Neonate Flashcards
Goals of Newborn Care
To establish and maintain airway
Support respirations
Maintain warmth and prevent hypothermia
To identify actual or potential problems
S/S of cold stress
Axils art temp of 97.6 or lower, skin is cool, lethargic, pallor, grunting, hypoglycemic, hypotonia, jittery, don’t suck well
When do you do an apgar score?
1 and 5 minutes after birth
Cold stress
When they have a cold stress they have excessive heat loss, this links to their hypothermia, decreased compensatory mechanisms to create and maintain body temperature
4 ways baby can lose their body heat
Convection (body surface is open to air); radiation (body surface is next to cool solid surface but not direct contact); evaporation (liquid converts to vapors, most significant way baby loses heat first few days); conduction (the body is in direct contact with cool surface)
Good baby’s skin temperature
97.7-99 degrees Fahrenheit
Nursing interventions for cold stress
Maintain neutral thermal environment, swaddled in warm blankets, put skin to skin with mom, dry baby thoroughly, put cap on head, assess for hypoglycemia
Risk factors for cold stress
Prematurity, small for gestational age, become hypoglycemic, prolonged resuscitating efforts, septic, neurological/endocrine/cardio/respiratory problems
Brown fat distribution
Majority located: Major thoracic vessels Neck Clavicles Axillae Sternum Kidneys Adrenal glands
Respiratory rate in newborns
30-60
What helps stimulate breathing?
When babies are first born they have mild hypoxia, acidosis, and hyperkinepia which stimulates them to breath (breathing onset)!
2 factors that negatively affect respiratory effort
Decreased surfactant level OR have persistent hypoxemia or acidosis
What is mom given if baby is born prematurely?
If baby is born prior to 36 weeks mother has had betamethazon (12 mg- 2 doses 24 hrs apart)
If baby comes before mom receives betamethazone they can give baby artificial surfactant through an ET tube
Other respiratory system extra uterine life information.
Small amounts of fluid retained in lungs is absorbed
When the chest wall expands after delivery the first breath of air is inhaled
Causes an increase in alveolar PO2 with subsequent relaxation of pulmonary arteries
Pulmonary vascular resistance decreased allowing increased pulmonary vascular flow
Results in oxygenation of newborn tissues
Respiratory Distress syndrome S/S
Nasal flaring, intercostal or subcostal retraction, grunting with respirations, sea saw or paridoxical respirations, tachyons, cyanosis, hypotonia
Severe respiratory syndrome
When in severe respiratory distress baby will have shock like symptoms, diminished cardiac return, bradycardia, low systemic BP, rapid breathing
When is majority of surfactant made?
36 weeks gestation
Foramen Ovale
Causes increased PO2
It is an opening between the two atrias
Usually closes functionally in minutes to an hour after birth
Structurally it closes within a week
Ductus Arteriosus
Increased PO2 leads to closure of ductus Arteriosus
Opening between pulmonary artery and aorta
Functionally it usually closes within 96 hours of birth
Structurally it closes within 4 months of birth
Ductus Venosus
Closure of ductus Venosus and umbilical arteries veins r/t decreased blood flow
Opening between the umbilical vein and inferior vena cava
Functionally closes within 2-3 days
Structurally closes within 1 week
Newborn BP
72/47
Premature BP
64/39
Apical pulse
Want to take apical pulse for a full minute
Take it at point of maximum impulse (4th intercostal space left of midclavicular line
Not unusual to hear. Murmur on a baby.
What happens as respiratory distress syndrome continues?
They may develop apnea, unresponsive, may not hear breath sounds, may have mottling
What does increased pulmonary resistance do?
Increased pulmonary resistance forces most of the blood through the ductus Arteriosus into the descending aorta.
What does the umbilical cord contain?
2 arteries and 1 vein
Conditions that affect the transport of oxygen:
Alkalosis Hypothermia Acidosis Hypercarbia Hyperthermia HbF fetal hemoglobin 70-90% HbA adult hemoglobin
