Chapter 15 - Phys + Behavioral Responses of Neonates (metab, GI, assessment) Flashcards
T/F large quantities of glycogen is stored in BB during pregnancy
T: in prep for meeting energy requirements when transitioning
rise + fall of gluc after delivery
1 hr: fall
2-3 hr: rise + stabilize
optimal range for glucose
70-100 mg/dL
why do neonates of diabetic moms have a higher risk of hypoglycemia?
in uterine, mom produces a lot of insulin in response to high levels of circulating maternal glucose
-neonates’ insulin level remains higher than normal leading to hypoglycemia
risk for hypoglycemia
- neonates of diabetic mom
- neonates weighing more than 4,000g or lga
- post-term bb
- preterm bb
- sga
- hypothermia
- infection
- resp distress
- neonatal resuscitation
- birth trauma
hypoglycemia s/s
- jittery
- hypotonia
- irritability
- apnea
- lethargy
- temp instability
hypoglycemia nursing actions
- monitor for s/s
- assess blood gluc level
- assist w breast feed or formula feed
- IV infusion of dextrose soln or buccal 40%
functions of liver
- carb metab
- amino acid metab
- lipid metab
- synth of plasma proteins
- blood coag
- conjugation of bilirubin
- phagocytosis by kupffer/macrophage
- storage of fat sol vit (ADEK) + Fe
- detox
carb metab of liver
- reg blood gluc by converting into GLYCOGEN (facilitated by insulin + cortisol)
- converts glycogen to glucose when low
blood coag factors that are synth by liver
factors 2, 7, 9, 10
-vitamin K influences activation of these factors
where is vit K synthesized in BB
intestinal flora
- absent in newborn
- develops thru introduction of microbes (feeding)
phytonadione [vit K, aquamephyton]
prophylaxis to prevent hemorrhagic disease
phytonadione [vit K, aquamephyton]
s/s
erythema
pain
swelling at injection site
phytonadione [vit K, aquamephyton]
route + dose
IM
0.5-1 mg w/ 1 hr of birth
cause of hyperbilirubinemia
incr in RBC turnover (shorter lifespan) + incr RBC count at birth
>leads to incr bilirubin production
2 forms of bilirubin
DIRECT (conjugated)
INDIRECT (unconjugated)
indirect/unconjugated bilirubin
fat soluble
- produced fr breakdown of RBC
- converts into direct bilirubin
direct/conjugated bilirubin
water sol
- bound to albumin
- can be excreted in urine/stool
physiological jaundice
fr hyperbilirubinemia that commonly happns AFTER 24 hr + during first week
-usually peaks at day 3
pathological jaundice
fr various disorders that exacerbate hyperbilirubinemia
- occurs WITHIN first 24 hr
- jaundice last more than a week
gastric capacity for first few days then day 7
5-10mL
>60 mL by day 7
stomach emptying time
2-4 hr
which has more stools per day? breastfed or formula fed
breasfed has more stools
4-8 stools per day
meconium stool
- passed in 1-2 days
- sticky, thick, black, odorless
- forms during 4th gestl month
transitional stool
- passed in day 3-5
- greenish black, greenish brown, greenish yellow
breastfed stool
- after day 5
- yellow + semiformed
- later becomes golden yellow w pasty consistency
- sour odor
formula fed stool
- drier + more formed than breastfed
- pale yellow to brownish yellow
- unpleasant odor
diarrheal stool
loose + green
active immunity
B cells detect antigens + produce antibodies
- ACQUIRED: vaccine
- NATURAL: exposed to antigen
passive immunity
not permanent
- ARTIFICIAL: gamma globulin
- NATURAL: placental transmission of antibodies
IgG IgA IgM IgD IgE
G - blood, ECF, long term
A - external secretin (milk, tears, saliva)
M - blood; produced first
D - B lymphocytes
E - mast cells or basophils for allergies
sunken head
sign of dehydration
Dubowitz
neurological exam
- assess 33 responses in 4 cases:
- –habituation (response to repetitive light + sound stimuli)
- –mvmt + muscle tone
- –reflexes
- –neurobehavioral items
Ballard Maturation Score
calculated by assessing the physical + neuromuscular maturity of neonate
- classifies bb as preterm (<37wk), term (37-42wk), post-term (>42wk)
- helps to determine if bb is SGA or LGA
SGA/LGA
sga: below 10th percentile
lga: above 90th percentile
Caput Succedaneum
localized soft tissue edema of scalp
- spongy
- can cross suture lines
- caused by prolonged head against cervix
- resolves w/in first week
Cephalhematoma
hematoma formatn bw periosteum + skull w UNILATERAL swelling
- well defined outline
- does NOT cross suture lines
- appears w/in fe hours of birth + increases over next few days
- r/t trauma to head fr prolonged labor, forces, or vacuum
- can lead to jaundice
- resolves w/in 3 months
Epsteins pearls
white pearl like epithelial cysts on gum margins + palate
- benign
- usually disappears in few weeks
Newborn screening consists of..
hearing test + blood test
- include whether or not bb is breastfed
- DOES NOT test for downs
blood test
screens for infections, genetic disease, inherited, metabolic disorders, PKU
- best done at 2-5 days bc bb has time to ingest milk or formula
- but norm done 1-2 days
heelstick
warm foot for 10 min
- don gloves, clean heel w stick
- puncture in lateral or medial aspect
- wipe off first drop
- then use following drops
hearing screens
1 otoacoustic emission (OAE)
2 automated auditory brain stem response (AABR)
otoacoustic emission (OAE)
-painless test
-done when bb is sleeping or lying still
-tiny flexible ear probe is inserted
-record the response of hair cells of cochlea to clicking sounds
BAD: no response
automated auditory brain stem response (AABR)
- painless test
- done when bb is asleep or still
- electrodes are placed on forehead, mastoid + nape of neck
- screens for electrical activity of cochlea, auditory nerve, + brain stem in response to sound
BAD: no response
