Care of the Newborn (Physiologic Adaptations) Flashcards
time from birth through the first 28 days of life
Neonatal Period
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.
Neonatal Period
Immediate changes happen in the newborn’s anatomy and physiology after birth
Neonatal Period
Within minutes being exposed in the extrauterine life, respirations and circulatory adaptations need to be established along with other functions
Neonatal Period
____________________________ are vital needs of a fetus wherein such needs are fully dependent on the mother.
Oxygen, nutrition and waste removal
Immediately after birth, the newborn’s lungs must:
- inflate,
- absorb the remaining lung fluid ; and
- oxygen exchange must begin.
3 basic mechanisms in initiation of respirations:
- Development of the Lungs
- Causes of Respiration
- Continuation of Respirations
produced by the alveoli for maximum expansion and normal development of lungs
Fetal Lung Fluid
Fetal Lung Fluid produced by the alveoli for
maximum expansion and normal development of lungs
production of Fetal Lung Fluid ____________________ as fetus nears term and absorption begins during _____________________________________
decreases; early labor and at birth
during labor, Fetal Lung Fluid begins to move into the ___________________ for ___________________
interstitial spaces; absorption
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
Surfactant
function of Surfactant
reduce surface tension that allows it to remain partially open when infant begins to breath at birth
chemical changes that takes place at birth
Internal Stimuli
includes the thermal, sensory and mechanical factors
External Stimuli
Internal causes of the initiation of respirations are the
chemical changes at birth
External causes of respirations include
thermal, sensory and mechanical factors
Low Surfactant =
ARDS (acute respiratory distress syndrome)
As alveoli expands,
surfactant allows them to remain partially open between respirations
FRC
functional residual capacity
_________________ of air from first breath becomes the functional residual capacity (FRC)
20-30 mL
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.
VAGINAL SQUEEZE
Nursing Responsibility for Infants born by cesarean delivery
Closely monitor the respirations of the newborn after cesarean delivery.
Maturity of the respiratory system can be determined prenatally by measuring the
ecithin/ sphingomyelin (L/S) ratio of amniotic fluid
Assessment: Check for the ____________________ of the newborn and note for ______________________
respiratory rate; signs of respiratory distress
Signs of Respiratory Distress in Newborns
● 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
sustained respiratory rate greater than 60 breaths per minute
Tachypnea
Deoxygenated blood that enters the heart after________________________________________________________; therefore, ________________________
birth must go to the lungs for gas exchange; the fetal shunts must close
Factors contributing to the closing of shunts:
- 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.
- 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
BLOOD VALUES
- 80 to 110 mL per kilogram of body weight, or about 300 mL total
- Newborn hemoglobin carries a greater proportion of oxygen than adult hemoglobin
- Hemoglobin level averages 17 to 18 g/100 mL of blood
- 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
- has an elevated red blood cell count, about 6 million cells per cubic millimeter
- indirect bilirubin level at birth is 1 to 4 mg/100 mL
BLOOD COAGULATION
- 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)
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)
maintenance of body temperature
Thermoregulation
process by which heat production is balanced with heat loss
Thermoregulation
Thermoregulation is developed poorly in the newborn because of two key factors:
- The newborn is prone to heat loss
- The newborn is not readily able to produce heat by muscle movement and shivering
Newborn Characteristics that Lead to Heat Loss
- Skin is thin & blood vessels are close to the surface
- Little subcutaneous fat
- Degree of flexion
Methods of Heat Loss
Conduction
Convection
Radiation
Evaporation
is loss of heat through conversion of a liquid to a vapor
Evaporation
to prevent Evaporation:
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.
is the transfer of body heat to a cooler solid object in contact with a baby
Conduction
to prevent Conduction: cover surfaces with a warmed blanket or towel helps to minimize conduction heat loss.
cover surfaces with a warmed blanket or towel helps to minimize conduction heat loss.
is the flow of heat from the newborn’s body surface to cooler surrounding air
Convection
To prevent Convection:
Eliminate drafts from windows or air conditioners reduces convection heat loss
is the transfer of body heat to a cooler solid object not in contact with the baby
Radiation
to prevent Radiation:
move infant as far from the cold surface as possible helps reduce this type of heat loss
It takes oxygen to produce heat. If the newborn is allowed to become cold stressed, he will eventually develop _____________________________
respiratory distress
Newborn’s Stomach Capacity
6 mL/kg at birth
stimulated when stomach fills causing peristalsis
Gastrocolic Reflex
caused by immature cardiac sphincter
Regurgitation
Gastrocolic Reflex is stimulated when _________________ causing _________________
stomach fills; peristalsis
Regurgitation is caused by ____________________________
immature cardiac sphincter
Limited ability to digest fat & starch-
pancreatic enzymes, lipase and amylase remains deficient for the first few months (4-6 months)
Bowel Sounds- may be heard beginning at __________________________________
15 minutes after birth
Stools
Meconium
Transitional
Milk
Others
1st stool excreted by NBs within 24-48 hours
Meconium
Meconium is the1st stool excreted by NBs within _________________________
24-48 hours
blackish green with sticky tar like consistency; odorless
Meconium
characteristics of Meconium
blackish green with sticky tar like consistency; odorless
combination of meconium and milk stool
Transitional
characteristics of Transitional
greenish brown with looser consistency compared to meconium ((2nd-3rd day of life))
seedy, color & consistency of mustard with sweetsour smell
breast milk stool
pale yellow to light brown; more firm and has the characteristic odor of feces
formula milk stool
MILK STOOL
- breast milk
- formulated milk
characteristics of breast milk stool
seedy, color & consistency of mustard with sweetsour smell
characteristics of formulated milk stool
pale yellow to light brown; more firm and has the characteristic odor of feces
Other Stools
❖ bright green stool
❖ gray colored stool
❖ stool with mucus or loose/watery stool
Blood glucose: 1st day- ________________ then _________________ thereafter
40-60 mg/dL; 50-90 mg/dL
Blood glucose
Increased risk for hypoglycemia:
Preterm, SGA, Post Term
is defined as a blood glucose level of less than 40 mg/dL.
Neonatal hypoglycemia
Neonatal hypoglycemia is defined as a blood glucose level of _____________________________
less than 40 mg/dL
Neonatal hypoglycemia possibly happens if __________________________________________________________________________________________
newborn is excessively stressed during labor or during the transition period immediately after birth
are two stressors that often lead to Neonatal hypoglycemia
Respiratory distress and cold stress
Early signs of Neonatal hypoglycemia:
jitteriness, poor feeding, listlessness, irritability, low temperature, weak or high-pitched cry, and hypotonia
late signs of Neonatal hypoglycemia:
Respiratory distress, apnea, seizures, and coma
LIVER
Functions:
-
-________________________________________________________________________________________ then bilirubin is excreted in the feces
❖ ___________________________________________ that gradually die as newborn adapts to extrauterine life
a. to conjugate bilirubin
❖ makes it water soluble
; breaks down “extra” RBCs from intrauterine life
Factors in Increased Bilirubin
- Excess Production
- RBC lifespan
- Albumin
- Liver immaturity
- Blood incompatibility
- Gestation
- Intestinal Factors
- Delayed feeding
- Trauma
- Fatty Acids
Jaundice in newborns, How does it happen
❖ 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.
Average Newborn voids
within 12-24 hours after birth
If failed to void within the time, newborn should be evaluated for the possibilities of
urinary stenosis or absent kidney or ureters
Newborn Urine Output
1st 1-2 days:
30 – 60 mL per day
Newborn Urine Output
By 1 week:
300 mL/ day
Newborn Urine Output is monitered through
weighing of diaper
What is the Characteristic of a Newborn’s Immune System
❖ 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)
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.
Immunoglobulins
provides immunity to bacteria & viruses
Ig G
first Ig produced when newborn is challenged
Ig M
protects NB against gram (-) bacteria
Ig M
if found in cord blood- signifies exposure to infection in utero
Ig M
protection against gastrointestinal & respiratory systems infection
Ig A
present in colostrum & breast milk
Ig A
Respiratory System of a Fetus
fluid-filled, high-pressure system causes blood to be shunted from the lungs through the ductus arteriosus to the rest of body
Respiratory System of a 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)
site of gas exchange for fetus
placenta
site of gas exchange for newborn
lungs
Circulation through the heart of a Fetus
Pressures in the right atrium greater than in the left; encourages blood flow through the foramen ovale
Circulation through the heart of a Newborn
Pressures in the left atrium greater than in the right; causes the foramen ovale to close
Hepatic portal circulation of a Fetus
Ductus venous bypasses; maternal liver performs filtering function
Respiratory System of a Fetus
___________________, _________________ system causes blood to be shunted from the ___________ through the __________________ to the ___________________
fluid-filled; high-pressure; lungs; ductus arteriosus; rest of body
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 _____________________)
Air-filled, low-pressure; lungs; gas exchange; closing; ductus arteriosus; ligament
Internal Stimuli
- PO2 decreases, PCO2 increases, pH decreases, affect chemoreceptors
- Message is transmitted to respiratory center in the medulla
- Diaphragm is stimulated to contract
- Infant draws first breath
External Stimuli
- Cold air and touch stimulate skin sensors
- Impulses from skin sensors and responses to sound and light affect respiratory center
- Infant draws first breath
- Chest compression and release during birth cause air to be drawn into lungs
Factors contributing to the closing of shunts:
- reversal of pressures in the right and left atria causes the foramen ovale to close
- increased oxygen closes the ductus arteriosus, ductus venosus also closes
BLOOD VALUES
_______________________________ of body weight, or about _______________ total
80 to 110 mL per kilogram; 300 mL
Blood Values
Hemoglobin level averages _____________________ of blood
17 to 18g/100 mL
BLOOD VALUES
hematocrit is ________________________ and has an equally high white blood cell count at birth, about _______________________________
between 45% and 50%; 15,000 to 30,000 cells/mm3
BLOOD VALUES
has an elevated red blood cell count, about _________________________________
6 million cells per cubic millimeter
indirect bilirubin level at birth is ______________________
1 to 4mg/100 mL
heat is lost to a cold surface. such as a cold scale or circumcision board, touching the newborn’s skin.
Conduction
heat is lost to air currents that flow over the newborn (e.g., from a fan, air conditioner, or movement around the crib)
Convection
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.
Radiation
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.
Evaporation
Onset of Physiological Jaundice
After 36hr ( 2nd - 3rd day)
Rate of Bilirubin Rise of Physiological Jaundice
< 5 mg/dl per 24hr
Peak Bilirubin Concentration of Physiological Jaundice
- Up to 12mg/di in FT NB
- Up to 14mg/dl in preterm
Duration of Persistence of Physiological Jaundice
- 8 days in FT NB
- 14 days in preterm NB
Serum CB Level of Physiological Jaundice
< 2 mg/di at any time
Clinically NB of of Physiological Jaundice
Looks normal not anemic not sick normal urine & stool color
Onset of Pathological Jaundice
At any time, even 1” hr
Rate of Bilirubin Rise of Pathological Jaundice
< 5 mg/dl per 24hr or 0.5 mg/dl/hr
Peak Bilirubin Concentration of of Pathological Jaundice
> 12 mg/di in FT NB
14 mg/dl in preterm NB
Duration of Persistence of Pathological Jaundice
> 1 wk in FT NB
14 days in preterm NB
Serum CB Level of Pathological Jaundice
> 2 mg/di at any time
Clinically NB of of Pathological Jaundice
Looks abnormal, anemic sick & abnormal color of urine & stool
normale hemoglobin level of Male Adult
14-18 g/dL
normale hemoglobin level of Female Adult
12-15/16 g/dL
normal WBC count in adults
4000-11000 cells/mm3
normal RBC count in adults
4.5-5.5 ml/mm3
normal adult indirect bilirubin
0.2-0.8 mg/dL
normal adult blood glucose
70-120 mg/dL
nomral PO2
80-100 mmHg
normal PCO2
35-45 mmHg
normal blood pH
7.35-7.45
