ch. 15 from notes

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  1. neonate period
    • newborn
    • -birth through first 28 days
    • -needs to adjust from intrauterine to extrauterine life
  2. transition to extrauterine life: resp. system
    • -approx 30 ml amniotic fluid in lungs
    • -surfactant in alveoli
    • -initiation of respitations (pg. 282)
    • -effect on pulmonary circulation and gas exchange
  3. transition to exrauterine life: circulatory system
    • -physiological changes
    • -initiation of changes
    • -decrease pulmonary resistance-increase pulmonary blood flow-increase systemic vascular resistance
    • -ductus venosus, foramen ovale, ductus arteriosus
  4. transition to extrauterine life: termoregulatory system
    • -physiological changes
    • -neutral thermal environment
    • -brown fat
    • -factors that negatively affect thermoregulation
    • -decreased subcutaneous fat
    • -decreased brown fat in preterm infants
    • -large body surface
    • -LOSS OF HEAT (cover head)
    • -convection-air, o2
    • -radiation-heat from baby to cooler objects
    • -conduction-direct skin contact
    • -evaporation-through fluid on skin
  5. thermoregulation: cold stress
    -cold stress occurs when: decreased environmental temp-decreased body temp-increased heart and resp. rate-increased o2 consumption, depletion of glucose and decrease surfactant-respiratory distress

    signs and symptoms: cool skin, low temp, lethargy, tachypnea, hypoglycemia, etc
  6. transition to extrauterine life: metabolic system
    • -physiological changes
    • -hypogylcemia - blood sugar less than 40
  7. transition to extrauterine life: hepatic system
    • -conjugation of bilirubin
    • -conversion of yellow lipid soluble pigment into water soluble pigment (pee out)
    • -conjugated (direct)

    • -unconjugated (indirect) is the breakdown product derived from hemoglobin released primarily from destroyed RBC's
    • -not in extractable form (cannot excrete)
    • -potential toxin to CNS because of immature CNS and Liver
  8. transition to extrauterine life: gastrointestinal system
    • -physiological changes
    • -characteristics of stools
    • -meconium- 1st stool within 1st 24 hrs (forms within the 4th gestational week-tarr like)
    • -transitional-similar to meconium (watery 3-4 days)
    • -breastfeed-yellowish, semi formed
    • -formula feed-yellow, more formed
    • -diarrhea-liquid
  9. transition to extrauterine life: immune system
    • -physiological changes
    • -active humoral immunity-immunizations
    • -passive immunity-not permanent, from moms immunoglobins
    • -immunoglobins-delayed response
    • -lymphocytes
  10. PMI-point of maximal impact
    • -3rd and 4th intercostal space
    • can feel babys heart beat
  11. dubowitz neurological examination
    neonates in the NICU
  12. Ballard maturational score
    physical and neuromuscular maturity
  13. SGA
    small gestational age
  14. AGA
    average gestational age
  15. LGA
    large gestational age
  16. periods of reactivity
    • -initial period of reactivity (alot of mucous, cry alot)
    • -period of relative inactivity (minutes after birth-sleep state-not reactive to external stimuli)
    • -second period of reactivity (2-8 hrs-awake and alert-quiet, alerty, rapid, resp. with stimuli)
  17. brazeltons neonatal assessment scale
  18. nursing care of the neonate first 4 hrs
    • -universal precautions
    • -maintain body heat
    • -dry immediately
    • -support respirations
    • -apgar score
    • -vital signs
    • -identify bands
    • -neonatal assessment
    • -gestational age assessment
    • -administer erythromycin opthalmic
    • -administer vit. k
    • -bath with neutral ph soap
    • -promote parent infant attachement
    • -glucose level
  19. nursing care of the neonate 4 hrs to discharge
    • -vitals
    • -temp
    • -promote parent infant attachment
    • -promote sibling attachment
    • -prevent infant abduction
    • -instruct parents to place neonate on back
    • -assist with feedings
    • -provide info on newborn care
    • -provide information on normal newborn characteristics
  20. lab and diagnostic test
    • -newborn screening
    • -state and national requirements
    • -obtaining blood sample
    • -newborn hearing screening
  21. procedures
    immunizations, hep b, vit k, intramuscular injections
  22. 3 types of circumcisions
    • 1) plastibell
    • 2) mogen
    • 3) gomco
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ch. 15 from notes
2013-02-18 01:17:23

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