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NURS 4500: Final Material > Class 9: Uncomplicated Newborn > Flashcards

Class 9: Uncomplicated Newborn Flashcards

1
Q

birth thru the 1st 2 hrs of life is a time of…

A
  • immense change and adaptability for newborn
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2
Q

what is included in changes for the newborn from birth thru the first 2 hrs of life (6)

A
  • establish respirations
  • adjust to circulatory changes
  • regulate temp
  • ingest, retain, and digest nutrients
  • eliminate waste
  • adjust to social enviro and new behaviors (sleep/stimuli/relationships)
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3
Q

prep of the neonatal transition includes assessment of… (5)

A

risk factors such as:
- fetal
- maternal
- intrapartum
- preconception
- prenatal

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4
Q

what are prenatal risk factors for neonatal transition to extrauterine life (7)

A
  • prenatal care (when started, if attended regularly)
  • nutrition
  • health-compromising behaviors
  • blood group or Rh sensitization
  • meds
  • history of infection (STBBIs, GBS)
  • hx of antepartum bleeding, HTN, DM
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5
Q

what are prenatal risks for neonatal transition to extrauterine life r/t nutrition (4)

A
  • weight gain
  • diet
  • obesity
  • eating disorders
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6
Q

what are intrapartum risk factors for neonatal transition to extrauterine life (4)

A
  • length of gestation
  • first stage of labor
  • GBS status (adequate treatment?)
  • 2nd stage of labor
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7
Q

what are intrapartum risks for neonatal transition to extrauterine life r/t 1st stage of labor (6)

A
  • fetal position/presentation
  • length
  • ROM (length of, meconium, S&S of infection)
  • signs of fetal distress (scalp sampling done? FHR)
  • complications in labor (bleeding, eclampsia, tx w magnesium)
  • analgesia/anesthesia (fentanyl, morphine –> resp distress?)
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8
Q

what are intrapartum risks for neonatal transition to extrauterine life r/t 2nd stage of labor (3)

A
  • length
  • type of birth (c-section - planned/unplanned, vaginal - spontaneous, assisted)
  • complications (shoulder dystocia, cord prolapse)
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9
Q

define: meconium

A
  • first stool
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10
Q

describe meconium (2)

A
  • green-black stool
  • viscous and sticky (contains occult blood)
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11
Q

when does meconium usually occur?

A
  • usually passes within 12-24 h after birth
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12
Q

meconium may occur when?

A
  • in utero
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13
Q

the passage of meconium in utero can be due to (2)

A
  1. be a normal function that occurs with maturity of fetus (chances increased after 38 weeks gestation, more common w postdates)
  2. can be caused by hypoxia induced peristalsis & sphincter relaxation
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14
Q

what is the risk of meconium being passed in utero

A
  • can be aspirated in fetal lung
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15
Q

what is the site of gas exchange for fetus?

A
  • placenta
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16
Q

describe pulmonary circulation r/t fetal circulation

A
  • high vascular resistance –> increased P in right ventricle and pulmonary arteries
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17
Q

describe systemic circulation r/t fetal circulation

A
  • low P in left atrium, ventricle, aorta
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18
Q

describe umbilical arteries r/t fetal circulation

A
  • carrying blood from hypogastric arteries to placenta
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19
Q

describe umbilical vein r/t fetal circulation

A
  • carrying blood from placenta to ductus venosis
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20
Q

describe ductus venosis r/t fetal circulation

A
  • connection of umbilical vein to IVC
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21
Q

describe ductus arteriosis r/t fetal circulation

A
  • shunting of blood from pulmonary artery to descending aorta
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22
Q

describe foramen ovale r/t fetal circulation

A
  • valve opening that allows blood to flow directly to left atrium –> shunting of blood from right to left atrium, due to low pressure in left atrium
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23
Q

what 4 things happen at birth r/t resp system

A
  • baby breathes
  • fluid in alveoli is absorbed
  • the umbilical cord is clamped
  • blood vessels in the lungs dilate
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24
Q

when the baby breathes for the first time, what impact does this have on gas exchange

A
  • baby uses their lungs for gas exchange
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25
Q

what kind of breathing do we want the newborn to do at birth (3)

A
  • big, deep breaths
  • crying
  • no gasping
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26
Q

when the baby breaths for the 1st time, what impact does this have on alveoli?

A
  • fluid in alveoli is absorbed –> fluid is replaced w air
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27
Q

the replacement of fluid in alveoli w air has what impact on the pulmonary vessels? resistance and pressires? what does this allow for?

A

= relaxation of the pulmonary vessels
- low pulmonary vascular resistance
- decreased P in R atrium, ventricle, and pulmonary arteries

= allows for gas exchange and perfusion to lungs

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28
Q

shortly after birth, the umbilical cord is clamped. what impact does this have on gas exchange? pressures and resistance? what does this promote?

A
  • placenta no longer used for gas exchange
  • increased systemic vascular resistance
  • increased pressure in L atrium, ventricle, and aorta

= promotes closure of foramen ovale

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29
Q

what impact does dilation of the blood vessels in the resp system have on pulmonary blood flow? this promotes gradual constriction of?

A
  • pulmonary blood flow increases
  • ductus arteriosus gradually constricts (may take hours/days)
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30
Q

describe newborn O2 sats PP?

A
  • can take up to 10 min for neonatal O2>90%
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31
Q

define: meconium aspiration syndrome (MAS)

A
  • resp distress in newborn infants born thru meconium stained amniotic fluid whose symptoms cannot be otherwise explained
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32
Q

MAS is more likely with situations of… (2)

A
  • fetal distress (abnormal FHR patterns)
  • postterm newborns
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33
Q

if meconium is present, and newborn is not vigorous at birth (not breathing or crying/flat tone), what is done?

A
  • may intubate to suction below the cords
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34
Q

MAS requires close monitoring such as.. (2)

A
  • electronic fetal monitoring in labor
  • neonatal resus team likely at delivery
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35
Q

complications of MAS include? (4)

A
  • terminal airway obstruction
  • resp distress
  • inflammation
  • infection
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36
Q

what impact does MAS have on pressure in resp system

A
  • can cause persistent pulmonary HTN of newborn
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37
Q

all births needs to be attended by?

A
  • someone certified in neonatal resuscitation
38
Q

what is included in routine care for neonatal transition? (6)

A
  • prone on birther’s chest (skin to skin)
  • clear secretions as needed
  • dry & stimulate to breathe
  • delayed cord clamping
  • newborn stays w parents
  • ongoing observations
39
Q

what 3 things indicate routine care for neonatal transition

A
  • term
  • crying or breathing
  • good tone (well flexed)
40
Q

what is the most imp thing for neonatal transition

A
  • establish effective respirations
41
Q

what are potential benefits of delayed cord clamping for preterm newborns? (5)

A
  • decreased mortality
  • higher BP and blood volume
  • less need for blood transfusion after birth
  • fewer brain hemorrhages
  • lower risk of necrotizing enterocolitis
42
Q

what are potential benefits of delayed cord clamping for term newborns? (2)

A
  • decrease change of developing iron-deficiency anemia
  • may improve neurodevelopmental outcomes
43
Q

what are potential adverse effects of delayed cord clamping (3)

A
  • delaying resus for compromised newborns
  • increased risk of polycythemia (high RBC conc.)
  • jaundice
44
Q

cord clamping is delayed for which types of newborns? (2)

A
  • all vigorous (crying, deep breaths) infants regardless of gestational age
  • who do not require immediate resus or other contraindications (= resus usually not delayed for cord clamping)
45
Q

for infants born at less than 37 weeks gestational age, DCC for how long?

A
  • at least 1 min
46
Q

for infants born at 37 weeks or more, DCC for how long?

A
  • 1-3 min
47
Q

what are contraindications for DCC (5)

A
  • known or suspected placental abruption
  • uncontrolled maternal hemorrhage
  • vasa previa
  • fetuses w pre-existing volume overload such as hydrops fetalis
  • multiple gestation deliveries where the 2nd twin is in distress
48
Q

collection of cord blood can be done for? (2)

A
  • Rh
  • pH
49
Q

cord blood sample for pH reflects??

A
  • acid/base balance status of newborn at birth
50
Q

umbilical artery values reflect?

A
  • fetal condition –> fetal oxygenation
51
Q

what are normal pH lvls for umbilical artery values

A

7.2-7.34

52
Q

umbilical venous blood values reflect?

A
  • placental function
53
Q

what are normal pH values for umbilical venous blood values

A

7.28-7.4

54
Q

what score is used for rapid assessment of newborn’s transition

A
  • agpar
55
Q

agpar includes what 5 aspects?

A
  • Activity (muscle tone)
  • Pulse
  • Grimace (reflex irritability)
  • Appearance (skin color)
  • RR
56
Q

when is agpar assessed?

A
  • at 1 min and 5 min
57
Q

what is meant by color with agpar assessment

A
  • assessment of mucus membranes for central cyanosis
58
Q

on agpar, what HR = score of 0? 1? 2?

A

0 = absent
1= slow <100 bpm
2 = >= 100

59
Q

on agpar, what RR = score of 0? 1? 2?

A

0 = absent
1 = slow, hypoventilation, weak cry
2 = good, crying

60
Q

on agpar, what muscle tone = score of 0? 1? 2?

A

0 = flaccid
1 = some flexion of extremities
2 = well flaxed

61
Q

on agpar, what reflex irritability = score of 0? 1? 2?

A

0 = no response
1 = grimace
2 = cry or active withdrawal

62
Q

on agpar, what color = score of 0? 1? 2?

A

0 = blue, pale
1 = body pink, extremities blue
2 = completely pink

63
Q

define: acrocyanosis

A
  • body pink/red undertone
  • extremities blue
  • considered normal at birth
64
Q

what does agpar score of 0-3 mean? 4-6? 7-10?

A
  • 0-3: severe distress
  • 4-6: moderate difficulty
  • 7-10: normal transition, little difficulty
65
Q

if the APGAR score is <10, what is done?

A
  • do at 10-20 min
66
Q

APGAR is a tool for…. it’s not?

A
  • tool for assessment of transition to extrauterine life
  • not a predictor of neuro outcomes
67
Q

describe thermoregulation of the newborn

A
  • is the maintenance of balance between heat loss & heat production
68
Q

what is common r/t temp in newborns?

A
  • hypothermia –> dangerous in newborn
69
Q

why is hypothermia common in newborn?

A
  • thin layer of subcut fat/blood vessels close to skin’s surface / large body surface to mass ratio
70
Q

what 4 terms describe the relationship of the newborn to the external enviro

A
  • convection
  • radiation
  • evaporation
  • conduction
71
Q

define: convection

A
  • loss of heat from the infant’s skin to the surrounding air
  • infants lose a lot of heat by convection when exposed to cold air or draughts.
72
Q

describe interventions to protect newborn from convection (3)

A
  • keep ambient temp at 24*C
  • newborns wrapped in open bassinets
  • newborn cap
73
Q

define: radiation

A
  • loss of heat from an infant’s skin to distant cold objects
  • not impacted by temp of surrounding air
74
Q

describe interventions to protect newborn from radiation (2)

A
  • keep newborns away from outside windows and air drafts
  • radiant warmers
75
Q

define: evaporation

A
  • loss of heat from an infant’s wet skin to the surrounding air
76
Q

describe interventions to protect newborn from evaporation (2)

A
  • dry newborn immediately after birth & baths
  • timely, efficient baths
77
Q

define: conduction

A
  • loss of heat when the infant lies on a cold surface
78
Q

describe interventions to help prevent newborn from conduction (2)

A
  • cover scales w blanket/pad when weighing newborn
  • skin-to-skin contact
79
Q

what is v imp with thermoregulation of newborn? why?

A
  • maintaining a neutral thermal enviro for newborns is v important
  • minimizes oxygen and glucose consumption
80
Q

how does the newborn body respond to hypothermia? (5)

A
  • thermogenesis
  • increase in cellular metabolic activity
  • position
  • constriction of peripheral blood vessels
  • shivering mechanism not generally operable in newborn
81
Q

describe: thermogenosis

A
  • newborn attempts to generate heat by increasing muscle activity
82
Q

what are signs of thermogenesis (3)

A

could appear:
- restless
- cry
- skin feel cool due to vasoconstriction

83
Q

what impact does increase in cellular metabolic activity with hypothermia have?

A
  • increases consumption of oxygen and glucose
84
Q

what position does the newborn assume in response to hypothermia

A
  • flexion = reduces exposure
85
Q

due to the lack of shivering mechanism in newborn, what occurs?

A
  • non shivering thermogenesis
86
Q

non-shivering thermogenesis leads to?

A
  • metabolism of brown fat
  • increase metabolic activity in brain, heart, liver
87
Q

there are higher reserves of brown fat in…?

A
  • term infants
88
Q

cold stress can lead to.. (3)

A
  • metabolic acidosis
  • resp acidosis
  • hypoglycemia
89
Q

hyperthermia in the newborn is usually related to?

A
  • sepsis
  • inappropriate use of heat sources (ex. radiant warmers, excessive blankets)
90
Q

describe skin-to-skin contact in newborn

A
  • place naked, well, and DRIED newborn next to birther’s skin covered with blanket
91
Q

what are the benefits of skin-to-skin contact (3)

A
  • reduces heat loss
  • enhances newborn temp control
  • positive impact on maternal-infant interaction

NURS 4500: Final Material (16 decks)

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