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OB WEEK 4 FLASHCARDS (TEST 2)

Terms in this set (90)

neonatal period
first 28 days of life
Fetus vs. Newborn: Respiratory system
Fetus: Fluid-filled, high-pressure system causes blood to be shunted from the lungs through the ductus arteriosus to the rest of the body.
Newborn: Air-filled, low-pressure system encourages blood flow through the lungs for gas exchange; increased oxygen content of blood in the lungs contributes to the closing of the ductus arteriosus (becomes a ligament).
Fetus vs. Newborn: Site of gas exchange
Fetus: Placenta
Newborn: Lungs
Fetus vs. Newborn: Circulation through the heart
Fetus: Pressures in the right atrium are greater than in the left, encouraging blood flow through the foreman ovale. Newborn: Pressures in the left atrium are greater than in the right, causing the foreman ovale to close.
Fetus vs. Newborn: Hepatic portal circulation
Fetus: Ductus venosus bypasses; maternal liver performs filtering functions.
Newborn: Ductus venosus closes (becomes a ligament); hepatic portal circulation begins.
Fetus vs. Newborn: Thermoregulation
Fetus: Body temperature is maintained by maternal body temperature and the warmth of the intrauterine environment.
Newborn: Body temperature is maintained through a flexed posture and brown fat.
The umbilical vein
carries oxygenated blood from the placenta to the fetus
The ductus venosus
allows the majority of the umbilical vein blood to bypass the liver and merge with blood moving through the vena cava, bringing it to the heart sooner
-shunts blood from the left umbilical vein to the inferior vena cava during intrauterine life.
-It closes within a few days after birth, because this shunting is no longer needed as a result of activation of the liver.
-The activated liver now takes over the functions of the placenta (which was expelled at birth).
-The ductus venosus becomes a ligament
formamen ovale
allows more than half the blood entering the right atrium to cross immediately to the left atrium, bypassing the pulmonary circulation
-normally closes functionally at birth when left atrial pressure increases and right atrial pressure decreases. Permanent anatomic closure, though, really occurs throughout the next several weeks.
ductus arteriosus
connects the pulmonary artery to the aorta, which allows bypassing of the pulmonary circuit. Only a small portion of blood passes through the pulmonary circuit for the main purpose of perfusion of the structure, rather than for oxygenation
-protects the lungs against circulatory overload by shunting blood (right to left) into the descending aorta, bypassing the pulmonary circulation.
-Its patency during fetal life is promoted by continual production of prostaglandin E2 (PGE2)
-becomes functionally closed within the first few hours after birth.
-Oxygen is the most important factor in controlling its closure. Closure depends on the high oxygen content of the aortic blood that results from aeration of the lungs at birth.
-At birth, pulmonary vascular resistance decreases, allowing pulmonary blood flow to increase and oxygen exchange to occur in the lungs. It occurs secondary to an increase in PO2 coincident with the first breath and umbilical cord occlusion when it is clamped.
What changes lead to an increased release of catecholamines that is critical for the changes involved in the transition to extrauterine life?
-The physical forces of the contractions of labor and birth
-mild asphyxia
-increased intracranial pressure as a result of cord compression and uterine contractions
-cold stress experienced immediately after birth
What stimulates increased cardiac output and contractility, surfactant release, and promotion of pulmonary fluid clearance?
The increased levels of epinephrine and norepinephrine
changes that occur immediately when cord is clamped and lungs begin to function
-systemic vascular resistance increases and blood return to the heart via the inferior vena cava decreases.
-rapid decrease in pulmonary vascular resistance and an increase in pulmonary blood flow
-The foramen ovale functionally closes with a decrease in pulmonary vascular resistance, which leads to a decrease in right-sided heart pressures.
-An increase in systemic pressure, after clamping of the cord, leads to an increase in left-sided heart pressures.
Overview of cardio/pulmonary changes after birth
-Clamping umbilical cord at birth eliminates the placenta as a reservoir for blood.
-Onset of respirations causes a rise in PO2 in the lungs and a decrease in pulmonary vascular resistance, which...
Increases pulmonary blood flow and increases pressure in the left atrium, which...
-Decreases pressure in the right atrium of the heart, which causes closure of the foramen ovale (closes within minutes after birth secondary to a decreased pulmonary vascular resistance and increased left heart pressure)
-With an increase in oxygen levels after the first breath, an increase in systemic vascular resistance occurs, which...
-Decreases vena cava return, which reduces blood flow in the umbilical vein (constricts, becomes a ligament with functional closing).
-Closure of the ductus venosus (becomes a ligament) causes an increase in pressure in the aorta, which forces closure of the ductus arteriosus within 10 to 15 hours after birth.
Normal heart rate for a newborn minutes after birth
120 to 180, then it slows down to 120 to 130
Cardiac murmurs
may be normal due to the changing dynamics of the heart after birth
Tachycardia and bradycardia in the newborn
Tachycardia may be found with volume depletion, cardiorespiratory disease, drug withdrawal, and hyperthyroidism. Bradycardia is often associated with apnea and is often seen with hypoxia.
-It is normal for heart rate to increase in response to stimulation
Benefits of delayed cord clamping
-improving the newborn's cardiopulmonary adaptation -preventing anemia in full-term newborns without increasing hypervolemia-related risks
-ncreasing blood pressure
-improving oxygen transport
-increasing red blood cell flow
Normal blood volume of a newborn
80 to 85 mL/kg of body weight
Differences in newborn RBC's
-large, but few in number.
-After birth, the red cell count gradually increases as the cell size decreases, because the cells now live in an environment with much higher PO2.
-life span of 80 to 100 days, compared to 120 days in adults
What factors can affect a newborn's hematologic values?
-the site of the blood sample (capillary blood has higher levels of hemoglobin and hematocrit compared with venous blood)
-placental transfusion (delayed cord clamping and normal shift of plasma to extravascular spaces, which causes higher levels of hemoglobin and hematocrit)
-gestational age (increased age is associated with increased numbers of red cells and hemoglobin
Leukocytosis
commonly present in newborns due to birth trauma
Hemoglobin
17-23 g/dL
Hematocrit
46-68%
Platelets
150,000-350,000/μL
Red blood cells
4.5-7.0 (1,000,000/μL)
White blood cells
10-30,000/mm3
Stimuli from normal labor that initiate normal respirations
Hypercapnia, hypoxia, and acidosis
Surfactant
-surface tension-reducing lipoprotein found in the newborn's lungs that prevents alveolar collapse at the end of expiration and loss of lung volume.
-It lines the alveoli to enhance aeration of gas-free lungs, thus reducing surface tension and lowering the pressure required to open the alveoli.
-Normal lung function depends on surfactant, which permits a decrease in surface tension at end expiration (to prevent atelectasis) and an increase in surface tension during lung expansion (to facilitate elastic recoil on inspiration)
Why are accessory muscles ineffective in the newborn?
The chest wall of the newborn is floppy because of the high cartilage content and poorly developed musculature
How does fluid get removed from the lungs?
Passage through the birth canal allows intermittent compression of the thorax, which helps eliminate the fluid in the lungs. Pulmonary capillaries and the lymphatics remove the remaining fluid. C section babies need to be watched carefully cuz their fluid doesn't get squeezed out (watch for transient tachypnea- respirations above 60)
What has to happen before the newborns lungs can maintain respiratory function?
Initiation of respiratory movement
Expansion of the lungs
Establishment of functional residual capacity (ability to retain some air in the lungs on expiration)
Increased pulmonary blood flow
Redistribution of cardiac output
What is considered normal short periods of apnea in a newborn?
15 seconds or less
aka periodic breathing
must also have no change in color or heart rate
Signs of respiratory distress
cyanosis, tachypnea, expiratory grunting, sternal retractions, and nasal flaring
-chest movement should be symmetric
Average newborn body temperature
97.9° to 99.7° F (36.5° to 37.5° C)
Characteristics that predispose infants to heat loss
Thin skin with blood vessels close to the surface
Lack of shivering ability to produce heat involuntarily
Limited stores of metabolic substrates (glucose, glycogen, fat)
Limited use of voluntary muscle activity or movement to produce heat
Large body surface area relative to body weight
Lack of subcutaneous fat, which provides insulation
Little ability to conserve heat by changing posture (fetal position)
No ability to adjust their own clothing or blankets to achieve warmth
Inability to communicate that they are too cold or too warm
Conduction
Conduction involves the transfer of heat from one object to another when the two objects are in direct contact with each other
-this could be from them coming into contact with a cold object such as a matress, etc.
Convection
involves the flow of heat from the body surface to cooler surrounding air or to air circulating over a body surface. An example of convection-related heat loss would be a cool breeze that flows over the newborn
Evaporation
involves the loss of heat when a liquid is converted to a vapor. Evaporative loss may be insensible (such as from skin and respiration) or sensible (such as from sweating). Insensible loss occurs, but the individual is not aware of it.
-this could occur after a bath or as their amniotic fluid
Radiation
nvolves the loss of body heat to cooler, solid surfaces that are in proximity but not in direct contact with the newborn.
-an example would be placing an infact inside of a heated isolette next to a cold window, they will still lose heat
What factors contribute to infants increase risk of overheating?
Limited insulation and limited sweating ability
immaturity of the newborn's central nervous system (can't maintain homeostasis)
How does the newborn attempt to conserve heat and increase heat production?
increasing the metabolic rate, increasing muscular activity through movement, increasing peripheral vasoconstriction, and assuming a fetal position to hold in heat and minimize exposed body surface area.
Neutral thermal environment
-An environment in which body temperature is maintained without an increase in metabolic rate or oxygen use
-Within an NTE, the rates of oxygen consumption and metabolism are minimal, and internal body temperature is maintained because of thermal balance.
-An NTE promotes growth and stability, conserves energy for basic bodily functions, and minimizes heat (energy) and water loss
The newborn's primary method of heat production
is through nonshivering thermogenesis, a process in which brown fat (adipose tissue) is oxidized in response to cold exposure
Brown fat
-a special kind of highly vascular fat found only in newborns.
-The brown coloring is from the fat's rich supply of blood vessels and nerve endings.
-capable of intense metabolic activity—and thus can generate a great deal of heat
—are found between the scapulae, axillae, at the nape of the neck, in the mediastinum, and in areas surrounding the kidneys and adrenal glands.
-When the newborn experiences a cold environment, the release of norepinephrine increases, which in turn stimulates brown fat metabolism by the breakdown of triglycerides.
-Cardiac output increases, increasing blood flow through the brown fat tissue, which warms the blood
effects of cold stress if not reversed
depleted brown fat stores
increased oxygen needs
respiratory distress
increased glucose consumption leading to hypoglycemia
metabolic acidosis
jaundice
hypoxia
decreased surfactant production
Where should you place a temp probe?
preferably over the liver
definitely not over a bony prominence or over brown fat area because you will get a higher reading
Function of liver
blood coagulation
iron storage
carbohydrate metabolism
conjugation of bilirubin
Glycogen reserves
Iron storage by the liver
as RBC's are destroyed after birth, their iron is released and stored by the liver until new RBC's are produced
-if mom had sufficient iron during pregnancy, the newborn should have a 6 months supply of iron in the liver
Glucose storage
there is no need to routinely check an infant's blood glucose unless they are at risk
-they must learn to adjust to intermittent feeding schedule and regulate their own blood glucose
-at birth their glucose is around 70 to 80% of mom's
Conjugation of bilirubin
-bilirubin: bile pigment from the breakdown of RBC's
-because of their increased turnover of RBC's, newborns produce twice the amount of bili than adults, which they can't process fast enough, so it can lead to jaundice
-plus the metabolic pathways of the liver are immature
-it returns to normal levels after 10 to 14 days
-bilirubin is toxic and must be eliminated
conjugated bilirubin or direct bilirubin
water soluble
unconjugated bilirubin
fat soluble
Jaundice
also known as icterus, refers to the yellowing of the skin, sclera, and mucous membranes that results from increased bilirubin blood levels.
-occurs in more than half of all healthy newborns
Bilirubin encephalopathy
permanent brain damage that results from the toxicity of bilirubin
Risk factors for jaundice
-fetal-maternal blood group incompatibility
-prematurity
-breast-feeding
-drugs (such as diazepam [Valium], oxytocin [Pitocin], sulfisoxazole/erythromycin [Pediazole], and chloramphenicol [Chloromycetin])
-maternal gestational diabetes
-infrequent feedings
-male gender
-trauma during birth resulting in cephalhematoma
-cutaneous bruising
-polycythemia
-previous sibling with hyperbilirubinemia
-infections such as TORCH (toxoplasmosis, other viruses, rubella, cytomegalovirus, herpes simplex viruses)
-ethnicity such as Asian or Native American
Causes of newborn jaundice
-Bilirubin overproduction: blood incompatibility (Rh or ABO), drugs, trauma at birth, polycythemia, delayed cord clamping, and breast milk jaundice
-Decreased bilirubin conjugation: physiologic jaundice, hypothyroidism, and breast-feeding
-Impaired bilirubin excretion: biliary obstruction (biliary atresia, gallstones, neoplasm), sepsis, hepatitis, chromosomal abnormality (Turner syndrome, trisomies 18 and 21), and drugs (aspirin, acetaminophen, sulfa, alcohol, steroids, antibiotics)
Changes in the GI system
babies are born with no mucosal layer
they have no vitamin K because their gut is sterile
vitamin K production is dependent on feeding to introduce colonization of their gut
newborn stomach can't stretch for 1 to 2 days (so whatever it can't hold will come right back up)
How much of their birth weight do term newborns usually lose within the first week of life
5 to 10%
Normal calorie requirements for a healthy newborn
108 kcals/kg/day
contents of meconium
amniotic fluid
shed mucosal cells
intestinal secretions
blood
-it is usually passed within 12 to 24 hours
What percentage of the newborn's body mass is water?
75%
Although newborn's kidneys can function, they are immature at concentrating urine until about what age
3 months
This will manifest as a low urine specific gravity
Average number of voidings for a healthy infant
6 to 8 per day
The glomerular filtration rate does not mature until about what age
12 to 18 months
it runs at about 30% at birth and increases to 50% by about day 10 of life
-this increases the newborns risk of fluid overload and drug toxicity
Natural immunity
responses or mechanisms that do not require previous exposure to the microorganism or antigen to operate efficiently. Physical barriers (such as intact skin and mucous membranes), chemical barriers (such as gastric acids and digestive enzymes), and resident nonpathologic organisms
Acquired immunity
(1) the development of circulating antibodies or immunoglobulins capable of targeting specific invading agents (antigens) for destruction and (2) formation of activated lymphocytes designed to destroy foreign invaders. Acquired immunity is absent until after the first invasion by a foreign organism or toxin
immunoglobins essential for immunity
IgG, IgM, and IgA
IgG
the major immunoglobulin and the most abundant, making up about 80% of all circulating antibodies
-It is found in serum and interstitial fluid.
-It is the only class able to cross the placenta, with active placental transfer beginning at approximately 20 to 22 weeks' gestation.
-produces antibodies against bacteria, bacterial toxins, and viral agents.
IgA
-the second most abundant immunoglobulin in the serum. -does not cross the placenta, and maximum levels are reached during childhood.
-believed to protect mucous membranes from viruses and bacteria.
-predominantly found in the gastrointestinal and respiratory tracts, tears, saliva, colostrum, and breast milk.
IgM
-found in blood and lymph fluid and is the first immunoglobulin to respond to infection.
-does not cross the placenta, and levels are generally low at birth unless a congenital intrauterine infection is present.
-offers a major source of protection from blood-borne infections. The predominant antibodies formed during neonatal or intrauterine infection are of this class.
Newborns skin makes up approximately what percent of it's body weight?
13%
Newborn senses
Hearing—well developed at birth, responds to noise by turning to sound
Taste—ability to distinguish between sweet and sour by 72 hours old
Smell—ability to distinguish between mother's breast milk and breast milk from others
Touch—sensitivity to pain, responds to tactile stimuli
Vision—is incomplete at birth. Maturation is dependent on nutrition and visual stimulation. Newborns have ability to focus only on close objects (8 to 10 inches away) with a visual acuity of 20/140; they can track objects in midline or beyond (90 inches). This is the least mature sense at birth. The ability to fix, follow, and be alert is indicative of an intact CN
1. When assessing the term newborn, the following are observed: newborn is alert, heart and respiratory rates have stabilized, and meconium has been passed. The nurse determines that the newborn is exhibiting behaviors indicating:
b. The behaviors demonstrated by the newborn, such as alertness, stabilized heart and respiratory rates, and passage of meconium are associated with the second period of reactivity. The first period of reactivity starts with a period of quiet alertness followed by an active alertness with frequent bursts of movement and crying. During the decreased responsiveness period, also called the sleep period, the newborn is relatively unresponsive and difficult to waken.
2. A nurse observes a 3-day-old term newborn who is starting to appear mildly jaundiced. What might explain this condition?
a. Physiologic jaundice typically starts after 72 hours of breast feeding. There is an enzyme in breast milk that inhibits the breakdown of bilirubin, and it is reflected on the newborn skin as jaundice. Hemolytic disease of the newborn typically shows within 24 hours after birth due to the different types of blood between mother and newborn. Exposure to oxygen has no link to causing jaundice in the newborn. Glucose water is not a cause of jaundice, but it might promote more frequent bowel movements which assists in eliminating bilirubin.
3. After teaching a group of nursing students about thermoregulation and appropriate measures to prevent heat loss by evaporation, which of the following student behaviors would indicate successful teaching?
d. Evaporation is the loss of heat as water is lost from the skin to the environment. Drying the newborn at birth and after bathing, keeping linens dry, and using plastic wrap blankets and heat shields will all prevent heat loss through evaporation. Placing the newborn on a warmed surface will prevent heat loss via conduction. Maintaining a warm room temperature will prevent heat loss via convection. Transporting the newborn in an isolette will prevent heat loss via radiation.
4. After birth, the nurse would expect which fetal structure to close as a result of increases in the pressure gradients on the left side of the heart?
a. The foramen ovale is the fetal structure within the heart that allows blood to cross immediately to the left side and bypass the pulmonary circuit. When left-side pressure gradients increase at birth, this opening closes, thereby establishing an extrauterine circulation pattern. The ductus venosus is not located in the heart; it is located between the umbilical vein and the inferior vena cava, and it shunts blood away from the liver during fetal life. The ductus arteriosus connects the pulmonary artery to the aorta to bypass the pulmonary circuit. It begins to constrict as pulmonary circulation increases and arterial oxygen tension increases. The umbilical vein, along with two umbilical arteries, is part of the umbilical cord that is cut at birth.
5. Which of the following newborns could be described as breathing normally?
The correct answer is newborn D. Normal breathing can be described as shallow, at a rate of 36 bpm, with short periods of apnea.
6. When assessing a term newborn (6 hours old), the nurse auscultates bowel sounds and documents recent passing of meconium. These findings would indicate:
The correct answer is C. The findings indicate a patent anus with no bowel obstruction and normal peristalsis.
1. As the nurse manager, you have been orienting a new nurse in the nursery for the past few weeks. Although she has been demonstrating adequacy with most procedures, today you observe her bathing several newborns without covering them, weighing them on the scale without a cover, leaving the storage door open with the transporter nearby, and leaving the newborns' head covers and blankets off after showing them to family members through the nursery observation window.
It is evident the new nurse's behaviors demonstrate a lack of awareness or knowledge about thermoregulation in newborns. Reinforcement of these principles is needed. Perhaps she needs to be reminded of newborns' inability to keep themselves warm as a result of a variety of factors, or perhaps she may feel overwhelmed with caring for more than one newborn at a time. An in-service for all nursery personnel might be a good reinforcement of this concept. All four. The nurse is subjecting the newborn to heat loss by all four methods—evaporation (bathing), radiation (leaving door open), convection (cap off), and conduction (weighing). Newborns are unable to conserve body heat and experience heat loss through four mechanisms: conduction, convection, evaporation, and radiation. Placing newborns on cold surfaces without any protection (such as a blanket or cover) will cause them to lose body heat via conduction. By exposing them while wet, such as during bathing, heat is lost through evaporation. Leaving the storage room open permits cool air flow over the newborn, allowing heat loss by convection. Placing the infant transporter near cold rooms allows for transfer of neonatal body heat via radiation.
2. The most important adaptations for the newborn to make after birth are to establish respirations, make cardiovascular adjustments, and establish thermoregulation. Nursing care focuses on monitoring and supporting adjustments to extrauterine adaptation. Write appropriate nursing interventions to help achieve the following newborn adaptations:
A. Suction the mouth and then the nose to remove any mucus. Stimulate crying by drying the newborn immediately after birth. Assess respiratory effort to validate that it is within normal parameters. Observe for signs of respiratory distress. Auscultate chest for gas for normal gas exchange. B. Safety measures include matching identification bracelets for mother and infant; footprinting the newborn and thumbprinting the mother for identification purposes as well as prevention of abduction; handling the newborn with both hands securely to prevent dropping; positioning the newborn on his or her back to sleep; frequent handwashing when handling all newborns. C. Provide warmth by placing a hat on the newborn's head to prevent heat loss through the scalp. Take and record the newborn's axillary temperature frequently to monitor thermoregulation. Keep the newborn away from drafts and wrap in a blanket to keep warm or place under a radiant heater. After temperature stabilizes, bathe the newborn.
1. At birth, a newborn's assessment reveals the following: heart rate of 140 bpm, loud crying, some flexion of extremities, crying when bulb syringe is introduced into the nares, and a pink body with blue extremities. The nurse would document the newborn's Apgar score as:
d. One point would be subtracted for color (acrocyanosis) and 1 point for fair flexion of extremities. All the assessment parameters should rate 2 points, except for color and flexion. Therefore, any score except 8 points would be incorrect.
2. The nurse is explaining phototherapy to the parents of a newborn. The nurse would include which of the following as the purpose?
d. Phototherapy reduces the bilirubin on the newborn's skin via oxidation. Phototherapy does not affect surfactant levels in the newborn's lungs, nor does it help to stabilize temperatures in the newborn. In fact, it might cause hyperthermia at times if not monitored closely. Phototherapy cannot destroy Rh antibodies attached to RBCs within the circulation.
3. The nurse administers a single dose of vitamin K intramuscularly to a newborn after birth to promote:
b. Vitamin K is needed for blood clotting and is a vital component of the blood-clotting cascade. The newborn's gut is sterile at birth and unable to manufacture vitamin K on its own without an outside source initially. Vitamin K has no impact on bilirubin conjugation, transport, or excretion. It is not involved in closing the foreman ovale; cutting the cord and changing gradient vascular pressures are responsible for this closure. Vitamin K has no influence over the digestive process of complex proteins.
4. A prophylactic agent is instilled in both eyes of all newborns to prevent which of the following conditions?
a. The eyes of newborns can be exposed to gonorrhea and/or chlamydial organisms if they are present in the mother's vagina during the birth process, possibly resulting in a severe infection and blindness. Therefore, eye prophylaxis is administered. Thrush and Enterobacter typically do not affect the eyes. Thrush develops in the newborn's mouth after exposure to maternal vaginal yeast infections during the birth process. Infections with Staphylococcus and syphilis are contracted through bloodstream exposure or via the placenta and not by contact with the maternal vagina during birth. Eye treatment would not impact/treat either infectious process. Hepatitis B and herpes are not treatable with eye ointment.
5. The AAP recommends that all newborns be placed on their backs to sleep to reduce the risk of:
c. Research has identified sleeping position and its link to SIDS. Since 1992, the AAP has recommended that all newborns be placed on their backs to sleep. This recommendation has reduced the incidence of SIDS dramatically. Respiratory distress syndrome involves a lack of surfactant in the lungs, not sleeping position. The intake of formula or juice (high lactose exposure) being allowed to sit in the infant's mouth during sleep is the cause of bottle mouth syndrome. Positioning on the back might aggravate the GI regurgitation syndrome rather than help it.
. Which one of the following immunizations is most commonly received by newborns before hospital discharge?
d. Most newborns are started on the hepatitis B series before discharge from the hospital and receive the remaining two immunizations at 1 month and 4 to 6 months of age. The pneumococcal vaccine is given between 2 to 23 months of age, not at birth. Varicella immunization is not given until 12 to 18 months of age. Hepatitis A immunization is recommended for children and adolescents in selected states and regions and for high-risk groups. It is not a universal vaccine for all children.
7. Which condition would be missed if a newborn were screened before he had tolerated protein feedings for at least 48 hours?
c. Ingestion of certain amino acids found in breast milk or formula must be accumulated in the newborn to identify a deficiency in an enzyme that cannot metabolize them. If the PKU test is done prior to 24 to 48 hours after feeding, it must be repeated after the infant has tolerated feedings for at least that length of time. Identifying hypothyroidism is not linked to ingesting protein feedings. Cystic fibrosis is a genetic inherited condition not related to protein intake. Sickle cell disease is a genetically inherited condition unrelated to protein ingestion in the newborn.
1. Linda Scott, an African American mother who delivered her first baby and is on the mother-baby unit, calls the nursery nurse into her room and expresses concern about how her daughter looks. Ms. Scott tells the nurse that her baby's head looks like a "banana" and is mushy to the touch, and she has "white spots" all over her nose. In addition, there appear to be "big bluish bruises" all over her baby's buttocks. She wants to know what is wrong with her baby and whether these problems will go away.
In a calm manner, explain to Ms. Scott that all her observations are normal variations and address each one separately:

"Banana-shaped head"—is molding where the newborn had a slight overriding of the skull bones to navigate the bony pelvis and birth canal during the birth process
"Mushy" feel to head—caput succedaneum, which is an edematous area of the scalp as a result of sustained pressure of the occiput against the cervix during labor and birth process
"White spots on nose"—milia, which are plugged, distended, small, white sebaceous glands that are present in most newborns and should not be squeezed by the mother
"Blue bruises on buttocks"—Mongolian spots, which are bluish-black areas of pigmentation that are common in African-Americans and have no clinical significance, but can be mistaken for bruises

Molding—transient in nature and should disappear within 72 hours
Caput succedaneum—disappears spontaneously within 3 to 4 days
Milia—will clear up spontaneously within the first month
Mongolian spots—will gradually fade during the first or second year
2. At approximately 12:30 AM ON a Friday, a woman enters a hospital through a busy emergency department. She is wearing a white uniform and a lab coat with a stethoscope around her neck. She identifies herself as a new nurse coming back to check on something she had left on the unit on an earlier shift. She enters a postpartum client's room containing the mother's newborn, pushes the open crib down a hallway, and escapes through an exit. The security cameras aren't working. The infant isn't discovered missing until the 2 AM check by the nurse.
The woman was able to pass into the hospital via the emergency room posing as a "nurse" without anyone checking her name tag. The security cameras were not working at the time of the abduction. This allowed the abductor to pass down the hall with the infant unnoticed and unrecorded. The nurses on the unit were unaware of this woman on their unit, which should not happen. There should be an alarm on the doors leading into the unit and the doors should remain locked and only be opened electronically by a staff member on the unit after the person has been identified. There was truly a breakdown of several security measures in this scenario.
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