Test 1 Information Flashcards
The most critical adaptations for a neonate to make when getting adjusted to extruterine life
establishment of effective respirations
what factors cause the initiation of breaths from a newborn
chemical, mechanical, thermal, and sensory factors
post partum period
interval in between birth and the return of reproductive organs to their normal nonpregnant state
puerperium
another word for postpartum
involution
the return of the uterus to a nonpregnant state after giving birth and begins immediately after expulsion of the placenta with contraction of the uterine smooth muscle
Uterus location at the end stage of labor
uterus should be midline approx. 2cm below the umbilicus
uterus location within 12 hours of birth
the fundus can raise to be 1 cm above the umbilicus
uterus location by 24 hours after birth
the uterus is about the same size as it was 20 weeks gestation
how much does the uterus shrink every 24 hours
the fundus descends 1 to 2cms per 24 hour period
uterus location at the 6th day after birth
fundus is normally located halfway between the umbilicus and the symphysis pubis
uterus location at 2 weeks after birth
should not be palpable
uterus location at 6 weeks
should have returned to its non pregnant location
subinvolution
the failure of the uterus to return to a non pregnant state due to ineffective uterine contractions
most common cause of subinvolution
retained placental fractions and infection
lochia
uterine discharge after birth
how long does lochia last after birth
4 to 6 weeks after birth
what will increase the flow of the lochia
walking and breastfeeding will increase the flow of the lochia
Lochia rubra
first 3-5 days after birth, dark/bright red blood
lochia serosa
5-8 days after birth, light pink with RBCs, WBCs, and tissue in it
lochia alba
2-6 weeks after birth, white/yellow with WBCs
When is the first period of reactivity?
lasts up to 30 mins after birth
How does the infant react during the first period of reactivity?
Heart Rate Increases to 160 to 180 bpm, but grdually decreases after 30 minutes
the infant is alert
when is the period of decreased responsiveness?
lasts from 60 to 100 minutes
how does the infant react during the period of decreased responsiveness
newborn either sleeps or has a marked decrease in motor activity
when is the second period of reactivity?
occurs 2 to 8 hours after birth and lasts from 10 minutes to several hours
how does the infant react during the second period of reactivity?
Tachycardia, tachypnea occur
increased muscle tone
improved skin color
mucous production
meconium finally passed
Chemical Factors that initiate the respiratory system
activation of chemoreceptor in the carotid arteries and aorta results from the relative state of hypoxia associated with labor
decreased levels of oxygen and increased levels of carbon dioxide seem to have a cumulative effect that is involved in initiating neonatal breathing by stimulating the respiratory center in medulla
Mechanical Factors that initiate the respiratory system
stimulated by changes in intrathoracic pressure resulting from the compression during vaginal birth
crying increases the distribution of air in the lungs and promotes expansion of the alveoli. the positive pressure of crying keeps the alveoli open
Thermal Factors that initiate the respiratory system
the extrauterine world is typically colder than the intrauterine world and the shock to the system, i.e. the sudden drop in temperature, stimulates the respiratory center in the medulla
sensory factors that initiate the respiratory center
handling by the OB team
suctioning mouth and nose
drying by the nurses
environmental factors (light, sounds, smells) also initiate the respiratory system
Normal or Potential problem: Infant has 36 respirations per minute, they are irregular, and shallow
Normal
Normal or Potential Problem: Episodic Apnea lasting 5 to 10 seconds
Normal; any apenic episodes lasting longer than 20 seconds needs to be checked out by the doctor
What airway do infants breath out of the most?
Their nose
When do infants develop the reflex to switch from nose breathing to mouth breathing when the nose is plugged?
3 weeks
What happens if a 1-3 week infant’s nose is clogged?
cyanosis and asphyxia can occur because they lack the ability to switch to breathing through their mouth
Lung Sounds for infants
loud, clear, and seem very near because there is very little chest mass to interfere
Normal or Potential Problem: Crackles on Auscultation of the lungs immediately following birth
Normal: fine rales are normal within the first few hours
signs of respiratory distress in neonates
- nasal flaring
- intercoastal or subcoastal retractions
- grunting with respirations
- changes in infant color(Late sign of respiratory distress)
Signs of upper airway obstruction in neonate
suprasternal or subclavicular retractions with stridor or gasping
What can happen to the baby if mom gets analgesics or anesthetics during labor and birth
slowed, depressed or absent breathing
causes of apneic episodes in neonates
- rapid increase in body temperature
- hypothermia
- hypoglycemia
- sepsis
causes of tachypnea in neonates
- inadequate clearance of fluid in the lungs
- respiratory distress syndrome
When should the newborns skin color change from blue to pink?
3 to 5 mins (APGAR score)
acrocyanosis
bluish discoloration of hands and feet is a normal finding in the first 24 hours after birth
TTN
Transient Tachypnea of the Newborn
TTN presentation
- signs of respiratory depression
- tachpnea up to 100bpm
- intermittent grunting
- nasal flaring
- mild retractions
Treatment for TTN
Supplemental oxygen
When should TTN resolve?
48 to 72 hours
normal heart rate range for neonates
120 to 160 bpm
full term infant heart rate
80 to 100 bpm during sleep and up to 180 bpm when the infant cries
in between (100 and 160bpm)
Normal or Potential Problem: irregular heart rate or sinus dysrhythmia
normal in the first few hours of life but as the foramen ovale closes
Normal or Potential Problem: Murmur heard in the neonatal period
Normal and have no pathological significance, more than half of them disappear within 6 months
if the baby has other signs such as not tolerating feeds, cyanosis, or pallor with a murmur the baby needs to have follow up done
factor affecting BP in neonates
- gestational age
- postconceptional age
- birth weight
BP values rise as these values rise
What should the MAP be equal to in neonates
the neonates gestational age
Normal or potential problem: drop in systolic blood pressure in first hour of life
normal
Normal or Potential problem: Jaundice right after birth
Potential problem, it is a problem for the baby to come out jaundice (pathologic jaundice), but it is normal for them to develop jaundice(Physiologic jaundice)
When should newborn pass meconium stool?
meconium should pass within in teh first 24 hours
desquamation
peeling of the skin
Normal or Potential Problem: Desquamation of the feet
Normal Finding in some newborns, especially those who are born late or post-term gestation.
interventions for desquamation on the feet of a neonate
moisturizers can be applied, but usually it fixes itself
what is the average newborn head circumference
13-14in or 33 to 35 cm
Postterm infants are born at
over 42 weeks
Normal or Potential Problem: deep plantar creases over entire sole of the foot in a postterm gestational baby
Normal
Normal or Potential Problem: Dry, cracked, and peely skin, especially on the hands and feet of postterm gestational baby
Normal
Normal or Potential Problem: Abudnant Scalp hair and long fingernails in postterm gestational baby
Normal
Normal or Potential Problem: Minimal to absent vernix caseosa in a postterm gestational age baby
Normal
vernix caseosa
protective, white, waxy substance on the skin of a neonate
Lanugo
fine, downy hair that covers the fetus early in gestation and begins to disappear around 32 weeks gestation; it is normaly no present in term or postterm babies
1st stage of labor
break of water to dilated 10 cm
transition phase of labor
8 to 10 cm dilated
Maternal signs of the transition phase
N/V, increased pain, trembling, fear, irritability, anxiety, and self doubt in the ability to birth
how often should you breastfeed?
every 2-3 hours and on baby’s demmand as they demonstrate their reflexes
position of teh newborn for breastfeeding
tummy to tummy with mouth infront of nipple and head in line with the body
proper latch for breastfeeding
nippe and part of areola in the mouth
how long should you breast feed for?
15 to 20 mins per breast or until the newborn seems satisfied
how fast is too fast for saturating a pad after a vaginal birth
in less than an hour
signs of oral candidiasis on newborn
white, adherent, patches on the tongue and palate
erythema toxicum
firm, white, or yellow papules or pustules surrounded by erythema. This idiopathic rash, which closely resembles flea bites appears in the first few days after birth and resolves within 5-7 days
epstein pearls
small white, cysts found on the hardpalate of newborns. These are considered normal findings and they disappear a few weeks after birth
how much to dress neonates in?
dressing newborns in no more than one additional layer of clothing than an adult requires. A wearable blanket can provide wormth and prevent the head from being covered.
what should the baby be wearing when getting phototherapy
fully exposed expect for diaper and eye shields. Mainting skin integrity is important becuase the breakdown of bilirubin can cause frequent loose stools and produce skin excoriation and breakdown.
Lotions and ointements should not be applied becuase they absorb heat and cause burns
clinical manifestations of spinabifida in a newborn
tuft of hair, a hemangioma, a nevus, or a dimple along the base of the spine
caput succedaneum(CS)
CS- crosses suture, edema of the soft tissue of the scalp due to prolonged pressure of the presenting part against the cervix during labor
NAS
Neonatal Absitence Syndrome
neonatal abstinence syndrome
potentially life-threatening condition affecting noewborns exposed in utero to physiologically addictive substances.
manifestations of NAS in newborn
irritabiliyt, inconsolability, hig-pitched/shrill cry, neuromuscular irritability
interventions for baby with NAS
environmental stimuli should be minimized, and the nurse should swaddle the newborn in a flexed position and gently rock the newborn to provide comfort and decrease irritability
What position should an infant who has NAS be put in after feedings?
they should be held in an upright position and regurgitation is common in newborns with NAS
what type of environment should a baby with NAS be kept in?
quiet, dimly ilt, environment, cluster care, and minimize stimulation to prevent seizure activity
treatment for breast engorgement
applying ice packs to both breasts for 15 to 20 minutes every 3-4 hours to reduce blood flow and swelling
apply chilled, fresh cabbage leaves to both breasts, replacing with fresh leaves after they wilt.
Take antiinflammatory analgesic as directed to reduce pain
maintaining firm breast support until milk flow is diminished
