W6: Newborn Assessment Flashcards
3 components of physiologal adjustments for newborns
- establishing and maintaining respirations
-adjusting to circulatory changes - regulating temperature
Chemical factors of establishing respirations
activation of chemoreceptors on carotid arteries & aoorta d/t fetal hypoxia
contraction temporarly decreases uterine blood flow and gas exchange = transient fetal hypoxia
dec PO2, inc PCO2, dec blood pH
stimulation of respiration centre
thermal factors of establishing respirations
cold extrauterine environment
stiumulates receptors in the skin resultng in stimulation of the respiratory centre in the medulla
(cold stress important for initializing breathing)
mechanical factors of establishing respirations
changes in intrathoracic pressure from compression of the chest during vaginal breath
relieve of the perssure results in negatice intrathoracic pressure which helps draw air into lungs
crying of baby (increases air distribution in lung, + pressure keeps alveoli open)
sensory factors of establishing respirations
handling or drying, lights, sounds, smells stimulate respiratory centre
pain associated w/ birth
cirulatory changes after birth
expansion of lungs increases BP –> dec in pulmonary pressure –> dec shunting of blood to ductus arterious and closure of ductus arteriosus
in pressure in LA of the heart & low pressure in RA cause foramen ovale to close
faliure of closure = patent foramen ovale = surgical repair
physiological: why are newborns at tisk of heat loss-hypothermia
larger body surface to body weight
less adipose tissue & fat in newborns
underdeveloped sweating and shivering mechanisms
blood vessels closer to skin surface = heat loss
Newborn Heat-Loss: Evaporation
loss of heat when water evaporates from the skin &b resp tract
- falling completely dry after bathing
- dry baby quickly and remcoe we towels/blankets
Newborn Heat-Loss: Conduction
heat loss from the body surface to cooler surface in direct contact
-prewarm incubator/radiant warmer to ensure warm matress
-cover x-ray plates & scales
- prewarm hands, blankets, equipments
- weighing the newborn should have a protective cover to minimize conductive heat loss
- skin to skin!!
Newborn Heat-Loss: radiation
heat loss to surrounding colder solid objects (not in direct contact)
keep incubator, table, cots away from outside walls
dress baby
avoid exposing direct air
Newborn Heat-Loss: convection
heat loss from the body surface to cooler ambient air
- temp should be 22-26
-cover baby head
-wrap/dress baby
-warm o2
describe cold stress
cold
–> oxygen consumption inc –> pulmonary + peripheral vasoconstriction –> decreasing oxygen uptake by the lungs & oxygen to tissues –> aerobic glycolysis —> dec pO2 + pH –> metabolic acidosis
What are the components of APGAR
apperance
pulse
grimace
activity
respiration
APGAR: Apperance
0 = pale/blue
1= extremeties blue
2= pink
APGAR: Pulse
0 = no pulse
1 = <100 bpm
2 = >100 bpm
APGAR: Grimace
0= no response to stimulation
1 = grimaces or weak cry
2 = cries and pulls away
APGAR: Activity
0 = no movement
1= arms, legs flexed
2= active movement
APGAR: Respiration
0= no breathing
1= slow irregular
2= strong cry
Interpreting APGAR Score
0-3 = severe distress
4-6 = moderate difficulty
7-10 = minimal-no difficulty
when do you reassess APGAR scores
is the score is less than 7 @ 5 mins, you reassess at 10-20 mins
when is APGAR score done?
1-5 mins after birth
PA: Respiratory System
observe for 1 full min
auscultate
normal = 30-60 bpm
shallow & irregular
apneic periods of 5-10 secs as fluid is absorbed/expelled
possible crackles (1st hour PP)
acrocyanosis - normal during transition
Signs of Respiratory Distress
chest retractions
grunting w/ expirations
increase use of intercostal msucles
nasal flaring
respiration rate <30 / >60
PA: Cardiovascular System
110-160 bpm
- <110/160< = reeval after 30m-1hr
heart murmurs for first 6 mo
BP: 60-80/40-50
Fetal Hb: 14-24g/dl
Blood volume: 300mls
PA: Cardiovascular Abnormal
persistent tachy (>160)
persistent brady (<100)
anemia
hypovolemia
hyperthermia
sepsis
congenital heart block
hypoxemia
normal sinus brady
hypothermia
unrqual/absent pulses
dec./inc. BP
How long does anterior fonatel take to close?
18 months
how long does it take porterior fonatel take to close
8-12 months
Widely spaces sutures =
hydrocephaly