Test-3 Flashcards by laura Blakeney

Neonatal period

Birth to 28 days

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Nursing care for neonate

Body heat
Respiratory function
Infection
Nutrition, hydration 
Assist parents

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Transitional phase

First 6-12 hrs of life

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4th stage

Birth-4hrs

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Respiratory mechanical changes

30 mL forced out of lungs into lymphatic system

PULMONARY arteries dilate and receive blood

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Respiratory chemical

Mild hypoxia and acidosis produced by labor-stimulate breathing center in medulla
-sensory stimulation

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Ability to establish functional residual capacity

Depends on surfactant in alveoli

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Normal respiration in newborn

Irregular, shallow, diaphragmatic, moist

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Periods of apnea in newborn

> 15 seconds should be noted
<30 seconds- side effect of drugs
60 seconds- respiratory distress

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Signs of respiratory distress

Cyanosis
Apnea, tachypnea
Retractions of chest wall
Grunting
Flaring nostrils
Hypotonia

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Assess newborn

Every 30 minutes for first hour
Every hour up to 4 hours
Once per shift> 4 hours old

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Respiratory distress cause

Lack of surfactant 
Pneumothorax 
Bronchopulmonary hypertension 
Hypoglycemia 
Patent ductus arteriosus 
Transient tachypnea ( common in c/s, delay lung clearance)

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Pathophysiology of respiratory distress- preterm

Surfactant starting at 24-28 weeks

Phospholipid (70-80%)

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PG test

Phosphatidylglyerol

Represents advanced fetal PULMONARY maturity

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LS ratio

Lecithin/sphingomyelin

Are the lungs mature?

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Atelectasis

May be caused by hypoxemia, hypercarbia, right to left shunt, metabolic acidosis

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Complications of respiratory distress

Necrotizing enterocolitis

Bronchopulmonary dysplasia- chronic lung problem from treatment of ventilation

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Respiratory distress nursing actions

Patent airway- assess e.g. tube
O2, CPAP, ventilation 
Maintain neutral thermal environment 
VS, O2 sats, suction, blood gases
Claiming measures

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Circulatory system

Transition occurs within seconds of clamping cord

Influenced by respiratory system

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Three physiologic shunts during fetal life

Foreman ovale
Ductus arteriosus
Ductus venosus

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Foramen ovale

Opening between right and left atrium- hole allows reddest blood go from right atrium to left atrium, then left ventricle and out aorta. Blood with most O2 goes to brain

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Ductus arteriosus

Connects PULMONARY artery and aorta 
Closes within 15 hours after birth
PULMONARY resistance less than vascular resistance 
Left to right shunt
Closes ductus arteriosus

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Ductus venosus

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Connects umbilical vein to inferior vena cava
Closes by day 3 of life, becomes a ligament
Blood flow stops when cord is clamped

Circulatory system nursing actions

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Birth to 1st hour 
Cyanosis/hr every 30 mins
1-4 hours old
Cyanosis/ Hr every hour 
4-24 hours old
HR once/ shift

Factors that negatively affect thermoregulation

Little subcutaneous fat Little brown fat Loss of heat Large body surface

Neutral thermal environment

Environment that maintains body temperature with minimal metabolic changes or changes in oxygen consumption

Brown adipose tissue

Dense adipose tissue No shivering thermogenesis Neck, thorax, axillary, kidney

Brown adipose tissue promotes

``` Increase metabolism Heat production Heat transfer to peripheral system Reserves rapidly depleted during cold stress Preterm have limited amount ```

Evaporation

Water on skin converted to vapors - bathing, birth

Conduction

Heat to cooler surfaces | Cold hands/bed

Convection

Air currents | Oxygen masks

Radiation

Heat to cooler near by objects | Walls

Cold stress

``` Decrease temp Increase respirations, HR Increase O2 demand Depletion of glucose Decrease surfactant Respiratory distress ```

Cold stress risk factors

``` Prematurity Small for gestational age Hypoglycemia Prolonged resuscitation efforts Sepsis ```

Signs and symptoms of cold stress

``` TEMP <36.5 or 97.7 Pallor Mottling Lethargy Apnea ```

Cold stress actions

Skin to skin Dry baby Preheat warmer Monitor TEMP Glucose check

Critical lab value | Glucose

Less than 40

Risk factors for hypoglycemia

``` Small or large for gestational age <37 weeks Diabetic mom Delayed feeding Stressed or ill baby Medication ```

Signs and symptoms of hypoglycemia

``` Apnea Lethargy Decreased tone TEMP instability Poor feeding ```

Nursing actions hypoglycemia

Prevention Assess s&is Check glucose Decrease cold risk stress

Conjugation of bilirubin

Increased RBC volume + Shorter RBC life span= Increased bilirubin

Indirect bilirubin

From breakdown of RBCs converted by liver enzymes to direct bilirubin

Direct bilirubin

Excreted through urine/ stool

Normal bilirubin levels and critical level

Normal: 5-6 Critical: >13

Preterm and bilirubin

Worry about kernicterus: abnormal accumulation of unconjugated bilirubin in brain cells

Pathological jaundice | Red flag

``` Occurs <24 hrs old >12.9 term neonate >15 preterm Increased more than 5 per day Lasts more than a week ```

Risk factors for pathological jaundice

ABO and Rh incompatibility Sepsis Hypoxemia Metabolic factors

Nursing actions | Jaundice

Assessment Tests: blood draw Coombs test

Jaundice treatment

Phototherapy Fluids Exchange transfusion

Gastric capacity for newborns

5-10 mL then increases to 60 mL by 7th day

Types of stool

Meconium Transitional (3rd day) Breastfeed- yellow mustard seed, not smelly Formula- less often, tan, yellow, green, stronger odor

Necrotizing enterocolitis- preterm

Inflammation of bowel

Necrotizing enterocolitis risks

Prematurity Impaired GI host defense Bacterial colonization from feeding tubes Umbilical Cathe placement

Necrotizing enterocolitis | Causes

Hypoxia Cold stress Hypocolemia Patent ductus arteriosus

Necrotizing enterocolitis | Findings

``` Apnea Respiratory failure Hypoxemia Unstable TEMP Abdominal distension Bloody stools Lethargy ```

Necrotizing enterocolitis | Nursing

Distension With hold feeding Orogastric tube for decompression

Bronchopulmonary dysplasia

Chronic lung problem that effects neonates who have been treated with mechanical ventilation

Test-3 Flashcards

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