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Nursing - obstetric component > Neonatal Period > Flashcards

Neonatal Period Flashcards

1
Q
  1. Weeks 25-30, Type II alveolar cells begin production
  2. Mature amount at 35-37 weeks gestation
  3. Phospholipid
A

Surfactant

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2
Q
  1. Decrease surface tension of pulmonary fluids
  2. Prevents alveolar collapse at end of expiration
  3. Facilitates gas exchange
  4. Lower inflation pressures needed to open airway
  5. Improves lung compliance
  6. Decreases labor of breathing
A

Functions of Surfactant

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3
Q

Marker of fetal lung maturity; test of fetal amniotic fluid to assess for fetal lung immaturity; surfactant

A

lecithin–sphingomyelin ratio ( L/S ratio): 2:1 or >

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4
Q

A phosphatidic acid that is a constituent in human amniotic fluid and is used as an indicator of fetal lung maturity when present in the last trimester of gestation (36 weeks)

A

Phosphatidyl glycerol

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5
Q
  • Secreted by lungs, amniotic cavity, trachea
  • Air must replace lung fluid
  • 1/3 removed at birth; 2/3 pulmonary circulation and lymphatic system
  • Total time to clear = 6-24 hours after vaginal delivery
  • Inadequate clearance = TTN
A

Lung fluid

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6
Q
  1. Term
  2. Delivery route - cesarean birth
  3. Low dose oxygen thereapy
  4. Rapid improvement (3 days)
A

TTN - Transient Tachypnea of Newborn

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7
Q
  1. Mild asphyxia in normal birth - high carbon dioxide and low oxygen
  2. Others: thermal, tactile stimulation (flicking the soles of the feet; rubbing the back gently), lights, noise, cord occlusion
A

Breathing stimuli at birth

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8
Q

Respiratory rate in neonates

A

30-60

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9
Q
  1. Diaphragmatic, shallow, irregular depth and rhythm
  2. Abdominal, synchronous with chest movement
  3. Short periods of apnea
  4. Deep sleep - regular breathing
  5. REM sleep - periodic breathing
  6. Crying/ motor activity - grossly irregular
A

Characteristics of respirations in neonates

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10
Q

Until age 3 weeks, obstruction → respiratory distress (sleep on the back)
Reflex takes over
Relation to SIDS (Sudden infant death syndrome)
Oral mucus secretions, cough/gag

A

Obligatory Nose Breathers

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11
Q 
Assessment tool to determine the degree of respiratory distress (0,1 or 2) ; > 7 - severe respiratory distress 
Features observed:
1. Chest movement 
2. Intercostal retraction
3. Xiphoid retraction
4. Nares dilation
5. Expiratory grunt
A

Silverman-Anderson Index - RDS : respiratory distress syndrome (resulting from lung immaturity and lack of alveolar surfactant )

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12
Q

Purposes:
Decrease blood flow to fetal lungs
Direct blood to the placenta
Increase blood flow to head & heart

A

Fetal Circulation

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13
Q

Fetal pulmonary BP > adult pulmonary BP

Diverts blood flow away from non-functioning fetal lungs

A

Decrease Blood Flow to Fetal Lungs

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14
Q

Fetal systemic BP lower than adult

Flow leads to the placenta readily

A

Direct Blood to the Placenta

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15
Q
  1. Umbilical vein - oxygenated blood from the placenta to the fetus
  2. Umbilical artery - waste
  3. Wharton’s jelly - keep vein and artery from tangling ; keep them separated
A

Umbilical Cord

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16
Q

Ductus venosus
Ductus arteriosus
Foramen ovale

A

Increase Blood Flow to Head and Heart

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17
Q

Shunts arterial blood into inferior vena cava
Functional closure - few hours after birth
Anatomic closure - turns into ligament

A

Ductus venosus

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18
Q

Shunts arterial and some venous blood from pulmonary artery to aorta; allows blood to go around lungs
Functional closure
Anatomic closure

A

Ductus arteriosus

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19
Q

Leads to abnormal blood flow between the aorta and pulmonary artery, two major blood vessels that carry blood from the heart.

A

Patent Ductus Arteriosus (PDA)

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20
Q

Connects right and left atria ( allows more than half the blood entering the right atrium to cross immediately to the left atrium, passing the pulmonary circulation)
Usually obliterated within hours after birth
Pressure highest right atrium

A

Foramen ovale

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21
Q

Umbilical cord clamped - neonate draws first breath - Systemic vascular resistance increases- Blood flow through ductus arteriosus decreases - Most of right ventricular output flows through lungs, boosting pulmonary venous return to the left atrium - Left atrial pressure rises in response to the increased blood volume to the lung - This, combined with increased systemic resistance causes functional closure of foramen ovale

A

Changes to Neonatal Circulation

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22
Q

Neonatal Heart Rate
Check apical for full minute
Also evaluate peripheral pulses (brachial, femoral)

A

120-150 awake

Range: 70-90 asleep, 180 crying

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23
Q

Blood Pressure
Sensitive to changes in blood volume that occur with transition to neonatal circulation
Most accurate: measure in quiet newborn

A

At term, 60-80/40-50 mm Hg. (75/42 avg.)

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24
Q

Turbulent blood flow, transient
Abnormal valve, ASD (atrial septal defect) or VSD (ventrical) , too high a blood flow across normal valves
Check all 4 extremity BPs if heard, record MAP, pulse ox.

A

Heart Murmurs

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25
Q
  • blotchy and mottled skin in the extremities; feels “chilly”
  • first few hours after delivery
  • response to exposure to cold - normal and intermittent
A

Acrocyanosis

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26
Q

Blue around philtrum & lips
Tongue & mucous membranes pink
Type of acrocyanosis
Resolves spontaneously

A

Perioral (Circumoral) Cyanosis

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27
Q

10-15% total body weight
Low O2 tension of maternal blood stimulates fetal RBCs (↑ HCT)
About 300 ml.
Mode of delivery effects TBV
Vaginal vs. C/S
- clamping of the umbilical cord : early ( before 30-40 sec) vs late (after 3 min additional 150 ml of blood)

A

Total Blood Volume

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28
Q
  • clamping of the umbilical cord : early ( before 30-40 sec) vs late (after 3 min additional 150 ml of blood)
    ↓ anemia →↓ transfusions
    Stem cells
    ↓ disorders R/T prematurity
A

Delayed Cord Clamping benefits

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29
Q

R/T normal destruction of fetal RBCs
Bilirubin transported to liver for conjugation
Immature livers
50%+ develop

A

Physiologic Jaundice

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30
Q

Hemolysis of erythrocytes (normal after birth) - bilirubin - liver - water soluble pigment - GI system via bile - feces + urine

A

Bilirubin

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31
Q

Predisposition: Asians, Greeks, Native Americans
Less likely: African-Americans
Differentiate from pathologic jaundic
- if not treated - kernicterus - brain damage - death

A

Physiologic Jaundice

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32
Q

Yellowish skin , mucous membranes, and sclera within the first 3 days of life ; asses by pressing gently with a fingertip on the bridge of the nose , sternum, or forehead - if present the blanched area will appear yellow before the cap refill

A

Visual Inspection for Jaundice

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33
Q

Involves exposing the newborn to ultraviolet light , which converts unconjugated bilirubin into products that can be excreted through feces and urine

A

Phototherapy ( Light changes the angle of bonds within bilirubin molecule, making it easier to excrete it
(unconjugated) in the bile)

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34
Q

is a way to find out how much bilirubin is in the blood; The test sends a quick flash of light through the skin; The measurement is usually taken by gently pressing the meter against the sternum or forehead ; no blood test.

A

Transcutaneous Bilirubin Measurement

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35
Q

Place the automated lancing device on the appropriate area on the side of the heel

A

Heelstick

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36
Q 
First 24 hours of life
Rises 5 mg/dL every 24 hours
Premature neonates
LBW neonates
Rh or ABO incompatibility
G6PD deficiency: x-linked recessive
High H/H
17-20 g/dL, 52-63% normal
A

Pathologic Jaundice

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37
Q

Bilirubin neurotoxic at high levels

Crosses blood-brain barrier, causes irreversible CNS damage

A

Kernicterus

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38
Q

Watch temperature
Watch hydration status
Protect eyes and genitals
Positioning

A

Nursing Care of Neonate “Under the Lights”

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39
Q

removes the newborn’s blood and replaces it with nonhemolyzed RBC from a donor ; monitor cardiovascular status continuously ; second line therapy after phototherapy

A

Exchange Transfusion - Treatment for Severe Hyperbilirubinemia

40
Q

After first week of life → 6 weeks
1 - 2% of newborns
Unclear cause
Calories, wt. loss, components of breast milk
Avoid by frequent nursing, supplementing
If 14-16 mg/dL, stop breastfeeding for 24-48 hours
Rapid drop in bilirubin

A

Breastmilk Jaundice

41
Q

Normal finding, due to birth trauma
10,000-30,000 ccm
Neutrophils predominate in first week of life, then overall WBC count falls and lymphocyctes
primary form

A

Leukocytosis (elevated WBC)

42
Q

Low at birth (7, 9, 10, prothrombin)
Synthesized by intestinal bacteria
Untreated, transitory deficiency in clotting, days 2-5

A

Vitamin K-Dependent Clotting Factors

43
Q

Aquamephyton 1 mg. IM

A

Vitamin K ; Treats blood clotting problems.

44
Q

Give Vitamin K into …

A

Vastus Lateralis of Thigh

45
Q

Same range of adults at birth, but may have mild transient aggregation defect ( 150000-400000 )
Phototherapy makes this worse

A

Platelets/Bleeding Problems

46
Q

Score 8-10: good condition
Score 4-7: fair condition, call peds
Score 0-3: poor condition; need immediate resuscitation

A

Apgar Score Meaning ( done at 1 and 5 min of age; can be extended prn )

47
Q 
Appearance (skin color)
Pulse (heart rate)
Grimace (reflex irritability)
Activity (muscle tone)
Respirations (crying & breathing)
A

Apgar Score Mnemonic

48
Q

At birth, enters cooler environment
Temperature varies with environmental temperature
Limited subcutaneous fat
Large surface area in relation to body weight
Blood vessels closer to skin

A

Thermoregulation in Newborns

49
Q
  1. Conduction - objects in direct contact with each other (cold surface )
  2. Convection - flow of heat from the body surface to cooler surrounding surface ( e: cool breeze)
  3. Evaporation - when a liquid is converted to a vapor (e: amniotic fluid that covers body)
  4. Radiation - to cooler, solid surfaces in close proximity but not in direct contact with the newborn (e: away from walls, windows, air conditioners )
A

Means of Heat Loss

50
Q

Taking Axillary Temperature

A

36.5-37.5 C

51
Q

Transition to Extrauterine Life: Initial VS Checks

A

Every 15 minutes x 4 (=1 hour)
Every 30 minutes x 2 (=1 hour)
Every 60 minutes x 2 (=2 hours)

52
Q
  1. Double-wrapping (36.4 C )
  2. Kangaroo care ( 36.4 C )
  3. Radiant heat warmer ( 36 C - for 1 hour)
A

Warming a Neonate

53
Q

Primary mechanism of heat production
Increase metabolic rate
Chemical reaction in brown fat ( good blood supply )

A

Non-shivering Thermogenesis

54
Q

  metabolic rate, non-shivering thermogenesis
Leads to  O2 and energy use
Causes physiologic stress
Leads to metabolic acidosis
Result → hypoxia, hypoglycemia, acidosis

A

Cold Stressed Neonates

55
Q 
Thermal balance
O2 consumption and metabolism are at minimal level
Internal body temperature maintained
Needs high environmental temperature
Flexed, term vs. extended, preterm NBs
A

Thermal Neutral Zone (TNZ)

56
Q

Liver is large, 40% abdominal cavity
Palpate 2-3 cm. below right costal margin
Aids in Fe storage
Aids in carbohydrate metabolism

A

Hepatic Adaptation

57
Q

Fe stores determined by total body Hgb. content & length of gestation
If maternal diet was adequate, Fe stores last until age 5 months
Need Fe for RBC production

A

Fe Storage

58
Q

Glycogen in fetal liver, starting at 9-10 weeks’ gestation
Major energy source for fetus
Major energy source for neonate until begins feeding
Glucose level influenced by liver output and uptake, body temp., insulin, muscular activity

A

Carbohydrate Metabolism

59
Q 
Diabetic mother
SGA or LGA status
Premature
Postmature
Fetal distress in labor/low Apgars
Maternal corticosteroid use (asthmatic moms)
A

Neonates at Risk: Hypoglycemia

60
Q

Signs of Hypoglycemia

A
  1. Lethargy
  2. Jitteriness
  3. Poor feeding
  4. Pallor
  5. Vomiting
  6. Apnea
  7. Respiratory distress
  8. Cyanosis
  9. Loss of swallowing reflex
  10. Seizure activity
  11. High-pitched cry
61
Q

Glucose-checking is part of differential diagnosis if sepsis, CNS disease, metabolic disorders, drug withdrawal, temperature instability, hypocalcemia, polycythemia, heart disease occur or are suspected.

A

Hypoglycemia

62
Q

Vary from one institution to another
Most check 1 heelstick on all newborns, then more prn
At-risk newborns: check hourly x4, then 4 before-meal checks

A

Glucose Protocols

63
Q

Normal glucose

A

40 – 80 mg/dL

64
Q

Critical glucose value

A

< (25) 30 mg/dL

65
Q

Early feeding

Check blood glucose, feed, re-check 30-60 minutes after feeding

A

Prevent Hypoglycemia

66
Q

If feeding doesn’t resolve issue or blood glucose is <(25) 30 mg/dL - treat with …

A

Dextrose 5 – 10% IV @ 6-8 mg/kg/minute (NICU)

67
Q

Causes kernicterus at lower bilirubin levels (10 mg/dL or less), due to baby switching to fat metabolism instead of carbohydrate metabolism
Untreated hypoglycemia can cause permanent, irreversible CNS damage or death

A

Prevent Hypoglycemia!!!!!

68
Q

NBs swallow, digest, metabolize, absorb proteins & simple carbohydrates
Fat digestion poor
GI tract proportionately longer
Immature motility & sphincter control

A

Gastrointestinal Adaptation

69
Q

Feeding behavior rehearsed in utero: rooting
Reflexes: gag, suck & swallow
Salivary glands immature
Sucking pads

A

Gastrointestinal Adaptation

70
Q

Stomach capacity 50 -60 ml.
Problems with vomiting, regurgitation
Calorie requirements vary; however, most books state 108 cal/kg/day
Regular formula 20 cal/oz.
Initial weight loss of 5 -10% within first 5 – 10 days

A

Gastrointestinal Adaptation

71
Q

Lose water to respirations, from skin, stool, urine
Radiant warmers & phototherapy
Need to 150 ml/kg/day

A

Hydration Requirements

72
Q

Formed in utero: amniotic fluid, intestinal secretions, mucosal cells
Thick, tarry, green-black
Usually passed within first 48 hours

A

Stool: Meconium

~ meconium plug - 24 hr (tickle anus with thermometer; measure abdomen); 48 hr ( pediatrics put finger in anus )

73
Q

Part meconium, part feces
Have these for a couple days, then entirely fecal
Bright green or yellow
“Seedy” appearance of milk curds

A

Stool: Transitional

74
Q

Pale yellow or pasty green color
More liquid, more frequent
Not watery

A

Stool: Breastfed Newborn

75
Q

Pale color

Firmer than stool of breastfed newborn

A

Stool: Formula-fed NB

76
Q

Perform gastric lavage in all babies born with meconium stained amniotic fluid after stabilisation

A

stomach pumping or gastric irrigation, is the process of cleaning out the contents of the stomach.

77
Q

Relatively immature
Susceptible to dehydration, acidosis, electrolyte imbalance if vomiting or diarrhea occur
Limited ability to reabsorb sodium and hydrogen
Low GFR until 34 weeks’ gestation

A

Renal System

78
Q

Birth: 70% body is water, 40% extracellular
Most void by 24 hours
First void: dark red & cloudy, no odor, low specific gravity
As intake , output & urine clears
6 – 10 voids/day expected

A

Fluid Balance

79
Q

Many immunologic mechanisms not fully-developed in NB; therefore, resistance to disease
is limited
Phagocyctes (destroy)
Serum immunoglobulins (antibodies)

A

Immune System Changes

80
Q 
- IgG ( cross the placenta) 
Infections that generated maternal antibody response 
IgM
Bloodborne infections
IgE
Hypersensitivity (allergy) reactions
A

Serum Immunoglobulins

81
Q

NB produce little or no IgA
IgA provides local mucosal immunity to respiratory and GI viruses and bacteria
Predominant immunoglobulin in colostrum (pre-milk)
Breastfeeding gives some passive immunity

A

Serum Immunoglobulin: IgA

82
Q

Immature

Traditional measures for detecting inflammation not valuable (fever, leukocytosis)

A

Response to Inflammation

83
Q

Immature
All neurons present, but takes 4 years to fully myelinate them
Brain ¼ adult size
Uncoordinated, labile temperature regulation, poor control over musculature
Development rapid in neonatal period

A

Neurologic System

84
Q

Indicators of development
Assist in safety and survival
Primitive reflexes (Moro, palmar & plantar grasp) give way to righting reflexes (righting of
head & neck) and protective reactions: blinking, sneezing, gagging, caughing
Feeding reflexes

A

Newborn Reflexes

85
Q

Newborn Reflexes

A
  1. Sucking reflex - touch lips
  2. Moro reflex - startled baby
  3. Stepping reflex - walking
  4. Tonic neck reflex -
  5. Rooting reflex - stroking cheek
  6. Babinski reflex - toes fan out (disappears at 1 year)
  7. Palmar&plantar grasp reflexes -
86
Q 
Range of focus
Poor acuity
Contrast sensitivity
Peripheral vision
Can defend against unpleasant visual stimuli
A

Vision

87
Q

Innate preference for human face
2 months: follow object smoothly
~2 months: differentiate colors (red/green)

A

Visual Response

88
Q

T. Berry Brazelton

A

Optimal responses
Orientation
Habituation

89
Q 
Hearing threshold 40-50 dB > adults
Can’t hear quiet sounds
Limited range of frequencies
•Hear low frequencies better
•Soothing
Can discriminate between voices 
Brazelton: orientation/habituation
A

Hearing

90
Q 
Scent-memory: 
Amniotic fluid
Breast odors
•Breast pad experiments
•Painful stimuli experiments
•Well-developed
Prefer sweet odors (breastmilk & vanilla)
A

Smell

91
Q

5 primary tastes: sweet, salt, bitter, sour, umami (glutamate)
Can’t taste salt until ~4 months
Sweet: the sweeter the better
Breastmilk: glutamate
Bitter & sour: negative reactions
Research, July 2011: newborn taste influenced by mother’s diet

A

Taste

92
Q

Most advanced sense at birth
Important cognitive, emotional development, immune function
Best able to feel using mouth
Can recognize temperature differences, but can’t regular own body temperature
Move more/sleep less if cold

A

Touch

93
Q

Predictable
Generally within first 24 hours of life
Physiologic & behavioral adjustments
Influenced by difficulty of L & D, intrapartal medications taken by mother

A

Periods of Reactivity in NB

94
Q

First Period of Reactivity: 30 Minutes

A 
15 minutes: quiet alert
•Eyes open, bright
•Focus on faces, attend to voices, especially mom’s
15 minutes: active alert
•Bursts of movements
•May be crying
•Strong sucking reflex
•Act hungry
95
Q
  1. Deep sleep
  2. Light sleep
  3. Drowsiness or semidozing
  4. Quiet alert
  5. Active alert
  6. Intense crying
A

Brazelton: Behavior in Newborns, 6 Levels of Arousal

96
Q

Diurnal pattern desirable
Nighttime sleep periods > daytime by 4-6 weeks
•Longest stretch 3-5 hours
Sleeps 13 hours/day (5.4 day/7.8 night)
2-6 night wakings
Diurnal influences: feeding, nurturing, fussing, weight

A

Sleep – Wake Cycles

97
Q 
Orientation/habituation
Consolability: change from crying state
Self-quieting: sucking, motor activity
Cuddliness: response to being held
Motor Organization: help NB control &amp; coordinate movements; rhythmic &amp; spontaneous, 
CNS organization
A

Behavioral Responses to Environment & Caregivers

Nursing - obstetric component (10 decks)

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