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OB > ch 23 newborn adaptations > Flashcards

ch 23 newborn adaptations Flashcards

1
Q

baby’s first 28 days of life

A

neonatal period

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2
Q

baby’s first year of life

A

infancy

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3
Q

biological tasks during neonatal period (6)

A

-establish and maintain respirations
-adjust to circulatory changes (close shunts)
-*regulate temp
-ingest, retain and digest nutrients
-eliminate waste
-regulate weight

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4
Q

phases of instability during first 6-8 hours after birth; from intra-uterine to extra-uterine life

A

transition

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5
Q

what happens in first period of reactivity in transition (up to 30 min after birth)

A

-tachycardia
-tachypnea, irregular
-possible resp crackles
-possible brief periods apnea
-alert, eyes open
-decreased body temp
-increased motor activity and muscle tone
-GI (variable bowel sounds, meconium, saliva)
-strong suck reflex

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6
Q

3 phases in transition

A

-first period reactivity
-period of decreased responsiveness
-second period of reactivity

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7
Q

what happens during period of decreased responsiveness in transition (60-100 mins after birth)

A

-unresponsiveness, deep sleep
-color is pink
-resps are rapid and shallow, but unlabored
-bowel sounds audible

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8
Q

what happens during second period of reactivity in transition (from 2-8 hrs after birth, lasts 10 mins to several hours)

A

-tachycardia, tachypnea
-increased muscle tone
-changes in skin color
-lots of mucus production
-meconium
(preterm infants don’t experience this phase)

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9
Q

respiratory adaptations of neonate

A

-breathing becomes coordinated and regular
-lungs are mature (surfactant - keeps alveoli dilated on expiration)
-pulmonary vascular bed
-CNS responsiveness to blood gases

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10
Q

how to measure adequate surfactant in lungs

A

amniocentesis:
-L/S ratio 2:1
-PG positive

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11
Q

4 types of stimuli that initiate respiration after birth

A

-chemical stimuli (blood gases)
-sensory stimuli
-thermal stimuli
-mechanical stimuli

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12
Q

characteristics of normal respirations in neonate

A

-nose breathing without flaring
-quiet, shallow, irregular resps with brief periods apnea
-rate 30-60 breaths/min
-resp movements are abdominal (abdomen rises with chest)

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13
Q

characteristics of abnormal respirations in neonate

A

-nasal flaring
-chest retractions (intercostal retractions)
-grunting
-see-saw respirations (abdomen and chest rise at opposite times)
-crackles
-tachypnea
-central cyanosis

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14
Q

what can tachypnea in neonate indicate

A

-resp problem
-cardiac problem
-metabolic problem; cold stress
-infectious illness

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15
Q

cardiovascular adaptations in neonate

A

-closure of foramen ovale (because of increased LH pressure)
-closure of ductus arteriosus (because of increased oxygen)
-closure of ductus venosus
-heart rate variations, irregular is ok for first few hours
-murmurs might be normal (shunts are closing)

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16
Q

HR sleeping neonate

A

100 bpm

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17
Q

HR awake neonate

A

110-160 bpm

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18
Q

HR crying neonate

A

up to 180 bpm

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19
Q

where is apical pulse on neonate

A

3rd to 4th intercostal space to left of midclavicular line

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20
Q

approximate blood pressure for neonate

A

60-80/40-50
*MAP = EGA
*check upper and lower extremities

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21
Q

cardiovascular signs of problems in neonate

A

-abnormal rate (persistent tachycardia/bradycardia)
-murmurs (maybe)
-alterations and differentials in pulses
-changes in perfusion and skin color (jaundice, cyanosis, pallor)
-tachypnea

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22
Q

normal Hgb and Hct for neonate

A

Hgb: 15-24
Hct: 44-70%

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23
Q

normal RBC for neonate

A

4.8-7.1

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24
Q

normal WBC for neonate

A

9K-30K
*elevated WBC is very late sign of infection in newborn

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25
Q

normal platelets for neonate

A

<1 week: 85-500K
>1 week: 150-300K

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26
Q

what vitamin is needed for clotting factors to activate in neonate

A

vitamin K

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27
Q

factors contributing to heat loss

A

-higher surface area to body weight ratio
-thin adipose tissue, thin skin, blood vessels close to surface
-wet skin at birth
-extra-uterine environment (colder, less humid, air currents)

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28
Q

4 mechanisms of heat loss

A

-convection (to cooler air or air currents)
-radiation (to colder substance without touching it)
-evaporation (skin is wet)
-conduction (to colder substance by touch)

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29
Q

how to prevent heat loss by convection in neonate

A

-delivery room is warm
-warmers
-tall walls on basinets
-two blankets wrapped around baby
-cap on head

30
Q

how to prevent heat loss by radiation in neonate

A

-keep them away from outside doors and windows

31
Q

how to prevent heat loss by evaporation in neonate

A

-dry newborn
-remove wet linens

32
Q

how to prevent heat loss by conduction in neonate

A

-warm everything before it comes into contact with baby
-warm hands
-skin to skin contact
-warmers

33
Q

can newborns shiver

A

no

34
Q

what warms baby during non-shivering thermogenesis

A

brown fat

35
Q

what is needed to metabolize brown fat to provide warming

A

-increased O2
-glucose

36
Q

locations of brown fat in neonate

A

-superficial: interscapular, axillae
-deep: thoracic inlet, along vertebral column, around kidneys

37
Q

physiological consequence of hypoxia in neonates

A

shunts reopen

38
Q

how to prevent cold stress in neonate

A

-dry infant quickly
-remove wet linens
-maintain skin to skin
-radiant warmer
-double wrapped with blankets
-hat on head

39
Q

physiological adaptations in renal system in neonate

A

-5-10% weight loss in first 3-5 days because of diuresis (regains by 10-14 days)
-infant should void within first 24 hours of life
-uric acid crystals ok for 1 week (“brick dust”)
-normal void: straw color, odorless, minimum 1 wet diaper/day of age (up to day 4, then 6-8/day)

40
Q

stomach size of neonate day 1, day 3, and day 7

A

day 1: 10 mL
day 3: 30 mL
day 7: 60 mL

41
Q

when does neonate usually pass meconium

A

within 12-24 hrs

42
Q

signs of risk for GI problems

A

-no meconium
-diarrhea
-forceful vomiting
-meconium from vagina/urinary meatus

43
Q

what does transitional stool look like, and when should it occur by

A

-greenish brown to yellow brown
-thin, less sticky than meconium
-may contain milk curds
-by day 3

44
Q

what does breast milk stool look like

A

-yellow to golden
-pasty
-“cottage cheese with mustard”
-little to no odor

45
Q

what does formula milk stool look like

A

-pale yellow to light brown
-firmer consistency
-odorous

46
Q

3 functions of liver

A

-produce Hgb
-regulate glucose
-conjugation of bilirubin

47
Q

how long does neonate iron storage from mother last

A

4 months

48
Q

why are neonates at risk for hypoglycemia

A

-limited glycogen stores
-loss of maternal glucose supply

49
Q

what increases risk of neonate hypoglycemia

A

-big baby
-maternal diabetes
-poor placental perfusion
-preterm/small baby

50
Q

what is bilirubin

A

breakdown of dead RBCs

51
Q

can unconjugated (indirect) bilirubin be excreted from body

A

no

52
Q

why are neonates unable to conjugate bilirubin to be excreted

A

-shorter lifespan RBCs
-extra supply of RBCs
-immature liver

53
Q

what increases risk of hyperbilirubinemia in neonate

A

not eating

54
Q

4 causes physiologic jaundice (hyperbilirubinemia)

A

-increased bilirubin production due to increased RBCs
-decreased lifespan RBCs
-immature liver
-reabsorption bilirubin in intestines

55
Q

when does physiologic jaundice occur

A

after 24 hours of life

56
Q

when does pathologic jaundice occur

A

before 24 hours of life

57
Q

causes pathologic jaundice

A

-hemolytic disease of newborn (Rh incompatibility, ABO incompatibility)
-trauma

58
Q

2 types jaundice related to breastfeeding

A

-breastfeeding associated jaundice
-breast milk jaundice

59
Q

characteristics of breastfeeding associated jaundice?
how to fix?

A

-begins 2-5 days
-lack of effective breastfeeding

Tx: feed baby, monitor wet diapers

60
Q

characteristics of breast milk jaundice? how to fix?

A

-begins at 5-10 days, may last 3-12 weeks
-uncertain cause

Tx: none, educate mom to monitor and bring in baby

61
Q

what levels of bilirubin are too high for neonate

A

> 20-25 mg/dL

62
Q

term for bilirubin levels that are too high can cause bilirubin encephalopathy

A

kernicterus

63
Q

early signs of infection in neonate

A

-temp instability/hyperthermia
-lethargy, irritability
-poor feeding, V/D
-decreased reflexes
-pale/mottled skin
-resp: apnea, tachypnea, grunting, retractions
-discharge from eyes, nose, mouth
-rashes

64
Q

hierarchy of developmental challenges of neonate (most basic to advanced)

A

-regulate physiologic/autonomic system
-motor organization
-state (of consciousness) regulation
-attention and social interaction

65
Q

6 states of neonate sleeping and wakefulness

A

-deep sleep
-light sleep
-drowsy
-quiet alert (*optimal for parent interaction)
-active alert
-crying

66
Q

neonate purposeful behavior that communicates overstimulation and want to modulate state of wakefulness

A

-actively withdrawing by increasing physical distance
-rejecting by pushing away with hands/feet
-decreasing sensitivity by falling asleep/breaking eye contact
-fussing/crying

67
Q

how far can babies see

A

8-12 inches away

68
Q

when can babies see color

A

2 months

69
Q

characteristics of neonate hearing

A

-attempts to locate sounds
-recognizes familiar voices
-prefers high pitched voices
-responds to rhythmic sounds

70
Q

what sense is very strong in neonate

A

smell

71
Q

what parts of baby is most sensitive

A

-face
-hands
-soles of feet

OB (21 decks)

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