Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
OB Exam 2
NB chapters 26
| Question | Answer |
|---|---|
| Birth to 28th day of life | Newborn |
| Fist few hours of life, stabalizes circulatory and respiratory functions | Neonatal transition |
| Limited to differentiation of pulmonary, vascular, and lymphatic structures | Fetal lung development; 20 weeks |
| Aveolar ducts and primitive aveoli | Fetal lung development; 20-24 weeks |
| Type I cells (gas exchange), type II cells (surfactant) | Fetal lung development; 28-32 weeks |
| Surfacant production peaks and developed enough top permit expansion and gas exchange. We want baby to be at least at this level. | Fetal lung development; 35 weeks |
| Baby starts practicing at around 11 weeks gestation to convert from fluid filled lungs to air filled organ, increases muscle development which allows lungs to grow | Fetal breathing movements (FBM) |
| (1) Pulmonary ventilation must occur through lung expansion (2) Marked increase of pulmonary circulation must occur; Occur due to mechanical, chemical, thermal, sensory stimuli | Inititaion of breathing |
| What is the first breath called? | Gasp |
| Temporary asphyxia of fetus and NB, increases in PCO2, decreases in pH and O2 with cessation of placental gas exchange from clamping the cord. This triggers chemoreceptors that trigger R centers in the brain (Prolonged asphyxia = decreased R... not good | Chemical stimuli to initate breathing |
| Temperature of environment drops from 98.6 to 70-75 = chilled NB = stimulated skin nerve endigs = Rhymthic R (Too cold = cold stress or decreased R) | Thermal stimuli to initate breathing |
| Goes from none to hospital room and experiences gravity, tatctile, auditory and visual stimuli. This helps R begin. | Sensory stimuli to initate breathing |
| The pressure on the head and chest as baby is squeezed out also squeezes out fluid. + intrathoracic pressure squeezes fluid out of the lungs; after birth trunk and chest wall recoil causing empty space; inspiration = - intrathoracic pressure and air fill | Mechanical forces to initate breathing |
| During gestation lungs fill with fluid and there is | Almost complete expansion of lungs |
| 2-4 days before labor lung fluid | decreases |
| Breathing movements decrease at | 24-36 hours before onset of labor |
| How much fluid remains in the passageway of a full term baby that must be removed with a bulb syringe? | 80-100 ml |
| An increase in + intrathoracic pressure distributes inspired air in aveoli this is called? | FRC, functional residual capacity (the air left in the lungs at end of normal expiration) |
| Increase in + pressure causes increased absorbiton of fluid in the | Capillaries and lymph system |
| When diaphragm goes down with inspiration lungs fluid -->aveoli -->aveolar membranes --> | Pulmonary intertestinal tissue |
| There is more protein in the capillaries and to balance out the fluid due to osmotic pressure the water follows the concentation graident and draws intertestinal fluid into the | Pulmonary capillaries and lymph tissue |
| When pulmonary blood flow increases vascular resistance decreases leading to more intertestinal fluid into the blood stream, this takes | 2 hours for most of it, 12-24 hours for all |
| underdeveloped lymphatic system = decreased absorbtion; decreased pulmonary blood flow before or during birth; decreased lung expansion due to what 3 things that lead to problems with fluid shift? | (1) inadequate chest compression due to small NB and c-section, (2) maternial anesthesia = R depression, (3) Aspiration of amniotic fluid or meconium |
| What four factors oppose the first breath? | Alviolar surface tension, Surfactant, viscosity of lung fluid due to surfacant, pressure |
| Created when moist surfaces of alveoi contract, healthy R needs it, but if not enough surfactant can cause alveoliar collapse of small airways between each respiration. | Alviolar surface tension (factor opposing first breath) |
| It promiets lung expansion and increases compliance (ability for lung to fill with air easily) | decreased contracting force of alvoli (factor opposing first breath) |
| 1st breth most difficult due to need of 30-40 cm of H2O pressure to open lung to establish functional residual capasity (FRC) allowing alvoler sacs to remain partially open on expiration so following breaths will only need 6-8 cm H2O pressure to open alvo | pressure |
| Viscosity of lung fluid is dependent on | surfacant |
| Undeveloped lymphatic system = decreased absorbiton; decreased pulmonary blood flow before or during birth; decreased lung expansion | Factors that can cause problems with fluid shift |
| underdeveloped lymphatic system = decreased absorbtion; decreased pulmonary blood flow before or during birth; decreased lung expansion due to what 3 things that lead to problems with fluid shift? | (1) inadequate chest compression due to small NB and c-section, (2) maternial anesthesia = R depression, (3) Aspiration of amniotic fluid or meconium |
| What four factors oppose the first breath? | Alviolar surface tension, Surfactant, viscosity of lung fluid due to surfacant, pressure |
| Created when moist surfaces of alveoi contract, healthy R needs it, but if not enough surfactant can cause alveoliar collapse of small airways between each respiration. | Alviolar surface tension (factor opposing first breath) |
| It promiets lung expansion and increases compliance (ability for lung to fill with air easily) | decreased contracting force of alvoli (factor opposing first breath) |
| 1st breth most difficult due to need of 30-40 cm of H2O pressure to open lung to establish functional residual capasity (FRC) allowing alvoler sacs to remain partially open on expiration so following breaths will only need 6-8 cm H2O pressure to open alvo | pressure |
| Viscosity of lung fluid is dependent on | surfacant |
| transition to extrauterine life | cardiopulmonary adaptation |
| R stimultae the cardiovascular system, increased PO2 in alveoli - relaxed pulmonary arteries= decreased pulmonary resistance = increased pulmonary vascular flow (100% with in 24 hours) = Greater blood flow converts fetal circulation to NB circulation-->lu | Cardiopulmonary adaptation |
| Shunting is common; bidirectional blood flow or R&L shunting through ductus arterious can divert blood away from the lungs depending on pressue changes from crying changes in R or cardiac cycle = unstable transitional period in | Cardiopulmonary function |
| Babies have HbF and HbA; What % of HbF? | 70-90% (HbF, fetal hemoglobin, HbA adult hemoglobin) |
| HbF has an infinity of | O2 increasing O2 saturation in NB blood, but tissue O2 is decreased compared to adults |
| Umbilical PO2 must not exceed | uterine PO2 (for O2 transport) |
| increase pH and hypothermia leads to | decrease in O2 in fetal body tissues |
| a decrease in pH (acidosis) hypercarbia and hypterthermia leads to | decrease in O2 bound to Hemoblobin and move O2 released to body tissues |
| Determined by elastic recoil and anatomic differences in NB; Airway resistance increases compared to adult | lung compliance (maintaining R function) |
| Intercostal muscles, rigid ribs, high diapragm that restricts space for lung expansion | Factors that effect Lung compliance (maintaining R function) |
| Radii, lenght and number of airways when compared to adult does what | Airway resistance increases |
| What is the normal R rate of newborn? | 30-60 |
| Initally diaphragmic, shallow, irregular in depth and rhythm, abdomen and chest synchronized | Charasterics of NB R |
| Pauses of R for 5-15 seconds (dont like above 10) are called | periodic breathing |
| Tactile or sensory stimulation converts periodic breathing to | regular |
| deep sleep R are usually | Regular |
| REM sleep can have | periodic breathing |
| Motor activity, suckin and crying can lead to what type of R? | Grossly irregular breathing |
| Cessation of above 20 seconds (10 class), is abnormal, may have skin color changes, HR decreased below 100. | Apnea Always evaluate |
| From Birth to 1- 2 hours R can be | 60-70, never below 30 |
| Newborns are what type of breathers? | obligatory nose breathers; suction mouth then nose |
| Acrocyanosis and SOME cyanosis can be evident during what time? | B--> 1-2 hours, must have color improve |
| How can you tell there is problem with the NB's respirations (these can be transiet for up to 1 hour)? | below 30, above 60 at rest, grunting, nasal flare, tachypnea, rectractions (respiratory distress). these are not nomral notify doctor. |
| What do we want to be 2-1 | surfactant (lecithin and sphengomyelin |
| ASSESSMENT WITHIN 2 HR. OF BIRTH. | GESTATIONAL AGE |
| EXAM WITHIN 24hr. | COMPREHENSIVE EXAM |
| Infant's cardiovascular and respiratory system change rapidlyInfant is dried and stimulated to breatheAvoid cold-stressFree flow oxygen available to assist infant's transitionApgar score and vital signs used to assess infant's transitionIdentify infant an | Maintenance of a Clear Airway and Stable Vital Signs |
| HEART RATE RESP.RATEMUSCLE TONEREFLEX IRRITABILITYCOLOR | 0 1 2 Absent <100 >100Absent Irreg. GoodFlaccid Some ActiveNone Grimace Good Pale/ pink/ Pink Blue acrocyanosis |
| The nurse would expect which of the following findings during the initial respiratory adaptation period of a newborn? | Changes occur in the blood caused by decreased oxygen, increased carbon dioxide, and decreased pH. |
| Why would the baby have decreased oxygen, increased carbon dioxide at birth? | Initial responses are triggered by physical, sensory, and chemical factors. The chemical factors include a decreased oxygen level, increased carbon dioxide level, and a decrease in the pH as a result of the transitory asphyxia that occurs during delivery. |
| Apgar scoresAny resuscitation effortVital signs (know)VoidingPassage of meconium | Assess Condition of the Newborn |
| Common complications to assess for:Abnormal number of vessels in cord.PolydactylyHip displacementErbs PalseyTalipes (club foot)HypospadisHyperspadis | ASSESS FOR ABNORMALITIES |
| Skin appearance Ear CartilageAppearance of genitalsSole creasesAmount of Lanugo(Amount of Vernix) | Assess Major Signs of Gestational Age. |
| Review Labor and Birth RecordsLength and course of laborType of deliveryConditions at deliveryMedications given during labor and/orMaternal Health ConditionMay affect newborn conditionMay affect gestational age assessment | Initiation of Admission Proceedures |
| Infections during pregnancyEstimated date of birth (EDB)Test results of motherHIV statusStrep B (GBBS) statusHepatitus, B, C,etc. statusVaginal Infections present | Antepartal Record |
| Type of infant feeding desiredDesire for circumcision if infant is maleRemember Circ preference is Cultural preference, not necessity.Support system available | Parent and Newborn Interaction Information |
| Infant stressed by change from warm, moist environment of uterus to dry, drafty environment of delivery room and nurseryNeutral thermal environment needed to prevent need for increased oxygen and caloriesRemember: Cold stress can result in | hypothermia, hypoglycemia, hypoxia; Maintenance of a Neutral Thermal Environment |
| Newborn is dried and placed under radiant warmerNo clothes or hat are placed on infant – radiant warmer heats skin – allows observation of NB respirations and skin colorTemperature checked frequently and infant is kept from drafts and open windowsHow does | Babies warm self by nonshivering thermogenesis by the use of brown fat, the will loose O2, glucose, glycogen from liver = hypotermia, hypoglycemia, and hypoxia |
| How do babies loose heat? | Convectin, radiation, conduction, evaporation |
| A newborn's temperature drops when placed on the cool, plastic surface of an infant seat. This is an example of heat loss via: | Conduction |
| Why do we use foil tape to measure temp under the radiant heater? | The foil refects the heat back so the heater doesn't think that the baby is that hot. |
| The nurse who is trying to prevent heat loss in the newborn would realize that which of the following physical characteristics serves to decrease a newborn's loss of heat? | The flexed position of the term infant decreases the surface area exposed to the environment, thereby, reducing heat loss |
| Flat, or slightly raised.May swell when crying May pulsate with heartbeatMay swell when stool is passed | Newborn Fontanels; Normal Findings: |
| Sunken = dehydrationBulging = increased intracranial pressure | Newborn Fontanels; abnormal findings |
| Why does baby maintain flexed positon? | due to large surface, immature thermal regulatory sensors in brain, close vessels, limited subq fat |
| Can not cross suture lines due to ruptured bv between surface of a cranial bone. Emerge on first or second day | Cephlahematoma |
| present at birth, overrides suture lines, from pressure | Caput succedaneum |
| Newborn lacks intestinal bacterial flora necessary for production of vitamin KProthrombin levels low during first few days of lifeVitamin K injection given IM quickly after birth. | Vitamin K |
| Why do we give vitamin K? | To prevent DIC, babies lack the bactrial flora in gut necessary for production of Vitamin K |
| What can a baby do if they don't recieve vitamin K? | DIC, they will bleed out of every orface... and die |
| How long does it take for baby to synthesize vitamin K? | 8 days, breastfeeding will help establish bacterial flora in gut |
| Baby shot given after birth vastus lateralis muscle 90* angle with 5/8, 25 gauge needle | Vitamin K in one leg, HBV in other leg, don't forget to ASPERATE |
| Infant may come in contact with infected material during birth like gonorrhea or clymadia-Eye prophylaxis given to all newborns to prevent serious eye infection and blindnessMedication: | Erythromycin (Ilotycin) Opthalmic OintmentSide effects: edema, inflammation, or slight drainage (Usually gone in 24-48 hours) |
| Tachypnea – >60Nasal flaring Grunting Sternal retractions Change in color Excessive mucous Facial grimace Jitteriness (# 1 sign of | hypoglycemia -Blood Glucose <40); Nurse assesses and teaches parents signs and symptoms of respiratory distress |
| Newborn may choke on mucus | lower baby’s head and suction with bulb |
| positioning for sleep) | supine |
| The nurse sees a newborn in respiratory distress due to excessive oropharyngeal mucus. The first action is to: | Hold the newborn in a head-down position |
| Infant usually alert for first hour after birthNurse should encourage eye-to-eye contact between the infant and parentsNurse should initiate first feeding if infant is stable (especially breast feeding) | First period of Reactivity |
| may spit up mucous. | Second period of Reactivity |
| A newly delivered client spends increasingly more time with her infant positioned to have direct face-to-face and eye-to-eye contact. The nurse interprets this finding as the: | En face position, which promotes positive parent-infant attachment. |
| Monitor vital signs every 30 minutes – for 1-2 hours, then four times dailyAssess and monitor skin color, including acrocyanosis, jaundice.Assess condition of cord (note number and type of vessels)Assess weight, length, head circumferenceAssess extremity | Nursing interventions during first 4 hours after birth include |
| Determine gestational age classificationAssess for presence of any anomaliesCheck for expected reflexesAssess ability to suck and swallowBathe infant when temperature is stableAssist mother to feed as soon as infant is stable | Nursing Interventions |
| Babies loose how much of their birthweight? | 5-10% after birth |
| Vital signsWeightOverall colorIntake and outputCaring for umbilical cordCircumcisionParent attachmentParent Education | Essential Daily Care Assessments |
| Monitor vital signs every 4 to 8 hoursAssess condition of umbilical cordAssess weight (5-10% loss of birth wt. normal) – teach parents.Assess Intake and Output infant's ability to void and stoolDetermine if infant is feeding adequately | Subsequent Daily Care |
| Swaddle infant to provide for warmthHat on headInitiate necessary immunizationsAssess parental bonding processProvide teaching to parents concerning newborn careAssist parents in identifying newborns individuality (behavior assessment scale) | Subsequent Daily Care |
| Normal color of urine and appropriate number of voidings | 6-8 per day |
| Do not give tub bath until cord falls off in | 7 to 14 days |
| Check cord daily for | odor, oozing, and reddened areas |
| NEED SIGNED PARENTAL CONSENTUSUALLY DONE PRIOR TO DISCHARGE BY A PHYSCIAN.RISKS: HEMORRHAGE, INFECTION. | CIRCUMCISION OF MALE INFANTS |
| Following circumcision what may be applied for the next few diaper changes? | petroleum ointment |
| fitted over the glans. A suture is tied around the bell’s rim and the excess prepuce is cut away. The plastic rim remains in place for 3 to 4 days until healing occurs. The bell may be allowed to fall off; it is removed if still in place after 8 days. | Circumcision using the Plastibell |
| What is brick dust? | Concentrated uric acid seen in urine, it is normal, tell mom may last for a couple of weeks |
| How long ago had mom been taking drugs when tested with urine? | couple of weeks |
| How long has mom been taking drugs when muconium was tested? | 3 months ago |
| When should baby get HBV vaccination? | at birth, at 1 month, 6 months |
| Who automatically gets drug screen | women with no prenatal care, increased % are positive under 18 years of age, past hx of drug abuse |
| muconioum is black due to | bilirubin |
| What helps with the passage of muconioum? | brestfeeding |
| Breatfeeding is a cathartic, what does this do the the stool? | makes it thinner |
| What is significant about bathing with a NB? | No tub baths until cord falls off |
| What determines proper GI functioning and kidney function? | 1st void |
| should we force foreskin back on a baby? | no |
| Does the plastibell need dressings? | no |
| Yellow exudate CIRCUMCISION | part of healing process – Educate mother to not removeChange diaper frequently – use clear water only |
| ASSESSMENT: EVERY 30 MINUTES X’S 2. | CIRCUMCISION |
| Sugar Water on Pacifier if | OK with Mother. |
| If bleeding – apply gentle pressureAvoid positioning baby on his stomachCheck for any foul-smelling drainage or bleeding * - Light, sticky, yellow drainage part of healing process | If circumcised care |
| Clean penis with water during diaper changes and with bathDo not force foreskin back over penis | If uncircumcised: care |
| Hypospadias or Epispadias.Hx. Of bleeding disorders in familyAmbiguous genitaliaIllness or infection | Contradictions for Circumcision |
| Use of bulb syringeSigns of chokingPositioningWhen to call for assistanceTemperature maintenanceHolding and feeding skills - Latching-on techniques if breastfeeding; Bottle-feeding techniquesSoothing and calming techniquesDiapering | Common Concerns of Parents |
| Normal void and stool patternsBathingNail careCircumcision/uncircumcised penis/genital careRashesJaundiceSleep-wake cyclesSoothing activitiesSigns and symptoms of illnessInfant safety - Car seatsImmunizations, metabolic screening | Most parents concerned about |
| The nurse is caring for a 15-year-old primipara who delivered yesterday. The nurse identifies the following nursing diagnosis for this client: Risk for impaired parenting related to knowledge deficit in newborn care. Which is the most appropriate interven | Demonstrate how to care for the newborn and have the client return the demonstration. |
| Dress, undress, or bathe hands and feet of infantChange diaperTalk to infant, place in upright positionIncrease skin contactHand-express milk onto baby’s lipsStimulate rooting reflex - Brush one cheek with hand or nipple | How to Awaken an Infant |
| Move infant slowly and calmlyBurp infant or change soiled diaperSwaddle infantTalk to or coo to infant | How to Quiet an Infant |
| TemperatureTeach How to take temperature - Axillary temperature above 38°C (100.4°F) or below 36.6°C (97.8°F) – call DoctorMore than one episode of forceful or frequent vomiting over six hoursRefusal of two feedings in a rowLethargy (listlessness) | Educate Parents -Signs of Illness |
| Inconsolable infantDischarge/bleeding from umbilical cord, circumcision, or any openingTwo consecutive green, watery stoolsNo wet diapers for 18 to 24 hours - Fewer then 6 to 8 wet diapers a day (after 4 days).Development of eye drainageKnow when & how to | Signs of Illness |
| Individualized parent teaching best accomplished by one-on-one teaching, demonstration & return demonstration by parent(s), of common infant activities such asFeedingBathingDiaper changingCord careCircumcision careHandling | Individualized Parent Teaching |
| Video tapes of selected infant care activitiesWritten handouts of selected infant care activitiesReturn demonstration of parents completing selected infant care activities is the only | (only way to evaluate understanding of teaching). |
| Place baby on back to sleepProper use of car seatsBaby needs “TUMMY TIME” when awake!Remaining newborn screenings and inform about when to return if further tests are needed, NB screenings | Additional Teaching Points |
| It is a Federally mandated law that all 50 States screen all newborns for the following | Phenylketonuria (PKU) (test 24-48 hrs. after first feed)Hearing Loss (Hearing loss can occur in 1 to 3 per 1,000 infants in normal newborn population)Screening for other metabolic diseases or inborn errors of metabolism ( congenital hypothyroidism, Maple- |
| Schedule for newborn immunizations; first dose of hepatitis B vaccine should be given prior to dischargeAppointment for infant's next visit with healthcare providerNewborn Safety measures:Hand-washingCar Seat SafetyAvoid people with colds, illnessNever sh | Discharge Planning |
| When do we put babies under radiant warmer | below 98*F |
| We need 3 vessels on the cord, what are they? | 2 ARTERIES, 1 vein |
| What can the fonanentells be like? | open, overlapped, flat, bulging |
| What is the radiant warmer kept at? | 98-98.6, make sure baby is not covered |
| PUtting baby on cooler surface | conduction |
| cool air | convection |
| heat goes some place else | radiant |
| dry baby off | evaporation |
| If mom is GBBS positive what % of babies can get sepsis | 50%, treat mothers and babies with penicillin before delivery, loading dose and q 2-4* |
| What can hypothermia in baby mean? | May have infection, get blood work up |
| An 8 pounder preterm baby may be from | gestational diabetes |
| What can preeclampsia do to baby due to constricted bv? | decrease O2 |
| Baby get lots of sugar in utero-->makes lots of insulin-->born-->sugar cut off-->pancreas is still kicking out insulin= | low blood sugar in baby=hypoglycemia=assess hypoxia and blood sugar on baby... early feeding necessary before brain damage occurs |
| This can make baby hypoflexic due to | mom gettin mag. sulfate |
| when baby is born after 42 weeks what will not be present? | vernix |
| when baby is born before 37 weeks the baby will have | tons of vernix, like slathered in creme-cheese |
| 38-40 weeks the vernix will be | under the armpits |
| The blood pressure of a NB will be | 60/80-40/60 |
| polydactily | 6 fingers or toes |
| syndactily | webbed |
| transient or can be perminate form of dystosa (difficult or prolonged birth), LGA babies with big shoulders what gets damaged? | 5th and 6th cervical roots of brachal nerve plexus |
| Talipes is | club foot |
| Try to move foot to midline, if goes this is | positional clubfoot, just from potition in utero |
| The soles of the feet at 38-40 weeks will be | 2/3 covered with lines |
| the soles of the feet at +40 weeks will | have the whole sole covered |
| Apgar if baby is crying vigirously the R will be | 2 |
| At term the NB is | 38-42 WEEKS |
| Preterm is | 20-37 weeks |
| below 20 weeks is | spontaious abortion, or elective |
| APGAR we check for | HR, R, MT, Reflex irritability, color |
| At birth if baby doesn't pink up what do we do? | Give O2 |
| APGAR prediction of baby what are the total scores? | 0-3 severe, 3-5 moderate, 7-10 no R distress |
| REFERS TO THE PHYSIOLOGIC CHANGES OCCURING DURING THE TRANSITION FROM FETUS TO NEWBORN.Last from birth to approximately 6 –8 hours after birth. | THE Transitional PERIOD |
| A VERY CRITICAL TIME FOR THE NEWBORN.IT IS ESTAMATED THAT A HIGHER INCIDENCE OF MORBIDY AND MORTALITY OCCURS DURING THIS PERIOD THAN ANY OTHER TIME OF LIFE. | THE TRANSITIONAL PERIOD |
| ESTABLISHING RESPIRATIONSADJUSTING TO CIRCULATORY CHANGESREGULATING TEMPERATUREDIGESTING NUTRIENTSELIMINATING WASTESREGULATING WEIGHT. | BIOLOGICAL TASKS of transitional period |
| MOST CRITICAL ADJUSTMENT OF NEWBORN AT BIRTH.BEFORE BIRTH LUNGS ARE FILLED WITH FLUID.WITH THE FIRST BREATH OF AIR, THE NEWBORN BEGINS A SERIES OF CARDIOPULMONARY CHANGES. | ESTABLISHING RESPIRATIONS |
| ALL OXYGEN USED BY THE FETUS DIFFUSES ACROSS THE PLACENTAL MEMBRANE FROM MOTHERS BLOOD TO | BABY’S BLOOD. |
| THE FETAL LUNGS DO NOT | FUNCTION FOR RESPIATORY GAS EXCHANGE IN UTERO |
| THE FETAL LUNGS ARE EXPANDED IN UTERO, BUT THE ALVEOLI ARE FILLED WITH | fluid rather than air |
| In addition, the pulmonary blood vessels are markedly constricted.Before birth most of the blood from the right side of the heart cannot enter the | lungs due to constructed vessels in the lungs. |
| THERE ARE 3 SPECIALIZED STRUCTORS IN FETAL CIRCULATION THAT CREATE A CIRCULATORY PATHWAY FOR | blood to bypass the lungs |
| ALLOWS 02 RICH BLOOD TO FLOW DIRECTLY INTO THE INF. VENA CAVA – TO RT. ATRIUM. | THE DUCTUS VENOSUS |
| OPENING INTO LEFT ATRIUM | THE FORAMEN OVAL |
| ALLOWS BLOOD TO FLOW FROM THE PULMONARY ARTERY DIRECTLY INTO THE AORTA. | THE DUCTUS ARTEIOSUS |
| MOST OF THE BLOOD IN THEFETAL HEART BYPASSES THE LUNGS BY BEING DIVERTED to the | AORTA, THROUGH THE DUCTUS ARTERIOSUS |
| After birth, the newborn will no longer be connected to the placenta and will depend on the | lungs as the only source of oxygen. |
| At birth, Over a matter of seconds, the lungs must fill with oxygen, and the blood vessels in the lungs must dilate so that blood can rush into | the alveoli and absorb the oxygen to carry throughout the body |
| For the baby to get oxygen, three changes must take place within several seconds after birth. | THE FLUID IN THE ALVEOLI IS ABSORBEDTHE UMBILICAL ARTERIES AND VEIN ARE CLAMPEDTHE VESSELS IN THE LUNG TISSUE RELAXWITH INCREASED OXYGEN THE DUCTUS ARTERIOSUS CONSTRICTS. |
| SEVERAL FACTORS CONTRIBUTE TO THE INITIATION OF BREATHING – THAT 1ST GASP AND CRY!* MOST IMPORTANT FACTOR | Chemical stimuli = >PCO2, <PO2, & Ph |
| MECHANICAL EVENTSTHERMAL STIMULISENSORY STIMULIchemical stimuli | Initiation of Respirations |
| closed by cord clamping. | Ductus Venoses; Initiation of Respirations |
| as blood rushes to lungs FO closed by equal pressure in Atria. | Foramen Ovale; Initiation of Respirations |
| constricts with inc. O2 | Ductus arterioses; Initiation of Respirations |
| DEPENDS ON 3 FACTORS:EGRESS OF LUNG FLUIDADEQUATE PULMONARY BLOOD FLOW (MUST BE SUFFICIENT TO OXYGENATE)ADEQUATE SURFACTANT PRODUCTIONL/S RATIO MUST BE AT 2:1 | establishment of respirations |
| RATE: 30 – 60NB’S ARE OBLIGATORY NOSE BREATHERS – SUCTION NOSERESPIRATIONS are MARKED BY IRREGULARITY AND PERIODS OF APNEA APNEA LASTING 5-15 SECONDS IS WNL (AVERAGE = 10 SECONDS) | Newborn Respirations |
| NASAL FLARINGSTERNAL RETRACTIONSGRUNTING WITH EXPIRATIONSRESP. RATE LESS THAN 30 OR GREATER THAN 60.Note: during transition the neonatal resp. rate may be as high as 70 – 80 – but should never be lower than 30 | Signs of Respiratory Distress |
| HEART RATE – 120 -160 (AWAKE)ACTIVELY CRYING – UP TO 180SLEEPING – 100 bpm.Can palpate umbilical cord.PMI often visible.Auscultate – between nipple line & to the left to 3-4 intercostal space. Murmurs may be present. | CARDIOVASCULAR SYSTEM. |
| The fetus is never 100% oxygenated. SO, Fetal cells are larger & pick of O2 more easily.2. fetus has increased # of RBC’s3. fetal cells have shorter life-span4. Heart rate is faster________bpm | 2x (120-160) to get O2 to body to distribute O2; Compensatory mechanisms before birth |
| RED BLOOD CELLS AND HEMOGLOBIN HIGHER AT | Birth |
| HEMOGLOBIN at birth | 14-24 |
| Why are fetal blood cells larger? | To pick up more O2 easier |
| At birth INC. IN RED BLOOD CELLS – FOLLOWED BY RAPID | decrease, MAY LEAD TO NORMAL PHYSIOLOGIC JAUNDICE |
| An hb of 25 at birth may indicate that | there was a knot in the cord or preeclampsia, the body built up more RBC in utero.. leading to jaundice after birth |
| What is the RBC waste after birth when the RBC's of fetal life (3 days life span) decrease? | Billirubin=yellow color |
| Hemoconcentration can lead to | extra RBC's |
| hemoconcentration and extra RBC's (22-24) is | polycytemia (ruddy skin color) |
| Billirubin is unconguated at birth (fat soluable) then what turns it into congiated (water soluable)? | Liver |
| What if a NB's liver is not mature? | Billirubin grabs receptor sites until it can be congugated and hangs out in the skin= jaundice... this is pathological jaundice |
| Physiological jaunidce occurs | after the first 24 hours |
| When the sclera turns yellow we are at | +15 billirubin |
| What is the normal value of billirubin? | 8-12 in NB |
| Higher levels than 12 for billirubin and needs treatment will show up after | 24* physiological jaundice |
| Jaundice within the first 24* is | Pathological jaundice.. they are born with it |
| AT BIRTH BLOOD FROM THE | umbilical cord is collected USED TO IDENTIFY THE BABY’S BLOOD TYPE AND Rh STATUS. |
| NORMAL RANGE 97.7 -99 | temperature |
| Metabolize (BURN) BROWN ADIPOSE TISSUE (BAT)METABOLIZING BAT STORES USES UP NB’S GLUCOSE AND OXYGEN – LEADING TO HYPOGLYCEMIA, HYPOXIA, ACIDOSIS - AND DEATH WITHOUT INTERVENTION | NEWBORNS DO NOT SHIVER TO INC. BODY TEMP.EXP. NON-SHIVERING THERMOGENESIS |
| Uses up brown fat stores.Leads to hypoxiaHypoglycemiaMetabolic acidosis | Cold stress |
| Larger body surface to body weight.Less adipose tissueImmature thermal regulatory centers in brain. | NEWBORNS HAVE TROUBLE REGULATING HEAT DUE TO |
| Flexed positionConstriction of peripheral blood vessels. | The NB conserves heat by |
| TREMMORS OF HANDS | MAIN SIGN OF HYPOGLYCEMIA |
| ACROCYANOSISCOLD TO TOUCH – ESP. HANDS AND FEETTREMMORS OF HANDSMAIN SIGN OF HYPOGLYCEMIA | SIGNS OF HYPOTHERMIA IN NB |
| VOIDING BEGINS IN UTEROURINE PRESENT AT BIRTHMUST RECORD ALL VOIDINGS WHY? | Recording intake and ouput to determine if infant is recieving enough nourishment, and is properly hydrated, ensure renal system is working properly |
| SHOULD VOID WITHIN FIRST 24 HOURS.AFTER 4TH DAY SHOULD VOID AT LEAST 6-8 TIMES A DAY | renal system functioning |
| STOMACHE CAPICITY – 30-90 ML.IST STOOL – MECONIUMUSUALLY PASS WITHIN 12-24 HOURS.MUST ASSESS ADEQUACY OF ESOPHAGUS AND RECTAL PATENCY. | THE GASTROINTESTINAL SYSTEM. |
| IRON STORAGECONJUGATION OF BILIRUBINPHYSIOLOGIC JAUNDICECOAGULATION | HEPATIC SYSTEM |
| Before birth the NB's liver stores glycogen to be used as glucose in the immediate post-natal period, the blood sugar range should be | 40-80 |
| PERFORMED TO ASSESS THE INTACTNESS OF THE DEVELOPING NERVOUS SYSTEM.Most important neuro assessment is | moro reflex |
| SUCKING AND ROOTINGSWALLOWINGGRASPMOROSTEPPINGBABINSKI SIGNTRUNK INCURVATION | NEWBORN REFLEXES |
| SLEEP-WAKE STATES GESTATIONAL AGESTIMULIMEDICATIONS | FACTORS INFLUENCING BEHAVIORAL STATE |
| VISION HEARING SMELL TASTE TOUCH | SENSORY BEHAVIORS |
| TEMPERMENTHABITITUATION (Know definition)CONSOLABILITYCUDDLINESSIRRATIBILITYCRYING | RESPONSE TO ENVIRONMENTAL STIMULI |
| FIRST PERIOD OF REACTIVITYPERIOD OF DECREASED ACTIVITYSECOND PERIOD OF REACTIVITY | NEUROBAHAVIORAL TRANSITION THE FIRST 12 HOURS |
| acidosis is from | hypoglycemia this is a decrease in temp = brain damage, learning disabilities |
Created by:
Cinderelle