Newborn Physiologic Adjustments (Respiratory)

Question 1

What is the most critical physiological adaption after birth?

Answer 1

Establishment of effective respirations

Question 2

During intrauterine life, how does oxygenation occur?

Answer 2

Occurs though transplacental gas exchange.

Question 3

In utero what is the fetal blood shunted away from?

Answer 3

The lungs.

Question 4

What happens when the umbilical cord is clamped?

Answer 4

Clamping the umbilical cord causes a rise in BP, which increases circulation and lung perfusion.

Question 5

The initiation of respirations in the neonate is the result of a combination of:

Answer 5

Chemical, mechanical, thermal, and sensory factors.

Question 6

What chemical factor initiates respirations based off of contractions?

Answer 6

Decreased levels of O2 and increased CO2 have a cumulative effect that is involved in initiating neonatal breathing by stimulating the respiratory center in the medulla.

Question 7

What chemical factor initiates respirations based off clamping the cord?

Answer 7

As a result of clamping the cord, there is a drop in level of a prostaglandin that can inhibit respirations.

Question 8

What mechanical factor promotes respirations based off the birth canal?

Answer 8

Intrathoracic pressure resulting from compression of the chest during vaginal birth can stimulate respirations.

Question 9

What does negative intrathoracic pressure due to an infants lungs?

Answer 9

Helps draw air into the lungs and may stimulate crying.

Question 10

How does crying help the stimulation of respirations?

Answer 10

Cry increases the distribution of air in the lungs and promotes expansion of the alveoli.
Helps keep the alveoli open.

Question 11

What thermal factor promotes respiration?

Answer 11

The profound change in environmental temperature stimulates receptors in the skin, resulting in stimulation of the respiratory center in the medulla.

Question 12

What sensory factors stimulate respirations?

Answer 12

Include:
Handeling infant 
suctioning the mouth and nose
drying the infant 
lights
sounds
smells

Question 13

At term the lungs hold approximately how many mL of fluid per kilogram?

Answer 13

20mL.

Air must be substituted for the fluid that filled the fetal reparatory tract.

Question 14

Which infants are more likely to develop transient tachypnea of the newborn (TTNB)?

Answer 14

Infants born by cesarean in which labor did not occur before birth.

Question 15

What exactly causes transient tachypnea of the newborn (TTNB)?

Answer 15

Caused by the lower levels of catecholamines.

Question 16

What are the alveoli of a term infant’s lung lined with?

Answer 16

Surfactant.

Question 17

What is lung expansion largely dependent upon?

Answer 17

Depends largely on chest wall contraction and adequate recreation of surfactant.

Question 18

Why is surfactant important in respirations?

Answer 18

Surfactant lowers surface tension and prevents total alveolar collapse on exhalation.

Question 19

What is beneficial regarding decreased surface tension during respirations?

Answer 19

Reduces pressure required to keep the alveoli open with inspiration.
Results in increased lung compliance, helping to establish the functional residual capacity of the lungs.

Question 20

What happens when an infant has absent or decreased surfactant?

Answer 20

More pressure must be generated for inspiration, which can soon tire or exhaust preterm or sick term infants.

Question 21

What is the normal range of breath per min. in term infants?

Answer 21

30 to 60 breaths/min with periods of breathing that include pauses in respirations lasting less than 20 seconds.

Question 22

When do the episodes of periodic breathing occur most often?

Answer 22

REM sleep cycle. They decrease in frequency and duration with age.

Question 23

When should episodes or periodic breathing be a concern?

Answer 23

Apneic periods longer than 20 seconds indicate a pathologic process and should be evaluated.

Question 24

What airway do newborns prefer to breath from?

Answer 24

Nose

Question 25

What is the reflex that occurs due to nasal obstruction and when does this reflex present itself?

Answer 25

The reflex response to nasal obstruction is to open the mouth to maintain airway. This response isn not present in most infants until 3 wks after birth.

Question 26

What can occur due to a nasal obstruction up to 3 weeks after birth?

Answer 26

Cyanosis or asphyxia can occur with nasal blockage.

Question 27

Why is abdominal breathing a large characteristic in newborns?

Answer 27

Because neonatal respiratory function is largely a matter of diaphragmatic contractions.

Question 28

What are some major signs of infant respiratory distress?

Answer 28

1. Nasal flaring
2. Intercostal or subcostal retractions (in-drawing of tissue between the ribs or below the rib cage)
3. Grunting with respirations.

Question 29

What two factors most often represent an upper airway obstruction?

Answer 29

Suprasternal or subclvicula retractions with stridor or gasping.

Question 30

What two characteristics that replace abdominal respirations are abnormal and should be reported?

Answer 30

1. Seesaw

2. Paradoxical respirations (exaggerated rise in abdomen with respirations as the chest falls)

Question 31

What respiratory rate must be evaluated in a resting infant?

Answer 31

60 breaths/min

Question 32

How can analgesics or anesthetics that were administered to the mother during labor effect the respirations of infants after birth?

Answer 32

Infant respirations can be slowed, depressed, or absent.

Question 33

What can apneic episodes be related to?

Answer 33

1. Rapid increase in body temp.
2. Hypothermia
3. Hypoglycemia
4. Sepsis

Question 34

What can tachypnea result from?

Answer 34

Inadequate clearance of lung fluid, or it can be an indication of newborn respiratory distress syndrome (RDS).

Question 35

What integumentary finding can indicate respiratory distress?

Answer 35

Changes in the infant’s color.

Question 36

What is acrocyanosis?

Answer 36

The bluish discoloration of hands and feet, is normal finding in the first 24 hours after birth.

Question 37

What is significant about central cyanosis?

Answer 37

Is an abnormal finding and signifies hypoxemia.

Question 38

How can a nurse identify central cyanosis?

Answer 38

The lips and mucous membranes are blueish.

Question 39

What can central cyanosis be the result of?

Answer 39

1. Inadequate delivery of O2 to the alveoli
2. Poor perfusion of the lungs that inhibits gas exchange
3. Cardiac dysfunction

Question 40

Is central cyanosis an early or late sign?

Answer 40

Late sign of distress, newborns usually have significant hypoxemia when cyanosis appears.

Question 41

Infants who experience mild TTNB often have signs of respiratory distress during:

Answer 41

The first 1 to 2 hrs after birth as they transition to extrauterine life. Tachypnea rates (up to RR: 100) can be present along with intermittent grunting, nasal flaring, and mild retractions.

Question 42

What nursing intervention may be necessary for infants experiencing respiratory distress?

Answer 42

Supplemental O2.

Question 43

What are 4 common respiratory complications affecting neonates?

Answer 43

1. RDS
2. Meconium aspiration
3. Pneumonia
4. Persistent pulmonary hypertension of the newborn (PPHN)