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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
Q

brown adipose tissue [BAT]

A
  • highly dense + vasc fat tissue

- located in neck, thorax, axillary area, interscapular areas around adrenal glands, + kidneys

26
Q

BAT promotes

A
  • incr in metab
  • heat productions thru intense lipid metab of BAT
  • heat transer to periph system
27
Q

BAT promotes

A
  • incr in metab
  • heat productions thru intense lipid metab of BAT
  • heat transfer to periph system
28
Q

neonates are at higher risk for thermoregulatory problems r/t…

A
  • high body-surface area to body mass ratio
  • higher metab rate
  • limited + immature thermoregulatory abilities
29
Q

factors that negatively affect thermoreg

A
  • decr subcutaneous fat
  • decr BAT in preterm neonates
  • large body surface
  • loss of body heat fr evaporation, conduction, convection, or radiation
30
Q

evaporation

A

loss of heat occurs when water on skin is converted into vapor
ex) bathing or directly after birth

31
Q

conduction

A

transfer of heat to cooler surface by DIRECT SKIN CONTACT

ex) cold hands or cold equipment

32
Q

convection

A

loss of heat fr warm body surface to cooler air currents

ex) a/c or o2 mask

33
Q

radiation

A

transfer of heat to cooler objects but NOT direct contact

ex) cold walls or cold equipment neat BB

34
Q

cold stress

A

excessive heat loss that leads to hypothermia

-results in utilization of compensatory mechanisms to maintain BB’s temp

35
Q

consequences of cold stress

A
  • 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
Q

risk factors for cold stress

A
  • premature
  • sml for gest age
  • hypoglycemia
  • prolonged resucitatn effort
  • sepsis
  • neurolgcl, endocrn, or cardioresp problems
37
Q

cold stress s/s

A
  • less than 97.7F
  • cool skin
  • lethargy
  • pallor
  • tachypnea
  • grunting
  • hypoglycemia
  • hypotonia
  • jittery
  • weak suck
38
Q

how to prevent cold stress

nursing action

A
  • 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
Q

stocking cap prevents what type of heat loss?

A

radiation + convection

40
Q

skin to skin contact prevents what type of heat loss?

A

radiation + conduction

41
Q

type of heat loss fr wet blanket

A

radiation, evaporation, conduction

42
Q

swaddle prevents what type of heat loss?

A

radiation + convection

43
Q

cold stress

nursing action

A
  • 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
Q

hypoglycemia in bb

A

less than 40 mg/dL

45
Q

hypothermia

A

<97.7

46
Q

how does cold stress lead to hypoglycemia

A

metab of BAT> metab of FAT> metab of glucose> hypoglycemia

47
Q

how often is VS assessed

A

Q30min

48
Q

where is injection administered in neonates?

A

thighs

vastus lateralis

49
Q

2 priority NANDAs for cold stress

A

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
Q

norm glucose range for BB

A

7-100 mg/dL

51
Q

hypoglycemia can lead to…

A

seizures

ob (18 decks)

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