Newborn adaptation- Dormire

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NurseFaith
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287291
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Newborn adaptation- Dormire
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2014-10-28 18:54:34
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Newborn adaptation
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Newborn Adaptation
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  1. Continuously monitor ____ and ____ in the neonate
    Temperature and Glucose
  2. Alveoli are developed by the ____ week gestation and adequate surfactant by the ___ week
    25th and 35th
  3. What keeps the fetus from taking real breath before birth:
    Inhibitory mechanisms:

    • Physical stimuli
    • (compression on babies chest clears fluid)

    • Thermal stimuli
    • (temperature going from warm to cooler)

    • Chemical stimuli
    • (pH regulator...imbalance from when bloodflow wasn't being given to baby during contractions)

    • Tactile Stimuli
    • (dry baby vigorously)
  4. C-Section babies will have more -___ issues because they don't have the compression on their lungs during labor
    respiratory
  5. Types of inhibitory mechanisms
    Facial immersion

    Inhibition by presence of fluid in the laryngeal area
  6. Types of physical stimuli that initiate respiration
    passing the birth canal and compression on the thorax (excretion of up to 30 ml of tracheal fluid )

    Some fluid remains in small airways to decrease the pressures needed to establish lung expansion than if the area was fluid free (air-fluid interface)

    First breath creates negative intrathoracic pressure and some of the air then remains as residual (less pressure to reinflate subsequently)
  7. Types of thermal stimuli initiating respirations:
    Cold stimulation induces breathing (exit from uterus stimulates impulses to stimulate respiratory center)
  8. Chemical stimuli initiating respirations
    Chemoreceptor in the carotid artery are stimulated to initiate respirations....stimulated by:

    • Decreased ox (80-15)
    • Increased CO2 (40- 70)
    • Decreased pH (below 7.35)

    Delayed respirations (increased CO2, decreased pH, and increased resp depression)
  9. Types of Tactile stimuli initiating respirations:
    Normal handling in the delivery room

    ***If newborn respirations are depressed, time should not be spend on using tactile effects to stimulate respirations
  10. Lipoprotein produced by alveolar epithelium (first detected at 28 weeks)...acts to decrease surface tension therefore alveoli remains open
    Surfactant
  11. Surface tension is ____ proportional to the size of the alveoli...
    Inversely

    (Small alveoli increase the effect of surfactant. This is a significant property since the size of alveoli decrease during expiration)
  12. Fluid remaining in the baby's lungs is absorbed by:
    alveolar capillaries and lymphatics
  13. Neonatal breathing is ___ due to the horizontal rib position
    abdominal
  14. Neonates are obligatory ______
    • nose breathers!!! (make sure nose is clear!!! )
  15. The Apgar score is determined by evaluating the newborn on:
    5 simple criteria on a scale from 0 to 2, then adding up the five values obtained (anything less than 5 total is not very good)
  16. 5 criteria used to summarize for APGAR
    • Appearance
    • Pulse
    • Grimace
    • Activity
    • Respiration
  17. Apgar score is done at ____ , ____, and ____ min after birth
    1, 5, and 10
  18. Normal rate of respiration for neonate:
    • 30 - 60
    • (periodic breathing, diaphragmatic initially)
  19. If neonatal breaths are higher than 60, we worry about _____
    sepsis
  20. Abnormal respiratory symptoms:
    • Dyspnea
    • Cyanosis
    • Nasal flaring
    • Expiratory grunting
    • Intercostal retractions
  21. Form of compensation for baby to keep alveoli open during breathing (positive pressure)
    Expiratory grunting
  22. Last sign of respiratory struggling in a baby
    Intercostal Retractions 

    (skin between ribs goes inward like accessory breathing...pressures are not equal within the body)
  23. First type of SAFETY for baby
    ID band
  24. ____ are made soon after birth and usually become part of the birth certificate along with mom's fingerprint
    Footprints
  25. Normal Cardiovascular V/S of baby
    • HR = 120-160
    • (resting = 80-90, crying= 180)

    Average BP = 65-95/30-60
  26. Arteries in baby carry _____ blood
    Deoxygenated
  27. Veins in baby carry ____ blood
    Oxygenated
  28. Circulation between mom/baby stops when:
    • cord is clamped
    • (controversial topic about when to clamp)
  29. When the umbilical cord is clamped, the ____ is lost right away (shunt)
    • ductus venosus
    • (becomes a ligament)
  30. ____ (shunt) constricts at birth due to an increase of blood oxygen concentration (PO2)...may remain for a few days
    Ductus Arteriosus
  31. Cardio Adaptations of Foramen Ovale
    Clamping of the cord causes a fall of pressure in the right atrium and pulmonary artery

    Breathing causes decreased pulmonary resistance therefore increasing pulmonary blood flow

    The increase in pulmonary blood flow results in left atrium pressure being greater than right atrium
  32. Cardiovascular Adaptation in newborn:: Peripheral circulation is usually sluggish resulting in _______
    Acrocyanosis or some Circumoral Cyanosis
  33. The neonate produces heat as a result of ____
    • metabolic activity
    • (to maintain a constant body temp, heat must be dissipated to the environment at a rate equal to production)
  34. Babies only produce heat by ______
    burning glucose
  35. Babies only get glucose through _____
    milk! (they need to eat!)
  36. Mechanisms of Heat Loss
    • Evaporation
    • Radiation
    • Conduction
    • Convection
  37. Loss of heat to cool objects not in contact with the infant
    Radiation

    (prevention: avoid outside walls/windows)
  38. Loss of heat to the air by way of moisture from skin or lungs
    Evaporation

    (Prevention: dry well, protect from exposure during bath)
  39. Loss of heat from infant to cold surface
    conduction
  40. ____ is used to conserve heat fro the body core...This leads to acrocyanosis, mottling of the skin, or cold skin to the touch
    Vasomotor Control

    (the baby has a well-developed ability to control skin blood flow but there is poor skin insulation)
  41. Organ unique to neonate located over the essential organs (sternum, scapula adrenals, and base of skull)
    Brown Fat
  42. Using brown fat increases ______ (if the baby is cold stressed, brown fat will be used up and never used again)
    Consumption of calories!
  43. Response to cold stress is impaired by
    Hypoxia
  44. Check baby's _____ first!
    Temperature
  45. After checking temperature, check baby's ____
    Glucose!!!
  46. Non-Shivering Thermogenesis
    Brown Fat metabolism!
  47. Babies born 8 weeks prematurely have no ability to _____
    Sweat
  48. Cold Stress manifestations:
    Hypoglycemia

    Respiratory Acidosis

    Metabolic Acidosis

    Increased risk of Jaundice
  49. Why does blood sugar decrease rapidly in an unfed neonate
    The liver is immature-- it is deficient in gluconeogenesis
  50. Why do babies spit up and regurgitate
    Sphincter is immature...breast fed babies eat until they are done, bottle fed are usually forced
  51. First stool
    Meconium (collection of dead cells)
  52. Normal weight loss once baby is born:
    5-10%

    Due to loss of fluid, stool, and decreased food intake *Should NEVER be more than 10%
  53. Newborns have a higher _____ to assure adequate oxygenation during labor
    RBC

    (polycythemia)
  54. Breakdown of the extra RBC babies have can result in
    Bilirubin --> JAUNDICE
  55. Around the 3rd month of life, babies usually have
    decreased hemoglobin concentration (physiologic anemia)
  56. Too much bilirubin on the myelin sheath
    Kernicterus
  57. Hematological Adaptations of the newborn:
    Hgb:  14.5- 22.5

    RBC: 5-7million

    Hct:  48-69%

    WBC:  9000-30,000
  58. Coagulation difficulties in newborns:
    •No GI flora, therefore decreased vitamin K (needed for synthesis of prothrombin)
  59. Treatment of coagulation difficulties in the newborn:
    Give vitamin K (AguaMEPHYTON) 1 mg IM at birth (especially important for circumscisions…given vastus lateralis)

    Acts as a catalyst for prothrombin synthesis

    Given in the vastus lateralis.
  60. Where is vitamin K given in infant
    Vastus Lateralis
  61. Why is Vitamin K injection given
    To promote blood clotting and prevent a rare problem of bleeding in the brain
  62. The kidneys cannot ______ at birth
    Concentrate urine

    (The nephrons are not functionally developed until 1 month...The tubules do not mature for 5 months...The posterior pituitary production of ADH is limited)
  63. A brick red stain on baby's diaper may be seen due to:
    Uric Acid (blocks renal tubules and causes bleeding of the tubules)
  64. Babies are at huge risk for _____ because the kidneys don't function like normal
    dehydration!

    (check fluid balance, skin turgor, and interior fontanel!)
  65. The immune system is _____ at birth
    Deficient

    (COLOSTRUM provides immunity)
  66. Erythromycin ointment is give ____ after birth
    • 1 hour
    • (do not give right away, we want imprinting to occur)
  67. Nervous system development
    Cephalocaudal, Proximal-Distal
  68. Sensory, Cerebella, and Extrapyramidal tracts develop _____ first
    Myelin (important effect for impulse transmission)
  69. Why is the ANS important for Neuro adaptations in the infant
    It stimulates respiration, assists in acid base balance, and contributes to temp control.
  70. Babies are born with _____ senses
    All 5

    Vision- fixates on objects 8 to 12 inches away
  71. Eye muscles are coordinated at _____ in the infant
    1 month
  72. Protective reflexes
    • Cough
    • Blink
    • Sneeze
  73. Feeding Reflexes
    • Sucking
    • Swallowing
    • Gagging
    • Rooting
  74. Motor/Postural Reflexes
    • Walk
    • Tonic Neck (fencers)
    • Grasp
    • Positive Babinski for 6 months
    • Step
    • Plantar grasp
    • Moro and trunk incurvative
  75. Indicates vestibular stimulation and can be used as a gauge of gestational/neurological development
    Moro Reflex
  76. Causes the baby to draw his legs up and bring his arms forward in an embracing or "C" position
    Moro Reflex
  77. End of the moro reflex is:
    Infant Cry
  78. The ______ reflex is present at birth in the hands/feet of infants who are of normal gestational age
    Grasp
  79. Hand grasp response:
    Palmar Grasp
  80. Toe response for Grasp Reflex
    Plantar grasp
  81. When lying on baby's back, she rotates her head to one side and extends the arm and leg that she faces (the opposite arm and leg are flexed)
    Tonic Neck Reflex (fencers position)
  82. "Stepping" or "dancing" reflex....Holding infant upright with one foot touching a flat surface
    Walking Reflex
  83. Infant hyperextends and fans his or her toes apart when foot is stroked from the heel upward and across the ball of the foot
    Babinski Toe Reflex
  84. The infant will curl his/her toes inward and downward if the ball of his foot is pressed- as if grasping something
    Plantar Grasp Reflex
  85. System responsible for bilirubin clearance, blood coagulation carbohydrate metabolism, and iron storage
    • Hepatic System
    • (immature but functions adequately)
  86. Dermis and Epidermis are thin and loosely bound, therefore rubbing causes:
    abrasion and blisters
  87. Sebaceous glands cause ____...tell mom not to mess with them
    Milia
  88. Plugging of the sebaceous glands of the scalp
    Cradle Cap
  89. Sweat glands are inactive until ______
    a few days after birth
  90. Decreased sweat and sebum leads to _____
    dry skin and minimal bacterial growth
  91. White cysts on the skin of the newborns caused by obstruction of hair follicles or sebaceous gland secretions
    Milia
  92. Milia are usually found on:
    • Chin
    • Cheeks
    • Bridge of Nose
  93. Find, Downy hair that covers the fetus while in utero giving the newborn a "fuzzy" appearance
    Lanugo
  94. Lanugo begins to rub off from friction of clothing and bed linen....it is normally found on:
    on shoulders, back, upper arms at birth
  95. White cheese-like substance covering the baby's skin that serves as protective skin covering for the fetus while in utero (36-38 weeks gestation)
    Vernix
  96. ____ is caused by the excess of maternal hormones passed to the fetus just before birth
    Swollen Breast Tissue

    (may or may not have a filmy discharge)
  97. Localized cyanosis (blue-gray colorization) of the hands and feet common in the newborn...result of sluggish peripheral circulation
    Acrocyanosis
  98. Treatment of Acrocyanosis
    Make sure baby is warm!!!
  99. When the skin of a newborn's lips may peel....formed as a result of the friction of sucking womb or from feeding
    Sucking Blister

    No treatment needed
  100. Treatment of Dry, Peeling skin on newborns:
    No treatment necessary....oils or lotions may worsen the condition by causing a rash
  101. Common "Newborn Rash" appearing in the first few days of life (any part of skin except the palms and soles)
    • Erythema Toxicum
    • (resolves without treatment)
  102. Stork Bite marks
    • Normal skin alteration
    • (not a birth mark..it will go away!!!)
  103. Bluish-Gray spot at the base of the spine that gradually fades during the 1st or 2nd year of life
    Mongolian Spot
  104. Mongolian Spots are common in:
    Asain and Black infants
  105. Important nursing intervention for mongolian spots:
    DOCUMENT! can be mistaken as abuse
  106. An overlapping of the cranial bones occur as the fetus moves through the birth canal
    • Molding
    • (it is temporary, the head will assume a rounded appearance within several days)
  107. Swelling of the soft tissue of the scalp (across suture lines) caused by pressure of the fetal head on the cervix
    Caput Succedaneum

    (can be from suction or just pushing/hitting bone)
  108. Subperiosteal bleeding due to ruptured blood vessels caused by pressure of the head against the mother's pelvis (will not cross suture lines)
    Cephalhematoma
  109. Babies with cephalhematoma are at risk for ____ because of the collection of blood
    Jaundice
  110. The labia in female newborns and scrotum in male newborns may be swollen and red with slight discharge as a result of:
    Maternal hormones that have passed to the fetus in utero (no treatment necessary)
  111. The posterior pituitary secretes limited amount of ____ which puts neonate at greater risk of dehydration
    ADH (antidiuretic hormone)
  112. After birth, when is the baby the most wide awake
    1 hour after birth (let them see mom!!)

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