Ch. 22 Physiologic and behavioral adaptations of newborns Flashcards
How long does the 1st period of reactivity last
30min after birth
Describe the newborns heart, respirations, bowel sounds during the 1st period of reactivity
HR= 160-180 then falls to 100-120 after 30min
RR= irregular 60-80b/m grunting nasal flaring, infant is alert
Bowel sounds audible
How long odes the period of decreased responsiveness last
60-100min
During the decreased responsiveness period the infant is
sleep or has decrease activity
How long does the 2nd period of reactivity last
2-8hr after birth and last 10min to several hours
Describe the HR and RR during the 2nd period of reactivity
tachycardia and tachypnea may occur.
How does clamping the cord aid in initiating breathing
it causes a rise in BP, which increases circulation and lung perfusion
What are the chemical factors that aid in the initiating breathing
activation of chemoreceptors (decrease levels of O2 and increase levels of CO2) stimulate the respiratory center in the medulla
Describe the mechanical factors that initiate breathing
intrathoracic pressure resulting from compression of the chest during vaginal birth helps draw air into the lungs
Describe how crying aids in breathing
it increases the distribution of aid in the lungs and promotes expansion of the alveoli. positive pressure created by crying helps keep the alveoli open
What are the thermal factors associated with breathing
newborn enters extrauterine environment where temp is lower which stimulates the receptors in the skin, resulting in stimulation of the respiratory center in medulla
What is the importance of surfactant
lowers surface tension, reducing the pressure required to keep the alveoli open
What happens with absent or decreased surfactant
more pressure must be generated for inspiration, which can soon tire the infant
What is the average RR for newborn
30-60b/min w/periods of pauses less than 20sec
T/F Apneic periods longer than 20sec indicates a path problem
True
T/F Newborns are by preference nose breathers
True; therefore cyanosis or asphyxia can occur w nasal blockage
T/F RR less than 30sec or greater than 60 should be evaluated
true
Define acrocyanosis
bluish discoloration of hands and feet
Define central cyanosis
abnormal and signifies hypoemia. lips and mucus membranes are bluish
When does the ductus arteries close
for term infant; w/in the 1st hr after birth. permanent closure at 3-4wk
What is the HR range for newborn
120-160b/min
What is the HR range for newborn asleep
85-100b/min
What is the range for BP for infant
Systolic; 60-80
Dyastolic; 40-50
What are the pros of delayed cord clamping
(greater 2min) improves hematocrit and iron status and decreasing anemia
What is the RBC range in a newborn
4.6-5.2mill
What is the hemoglobin level of a newborn
13.7-20.1 at birth, decreasing gradually to 12-20 during 1st 20wk
What are the hematocrit levels for infant
51-56% by wk 8 @ 39-59%
What is polycythemia
central venous hematocrit greater than 65%; can occur in infants from delayed cord clamping, maternal hypertension or diabetes, IUGR
What is the normal WBC count
9000=30,000
T/F Serious infection is not tolerated well by the newborns because leukocytes are slow to recognize protein
True
What is the platelet count range
150,000-300,000
Define thermoregulation
maintenance of balance b/w heat loss and heat production
What is the physiologic characteristics of neonates that put them at a higher risk for heat loss
have thin layer of subcutaneous fat, blood vessels are close to the surface of the skin
What are the 4 modes of heat loss in the neonate
convection (body-air)
radiation (draft)
evaporation ( damp skin)
conduction (warm crib)
In reguards to heat loss skin to skin contact
reduces conductive and radiant heat loss and enhances newborn temp control
T/F in an effort to conserve heat, newborns assume a position of flexion that helps guard against loss because it diminishes the amount of body surface exposed to the environment
True
What happens to the brown fat with cold stress
it is rapidly depleted
What are the effects of cold stress
RR increase w/need for oxygen, oxygen and energy are diverted from brain and cardiac function, growth to thermogenesis for survival, pulmonary vasoconstriction; decreases oxygen uptake by lungs and decreases oxygen to tissues leading to aerobic glycolosis metabolic acidosis
T/F 6-8 voidings per day of pale, straw colored urine indicate adequate fluid intake
true
What causes the weight loss experienced by most newborns during the 1st few days
extracellular loss
At birth the term infant has an iron stores to last
4-6wk
Where should breastfeed infants receive iron supplementation
4months
What is jaundice
visibly yellowish color of skin and sclera caused by serum levels of unconjugated bilirubin
Which organ is responsible for the conjugation of bilirubin
liver
T/F unconjugated bilirubin is insoluble
true
Jaundice is likely to appear when bilirubin levels exceed
5-6
______ jaundice appears after 24hrs usually w/o treatment
Physiologic
______ Jaundice appears after within 24hrs of birth
Patho
Describe what breastfeeding associated jaundice is
lack of effective breastfeeding contributes to the hyperbilirubinemia (dehydration = less stress to eliminate it)
Why do newborns receive vitamin K
to protect clotting problems; they lack intestinal bacteria needed to make their own
Define Caputo Succedaneum
edematous area of the scalp, most commonly found on the occiput; extends across sutures and usually disappears within 3-4days
What is a cephalhematoma
Collection of blood between a skull bone and its periosteum (does not cross the suture line). Resolves in 3-6wks
Define subgaleal hemorrhage
Bleeding into the subgleal compartment; commonly associated with vacuum extraction
What are the early signs of subgaleal hemorrhage
Boggy scalp, pallor, tachycardia, increasing head circumference
What are the two test used to assess for hip displacement
Barlow and Ortolani
What is the Babinski relfex
Beginning at the heal stroke upwards along lateral aspect of sole the move finger across ball of foot. All toes hyperextend with dorsiflexion of big toe
What is the average time the newborn sleeps in a day
17hrs
