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38 Cards in this Set
- Front
- Back
Neonatal period
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0-28 days
There are certain things that newborns have to do to adapt to extrauterine life |
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Respiratory adaptations
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Initiation of respirations: things done to stimulate babies to breathe
1. Chemical Stimuli: chemical asphyxia due to decreased blood through the placenta & cutting of cord; this stimulates the medulla to have the baby to take a breath. 2. Mechanical Stimuli: vaginal wall compresses chest & lungs of baby and squeezes out 30-50% of fluid; remainder of fluid is pushed down to the bottom of lungs and reabsorbed by body. C-section babies: once the lungs expand, the surfactant keeps the lungs open but it takes them longer to get rid of the mucus. 3. Thermal Stimuli: occurs when the baby is delivered; with stimulation of the skin receptors; sends a message to the medulla for the baby to breathe. |
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Normal resp of newborn
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30-60 breaths/min
if crying, can be as high as 80 |
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Cardiovascular adaptations
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Once the baby is delivered, the shifts in pressure cause the following to close & fetal circulation is no more; regular circulation takes over.
May hear a murmur upon initial assessment, usually just a transient murmur. The following close upon delivery because of shift in pressure: Foramen Ovale, Ductus Arteriosus, Ductus Venosus. |
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Cardiac characteristics
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120-160blm = normal
Always assess apical pulse on newborns, listen over all the valves BPs not done on newborns unless specifically requested by MD; if requested, do on all four limbs. |
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Avg blood volume for newborn
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80 ml/kg
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Hematopoietic adaptations
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At birth, NB has more RBCs & higher Hgb/Hct than adults.
RBCs in NB have shorter life span than adults which is what causes jaundice. WBCs normally rise w/i 1st 12 hrs & then start dropping. Elevated WBC count in baby is not always indicative of infection; often septic babies have decreased WBC count. Platelets will often decrease if infection is present. Babies have clotting factors but lack Vit K to release those factors (K made in GI tract which is sterile at birth until shot of K is given after birth) |
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Normal Hct in NB
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48-69% (40-42% in adults)
anything > 65% from a central site indicates polycythemia (excessive RBCs) |
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Polycythemia
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puts babies at an increased risk for jaundice and damage to brain & other organs as a result of blood stasis.
Need to monitor closely for jaundice; can build up in brain & other organs. |
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Temperature regulation
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necessary for baby to survive
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Thermoregulation
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ability of the neonate to producce heat and maintain a normal body temperature (mom does it for him in utero)
RED FLAG if baby cannot maintain body temp (sepsis) |
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reasons that neonates are predisposed to heat loss
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limited subQ fat
thin skin, vessels close to surface large body surface (3x more than adults) flexed position of full-term reduces amt of skin surface exposed |
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Mechanisms of heat loss
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evaporation - babies wet when delivered, if not wiped off quickly, evaporates & takes heat with it
conduction - if laid on cold bed, heat taken convection - body exposed to air radiation - baby is laid close to windows |
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Baby's optimal environment
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89.6-93.2 degrees in environment
97.5-99 degrees skin temp |
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nonshivering thermogenesis
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(babies do not shiver)
increases metabolic rate consumes calories & O2 metabolism of their stores of brown fat (usually present on chest, abdomen, & upper middle back; preemies have very little, if any, brown fat) |
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effects of cold stress
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O2 deprivation
rapid depletion of stored glycogen (converted to glucose for heat) go into metabolic acidosis decrease in blood glucose (hypoglycemia) respiratory distress **if baby has to use their brown fat to maintain heat, it can throw the baby into a state of metabolic acidosis & death can occur. |
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Hyperthermia
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baby gets too hot
elevated temp b/c of possible sepsis at delivery metabolic rate rises increased need for O2 & glucose |
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Hepatic adaptations
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liver is working, but immature
Blood Glucose Maintenance: *glucose stored in fetal liver as glycogen in last 4-8 wks before delivery *Glycogen converted to glucose for use *Glucose rapidly used to maintain temp which depletes store quickly *Glucose levels s/b 40-60 *40-45=hypoglycemic |
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Bilirubin (hepatic adaptations)
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Is released when RBCs are broken down
Bilirubin is released in unconjugated form which is also known as indirect bilirubin. *Indirect bilirubin - is fat soluble & bound to circulating albumin, body cannot get rid of it b/c its fat soluble (must be water soluble), so it must go to liver to be converted; however the liver is immature & may not be able to convert it. If unable to convert, can lead to jaundice |
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Physiological Jaundice
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usually occurs a couple of days after delivery; could be b/c of traumatic/hard delivery.
Monitor baby (best place to check is by pressing end of nose) |
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Pathological Jaundice
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occurs w/i the 1st 24 hours after delivery.
Rh incompatibility ABO incompatibility Phototherapy is the best treatment; helps liver break inconjugated bilirubin to conjugated form. |
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Phototherapy
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monitor hydration status
protect eyes monitor temp |
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Blood coagulation
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PT & coagulation factors produced by liver, activated by Vit K
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Iron storage
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Fe stored in liver during last weeks of PG.
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GI adaptations - Stomach
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holds 50-60ml (a little less than 2 oz) initially
*gastric emptying may be delayed, unless breastfeeding b/c gastric emptying is rapid after ingestion of human milk *Gastrocolic reflex - when stomach fills, signals peristalsis which comes in waves & is painful for baby. *relaxed cardiac sphincter b/t esophagus & stomach which causes tendency to spit up. |
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GI adaptations - intestines
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long in comparison to adults
sterile at birth, need food to produce the normal flora |
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transitional stools
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looser consistency than meconium, greenish
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milk stools
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depends on milk; formula is yellowy; breastfed is looser consistency
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Urinary adaptations
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immature kidney function
voiding occurs 12-24 hrs after birth - need to make sure to document first void. lower tolerance for total fluid volume changes bladder can hold 6-44ml |
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immunity adaptations
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immature
risk for infection HANDWASHING! |
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Immunoglobulins
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IgG - crosses placenta; fights against bacteria/viruses
IgM - does not cross placenta; produced after birth; fights against Gram Neg bacteria IgA - does not cross placenta; not produced until 6-12 wks after birth; protects against GI & URIs. |
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Periods of Reactivity
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1st period of reactivity: Birth - 30 minutes. Baby is active, lots of eye contact, looking around, resp rate as high as 80 & heart rate as high as 180 b/c so active.
Period of Inactivity: 2-4 hours after) quiet, not much activity, deep sleep possible. Heart & resp rates drop. 2nd period of Reactivity: 4-6 hours. had a nap, ready for more. Wants to eat, first meconium often happens here. Heart/resp rate may increase again. |
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Quiet sleep
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eyes closed, no mvmt under eyes
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Active sleep
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eyes closed & moving, resps usually irregular & are easily startled
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Post delivery assessments
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L&D Hx & notes
Apgar scoring Gest age assess observe for anomalies ID process Measurement/VS Prophylactic meds initial bath |
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Gestational age assessment
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Physical:
>skin (preterm is thin, post-term is dry/cracked) >foot creases - do not show up until 32 wks, start forming from top down >lanugo >size of breast tissue >rugae on scrotum >labia majora covers minora >ear cartilage (if pulled forward does ear pop back or lay there) >eyes Neurological >posture - when laid down >square window (wrist) - push down on fingers, full term will lay flat, preterm will meet resistance >scarf sign - where elbow is in relation to midline when pulled across chest >arm recoil - fold arms & hold down at side; when released should return to original position; if preemie, will not. >Popliteal Angle - keep hips on bed & extend leg, measure angle behind knee >heel to ear - preemies legs will go all the way to ears. |
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Newborn Norms
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HR = 120-160
Resp = 30-60 BP = 60-80/40-45 Temp = 97.5-99 Weight = 5lb 8oz - 8lb 13oz (2500-4000 grams) length = 18-22" (48-53cm) H/C = 32-37cm Chest Circum = 32.5cm (usually 1-2cm < H/C |
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Signs of resp distress in NB
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tachycardia
retractions nasal flaring cyanosis grunting see-saw resps decreased O2 sat asymmetry |