Physiological and Behavioral responses of the neonate- 15 Flashcards
protect and support neonates by:
● Maintaining body heat.
● Maintaining respiratory function.
● Decreasing risk for infection.
● Assisting parents in providing appropriate nutrition and hydration.
● Assisting parents in learning to care for their newborn.
Two factors that negatively affect the transition to extrauterine respirations are:
● Decreased surfactant levels related to immature lungs.
● Persistent hypoxemia and acidosis that leads to constriction of the pulmonary arteries.
establishment of extrauterine respirations
Mechanical and chemical stimuli
initiated by compression of the thorax, which forces amniotic fluid from the lungs; lung expansion; increase in alveolar oxygen concentration; and vasodilatation of the pulmonary vessels.
Signs of Fetal Respiratory Distress
- Cyanosis
- Abnormal respiratory pattern such as apnea and tachypnea
- Retractions of the chest wall
- Grunting
- Flaring of nostrils
- Hypotonia
First breath
↑ alveolar oxygen tension (Pao2) and ↓ arterial pH → dilation of pulmonary arteries → ↓ pulmonary vascular resistance → ↑ blood flow through pulmonary vessels → ↑ oxygen and carbon dioxide exchange within the lungs
transition to neonatal circulation
The decrease in pulmonary vascular resistance causes an increase in pulmonary blood flow, and the increase in systemic vascular resistance influences the cardiovascular changes
ductus venosus
connects the umbilical vein to the inferior vena cava, closes by day 3 of life and becomes a ligament. Blood flow through the umbilical vein stops once the cord is clamped.
foramen ovale
an opening between the right atrium and the left atrium, closes when the left atrial pressure is higher than the right atrial pressure. Significant neonatal hypoxia can cause a reopening of the foramen ovale.
ductus arteriosus
connects the pulmonary artery with the descending aorta, usually closes within 15 hours postbirth. It will remain open when the lungs fail to expand or when Pao2 levels drop.
neutral thermal environment (NTE)
environment that maintains body temperature with minimal metabolic changes and/or oxygen consumption.
The neonate responds to cold by:
● An increase in metabolic rate.
● An increase of muscle activity.
● Peripheral vascular constriction.
● Metabolism of brown fat.
Brown adipose tissue (BAT) promotes
● An increase in metabolism.
● Heat production through intense lipid metabolic metabolism of BAT.
● Heat transfer to the peripheral system
Neonates are at higher risk for thermoregulatory problems related to:
● Higher body-surface-area-to-body-mass ratio.
● Higher metabolic rate.
● Limited and immature thermoregulatory abilities.
Factors that negatively affect thermoregulation are:
● Decreased subcutaneous fat.
● Decreased BAT in preterm neonates.
● Large body surface.
● Loss of body heat from evaporation, conduction, convection, and/or radiation
Evaporation
Loss of heat that occurs when water on the neonate’s skin is converted to vapors, such as during bathing or directly after birth
Conduction
Transfer of heat to cooler surface by direct skin contact, such as cold hands of caregivers or cold equipment
Convection
Loss of heat from the neonate’s warm body surface to cooler air currents, such as air conditioners or oxygen masks
Radiation
Transfer of heat from the neonate to cooler objects that are not in direct contact with the neonate, such as cold walls of the isolette or cold equipment near the neonate
Possible consequences of cold stress are:
● Hypoglycemia.
● Metabolic acidosis.
● Decreased surfactant production.
● Respiratory distress that can lead to neonatal death.
● Hypoxemia.
● Increased indirect bilirubin.
● Delayed transition from fetal to neonatal circulation.
● Weight loss.
Cold stress s/s
● Axillary temperature at or below 36.5°C (97.7°F)
● Cool skin
● Lethargy
● Pallor
● Tachypnea
● Grunting
● Hypoglycemia
● Hypotonia
● Jitteriness
● Weak suck
Hypoglycemia
Hypoglycemia is defined as a blood glucose level below 40 mg/dL in the neonate.
Risks for Hypoglycemia
- Neonates of diabetic mothers
- Neonates weighing more than 4,000 g or large for gestational age
- Post-term neonates
- Preterm neonates
- Small-for-gestational-age neonates
- Hypothermia
- Neonatal infection
- Respiratory distress
- Neonatal resuscitation
- Birth trauma
hypoglycemia s/s
- Jitteriness
- Hypotonia
- Irritability
- Apnea
- Lethargy
- Temperature instability
Functions of the liver
●carb metabolism ●amino acid metabolism ●lipid metabolism ●synthesis of plasma proteins ●blood coagulations- vit k given ●conjugation of bilirubin ●phagocytosis by kupffer cells ●storage of fat soluble vitamins ●detoxification
why there is more bilirubin in neonate
increase in the neonate’s red blood cell (RBC) turnover (shorter RBC life span) and an increased RBC count at birth. These factors contribute to a proportionally greater amount of bilirubin production.
Hyperbilirubinemia
condition in which there is a high level of unconjugated bilirubin in the neonate’s blood related to the immature liver function, high RBC count that is common in neonates, and an increased hemolysis caused by the shorter life span of fetal RBCs.
Phytonadione (Vitamin K, AquaMEPHYTON)
Indication: Prevention of hemorrhagic disease in neonate
Meconium stool:
: begins to form during the fourth gestational month and is the first stool eliminated by the neonate. It is sticky, thick, black, and odorless. It is first passed within 24 to 48 hours.
Transitional stool:
begins around the third day and can continue for 3 or 4 days. The stool transitions from black to greenish black, to greenish brown, to greenish yellow. This phase of stool characteristics occurs in both breastfed and formula-fed neonates.
Breastfed stool
yellow and semiformed. Later it becomes a golden yellow with a pasty consistency and has a sour odor.
Formula-fed stool
yellow and semiformed. Later it becomes a golden yellow with a pasty consistency and has a sour odor
Two major functions of the kidneys
control of fluid and electrolyte balance and excretion of metabolic waste.
Initially the neonate’s kidneys are immature and place the neonate, especially preterm neonates, at risk for:
over hydration
dehydration
electrolyte disorders
drug toxicity
urine output neonate
15 to 60 mL/kg of urine per day for the first few days of life. Urinary output increases to 250 to 400 mL by the end of the first month of life
Neonates are at risk for infections related to:
● Immature defense mechanism.
● Lack of experience with and exposure to organisms, which leads to a delayed response to antigens.
● Breakdown of skin and mucous membranes, which provides a portal of entry for bacteria
Major components of the immune system
active humoral immunity- B cells detect antigens and produce antibodies against them.
passive immunity- which is not permanent, is acquired either naturally or artificially.
lymphocytes-white blood cells that are primarily composed of T cells and B cells.
immunoglobulins-antibodies
neonatal assessment
This initial assessment provides the baseline data for the neonate, evaluates the neonate’s transition to extrauterine life, and assists in determining the course of nursing and medical care.
within 2 hours
Preparation for assessment
● Review the prenatal record and birth record for factors that could place the neonate at risk for complications.
● Gather the equipment needed for the assessment
● Ensure that assessment is done in an NTE
● Inform the parents of the assessment and invite them to watc
General survey then physical assessment
● A general survey of the neonate is completed before the physical assessment. This survey is best completed while the neonate is quiet.
● Observe the respiratory pattern and assess respirations and breath sounds. It can be difficult to assess respiratory rate once the neonate responds to being handled (cries) during the physical assessment.
● Observe posture.
● Assess the skin for color, birth trauma, and birthmarks.
● Observe the level of alertness/activity.
● Assess muscle tone and posture.
Dubowitz neurological exam
standardized tool that assesses 33 responses in four areas:
● Habituation (the response to repetitive light and sound stimuli)
● Movement and muscle tone
● Reflexes
● Neurobehavioral items
Gestational age assessment is commonly completed on:
● Neonates who are preterm, born before 37 weeks based on the maternal menstrual history, or post-term, born after 42 weeks by dates.
● Neonates who weigh less than 2,500 g or more than 4,000 g.
● Neonates of diabetic mothers.
● Neonates whose condition requires admission to a neonatal intensive care unit
SGA
neonates whose w
LGA
neonates whose weight is above the 90th percentile for gestational age.
