Chapter 11 Postpartum Changes

Question 1

What systems of the body are alterated in a newborn infant?

Answer 1

Transitional period
first 6 – 8 hours
heart rate increases, respirations – irregular

• Respiratory System
• Cardiovascular System
• Hematopoietic System
• Thermogenic System
• Hepatic System

Question 2

Descrive the physiological changes to the following in a newborn infant.

• Respiratory System
• Cardiovascular System
• Hematopoietic System
• Thermogenic System
• Hepatic System

Answer 2

Respiratory System - Initiation of respiration

• after cord is cut, increased CO2 levels in blood cause muscular contractions and first breath
• Chemical, thermal and sensory stimuli
• breathing rate begins at 30-60/minute for the first 2 weeks & declines to reach normal rate

Cardiovascular System

• Closure of shunts
• foramen ovale closes at moment of birth
• ductus arteriosus & umbilical vein close down by muscle contractions & become ligaments
• Heart rate after the first cry, 175 – 180 beats/min

Hematopoietic System

• Hb level declines over the first 2 months
• Delayed clumping – increased Hb and rbc count – offer protection from anemia

Thermogenic System

• Non shivering thermogenesis by brown fat

Hepatic System

• Iron storage
• Carbohydrate metabolism
• Bilirubin metabolism
• increase in rate of RBC & hemoglobin formation
• decreased glucoronyl transferase enzyme in neonatal liver

Question 3

Describe how the cardio/respiratory systems and hepatic systems change upon birth of an infant.

Answer 3

cardio/respiratory: http://postimg.org/image/oaeklwmi5/

hepatic: http://postimg.org/image/ia91n5a91/

Question 4

Describe the assessments a newborn will undergo after birth.

Answer 4

First assessment – immediately after birth
Second assessment – 1 – 4 hours after birth

• Determination of gestational age
• Assessment of high-risk problems

Third assessment – first 24 hours or prior to discharge

• Complete physical examination
• Ability to bottle-feed or breastfeed

Question 5

What is an apgor score?

Answer 5

1 minute after delivery
5 minutes later

5 vital signs to check

• Heart rate - by auscultation
• Respiration – by watching respiratory movements
• Muscle tone – their resistance to any effort to extend their extremities
• Reflex irritability – stimulus like catheter in the nostril
• Color – pink shortly after first breath

Question 6

What newborns are considered to be at risk?

Answer 6

Small for gestational age

• Asphyxia
• Aspiration syndrome
• Hypothermia
• Hypoglycemia
• Polycythemia

Large for gestational age

• Birth trauma
• Increased incidence of C section

Conditions present at birth

• Premature newborn
• Drug-dependant newborn

Birth-related stressors

• Asphyxia
• Respiratory distress syndrome
• Hypoglycemia
• Jaundice

Question 7

What is jaundice?

Answer 7

Elevation of bilirubin levels in the blood giving a yellow tinge to the skin
Physiological jaundice

• Jaundice starts from 2nd to 5th day
• Lasts for not longer than 2 weeks
• Unconjugated bilirubin level not higher than 5-6 mg/100ml

Question 8

What is pathological jaundice?

Answer 8

1. Jaundice appears within 24 hours after birth
2. Serum bilirubin level increased rapidly
3. Premature babies
4. Hemolytic disease of the new born is the most common cause
5. Other causes;

• Polycythemia
• Atresia of the biliary duct
• hypothyroidism

Question 9

What are the complications of pathological jaundice?

Answer 9

Anemia (hemolytic cause)
Kernicterus

• Cerebral palsy
• Mental retardation
• Hearing loss
• Delayed speech development

The best treatment

• Early recognition and prevention

Question 10

How often should babies have their hearing testing?

Answer 10

It is recommended that babies in the following conditions should be considered for hearing testing:

• rubella virus infection or history of using aminoglycosides during pregnancy
• perinatal asphyxia
• preterm infants
• neonatal jaundice

under 3 years of age – at risk for otitis media

• peak – between 6 and 20 months of age

Question 11

What is the pathophysiology of inflammation?

Answer 11

Inflammation

• is the body’s response to injury
• Initiated by any form of cellular injury
  
  • Infection, physical trauma, chemical, thermal injury
• Usually a beneficial response with the purpose of eliminating the offending agent

The inflammatory process causes local and systemic effects

Signs of inflammation

• redness
• heat
• swelling
• pain
• loss of function

Question 12

What is otitis media in infants?

Answer 12

Inflammation of the middle ear associated with an

• Acute infection (acute otitis media)
  
  • with signs and symptoms of infection
• Or, accumulation of fluid (otitis media with effusion)
  
  • no signs of infection

Etiology

• Upper respiratory tract infection
• Otitis externa
• Blockage of the auditory tube
• Enlarged tonsils

Incidence and Risk Factors

• Age
• Sex
• Heredity
• Colds/allergies
• Tobacco smoke
• Bottle-feeding
• Day care
• Cranio-facial abnormalities

Question 13

What is the pathophysiology of otitis media in infants?

Answer 13

The structure of the middle ear cavity with its communications

http://postimg.org/image/qxsjroen7/

Question 14

What are the clinical manifestation and complications of otitis media?

Answer 14

Clinical Manifestations

1) Inflammation

• pain
• fever
• ear discharge

2) Difficulty in hearing, consequences

• delay in speech and language development
• permanent hearing loss

Complications

• Recurrent otitis media – chronic otitis media
• Conductive hearing loss
• Chronic mastoiditis
• Intracranial complications

Question 15

Which of the following explains why infants are more susceptible to acute otitis media?

Poor hygiene
Kids will usually put things in their ears
The infant ear canal is smaller
The eustachian tube is shorter

Answer 15

The eustachian tube is shorter