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Flashcards in Care of the Neonate Deck (66)
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1

Within minutes after birth...

-a newborn has to initiate respirations -adapt a circulatory system to extrauterine oxygenation

2

Within 24 hours...

-neurologic, renal, endocrine, and GI functions must be operating competently for life to be sustained

3

Fetal breathing starts...

11 weeks

4

Fetal breathing is characterized by...

minimal circulation to the pulmonary bed

5

intrauterine oxygenation occurs via..

placenta -no gas exchange in fetal lungs

6

Fetal lungs are...

fluid filled -some reduction in this prior to birth -there is still 100mL of fluid remaining in the respiratory passages at delivery

7

Intrauterine role of surfactant

-promotes lung maturity by overcoming surface tension inside and outside the alveolar sacs in the fetus -surfactant peaks at 35 weeks and remains high

8

How is blood shunted

-shunted away from the pulmonary (right side) circulation via the foramen ovale and ductus arterisus

9

Extra uterine circulation begins...

with the first breath

10

Respiratory gas exchange in conjunction with marked circulatory changes...

must occur immediately for the baby to begin life as a separate being

11

what 2 changes are needed to maintain life

-lungs must expand and allow for pulmonary ventilation -marked increase in pulmonary circulation

12

Initiation of Respirations

-thoracic squeeze decreases fluid further -chest wall recoil-small amount of air in, more fluid out -chemoreceptor response to decrease pO2, pH, and increase in CO2 -cold air means less resp effort -sensory stimuli including tactile, auditory, and visual that stimulate resp effort

13

What happens after umbilical cord is clamped and respirations are initiated

14

3 Anatomic Shunts that normally close after delivery

  1. Foramen Ovale
  2. Ductus Arteriosus
  3. Ductus Venosus

15

Why do the 3 shunts close after delivery?

due to the response to pressure gradient shifts following the first few breaths

16

What happens to pulmonary blood flow with first few breaths?

  • lung fluid has been removed
  • pulmonary vascular resistance decreases and pulmonary blood flow increases
  • sometimes this doesn't happen right away and the baby develops Transitory Tachypnea of the Newborn (TTN)

17

Tx for TTN

  • support until the lungs clear
  • O2
  • hold PO feeds
  • IVF with expected recovery in 24-72 hours

18

Initial steps for newborn

  • drying
  • warming
  • stimulation
  • positioning
  • clear airway
  • necessary for all newborns

19

Immediately after delivery, look at...

  • general appearance
  • color and cry
  • ease of breathing

first exam begins as nurse is drying, stimulating and wrapping infant or when infant is placed on mothers abdomen after being born

20

Skin to skin

promotes bonding and breastfeeding

21

Immediate newborn care

  • wear gloves
  • maintain airway
    • suction, O2 prn
    • RR: 30-70's
    • Apgar score
  • Neutral thermal environment
    • warmer, maintain temp of 36.5-37.2 C
  • Safety ID Bands

22

Convection

losses from circulating air

23

Radiation

body heat transferring to nearby objects

24

Evaporation

heat loss when moisture on baby vaporizes into air

25

Conduction

body heat lost when baby in direct contact with cold object

26

Increase in muscular activity

shown by crying and restlessness (increases BMR)

27

Non-shivering thermogenesis

unique to newborns

-uses the infants stores of brown fat

28

brown fat

found in the midscapular area, around the neck, axillas, trachea, kidneys, and adrenal glands

29

Cold Stress

  • Hypothermia
  1. ↑ O2 consumption (to keep warm) that leads to ↑ RR
  2. Pulmonary vasoconstriction and Peripheral vasoconstriction
  3. ↓ O2 to tissues causing Anaerobic glycolysis OR metabolic acidosis

30

Metabolic acidosis

↓O2, ↑ CO2 leading to ↓ pH (acid)