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Newborn

Ch.19 Study Guide

QuestionAnswer
Slippery substance that reduces surface tension in lung alveoli Surfactant
Permanent neurologic damage from bilurubin Kernicterous
Production of heat by use of specialized fat Nonsivering thermogenesis
Tissue designed for newborn heat production Brown fat
Bilirubin staining of the skin & sclerae Jaundice
Low blood O2 & High blood & tissue CO2 Asphyxia
Surroundings in which the infant can maintain a stable temp w/ minimal O2 consumption & low metabolic rate Neutral thermal environment
Explain how chemical factors help newborn initiate respirations Decreased blood oxygen and pH and increased blood carbon dioxide stimulate the respiratory center in the medulla. Cutting the umbilical cord vessels may end the flow of a substance from the placenta that inhibits respirations
Explain how mechanical factors help newborn initiate respirations Fetal chest compression during vaginal birth forces a small amount of lung fluid from the chest and draws air into the lungs when the pressure is released.
Explain how thermal factors help newborn initiate respirations The sudden change in environmental temperature at birth stimulates skin sensors, which then stimulate the brain’s respiratory center. Other stimuli to breathe include suctioning, drying, holding, sounds, and light.
Why is adequate functional residual capacity in the lungs important? Residual air in the lungs allows the alveoli to remain partly expanded after exhalation. This reduces the work necessary to expand the alveoli with each breath.
What factors cause changes in fetal circulatory structures? (KNOW WHERE THE STRUCTURES ARE LOCATED!) See pg 444-446
Place in order: increased blood O2 level; Respirations initiated; Fibrosis of ductus venosus; Increased pressure in L-side heart; Increased blood CO2 level; Surfactant action keeps alveoli open; Foramen ovale closes; Ductus arteriosus constricts Increased blood O2 level, Respirations initiated, Surfactant action keeps alveoli open, Increased blood O2 level, Ductus areteriosus constricts, Increased pressure in L-side heart, Foramen ovale closes, Fibrosis of ductus venosus
List characteristics that predispose newborns to heat loss Thin skin; blood vessels near the surface; little insulating subcutaneous white fat; heat readily transferred from internal organs to skin; greater ratio of surface area to body mass
Describe each method by which newborn can lose heat. Evaporation- wet surfaces are exposed to air and the surfaces dry. Conduction-infant has direct contact with a cool surface/object. Convection- heat loss to air currents near the infant. Radiation-heat loss when infant is near,not touching, cold surface.
Which methods can also be promote heat gain? All methods except evaporation can also be sources of heat gain, such as contact with warm blankets or exposure to warmed air currents or heat from a radiant warmer.
How does brown fat hel neworn maintain body temp? Brown fat is metabolized to generate heat, which is transferred to the blood vessels running through it and then circulated to the rest of the body
Under what circumstances can newborms have inadequate brown fat & why? Infants who may have inadequate brown fat include preterm infants who may not have accumulated brown fat, those with intrauterine growth restriction whose stores were depleted, and those exposed to prolonged cold stress who use up their brown fat.
Explain relationship between oxygenation, body temp, glucose stores & bilirubin levels in newborn. Heat production requires oxygen for metabolism, which can exceed the infant’s capacity to supply the oxygen. Cold stress decreases production of surfactant, which can cause respiratory difficulty. Glucose use is accelerated when the metabolic (next card)
rate rises to produce heat, possibly depleting these stores and resulting in hypoglycemia. Metabolism of glucose and brown fat without adequate oxygen causes increased production of acids. These acids may cause jaundice because they interfere with transport of bilirubin to the liver, where it can be conjugated and excreted.
Compare normal values for fetal & adult erythrocytes, Hgb & Hct. Values for all three are higher in the newborn than in the older infant or adult. The fetus needs these higher levels to supply adequate oxygen to the tissues because the partial pressure of oxygen in fetal blood is lower than in the adult.
How would you explain prophylactic neonatl vitamim K injection to new parents? Newborns may have a problem with bleeding because they have a temporary lack of vitamin K, which is necessary for clotting. One injection of vitamin K given shortly after birth provides the newborn with vitamin K until the intestines are able to make it.
From what pathogens does IgA protect the newborn? Is it received from the mother? IgA is produced by the infant and is received in colostrum and breast milk. It helps protect against infections of the respiratory and gastrointestinal systems.
From what pathogens does IgM protect the newborn? Is it received from the mother? IgM is produced by the infant to protect against gram-negative bacteria.
From what pathogens does IgG protect the newborn? Is it received from the mother? IgG is received from the mother to provide passive antibodies to viruses, bacteria, and bacterial toxins to which the mother has immunity. The infant increases production of his or her own IgG after 6 months of age
When does jaundice become nonphysiologice rather than physiologic? Nonphysiologic jaundice rises more rapidly and to higher levels than expected or stays elevated longer than expected. See Figure 19-7(p.454)for bilirubin levels at different times after birth.
How does poor intake result in jaundice? What is the usual treatment? Inadequate intake of colostrum or formula causes retention of meconium, which is high in bilirubin. High levels of beta-glucuronidase in the intestine deconjugate bilirubin in the meconium, adding to the load on the liver. Poor intake reduces the (cont'd)
lactating mother’s milk supply, worsening the problem. Nursing measures and teaching to stimulate the infant to feed better and, in the breastfeeding mother, increase milk production are appropriate treatment.
How does true breast-milk jaundice result in jaundice? What is the usual treatment? True breastmilk jaundice is characterized by rising bilirubin levels later than the first 3 to 5 days after birth that usually peak at 5 to lOmg/dL. Jaundice can last several months. Treatment may include frequent feedings, phototherapy, formula(cont'd)
supplementation, and possibly discontinuing breastfeeding for 12 to 48 hours.
Compare total body water & extracellular water distriburion in the newborn & the adult Water is 78°/o of a newborn’s body but only 60% of an adult’s body. The proportion of extracellular water in newborn is more than double that of adults.
What limitations does the newborn have in terms of handling excess fluid & compensating for inadequate fluid A newborn’s kidneys are not well equipped to handle a large load of fluid, which may cause fluid overload. Newborns have half the adult’s ability to concentrate urine and thus cannot conserve fluid efficiently.
How much fluid does a 1-day-old newborn weighing 9lbs(4082g) need each day? A 1-day-old infant needs 40 to 6OmL/kg or 18 to 27 mL/lb per day. If the infant weighs 4082 g (9 lb), the infant would need 162 to 245 mL/day.
What factors make the newborn vulnerable to infection that might not be a problem for an older infant/child? Leukocytes respond slowly to the site of infection and are inefficient in destroying invading organisms. The usual inflammatory response may not be present. Fever is often not present because of the immature hypothalamus.
Describe the 1st period of reactivity. What nursing implications associated with it? Newborns during the first period of reactivity are wide awake and active. Respirations may be as high as 80 breaths per minute, and the heart rate may be as high as 180 beats per minute. Respiratory assessments show nasal flaring, crackles, (cont'd)
retractions, and increased mucous secretions. This is an ideal time to facilitate parent-infant acquaintance, because both are highly interested in each other
Describe the 2nd period of reactivity. What nursing implications associated with it? After the sleep period following the first period of reactivity, infants are alert, interested in feeding, and often pass meconium. The pulse and respiratory rates may increase, and some infants may have cyanosis or periods of apnea. Mucous (cont'd)
secretions increase. The nurse must be alert for respiratory complications during this stage.
Describe 6 behavioral states seen in newborn See pg. 457-458 or powerpoint from class
Created by: L.moore