The Normal Newborn (1) Flashcards
what is necessary for fetus lung compliance?
surfactant (lecithin and sphingomyelin)
(open alveolar sacs in lungs so oxygenation can take place)
what is the ideal ratio of lecithin adn sphingomyelin (surfactant)
2:1 or greater lecithin:sphingomyelin
what are fetal breathing mvmts
breathing mvmt in the amniotic fluid
describe a babys first breath
inspiratory gasp from CNS response to mechanical, reabsorptive, chemical, thermal, and sensory changes
what are the mechanical events of respiration before/during birth
- lung fluid decreases prior to onset of labor
- chest compression during labor
- higher intrathoracic pressure leads to absorption of lung fluid
what do chemical stimuli do for the resp system
stimulate chemoreceptors that stimulate the respiratory center
what are examples of cemical stimuli
- transitory asphyxia (HR decelerations, less o2=inc. resp)
- elevation of PCO2 (inc. co2=inc. resp)
- decrease in pH
- clamping umbilical cord, dec. prostaglandins
what is thermal stimuli
cold stimulates sensory receptors
what is sensory stimuli
tactile, auditory, visual, and painful stimuli stimulate receptors
what is the normal respiratory rate for newborns?
30-60
describe newborn breathing
- irregular breathing pattern
- obligatory nose breathers
what are some potential signs of respiratory distress?
- inc. resp rate
- grunting
- retracting
- flaring
- color change
what part of fetal circulation allows blood from the umbilical vein to bypass the liver and enter the right atrium
ductus venosis
what part of fetal circulation allows blood flow from right atrium to left atrium
foramen ovale
what part of fetal circulation allows blood flow from pulmonary artery to aorta
ductus arteriosis
when will the ductos venosis close?
when blood supply from umbilical venous return is closed off
when will closure of the extra fetal circulation pathways take place?
when blood starts going to the lungs
how long does it take for the ductus venosis to close
4 weeks
how long does it take for the foramen ovale to close
30 months
how long does it taje for the ductus arteriosis to close
2 months
normal newborn heart rate is ____ following delivery, ____ in full term newborn, and ____ during deep sleep
180, 110-160, 80-100
what is turbulent blood flow through narrow opening
presence of murmur
what can happen if the cardiovascular ducts don’t close?
-mix of oxyegnated and nonoxygenated blood, can lead to color changes and poor feedings
what is a normal fetal pulse ox?
50%
describe hemoglobin levels in newborns
levels rise initially , get additional hgb from placenta, atransient dehydration
describe physiologic anemia of the newborn
cell life is shorter, cells die off faster than they can reproduce, peaks @ 3 mo., iron supplements given
what patients does Rh incompatibility effect?
people that are Rh- (negative blood type)
describe Rh incompatibility
rh- mother is not effected during the first pregnancy, but antibodies are made that will attack subsequent pregnancies
what works to prevent antibody (rh) formation against subsequent pregnancies
rhogam
when is rhogam given
-during pregnancy
-postpartum
-after abortions
what blood type does Rh incompatibility effect?
-
what is heat loss from air current
convection
what is heat lost when the surface around baby is colder
radiation
what is heat lost when the body is moise with dry air?
evaporation
what is heat lost when baby loses heat to a cold surface (like a scale)
conduction
what is a normal baby temp
36.4-37.2
describe relation of gestation/brownfat/flexed position
full-term babies have more brown fat and can flex better
what allows for optimal oxygen use, metabolism, and internal temp because of thermal balance?
neutral thermal environment
what helps thermogenesis
increased BMR, muscular activity, nonshivering thermogenesis
what are interventions for baby hypothermia
- verift reading
- double wrap and hat
- kangaroo care (skin/skin)
- warmer or isolette
what is the role of the liver in a newborn
iron storage, carbohydrate metabolism, conjugation of bilirubin
is jaundice a normal biologic response?
yes
what is jaundice from?
increased bilirubin levels
physiologic jaundice occurs after low long?
after the first 24 hours
interventions for physiologic jaundice
-notify pediatrician
-well hydrated
-phototherapy (maximum skin, exposure cover eyes, monitor diapers)
where does bilirubin go if theres too much?
brain
what is long term irreversible permanent brain damage
kernicterus
what is breast feeding jaundice associated with
poor feeding and inadequate fluid intake
what are interventions for breast feeding jaundice
frequent feedings and lactation support
when does breast milk jaundice begin
after day 7
what is breast milk jaundice r/t
breast milk itself
what results from breastmilk causing reabsorption of bilirubin from the intestine. free fatty acids from BM comoete for binding sites on albumin and inhibit coagulation
breast milk jaundice
when is swallowing and peristalsis initiated?
in utero
when does the first BM normally occur, and what is the goal time
within 48 hours, goal of 8-24 hr
what is 1st BM called?
meconium
what is the implication and function of vitamin k in newborns
since the GI tract is sterile, there is limited vitamin k. it is used for clotting
what is the normal BM frequency
vary, 1 BM every 2-3 days up to 10 per day
what kind of stool is greenish “raspberry seed” appearance, lasts 1-2 days
transitional stool
is breastfed or formula stool more formed?
formula
how long does it take for most babies to void, and nearly 100% void by when?
most within 24 hr, 100% 48 hr
do babies have a higher or lower GFR than adults
lower
when can babies fully concentrate urine?
3 months
pain relief for circumcision
lidocaine @ site prior tylenol after
what is the pain assessment tool for newborns?
NIPS (neonatal infant pain score)
what pain meds are used in infants?
local, emla (cream numb), tylenol, sweetease (sucrose solution)
what is the normal appearance of the penis after circumcision?
beefy red and raw (no swelling/active bleeding)
should petroleum jelly be used after circumcision?
yes!!!! liberally
what kind of immunity is where the pregnant woman forms antibodies from exposure
active acquired immunity
what kind of immunity is where IgG antibodies are transferred to teh fetus? (fetus gets from mom)
passive acquired immunity
between IgG and IgM, which crosses the placenta?
IgG
where is IgA found?
colostrum
what is seen in the first period of reactivity in newborn neurological function
Hr and RR are elevated
alert from time of birth-30 mins
what is seen during the period of inactivity in newborn neuro function
Hr and RR decrease
may sleep up to 4 hours
what is seen in the second period of reactivity in newborn neuro
HR and RR may increase
awake/alert for 4-6 hr
what sleep state for newborns has eyes closed, no eye movement, regular resps, and HR 100-120
deep sleep
what sleep state in newborns has irregular resps, rapid eye mvmt, irregular sucking
light sleep (REM)
what newborn alert state has open/closed eyes w/ fluttering eyelids
drowsy/awake
what newborn alert state has the baby alert, may fixate on attractive object
quiet alert
what newborn alert state has eyes open and motor activity quite intense
active alert
what newborn alert state is an intense state
crying
what is the visual capability of newborns
faces, bright colors, and patterns
what is the auditory capability of newborns
can hear, conduct hearing test
what is the olfactory capability of newborns
identify people through smell
what is the taste capability of newborns
can respond to taste
describe the grasping reflex
holding a placed finger
describe the rooting reflex
stroke face, it turns with attempt to suck
when does teh rooting reflex disappear
4 mo.
when does the stepping reflex disappear
4-8 weeks
describe the babinsky reflex
stroke sole of foot, fans/extends toes
describe the tonic neck reflex
turns head to one side when laying on back, arm extended on baby side faces, flexed on opposite side
