Adaptation of the Newborn (PowerPoint) Flashcards
the neonatal period
begins at birth and ends at 28 days
at birth, factors that act as triggers responsible fro newborns taking their first breath
Chemical
Mechanical
Thermal
Sensory
during the neonatal period, the neonate must
adapt, coordinate, and integrate changes
physical changes the neonate must adapt, coordinate, and integrate
- Establish respirations
- Changing circulation route
- Regulate temperature
- Ingest, retain, and digest food
- Getting rid of waste
- Regulare weight
behavioral changes the neonate must adapt, coordinate, and integrate
- Regulate arousal and sleep
- Process, store, and organize multiple stimuli
- Establish relationships with caregivers and environment
environmental differences between intrauterine and extrauterine
Intrauterine:
- Quiet
- Warm
- Dark
- Comfortable
- Cozy/cramped
- Safe
- Familiar
Extrauterine:
- Loud
- Cold
- Bright
- Painful
- Unswaddled
- Vulnerable
- Unfamiliar
first period of reactivity
up to 30 minutes past birth
- HR increased at first but gradually falls back between 100-120 (may be tachy for 1st 30min)
- RR high at 60-80 (norm 40-60) and may hear fine crackles
- Audible grunting, nasal flaring, and chest retraction can be present but should be clear within 1hr
- This is the time to initiate breastfeeding and bonding
after the first period of reactivity, the baby
either sleeps or has a marked decreased in activity
- after 1st 30min, there is a period of decreased responsiveness where the baby will sleep and wake occasionally
(this lasts about 1-1.5 hours)
second period of reactivity
2-8hrs after birth (lasts 10min to several hours)
may have brief periods of
- tachycardia
- tachypnea
- increased muscle tone (really jumpy)
- increased mucus production (watch for gag and choking - may have to suction)
most critical after birth
- RESPIRATION
- Circulation
- Thermoregulation
- GI
(ABCs)
most critical adaptation after birth
Respirations
- 30-60 breaths/min
- shallow, irregular breaths
- short periods of apnea <15sec
- assessed over a full 60sec
- symmetrical chest movements
suction after birth
prevents infant from inhaling fluid when the nares are touched
(mouth then nose)
newborns prefer to breathe out
nose
established as the crucial site of gas exchange
the lungs
establishment of the lungs as the crucial site of gas exchange causes
- rise in blood pressure
- increase in circulation into the lungs for perfusion
establishing gas exchange in the lungs is facilitated by
several mechanisms occurring during birth, such as clamping the cord
stimulating respirations at birth
The most critical adjustment a newborn makes
The first breath of air initiates a sequence of cardiopulmonary changes
- Converting from fetal to neonatal circulation (clamp the cord)
- Emptying the lungs of fluid
- Retention of fluid interferes with ability to maintain adequate oxygenation (c/s delivery)
Establishing pulmonary function
- Diaphragm descends creating negative intrathoracic pressure
- Alveoli are lined with surfactant, which lowers surface tension, so alveoli stay open with less pressure (not every breath is a first breath)
- Chest and abdomen rise simultaneously with inspiration of air (seesaw respirations are not normal)
- When suctioning always suction mouth before nose (M before N)
at birth, transitions from intrauterine to extrauterine are essential and continue during the first
6-8 hours
transitions at birth are a predictable series of events, mediated by the
sympathetic nervous system
involving the heart rate, respiration, temperature, and GI function
transitions represent a time of
vulnerability requiring careful observation and timely intervention by the nurse
chemical respiratory transition/adaptation/integration
progressive - decrease in PO2 - increase PCO2 - decreased blood pH (respiratory center in medulla)
mechanical respiratory transition/adaptation/integration
compression increase intrathoracic pressure -> release of chest compression -> negative pressure -> drawing air in lungs
thermal respiratory transition/adaptation/integration
decreased environmental temp -> skin receptors -> respiratory center in medulla
sensory respiratory transition/adaptation/integration
handling, mouth and nose suctioning, and drying