Chapter 15 Flashcards
neonatal period
first 28 days of life
when does transition begin
- immediately
- when neonate takes their first breath and then…
- when the umbilical cord is clamped and cut
nurse’s role in the neonatal period
- maintain respirations
- maintain heat
- decrease risk of infection
- provide adequate nutrition and hydration
- assist parents in caring for baby
- provide teaching to the couple/partners
what is the family’s role in neonatal period
- families support infant transition
respiratory changes
- establishing respirations is the most important physiological change
- chemical and mechanical stimuli initiate process
mechanical stimuli that initiate establishing respirations
- loss of amniotic fluid from the lungs
- negative pressure in the lungs causes passive inspiration
- air enters alveoli
- lymph system absorbs excess fluid
- crying leads to positive pressure
- lungs remain open
chemical stimuli that initiate establishing respirations
- cessation of placental flow leads to hypoxia
- acidosis results from retained CO2
- this stimulates the respiratory center
- breathing occurs
2 factors that negatively affect respirations
- low levels of surfactant
- preterm or early term infants - persistent hypoxemia and acidosis
what % of infants need some degree of assistance with respirations?
10%
- 1% actually need resuscitation
signs of respiratory distress
- cyanosis: (central) bluish-gray mucous membranes
-acrocyanosis: bluish tinge to hands and feet - abnormal pattern: apnea, tachypnea
- nasal flaring
- grunting
- intercostal or subcostal retractions
- hypotonia
when does acrocyanosis occur, what is it?
bluish discoloration of the hands and feet
- very common if there is no delayed cord clamping
- most common during the first 2-6 hours after birth
- lasts first 24 hours
transition to neonatal circulation
- begins within seconds
- need pressure changes inside to outside
1. ductus venosus
2. foramen ovale
3. ductus arteriosus
ductus venosus
- connects the umbilical vein to inferior vena cava
- diverts most of the blood AWAY from the liver
- usually permanently closed about 2 weeks after delivery
foramen ovale
- opening between the R and L atrium
- needs to close
- if not closed, significant hypoxia
- usually closes within 1-2 hr post birth, permanently within 30 days
ductus arteriosus
- connects the pulmonary artery with the aorta
- usually closes within 15 hours
- can reopen if lungs fail to expand, and hypoxia
what helps regulate baby’s temperature in-utero?
amniotic fluid
thermoregulation after birth
- must adapt to changes in the environment once born
- at risk for cold stress
- need neutral thermal environment (NTE)
how does a baby respond to cold?
use fat to metabolize to make heat
- increases metabolic rate
- increases muscle activity
- peripheral vascular constriction
- metabolism of brown fat
brown fat
- brown adipose tissue
- used to stay warm because baby doesn’t understand how to shiver to stay warm
methods of heat loss
- evaporation
- convection
- conduction
- radiation
method of heat loss: evaporation
loss of heat when water is converted to a vapor
method of heat loss: convection
loss of heat from a warm body surface to cooler air currents
method of heat loss: conduction
heat loss occurs when body heat rises to cooler surfaces & objects NOT in direct contact with the skin
method of heat loss: radiation
loss of heat to a cooler surface by skin contact
(naturally moves away from the body)
what is another name for cold stress
hypothermia
what is the baby at risk for due to cold stress
- hypoglycemia
- metabolic acidosis
- decreased surfactant production
- respiratory distress that can lead to death
- hypoxemia
- increased direct bilirubin
- delayed transition from fetal to neonatal circulation
- weight loss
s/s/x of cold stress
- temp below 97.7 axillary
- cool skin
- lethargy
- pallor
- tachypnea
- grunting
- hypoglycemia
- hypotonia
- jitteriness
- weak suck
nursing interventions: cold stress/cold baby
- prevent heat loss: radiant warmer
- provide immediate care- dry quickly, cover head with cap, replace wet blankets
- provide on-going prevention- safety
- restore thermoregulation- if becoming chilled, intervene
what is the most important tool/nursing intervention for cold stress?
prevention
- reduce heat loss by drying neonate immediately and wrapping in a dry blanket with a hat once out of warmer
metabolic system before delivery contains ___
large store of glucose
- immediate need to balance glucose on own once born
blood glucose/glucose storage post-birth
1-hour: level decreases
2-3 hours: level stabilizes
what is the proper blood glucose range post-birth?
40-100 mg/dl
hypoglycemia
blood glucose below 40
hypoglycemia risk factors
- diabetic mom
- LGA or above 4000g
- SGA
- post term
- preterm
- hypothermia
- neonatal infection
- respiratory distress
- neonatal resuscitation
- birth trauma
hepatic system: liver functions
- carbohydrate metabolism
- amino acid metabolism
- blood coagulation (Vit K)
- conjugation of bilirubin
- storage of fat- soluble vitamins
- detoxification
babies have ____ in turnover of RBC
increase in turnover of RBC
hyperbilirubinemia
build up of bilirubin the baby’s bloodstream, tissues, and fluids
- aka jaundice
- makes them sleepy and eat less, which makes the sleepier…
*need to break cycle
bilirubin
2 types:
- indirect (unconjugated)
-fat soluble
-byproduct of RBC breakdown
-liver converts it to direct
- direct (conjugated)
-water soluble
-the GI tract and kidney can now excrete it by stool and urine
meconomium
- first stool
- 24-48 hours
transition stools
- 3rd day
- green
- yellow
breastfeeding stools
- yellow and seedy
how often should newborns be fed?
- feed q2-4 hours
the kidneys role
- control fluid and electrolyte balance
- excrete waste
immature kidneys/renal adaptation, puts baby at risk for
- overhydration
- dehydration
- electrolyte imbalance
- drug toxicity
an infant should void within ____ of life
within 24 hours of life (at least once)
- amount varies with BF or formula
frequency of voids
may be as little as 2 in the first 24-48 hours due to limited amount of colostrum (applies to BF infants)
what should mom/nurse do when baby voids?
- make a record of number of voids
- very important
total amount (volume) of voids in 1st few days
- full term babies: 15-60 mL/kg/day for the first few days
at 1 month old, what amount (volume) should baby void?
250-400 mL/kg/day
how much weight is lost in the first few weeks of life? what causes this?
- 5-10% of birth weight is lost
- due to diuresis
wet diaper amount: day 1
1 wet
wet diaper amount: day 2
2 wet
wet diaper amount: day 3
5-6 wet
(3?- professor buckner)
wet diaper amount: day 4
6 wet
wet diaper amount: day 5-1 month
6-8 wet in 24 hour period
immune system (function)
protects body from invasion of bacteria and viruses
immune system risks for newborn
- immature defense mechanisms
- delayed response to antigens
- skin breakdown
types of immunity
- acquired (vaccine)
- natural (breastmilk/colostrum- IgA)
- passive (placenta-IgG)
what is one of the most vital actions for a nurse to do immediately after delivery
support initial bonding between mom and baby
- skin to skin
- don’t take baby away from mom
fetal lungs during vs after delivery
- compression of fetal thorax (squeezed)
-*gets fluid out of lungs - expansion of lungs (unsqueezed)
mild hypoxia of the neonate at birth causes what
immediate retraction after birth
what happens when the umbilical cord is cut (r/t neonatal circulation)?
systemic vascular resistance increases
what happens to the body when baby is cold?
- blood sugar drops
- then become more hypothermic
- leads to respiratory distress
what can cause cold stress/hypothermia in a newborn?
- septic from mother’s infection
- hypoglycemia
- SGA
- premie with less body fat
how do we check blood sugar on a newborn?
heel stick
what could cause hypoglycemia?
hypothermia
- baby is cold
- warm and recheck in 1 hr
“sweet cheeks” is
glucose in gel form that is rubbed on the inside of baby’s cheeks to treat hypoglycemia
what causes the clotting deficiency in newborns?
immature liver
- this is why we give Vit K injection: to promote clotting
how is hyperbilirubinemia treated?
- treat by increasing feeds
- colostrum and fluid hydration flushes out the direct bilirubin and encourages liver to break down the indirect bilirubin
- place under UV light if feedings do not resolve the dx
do not give babies under 1 year of age ___ (drink).
water
how does passive immunity work?
IgG can cross the placenta and provide passive immunity for baby
how does natural immunity work?
maternal IgA does not cross the placenta, but does happen to be in the breastmilk (colostrum)
what are the primary antibodies produced in utero by the fetus in response to a pathological organism?
fetal IgM are the primary antibodies produced in utero is produced by the fetus in response to a pathological organism
