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Pedia > Care of the Newborn (Physiologic Adaptations) > Flashcards

Care of the Newborn (Physiologic Adaptations) Flashcards

1
Q

time from birth through the first 28 days of life

A

Neonatal Period

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2
Q

critical period as it requires a complex transition in the different systems of the body in order to go through a successful shift of environment.

A

Neonatal Period

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3
Q

Immediate changes happen in the newborn’s anatomy and physiology after birth

A

Neonatal Period

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4
Q

Within minutes being exposed in the extrauterine life, respirations and circulatory adaptations need to be established along with other functions

A

Neonatal Period

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5
Q

____________________________ are vital needs of a fetus wherein such needs are fully dependent on the mother.

A

Oxygen, nutrition and waste removal

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6
Q

Immediately after birth, the newborn’s lungs must:

A
  1. inflate,
  2. absorb the remaining lung fluid ; and
  3. oxygen exchange must begin.
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7
Q

3 basic mechanisms in initiation of respirations:

A
  1. Development of the Lungs
  2. Causes of Respiration
  3. Continuation of Respirations
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8
Q

produced by the alveoli for maximum expansion and normal development of lungs

A

Fetal Lung Fluid

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9
Q

Fetal Lung Fluid produced by the alveoli for

A

maximum expansion and normal development of lungs

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10
Q

production of Fetal Lung Fluid ____________________ as fetus nears term and absorption begins during _____________________________________

A

decreases; early labor and at birth

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11
Q

during labor, Fetal Lung Fluid begins to move into the ___________________ for ___________________

A

interstitial spaces; absorption

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12
Q

slippery detergent-like combination of lipoproteins that lines the inside of the alveoli to reduce surface tension that allows it to remain partially open when infant begins to breath at birth

A

Surfactant

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13
Q

function of Surfactant

A

reduce surface tension that allows it to remain partially open when infant begins to breath at birth

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14
Q

chemical changes that takes place at birth

A

Internal Stimuli

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15
Q

includes the thermal, sensory and mechanical factors

A

External Stimuli

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16
Q

Internal causes of the initiation of respirations are the

A

chemical changes at birth

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17
Q

External causes of respirations include

A

thermal, sensory and mechanical factors

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18
Q

Low Surfactant =

A

ARDS (acute respiratory distress syndrome)

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19
Q

As alveoli expands,

A

surfactant allows them to remain partially open between respirations

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20
Q

FRC

A

functional residual capacity

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21
Q

_________________ of air from first breath becomes the functional residual capacity (FRC)

A

20-30 mL

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22
Q

Infants born by cesarean delivery: does not have the
same benefit of the ______________________ which may mean
that more fluid is in their lungs that must be absorbed
after birth, which makes respiratory adaptation more
challenging.

A

VAGINAL SQUEEZE

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23
Q

Nursing Responsibility for Infants born by cesarean delivery

A

Closely monitor the respirations of the newborn after cesarean delivery.

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24
Q

Maturity of the respiratory system can be determined prenatally by measuring the

A

ecithin/ sphingomyelin (L/S) ratio of amniotic fluid

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25
Q

Assessment: Check for the ____________________ of the newborn and note for ______________________

A

respiratory rate; signs of respiratory distress

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26
Q

Signs of Respiratory Distress in Newborns

A

● Tachypnea (sustained respiratory rate greater than 60 breaths per minute)
● Nasal flaring
● Grunting (noted by stethoscope or audible to the ear)
● Intercostal or xiphoid retractions
● Unequal movements of the chest and abdomen during breathing efforts
● Central cyanosis

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27
Q

sustained respiratory rate greater than 60 breaths per minute

A

Tachypnea

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28
Q

Deoxygenated blood that enters the heart after________________________________________________________; therefore, ________________________

A

birth must go to the lungs for gas exchange; the fetal shunts must close

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29
Q

Factors contributing to the closing of shunts:

A
  1. The lungs fill with air, causing the pressure to drop in the chest as soon as the newborn takes his first breath. This change results in a REVERSAL OF PRESSURES in the right and left atria, causing the FOREMAN OVALE TO CLOSE so that blood is redirected to the lungs.
  2. The OXYGEN content of blood circulating through the lungs INCREASES with the first few breaths. This chemical change contributes to the CLOSING OF THE DUCTUS ARTERIOSUS, which eventually becomes a ligament. The DUCTUS VENOSUS ALSO CLOSES, allowing nutrient-rich blood from the gut to circulate through the newborn’s liver
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30
Q

BLOOD VALUES

A
  1. 80 to 110 mL per kilogram of body weight, or about 300 mL total
  2. Newborn hemoglobin carries a greater proportion of oxygen than adult hemoglobin
  3. Hemoglobin level averages 17 to 18 g/100 mL of blood
  4. hematocrit is between 45% and 50% and has an equally high white blood cell count at birth, about 15,000 to 30,000 cells/mm3
  5. has an elevated red blood cell count, about 6 million cells per cubic millimeter
  6. indirect bilirubin level at birth is 1 to 4 mg/100 mL
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31
Q

BLOOD COAGULATION

A
  • Prolonged coagulation or prothrombin
    time
  • Vitamin K synthesis is necessary for the formation of:
    factor II (prothrombin)
    factor VII (proconvertin)
    factor IX (plasma thromboplastin
    component)
    factor X (Stuart-Prower factor)
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32
Q

Vitamin K synthesis is necessary for the formation of:

A

factor II (prothrombin)
factor VII (proconvertin)
factor IX (plasma thromboplastin
component)
factor X (Stuart-Prower factor)

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33
Q

maintenance of body temperature

A

Thermoregulation

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34
Q

process by which heat production is balanced with heat loss

A

Thermoregulation

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35
Q

Thermoregulation is developed poorly in the newborn because of two key factors:

A
  1. The newborn is prone to heat loss
  2. The newborn is not readily able to produce heat by muscle movement and shivering
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36
Q

Newborn Characteristics that Lead to Heat Loss

A
  1. Skin is thin & blood vessels are close to the surface
  2. Little subcutaneous fat
  3. Degree of flexion
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37
Q

Methods of Heat Loss

A

Conduction
Convection
Radiation
Evaporation

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38
Q

is loss of heat through conversion of a liquid to a vapor

A

Evaporation

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39
Q

to prevent Evaporation:

A

a. dry newborns as soon as possible, especially their face and hair.
b. Cover the hair with a cap after drying it further reduces the possibility of evaporation cooling.

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40
Q

is the transfer of body heat to a cooler solid object in contact with a baby

A

Conduction

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41
Q

to prevent Conduction: cover surfaces with a warmed blanket or towel helps to minimize conduction heat loss.

A

cover surfaces with a warmed blanket or towel helps to minimize conduction heat loss.

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42
Q

is the flow of heat from the newborn’s body surface to cooler surrounding air

A

Convection

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43
Q

To prevent Convection:

A

Eliminate drafts from windows or air conditioners reduces convection heat loss

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44
Q

is the transfer of body heat to a cooler solid object not in contact with the baby

A

Radiation

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45
Q

to prevent Radiation:

A

move infant as far from the cold surface as possible helps reduce this type of heat loss

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46
Q

It takes oxygen to produce heat. If the newborn is allowed to become cold stressed, he will eventually develop _____________________________

A

respiratory distress

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47
Q

Newborn’s Stomach Capacity

A

6 mL/kg at birth

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48
Q

stimulated when stomach fills causing peristalsis

A

Gastrocolic Reflex

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49
Q

caused by immature cardiac sphincter

A

Regurgitation

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50
Q

Gastrocolic Reflex is stimulated when _________________ causing _________________

A

stomach fills; peristalsis

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51
Q

Regurgitation is caused by ____________________________

A

immature cardiac sphincter

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52
Q

Limited ability to digest fat & starch-

A

pancreatic enzymes, lipase and amylase remains deficient for the first few months (4-6 months)

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53
Q

Bowel Sounds- may be heard beginning at __________________________________

A

15 minutes after birth

54
Q

Stools

A

Meconium
Transitional
Milk
Others

55
Q

1st stool excreted by NBs within 24-48 hours

A

Meconium

56
Q

Meconium is the1st stool excreted by NBs within _________________________

A

24-48 hours

57
Q

blackish green with sticky tar like consistency; odorless

A

Meconium

58
Q

characteristics of Meconium

A

blackish green with sticky tar like consistency; odorless

59
Q

combination of meconium and milk stool

A

Transitional

60
Q

characteristics of Transitional

A

greenish brown with looser consistency compared to meconium ((2nd-3rd day of life))

61
Q

seedy, color & consistency of mustard with sweetsour smell

A

breast milk stool

62
Q

pale yellow to light brown; more firm and has the characteristic odor of feces

A

formula milk stool

63
Q

MILK STOOL

A
  • breast milk
  • formulated milk
64
Q

characteristics of breast milk stool

A

seedy, color & consistency of mustard with sweetsour smell

65
Q

characteristics of formulated milk stool

A

pale yellow to light brown; more firm and has the characteristic odor of feces

66
Q

Other Stools

A

❖ bright green stool
❖ gray colored stool
❖ stool with mucus or loose/watery stool

67
Q

Blood glucose: 1st day- ________________ then _________________ thereafter

A

40-60 mg/dL; 50-90 mg/dL

68
Q

Blood glucose
Increased risk for hypoglycemia:

A

Preterm, SGA, Post Term

69
Q

is defined as a blood glucose level of less than 40 mg/dL.

A

Neonatal hypoglycemia

70
Q

Neonatal hypoglycemia is defined as a blood glucose level of _____________________________

A

less than 40 mg/dL

71
Q

Neonatal hypoglycemia possibly happens if __________________________________________________________________________________________

A

newborn is excessively stressed during labor or during the transition period immediately after birth

72
Q

are two stressors that often lead to Neonatal hypoglycemia

A

Respiratory distress and cold stress

73
Q

Early signs of Neonatal hypoglycemia:

A

jitteriness, poor feeding, listlessness, irritability, low temperature, weak or high-pitched cry, and hypotonia

74
Q

late signs of Neonatal hypoglycemia:

A

Respiratory distress, apnea, seizures, and coma

75
Q

LIVER
Functions:
-
-________________________________________________________________________________________ then bilirubin is excreted in the feces
❖ ___________________________________________ that gradually die as newborn adapts to extrauterine life

A

a. to conjugate bilirubin
❖ makes it water soluble
; breaks down “extra” RBCs from intrauterine life

76
Q

Factors in Increased Bilirubin

A
  • Excess Production
  • RBC lifespan
  • Albumin
  • Liver immaturity
  • Blood incompatibility
  • Gestation
  • Intestinal Factors
  • Delayed feeding
  • Trauma
  • Fatty Acids
77
Q

Jaundice in newborns, How does it happen

A

❖ immature liver is easily overwhelmed by the large volume of red blood cells
❖ since unconjugated bilirubin is fat soluble, it builds up in the bloodstream, crosses into the cells and stains them yellow
❖ large amount of unconjugated bilirubin is present (serum levels of 4 to 6 mg/dL and greater), a yellow staining of the skin occurs, hence, jaundice
❖ first seen on the head and face; as bilirubin levels rise, it progresses to the trunk and then to the extremities in a cephalocaudal manner.

78
Q

Average Newborn voids

A

within 12-24 hours after birth

79
Q

If failed to void within the time, newborn should be evaluated for the possibilities of

A

urinary stenosis or absent kidney or ureters

80
Q

Newborn Urine Output
1st 1-2 days:

A

30 – 60 mL per day

81
Q

Newborn Urine Output
By 1 week:

A

300 mL/ day

82
Q

Newborn Urine Output is monitered through

A

weighing of diaper

83
Q

What is the Characteristic of a Newborn’s Immune System

A

❖ Immature immune system- susceptible to pathogens not usually affecting older children
❖ difficulty forming antibodies until about 2 months ( that is why most immunizations are given not until 2 months of age)

84
Q

are glycoprotein molecules produced by plasma cells (white blood cells) that act as a critical part of the immune response by specifically recognizing and binding to particular antigens, such as bacteria or viruses, and aiding in their destruction.

A

Immunoglobulins

85
Q

provides immunity to bacteria & viruses

A

Ig G

86
Q

first Ig produced when newborn is challenged

A

Ig M

87
Q

protects NB against gram (-) bacteria

A

Ig M

88
Q

if found in cord blood- signifies exposure to infection in utero

A

Ig M

89
Q

protection against gastrointestinal & respiratory systems infection

A

Ig A

90
Q

present in colostrum & breast milk

A

Ig A

91
Q

Respiratory System of a Fetus

A

fluid-filled, high-pressure system causes blood to be shunted from the lungs through the ductus arteriosus to the rest of body

92
Q

Respiratory System of a Newborn

A

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)

93
Q

site of gas exchange for fetus 


A

placenta

94
Q

site of gas exchange for newborn


A

lungs

95
Q

Circulation through the heart of a Fetus

A

Pressures in the right atrium greater than in the left; encourages blood flow through the foramen ovale

96
Q

Circulation through the heart of a Newborn

A

Pressures in the left atrium greater than in the right; causes the foramen ovale to close

97
Q

Hepatic portal circulation of a Fetus

A

Ductus venous bypasses; maternal liver performs filtering function

98
Q

Respiratory System of a Fetus
___________________, _________________ system causes blood to be shunted from the ___________ through the __________________ to the ___________________

A

fluid-filled; high-pressure; lungs; ductus arteriosus; rest of body

99
Q

Respiratory System of a Newborn
___________________________ system encourages blood flow through the _________ for _______________; increased oxygen content of blood in the lungs contributes to the _____________ of the __________________ (becomes a _____________________)

A

Air-filled, low-pressure; lungs; gas exchange; closing; ductus arteriosus; ligament

100
Q

Internal Stimuli

A
  1. PO2 decreases, PCO2 increases, pH decreases, affect chemoreceptors
  2. Message is transmitted to respiratory center in the medulla
  3. Diaphragm is stimulated to contract
  4. Infant draws first breath
101
Q

External Stimuli

A
  1. Cold air and touch stimulate skin sensors
  2. Impulses from skin sensors and responses to sound and light affect respiratory center
  3. Infant draws first breath
  4. Chest compression and release during birth cause air to be drawn into lungs
102
Q

Factors contributing to the closing of shunts:

A
  1. reversal of pressures in the right and left atria causes the foramen ovale to close
  2. increased oxygen closes the ductus arteriosus, ductus venosus also closes
103
Q

BLOOD VALUES
_______________________________ of body weight, or about _______________ total

A

80 to 110 mL per kilogram; 300 mL

104
Q

Blood Values
Hemoglobin level averages _____________________ of blood

A

17 to 18g/100 mL

105
Q

BLOOD VALUES
hematocrit is ________________________ and has an equally high white blood cell count at birth, about _______________________________

A

between 45% and 50%; 15,000 to 30,000 cells/mm3

106
Q

BLOOD VALUES
has an elevated red blood cell count, about _________________________________

A

6 million cells per cubic millimeter

107
Q

indirect bilirubin level at birth is ______________________

A

1 to 4mg/100 mL

108
Q

heat is lost to a cold surface. such as a cold scale or circumcision board, touching the newborn’s skin.

A

Conduction

109
Q

heat is lost to air currents that flow over the newborn (e.g., from a fan, air conditioner, or movement around the crib)

A

Convection

110
Q

heat moves away from the newborn’s body toward a colder object that is close by, such as a cold window or the sides of the crib.

A

Radiation

111
Q

heat is lost along with the moisture that evaporates from the newborn’s wet skin, if he is not dried immediately after birth or if damp clothes or blankets are left next to his skin.

A

Evaporation

112
Q

Onset of Physiological Jaundice

A

After 36hr ( 2nd - 3rd day)

113
Q

Rate of Bilirubin Rise of Physiological Jaundice

A

< 5 mg/dl per 24hr

114
Q

Peak Bilirubin Concentration of Physiological Jaundice

A
  • Up to 12mg/di in FT NB
  • Up to 14mg/dl in preterm
115
Q

Duration of Persistence of Physiological Jaundice

A
  • 8 days in FT NB
  • 14 days in preterm NB
116
Q

Serum CB Level of Physiological Jaundice

A

< 2 mg/di at any time

117
Q

Clinically NB of of Physiological Jaundice

A

Looks normal not anemic not sick normal urine & stool color

118
Q

Onset of Pathological Jaundice

A

At any time, even 1” hr

119
Q

Rate of Bilirubin Rise of Pathological Jaundice

A

< 5 mg/dl per 24hr or 0.5 mg/dl/hr

120
Q

Peak Bilirubin Concentration of of Pathological Jaundice

A

> 12 mg/di in FT NB
14 mg/dl in preterm NB

121
Q

Duration of Persistence of Pathological Jaundice

A

> 1 wk in FT NB
14 days in preterm NB

122
Q

Serum CB Level of Pathological Jaundice

A

> 2 mg/di at any time

123
Q

Clinically NB of of Pathological Jaundice

A

Looks abnormal, anemic sick & abnormal color of urine & stool

124
Q

normale hemoglobin level of Male Adult

A

14-18 g/dL

125
Q

normale hemoglobin level of Female Adult

A

12-15/16 g/dL

126
Q

normal WBC count in adults

A

4000-11000 cells/mm3

127
Q

normal RBC count in adults

A

4.5-5.5 ml/mm3

128
Q

normal adult indirect bilirubin

A

0.2-0.8 mg/dL

129
Q

normal adult blood glucose

A

70-120 mg/dL

130
Q

nomral PO2

A

80-100 mmHg

131
Q

normal PCO2

A

35-45 mmHg

132
Q

normal blood pH

A

7.35-7.45

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