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NURS787 Exam 2 > Newborn Transition > Flashcards

Newborn Transition Flashcards

1
Q

What are the structures of the upper respiratory tract?

A

1) nose
2) nasal cavity
3) sinuses
4) larynx
5) trachea

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2
Q

What are the structures of the lower respiratory tract?

A

1) lungs
2) bronchi and bronchioles
3) alveoli

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3
Q

Fetal pulmonary circulation has (high/low) vascular resistance

A

high

lungs are closed, fluid-filled w/ minimal blood flow

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4
Q

What occurs during the canalicular stage?

A

@16-24wks GA

  • terminal alveolar sacs appear
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5
Q

What occurs during the saccular stage?

A

@28-34wks GA

  • capillaries come into contact with alveolar basement membrane
  • primitive alveoli develop and are lined w/ 2 types of alveoli cells
    1) type 1 = thin epithelial alveolar cells = gas exchange
    2) type 2 = cuboidal epithelial cells = surfactant production and storage
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6
Q

What occurs during the alveolar period?

A

@36wks GA through childhood

  • more alveoli form –> larger surface area for gas exchange
  • 1/3 of alveoli mature at birth; rest mature after
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7
Q

What happens to the fluid in fetal lungs?

A

begins to clear a few days before labor

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8
Q

Fetal Hgb has (higher/lower) affinity for O2.

A

higher

  • facilitates O2 transport across placenta
  • may result in 80% O2 saturation
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9
Q

How is respiration initiated in the NB?

A

1) fetal plasma levels of catecholamines and cortisol increase during labor
2) stimulates reabsorption of lung fluid (vs secretion before)

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10
Q

What effect does the first active breath have?

A

1) assists w/ conversion from fetal to adult circulation
2) further empties lungs of fluid
3) establishes neonatal lung volume and characteristics of pulmonary function
4) decreases pulmonary artery pressure

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11
Q

At which gestational age is there sufficient surfactant?

A

34wks

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12
Q

What is the function of surfactant?

A
  • reduces surface tension at air/liquid interface in alveoli
  • stabilizes alveolar walls so they don’t collapse at end of each breath
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13
Q

What stimulates release of surfactant?

A

lung expansion

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14
Q

Define functional residual capacity

A

gas volume left in lungs at end of each expiration

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15
Q

What helps maintain functional residual capacity in a NB?

A
  • crying –> slower expiration

- diaphragm

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16
Q

What keeps the ductus arteriosus open?

A

1) placental prostaglandin
2) prostacyclin
3) low O2 tension

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17
Q

What occurs at birth to the ductus arteriosus?

A

constriction!

  • blood from R ventricle enters pulmonary circulation
  • facilitated by oxygenated blood that otherwise flowed past it
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18
Q

When does the ductus arteriosus close?

A

w/in 48h

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19
Q

What is the effect of cord clamping on NB circulation?

A
  • stops low pressure fetal-placental circulation –> NB circulation = closed system

+ first breaths –> decreased pulmonary vascular resistance + increased systemic vascular resistance –> blood flow to pulmonary system

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20
Q

Which substances facilitate vasodilation?

A

1) prostacyclins
2) nitric oxide
3) O2

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21
Q

What lowers pulmonary vascular resistance in the NB?

A

1) physical lung expansion
2) release of prostacyclins and nitric oxide
3) increased O2 tension

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22
Q

What stimulates release of prostacyclins and nitric oxide?

A

1) shearing forces on endothelium w/ increased pulmonary blood flow
2) artery distention –> bradykinin release –> prostacyclin and NO release

23
Q

Define asphyxia

A

state of extreme O2 deficiency and CO2 excess

24
Q

What are the consequences of asphyxia?

A

1) metabolic acidosis

2) signs of organ failure

25
Q

What are various issues that can exacerbate asphyxia and result in respiratory depression in the NB?

A

1) acute interruption of umbilical blood flow (e.g. cord compression)
2) premature placental separation
3) maternal hypotension or hypoxia
4) the above superimposed on chronic uteroplacental insufficiency
5) failure to execute proper resuscitation
6) maternal use of anesthetics/analgesics
7) mode and difficulty of delivery
8) maternal health
9) prematurity

26
Q

Define ductus venosus

A

shunts blood from umbilical vein to inferior vena cava –> allows blood to bypass fetal liver

27
Q

Define ductus arteriosus

A

shunts blood from pulmonary artery to descending aorta –> allows oxygenated blood to bypass fetal lungs

28
Q

Define foramen ovale

A

shunts blood from right to left atria–> allows blood to bypass fetal lungs

29
Q

Define umbilical artery

A

2 arteries in cord –> deoxygenated blood from fetus to placenta

30
Q

Define umbilical vein

A

carries oxygenated blood from placenta to fetus

31
Q

What causes the ductus venosus to close?

A

lack of blood return from placenta

32
Q

What causes the foramen ovale to close?

A

increased pulmonary blood flow –> increased venous return to L atrium –> increased L atrial pressure –> stents foramen ovale closed

33
Q

When should the foramen ovale close?

A

soon after birth

34
Q

What are NB sources of heat?

A

1) non-shivering thermogenesis = primary method
2) oxidative glucose, fat, and protein metabolism
3) voluntary muscle activity
4) shivering

35
Q

Describe non-shivering thermogenesis

A
  • birth = cold –> triggers hypothalamus to oxidize stored lipids in brown fat –> heat production
  • warms blood before circulating to peripheral areas
  • in NBs w/ hypoglycemia or thyroid dysfunction –> ineffective use of brown fat
36
Q

What is a normal NB axillary temp?

A
  1. 5 - 37.5 C

97. 5 - 99.3 F

37
Q

What are the 4 mechanisms of heat loss?

A

1) convection = transfer of heat through air
2) conduction = transfer of heat to cooler surfaces
3) radiation = transfer of heat via thermal waves to cooler surfaces not in direct contact
4) evaporation = loss of heat from evaporation of moisture

38
Q

How should NB temperature be maintained?

A

1) skin-to-skin = best!
2) drying, bundling
3) warmer
4) postpone first bath
5) cute lil’ hat!

39
Q

What factors predispose the NB to hypothermia?

A

1) large surface
2) limited subQ fat insulation
3) limited ability to generate heat via shivering
4) immature permeable skin
5) wet w/ amniotic fluid

40
Q

What are s/sx of NB issues w/ thermogenesis?

A

1) low core temp + cold skin
2) pale skin, pallor
3) hypotonia
4) lethargy, irritability
5) poor feeding
6) vomiting
7) tachypnea
8) increased HR
9) shivering = severe cold stress

41
Q

Describe how hypothermia can result in hypoglycemia

A

increased metabolic rate –> increased use of glucose –> hypoglycemia

42
Q

Describe how hypothermia can result in respiratory distress/hypoxia

A

hypoglycemia –> decreased surfactant production –> respiratory distress

inc O2 consumption –> anaerobic metabolism –> lactic acid production –> metabolic acidosis –> decreased surfactant production –> respiratory distress

43
Q

Describe how hypothermia can result in metabolic acidosis

A

brown adipose tissue metabolism –> anaerobic metabolism –> lactic acid production –> metabolic acidosis

44
Q

What 4 systems undergo the greatest change during the transition from intra to extrauterine life?

A

1) respiratory
2) circulatory
3) thermoregulatory
4) glucose metabolism

45
Q

Upon what are circulatory changes in the NB dependent?

A

respiratory transition and oxygenation

46
Q

What are low thresholds for NB glucose levels?

A

1-2h: 28 mg/dL
3-23h: 40 mg/dL
24-47h: 41 mg/dL
48-72h: 48 mg/dL

47
Q

How are the three ways in which NBs receive glucose?

A

1) breastmilk/formula
2) glycogenolysis = breakdown of fetal glycogen stores in liver
3) gluconeogenesis

48
Q

What are the benefits of vernix?

A

Antimicrobial proteins and peptides…

1) moisturizes skin
2) keeps skin acidic –> inhibits growth of pathogens

49
Q

How much glucose do NBs need?

A

4-8 mg/kg/min

50
Q

What are s/sx of hypoglycemia in the NB?

A

1) jitteriness
2) irritability
3) lethargy
4) poor feeding

51
Q

What NB blood glucose level requires further intervention?

A

<45-50 mg/dL

confirm w/ venous sample and inform pediatric provider

52
Q

Define APGAR

A

0, 1, or 2 pts

Appearance (skin color)
Pulse 
Grimace (reflex irritability)
Activity (tone) 
Respiration
7-10 = vigorous
4-6 = some resuscitation needed
<3 = intense resuscitation needed
53
Q

When does the NB no longer experience the Moro reflex?

A

2-4 months

NURS787 Exam 2 (8 decks)

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