0 to 6 months 90/45 (mm Hg)
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Patty Hanks Shelton School of Nursing

CBCR Spring 2015
Pre-Clinical Preparation Assignment: Nursery

Temperature: 98.6 F (normal range is 97.4 F to 99.6 F)

4. What is the Apgar system? How and when is it used? What do the scores
indicate?
The Apgar score, the very first test given to a newborn, occurs in the delivery
or birthing room right after the baby's birth. The test was designed to quickly
evaluate a newborn's physical condition and to see if there's an immediate
need for extra medical or emergency care.
1. Appearance (skin color)
2. Pulse (heart rate)
3. Grimace response (reflexes)
4. Activity (muscle tone)
5. Respiration (breathing rate and effort)

Apgar Sign
Appearance
(skin color)
Pulse
(heart rate)
Grimace
("reflex
irritability")
Activity
(muscle tone)
Respiration
(breathing rate
and effort)

2
1
Normal color all over (hands Normal color (but hands
and feet are pink)
and feet are bluish)
Normal (above 100 beats per Below 100 beats per
minute)
minute

0
Bluish-gray or pale
all over
Absent
(no pulse)

Pulls away, sneezes, coughs, Facial movement only

Absent (no response
or cries with stimulation
(grimace) with stimulation to stimulation)
Active, spontaneous
movement

Arms and legs flexed with No movement,

little movement
"floppy" tone

Normal rate and effort, good Slow or irregular

cry
breathing, weak cry

Absent (no breathing)

5. What is the Ballard score? How is it rated? What do the scores indicate?

A thorough physical examination should be done within 24 h. Basic measurements include

length, weight, and head circumference (see Physical Growth of Infants and Children). Length is
measured from crown to heel; normal values are based on gestational age and should be plotted
on a standard growth chart. When gestational age is uncertain or when the infant seems large or
small for age, the gestational age can be precisely determined using physical and neuromuscular
findings.
Physical Maturity:
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Patty Hanks Shelton School of Nursing

CBCR Spring 2015

Pre-Clinical Preparation Assignment: Nursery

Lanugo (the soft downy hair on a baby's body). Absent in immature babies, then
appears with maturity, and then disappears again with post maturity.
Plantar creases. These creases on the soles of the feet range from absent to covering the
entire foot, depending on the maturity.

Breast. The thickness and size of breast tissue and areola (the darkened ring around each
nipple) are assessed.

Eyes and ears. Eyes fused or open and amount of cartilage and stiffness of the ear tissue.

Genitals, male. Presence of testes and appearance of scrotum, from smooth to wrinkled.

Genitals, female. Appearance and size of the clitoris and the labia.

Neuromuscular maturity
Six evaluations of the baby's neuromuscular system are done. A score is assigned to each
assessment area. Typically, the more neurologically mature the baby, the higher the score. The
areas of assessment include:

Posture. How does the baby hold his or her arms and legs?
Square window. How far the baby's hands can be flexed toward the wrist.

Arm recoil. How much the baby's arms "spring back" to a flexed position?

Popliteal angle. How far the baby's knees extend.

Scarf sign. How far the elbows can be moved across the baby's chest.

Heel to ear. How close the baby's feet can be moved to the ears.

6. What are the parameters for normal blood glucose for a newborn?
70-100mg/dL
7. Why are infants of diabetic mothers at risk for hypoglycemia? What
interventions are taken to prevent this from occurring?
Hyperglycemia could result in fetal hyperinsulinemia, restricted intrauterine
growth, cardiomyopathy and asphyxia.
Interventions: Exercise has been shown to improve glycemic control.
Reinforce diet management, teach the woman to monitor fasting ketonuria
levels in the morning.
8. What physiologic changes must occur in the newborn as it transitions to
extrauterine life?
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Patty Hanks Shelton School of Nursing

CBCR Spring 2015
Pre-Clinical Preparation Assignment: Nursery
Respiratory System: Lung adaptation requires coordinated clearance of
fetal lung fluid, surfactant secretion, and onset of consistent breathing. The
initiation of respiration has an effect on the pulmonary circulation and gas
exchange, First breath increases alveolar oxygen tension and decrease
pulmonary vascular resistance, increases blood flow through pulmonary
vessels and increases oxygen and carbon dioxide exchange within the lungs.
Persistent hypoxemia and acidosis that leads to constriction of the pulmonary
arteries.
The cardiovascular system: Response requires striking changes in blood
flow, pressures, and pulmonary vasodilation. The ductus venosus which
connects to the umbilical vein to the inferior vena cava, closes by day 3 of life
and becomes a ligament. Blood flow through the umbilical vein stops once
the cord is clamped.
The foramen ovale, which is an opening between the right atrium and the left
atrium, closes when the atrial pressure is higher than the right atrial
pressure.
The ductus arteriosus which connects the pulmonary artery when the
pulmonary vascular resistance becomes less than system vascular
resistance, left to right shunt, closure of ductus arteriosus. It will remain open
if lungs fail to expand or PaO2 levels drop.
Thermoregulatory system: The fetus is surrounded by the amniotic fluid
which remain a fairly constant temperature based on the maternal body
environment. The neonates response to the extrauterine temperature
changes during the first few weeks are delayed and place neonate at cold
stress. They are at risk for thermoregulatory problems related to higher body
surface area to body mass ratio. Higher metabolic rate and limited and
immature thermoregulatory abilities.
The Metabolic System:
Large quantities of glycogen is stored by the fetus during pregnancy in
preparation for meeting energy requirements when transitioning from
intrauterine to extrauterine life. Glucose values decrease about 1 hour post
birth, and then the value rise and stabilize by 2 to 3 hours. Optimal range for
plasma glucose is 70-100 mg/dL
Hypoglycemia (blood glucose level under 40 mg/dL in the neonate) is
common during this transitional time.
The Hepatic System:
Functions of the liver include: Carbohydrate metabolism, the liver regulates
the blood glucose level by converting excessive glucose to glycogen and
converting glycogen levels to glucose when glucose levels are low.
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Patty Hanks Shelton School of Nursing

CBCR Spring 2015
Pre-Clinical Preparation Assignment: Nursery

Coagulation factors II, VII, IX, and X are synthesized in the liver. A Vitamin K
injection is given as a prophylaxis to decrease risk for bleeding.
Detoxification: The smooth endoplasmic reticulum of the liver produces
enzymes that detoxify harmful substances such as medications.
The Gastrointestinal System: The neonates GI system is functionally
immature but rapidly adapts to the demands for growth and development.
Through ingestion, digestion and absorption of nutrients. Neonates may
appear uninterested in the feeding during the first few days.
The characteristics of stool: Meconium Stool: Begins to form during the
4th gestational month and is eliminated in the first stool by the neonate.
Within first 24-48 hours.
Transitional stool: Begins around 3rd day and can continue for 3-4 days.
Color: Greenish black to greenish brown to greenish yellow.
Breastfeed stool: yellow and semi formed, later it becomes a golden yellow
with a pasty consistency and has sour odor.
Formula Fed Stool: drier and more formed than breastfeed stool. It a pallor
or brownish yellow.
Diarrheal stool: is loose and green.
The Renal System: Two major functions of Kidney is to eliminate metabolic
waste and control of fluid and electrolyte balance. The GFR is low in the
neonate but doubles by week 2 of age. The limited abilities of kidneys can
affect the excretion of drugs from the neonates system and increase the risk
for toxicity.
The Immune System: The immune system protects the body from invasion
of foreign materials such as bacteria and viruses.
Active humoral activity is the process by which B cells detect antigens and
produce antibodies against them. Neonates are at risk for infection related to
immature defense mechanisms.
9. What is the protocol if baby is Coombs positive?
10.How do you recognize and assess jaundice?
Jaundice is characterized by a yellowish tint to the skin and sclera of the eye.
Mean peak total serum bilirubin level is 5-6mg/dL of full term neonate.
Typically visible after 24 hours of life.
11.How do you recognize and assess a drug addicted baby?

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Patty Hanks Shelton School of Nursing

CBCR Spring 2015
Pre-Clinical Preparation Assignment: Nursery

Signs and Symptoms of Drug Addicted baby: Tachypnea, excessive crying,

yawning, itching, sneezing, poor feeding, Hyperthermia, generalized seizure,
excoriation, hypertonia.
12. What is the importance of thermoregulation in a newborn? What problems
may occur should the baby not be able to maintain his/her temperature?
The neonates response to the extrauterine temperature changes during the
first few weeks are delayed and place neonate at cold stress. They are at risk for
thermoregulatory problems related to higher body surface area to body mass
ratio. Higher metabolic rate and limited and immature thermoregulatory
abilities. The baby will go into cold stress if he/she is not able to maintain
temperature. Excessive heat loss may occur which will lead to hypothermia.

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