Module Six Flashcards
(52 cards)
Catecholamines
Epinephrine
Norepinephrine
Dopamine
- Surge in response to birth process and are responsible for inc BP after birth, adaption of energy metabolism, initiation of thermogenesis
Cortisol
regulatory hormone that aids in neonates transition, aids in lung maturation, clearance of lung fluid, gut maturation, maturation of glucose metabolic pathways in the liver, maturation of the thyroid axis.
Initiation of Resps triggered by:
Chemical, Mechanical, Thermal, Sensory
Chemical Factors
Progressive decline in PO2 during labour and a drop in prostaglandin levels that results from clamping the cord
Mechanical
Squeezing of chest during vaginal delivery
Thermal
Shifts from warm intrauterine environment –> extra stimulates resp center in medulla
Sensory
Drying the neonate also stimulates resp center
Key Physiologic Changes
- expansion of lungs with air
- rapid dec in pulmonary vascular resistance and increase in pulmonary blood flow
- Initiation of gas exchange across alveolar membrane
- Pressure gradient changes (dec R side pressure, inc L side pressure)
- Closure of circulatory shunts (foramen ovale, ductus arteriosus)
- increase in arterial PO2
Hypoexpansion of lungs hypoxemia, persistent acidosis —> high pulmonary vascular resistance, delayed clearance of lung fluid, persistent R to L shunting
APGAR
A- appearance (colour) P- pulse (HR) G- Grimace (reflexes) A- Activity R- Respirations - breathing
Transition Period of Reactivity
First, Sleep, Second
First Period of Reactivity
Birth –> 30-60min
Quiet Alert State
HR 160-180 bpm settling to 100-120 by 30 mins
Resps irreg, fine crackles
transitory grunting, nasal flaring, chest retractions may be evident
Sleep Period of Reactivity
After first period
deep sleep for 60-100 mins
Stabilization- temp regulation, adequate oxygenation, circulation, resps rapid but not laboured
Second Period of Reactivity
2-6 hours after birth
lasts 10 mins - several hours
tachycardia, tachypnea, inc muscle tone, skin colour changes, passage of meconium
Skin-to-skin
stabilizes resps, thermal regulation, reduces apnea and bradycardia, improve infant state organization and self regulation, reduces stress, facilitates neurodevelopment, accelerated wt gain, decrease pain response, increase incident and duration of breast feeding
Increase self confidence, infant attachment, positive mood/behaviour, increased milk supply
Behavioural tasks of newborn
establish regulated behavioural tempo independent of the mother
Processing, storing, organizing multiple stimuli
Establishing a relationship with caregivers and environment
First level organization
regulate physiologic function
Second level organization
Motor, reduce excessive activity and improve muscletone
Third level organization
State regulation, predictable sleep and wake states, able to react to stress
Fourth level organization
atten and social reaction, able to attend to visual and auditory stimuli
“Organized”
- regulate physiologic functioning
- Maintain good tone
- Modulate states
- Interact with Environment
State Modulation
Ability to transition smoothly between states
Deep Sleep (Quiet)
Regular breathing, eyes closed, no movement, no spontaneous activity except startles and occasional suck, delayed response to ext stimuli, cannot be easily roused
Light Sleep (Active)
Breathing irreg, REM, may smile or be fussy, sporadic sucking, short crying sounds, responds to ext stimuli with a startle, will feed without opening eyes
Drowsy
Breathing irreg, eyes open or close, variable activity level, react to stimuli with delayed responses, usually feeds well- becomes more alert
