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NUR 318 > module 12 > Flashcards

module 12 Flashcards

1
Q

newborn transition to extrauterine life

A

respiratory gas exchange
circulatory modifications
changes in organ system

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2
Q

first period of reactivity

A

lasts up to 30 mins after birth
the newborns HR increases from 160-180 bpm
decreases after 30 mins to baseline
infant is alert and has spontaneous startles, crying and head movement

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3
Q

period of decreased responsiveness

A

lasts 60-100 minutes
infant is pink
respiration are rapid and shallow up to 60 breaths per minute
sleeps or has a marked decrease in motor activity

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4
Q

second period of reactivity

A 
lasts from 10 minutes to several hours
occurs between 2 and 8 hours after birth
tachycardia, tachypnea occur
meconium is passed 
increased muscle tone, changes in skin color and mucus production
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5
Q

challenges in the transition to extrauterine life

A

system wide changes
neutral thermal environment
prevention of cold stress
problems with bilirubin conjugation and jaundice

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6
Q

the cardiovascular system

A
  • switch from fetal to newborn circulation
  • physical forces leading to increased release of catecholamines are critical for the transition
  • changes in fetal structures: foramen ovale, ductus arteriosus, ductus venous and umbilical arteries, and vein
  • heart rate
  • blood volume depends on the amount of blood transferred from the placenta and is affected bu time of cord clamping
  • blood components: red blood cells with greater affinity for oxygen at a lower oxygen than adult RBCs
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7
Q

fetal circulation

A

placenta: provides oxygen and nutrients to the fetus and eliminates waste
three shunts allow the circulation to bypass fetal lungs and liver.
-foramen ovale: moves blood from R atrium to L atrium
-ductus arteriosus: moves blood from the pulmonary artery to the aorta
-deuctus venosus: moves blood from the L umbilical vein into the inferior vena caba

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8
Q

conversion from fetal to neonatal circulation

A

umbilical cord clamped-> fetal circ interrupted and first breaths taken–> pressure changes in the body

  • there is a decrease in pulmonary vascular resistance which increase pulmonary blood flow, increase left atrium pressure and decreases right atrium pressure (closing foramen ovale)
  • increased systemic vascular resistance: decreases vena cava return, decreases umbilical vein blood flow(ductus venosus closes), increase in aortic pressure (ductus arteriosus closes)
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9
Q

summary of fetal to neonatal circulation

A
  • clamping the umbilical cord at birth eliminates the placenta as a reservoir for blood
  • the onset of respirations causes a rise in PO2 in the lungs and a decrease in pulmonary vascular resistance
  • this increases pulmonary blood flow and increases the pressure in the left atrium
  • decreased pressure in the right atrium causes the closure of the foramen ovale
  • with an increase in oxygen level after the first breath, an increase in systemic vascular resistance occurs
  • this decreases vena cava return which reduces bf to the umbilical vein
  • closure of the ductus venosus causes an increase in pressure in the aorta which forces the closure of ductus arteriosus within 10 to 15 hours after birth
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10
Q

respiratory system

A

initiation of respirations: adjusting from a fluid-filled intrauterine environment to a gaseous extrauterine environment

  • surfactant: surface tension reducing lipoprotein that prevents alveolar collapse. production begins at 24 wks. sufficient amounts by 35 wks
  • respirations: 30-60 breaths per minute; irregular, hallow, unlabored with short periods of apnea; symmetrical chest movements
  • expansion of the lungs and establishment of the functional residual capacity
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11
Q

respiratory system with c section

A

a neonate born by c section does not have the same benefit of the birth canal squeeze as does the newborn born by vaginal delivery. closely observe the respirations of the newborn after cesarean delivery. crackles or ronchi are seen with c- section

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12
Q

intrapulmonary fluid

A

decreased secretion as infant approaches term
absorption increases during labor and delivery to a few hours after birth
decreased intrapulmonary fluid: reduces pulmonary resistance to blood flow and facilitates initiation of air exchange

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13
Q

production and release of surfactant

A

usually sufficient secretion at 34-36 weeks gestation
-RDS may occur in infants with immature lungs
-betamethasone if preterm birth is expected
ling expansion after birth stimulates surfactant release
surfactant decreases surface tension within alveoli
-allows alveolar re-expansion after exhalation

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14
Q

the first breath internal stimuli

A

chemical factors: hypercarbia, acidosis, and hypoxia
the stress of labor= hypoxia
hypoxia= low PaO2 and low pH
increased PaCO2= prompts initiation of breathing

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15
Q

the first breath external stimuli

A

sensory factors: sensory overload- touch, sound and light
thermal factors: temperature changes: warm to cool
mechanical factors: removal of fluid from lings and replacement with air

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16
Q

conduction

A

transfer of heat from the object to object when the two objects are in direct contact with each other

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17
Q

convection

A

loss of heat from warm body surface to cooler air current (keep away from air vents)

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18
Q

evaporation

A

loss of heat when water is converted into vapor insensible water loss (dry the baby)

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19
Q

radiation

A

loss of body heat to cooler, solid surfaces in close proximity but not in direct contact (windows away)

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20
Q

thermoregulation

A

the balance between heat loss and heat protection
heat production: primarily through nonshivering thermogenesis
heat loss via four mechanisms leading to cold stress
-the need for a neutral thermal environment: a high temp or a low temp increases oxygen consumption and increases metabolic demands
overheating: large body surface area, limited insulation, and limited sweating ability

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21
Q

newborn risk factors for cold stress

A

think skin; blood vessels close to the surface
lack of shivering ability; limited stores of metabolic substrates
limited use of voluntary muscle activity
large body surface area relative to body weight
lack of subq fat
cannot adjust own blanket or clothing for warmth
cannot communicate they are too cold or too warm

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22
Q

what mechanisms does the newborn have to maintain temperature

A

increase respirations
increase metabolism of brown fat
pulmonary and peripheral vasoconstriction

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23
Q

what are the consequences of cold stress

A

metabolic acidosis

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24
Q

nursing interventions to prevent cold stress of the neonate

A

dry immediately after birth
place infant skin to skin with mom
cover with a blanket and hat
assess the newborn’s temperature every hour until stable
observe for clinical signs of cold stress such as respiratory distress, central cyanosis, hypoglycemia, lethargy, weak cry, abdominal distension, apnea, bradycardia, and acidosis

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25
Q

renal system

A

limited ability to concentrate urine until about 3 months of age
six to eight voidings per day are considered normal
low GFR and limited excretion and conservation capability: affects a newborn’s ability to excrete salt, water loads, and drugs

26
Q

gastrointestinal system

A

development of a mucosal barrier to prevent the penetration of harmful substances
physiologic capacity of the newborns stomach is considerably less than the anatomic capacity
cardiac sphincter and nervous control of stomach are immature leading to regurg and uncoordinated peristaltic activity
to gain weight the newborn requires an intake of 108 kcal/kg/day from birth to 6 months

27
Q

characteristics of newborn stool

A

meconium, then transitional stool, then milk stool
breast fed newborns: yellow-gold, loose, stringy to pasty, sour-smelling
formula-fed: yellow, yellow-green, loose, pasty or formed, unpleasant odor
colostrum has a laxiatice effect

28
Q

hepatic system

A

the liver is immature at the time of birth and slowly becomes functional
iron storage: lower in preterm and SGA infants so depleted sooner
bioavailability of iron in breast milk is superior to formula
glucose homeostasis: regulates blood glucose levels: risk factors: SGA, LGA, preterm, diabetic mother
carbohydrate metabolism
blood coagulation (vita k given to help with clotting)
bilirubin conjugation so that it becomes soluble and excreted

29
Q

who to monitor of hypoglycemia

A

SGA, LGA, preterm and diabetic moms

usually done after 30 mins of birth

30
Q

jaundice

A

increased change of jaundice due to hemolysis of RBCs
-the appearance of jaundice in the first 24 hours of life or persistence beyond the ages discusses= pathologic issue that needs intervention to be immediately dealt with

31
Q

first places to see jaundice

A

skin of:
face
chest
abdomen

32
Q

natural immunity

A

physical barrieres, chemical barriers, and resident non pathologic organisms

33
Q

acquired immunity

A

development of circulating immunoglobulins; formation of activated lymphocytes
absent until after the first indication of foreign organism or toxin
newborn primarily dependent on three immunoglobulins: IgG, IgA, and IgM

34
Q

integumentary system

A

protective barreir between body and environment
function: limit loss of water, prevent absorption of harmful agents, protects thermoregulation and fat storage, and protects against physical trauma
accelerated epidermal development with exposure to air for all newborns
1st bath usually delayed unless GBS+., HIV+ or COVID+

35
Q

common skin variations

A

slides under integumetary system

36
Q

reproductive system

A

may be swelling of the breast tissue or signs of risk for reproductive problems

37
Q

neurologic system

A

the development follows a cephalocaudal and proximal-distal pattern
acute sense of hearing smell and taste
adaptations of the respiratory, circulatory, thermoregulation, and musculoskeletal systems indirectly indicating central nervous system transition
reflexes: indicating neurologic development and function

38
Q

variations in head size and appearence

A

caput succedaneum: a collection of serous fluid that passes the suture line
cephalhematoma: collection of blood that does not cross. suture line (is a risk factor for hyperbilirubinemia)

39
Q

hyperbillirubinemia rf

A

ABO incompatibility
Asian, Latino, African American
cephalohematoma
facial bruising

40
Q

orientation

A

response to stimuli

41
Q

habituation

A

ability to process and respond to auditory and visual stimuli as well as ability to block out external stimuli after newborn has become used to the activity

42
Q

motor maturity

A

ability to control movement

43
Q

self quieting ability

A

consolability

44
Q

social behaviors

A

cuddling and snuggling

45
Q

nursing interventions of the immediate newborn period

A

maintain airway patency
ensure proper identification
length/ weight of the newborn
maintain thermoregulation
eye prophylaxis: erythromycin and tetracycline antibiotic ointment within 1-2 hours
vitamin K:m0.5-1 mg IM shortly after birth in the vastus lateralis. it is given because the gut bacteria typically produces vitamin K and the newborn gut is sterile

46
Q

physical assessment of the newborn in the first 2 hours

A

general appearance
vital signs
baseline measurements of physical growth like weight, head circ, and body length, neurologic assessment

47
Q

common newborn problems

A

birth injury, hyperbilirubinemia, hypoglycemia(at birth it can drow to 30mg/dl. feed then test 30 mins after feeding. feed 1-5ml colostrom or donor milk or dextrose gel), hypocalcemia(common with mothers on anticonvulsants and is usually self limiting in early onset), subconjunctival hemorrhage,

48
Q

apgar in the first 1 min and 5 mins

A

Heart rate score: 0-absent, 1-slow (less than 100 bpm), 2->100 bpm
respiratory effort score: 0-absent cry, 2- slow, weak cry, 3-good cry
muscle tone: 0-flaccid, 1-some flexion of the extremities, 2- well flexed
reflex irritability: 0-no response, 2- grimace, 3-cry
color: 0-blue and pale, 1- body pink, extremities blue, 3- completely pink

49
Q

apgar of <7

A

some type of rescutation is needed, repeat q5 minutes for 20 minutes

50
Q

abnormal newborn breathing

A

bradypnea: <30 respirations/ minute
tachypnea: >60 respirations/ minute
abnormal breath sounds: coarse or fine crackles, wheezes
audible expiratory grunt: means the newborn needs to use pressure to open alveoli
increased work of breathing
paradoxical respirations
central cyanosis or mottling
O2 sat <95%

51
Q

appropriate for gestational age weight

A

10th-09th percentile

grew at a normal rate in utero regardless of the length of gestation

52
Q

large for gestational age weight

A

> 90th percentile
grew at an accelerated rate
at risk for hypoglycemia

53
Q

small for gestational age weight

A

<10th percentile
grew at a restricted rate
growth should equal fundal height after 24 weeks. this likely did not happen with this pregnancy

54
Q

the early newborn period

A

temperature stabilization
may lose 5-10% of birth weight
important to assess feeding pattern and important to assess void and stool pattern

55
Q

newborn screening tests

A

hearing
cardiovasculalr
metabolic screening: PKU (metabolic disorders, thyroid disorders, sicke cell, cystic fibrosis) usually taken at 24 hours

56
Q

circumcision

A 
observe for the first void
observe for bleeding
careful diaper change
application of vaseline or neosporin
heals within 10 days
57
Q

umbilical cord care

A

natural healing, soap and water, alcohol or povione-iodine.
clamp is removed when the stump is dry before discharge
falls off in approximately 10 days

58
Q

neonatal pain management

A

neonates feel pain
responses can be life threatening and can be greater in preterm neonates
cry is most often the response
nonpharmacologic management: skin to skin, swaddling, positioning, massage, rocking
topical anesthesia, acetaminophen

59
Q

bilirubin check

A

is done 6h before they leave
if it si less than 12, they are good to go
if it is greater, a serum bilirubin is typically done and phototherapy may be utilized

60
Q

discharge planning

A 
feeding and non nutritive sucking 
diapering and clothing
jaundice
bathing: spongue bath until the cord falls off
sleep: back to sleep
car seat safety
signs and symptoms to report
follow up appointment: practical suggestions for the first week at home, interpretation of crying and use of queting techniques, recognition of s/s

NUR 318 (10 decks)

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