chapter 14: phys8iological and behavioral adaptations of the newborn Flashcards
fetal preparation for extrauterine life
- fetal lungs develop and mature
- surfacant produced
- brown fat deposited
- glucose stored in the liver as glycogen
- adrenaglands produce catecholamines
surfacant
mixed of phospholipids and lipoproteins
brown fat
body fat infants use to regulate body temperature
glucose stores in the liver as ______ provides _______ for newborn at birth
liver; energy source
catecholamines
dopamine, norepinephrine, and epinephrine
thermoregulation system
infants at greater risk of hypothermia
four mechanisms of heat loss
evaporation
conduction
convection
radiation
evaporation
loss of heat as amniotic fluid on infant evaporates
conduction
transfer of heat from infant’s body to cooler surfaces
convection
transfer of the infant’s body heat to surrounding cool air
radiation
transfer of infant’s body heat to cooler object that infant is not in contact with
problems with heat regulation
- lack of subcutaneous fat to provide insulation
- blood vessels close to the surface
- infants rely on brown fat to provide additional heat
- metabolism of brown fat: nonshivering thermogenesis
cold stress
- brown fat rapidly metabolized
- can lead to metabolic acidosis in the newborn
consequences of an increased metabolic rate in a cold newborn
- increased need for oxygen
- decreased surfacant production
- increased use of stored glycogen turns to hypoglycemia
- rapid metabolism of brown fat, leading to metabolic acidosis
nursing interventions for thermoregulation
- dry immediately after birth
- place skin to skin with the mother
- cover the head
- monitor temperature every 15 minutes for the first hour
- avoid uncovering or exposing the entire body
- place under a preheated radiant warmer for procedures
- bathe after temperature stable for at least 2 hours
- avoid placing a crib near a draft or window
for breathing to occur, sequence of events but happen include internal and external stimuli
- internal stimuli are chemically focused
- external stimuli are mechanical, sensory, and thermal changes in newborn’s body
breathing at birth
- chest pressure sueezes out secretes and amniotic fluid
- chest recoils, causing air to fill the lungs
- surfacant increases to keep alveoli open after initial breaths
- cutting umbilical cord causes respiratory centers in brain to begin working in response to dropping blood pH
nursing interventions for newborn respiratory system
- count respirations per minute
- suction mouth and nose
- monitor respiratory effort
- observe abdomen
newborn cardiovascular system
- after newborn starts breathing, blood flow changes
- breakdown of rbc increases —> bilirubin released
- elevated wbc’s
- absence of vitamin k
nursing interventions of cardiovascular system of the newborn
- monitor heart rate
- use positive pressure ventilation to increase heart rate
- begin chest compressions if heart rate below 60 bpm
- monitor color of the trunk, mucous membranes, and the capillary refill time
renal system
- kidneys immature
- urine not concentrated until 6 weeks old
- urine odorless and a light color or clear
- void within 24 hours of birth with a volume of about 15 ml
- first 2 days of life: total daily output 30-60ml
- volume rises to 300 ml per day
nursing interventions for renal system of newborn
- monitor first void
- weigh diapers
- encourage frequent diapers
gastrointestinal system
- sterile at birth
- bacteria enters body and become probiotics
- intestinal bacteria that aids in digestion and synthesize vitamin k
- capacity of newborn stomach 60-90ml
- pancreas immature
- cardiac sphincter between esophagus and stomach is weak
- meconium stool expelled within 24-48 hours of birth
nursing interventions for gi system of the newborn
- monitor for meconium stool; report if not expelled within 24 hours
- teach not to overfeed
- teach about immature cardiac sphincter and regurgitation
hepatic system
- liver immature at birth, high number of unneeded RBCs
- if not removed efficiently —> normal physiological jaundice by days 2-4
- liver’s job is to remove indirect (unconjugated) bilirubin and convert/conjugate it to a form that can be excreted
- indirect bilirubin causes jaundice
- once conjugated, direct (conjugated) bilirubin is excreted into common duct, duodenum, and small amount of urine
nursing interventions for the hepatic system of newborns
- monitor for yellow sclera and skin
- teach about normal physiological jaundice
immune system
- born w/ passive antibodies (immunoglobulin G)
- protects for 2-4 months
- antibodies not produced until about 2 months of age
nursing interventions for newborn immune system
- strict hand washing
- protect from infection
- screen health care personnel and visitors for illness
- teach hand hygiene
- encourage immunizations to begin at 2 month of age
behavioral adjustment to extrauterine life
- newborns initiate interaction by crying, quiet when soothed, engage in mutual gazing
- newborn likes something when focusing eyes, tracking objects or person
- newborn demonstrates dislike when turning away, crying, yawning
- self soothe: thumb or hand sucking
periods of reactivity: first period
- first period occurs 30-60 min after birth, alert, active and cooperative
- period of inactivity: fall into a deep sleep 2-4 hours or longer, unresponsive to external stimuli
periods of reactivity: second period
- wakes up from long sleep
- alert, active, hungry
