Chapter 15 - Phys + Behavioral Responses of Neonates (resp, cardiovasc, therm) Flashcards
neonatal period
from time when umbilical is cut to 28 days
-adjustment fr intrauterine to extra uterine
most critical + dynamic changes
resp + cardiovasc systems
resp changes is initiated by…
- compression of thorax> forces amni fluid fr lungs
- lung expansion
- incr in alveolar o2 concentratn
- vasodilatn of pulmo vessels
___ + ___ stimuli are primary factors that initiate resp. secondary stimuli, _____, such as ______ also aid
mechanical + chemical stimuli
> sensory stimuli> temp change, sound, light, rouch
surfactant is responsible for…
functional residual capacity
2 factors that negatively affect resp transition
- decr surfactnt r/t immature lungs
- persistent hypoxemia + acidosis> leads to constriction
mechanical stimuli of resp:
Delivery of FACE>
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
mechanical stimuli of resp:
Delivery of CHEST>
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
chemical stimuli of resp
stop of placental BF> decr o2> mild hypoxia> incr co2> decr pH (acid)> stim of resp center in medula> stim of respirations
flow of initiation of resp affects pulmo circ + gas exchange (starts w first breath)
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
signs of fetal resp distress
- cyanosis
- abnormal resp pattern
- retraction of chest wall
- grunting
- flaring of nostrils
- hypotonia
ductus venosus connects the…
umbilical vein to inferior vena cava
ductus venosus closes…
day 3
-becomes a ligament
blood flow thru ductus venosus stops…
once cord is clamped
foramen oval connects…
right + left atrium
foramen oval closes when…
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
___ can cause the foramen oval to reopen
signifiant neonatal hypoxia
ductus arteriosus connects the…
pulmo artery w descending aorta
ductus arteriosus closure occurs when…
pulmo vasc resistance is less than system vasc resistance> left to right shunt> closure
-usually 15 hr after birth
ductus arteriosus WONT close if…
lungs fail to expand or if PaO2 levels drop
bc neonate’s response to temp change is delayed, neonate is at risk for..
cold stress
neutral thermal environment [NTE]
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
neonates responds to cold by
- incr in metab rate
- incr muscle activity
- periph vasc constriction
- metab of brown fat
BAT
brown adipose tissue
brown adipose tissue [BAT]
- highly dense + vasc fat tissue
- located in neck, thorax, axillary area, interscapular areas around adrenal glands, + kidneys
BAT promotes
- incr in metab
- heat productions thru intense lipid metab of BAT
- heat transer to periph system
BAT promotes
- incr in metab
- heat productions thru intense lipid metab of BAT
- heat transfer to periph system
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
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
evaporation
loss of heat occurs when water on skin is converted into vapor
ex) bathing or directly after birth
conduction
transfer of heat to cooler surface by DIRECT SKIN CONTACT
ex) cold hands or cold equipment
convection
loss of heat fr warm body surface to cooler air currents
ex) a/c or o2 mask
radiation
transfer of heat to cooler objects but NOT direct contact
ex) cold walls or cold equipment neat BB
cold stress
excessive heat loss that leads to hypothermia
-results in utilization of compensatory mechanisms to maintain BB’s temp
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
risk factors for cold stress
- premature
- sml for gest age
- hypoglycemia
- prolonged resucitatn effort
- sepsis
- neurolgcl, endocrn, or cardioresp problems
cold stress s/s
- less than 97.7F
- cool skin
- lethargy
- pallor
- tachypnea
- grunting
- hypoglycemia
- hypotonia
- jittery
- weak suck
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
stocking cap prevents what type of heat loss?
radiation + convection
skin to skin contact prevents what type of heat loss?
radiation + conduction
type of heat loss fr wet blanket
radiation, evaporation, conduction
swaddle prevents what type of heat loss?
radiation + convection
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
hypoglycemia in bb
less than 40 mg/dL
hypothermia
<97.7
how does cold stress lead to hypoglycemia
metab of BAT> metab of FAT> metab of glucose> hypoglycemia
how often is VS assessed
Q30min
where is injection administered in neonates?
thighs
vastus lateralis
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
norm glucose range for BB
7-100 mg/dL
hypoglycemia can lead to…
seizures
