T3 - Newborn Adaptation (Josh) Flashcards Preview

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Flashcards in T3 - Newborn Adaptation (Josh) Deck (88):
1

When is the first period of reactivity?

When is the second period of reactivity?

up to 30 mins past birth

2-8 hrs after birth (lastts 10 mins to several hrs)

2

After the first period of reactivity, what does the baby do?

sleeps or has a marked decrease in activity

3

What does the HR look like during the first 30 mins of reactivity?

increased at first but gradually falls back to b/t 100-120

4

What does the RR look like during the first 30 mins of reactivity?

high (60-80)

- audible grunting
- nasal flaring
- chest retraction

5

How long will the tachypnea and flaring, grunting, retractions of first reactivity stage last?

clear up within 1 hr

6

What do vitals look like during second reactive period?

Tachypnea
Tachycardia
Increased muscle tone (jumpy)
Increased mucous production (watch for gag and choking)

7

When is surfactant produced?

in utero (34-36 wks)

***alveoli would collapse w/ each breath w/out surfactant

8

Describe the initial respirations of a neonate.

Fetal lungs filled w/ AF

Fluid forced from lungs as fetus delivered (VAGINAL SQUEEZE)

Chest wall expands as pressure from maternal pelvis is relaxed

Lowered pressure from chest expansion draws air into lungs

9

Why would Cesarean babies be more likely to have bubbly lung fields?

they don't experience the VAGINAL SQUEEZE that forces fluid out of lungs

10

What happens to O2 and CO2 immediately post birth?

CO2 increases and O2 decreases

11

What conditions interfere w/ initiation and maintenance of respirations?

Prolonged hypoxia in utero (variable decels due to compression of cord)

Colds stress (temp decrease

12

What is one of the first priorities for baby after delivery?

warmth

13

Normal newborn respirations

shallow, irregular breathing

30-60/min

short periods of apnea (

14

Which type of breathers are neonates?

obligatory nose breathers b/c they don't have the reflex to open mouth to maintain airway

15

Apnea --- is an indication of a pathalogic process and should be evaluated.

> 20 secs

16

How should we listen to respirations?

count for 1 full minute by observing abdomen

listen for sounds w/ the BELL of the stethescope

17

What are some causes of respiratory distress in neonate?

Maternal analgesics during labor

Hyper or Hypothermia

Hypoglycemia

Sepsis

Inadequate clearance of AF

Respiratory Distress Syndrome (RDS)

18

Signs of Respiratory Distress in a Neonate

Resp 60 secs at rest

Nasal flaring

Apnea > 20 secs

Retractions

Seesaw or paradoxical breathing

19

Is acrocyanosis during the first 24 hours a concern?

Acrocyanosis in hands and feet is normal in first 24 hrs

20

CV system adaptation postbirth?

Foramen Ovale closes as atria pressure gradient changes and pushes blood from R atria to R ventricle

Ductus Arteriosis constricts and closes as O2 content of blood increases w/ first few breaths

21

When is permanent closure of Foramen Ovale and Ductus Arteriosis?

functional closure is immediate...

permanent closure is in 3-4 wks

22

Cardiac Assessment of neonate

HR = 120-140

PMI = 4th ICS MCL

Color = pink at rest, red when crying

***BP not usually measured unless for specific reason

23

What can crying do to blood flow during first few days?

may reverse blood flow through foramen ovale and lead to mild cyanosis until foramen ovale permanently closes in 3-4 wks

24

What do the RBCs and Hgb look like for newborn

high due to transport of O2 in utero

25

What is the Hbg in cord blood?

17 g/dL

26

What is the HCT in cord blood?

55%

27

What is the Leukocyte level in neonate?

elevated to 9000 - 30,000 mm3

28

In neonates, --- have a shorter lifespan than in adults.

RBCs

***breakdown leads to buildup of BILIRUBIN --> JAUNDICE

29

What contributes to RBC breakdown in neonates and what condition does this cause?

RBCs break down from trauma during birth (and they already have a shorter lifespan)

leads to buildup of bilirubin --> Jaundice!!!

30

Why is a serious infection not very well tolerated in neonate?

leukocytes don't recognize foreign protein early in life

31

What is an important action that affects volume of blood in neonate?

time of cord clamping

***Delayed clamping may increase workload of infant's heart

32

Why are clotting factors decreased in neonate?

newborn liver cannot synthesize Vit K except in presence of bacteria from GI tract and the GI tract in neonate is sterile (no bacteria yet)

33

What is the treatment to assist in development of clotting factors in neonate?

Vit K injection within 1 hr of birth

34

Which neonate position is used to conserve heat?

flexed position

35

Superficial deposits of brown fat and lipid activity increase heat production as much as --

100%

36

How is nonshivering thermogenesis accomplished in neonate?

metabolism of brown fat

metabolic activity of brain , heart, and liver

37

Why is nonshivering thermogenesis important?

b/c shivering mechanism in newborns is rarely operable (quivering lips is NOT shivering)

38

What is the most effective heat production in a newborn?

nonshivering thermogenesis (chemical reaction)

39

How does the Non-shivering Thermogenesis process work in a newborn?

Brown fat (brown adipose tissue) is highly vascular tissue around adrenal glands, kidneys, between scapula, neck, thorax, and axilla.

- Blood passing through brown fat is warmed --> distributes heat throughout body. Pg 528

- Brown fat may be depleted – Unable to respond to repeated episodes of cold stress


***Laid down from 26-30 weeks. Produces more heat than other fats.

40

What characteristics of neonate contribute to heat loss?

Little subq fat

Thin epidermis (BV close to surface)

Body mass is small in relation to surface area

Cannot shiver to generate heat

41

Why is body mass important in heat production?

body mass is the heat producing tissue such as muscle and adipose tissue

***baby's have little of such tissue at birth compared to surface area (skin)

42

Mechanisms of Heat Loss:

--- is moisture/heat evaporates from body surface.

Evaporation

43

Mechanisms of Heat Loss:

-- is body heat lost from direct contact

Conduction

***can also be a source of heat gain if we use warm blankets and warm hands

44

Mechanisms of Heat Loss:

--- is body heat loss from air currents flowing over newborn body.

Convection

***can also be a source of warmth if we blow arm air over baby

45

Mechanisms of Heat Loss:

--- is body heat loss from heat transfer to cold object close by (but not touching)

Radiation

46

What are some effects of Cold Stress on neonate?

Hypoxia

Hypoglycemia

Metabolic Acidosis BAT metabolism

Increased Bilirubin (Jaundice and Kernicterus)

47

Why would cold stress lead to Hypoglycemia?

glucose levels depleted in efforts to raise core temp

48

Why would cold stress lead to Hypoxia?

heat production uses reserves of O2

49

Why would cold stress lead to Increased Bilirubin levels?

excessive fatty acids released will displace bilirubin from binding sites

--> Jaunidice and Kernicterus

50

When is brown fat laid down?

last weeks of gestation


***for this reason, preterm infant is at greatest risk for cold stress

51

How often will newborn void?

2-6 times for first few days of life

52

What is urine like in newborn?

Pale, straw colored urine (not concentrated) Sp. Gr. 1.001 to 1.020

**ability to concentrate urine is about 3 mths

53

What is avg urine output for neonate?

20-70 mL/day

54

What amount of voidings indicate adequate fluid intake?

6-8 per day after first 3-4 days

55

Infants will lose --- of body weight during first 5 days of life.

5-7%

56

What is the newborn stomach capacity?

50-60 mL

**empty 2-4 hrs past feeding

57

Which newborns may not be able to suck?

preterm and SGA

58

Why can't newborn digest complex carbs?

pancreatic amylase is deficient until 5-6 mths

lipase, necessary to digest fats, is absent

59

What should we see in the Stool Cycle?

Meconium (thick, tarry, dark green)

Transitional Stool (brown to green and loose)

Breast fed (seedy, mustard colored, loose and aromatic)

Bottle fed (pale yellow brown, more firm than breast fed)

60

Is constipation normal for neonate?

constipation is ABNORMAL for either formula or breastfed baby

61

Mom calls the medical clinic where you are the nurse…saying “my 2-week old neonate has dark green, diarrhea stools” What would you advise?

See pediatrician.

May need to change formula. May have too much iron and infant is not tolerating

62

What are the functions of the Hepatic System?

Blood coagulation

Iron storage

Change bilirubin

Carb Metabolism

63

How long do newborn iron stores last?

4-6 mths of age

***less in preterm and SGA

64

Foods containing iron should start being given to neonates at ---

4-5 mths

***cereal
***dark green veggies

65

Fetal --- provided by mom's placenta.

Fetal --- is produced on its own by ---

glucose

insulin

pancreas

66

Why does glucose decrease rapidly post birth?

supply from placenta cut off

used to produce heat

***leads to hypoglycemia

67

How do we prevent hypoglycemia in neonate?

early and frequent feedings to maintain an glucose level of 60-70 mg/dL by day 3

***colostrum contains high glucose

68

What glucose level are we shooting for in neonate?

60-70 mg/dL by day 3

69

What is the heel stick schedule to check for glucose in infant at risk for hypoclycemia?

20 mins
30 min
1 hr
2 hr
3 hr
q 4hr until stable

70

S/S of neonatal hypoclycemia

Poor muscle tone

Tremors/Jitters

Poo suck reflex

High pitched cry

Tachypnea

71

Treatment for neonatal Hypoglycemia

Breast feed or D5W

Administer D10 by NGT or IV if poor suck ability

Keep warm (to reduce use of glucose for heat production)

72

Bilibubin is a by-product of ---

RBC breakdown

73

Immature liver is overwhelmed by large volume of -- --.

insoluble bilirubin

***leaves vascular system and permeates other tissue (Jaundice)

74

Serum bilirubin levels of --- result in skin staining.

4-6 mg/dL

**starts in HEAD/FACE and progresses to TRUNK

75

In the liver the unbound bilirubin is conjugated (changed) in the presence of -- -- into a soluble form that is excreted from the liver as a constituent of bile.

Glucornyl transferase

***direct bilirubin is excreted into duodenum

76

What is kernicterus?

bilirubin encephalopathy

- may occur r/t high levels of insoluble bilirubin

***IRREVERSIBLE

77

What conditions exacerbate the development of Jaundice?

Excess RBCs (w/ a short life span)

Tissue damage from birth process

Liver immaturity (not enough glucornal transferace enzyme)

GI tract sterile (bilirubin excreted through urine/feces)

78

Life span of neonatal RBCs is ----

Life span of adult RBCs is ---

80-100 days

120 days

79

What is difference b/t Physiological Jaundice and Pathological Jaundice?

Physiologic jaundice occurs after first 24 hours of life (usually day 2 or 3).


Pathologic jaundice due to pathologic destruction of rbc’s (example ABO incompatibility or Rh negative factor).

80

Treatment for Jaundice

Feedings (bilirubin is excreted through feces and urine)

Phototherapy to break down the bilirubin to an excretable form

81

Nursing care during Phototherapy for Jaundice

Minimal clothing (just bikini diaper)

Protect genitals, gonads and eyes

Prevent insensible water losses

Provide stimulation

Monitor temperature with skin probe

Turn frequently

82

What is Breast Milk Jaundice?

delay in elimination of meconium (which is high in bilirubin)

**levels rise on day 4-7 (true breast milk is developed ~6-7 days after delivery)

**discontinue breastfeeding and start phototherapy

83

Immune System Adaptation of Neonate:

--- is from mom and confers passive immunity.

--- is produced in utero in small amounts

--- is abundant in colostrum/breast milk while a formula fed baby doesn't have until about 1 year.

Immunoglobulin G

Immunoglobulin M

Immunoglobulin A
***produced by infant by about 4 wks of age

84

What is Caput Succedaneum?

edema usually on occiput

85

What is Cephalhematoma?

blood b/t skull and periosteum

***does not cross suture lines

86

What happens in female neonate reproductive system?

mucoid discharge and pseudo menstruation

87

What is Ortoloni's Maneuver?

movement of hips to discover any hip dislocation

88

Nonmovement or Asymmetrical movement of arms may indicate which pathologies?

Erb-Duchenne Paralysis (Erb's Palsy)