Newborn transition and Nursing care Flashcards
care of newborn at delivery: NPR
- provide warmth, clear airways, dry off, stimulate: rapid assessment:breathing and tone
- assess breathing: provide effective ventilations
- assess heart rate: provide effective ventilation or chest compressions
how do term newborns lose heat?
- external body surface to environment
- internal core to external body surface
why do they lose heat?
- large body surface in relation to mass
- less insulating subcutaneous fat
types of heat loss
- evaporation: water vapor
- convection: air currents
- conduction: direct skin contact
- radiation: indirect source
thermogenesis/heat production
cold air stimulate the skins theprmorecptos and transmits sensation to stimulate sympathetic nervous system. This causes peripheral vasoconstriction and increased activity of body. IF insulating fat is not enough to prevent heat loss, non shivering thermogenesis is initatited. brown fat is metabolized to keep body temperature stable.
brown fat
is an energy source and source of heat. to metabolize it oxygen and glucose are used up
cold stress
- when a baby is cold stressed, because of non shivering thermogenesis: and the metabolization of brown fat: they can become hypoxic and hypoglycemic. this can affect growth because less calories are used to for growth
- assess for o2 levels, blood gas, glucose levels
what ate the 3 events that redirect gas exchange from placenta to newborn lungs and initiate respirations
- AIr replaces fluid in alveoli: process of labor starts NA transport system, mechanical stimulation, and chemical stimulation of first breath. The presence of surfactant increase lung compliance and decreased surface tension
- onset of breathing: sensory and thermal stimulation. Chemical stimulation: the co2 levels rise and o2 levels decrease, causing pH to in decrease and stimulate chemoreceptors to stimulate the respiratory center to increase RR. prostaglandins decrease when the cord is clamped. there role is to suppress respiration
- increase in pulmonary flow: during transition pulmonary resistance decrease and when umbilical cord is clump it increases vascular resistance, allow more flow to lungs
normal repsirtion
- 30-60breath per minute
- periodic breathing
- nose breathers
- diaphragmatic breathing can be shallow and irregular but normal
- in first 2 hours normal for 60-70
- acrocyanosis is normal in first 24hrs
respiratory distress
-less than 20 or more than 60 breaths at rest
-use of intercostal muscles: retraction/labored breathing
-nasal flaring
grunting
-cyanosis central
-dyspnea
fetal circulation
- O2 poor blood enters the right atrium
- some blood goes to right ventricle; some blood goes though foramen ovale into the left atrium
- blood that goes to left atrium goes to left ventricle and is pumped to body via aorta.
- blood in right ventricle ; some blood bypasses lungs though the ductus artieriosus and straight to body and other blood travels to lungs via pulmonary artery.
- this happens because gf high lung pressure and low body pressure. high lung pressure because lungs do not oxygenate the placenta does
neonatal cirulation
- O2 poor blood goes into right atrium into right ventricle snf into lung via pulmonary artery
- blood returns to left atrium and goes to left ventricle into the body via aorta
- this happens because there is high body pressure and low lung pressure: high body pressure partly caused by clamping go cord that stops access to placental circulation
Heart rate
in first week of like: 110-160; assess for 1 minute
- can be lower than 100 when sleeping
- can be higher than 180 when crying
- check color, and signs of respiratory distress if concerned
neonatal blood pressure
average 70/50
heart murmurs of neonate
90% are transient
