CARE OF THE NEONATE Flashcards
TRANSITION
- newborns undergo profound physiologic changes at the moment of birth
- within minutes after birth, a newborn has to initiate respirations and adapt a circulatory system to extrauterine oxygenation
- within 24 hrs, neurologic, renal, endocrine, and gastrointestinal functions must be operating completely for life to be sustained
- oxygen levels are lower in utero
INTRAUTERINE LIFE
- fetal breathing starts at 11 weeks, characterized by minimal circulation to the pulmonary bed. oxygenation occurs via the placenta. no gas exchange in fetal lungs
- fetal lungs are fluid filled. There is some reduction in this prior to birth. There is still 100ml remaining in the respiratory passages at delivery
INTRAUTERINE LIFE CONTINUED
surfactant promotes lung maturity by overcoming surface tension inside and outside the alveolar sacs in the fetus. surfactant peaks at 35 weeks and remains high. keeps sacs open .
- blood is shunted away from the pulmonary circulation to the systemic circulation via the formen ovale and ductus arteriosus
ADAPTATIONS TO EXTRAUTERINE LIFE
- extra uterine circulation begins with the first breath
- respiratory gas exchange in conjunction with marked circulatory changes must occur immediately for the baby to begin life as a separate being.
- 2 changes are needed to maintain life
1. lungs must expand to allow for pulmonary ventilation
2. marked increase in pulmonary circulation
INITIATION OF RESPIRATIONS
-happens within 1st min of life
PHYSICAL/ Mechanical Changes :
- thoracic sqeeze decreases fluid further. chest wall recoil - small amount of air in , more fluid out
Chemoreceptor response to :
-low PO2 and PH and high CO2 (normal in utero)
Temperature:
- cold air= increased respiratory effort
Sensory stimuli:
tactile, auditory and visual that stimulate respiratory effort
CARDIOVASCULAR SYSTEM
Three anatomic shunts normally close after delivery in response to pressure gradient shifts following the first few breaths
- foramen ovale
- ductus arteriosus
- ductus venosus
CARDIOVASCULAR SYSTEM ANATOMY
HEART RATE= 110-160
BLOOD PRESSURE= average is 50-55 mmHg ( 70/40)
SOUNDS=
- murmurs are frequently heard
- 90% are transient and not associated with CHD
- due to closing ductus arteriosus and / or foramen ovale
- cardiology work up needed if there are other symptoms of distress or murmur persists
3 CORD VESSEL
2 arteries, 1 vein - abnormal can be associated with other congenital defects
SIGNS OF DISTRESS
tachycardia, bradycardia, low BP, decreased perfusion CRT> 2-3 sec, low BP in LE
WHAT HAPPENS TO PULMONARY BLOD FLOW WITH FIRST FEW BREATHS ?
- lung fluid has been removed. pulmonary vascular resistance decreases and pulmonary blood flow increases
- sometimes this doesn’t happen right away and the baby developes transitory tachypnea of the newborn(TTN)
- treatment for TTN is support until the lungs clear: O2, hold PO feeds and IV fluids with expected recovery in 24- 72 hrs
RESPIRATORY SYSTEM
- initial respiratory are shallow, irregular in depth and rhythm
- respiratory rate usually 60-70 bpm
- breathing is abdominal( expected)
- breathing is periodic (expected)
- obligatory nose breathers
- acroncyanosis is normal for several hours. central cyanosis is abnormal after birth and resusucitaion
ABNORMAL RESPIRATORY FINDINGS
- abnormal findings include retractions, nasal flaring , cyanosis, expiratory grunting
TRANSITION PERIOD/IMMEDIATE CARE
- drying
- warming
- stimulation
- positioning ( head support)
- clear airway (suction )
NECESSARY FOR ALL NEWBORNS !
IMMEDIATELY AFTER DELIVERY
look at general appearance= color,and cry , ease of breathing
-first exam begins as nurse is drying stimulating and wrapping infant or when infant is placed on mother’s abdomen after being born. this is known as skin to skin and promotes bonding and breastfeeding
HEAT LOSS ( INCREASE BSA FACILITATES HEAT LOSS)
- Convection- losses from circulating air
- Radiation- body heat transferring to nearby objects
- Evaporation- heat loss when moisture on baby
- Conduction- body heat lost when baby in direct contact with cold object
IMMEDIATE CARE
- wear gloves
- maintain airway
- suction, O2 prn
- RR= 30-70’s
- APAGAR scoring - neutral thermal environment
- warmer, maintain temp of 36.5-37.2C , dry - Safety ID bands
THERMOREGULATION
- increase in muscular activity- shown by crying and restlessness= increased BMR= heat loss
- non-shivering thermogenesis- unique to newborns. uses the infants stores of brown fat.
- brown fat is found in the midscapular area, around the neck, in the axillas, and around the trachea, kidneys, and adrenal glands (premies don’t have this)
COLD STRESS HYPOTHERMIA
increase O2 consumption (to keep warm ) =increased RR = pulmonary vasoconstriction and peripheral vasoconstriction= decreased O2 to tissues causes
- anaerobic glycolysis
- decreased O2, increased CO2= low PH = metabolic acidosis
CORD CLAMPING
- keep at level of uterus
- 45 second delay in clamping has benefits
- place clamp 1 inch from abdomen
- assess for 2 arteries/ 1 vein
- remove plastic clamp in about 24hrs and offer save it for patients
APGAR SCORING SYTEM
7-10 good condition
4-6 moderately depressed
0-3 severely depressed
5 things assessed
HR,RR, muscle tone, reflex irritability, color
taken at 1 and 5 minutes
NORMAL RANGES FOR VITAL SIGNS
axillary temp- 36.5-37.2 respirations - 30-60 apical pulse- 120-160 BP(not generally done )- 80-60/45-40 weight - 2500-4000 grams length - 46-56cm head circ. - 32-37 cm
IMMEDIATE CARE FOR BABY
- Vitamin K injection
- check cord clamp
- footprints and ID bands
- Security tag