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The flashcards below were created by user
coreygloudeman
on FreezingBlue Flashcards.
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What is thermoregulation?
The maintenance of equality between the heat dissipation and heat production from the body.
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What is themal neutral zone?
When the infant is neither gaining nor loosing heat and the oxygen consumption is its lowest, then balance is achieved.
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What is desired Rectal and Skin Temperature?
- rectal temperature at 36.5-37.5
- skin temperature 36-36.5
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What is Internal Thermal Gradient, and what is it regulated by?
- The difference in temperature between the warm core of the body and the cool skin
- - Regulated by:
- The metabolic rate.
- The amount of subcutaneous fat.
- The body surface area.
- The distance from the body core to the skin surface
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What is non shivering thermogenesis?
increased heat production due to burning of brown fat
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Why do preemies have a difficult time regulating ITG (Internal Thermal Gradient)?
- A large amount of skin surface to body weight.
- Relatively thin layers of skin.
- Low amounts of body fat.
- A high metabolic rate and rarely get enough calories to keep them warm
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What are the 4 types of heat loss that concerns us in the NICU?
- Radiant
- Conductive
- Convective
- Evaporative
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What is Radiant heat loss?
Dissipation of heat to surrounding objects not in direct contact with them
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What is Conductive heat loss?
Transfer of heat to cooler surfaces in contact with the infant like wet blankets or cold stethoscope.
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What is Convective heat loss?
Loss of heat from the skin to surrounding air. Air currents carry away warm blanket of air around them
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What is Evaporative heat loss?
As liquids (urine, sweat) evaporate, they carry away heat
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What is Hypothermia in a newborn referred to as and hazards of it?
- - Cold Stress:
- The initial response to cold stress is vasoconstriction to shunt away from the skin.
- - This leads to:
- Anaerobic metabolism in shunted areas causing metabolic acidosis.
- Pulmonary vasoconstriction and worsens the hypoxemia and acidosis but altering the V/Q ratio.
- Hypoxemia, further worsening the response to hypothermia
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___________ also triggers nonshivering thermogenesis and fat metabolism to produce heat resulting in further acidosis and hypoglycemia. All of these factors will keep the infant warm for a while. If the cold stress if corrected, the neonate may recover with no harm
Hypothermia
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___________ produces initial vasodilation to dissipate heat and is soon followed by increased metabolism and oxygen consumption
Hyperthermia
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What cause Hyperthermia?
- Infection.
- Dehydration.
- Malfunctioning incubator.
- Radiant warmer.
- Humidifier.
- Phototherapy lights
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What is Insensible Water Loss?
- Extra cellular fluid makes up 45% of body weight of a term infant vs. 60% of a 32 week infant.
- This means that the more premature the infant, the more they are prone to insensible water loss
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What are some factors the cause Insensible Water Loss?
- Increased motor activity.
- Skin break down.
- Respiratory distress.
- Fever.
- Phototherapy.
- Congenital skin defects.
- Environmental temperature.
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What is an Isolette?
An Isolette (incubator) is an environmental containment chambers that contains the neonate in a controlled temperature, humidity, and oxygen.
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What are the Advantages and Disadvantages of an Isolette?
- They are easy to operate but hard to control due to frequent opening.
- The neonate is not readily accessible inside the plastic case.
- If the incubator can be left closed they work well and maintain temperature without undue increases in room temperature
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What is a Radiant Warmer?
Radiant (i.e. open) warmers make the neonate more accessible.
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What are the Advantages an Disadvatages of Radiant Warmers?
- They are usually servo controlled to maintain the core temperature of the neonate.
- However, the neonate is openly exposed to the environment.
- Core temperatures of the maintained easily, but cold stress still may occur because the inability to control the environment
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What are the effects of Overstimulation of a newborn?
- Sensory overload from the noise, light, and activities of the NICU provide too much stimulation to the eyes, ears, and brain of the neonate.
- This can interfere with both the development and organization of the central nervous system
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What is behavioral-based care?
- Handling only when the behavioral and physiological sign indicate.
- Behavioral-based care seeks provide basic care during times of non-stress:
- - In theory, this will reduce overstimulation
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What can cause Skin Trauma to a newborn, and what are the risks of it?
- Because the skin is so thin, removing tape, excessive handling, and other such activities may tear the skin.
- This causes the break down the first barrier of their defense system.
- This leaves the premature infant much more susceptible to infection.
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How do we reduce the risks of Skin Trauma to a newborn?
- Use mild soaps applied with cotton ball when cleaning.
- Use ETT holders as opposed to taping.
- Appropriate placement and relocation of devices like transcutaneous monitors.
- Using elastic wraps rather than tape to hold pulse oximeter sensors in place.
- Use of transparent IV dressings.
- Increasing the infant's environmental humidity.
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What are the different electrolytes that concern us and what do they do?
- Sodium - water balance
- Potassium - acid-base balance and hydrogen diffusion (both are positively charged)
- Calcium - integral for heart function and bone integrity
- Magnesium - necessary for calcium regulation
- Chloride - anion gap and Hamburger phenomenon
- Phosphate - essential in energy metabolism
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Review Table 7-5 on slide 25.
Do it? Eright good.
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What is Jaundice (Hyperbilirubanemia) and facts about it?
- Jaundice is the yellow-orange skin color associated with abnormal levels of biliruban.
- Most biliruban comes from the breakdown of old red blood cells.
- It is common in neonates.
- 25 to 50% of all term infants.
- Higher percentage in premies.
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What causes an increase in biliruban (jaundice)?
- The higher percentage of red blood cells.
- The shorter life span of red blood cells.
- The inability of the neonatal liver to conjugate the excess biliruban.
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What are compications associated with Jaundice?
- Encephalopathy is the most serious complication associated with pathologic jaundice.
- This is because the fat from the unconjugated biliruban crosses the blood-brain and attaches itself to the brain cells.
- Hyperbilirubanemia, untreated can then lead to permanent brain damage and developmental delay.
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How do you treat Jaundice?
- Phototherapy (mostly used), where blue light causes the biliruban to decompose into water-soluble particles with are excreted by the kidneys.
- Phenobarbital, increases conjugation.
- Exchange transfusion, replacing the effected RBC's.
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What is Necrotizing Enterocolitis (NEC) characterized by?
- NEC is characterized by ischemia and necrosis of the intestines.
- Untreated it may lead to abdominal distention, perforation, sepsis, and maybe death
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What is Necrotizing Enterocolitis (NEC) associated with?
- Necrotizing entercolitis (NEC) is an idiopathic disorder associated with:
- - Mucosal wall injury.
- - Bacterial invasion of the damaged area.
- - Formula feeding.
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What is Necrotizing Enterocolitis (NEC)?
Break down and destruction of a portion of the intestines
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What are Clinical signs of Necrotizing Enterocolitis (NEC)?
- Blood in the stool.
- Bile tinged vomiting.
- Abdominal distention.
- Pneumatosis on x-ray (abnormal presence of air)
- General signs of sepsis.
- Poorly tolerated feeding.
- Lethargy.
- Increased O2 requirements. (pressure pushes on lungs cause smaller Vt)
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What is the Treatment for Necrotizing Enterocolitis (NEC)?
- Prevention is the best treatment.
- Good hand washing technique.
- Stop feedings.
- NG suctioning to remove bile residue.
- Frequent abdominal x-rays.
- Surgical intervention to repair perforated or necrotic intestines.
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