Newborn Adaptations to Extrauterine Life Flashcards
(95 cards)
1
Q
The initiation of respirations in the neonate is the result of:
A
a combination of factors
- chemical
- mechanical
- thermal
- sensory
2
Q
Describe the chemical processes associated with fetal respiratory adaptation:
A
1) Chemoreceptors in carotid arteries and aorta= hypoxia with labor
2) Contractions cause decrease in uterine blood flow= fetal hypoxia and hypercarbia
3) Cumulative effect on fetus= drop in PO2, increase PCO2, low blood pH
4) This STIMULATE THE RESPIRATORY CENTER IN MEDULLA
Clamp in cord can also cause prostaglandin to drop (prostaglandin INHIBITS respirations)= this drop promotes breathing
3
Q
Describe the mechanical factors associated with fetal adaptation to repiratory function:
A
1 -intrathoracic pressure resulting from compression of the chest during vaginal birth.
2 -With birth this pressure on the chest is released, and the negative intrathoracic pressure helps to draw air into the lungs.
3 -Crying increases the distribution of air in the lungs and promotes expansion of the alveoli.
4 -The positive pressure created by crying helps to keep the alveoli open
4
Q
Describe thermal factors associated with newborn adaptation to respiratory function:
A
- With birth the newborn enters the extrauterine environment in which the temperature is significantly lower.
- The profound change in environmental temperature stimulates receptors in the skin, resulting in STIMULATION OF THE RESPIRATORY CENTER
5
Q
Describe sensory factors associated with newborn adaptation to respiratory function:
A
- handling by the obstetric health care provider
- suctioning the mouth and nose
- drying by the nurses
- Environmental factors (lights, sounds, smells)
THESE ALL STIMULATE THE RESPIRATORY CENTER
6
Q
What is an abnormal amount of time for the newborn to not breath?
A
Apneic periods longer than 20 seconds are abnormal and should be evaluated
7
Q
The reflex response to nasal obstruction is to open the mouth to maintain an airway. This response is not present in most infants until 3 weeks after birth; therefore:
A
cyanosis or asphyxia can occur with nasal blockage
8
Q
In most newborns, auscultation of the chest reveals:
A
- loud, clear breath sounds that seem very near because little chest tissue intervenes
- clear and equal bilaterally
- fine rales for the first few hours are not unusual
9
Q
Signs of respiratory distress can include:
A
- nasal flaring
- intercostal or subcostal retractions (in-drawing of tissue between the ribs or below the rib cage)
- grunting with respirations
10
Q
Suprasternal or sub-clavicular retractions with stridor or gasping most often represent:
A
an upper airway obstruction
11
Q
What are seesaw or paradoxic respirations?
A
Seesaw or paradoxic respirations (exaggerated rise in abdomen with respiration as the chest falls) instead of abdominal respirations are abnormal and should be reported.
12
Q
What is the normal respiratory rate for the newborn?
A
A respiratory rate of less than 30 or greater than 60 breaths/ min with the infant at rest must be evaluated.
13
Q
Describe the normal and abnormal findings regarding the color of the newborn (blue vs. pink):
A
- Acrocyanosis, the bluish discoloration of hands and feet, is a normal finding in the first 24 hours after birth
- Transient periods of duskiness while crying are common immediately after birth
- central cyanosis is abnormal and signifies hypoxemia. (the lips and mucous membranes are bluish) (circumoral cyanosis)
- central cyanosis is a late sign of distress, newborns usually have significant hypoxemia when cyanosis appears
14
Q
When does the ductus arteriosus close? What causes this closure?
A
- In term infants, it functionally closes within the first 24 hours after birth; permanent (anatomic) closure usually occurs within 2 to 3 months, and the ductus arteriosus becomes a ligament.
- After birth, when the PO 2 level in the arterial blood approximates 50 mm Hg, the ductus arteriosus constricts in response to increased oxygenation.
- Circulating prostaglandin E2 (PGE2) levels also have an important role in closing the ductus arteriosus.
15
Q
Can the ductus arteriosus reopen?
A
YES> The ductus arteriosus can reopen in response to low oxygen levels in association with hypoxia, asphyxia, prolonged crying, or pathologic problems.
16
Q
What would an open ductus arteriosus resemble?
A
With auscultation of the chest, a patent ductus arteriosus can be detected as a heart murmur
17
Q
When and how should the nurse respond to heart rate changes in the newborn?
A
A heart rate that is either high (more than 160 beats/ min) or low (fewer than 100 beats/ min) should be reevaluated within 30 minutes to 1 hour or when the activity of the infant changes.
18
Q
Where does the nurse know to place her stethoscope when she is listening to the apical impulse/PMI of a newborn?
A
- fourth intercostal space and to the left of the midclavicular line
- The PMI is often visible and easily palpable because of the thin chest wall; this is also called precordial activity
19
Q
When should the newborn be evaluated for sinus dysrhythmias?
A
Irregular heart rate or sinus dysrhythmia is COMMON IN THE FIRST FEW HOURS but thereafter may need to be evaluated
20
Q
Heart sounds during the neonatal period:
A
- higher pitch, shorter duration, and greater intensity than adults
- (S1) is typically louder and duller than the second sound (S2), which is sharp
- third and fourth heart sounds are not audible in newborns
21
Q
Are heart murmurs an ominous sigh in the newborn?
A
Not really > Most heart murmurs heard during the neonatal period have no pathologic significance, and more than one-half of the murmurs disappear by 6 months of age
22
Q
When should heart murmurs be evaluated?
A
the presence of a murmur and accompanying signs such as poor feeding, apnea, cyanosis, or pallor is considered abnormal and should be investigated
23
Q
What should the nurse expect in the newborn concerning MAP?
A
The mean arterial pressure (MAP) should be nearly equivalent to the weeks of gestation. For example, an infant born at 40 weeks of gestation should have a MAP of at least 40.
24
Q
A drop in systolic BP (approximately 15 mm Hg) in the first hour of life is common.
Expected values for BP (systolic/ diastolic) in a term infant are:
A
- At birth: 75– 95/ 37– 55
- 12 hours: 50– 70/ 25– 45
- 96 hours: 60– 90/ 20– 60
25
What is a normal range of blood volume for the term and the preterm infant?
- term newborn ranges from 80 to 100 mL/ kg of body weight
| - preterm infant, the range is 90 to 105 mL/ kg
26
The preterm infant has a relatively greater blood volume than the term newborn. Why does this occur?
the preterm infant has a PROPORTIONATLY greater plasma volume
(not a greater red blood cell mass)
27
Delayed clamping of the umbilical cord (DCC):
changes the circulatory dynamics of the newborn
28
DCC has been associated with:
- increased blood volume and BP
- reduced risk for intraventricular hemorrhage and necrotizing enterocolitis
- These benefits are most important for preterm infants.
29
Persistent tachycardia (more than 160 beats/ min) can be associated with:
- anemia
- hypovolemia
- hyperthermia
- sepsis
30
Persistent bradycardia (less than 80 beats/ min) can be a sign of:
- congenital heart block
| - hypoxemia
31
Unequal or absent pulses, bounding pulses, and decreased or elevated BP can indicate:
-cardiovascular problems
32
The newborn’s skin color can reflect cardiovascular problems. Describe findings and meanings for each:
- Pallor = anemia or marked peripheral vasoconstriction as a result of intrapartum asphyxia or sepsis
- Cyanosis other than in the hands or feet, with or without increased work of breathing= respiratory and/ or cardiac problems.
- jaundice = ABO or Rh factor incompatibility problems
33
What factors may increase the risk for neonatal cardiac defects?
- rubella
- diabetes
- maternal drugs
34
Heat loss must be controlled to protect the infant who is at risk for hypothermia. What interventions are implemented at birth to prevent excessive heat loss?
- Drying the infant quickly after birth
- The naked newborn is placed on the mother’s bare chest and covered with a warm blanket
- a cap may be placed on the infant’s head
- Or… the neonate is placed under a radiant warmer
35
How do newborns produce heat (thermogenesis)?
NONSHIVERING THERMOGENESIS:
- metabolism of brown fat, which is unique to the newborn
- increased metabolic activity in the brain, heart, and liver
36
Describe the etiology of Cold Stress in the newborn using 8 steps:
1) DROP IN TEMPERATURE=VASOCONSTRICTION= pale and mottled; the skin feels cool, especially on the extremities.
2) IF UNCORRECTED> COLD STRESS
3) RESPIRATORY RATE INCREACES (oxygen consumption and energy are diverted from maintaining normal brain and cardiac function and growth to thermogenesis for survival)
4) If the infant cannot maintain an adequate oxygen tension, vasoconstriction follows and jeopardizes pulmonary perfusion.
5) PO2 DECREASES AND PH DROPS
6) Surfactant synthesis can be altered
7) THIS CAUSES> transient respiratory distress or aggravate existing RDS
8) DUCTUS ARTERIOSUS CAN REOPEN
37
Although less frequently than hypothermia, hyperthermia can occur and must be corrected. When is the nurse alerted to a need for intervention concerning newborn temperature?
A body temperature greater than 37.5 ° C (99.5 ° F) is considered to be abnormally high and is typically caused by excess heat production related to sepsis or a decrease in heat loss.
38
Hyperthermia can result from:
the inappropriate use of external heat sources such as radiant warmers, phototherapy, sunlight, increased environmental temperature, and the use of excessive clothing or blankets.
39
Infants who are overheated because of environmental factors such as being swaddled in too many blankets exhibit signs of heat-losing mechanisms:
skin vessels dilate, skin appears flushed, hands and feet are warm to touch, and the infant assumes a posture of extension.
40
The newborn who is hyperthermic because of sepsis appears:
STRESSED> vessels in the skin are constricted, color is pale, and hands and feet are cool
41
Why does hyperthermia develop more rapidly in the infant than in adults?
- the RELATIVELY larger surface area of an infant.
| - Sweat glands do not function well.
42
Hyperthermia can cause:
- neurologic injury
- increased risk for seizures
- heat stroke
- death
43
During the first few days, term infants generally excrete:
15 to 60 mL/ kg/ day of urine; output gradually increases over the first month
44
What are normal findings concerning the frequency of voiding for the newborn?
- 2 to 6 times per day during first 2 days
| - 6-8 times per day by day 4 of straw-colored urine (this indicates adequate fluid intake)
45
What is the Nursing Alert concerning Newborn Voiding?
Noting and recording the first voiding are important. An infant who has not voided by 24 hours should be assessed for adequacy of fluid intake, bladder distention, restlessness, and signs of discomfort. The neonatal health care provider should be notified.
46
What is the specific gravity of newborn urine?
usually low (less than 1.004)
47
Pink-tinged uric acid crystals or “brick dust” can appear on the diaper. Is this normal? When should the nurse be concerned?
Uric acid crystals are normal during the first week but thereafter can be a sign of inadequate intake
48
In terms of fluid balance what is normal for newborns?
- Loss of fluid through urine, feces, lungs, increased metabolic rate, and limited fluid intake can result in a 5% to 10% loss of the birth weight over the first 3 to 5 days
- Excessive weight loss can be related to feeding difficulties or other issues
- The neonate should regain the birth weight within 10 to 14 days, depending on the feeding method (breastfeeding, breast milk feeding, or infant formula)
49
The weight loss experienced by most newborns during the first few days after birth is caused primarily by:
extracellular water loss
50
The daily fluid requirement during the first 2 days of life for neonates weighing more than 1500 g is:
60 to 80 mL/ kg
51
From 3 to 7 days the fluid requirement is:
100 to 150 mL/ kg/ day, and
52
from 8 to 30 days the fluid requirement is:
120 to 180 mL/ kg/ day
53
At birth, the glomerular filtration rate (GFR) of a newborn is significantly lower than in the adult. Describe the causes and effects of this phenomenon:
- This results in a decreased ability to remove nitrogenous and other waste products from the blood
- The GFR rapidly increases during the 2 to 4 weeks after birth as a result of postnatal physiologic changes, including decreased renal vascular resistance, increased renal blood flow, and increased filtration pressure
- The GFR gradually rises to adult levels by 2 years of age
54
Sodium reabsorption is decreased as a result of:
a lowered sodium- or potassium-activated adenosine triphosphatase activity
55
The decreased ability to excrete excess sodium results in:
hypotonic urine compared with plasma, leading to a higher concentration of sodium, phosphates, chloride, and organic acids and a lower concentration of bicarbonate ions
56
The newborn’s ability to cope with events (e.g., cold stress) that produce acidosis is reduced. What factors may be attributed to this?
1 - a lower renal threshold for bicarbonate and a limited capacity for reabsorption, the neonate’s serum
bicarbonate and plasma pH levels are lower
2 -Buffering capacity is decreased
57
The renal system has a wide range of functions. Describe some identifiable signs of renal system problems in the newborn:
- lack of a steady stream of urine to gross anomalies such as hypospadias and exstrophy of the bladder, which can be identified easily at birth.
- Enlarged or cystic kidneys can be identified as masses during abdominal palpation
- Some kidney anomalies also can be detected by ultrasound examination during pregnancy
58
As a result, newborns are prone to regurgitation, “spitting,” and vomiting, especially during the first 3 months. What can the nurse teach the new mother about this phase in her newborn?
-GER can be minimized by avoiding overfeeding, burping, and positioning the infant with the head slightly elevated.
59
Describe normal findings of the mouth (first place of digestion) in the newborn:
- the mucous membrane of the mouth is moist and pink; the hard and soft palates are intact
- The presence of moderate to large amounts of mucus is common in the first few hours after birth.
- Small whitish areas (Epstein pearls) may be found on the gum margins and at the juncture of the hard and soft palates
- The cheeks are full because of well-developed sucking pads. These, like the labial tubercles (sucking calluses) on the upper lip, disappear at approximately 12 months of age when the sucking period is over
60
Newborns lack pancreatic enzymes until later in development. What does this mean for digestion?
the normal newborn is capable of digesting simple carbohydrates and proteins but has a limited ability to digest fats
61
Describe normal findings for meconium:
Meconium is greenish black and viscous and contains occult blood. Most healthy term infants pass meconium within the first 12 to 24 hours of life, and almost all do so by 48 hours
62
What is one way the caregiver might suspect the new infant is hungry?
Random hand-to-mouth movement and sucking of fingers are well developed at birth and intensify when the infant is hungry
63
Failure to pass meconium can indicate:
bowel obstruction related to conditions such as an inborn error of metabolism (e.g., cystic fibrosis) or a congenital disorder (e.g., Hirschsprung disease or an imperforate anus).
64
An active rectal “wink” reflex (contraction of the anal sphincter muscle in response to touch) is:
a sign of good sphincter tone
65
Passage of meconium from the vagina or urinary meatus is a sign of:
a possible fistulous tract from the rectum
66
Fullness of the abdomen above the umbilicus can be caused by:
hepatomegaly, duodenal atresia, or distention
67
Abdominal distention at birth usually indicates:
a serious disorder such as a ruptured viscus (from abdominal wall defects) or tumors
68
A scaphoid (sunken) abdomen, with bowel sounds heard in the chest and signs of respiratory distress, indicates:
a diaphragmatic hernia
69
Fullness below the umbilicus can indicate:
a distended bladder
70
If an infant is allergic or unable to digest a formula:
the stools can become very soft with a high-water content that is signaled by a distinct water ring around the stool on the diaper
71
Forceful ejection of stool and a water ring around the stool are signs of:
diarrhea
72
Color change, gagging, and projectile (very forceful) vomiting occurs with:
esophageal and tracheoesophageal anomalies
73
Vomiting in large amounts, especially if it is projectile, can be a sign of:
pyloric stenosis
74
Bilious (green) emesis is suggestive of:
intestinal obstruction or malrotation of the bowel
75
The infant’s liver plays an important role in:
iron storage, glucose and fatty acid metabolism, bilirubin synthesis, and coagulation
76
Describe the information relative to newborns and iron:
- At birth, the term infant has an iron store sufficient to last approximately 4 months.
- Iron stores of preterm and small-for-gestational-age infants are often lower and are depleted sooner than in healthy term infants.
- Although both breast milk and cow’s milk contain iron, the bioavailability of iron in breast milk (lactoferrin) is far superior.
77
Glucose levels are not routinely assessed in newborns unless there are risk factors or symptoms of hypoglycemia. Risk factors include:
small or large for gestational age, preterm, and infant of a diabetic mother
78
The hypoglycemic infant can be asymptomatic or can display:
the classic symptoms of jitteriness, lethargy, apnea, feeding problems, or seizures
79
Persistent or recurrent hypoglycemia necessitates:
intravenous glucose therapy and possible pharmacologic intervention
80
Hypoglycemia and hyperbilirubinemia are the most common liver-related problems experienced by newborns. In most cases the problems are transient and require little, if any treatment. Describe risks and assessments related to this topic:
- Preterm infants are at increased risk for hepatic system problems because of the immaturity of the liver.
- The hematologic status of all newborns should be assessed for anemia.
- For the first week of life, neonates are at risk for bleeding until the coagulation factors are well established.
- Male newborns who are circumcised prior to discharge from the birth facility must be monitored carefully for bleeding.
81
Describe changes that may be associated with infection and thus need to be evaluated closely:
- Temperature instability or hypothermia can be symptomatic of serious infection; newborns do not typically exhibit fever, although hyperthermia can occur (temperature greater than 38 ° C [100.4 ° F]).
- Lethargy, irritability, poor feeding, vomiting or diarrhea, decreased reflexes, and pale or mottled skin color are some of the clinical signs that suggest infection.
- Respiratory symptoms such as apnea, tachypnea, grunting, or retracting can be associated with infection such as pneumonia
- Any unusual discharge from the infant’s eyes, nose, mouth, or other orifice must be investigated.
- If a rash appears, it must be evaluated closely; many normal rashes in the newborn are not associated with any infection
82
Newborn Risks for Infections include:
Immaturity, premature rupture of membranes, chorioamnionitis, maternal fever, antenatal or intrapartal asphyxia, invasive procedures, stress, and congenital anomalies.
83
What is a Caput succedaneum?
Caput succedaneum is a generalized, easily identifiable edematous area of the scalp, most often on the occiput caused by pressure that leads to slow venous return. Disappears within 3-4 days. Vaccuum extractions leads to a caput in the area. Bruising may be seen.
84
Cephalhematoma:
- a collection of blood between a skull bone and its periosteum
- firmer and better defined than a caput
- usually resolves in 2 to 8 weeks
- As the hematoma resolves, hemolysis of RBCs occurs, and hyperbilirubinemia can result
85
Subgaleal hemorrhage:
- bleeding into the subgaleal compartment
- Subgaleal hemorrhage is the result of traction or application of shearing forces to the scalp, commonly associated with difficult operative vaginal birth, especially vacuum extraction
- The scalp is pulled away from the bony calvarium; the vessels are torn, and blood collects in the subgaleal space
- Blood loss can be severe, resulting in hypovolemic shock (DIC), and death
86
With Subgaleal hemorrhage, early detection of the hemorrhage is vital; serial head circumference measurements and inspection of the back of the neck for increasing edema and a firm mass are essential. Describe other interventions that may take place:
- A boggy scalp, pallor, tachycardia, and increasing head circumference can be early signs of a subgaleal hemorrhage
- Computed tomography or magnetic resonance imaging is useful in confirming the diagnosis
- Replacement of lost blood and clotting factors is required in acute cases of hemorrhage
- forward and lateral positioning of the newborn’s ears because the hematoma extends posteriorly
- Monitoring the infant for changes in level of consciousness and decreases in hematocrit is also key to early recognition and management
- An increase in serum bilirubin level may be seen as a result of the degradation of blood cells within the hematoma
87
Describe assessment findings of the newborn spine:
- The vertebrae should appear straight and flat
- If a pilonidal dimple is noted, further inspection is required to determine whether a sinus is present
- A pilonidal dimple, especially with a sinus and nevus pilosis (hairy nevus), can be associated with spina bifida
88
Describe abnormal findings of the extremities:
- Digits may be missing (oligodactyly)
- Extra digits (polydactyly) are sometimes found on the hands or feet
- Fingers or toes may be fused (syndactyly)
89
Signs of DDH are:
asymmetric gluteal and thigh skinfolds, uneven knee levels, a positive Ortolani test, and a positive Barlow test
90
Moro reflex definition:
a reflex reaction of infants upon being startled (as by a loud noise or a bright light) that is characterized by extension of the arms and legs away from the body and to the side and then by drawing them together as if in an embrace
91
Describe the babinski reflex:
Babinski reflex is one of the normal reflexes in infants. Reflexes are responses that occur when the body receives a certain stimulus. The Babinski reflex occurs after the sole of the foot has been firmly stroked. The big toe then moves upward or toward the top surface of the foot.
92
Describe mongolian spots:
Mongolian spots are very common in any part of the body of dark-skinned babies. They are flat, gray-blue in color (almost looking like a bruise), and can be small or large. They are caused by some pigment that didn't make it to the top layer when baby's skin was being formed.
93
Describe Milia:
Milia are tiny white bumps that appear across a baby's nose, chin or cheeks. Milia are common in newborns but can occur at any age. You can't prevent milia. And no treatment is needed because they usually disappear on their own in a few weeks or months.
94
Telangiectatic Nevi:
About 30 to 50 percent of newborns have flat, pink spots on their skin. Such spots are called telangiectatic nevi—often referred to as “stork bites” or “angel kisses.” The spots appear on the face and neck, eyelids, upper lip, back of the neck, and forehead.
95
Witch's milk or neonatal milk is:
milk secreted from the breasts of some newborn human infants of either sex. Neonatal milk secretion is considered a normal physiological occurrence and no treatment or testing is necessary.
