Ch. 22 Physiologic and behavioral adaptations of newborns

Question 1

How long does the 1st period of reactivity last

Answer 1

30min after birth

Question 2

Describe the newborns heart, respirations, bowel sounds during the 1st period of reactivity

Answer 2

HR= 160-180 then falls to 100-120 after 30min
RR= irregular 60-80b/m grunting nasal flaring, infant is alert
Bowel sounds audible

Question 3

How long odes the period of decreased responsiveness last

Answer 3

60-100min

Question 4

During the decreased responsiveness period the infant is

Answer 4

sleep or has decrease activity

Question 5

How long does the 2nd period of reactivity last

Answer 5

2-8hr after birth and last 10min to several hours

Question 6

Describe the HR and RR during the 2nd period of reactivity

Answer 6

tachycardia and tachypnea may occur.

Question 7

How does clamping the cord aid in initiating breathing

Answer 7

it causes a rise in BP, which increases circulation and lung perfusion

Question 8

What are the chemical factors that aid in the initiating breathing

Answer 8

activation of chemoreceptors (decrease levels of O2 and increase levels of CO2) stimulate the respiratory center in the medulla

Question 9

Describe the mechanical factors that initiate breathing

Answer 9

intrathoracic pressure resulting from compression of the chest during vaginal birth helps draw air into the lungs

Question 10

Describe how crying aids in breathing

Answer 10

it increases the distribution of aid in the lungs and promotes expansion of the alveoli. positive pressure created by crying helps keep the alveoli open

Question 11

What are the thermal factors associated with breathing

Answer 11

newborn enters extrauterine environment where temp is lower which stimulates the receptors in the skin, resulting in stimulation of the respiratory center in medulla

Question 12

What is the importance of surfactant

Answer 12

lowers surface tension, reducing the pressure required to keep the alveoli open

Question 13

What happens with absent or decreased surfactant

Answer 13

more pressure must be generated for inspiration, which can soon tire the infant

Question 14

What is the average RR for newborn

Answer 14

30-60b/min w/periods of pauses less than 20sec

Question 15

T/F Apneic periods longer than 20sec indicates a path problem

Answer 15

True

Question 16

T/F Newborns are by preference nose breathers

Answer 16

True; therefore cyanosis or asphyxia can occur w nasal blockage

Question 17

T/F RR less than 30sec or greater than 60 should be evaluated

Answer 17

true

Question 18

Define acrocyanosis

Answer 18

bluish discoloration of hands and feet

Question 19

Define central cyanosis

Answer 19

abnormal and signifies hypoemia. lips and mucus membranes are bluish

Question 20

When does the ductus arteries close

Answer 20

for term infant; w/in the 1st hr after birth. permanent closure at 3-4wk

Question 21

What is the HR range for newborn

Answer 21

120-160b/min

Question 22

What is the HR range for newborn asleep

Answer 22

85-100b/min

Question 23

What is the range for BP for infant

Answer 23

Systolic; 60-80

Dyastolic; 40-50

Question 24

What are the pros of delayed cord clamping

Answer 24

(greater 2min) improves hematocrit and iron status and decreasing anemia

Question 25

What is the RBC range in a newborn

Answer 25

4.6-5.2mill

Question 26

What is the hemoglobin level of a newborn

Answer 26

13.7-20.1 at birth, decreasing gradually to 12-20 during 1st 20wk

Question 27

What are the hematocrit levels for infant

Answer 27

51-56% by wk 8 @ 39-59%

Question 28

What is polycythemia

Answer 28

central venous hematocrit greater than 65%; can occur in infants from delayed cord clamping, maternal hypertension or diabetes, IUGR

Question 29

What is the normal WBC count

Answer 29

9000=30,000

Question 30

T/F Serious infection is not tolerated well by the newborns because leukocytes are slow to recognize protein

Answer 30

True

Question 31

What is the platelet count range

Answer 31

150,000-300,000

Question 32

Define thermoregulation

Answer 32

maintenance of balance b/w heat loss and heat production

Question 33

What is the physiologic characteristics of neonates that put them at a higher risk for heat loss

Answer 33

have thin layer of subcutaneous fat, blood vessels are close to the surface of the skin

Question 34

What are the 4 modes of heat loss in the neonate

Answer 34

convection (body-air) radiation (draft) evaporation ( damp skin) conduction (warm crib)

Question 35

In reguards to heat loss skin to skin contact

Answer 35

reduces conductive and radiant heat loss and enhances newborn temp control

Question 36

T/F in an effort to conserve heat, newborns assume a position of flexion that helps guard against loss because it diminishes the amount of body surface exposed to the environment

Answer 36

True

Question 37

What happens to the brown fat with cold stress

Answer 37

it is rapidly depleted

Question 38

What are the effects of cold stress

Answer 38

RR increase w/need for oxygen, oxygen and energy are diverted from brain and cardiac function, growth to thermogenesis for survival, pulmonary vasoconstriction; decreases oxygen uptake by lungs and decreases oxygen to tissues leading to aerobic glycolosis metabolic acidosis

Question 39

T/F 6-8 voidings per day of pale, straw colored urine indicate adequate fluid intake

Answer 39

true

Question 40

What causes the weight loss experienced by most newborns during the 1st few days

Answer 40

extracellular loss

Question 41

At birth the term infant has an iron stores to last

Answer 41

4-6wk

Question 42

Where should breastfeed infants receive iron supplementation

Answer 42

4months

Question 43

What is jaundice

Answer 43

visibly yellowish color of skin and sclera caused by serum levels of unconjugated bilirubin

Question 44

Which organ is responsible for the conjugation of bilirubin

Answer 44

liver

Question 45

T/F unconjugated bilirubin is insoluble

Answer 45

true

Question 46

Jaundice is likely to appear when bilirubin levels exceed

Answer 46

5-6

Question 47

______ jaundice appears after 24hrs usually w/o treatment

Answer 47

Physiologic

Question 48

______ Jaundice appears after within 24hrs of birth

Answer 48

Patho

Question 49

Describe what breastfeeding associated jaundice is

Answer 49

lack of effective breastfeeding contributes to the hyperbilirubinemia (dehydration = less stress to eliminate it)

Question 50

Why do newborns receive vitamin K

Answer 50

to protect clotting problems; they lack intestinal bacteria needed to make their own

Question 51

Define Caputo Succedaneum

Answer 51

edematous area of the scalp, most commonly found on the occiput; extends across sutures and usually disappears within 3-4days

Question 52

What is a cephalhematoma

Answer 52

Collection of blood between a skull bone and its periosteum (does not cross the suture line). Resolves in 3-6wks

Question 53

Define subgaleal hemorrhage

Answer 53

Bleeding into the subgleal compartment; commonly associated with vacuum extraction

Question 54

What are the early signs of subgaleal hemorrhage

Answer 54

Boggy scalp, pallor, tachycardia, increasing head circumference

Question 55

What are the two test used to assess for hip displacement

Answer 55

Barlow and Ortolani

Question 56

What is the Babinski relfex

Answer 56

Beginning at the heal stroke upwards along lateral aspect of sole the move finger across ball of foot. All toes hyperextend with dorsiflexion of big toe

Question 57

What is the average time the newborn sleeps in a day

Answer 57

17hrs