Chapter 23 Flashcards by Fatima Avila

TRANSITION TO EXTRA UTERINE LIFE
-What position should the fetus be for delivery?

Head down position (cephalic position)

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TRANSITION TO EXTRA UTERINE LIFE
-As the baby moves through the birth canal, what gets squeezed?
-What does this do?

-The chest (thorax)
-Pushes fluid OUT of the lungs (around 30 mL) & stimulates respirations –> baby takes first breath

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NB RESPIRATORY SYSTEM
-What is the baby doing before birth?
-What does it do after birth?

-Breathing in the AF
-Breathes in oxygen

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NB RESPIRATORY SYSTEM
-What 3 things trigger breathing?

Mechanical stimuli
Chemical stimuli
Sensory stimuli

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NB RESPIRATORY SYSTEM
-Which two triggers are primary in initiating extrauterine respirations?

Mechanical –> chest gets squeezed to push fluid out
Chemical –> low O2 & high CO2 stimulates breathing

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NB RESPIRATORY SYSTEM
-What is sensory stimuli?
-What should we do when the baby is born?

-Temperature, light, sound changes & touch
-Warm them up!! –> baby now has to regulate its own temp!

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NB RESPIRATORY SYSTEM
-In utero, the lungs are filled with _____
-The delivery process forces nearly ____ mL of fluid from the lungs during delivery.
-______ for NSVD is very influential!!

-AF
-30
-Position

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NB RESPIRATORY SYSTEM
-What is lung surfactant?
-What does it do?

-Substance in the alveoli that is made of phospholipids
-It assists in functional residual lung capacity & prevents alveoli from collapsing (keeps lungs open)

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NB RESPIRATORY SYSTEM
-The Lecithin/Sphingomyelin ratio should be at least what for lung maturity?

2:1

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NB RESPIRATORY SYSTEM
-What is the last organ to develop in the baby?

The lungs

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NB RESPIRATORY SYSTEM
-If the mom has a preterm birth, what is she given in order to help support the newborn’s lungs?

Steroids

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NB RESPIRATORY SYSTEM
-What are the S/S of respiratory distress? (7)

Cyanosis
Apnea
Tachypnea
Grunting
Nasal flaring
Hypotonia
Chest retractions (supra/substernal & intercostal)

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NEWBORN ADJUSTMENT TASKS
-What is the neonatal period?

From birth through day 28 of life

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NEWBORN ADJUSTMENT TASKS
-What is the first and most important task?
-What will you look at?

-Establishing & maintaining respirations
-HR, RR, SpO2, & temp

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NEWBORN ADJUSTMENT TASKS
-How often do we monitor..
1. q____ for 1 hour
2. q___ after out of recovery time frame
3. q___ for 24 hours
4. q___ after that

15 minutes
30 minutes
4 hours
shift

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NEWBORN ADJUSTMENT TASKS
-What are the 5 other things the baby must do?

Adjust to circulatory changes
Regulate temperature
Ingest, retain, & digest nutrients
Eliminate waste
Regulate weight

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NEWBORN ADJUSTMENT TASKS: Eliminating Waste
-In terms of eliminating waste, what is the first stool called?
-What does it look like?
-What do the stools look like AFTER the first stool has passed?

-Meconium
-Thick & black with a different consistency
-Yellow seedy stool

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NEWBORN ADJUSTMENT TASKS: Eliminating Waste
-What should you observe in terms of elimination?
-Babies should void within ___ hours of delivery
-What is the wet diaper rule?

-Voiding & stool
-24 hours
-Day 1 = 1 wet diaper, Day 2 = 2 wet diapers

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NEWBORN ADJUSTMENT TASKS: Regulating Weight
-Babies lose ____% of water weight BUT we don’t want what?

-5-10%
-them losing too much

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NEWBORN ADJUSTMENT TASKS: Regulating Weight
-What reflex should you check?
-Why?

-Sucking reflex
-It determines how well they are feeding & gaining weight

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NEWBORN ADJUSTMENT TASKS: Regulating Weight
-What abnormality will make it harder to feed & gain weight?

Tongue tie

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NB BEHAVIORAL TASKS
-The baby must learn what 3 things?

Self-regulate
Process, store, & organize stimuli
Bonding/attachment with caregivers & environment

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NB BEHAVIORAL TASKS: Self-regulate
-What does the baby learn to do? (3)

Sleep/wake (arousal)
Calm themselves
Communicate needs through cry

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STAGES OF TRANSITION TO EXTRAUTERINE LIFE
-Major adaptations from intrauterine to extrauterine life occur during what?

The first 6-8 hours after birth

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**STAGES OF TRANSITION TO EXTRAUTERINE LIFE** -What are the three phases?

1. First period of reactivity 2. Period of decreased responsiveness 3. Second period of reactivity

**STAGES OF TRANSITION TO EXTRAUTERINE LIFE**: *First Period of Reactivity* -How long does this last? -What happens? -Describe the infant

-Up to 30 minutes after birth -HR increases to 160-180 bpm BUT gradually decreases after 30 minutes -**Infant is alert!!**

**STAGES OF TRANSITION TO EXTRAUTERINE LIFE**: *Period of Decreased Responsiveness* -How long does this last? -Describe what happens

-From 60-100 minutes -NB sleeps OR has marked decrease in motor activity (less active) --> NORMAL

**STAGES OF TRANSITION TO EXTRAUTERINE LIFE**: *Second Period of Reactivity* -When does this occur? -How long does it last?

-2-8 hours after birth -10 minutes-several hours

**STAGES OF TRANSITION TO EXTRAUTERINE LIFE**: *Second Period of Reactivity* -What will you see? (5)

1. Tachycardia & tachypnea 2. Increased muscle tone 3. Improved skin color 4. Mucous production 5. Meconium passed

**STAGES OF TRANSITION TO EXTRAUTERINE LIFE**: *Second Period of Reactivity* -What is a vital sign that is **REQUIRED**? -Describe them

-Pulse ox measurements -Preductal: wrist -Postductal: foot

**STAGES OF TRANSITION TO EXTRAUTERINE LIFE**: *Second Period of Reactivity* -Postductal & preductal measurements should *NOT* have more than ___% difference

4-5%

**FETAL CIRCULATION** -Placenta?

Contains oxygenated blood from mother to baby

**FETAL CIRCULATION** -Umbilical cord?

Contains 2 arteries & 1 vein (AVA)

**FETAL CIRCULATION** -Umbilical vein does what?

delivers **OXYGENATED** blood to baby from placenta

**FETAL CIRCULATION** -Umbilical artery does what?

Returns **DEOXYGENATED** blood back to placenta from aorta

**FETAL CIRCULATION** -What are 3 fetal structures that are used to bypass the lungs?

1. Foramen ovale 2. Ductus arteriosus 3. Ductus venous

**FETAL CIRCULATION** -Describe the foramen ovale -When does it close? -What will this cause you to hear in newborns?

-"HOLE" between RA & LA of heart -within the first day of life -a murmur bc it isn't closed

**FETAL CIRCULATION** -Ductus arteriosus is a vessel that does what? -Why does it do this?

-Moves blood from pulmonary artery to aorta -to bypass the fluid-filled lungs

**FETAL CIRCULATION** -The Ductus venous is vessel in the ____ that does what?

-liver -shunts umbilical vein to IVC (bypasses the liver)

**FETAL CIRCULATION** -After birth, what happens?

Shunts close once first breath is taken & the cord is clamped

**FETAL CIRCULATION** -How & when should you take RR & HR?

Swaddle them & take it when they are calm or sleeping

**NB CIRCULATORY SYSTEM** -Transition from intrauterine circulation to extrauterine circulation begins with what?

Clamping of the umbilical cord & the initiation of the first breath

**NB CIRCULATORY SYSTEM** -What is Peripheral vascular resistance?

Right-sided heart pressure

**NB CIRCULATORY SYSTEM** -What is systemic vascular resistance?

Left-sided heart pressure

**NB CIRCULATORY SYSTEM** -The ductus venosus becomes what by the ____ day of life

-round ligament of the liver -3rd

**NB CIRCULATORY SYSTEM** -The ductus arteriosus closes within ___ hours post delivery

**THERMOREGULATION OF THE NB** -What helps maintain a constant thermal environment for the newborn? -What is this based on?

-AF that surrounds the fetus -The maternal temperature

**THERMOREGULATION OF THE NB** -What is a normal maternal temp?

98.6F or 37C --> when this is normal, the baby's temp is normal

**THERMOREGULATION OF THE NB** -What does immediate NB thermoregulation begin with? -What can help the baby?

-Drying the NB & placing them under a radiant infant warmer -Warmer, blankets, & heater

**THERMOREGULATION OF THE NB** -What is NB thermoregulation controlled by? -How is this at birth? -If temp is unregulated, what happens?

-the NB's hypothalamus -It is immature --> NB is at risk for cold stress -HR & RR increase and SpO2 change is seen

**THERMOREGULATION OF THE NB** -Newborns lose heat easily, so they must wear a ____ that can help them. Why?

-Hat -Head is a source of heat loss

**THERMOREGULATION OF THE NB** -What helps the infant's stay warm? -What is it? -What does it do? -What mechanism this called?

-Brown Adipose Tissue (BAT) -brown fat that surrounds vital organs (heart, liver, kidneys) -Helps regulate temperature & increases NB's metabolism -Non Shivering Thermogenesis

**THERMOREGULATION OF THE NB** -What are the 4 mechanisms of heat loss?

1. Evaporation 2. Conduction 3. Convection 4. Radiation

**THERMOREGULATION OF THE NB** -What is conduction? -What should you do?

-The transfer of heat to cooler surfaces -Put them under warmer!

**THERMOREGULATION OF THE NB** -What is Evaporation? -What should you do?

-H2O on NB's skin is converted to vapors -DRY THEM!!

**THERMOREGULATION OF THE NB** -What is convection? -What should be avoided?

-NB loses body heat to cooler room air currents -FANS!!

**THERMOREGULATION OF THE NB** -What is radiation?

Transfer of NB heat to objects near BUT not in contact with neonate

**THERMOREGULATION OF THE NB** -The overhead infant warmer should be set to what temperature? -Why?

-37C -To mimic intrauterine temperature/normal maternal core body temperature

**THERMOREGULATION OF THE NB** -What MUST be documented in your nurse's notes? -Why?

-Infant warmer temperature setting & core NB temperature -Because heat is a treatment

**NB COLD STRESS** -What can cause cold stress? -What should you do instead?

-giving a bath too early -Wipe them down & make sure they are dry. Wait 24 hours before giving a bath

**NB COLD STRESS** -What are the S/S of NB Cold Stress? (8)

1. Axillary temp at or below 36.5C (97.7F) 2. Cool, pallor skin 3. Tachycardia, tachypnea 4. Hypoglycemia 5. Grunting 6. Hypotonia 7. Poor feeding 8. Jitteriness

**NB COLD STRESS** -What can you do to prevent NB cold stress? (4)

1. Monitor axillary temp 2. Skin to skin contact 3. Maintain under warmer 4. Dry & swaddle

**NB METABOLIC SYSTEM** -After delivery, infants must balance what?

The amount of insulin production with glucose availability

**NB METABOLIC SYSTEM** -What happens to glucose levels?

They decrease one hour after birth & then stabilize by 2-3 hours post birth

**NB METABOLIC SYSTEM** -What is the optimal glucose plasma range? -How are blood glucose levels obtained?

-70-100 mg/dL -By a heel stick --> it is very vascular

**NB HYPOGLYCEMIA** -What is this?

When glucose is <40 mg/dL

**NB HYPOGLYCEMIA** -Usually these babies won't be _____ great. -What must be done?

-Feeding -Feed them with a syringe & use pacifer so they swallow

**NB HYPOGLYCEMIA** -Which babies are at risk? (8)

1. Diabetic moms 2. SGA or LGA (more than 4000 grams) 3. Preterm 4. Respiratory distress syndrome 5. NB infection 6. Hypothermia (cold stress) 7. Neonatal resuscitation 8. Birth trauma

**NB HYPOGLYCEMIA** -What are the s/s? (4)

1. Temperature instability 2. Apnea 3. Lethargic & hypotonia 4. Irritability & jitteriness

**NB HYPOGLYCEMIA** -How can this be treated?

1. Bottle/breastfeeding 2. Thermoregulation --> keep them warm!

**NB HEPATIC SYSTEM** -What does the liver regulate?

Carbohydrate metabolism & blood coagulation (clotting)

**NB HEPATIC SYSTEM** -What medication are NBs given for clotting? -What NB coagulation factors does this influence?

-Vitamin K --> AquaMephyton -ii, vii, ix, & x

**NB HEPATIC SYSTEM** -Why is vitamin k given?

-During intrapartum life: fetus receives vitamin k from mom -AFTER birth: vitamin k levels **DECREASE** --> NB is at risk for delayed clotting & hemorrhage -Vitamin K is synthesized in the NBs intestinal flora, but flora is absent in the NB

**NB HEPATIC SYSTEM** -By state law, all NBs receive an ____ injection of vitamin K within ____ after delivery

-IM -1 hour

**NB HEPATIC SYSTEM** -Fullterm NB vitamin K dose is what? -Into what area?

-1 mg/0.5 mL -IM into vastus lateralis

**NB HEPATIC SYSTEM** -What does the vitamin K dose range from

0.5-1 mg/0.5 mL

**NB HEPATIC SYSTEM** -Most hospital nurseries use the NB's ____ thigh

left

**NB HEPATIC SYSTEM** -The liver is also responsible for the conjugation/processing of what?

bilirubin

**NB HEPATIC SYSTEM** -At birth, what does the NB have an excess of? -What does this cause? -What will allow for additional RBCs? how much?

-RBCs -greater amount of bilirubin production -delayed clamping of the cord; 30 mL extra

**NB HEPATIC SYSTEM** -What are the two forms of bilirubin?

1. Indirect 2. Direct

**NB HEPATIC SYSTEM** -What is indirect bilirubin known as? -What is it?

-Unconjugated bilirubin -fat-soluble substance that is a by-product of broken down RBCs (DANGEROUS)

**NB HEPATIC SYSTEM** -What is direct bilirubin known as? -What is it?

-Conjugated bilirubin -water soluble substance that CAN be excreted in urine & stool

**NB HEPATIC SYSTEM** -What are the 3 major problems that can occur?

1. Hyperbilirubinemia 2. Kernicterus 3. Jaundice

**NB HEPATIC SYSTEM** -What is *hyperbilirubinemia*? -What is this related to? -What can it cause?

-HIGH level of indirect (unconjugated) bilirubin in NB's blood -Immature liver -Jaundice

**NB HEPATIC SYSTEM** -What is *Kernicterus*? -How is it caused?

-Irreversible brain damage -when indirect bilirubin is **NOT** converted to direct bilirubin

**NB HEPATIC SYSTEM** -What is *jaundice*? -What is it caused by? -What indicates excessively high levels of jaundice?

-yellowing of the sclera or skin that progresses from the head to the toes -excess bilirubin in blood -Jaundice to the knees

**NB HEPATIC SYSTEM** -Most NBs with serum bilirubin levels of above ____ are treated with what? -What does this do? -When receiving this treatment, what should they be wearing?

-10 -UV light --> bili lights -Helps them break down & excrete excess bilirubin -ONLY a diaper

**NB GI SYSTEM** -What is the GI system responsible for?

Ingestion, digestion, absorption of nutrients, & elimination of waste

**NB GI SYSTEM** -What is the gastric capacity for the first few days?

5-10 mL

**NB GI SYSTEM** -What is the gastric capacity by day 7?

60 mL

**NB GI SYSTEM** -Mom's first milk is what? -How is it produced in? Why?

-colostrum -small amounts --> to match baby's capacity

**NB GI SYSTEM** -How often should newborns be fed?

Every 2-4 hours

**NB GI SYSTEM** -Which infants are fed more frequently: breastfed or bottle fed? -Why?

-Breastfed -Breastmilk is like water, but formula is like a shake --> breastmilk is digested quicker, so they get hungier

**NB GI SYSTEM** -For the first few hours after birth, the NB may prefer to do what? -What should you do?

-sleep rather than nurse of bottle feed -Wake them up!!! They need to eat

**NB GI SYSTEM** -What can sleepiness/sluggishness be due to? (2)

1. L&D process 2. Pain medications/anesthesia

**NB GI SYSTEM**: *Stool* -What is the newborn's first stool? -When does it begin to form? -When is it passed? -Characteristics?

-Meconium -during the 4th month of gestation -between 24-48 hours -thick, sticky, black, & odorless

**NB GI SYSTEM**: *Stool* -What is transitional stool? -Characteristics?

-Stool that begins on day 3 and continues for 3-4 days -changes from black to greenish-black to greenish brown to greenish yellow

**NB GI SYSTEM**: *Stool* -How does breastfed stool look like? -Characteristics?

-Yellow/semiformed stool -Golden yellow color with pasty consistency & a sour odor

**NB GI SYSTEM**: *Stool* -Which neonates tend to have more stools per day? -How many?

-Breastfed neonates -Approx. 4-8 stools/day

**NB GI SYSTEM**: *Stool* -What does formula-fed stool look like?

-Drier, paler yellow or bronwish yellow with unpleasant odor

**NB GI SYSTEM**: *Stool* -What does diarrheal stool look like? -Why is it dangerous?

-Loose & green -Because they can get dehydrated very quickly

**NB RENAL SYSTEM** -What do the kidneys control?

fluid & electrolytes

**NB RENAL SYSTEM** -The NBs kidneys are ____ & they are at risk for what?

-Immature -Over-hydration, dehydration, & electrolyte disorders

**NB RENAL SYSTEM** -The kidneys have a limited ability to do what? -What does this put them at risk for? -What should we look at?

-concentrate urine & excrete drugs -toxicity -mom's medications

**NB RENAL SYSTEM** -Babies should **NOT** get what medications prior to 6 months. -Why?

-motrin/ibuprofen -they are excreted by the kidneys

**NB RENAL SYSTEM** -Full term infants excrete ______mL/kg of urine a day -It increases to ____ mL by the first month -What should moms keep track of?

-15-60 -250-400 -number of wet diapers

**NB RENAL SYSTEM** -Neonates lose 5-10% of water weight during the first week of life due to what?

Diuresis

**NB IMMUNE SYSTEM** -What is active immunity acquired (artificial) from? -Example?

-Vaccinations -Hepatitis B vaccine

**NB IMMUNE SYSTEM** -Newborns have almost no immune system, so what do they receive?

DTap at 2 months

**NB IMMUNE SYSTEM** -How does natural active immunity develop?

From exposure to antigens --> NB produces antibodies

**NB IMMUNE SYSTEM** -What is passive immunity? -How is it acquired?

-Immunity that is not permanent -either actively or passively

**NB IMMUNE SYSTEM** -What is natural passive immunity? -How long does it protect the baby? -What is the mother given to help protect the baby?

-Placental tranmission of antibodies from mother to fetus -first few months of life -Tdap

**NB IMMUNE SYSTEM** -What is artifical passive immunity? -Example?

-Immunoglobulin that protects for a short period of time -IgA in breast milk

**NB IMMUNE SYSTEM** -Colostrum is secreted when? -What is it rich in? -This gives the NB natural immunity against what?

-for the first 1-3 days of life -IgA -bacteria, viruses, & certain cancers

Chapter 23 Flashcards

Physiological & Behavioral Adaptations of Newborn (114 cards)