09/02/2015 Lecture Flashcards
When is the neonatal period?
first 28 days of life
What are the two major systems that have to adapt during the neonatal period?
1) Respiratory System
2) Cardiovascular system
- most transitions happen within first 6-10 hours
Where is the site of gas exchange for the fetus? for the newborn?
1) fetus - placenta
2) newborn - lungs
What happens to the newborn’s circulatory system after birth?
3 shunts close up (ductus venosis, foramen ovale, ductus arteriosis), umbilical arteries/vein gone
what does the ductus venosis do? foramen ovale (why is this important)? ductus arteriosis?
1) bypass the liver
2) puts blood directly into left atrium to circumvent pulmonary circuit (blood then goes into left ventricle and into left aorta) -> allows blood to get to baby’s body as efficiently as possible b/c lungs don’t work yet
3) connects pulmonary artery to aorta allowing blood to bypass pulmonary circuit
What is the umbilical vein?
carries o2 blood from placenta to fetus
what is PDA?
patent ductus arteriosis, means it never closed when transition cardiovasc system from fetal to newborn
what will HR be for first half-hour of life?
160-180 HR
Newborn heart rate should be how many BPM? What should you be able to palpate in newborn?
at LEAST 100, should be able to palpate PMI at 3rd or 4th intercostal space and left of midclavicular line; pulses 2+ is normal
Is it normal to have a transient normal in newborn?
yes, wooshing sound from foramen ovale still closing off and you’re hearing the result of that
What is blood volume dependent on in newborn
- amount transferred from placenta at birth
- when the physician clamps the umbilical cord (early, 3 minutes
is late or early cord clamping beneficial?
late, anemia precention, increased BP, improve cardiopulmonary adaptation, improved o2 transport and RBC flow
What is nature’s first stem cell transplant?
cord blood, can potentiate into any cells the body needs
Newborn Blood values
Hg: 17-23 gm/dL Hct: 46-86% Platelets: 100k - 350k RBC: 4.5-7.0 WBC: 10-30k (elevation from trauma of going through birth)
What are the respiratory system adaptations?
1) surfactant: lipoprotein that will keep alveoli from collapsing
2) initiation of respirations: adjusting from flui-filled intrauterine enviro to gaseous extrauterine
Who has the most trouble making initial respirations?
- premature babies, baby’s not delivered vaginally
How does a vaginal birth help with respiratoins?
- coming out the baby’s lungs get squeezed and when outside of the uterus, the lungs naturally expand and suck in air and help to initiate first breath
What are environmental stimuli that help kickstart the baby’s systems?
- lighting
- sound
- temperature
- wet to dry
what’s the measurement of blood gases in the newborn like?
higher CO2 level and lower O2 concentration of blood
What are the signs of resp distress in the newborn?
1) nasal flaring
2) Intercostal or subcostal retractions
3) Grunting: a little bit more like a sigh/small fart sound/laboured exhale
4) Chest and abdomen not moving together with breathing (See-saw respirations)
How do we classify apnea in the newborn?
- periods of apnea have to be greater than 15 seconds, because the newborn has very abnormal breathing patterns which is normal (called periodic breathing)
What’s the normal respiratory rate for the newborn?
30-60 breaths/minute
how do newborns thermoregulate?
heat production: primarily through non-shivering thermogenesis
heat loss: caused by lots of factors
- thin skin with vessels close to surface
- little subQ fat
- can’t change posture
can newborns shiver?
not really, limited stores of metabolic substrates
do newborns have a large body surface area? what does that mean?
yes, large SA in terms of body weight, means lots of heat loss
what are the 4 mechanisms of heat loss for the newborn?
1) conduction (contact)
2) Convection (air)
3) evaporation (water evaporation, why we dry babies)
4) radiation (cold exterior spaces like cold walls/windows)
what can hypothermia in the baby cause in a newborn?
cold stress
What can cold stress cuase?
1) respiratory distress: to produce heat there’s an increase in need for O2 to raise body temp, so increased RR, pulmonary vasoconstriction can occur and blood pH goes down
2) exacerbate hyperbilirubinemia: more anaerobic glycolysis leads to increase production of acids which displace bilirubin from albumin-binding sites
3) hypoglycemia: anaerobic glycolysis uses more blood glucose which depletes them
what is brown fat?
specialized type of fat in babies that is very vasculature and can help boost heat BUT there’s very little of it so can be burnt through quickly
To create heat what do babies need to put into their bodies? what does this cause?
O2, higher RR
What’s the best way to maintain temperature in a newborn?
skin-to-skin with mom or dad (can then cover baby with a blanket)
*** if mom or dad not there put them under radiator warmer in nursery
what is thermogenesis
- an attempt to generate heat
<p>what are the two causes of hypothermia ***need to look up if it's hyperthermia on slides***(s/s?)</p>
<p>1) environmental cause - skin vessel dilate and appears flushed - skin is warm to touch - infant's posture is of extension 2) sepsis causation - skin vessel constrict and baby appears pale - hands and feet are cool to the touch</p>
so when the placenta is lost at birth, the maternal glucose supply is cut off (baby’s glucose = 70-80% of mom’s), what organ compensates for this in the first 24 hours of life?
the liver releases glucose from glycogen stores
- initiate early feeding assistance
What are the three different ways jaundice can happen in newborn?
1) overproduction of bilirubin
- RBCs being broken down very fast in newborn release heme groups resulting in increased levels of bilirubin
2) decreased conjugation
- not being made into form that the body can excrete, indirect or fat-soluble bilirubing needs to be made into a form that’s water-soluble to be excreted
3) impaired exretion
for how long can a newborn’s iron stores last for?
4-6 months
What’s do we do to combat jaundice? how can you tell if they’re getting jaundice other than color?
1) we start feeding them more and bilirubin then excreted through stool
2) baby gets really sleepy
how often does visible jaundice occur in newborns? when does jaundice peak?
in more than half of healthy newborns; day 3 or day 4 of life
what AE can jaundice in a newborn cause?
neuro damage
what can bilirubin overproduction be caused by?
RH or ABO incompatibility, drugs , trauma at birth, polycythemia, delayed cord clamping, and breast milk jaundice
what can decreased bilirubin conjugation be caused by?
- physiologic jaundice, hypothyroidism, and breastfeeding
what can cause impaired bilirubin excretion?
- biliary obstruction, sepsis, chromosomal abnormalities (Turner syndrome, Trisomy 18, 21), and various drugs
how much do we need to initially feed a newborn?
30-90 mLs and first day just 30mL
does the gut have normal flora? what does this mean?
no, can’t form vitamin K which prevent clotting, so with eyes and thighs that’s the thigh part where we give a shot of vitamin K into thigh
how can we test for drug abuse in mother?
can test the first meconium passage
What’s meconium and what does it look like?
first stool of newborn, sticky
Stool paterns of breast-fed and forumla-fed newborns?
breast-fed: yellow-gold, loose, stringy to pasty, sour-smelling
formula-fed: yellow, yellow-green, loose, pasty or formed, unpleasant odor
what stool would a nurse expect to find a 1-week old newborn?
yellow-gold loose stool
within which timeframe should first void occur?
within 24 hours after birth
until what age do the kidneys have a limited ability to concentrate urine?
until about 3 months of age
how many voids do you expect with a newborn?
1st day- 1 void 2nd- 2 void 3rd day - 3 voids etc etc then from 6th and on 6-8 voids a day
Purposeof immune system in newborn
1) defense
2) homeostasis
3) surveillance
Do babies have natural immunity?
yes some
What are the immunoglobulins from acquired immunity
IgG: 80% of circulating antibodies - crosses placenta, fights bacteria, bacterial toxins and viruses
IgA: 2nd most abundant (what we see in breast-milk)
IgM: in blood and lymp-fluid, help against bloodborne pathogens
What is the integument of a newborn like?
thin (eg we don’t use bandaids b/c can cause damage to skin)
When do sweat glands become fully functional?
2-3 years of life
What direciton does development go in newborn?
cephalocaudal, proximal -> distal
What’s the least developed sense in the newborn?
vision, can only focus on things 7-12 inches away
What is the period of reactivity?
birth to 30 minutes after life
- newborn is alert and moving and may appear hungry
- RR and HR elevated
what is the period of decreased responsiveness
30 min to 120 min of age
- sleep or decreased activity
What is the period between 2-8 hours of life?
Second period of reactivity
- shows interest in environment
- HR and RR increase
- peristalsis increases and may pass first meconium
- interaction encouraged
what is orientation and what is habituation?
1) oreintation:
2) habituation: ability to hear things and tune them out
some other newborn behavioral responses are
motor maturity, self-quieting ability (consolability), social behaviors (cuddling/snuggling)
What does the first and second assessments include after birth?
1st
- in birthing room
- vital signs, APGAR, length/weight, and eyes/thighs
2nds
- must be within first 24 hours
- head to toe, gestational age assessment, anthropometric measurements, and reflex testing
Signs of prblem during initial newborn assessment
- generalized cyanosis (acrocyanosis is normal, when extremities bluish)
- don’t want to see flaccid body posture
- abnormal vitals
- nasal flaring
look up Apgar score
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what is lanugo?
fine downy hair grown inutero, usually gone when they’re born so if baby has lanugo then probably pre-term
how do we measure temp in the newborn?
- axillary, rectal can be tricky b/c lining is sensitive
what is HR of newborn
120-160
what’s the BP of newborn
50-75 systolic and 30-45 diastolic, usually not part of assessment and only performed when ordered
how and when do we measure pulse ox in the newborn
r hand and either foot, after 24 hours of life
know the new ballard score system: physical maturity
there’s ano`wther new ballard we don’t need to know just fyi
what is recoil
when you pull pinna and it snaps back, in pre-term baby there’s a lack of recoil (look up)
what is the role of the nurse during delivery?
1) maintain airway
2) ensure proper identification
3) admin prescribes meds (vitamin K, eye prophylaxis)
4) maintaining thermoregulation - dry off right away, wrap
5) newborn assessment
what does the eye prophylaxis do?
prevents opthalmia neonatorum which can cause neonatum blindness
how do you want to give the vitamin K shot to the baby?
STRAIGHT down into the vastus lateralis b/c no adipose tissue in newborn so at an angle will cause it to hit the bone
look up how to do a newborn asessment on slides
too much info
what is group B strep?
normal flora that some women have and some do not and can cause sepsis in the newborn
what’s the expected length for a full-term baby
19-21 inches
know differences between LGA AGA and SGA
LGA: weight >90%
AGA: 10% 90%
SGA: less than 10th percentile
if baby’s legs are spread in the air, what does that mean?
was a breached baby and legs were like that in utero
what is vernix caseosa
- formed by secretions of fetus’ oil glands, need not be removed entirely, thick white cheasy looking substance, usually seen more on premie baby
what are milia
unopened sebaceous glands, mostly on nose chin and forehead
what is erythema toxicum
known as newborn rash
70% of newborns develop it
- some speculate occurs in healthy newborns b/c it’s an immune response to being touched
what is nevus simplex
also known as stork bites or salmon patches, concentration of immature blood vessels
nevus flammeus
“port wine stain” most often on face, permanent lasers to lighten should be done in first year of life to have best results
nevus vasculosus
or strawberry hemangioma
- benign capillary hemangioma`
if you have a lot of cafe au lait or a really big one what oculd that be associated with
neuro disorder
does a cephalhematoma cross sutures?
no, a caput succedaneum does
what’s the rule of thirds
from outer canthus to inner canthus should be one third the width of face (?)
