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NU 330 > Chapter 15 > Flashcards

Chapter 15 Flashcards

1
Q

neonatal period

A

first 28 days of life

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2
Q

when does transition begin

A
  • immediately
  • when neonate takes their first breath and then…
  • when the umbilical cord is clamped and cut
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3
Q

nurse’s role in the neonatal period

A
  • 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
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4
Q

what is the family’s role in neonatal period

A
  • families support infant transition
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5
Q

respiratory changes

A
  • establishing respirations is the most important physiological change
  • chemical and mechanical stimuli initiate process
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6
Q

mechanical stimuli that initiate establishing respirations

A
  • 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
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7
Q

chemical stimuli that initiate establishing respirations

A
  • cessation of placental flow leads to hypoxia
  • acidosis results from retained CO2
  • this stimulates the respiratory center
  • breathing occurs
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8
Q

2 factors that negatively affect respirations

A
  1. low levels of surfactant
    - preterm or early term infants
  2. persistent hypoxemia and acidosis
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9
Q

what % of infants need some degree of assistance with respirations?

A

10%
- 1% actually need resuscitation

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10
Q

signs of respiratory distress

A
  • 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
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11
Q

when does acrocyanosis occur, what is it?

A

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

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12
Q

transition to neonatal circulation

A
  • begins within seconds
  • need pressure changes inside to outside
    1. ductus venosus
    2. foramen ovale
    3. ductus arteriosus
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13
Q

ductus venosus

A
  • 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
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14
Q

foramen ovale

A
  • 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
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15
Q

ductus arteriosus

A
  • connects the pulmonary artery with the aorta
  • usually closes within 15 hours
  • can reopen if lungs fail to expand, and hypoxia
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16
Q

what helps regulate baby’s temperature in-utero?

A

amniotic fluid

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17
Q

thermoregulation after birth

A
  • must adapt to changes in the environment once born
  • at risk for cold stress
  • need neutral thermal environment (NTE)
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18
Q

how does a baby respond to cold?

A

use fat to metabolize to make heat

  • increases metabolic rate
  • increases muscle activity
  • peripheral vascular constriction
  • metabolism of brown fat
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19
Q

brown fat

A
  • brown adipose tissue
  • used to stay warm because baby doesn’t understand how to shiver to stay warm
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20
Q

methods of heat loss

A
  • evaporation
  • convection
  • conduction
  • radiation
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21
Q

method of heat loss: evaporation

A

loss of heat when water is converted to a vapor

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22
Q

method of heat loss: convection

A

loss of heat from a warm body surface to cooler air currents

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23
Q

method of heat loss: conduction

A

heat loss occurs when body heat rises to cooler surfaces & objects NOT in direct contact with the skin

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24
Q

method of heat loss: radiation

A

loss of heat to a cooler surface by skin contact
(naturally moves away from the body)

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25
Q

what is another name for cold stress

A

hypothermia

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26
Q

what is the baby at risk for due to cold stress

A
  • 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
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27
Q

s/s/x of cold stress

A
  • temp below 97.7 axillary
  • cool skin
  • lethargy
  • pallor
  • tachypnea
  • grunting
  • hypoglycemia
  • hypotonia
  • jitteriness
  • weak suck
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28
Q

nursing interventions: cold stress/cold baby

A
  • 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
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29
Q

what is the most important tool/nursing intervention for cold stress?

A

prevention
- reduce heat loss by drying neonate immediately and wrapping in a dry blanket with a hat once out of warmer

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30
Q

metabolic system before delivery contains ___

A

large store of glucose
- immediate need to balance glucose on own once born

31
Q

blood glucose/glucose storage post-birth

A

1-hour: level decreases
2-3 hours: level stabilizes

32
Q

what is the proper blood glucose range post-birth?

A

40-100 mg/dl

33
Q

hypoglycemia

A

blood glucose below 40

34
Q

hypoglycemia risk factors

A
  • diabetic mom
  • LGA or above 4000g
  • SGA
  • post term
  • preterm
  • hypothermia
  • neonatal infection
  • respiratory distress
  • neonatal resuscitation
  • birth trauma
35
Q

hepatic system: liver functions

A
  • carbohydrate metabolism
  • amino acid metabolism
  • blood coagulation (Vit K)
  • conjugation of bilirubin
  • storage of fat- soluble vitamins
  • detoxification
36
Q

babies have ____ in turnover of RBC

A

increase in turnover of RBC

37
Q

hyperbilirubinemia

A

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

38
Q

bilirubin

A

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

39
Q

meconomium

A
  • first stool
  • 24-48 hours
40
Q

transition stools

A
  • 3rd day
  • green
  • yellow
41
Q

breastfeeding stools

A
  • yellow and seedy
42
Q

how often should newborns be fed?

A
  • feed q2-4 hours
43
Q

the kidneys role

A
  • control fluid and electrolyte balance
  • excrete waste
44
Q

immature kidneys/renal adaptation, puts baby at risk for

A
  • overhydration
  • dehydration
  • electrolyte imbalance
  • drug toxicity
45
Q

an infant should void within ____ of life

A

within 24 hours of life (at least once)
- amount varies with BF or formula

46
Q

frequency of voids

A

may be as little as 2 in the first 24-48 hours due to limited amount of colostrum (applies to BF infants)

47
Q

what should mom/nurse do when baby voids?

A
  • make a record of number of voids
  • very important
48
Q

total amount (volume) of voids in 1st few days

A
  • full term babies: 15-60 mL/kg/day for the first few days
49
Q

at 1 month old, what amount (volume) should baby void?

A

250-400 mL/kg/day

50
Q

how much weight is lost in the first few weeks of life? what causes this?

A
  • 5-10% of birth weight is lost
  • due to diuresis
51
Q

wet diaper amount: day 1

A

1 wet

52
Q

wet diaper amount: day 2

A

2 wet

53
Q

wet diaper amount: day 3

A

5-6 wet
(3?- professor buckner)

54
Q

wet diaper amount: day 4

A

6 wet

55
Q

wet diaper amount: day 5-1 month

A

6-8 wet in 24 hour period

56
Q

immune system (function)

A

protects body from invasion of bacteria and viruses

57
Q

immune system risks for newborn

A
  • immature defense mechanisms
  • delayed response to antigens
  • skin breakdown
58
Q

types of immunity

A
  • acquired (vaccine)
  • natural (breastmilk/colostrum- IgA)
  • passive (placenta-IgG)
59
Q

what is one of the most vital actions for a nurse to do immediately after delivery

A

support initial bonding between mom and baby
- skin to skin
- don’t take baby away from mom

60
Q

fetal lungs during vs after delivery

A
  • compression of fetal thorax (squeezed)
    -*gets fluid out of lungs
  • expansion of lungs (unsqueezed)
61
Q

mild hypoxia of the neonate at birth causes what

A

immediate retraction after birth

62
Q

what happens when the umbilical cord is cut (r/t neonatal circulation)?

A

systemic vascular resistance increases

63
Q

what happens to the body when baby is cold?

A
  • blood sugar drops
  • then become more hypothermic
  • leads to respiratory distress
64
Q

what can cause cold stress/hypothermia in a newborn?

A
  • septic from mother’s infection
  • hypoglycemia
  • SGA
  • premie with less body fat
65
Q

how do we check blood sugar on a newborn?

A

heel stick

66
Q

what could cause hypoglycemia?

A

hypothermia
- baby is cold
- warm and recheck in 1 hr

67
Q

“sweet cheeks” is

A

glucose in gel form that is rubbed on the inside of baby’s cheeks to treat hypoglycemia

68
Q

what causes the clotting deficiency in newborns?

A

immature liver
- this is why we give Vit K injection: to promote clotting

69
Q

how is hyperbilirubinemia treated?

A
  • 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
70
Q

do not give babies under 1 year of age ___ (drink).

A

water

71
Q

how does passive immunity work?

A

IgG can cross the placenta and provide passive immunity for baby

72
Q

how does natural immunity work?

A

maternal IgA does not cross the placenta, but does happen to be in the breastmilk (colostrum)

73
Q

what are the primary antibodies produced in utero by the fetus in response to a pathological organism?

A

fetal IgM are the primary antibodies produced in utero is produced by the fetus in response to a pathological organism

NU 330 (18 decks)

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