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NUR 360 Maternal > Newborn Care Fundamentals > Flashcards

Newborn Care Fundamentals Flashcards

1
Q

Define: Transition to Extrauterine Life

A

The major adaptations occur during the first 6 to 8 hours after birth.
Changes are mediated by the SNS

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2
Q

What are the major changes needed to transition to extrauterine life?

A

heart rate
respirations
temperature
GI function

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3
Q

What are the time periods for the 3 stages of the “Transition Period”

A

I: minute 0-30 PP - period of reactivity 1
II: minute 60-100 PP - decreased responsiveness
III: 2-8 hours PP - period of reactivity 2

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4
Q

What happens during the first stage of the Transition Period

A
  • HR increases to 160-180 bpm then decreases to 100-160
  • RR may be irregular (60-80 bpm)
  • Fine crackles may be present on auscultation; audible grunting, nasal flaring
  • infant is alert and may have spontaneous startles or tremors
  • bowel sounds are audible, meconium may be passed
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5
Q

What happens during the second stage of the Transition Period

A
  • the newborn either sleeps or has a marked decrease in motor activity
  • RR will shallow (30 bpm) but not be laboured + infant should be pink
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6
Q

What happens during the third stage of the Transition Period

A
  • periods of tachycardia, tachypnea, increased muscle tone, mucus prodoction, increased colour
  • meconium commonly passed in this stage
  • very preterm infants do not experience this phase
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7
Q

What physiological adaptations occur in the respiratory system? What causes this?

A

The site of gas exchange changes from the placenta to the lungs
Clamping the umbilical cord = rise in BP = which increases circulation and lung perfusion

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8
Q

What are some signs of respiratory distress?

A
  • nasal flaring
  • intercostal or subcostal retractions
  • paradoxical respirations (exaggerated rise in abdomen, with respiration, as chest falls)
  • RR outside of 30-60 bpm
  • central cyanosis (bluish lips and mucous membranes)
    = hypoxia
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9
Q

T or F: the RR of the baby can be negatively influenced by analgesics or anesthetics given to mom

A

true

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10
Q

T or F: acrocyanosis is a normal finding in a nb infant

A

Acrocyanosis (bluish discolouration of hands and feet) is a normal finding in the first 7 to 10 days after birth

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11
Q

What are some common respiratory complications

A

Respiratory distress syndrome (RDS)
Meconium aspiration
Pneumonia
Persistent pulmonary hypertension

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12
Q

T or F: the symptoms of all respiratory complications last for hours

A

False: only serious respiratory problems have pronounced symptoms that last beyond the first 2 hours after birth
Ex. symptoms of transient tachypnea usually subside within 2 hours

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13
Q

What physiological adaptations occur in the cardiovascular system after birth? What causes this?

A

First breath -> alveolar distension -> inflation of lungs -> 1) increased blood flow to pulmonary arteries -> 2) closure of the foramen ovale
3) increase in PO2 in blood

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14
Q

Changes in BP PP

A

Range: 60/40 - 80/50
first hour of life: drop in bp (about 15 mmHg)
By second day of life: BP increases and stabilizes
- The number of weeks of gestation can be used as a guide for the mean arterial pressure (MAP).
Ex. Infant born at 40 weeks = MAP of at least 40

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15
Q

What do we use to measure bp on infants? Is this a routine measure?

A

oscillometric device (bp machine) - not a routine measurement in healthy newborns

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16
Q

What are sign of cardiovascular problems?

A
  • HR >160 bpm or HR >100 bpm
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17
Q

What components of the hematopoietic system are higher in infants than in adults?

A

RBC, Hb, leukocytes

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18
Q

How long does adjustment to extrauterine environment temperature take?

A

12 hours after birth

Should settle between the normal range of 36.5-37.5

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19
Q

What factors are controlled for to help the thermogenic system while it adapts?

A

Convection - flow of heat from body surface to cooler air in the room
Conduction - loss of body heat from body surface to colder objects in direct contact with body
Radiation - heat lost from the body to cooler solid surfaces not in direct contact with baby ex. window
Evaporation - cold caused by body heat lost to evaporation of fluids

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20
Q

T or F: infants remain warm by shivering

A

False.
The shivering mechanism is non-functional in newborns.
To stay warm nb will:
assume a position of flexion and use nonshivering thermogenesis

21
Q

What types of heat loss does S2S protect from?

A

Conductive and radiant

22
Q

What is nonshivering thermogenesis

A

The metabolism of brown fat reserves to preserve body heat

23
Q

What are the effects of cold stress?

A

Can cause

  • increased RR
  • vasoconstriction
  • ultimately metabolic acidosis
24
Q

What factors contribute to cold stress

A
  • Larger body surface to body mass
  • Higher metabolic rate with limited glycogen stores
  • Poorly developed shivering response
  • Heat loss through any of 4 modes
25
Q

Describe the expected findings for the GI system?

A
  • Mucous membranes should be moist and pink; the hard and soft palates are intact.
  • mucus is common in the first few hours after birth.
  • Small whitish areas (Epstein pearls) may be found on the gum margins and at the juncture of the hard and soft palates.
  • The infant is unable to move food from the lips to the pharynx; place nipple well inside the baby’s mouth
  • Peristaltic activity: uncoordinated to coordinated in first few days
  • Bowel sounds can usually be heard shortly after birth.
  • Stomach capacity 30 mL to 90 mL by day 7
  • The normal nb digests carbs and proteins but has a limited ability to digest fats. Lipase in human milk aids in digestion of fats by the newborn.
26
Q

Describe the changes in stool

A

o Meconium
Infant’s first stool, composed of amniotic fluid and its constituents, intestinal secretions, shed mucosal cells, and possibly blood (occurs in first 24-48 hours; may be delayed in very-low-birth-weight infants)
o Transitional Stool
Appear by the 3rd day after initiation of feeding. Greenish to yellowish brown in colour
o Milk Stool
Appears by 4th day
breastfed -> yellow, pasty, odour of sour milk
Formula -> yellow/brown, firmer, odour of normal stool

27
Q

How much fluid intake should a nb >1500g have?

A

day 1-2: 60-80mL/kg/day

day 3-7: 100-150mL/kg/day

28
Q

Signs of GI problems:

A
  • abnormalities in: stool + regurgitation
  • fullness of the abdomen above the umbilicus
  • Intolerance to formula
29
Q

What is the major function of the hepatic system in respect to jaundice? What types of problems can arise from this?

A
  • excretion of bilirubin
    Pathological jaundice -> within the first 24 hours and fast rise, something pathological ie: blood incompatibility
  • Physiological jaundice -> immature liver to excrete broken down RBCs, normal day 2-3
  • Breast milk jaundice -> not getting enough hydration to excrete bilirubin
30
Q

Why is vit K necessary for babies

A

to prevent hemorrhagic issues, coagulation factors made in liver depend on this, not naturally made in liver until intestinal microflora present

31
Q

What are some signs of infection

A

temp. instability
hypothermia
prematurity

32
Q

What are some common findings of the integument in nb?

A 
Vernix
erythematous (red) skin 
cyanotic hands and feet (acrocyanosis)
lanugo hair
Venous lacerations may occur underneath the skin
33
Q

How may a forceps-assisted birth or vacuum extraction cause integument damage?

A

edema of the face and ecchymosis (bruising)

34
Q

What is desquamation?

A

peeling of the skin (normal after a few days)

35
Q

What are some concerning findings during an integument assessment?

A

pallor, plethora (deep purplish colour from increased circulating RBCs),
petechiae, central cyanosis, or jaundice

36
Q

What are some normal findings in the assessment of the genitalia

A 
Edema (swelling)
Tight prepuce (foreskin) is common in newborns and completely covers the glans penis
37
Q

Signs of reproductive system problems

A

Abnormal placement of urethral opening (hypospadias/epispadias), absence of hymenal tags, fecal discharge from the vagina, undescended/maldescended testes
- If the male infant is born in a breech presentation, the scrotum is edematous and may be bruised

38
Q

Extra digits and missing digits are called

A

polydactyly and oligodactyly

39
Q

T or F: the neurmuscular system is almost completely developed at birth

A

True

40
Q

Are tremors and jitteriness normal?

A

Yes unless persistent / cannot by ceased with gentle restraint

41
Q

Describe the following reflex: Extrusion

A

Touch or depress tip of tongue -> newborn forces tongue outward.

42
Q

Describe the following reflex: tonic neck or “flexing”

A

With infant in a supine neutral position, turn head quickly to one side -> with infant facing left side, arm and leg on that side extend; the opposite arm and leg flex (turn head to right, and extremities assume opposite postures).

43
Q

Describe the following reflex: Moro (startle)

A

Hold infant in semisitting position, allowing head and trunk to fall backward (with
support) or place infant supine on flat
surface; make a loud, abrupt
noise -> Symmetrical abduction and extension of arms are seen; fingers fan out

44
Q

Describe the following reflex: Magnet

A

Place infant in supine position, partially flex both lower extremities, and apply light
pressure with fingers to soles of feet -> Both lower limbs should extend against examiner’s pressure

45
Q

Describe the following reflex: pull-to-sit

A

Pull infant up by wrists from supine position with head in midline -> Head lags until infant is in upright position; then head is held in same plane with chest and shoulder
momentarily before falling forward; infant attempts to right head.

46
Q

Describe the following reflex: babinski (plantar)

A

On sole of foot, beginning at heel, stroke upward along lateral aspect of sole, then move
finger across ball of foot  all toes hyperextend, with dorsiflexion of big toe—recorded as a positive sign.

47
Q

What is the normal range for: weight, height, head circ, chest circ

A

2600 - 4000 g
48-55 cm
Head 33-38 cm
Chest - 2-3 cm smaller than head

48
Q

go through last two pages of notes

A

go

NUR 360 Maternal (3 decks)

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