Chapter 9 and 10 Flashcards
what does amniotic fluid do to the fetal lungs
inhalation helps growth of fetal lung tissue, absorption accelerates during labor, birth and a few hours after which means decreased pulmonary resistance to blood flow initating air breathing
What do chemical factors do to initiate first breath
hypercarbia, acidosis, hypoxia - these factors stimulate respiratory system of brain to initiate breathing
what do sensory factors do to initiate the first breath
overwhelming new stimuli like tactile visual olfactory and auditory
what do thermal factors do to initiate first breath
drastic change in temp stimulates respiratory response to prevent cold stress and respiratory depression need to dry in place infant skin to skin
what do mechanical factors due to initiate first breath
fetal chest compression thoracic squeeze during vaginal delivery pushes fluid out of lungs, chest recoil after newborn trunk delivered creates intrathoracic pressure the air replaced the fluid that was squeezed out remaining lung fluid pushed into lymphatic and circulatory system and absorbed within a few hours this doesn’t happen in C-section so respiratory distress
what are some complications from O2 therapy
Broncopulmonary dyspnea and retinopathy of prematurity
what is a L/S ratio and how do you get it
lectin-to-sphingomyelin - Mature longs =2:1, less then 35 wks= less lactin, An amniocentesis can be done to get ratio
what happens to the fetal lungs after birth
lung expansion after birth stimulates surfactant release which decrease in surface tension within alveoli thus preventing alveolar collapse
what are some factors that interfere with fetal breathing
prematurity, birth asphyxiation can adversely affect lung compliance and surfactant production, respiratory distress, translate tachypnea of newborn
ss of respiratory distress syndrome
grunting, accessory muscle, retractions, nasal flaring, tachypnea
what is the treatment for respiratory distress syndrome
air maintenance and oxygenation by humidified O2 continuous positive airway pressure (CPAP) it is less invasive than intubation, but want to wean ASAP so they don’t become dependent
what is transient tachypnea of newborn
aka respiratory distress syndrome type 2 - delayed clearance of fetal lung fluid (usually resolves 2-3 days)
what are the risk factors for transient tachypnea of newborn
c-section, large baby, late preterm (34-36wks)
how is transient tachypnea of newborn
via blood gasses showing respiratory acidosis
what are the ss of transient tachypnea of newborn
tachypnea, grunting, retractions, cyanosis, nasal flaring
what is the treatment for transient tachypnea of newborn
hold oral feeds over 6oz to decrease risk of aspiration, CPAP at 40% for 24-48 hours
what does hypoxia trigger
impulses from chemoreceptors to stimulate respiratory center in medulla
what does sudden temp change trigger
sensors in the skin to send impulses that stimulate breathing
when does the foramen ovale and how
closes when the pressure in the LA is higher then RA pressure, semi closes 1-2 hours after birth and permanent closure by 6mths
when and how does the ductus arteriosus close
constricts preventing deoxygenation blood from pulmonary artery from entering aorta, usually closes within 72 hours with incomplete closure you can hear murmur in 2nd intercostal space/left sternal border, permeant closure at 3-4 wks and then called ligamentum arteriosum
when and how does the ductus venosus close
clamping umbilical cord occludes blood flow into umbilical circulation so closes ductus venosus which forces blood flow to liver, name is now ligamentation venosum by first week
what position do premies need to maintian body temp
flexed position
what increases heat production in babies
peripheral vasoconstriction , nonshivering thermogenesis
how do you prevent hyperthermia in newborns
sweatglands no developed until 1 mth so the baby does peripheral vasodilation and evaporation of insensible H2O loss
what are the effects of cold stress
Increase O2 requirements may result of worsening respiratory distress, decreased surfactant = collapsed alveoli and further respiratory distress, hypoglycemia common metabolic acidosis the increase of metabolism of glucose and decrease pressure of O2 related to increased demand for O2 leading to acid production, jaundice from metabolism of brown fat produces fatty acids that interfere with transport of bilirubin to liver
what is the neutral thermal environment of a newborn
the range of temp and which newborns body temp can be maintained with minimal metabolic demands and O2 consumption, most newborns can stabilize temp within two to three hours
what is non shivering thermogenesis
uses brown adipose tissue to provide heat and cold stress newborns, formation of brown adipose tissue begins at 26-30 weeks
where is brown adipose tissue located on newborns
mid scapular area, neck, axillae, deeper deposits around trachea, esophagus, abdominal aorta, kidneys and adrenal gland it is highly vascular fat
how much blood volume does a full term newborn have and what is it determined by
80-90ml/kg determined by time of clamping delayed clamping is more blood
where does erythropoiesis occur in an infant
in the liver for six months then hematopoiesis occurs in bone marrow lifespan is 90 days
what do glucose and glycogen levels do in a newborn
during last 4-8wks glucose is stored as glycogen in liver and muscles the infant used the glycogen stores for energy but depleted at 12 hours of life, glucose levels decrease during first three hours of life and gradually increase over the next 3-4hrs to reach steady state of 40-60
what is the treatment for hypoglycemia
feeding - it can be difficult because of the signs and symptoms, so if not send to NICU or give Iv glucose
what are the pros of delayed cord clamping
prevents anemia, potentially improved transition related to increased pulmonary perfusion, additional iron stores
what are the cons of delayed cord clamping
increase risk for jaundice related to increased volume of erythrocytes and possible polycythemia (lots of RBC’s they will look red)
what is the value in signs and symptoms of hypoglycemia in newborns
less than 35, jitteriness, apnea, seizures, lethargy, hypothermia, tachypnea, poor suck, requires immediate attention to prevent brain damage
what is pathologic jaundice and when should you treat
prevents at birth or within the 1st 24 hours of life related to underlying medical cause need treatment when bilirubin is over 13 for term or over 15 for preterm
what are the signs and symptoms of jaundice
yellow color of the skin, sclera, oral mucous membranes
what is psychologic jaundice and what is it caused by
occurs after first 24-48hrs total serum bilirubin over five to seven peak bilirubin level between 3rd and 5th day caused by liver immaturity, delayed feeding, cold stress, excessive bruising
How do you prevent psychological jaundice
maintaining temp, encourage feedings, monitor stools
what is breast milk jaundice
light on set after first week of life, peaks around day 10, the bilirubin levels continue to rise and peaks two to three weeks, infant eating well, stooling well and no signs and symptoms of hemolysis
what is the treatment for breast milk jaundice
phototherapy infant has to wear eye Shields cover genitals assess hydration by bowel movement and pee, take clothes off, monitor temp, turn off to feed, watch for skin breakdown
what is breastfeeding jaundice
early onset jaundice occurs from decreased intake which causes decreased meconium
what are the interventions for breastfeeding jaundice
initiate breastfeeding ASAP 11:50 feeds per day, assess latch and suckle
what is the first period of reactivity
alert, wakefulness immediately after birth, last 30 minutes, RR and HR increased then returned to baseline, great time to initiate breastfeeding
what is the second period of reactivity
newborn awakens becomes more alert s s of feeding readiness, infant may have brief periods of tachycardia and tachypnea last several minutes to hours increased mucosal secretions
what is the period of inactivity and sleep
decrease muscular activity, difficulty to awaken, recovers from stress of birth, central perfusion and general coloring should be good last few minutes to two to four hours
what is the average length and weight of a newborn and how is it measured
7.5lbs from crown to heel average is 18 to 22 inches
what is a newborn metabolic screening and why is it done and what is commonly Id
then to ID genetic common metabolic or infectious conditions, things that are commonly ideed are biotinidase deficiency, congenital hemoglobinopathies, galactosemia, cystic fibrosis, congenital hypothyroidism, sickle cell anemia it’s done 24 hours after birth so they can have first feeding if they are positive more testing is needing because it is only a screening
what is the skin like for term babies
flaky or dry skin
what is the skin like for post term babies
excessive cracking or peeling
what is langou and vernex and when is it seen
lanugo It’s soft, fine hair vernix is cheesy like substance both cover preterm babies
how is the head circumference measured and what is the normal length
measured above eyebrows and around occupit normal is around 13 to 15 inches repeated at
how is the chest circumference measured and what is the normal
measured at nipple line normal is 30.5 to 33 centimeters
after all fetal measurements have been done how is it determined if they are large small or appropriate for age
plot on a graph to determine -large is 90th percentile, appropriate is between 10th and 90th percentile, and small is less than 10th percentile done by Ballard or dubowitz system
what is molting on a newborn
red and white Lacy appearance to the skin
what is acrocyanosis in newborns
Blue or purple hands and feet it is normal at first
what are Mongolian spots on newborns
black to blue discoloration seen on butt extremities, or back takes one to two years to go away so when seeing document very specifically so future visits do not think that the baby is being harmed at home
what is a newborn rash (erythema toxicum)
popular lesions on trunk just skin adjusting to all the new things should go away in a few days
what is milia on newborns and what should be taught to parents
tiny white raised lesions on chin, nose and forehead do not pop could cause infection
what are stork bites on newborns
pale pink or reddish marks on nape of neck, eyelids and nose will fade as the child grows
what is a port wine stain on a newborn and how is it treated
dark red or purple birthmark commonly on face doesn’t go away laser therapy can be used
what is hemangionma (nevus vasculosus) on a newborn
deep blood vessels related to birthmark it grows with the infant then decreases in size
What is cephalhemotoma in an newborn
collection of blood between periosteum and Bone it is unilateral or bilateral, usually doesn’t cross suture lines should resolve in three weeks
what is caput succedaneum in newborn
localized swelling of soft tissue of scalp, cross the suture lines assess Q4 hours should resolve in first few days of life
what is molding in newborns
elongated shape of head caused by cranial bones not sutured so vaginal birth molds it should resolve in a few days
what should be monitored for for a bulging head assessment
increase intracranial pressure, normal when crying, straining, coughing, vomiting, sunken could mean dehydration
what are the types fontanels in newborns
anterior is diamond shape closes 12 to 18 months, posterior is triangle shape closes three months
what is assessed for the eyes of a newborn
they are bluish Gray darker for darker skinned baby, assess sclera color should be white permanent eye color established at six months visual field is 8 to 12 inches can focus for about 10 seconds no tears until two months
what is assessed for the nose of a newborn
they clear secretions by sneezing smell present at birth seen by rooting towards the breast, nose breather for first three months
what is an abnormal finding of newborn nose
deviation, nasal flaring
what is assessed in the newborn mouth
should be moist, pink, scant saliva, palpate for teeth assess for paralysis from birth, assess hard and soft palate for possible cleft palate, assess suckling and gag reflex, tongue for anlkoglossia (tongue tie) epstein’s pearls (small white cyst found along hard palate and gums
what should be monitored for the newborn neck
assess for no webbing and they can easily move from side to side, assess for torticollis (deviation of neck to one side caused by spasmodic neck muscular contraction)
what should be assessed for the newborn ears
assess size comma placement in relation to eyes comma top of ear is parallel to outer cantous of eye, assess for ear tags or pits this can indicate kidney problems bc they develop at the same time, hearing screen before discharge
what is assessed in an alcohol infant
short palpebral fissures, flattened nasal bridge with small upturned nose, flat mid face, thin upper lip, smooth philtrum, microcephaly, micrognathia (small chin)
what all should you assess for GU in newborn
bowel sounds in all 4 quadrants, bowel obstruction often 1st ID with careful assessment
what is diastasis recti
abdomen muscles separate it is noticed when crying
what is an umbilical hernia
abdominal distention
what is gastroschisis in an newborn
stomach and intestines herniate through abdominal wall so you need to cover the intestines with moist sterile gauze and wrap in plastic
what is an omphalocele
intestines protrude into umbilical cord region
when should a newborn void and what should it look like
should void within first 24 hours of life should be dark and concentrated then becomes more straw colored should have no odor it says for brick dust which could mean urate crystals pink would mean extra uric acid
what is the specific assessment done on a female newborn
external genitalia may be swollen blood tinged mucus or clear mucus discharges normal from maternal hormones labia majora should cover labia minora, assess for grossly enlarged clitoris could mean increased androgen production
what is the specific assessment done on a male newborn
testicles descend at 35 weeks rugae present on scrotum, assess for hydrocele (fluid filled scrotal sack), location of urinary meatus is hypospadias
what are the two types of hypospadias
episadia = require surgery smegma = waxy substance found under glands penis it is normal
what is the assessment done on the rectum/anus of newborn
newborn stool normally black and tarry should have no odor, first stool is called meconium, stool should transition to yellowish and color but not formed within a few days
what is circumcision
removal of scan from glance peenis done sterile technique infinus restrained must have consent
what are the different types of circumcisions and what is done after
gomaco clamp, mogen clamp or plastibell, after procedure used Vaseline until skin heals you will know it’s healed with a yellow crusty scab Vaseline is used to prevent sticking to diaper want to assess Q 30 minutes for two hours want to watch them pee and assess for infection
what do you want to assess for the muscoskeletal system on a newborn
want to assess where they can move around flexing and extending arms and legs sucking on fingers, moving head side to side, assess the symmetry and extremity lengths movement and tone
what are you assessing for for the hip joints
it’s done by a doctor developmental dysplasia of hip caused by frank breech, want to assess uneven skin folds and thighs when supine assess for galezzi maneuver assess Barlow and ortonian maneuver treatment used is pelvic harness should only be taken off for baths
what is a head lag maneuver
pull infant by the arms and watch for head to fall back
how do you differentiate a clubfoot or just positioning
clubfoot you cannot maneuver it treatment is serial casting
what is Synoddactyl
webbing fingers
what would a simian crease show you
the single crease and palm can be associated with Down syndrome
what are the characteristics of of a newborn cry
should be vigorous and medium pitch a high pitched cry could mean neurological problems
what are some common health problems associated with premature newborns
respiratory and feeding difficulty, cerebral palsy, developmental delays, vision and hearing problems, gerd, interventricular or pre ventricular hemorrhage, necrotizing enterocolitis
what nutrition should preemies be doing
preemies born without full development of GI enzymes needed for digestion to know they are ready for feedings they will root alert phase usually require enteral feedings IV parental feedings and TPN breast milk best to decrease risk of developing necrotizing enterocolitis
what is necrotizing enterocolitis
bowel inflammation result in bowel damage including ischemia related to limited blood and O2 flow to the gut, bowel can become necrotic and perforation can occur resulting in septicemia
what are GERD ss
frequent regurge, irritability when feeding, refusal to eat, only eating small amounts, arching back while feeding, frequent hiccups, or coughing, frequent waking during sleep, wheezing, pneumonia, poor weight and growth patterns or weight loss
what are the risks for preterm babies
maternal smoking, maternal age, maternal drug use, partner violence, multiple gestation, maternal uterine abnormalities, fetal anomalies, maternal infection, history of preterm birth, African American
what are the SS of necrotizing enterocolitis
lack of bowel movement, blood and stool, signs of infection, abdominal distention by one to two centimeters after feeding so measure before and after
what is the treatment for necrotizing enterocolitis
barrel rest, antibiotic, TPN and lipids
what is GERD related to premies
common in preemies related to small stomach and immature GI motility doesn’t go away for a while
what is the treatment for GERD
changing type of feeds and position for feeds, smaller more frequent feedings, elevated after meals, frequent burping, adding rice cereal to feeds, PPI or H2 receptors
what happens to the weight of a post term newborn
they can lose weight in utero
what are the ss of a post term newborn
but conium stained cord, peeling of the skin, skin is cracked on abdomen and extremities, fingers long and peeling, may have general muscle wasting
what are the risks for post term infants
passing meconium in utero meconium aspiration syndrome
how do you diagnose meconium aspiration syndrome
CXR
what are the symptoms of meconium aspiration syndrome
meconium stained skin common nails, cord, respiratory distress, cyanosis, decreased heart rate, barrel chest, rales/rhonchi
what is the treatment for meconium aspiration syndrome
chest physiotherapy Q3 to four hours and OT administration by CPAP
