chapter 14: phys8iological and behavioral adaptations of the newborn

Question 1

fetal preparation for extrauterine life

Answer 1

• fetal lungs develop and mature
• surfacant produced
• brown fat deposited
• glucose stored in the liver as glycogen
• adrenaglands produce catecholamines

Question 2

surfacant

Answer 2

mixed of phospholipids and lipoproteins

Question 3

brown fat

Answer 3

body fat infants use to regulate body temperature

Question 4

glucose stores in the liver as ______ provides _______ for newborn at birth

Answer 4

liver; energy source

Question 5

catecholamines

Answer 5

dopamine, norepinephrine, and epinephrine

Question 6

thermoregulation system

Answer 6

infants at greater risk of hypothermia

Question 7

four mechanisms of heat loss

Answer 7

evaporation
conduction
convection
radiation

Question 8

evaporation

Answer 8

loss of heat as amniotic fluid on infant evaporates

Question 9

conduction

Answer 9

transfer of heat from infant’s body to cooler surfaces

Question 10

convection

Answer 10

transfer of the infant’s body heat to surrounding cool air

Question 11

radiation

Answer 11

transfer of infant’s body heat to cooler object that infant is not in contact with

Question 12

problems with heat regulation

Answer 12

• 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

Question 13

cold stress

Answer 13

• brown fat rapidly metabolized
• can lead to metabolic acidosis in the newborn

Question 14

consequences of an increased metabolic rate in a cold newborn

Answer 14

• increased need for oxygen
• decreased surfacant production
• increased use of stored glycogen turns to hypoglycemia
• rapid metabolism of brown fat, leading to metabolic acidosis

Question 15

nursing interventions for thermoregulation

Answer 15

• 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

Question 16

for breathing to occur, sequence of events but happen include internal and external stimuli

Answer 16

• internal stimuli are chemically focused
• external stimuli are mechanical, sensory, and thermal changes in newborn’s body

Question 17

breathing at birth

Answer 17

• 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

Question 18

nursing interventions for newborn respiratory system

Answer 18

• count respirations per minute
• suction mouth and nose
• monitor respiratory effort
• observe abdomen

Question 19

newborn cardiovascular system

Answer 19

• after newborn starts breathing, blood flow changes
• breakdown of rbc increases —> bilirubin released
• elevated wbc’s
• absence of vitamin k

Question 20

nursing interventions of cardiovascular system of the newborn

Answer 20

• 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

Question 21

renal system

Answer 21

• 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

Question 22

nursing interventions for renal system of newborn

Answer 22

• monitor first void
• weigh diapers
• encourage frequent diapers

Question 23

gastrointestinal system

Answer 23

• 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

Question 24

nursing interventions for gi system of the newborn

Answer 24

• monitor for meconium stool; report if not expelled within 24 hours
• teach not to overfeed
• teach about immature cardiac sphincter and regurgitation

Question 25

hepatic system

Answer 25

• 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

Question 26

nursing interventions for the hepatic system of newborns

Answer 26

• monitor for yellow sclera and skin
• teach about normal physiological jaundice

Question 27

immune system

Answer 27

• born w/ passive antibodies (immunoglobulin G)
• protects for 2-4 months
• antibodies not produced until about 2 months of age

Question 28

nursing interventions for newborn immune system

Answer 28

• 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

Question 29

behavioral adjustment to extrauterine life

Answer 29

• 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

Question 30

periods of reactivity: first period

Answer 30

• 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

Question 31

periods of reactivity: second period

Answer 31

• wakes up from long sleep
• alert, active, hungry