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NUR 102 OB Assessment #1 > Normal Newborn: Adaptation & Assessment > Flashcards

Normal Newborn: Adaptation & Assessment Flashcards

1
Q

Newborn Adaptations

The first, most important task in newborn adaptation is the ___ ?

A

initiation of respiration

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2
Q

Development of the Lungs

?

* Alveoli produce ___ that expand the alveoli & assist in lung development

* As the fetus nears term, the production of ___ decreases

* During labor, the fluid begins to move into the interstitial space where it is absorbed

> Absorption is accelerated by labor, delayed w/cesarean births

* At birth, only about ___% of the original amount of fluid remains

A

Fetal Lung Fluid

35%

* Complications like HTN, placental insufficiency, maternal infection, & rupture of membranes greater than 48 hours may cause accelerated fetal lung maturity

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3
Q

?

* Reduces surface tension in the alveoli

> Without it, the alveoli collapse as the infant exhales, & needs to be re-expanded w/each breath

* Secretion increases during labor & immediately after birth

> Usually sufficient by ___ to ___ weeks gestation

* DM & gestational DM can delay ___ production

* Steroids may be given to women who are in preterm labor to help increase production & lung maturation

A

Surfactant (a combination of lipoproteins)

34-36 weeks

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4
Q

What causes respirations to initiate?

Chemical Factors

* ___ respond to changes in blood chemistry

* Stimulates the respiratory center in the ___, stimulating a forceful contraction of the diaphragm & air enters the lungs

* Does not occur if prolonged hypoxia (CNS depression)

A

Chemoreceptors

medulla

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5
Q

Mechanical Factors (Vaginal deliveries only)

* Fetal chest is compressed by the birth canal, forcing fluid out of the lungs

* At birth, chest recoils & brings air into the lungs, making 1st breath easier

A

Thermal Factors

* Sensors in the skin respond to the sudden change in temperature, sending impulses to stimulate respiratory center of the brain & breathing

Sensory Factors

* Tactile stimulation from birth & care following stimulate skin sensors

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6
Q

Maintaining Respiration

* Surfactant allows the alveoli to remain partially open

> Subsequent breaths require less effort

* As the infant cries, pressure within the lungs increase causing the remaining fetal lung fluid to move into the interstitial space to be reabsorbed

> Complete absorption may take as long as 24 hours

> Lungs may sound moist when first auscultated, but clear a short time later

A
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7
Q

Cardiovascular Adaptations: Fetal Circulation

* Ductus Venosus

* Foramen Ovale

* Ductus Arteriosus

A
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8
Q

?

About 1/3 of blood is directed away from the liver

Near the end of pregnancy the liver needs more perfusion, so blood flow is increased

A

Ductus Venosus

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9
Q

?

* Connects the pulmonary artery w/the aorta

* Only 10-12% of blood entering the pulmonary artery travels to the lungs, the remainder passes through the ___

* Patency is maintained by ___ from the placenta & the low oxygen content of the blood

A

Ductus Arteriosus

ductus arteriosus

prostaglandins

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10
Q

?

* Flap in the septum of the right & left atria of the heart

* 50-60% of blood from R atrium moves through the ___ to the L atrium

A

Foramen Ovale

foramen ovale

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11
Q

Cardiovascular Adaptation: Neonatal Circulation

After birth, the fetal shunts close & the pulmonary vessels dilate

?

Closes shortly after birth; permanently closes 1-2 weeks after birth

A

closure of the Ductus Venosus

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12
Q

?

Closes at about 72 hours of life, & permanently closes within 1-2 weeks

A

closure of the Ductus Arteriosus

* If it does not close = patent ductus arteriosus (PDA) & may need surgical intervention

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13
Q

?

Because the ___ opens only from right to left, when the pressures in the left atrium increases it closes; permanently closes within 7 months

Conditions such asphyxia & persistent pulmonary HTN can cause the ___ to reopen

A

closure of the Foramen Ovale

foramen ovale

* Can see adults w/PFO (patent foramen ovale)

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14
Q

Neurologic Adaptations: Thermoregulation

Methods of Heat Loss

* Evaporation

* Conduction

* Convection

* Radiation

Nonshivering Thermogenesis

Cold Stress

A
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15
Q

?

Is the transfer of heat to cooler objects that are not in direct contact w/the infant

* Do not place cribs near windows/open doors

A

Radiation

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16
Q

?

Is the transfer of heat from infant to cooler surrounding air

> e.g. incubator use

A

Convection

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17
Q

?

Is air-drying of the skin

A

Evaporation

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18
Q

?

Is the movement of heat away from the body that occurs when newborns come into direct contact w/objects that are cooler than their skin

A

Conduction

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19
Q

?

Increases O2 needs, decreases surfactant production; makes it harder to breathe, causing respiratory distress

> Can lead to hypoglycemia ⇒ metabolic acidosis, increased risk of jaundice

A

Cold Stress

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20
Q

?

Brown fat protects the heart & kidneys & is metabolized to produce heat

* A decrease in core temperature will not occur until this is no longer active

A

Nonshivering thermogenesis

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21
Q

Thermoregulation

* The rate of heat loss in a newborn is four times greater than that of adults

* Because preterm infants do not hold a flexed position like the term neonate, they are more susceptible to heat loss

A
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22
Q

Neutral Thermal Environment

* Where the infant can maintain a stable body temperature with minimal oxygen need & without an increase in metabolic rate

Called the ___ ?

* Healthy, unclothed full-term newborns: ___ to ___ °F

* Dressed infant: ___ to ___ °F

A

thermoneutral zone

  1. 6 - 92.3 °F
  2. 2 - 80.6 °F
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23
Q

Hematologic Adaptations

Term newborn blood volume = ___ to ___ mL/kg

Blood Values in the Newborn

* RBC’s: 4.8 - 7.1 million/microliter

* Hgb: 15-24 g/dL

* HCT: ___ to ___ %

* Leukocytes: ___ to ___ thousand/mm3

Average neonate weight 3 kg

A

80-100 mL/kg

44-70%

9.1-34

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24
Q

Risk of Clotting Deficiencies

* Newborns have low levels of Vitamin K

* Most newborns receive an intramuscular administration of Vitamin K within 12 hours of birth to reduce the risk of hemorrhagic diseases

> Especially important if there was any kind of operative vaginal delivery, i.e. vacuum or forceps use that could cause intracranial damage & bleeding

A

* Maternal rx’s like phenytoin, phenobarbital, & anti-tuberculosis drugs taken during pregnancy can interfere w/clotting abilities in the newborn

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25
Q

Gastrointestinal Adaptations

* Stomach capacity is 6mL/kg at birth

* Bowel sounds are present within the first hour of life

* Normal intestinal flora develops within the first few days

* Increased risk of water loss w/diarrhea (which can be deadly in a newborn)

* ___ is deficient for first 4-6 months

> This is why we don’t give solid food; there is a lack of enzymes to break down; at the 6 month mark can introduce solid foods

A

pancreatic amylase

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26
Q

* Sphincter between esophagus & stomach is relaxed

* Reflux is common

* Stools: meconium, transitional, milk

A
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27
Q

?

Stools that are greenish-brown

A

transitional

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28
Q

?

Stools that are tarry, sticky, dark in color

A

meconium

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29
Q

?

Stools related to formula or breastfeeding methods

A

milk

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30
Q

?

Are stools pale yellow to light brown, firmer

?

Are mustard-colored, seedy, sweet/sour-odored stools

A

formula

breastfed

31
Q

Hepatic Adaptations

* Blood glucose maintenance

> Uses glucose stores until feeding is adequate

* Conjugated bilirubin

> 60% of term newborns & 80% of preterm newborns experience jaundice

A

* Blood coagulation

> Newborn deficiency in Vitamin K (which activates factors II, VII, IX, X)

* Iron storage (in liver & spleen)

> If not breastfeeding, iron-fortified formulas

* Drug metabolism (done by the liver)

32
Q

?

Is a high level of bilirubin in the blood that results in jaundice

A

Hyperbilirubinemia

33
Q

Hyperbilirubinemia

* Physiologic jaundice

* Nonphysiologic jaundice

* Jaundice associated w/breastfeeding

A

Jaundice associated with Breastfeeding

* Develops by 1 week of age

* Cause d/t insufficient intake; eat & excrete

34
Q

?

A pathologic jaundice

Can appear in the 1st 24 hours of life

Levels rise faster & last longer

Happens from disorders that cause excessive destruction of RBC’s (e.g. Rh incompatability = didn’t receive RhoGAM)

Also from infection or metabolic disorders

A

Nonphysiologic jaundice

35
Q

?

Is nonpathologic or developmental

Caused by a transient hyperbilirubinemia

Is normal

Noticeable at 5-6 mg/dL

Happens 24 hours after life

A

Physiologic jaundice

36
Q

Urinary Adaptations

Kidney Development & Function

* Full kidney function does not occur until after birth

  • Issues r/t kidneys often identified in utero (assess the amniotic fluid)
  • GFR doubles or triples at 1st week of life
  • Takes 1-2 years to reach adult levels
A
37
Q

Fluid Balance

  • Newborn’s weight is 75% water
  • Normal to lose 5-10% of body weight after birth through diuresis

* Vomiting & diarrhea can be life-threatening in newborns

A

60-100 mL/kg/day in 1st 3-5 days of life

Increase to 150-175 mL/kg/day by 7 days of life

38
Q

Immunologic Adaptations

The neonate is less effective at fighting infection than the older infant or child

Major immunoglobulins

  • IgG
  • IgM
  • IgA
A
  • Sepsis is common in the young infant & newborn
  • Look for subtle changes in activity, tone, color, or feeding
39
Q

?

Protects the GI & respiratory systems

Production at 2 weeks of life

A

IgA

40
Q

?

Crosses the placenta & breastmilk

Provides passive temporary immunity for the first 6-8 months of life

A

IgG

41
Q

?

Helps to protect against Gram-negative bacteria

Reaches adult levels by 1 year of age

A

IgM

42
Q

Psychosocial Adaptations - Periods of Reactivity

* First period of reactivity (at birth)

* Period of sleep/decreased activity (deep sleep)

* Second period of reactivity (pass meconium, interested in feeding)

A

Psychosocial Adaptations - Behavioral State

* Deep or quiet sleep state

* Light or active sleep state (REM seen)

* Drowsy state

* Quiet alert state

* Active alert state

* Crying state

43
Q

Newborn Assessment

To Assess Before Delivery…

* Type of delivery being performed

* Gestational age at time of delivery (preterm or term infant?)

* Diabetic mother

* Prolonged rupture of membranes

* Rh+ status

* Maternal rx’s during pregnancy & labor (e.g. Zoloft taken during)

* Fetal heart tracing

A
44
Q

APGAR Scoring System

* Taken at 1 & 5 minutes of life; every 5 minutes after as needed

* To identify the at-risk infant

* A 7 or higher is a good score

A = ?

P = ?

G = ?

A = ?

R = ?

A

A = Activity (muscle tone)

P = Pulse

G = Grimace (reflex irritability)

A = Appearance (skin color)

R = Respiration

45
Q

Acrocyanosis is a bluish appearance of the hands and feet and is normal

A
46
Q

Immediate Respiratory Assessment

Pattern & Depth

  • Periodic breathing
  • Apnea (lasts 20 seconds or more)

Breath Sounds

  • Present throughout
  • Mostly clear
  • Some moisture from lung fluid
A
47
Q

?

Is a blockage or narrowing of 1 or both the nasal passages by bone or tissue

> Infants are nose-breathers

A

Choanal atresia

48
Q

What is the normal respiratory rate for newborns?

A

30-60 breaths/min

49
Q

Signs of Respiratory Distress

* Tachypnea

* Retractions

* Nasal flaring

* Cyanosis

* Grunting

* Paradoxical respiration

* Asymmetry in chest wall

A
50
Q

Immediate Cardiac Assessment

* Color (pink? or appropriate for ethnicity)

* Heart sounds

* Murmurs

* Peripheral pulses

* Capillary refill

A
51
Q

Heart Sounds

* PMI at 3rd/4th ICS at midclavicular line

* 120-160 HR up to 180 & as low as 100 sleeping

Murmurs

* Are typically temporary until the ductus arteriosus closes

A

Peripheral Pulses

* Check brachial & femoral pulses

* A weakened femoral pulse can indicate coarctation of the aorta (a congenital heart defect)

52
Q

Capillary Refill

* Indent on the chest, abdomen, or any extremity; 3-4 seconds is normal

A
53
Q

Vital Signs & Measurements

Temperature

?

A

36.5-37.5 °C

54
Q

Pulse

?

? when sleeping

? when crying

Respiration

?

A

120-160

100

180

30-60

55
Q

Weight

? g

Loss of up to 10% in early days

A

2500-4000

56
Q

Length

? cm

A

48-53

57
Q

Head circumference

? cm

A

32-36

58
Q

Chest circumference

? cm

A

30.5-33

59
Q
A

Skin Variations

  • Mongolian spot(s)
  • Fetal scalp electrode placement
  • Stork bites (concentrations of immature blood vessels; in response to hormones)
  • Milia (“baby acne”; small, white bumps)
  • Port-wine stain(s) (birth marks)
  • Normal newborn rashes
  • Facial bruising (can happen in rapid deliveries)
  • Trauma from vacuum or forceps deliveries
60
Q
A
61
Q

Variations of the Head & Face

* Down Syndrome

* Facial asymmetry

* Anterior/posterior fontanel

* Cleft lip

* “Cone head”

A
62
Q

* Caput succedaneum

* Subgaleal hemorrhage (bad; crosses the suture line) [photo next card]

* Cephalohematoma

A
63
Q

?

Is an area of localized edema that often appears over the vertex of the newborn’s head as a result of pressure against the mother’s cervix during labor

Resolves quickly & generally disappears within several days after birth

A

caput succedaneum

64
Q

?

Results from bleeding between the periosteum & the skull caused by pressure during birth

Can occur on 1 or both sides of the head, usually over the parietal bones

A

cephalohematoma

65
Q

Variations in the Neck & Chest

A
66
Q

Variations of the Abdomen & Genitalia

* The umbilical cord stump falls off within 14 days

A

* Intestines can be seen near the stomach [photo]

67
Q

?

A condition that occurs when the intestines protude out into the umbilical cord; requires surgical intervention

A

omphalacele

68
Q

Hypospadias

* A congenital anomaly in which the actual opening of the urethral meatus is below the normal placement on the glans of the penis

A
69
Q
A
70
Q

Variations of the Extremities & Back

* A closed spina bifida

* A dimple that could be a concealed spina bifida

* A singular palmar crease (typical w/Down syndrome babies)

* Extra digit

* Tuft of hair above the buttocks that could be a sign of a neural tube issue

* Club foot

* Hip dysplasias; see that creases in the back of the thighs aren’t equal

A
71
Q

Neonatal Reflexes

* Babinski

* Galant (trunk incurvation)

* Grasp (palmar/plantar)

* Moro (the startle reflex)

* Rooting (head will turn & infant’s mouth will open towards hand)

* Stepping

* Sucking

* Swallowing

* Tonic Neck (“fencing” reflex)

A
72
Q

Assessing Risk for Hypoglycemia

* Prematurity

* Postmaturity (past the 40 week gestation)

* Intrauterine growth restriction (IUGR) [did not grow properly in utero]

* Large or small for gestational age (LGA, SGA)

* Asphyxia (in utero or at delivery)

* Problems at birth

A

* Cold stress

* Maternal diabetes

* Maternal intake of betablockers or terbutaline (a tocolytic)

73
Q

Signs of Hypoglycemia

Jitteriness, tremors / poor muscle tone / diaphoresis (sweating) / poor suck / tachypnea

Tachycardia / dyspnea / grunting / cyanosis / apnea

A

Low temperature (*check blood glucose levels)

High-pitched cry / lethargy / irritability / seizures, coma

74
Q

Obtaining a Blood Sample via Heel Puncture

* If the infant has not yet been bathed, cleanse the area before puncturing the skin

* Warm the heel w/a heel warmer or warm, wet washcloth

* Provide comfort measures while obtaining sample

* Always wipe away 1st drop of blood to avoid contamination

A

NUR 102 OB Assessment #1 (11 decks)

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