Test-3 Flashcards
Neonatal period
Birth to 28 days
Nursing care for neonate
Body heat Respiratory function Infection Nutrition, hydration Assist parents
Transitional phase
First 6-12 hrs of life
4th stage
Birth-4hrs
Respiratory mechanical changes
30 mL forced out of lungs into lymphatic system
PULMONARY arteries dilate and receive blood
Respiratory chemical
Mild hypoxia and acidosis produced by labor-stimulate breathing center in medulla
-sensory stimulation
Ability to establish functional residual capacity
Depends on surfactant in alveoli
Normal respiration in newborn
Irregular, shallow, diaphragmatic, moist
Periods of apnea in newborn
> 15 seconds should be noted
<30 seconds- side effect of drugs
60 seconds- respiratory distress
Signs of respiratory distress
Cyanosis Apnea, tachypnea Retractions of chest wall Grunting Flaring nostrils Hypotonia
Assess newborn
Every 30 minutes for first hour
Every hour up to 4 hours
Once per shift> 4 hours old
Respiratory distress cause
Lack of surfactant Pneumothorax Bronchopulmonary hypertension Hypoglycemia Patent ductus arteriosus Transient tachypnea ( common in c/s, delay lung clearance)
Pathophysiology of respiratory distress- preterm
Surfactant starting at 24-28 weeks
Phospholipid (70-80%)
PG test
Phosphatidylglyerol
Represents advanced fetal PULMONARY maturity
LS ratio
Lecithin/sphingomyelin
Are the lungs mature?
Atelectasis
May be caused by hypoxemia, hypercarbia, right to left shunt, metabolic acidosis
Complications of respiratory distress
Necrotizing enterocolitis
Bronchopulmonary dysplasia- chronic lung problem from treatment of ventilation
Respiratory distress nursing actions
Patent airway- assess e.g. tube O2, CPAP, ventilation Maintain neutral thermal environment VS, O2 sats, suction, blood gases Claiming measures
Circulatory system
Transition occurs within seconds of clamping cord
Influenced by respiratory system
Three physiologic shunts during fetal life
Foreman ovale
Ductus arteriosus
Ductus venosus
Foramen ovale
Opening between right and left atrium- hole allows reddest blood go from right atrium to left atrium, then left ventricle and out aorta. Blood with most O2 goes to brain
Ductus arteriosus
Connects PULMONARY artery and aorta Closes within 15 hours after birth PULMONARY resistance less than vascular resistance Left to right shunt Closes ductus arteriosus
Ductus venosus
Connects umbilical vein to inferior vena cava
Closes by day 3 of life, becomes a ligament
Blood flow stops when cord is clamped
Circulatory system nursing actions
Birth to 1st hour Cyanosis/hr every 30 mins 1-4 hours old Cyanosis/ Hr every hour 4-24 hours old HR once/ shift
Factors that negatively affect thermoregulation
Little subcutaneous fat
Little brown fat
Loss of heat
Large body surface
Neutral thermal environment
Environment that maintains body temperature with minimal metabolic changes or changes in oxygen consumption
Brown adipose tissue
Dense adipose tissue
No shivering thermogenesis
Neck, thorax, axillary, kidney
Brown adipose tissue promotes
Increase metabolism Heat production Heat transfer to peripheral system Reserves rapidly depleted during cold stress Preterm have limited amount
Evaporation
Water on skin converted to vapors - bathing, birth
Conduction
Heat to cooler surfaces
Cold hands/bed
Convection
Air currents
Oxygen masks
Radiation
Heat to cooler near by objects
Walls
Cold stress
Decrease temp Increase respirations, HR Increase O2 demand Depletion of glucose Decrease surfactant Respiratory distress
Cold stress risk factors
Prematurity Small for gestational age Hypoglycemia Prolonged resuscitation efforts Sepsis
Signs and symptoms of cold stress
TEMP <36.5 or 97.7 Pallor Mottling Lethargy Apnea
Cold stress actions
Skin to skin
Dry baby
Preheat warmer
Monitor TEMP
Glucose check
Critical lab value
Glucose
Less than 40
Risk factors for hypoglycemia
Small or large for gestational age <37 weeks Diabetic mom Delayed feeding Stressed or ill baby Medication
Signs and symptoms of hypoglycemia
Apnea Lethargy Decreased tone TEMP instability Poor feeding
Nursing actions hypoglycemia
Prevention
Assess s&is
Check glucose
Decrease cold risk stress
Conjugation of bilirubin
Increased RBC volume +
Shorter RBC life span=
Increased bilirubin
Indirect bilirubin
From breakdown of RBCs converted by liver enzymes to direct bilirubin
Direct bilirubin
Excreted through urine/ stool
Normal bilirubin levels and critical level
Normal: 5-6
Critical: >13
Preterm and bilirubin
Worry about kernicterus: abnormal accumulation of unconjugated bilirubin in brain cells
Pathological jaundice
Red flag
Occurs <24 hrs old >12.9 term neonate >15 preterm Increased more than 5 per day Lasts more than a week
Risk factors for pathological jaundice
ABO and Rh incompatibility
Sepsis
Hypoxemia
Metabolic factors
Nursing actions
Jaundice
Assessment
Tests: blood draw
Coombs test
Jaundice treatment
Phototherapy
Fluids
Exchange transfusion
Gastric capacity for newborns
5-10 mL then increases to 60 mL by 7th day
Types of stool
Meconium
Transitional (3rd day)
Breastfeed- yellow mustard seed, not smelly
Formula- less often, tan, yellow, green, stronger odor
Necrotizing enterocolitis- preterm
Inflammation of bowel
Necrotizing enterocolitis risks
Prematurity
Impaired GI host defense
Bacterial colonization from feeding tubes
Umbilical Cathe placement
Necrotizing enterocolitis
Causes
Hypoxia
Cold stress
Hypocolemia
Patent ductus arteriosus
Necrotizing enterocolitis
Findings
Apnea Respiratory failure Hypoxemia Unstable TEMP Abdominal distension Bloody stools Lethargy
Necrotizing enterocolitis
Nursing
Distension
With hold feeding
Orogastric tube for decompression
Bronchopulmonary dysplasia
Chronic lung problem that effects neonates who have been treated with mechanical ventilation
