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OB > Chapter 15 - Phys + Behavioral Responses of Neonates (resp, cardiovasc, therm) > Flashcards

Chapter 15 - Phys + Behavioral Responses of Neonates (resp, cardiovasc, therm) Flashcards

1
Q

neonatal period

A

from time when umbilical is cut to 28 days

-adjustment fr intrauterine to extra uterine

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2
Q

most critical + dynamic changes

A

resp + cardiovasc systems

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3
Q

resp changes is initiated by…

A
  • compression of thorax> forces amni fluid fr lungs
  • lung expansion
  • incr in alveolar o2 concentratn
  • vasodilatn of pulmo vessels
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4
Q

___ + ___ stimuli are primary factors that initiate resp. secondary stimuli, _____, such as ______ also aid

A

mechanical + chemical stimuli

> sensory stimuli> temp change, sound, light, rouch

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5
Q

surfactant is responsible for…

A

functional residual capacity

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6
Q

2 factors that negatively affect resp transition

A
  • decr surfactnt r/t immature lungs

- persistent hypoxemia + acidosis> leads to constriction

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7
Q

mechanical stimuli of resp:

Delivery of FACE>

A

loss of amnio fluid fr lungs>
entry of air into alveoli to replace amnio fluid>
lung fluid is reabsorbed (lymph systm)/neonate crying incr intrathoracic pos pressure>
alveoli remains open

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8
Q

mechanical stimuli of resp:

Delivery of CHEST>

A

expansion of chest>neg pressure> passive inspiration> first breath>
entry of air into alveoli to replace amnio fluid>
lung fluid is reabsorbed (lymph systm)/neonate crying incr intrathoracic pos pressure>
alveoli remains open

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9
Q

chemical stimuli of resp

A

stop of placental BF> decr o2> mild hypoxia> incr co2> decr pH (acid)> stim of resp center in medula> stim of respirations

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10
Q

flow of initiation of resp affects pulmo circ + gas exchange (starts w first breath)

A

first breath> incr alv PaO2> decr arterial pH> dilatn of pulmo arteries> decr pulmo vasc resistnc> incr BF thru pulmo vessels> incr o2/co2 exchnage

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11
Q

signs of fetal resp distress

A
  • cyanosis
  • abnormal resp pattern
  • retraction of chest wall
  • grunting
  • flaring of nostrils
  • hypotonia
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12
Q

ductus venosus connects the…

A

umbilical vein to inferior vena cava

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13
Q

ductus venosus closes…

A

day 3

-becomes a ligament

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14
Q

blood flow thru ductus venosus stops…

A

once cord is clamped

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15
Q

foramen oval connects…

A

right + left atrium

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16
Q

foramen oval closes when…

A

when left atrial pressure is higher than the right

-incr PaO2> decr pulmo pressure> incr pulmo BF> incr lft atrium pressure> closure of foramen ovale

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17
Q

___ can cause the foramen oval to reopen

A

signifiant neonatal hypoxia

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18
Q

ductus arteriosus connects the…

A

pulmo artery w descending aorta

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19
Q

ductus arteriosus closure occurs when…

A

pulmo vasc resistance is less than system vasc resistance> left to right shunt> closure

-usually 15 hr after birth

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20
Q

ductus arteriosus WONT close if…

A

lungs fail to expand or if PaO2 levels drop

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21
Q

bc neonate’s response to temp change is delayed, neonate is at risk for..

A

cold stress

22
Q

neutral thermal environment [NTE]

A

maintains body temp w minimal metab changes + o2 consumption

  • needed to support infant during transition
  • decr possible complications r/t delayed response to environ changes
23
Q

neonates responds to cold by

A
  • incr in metab rate
  • incr muscle activity
  • periph vasc constriction
  • metab of brown fat
24
Q

BAT

A

brown adipose tissue

25
brown adipose tissue [BAT]
- highly dense + vasc fat tissue | - located in neck, thorax, axillary area, interscapular areas around adrenal glands, + kidneys
26
BAT promotes
- incr in metab - heat productions thru intense lipid metab of BAT - heat transer to periph system
27
BAT promotes
- incr in metab - heat productions thru intense lipid metab of BAT - heat transfer to periph system
28
neonates are at higher risk for thermoregulatory problems r/t...
- high body-surface area to body mass ratio - higher metab rate - limited + immature thermoregulatory abilities
29
factors that negatively affect thermoreg
- decr subcutaneous fat - decr BAT in preterm neonates - large body surface - loss of body heat fr evaporation, conduction, convection, or radiation
30
evaporation
loss of heat occurs when water on skin is converted into vapor ex) bathing or directly after birth
31
conduction
transfer of heat to cooler surface by DIRECT SKIN CONTACT ex) cold hands or cold equipment
32
convection
loss of heat fr warm body surface to cooler air currents ex) a/c or o2 mask
33
radiation
transfer of heat to cooler objects but NOT direct contact ex) cold walls or cold equipment neat BB
34
cold stress
excessive heat loss that leads to hypothermia | -results in utilization of compensatory mechanisms to maintain BB's temp
35
consequences of cold stress
- hypoglycemia - metab acidosis - decr surfactant production - resp distress (can lead to neonatal death) - hypoxemia - incr indirect bilirubin - delayed transition fr fetal to neonatal circulatn - wt loss
36
risk factors for cold stress
- premature - sml for gest age - hypoglycemia - prolonged resucitatn effort - sepsis - neurolgcl, endocrn, or cardioresp problems
37
cold stress s/s
- less than 97.7F - cool skin - lethargy - pallor - tachypnea - grunting - hypoglycemia - hypotonia - jittery - weak suck
38
how to prevent cold stress | nursing action
- dry bb quickly after bath - remove wet blankets - place stocking cap on bb - skin to skin contact - swaddle - radiant warmers - place bb away fr outside walls + windows - maintain NTE
39
stocking cap prevents what type of heat loss?
radiation + convection
40
skin to skin contact prevents what type of heat loss?
radiation + conduction
41
type of heat loss fr wet blanket
radiation, evaporation, conduction
42
swaddle prevents what type of heat loss?
radiation + convection
43
cold stress | nursing action
- same as prevention - reassess temp Q30 min until stable - place naked BB nder preheated warmer w attached servo-controlled probe - ---incr temp by 1.8F until 97.8F - --monitor temp Q5 min while rewarming - obtain heelstick to assess for hypoglycemia
44
hypoglycemia in bb
less than 40 mg/dL
45
hypothermia
<97.7
46
how does cold stress lead to hypoglycemia
metab of BAT> metab of FAT> metab of glucose> hypoglycemia
47
how often is VS assessed
Q30min
48
where is injection administered in neonates?
thighs | vastus lateralis
49
2 priority NANDAs for cold stress
1 risk for altered body temp r/t decr amt of fat or large body surface 2 risk for impaired gas exchange r/t cold stress
50
norm glucose range for BB
7-100 mg/dL
51
hypoglycemia can lead to...
seizures

OB (18 decks)

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