Newborn Care
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| The three major fetal shunts that close at birth are the | ductus venosus, foramen ovale, & ductus arteriosis
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| this closes with clamping and cutting of cord | ductus venosus
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| this closes when increased pulmonary blood returns to left atrium: pressure increases in the left atrium (permanent closure takes several months) | foramen ovale
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| constricts as oxygen level increases in the arterial blood: permanent closure starts at approximately 3-4 weeks of age | ductus arteriosus
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| what becomes the organ of gas exchange at birth? | the lungs
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| an increase in _____ clears the lungs by decreasing secretion of lunch fluids and increasing their absorption through the lymphatic system | catecholamines
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| APGAR stands for | appearance, pulse, grimace (reflex irritablity), activity, & respiratory efforts
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| in utero, RBCs are approximately _____ r/t low oxygen saturation | 5-7.5 million
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| After birth, RBCs _____ until 8-10 weeks of age | decrease
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| hemoglobin level after adaptation | 15-20 grams
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| hematocrit level after adaptation | 43-61%
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| platelet level after adaptation | 100,000-200,000
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| WBCs after adaptation | 10,000-30,000
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| the ability to produce heat and maintain body temperature | thermoregulation
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| process of heat generation includes the following 4 things: | vasoconstriction, increased metabolic rate, increased muscular activity, & non-shivering thermogenesis
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| this is accomplished by brown fat & increased metabolic activity in the brain, heart, & liver: heat produced by intense lipid metabolic activity: brown fat appears 26-30 wks gestation & lasts for 5 weeks after birth | non-shivering thermogenesis
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| location of brown fat | shoulders, axilla/thorax, lumbar area, & kidneys
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| heat loss when water is converted to vapor is called _____ (wet body @ birth, bathing) | evaporation
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| transfer of heat to cooler surface not in contact with skin is called _____ (walls of isolette. placing a cold object in isolette, equipment in crib) | radiation
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| transfer of heat from body to cooler surface through direct contact is called _____ (cool scales, hands, mattress, blankets) | conduction
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| flow of heat from body to cooler air (A/C, unheated oxygen, unstable room temp) | convection
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| an immature liver hinders _____ | coagulation
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| the gut is _____ at birth | sterile
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| ______ is given at birth | vitamin K
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| glucose levels should be between _____ | 50-60 mg
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| neonatal stress depletes _____ | glycogen stores
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| respiratory distress, apnea, lethargy, tremors, hypothermia, bradycardia, death | results of low glucose
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| water soluble, converted form, which is secreted by colon and kidneys | conjugated bilirubin
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| fat soluble, unconverted form, derived from the breakdown of RBCs | unconjugated bilirubin
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| produces jaundice and can cause kernicterus: value at birth less than 3mg, 4-13 mg within 3 days | bilirubin
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| golden yellow and sweet smelling, passes within 4 days of age | breast fed stool
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| soft, pale yellow, & malodorous, irritating to the skin, passes within 4 days of age | formulated fed stool
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| what percent body weight is extracellular fluid? | 40%
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| what percentage of total body weight is excreted each day? | 20%
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| immunoglobulin that crosses placenta, immunity against bacterial toxin, lasts weeks to months | IgG
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| elevation of this immunoglobulin indicates exposure to TORCH infection | IgM
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| this immunoglobulin is found in colostrum, protects respiratory & GI tract | IgA
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| perform physical assessment in a _____ manner | cephalocaudal
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| respirations should be between ______ | 30-60/min
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| heart rate should be between _____ | 120-160 (100-100: sleeping, 180: crying)
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| temperature should be between _____ | 97.7-98.6 F (axillary)
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| blood pressure should range between _____ | 60-80/40-50
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| maneuvers used during the physical exam to assess the hips for dysplasia | Ortolani and Barlow maneuvers
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| dorsal surface opening on male genitalia | epispadius
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| ventral surface opening on male genitalia | hypospadius
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| very still with regular breathing & strong stimuli needed to awaken | deep or quiet sleep
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| some movement, irregular breathing, and easier to arouse but returns to sleep | REM sleep
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| occasional eye opening with glazed appearance, irregular breathing, and easy to arouse | drowsy state
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| optimum state of arousal | alert state (quiet alert)
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| very active, may be fussy and irritable, and increased sensitivity to disturbing stimuli | active state (active alert)
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| increased motor activity, eyes tightly closed, grimaces present, extreme response to unpleasant stimuli | crying state
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| what test is performed after first breast milk or formula feeding: a state mandated screening test usually done @ discharge | PKU (phenylketonuria)
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| how many calories should the newborn get per day? | 110
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| how much fluid should the newborn get per day? | 80-100 ml
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| how much protein should the newborn get per day? | 2-2.5 grams
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| how much iron should the newborn get per day? | 6 mgs
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| how much urine output should the newborn put out per hour? | 1 cc (ml)
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| how long does a breast feeding usually last? and how often should you breast feed? | usually 3-5 minutes (sometimes up to 10 minutes): every 2-3 hours on demand
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| how long does a bottle feeding usually last? and how often should you bottle feed? | usually give 30 ml, then burp: every 3-4 hours on demand
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| caused by cord compression &/or poor placental perfusion: maternal hemorrhage | perinatal asphyxia: intrauterine hypoxia
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| signs and symptoms of perinatal asphyxia: intrauterine hypoxia include | low apgar scores, hypotonia, slowed HR and respirations, poor skin color, abnormal ABG
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| treatment of perinatal asphyxia: intrauterine hypoxia | oxygen supplement, parenteral nutrition, antibiotics, blood/blood products
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| caused by retained pulmonary fluids | transient tachypnea of the newborn (TTN)
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| signs and symptoms of transient tachypnea of the newborn include | rapid RR, grunting, flaring, retractions
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| treatment of transient tachypnea of the newborn | closely monitor, oxygen via hood, prophylactic abx, blood cultures, gavage feedings
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| caused by in-utero stress (hypoxia) | meconium aspiration syndrome
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| signs and symptoms of meconium aspiration syndrome include | meconium suctioned at delivery, x-ray confirmation
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| treatment of meconium aspiration syndrome | ET suction until clear, asessment of respiratory function, oxygen support, abx
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| caused by lung immaturity and underdevelopment, surfactant deficiency, less than 30 wks gestation age and/or less than 1200 grams | respiratory distress syndrome (RDS)
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| signs and symptoms of respiratory distress syndrome include | apnea due to fatigue, hypoxia, chest x-ray whited out
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| treatment of respiratory distress syndrome | oxygen supplement, positive and expiratory pressure, exogenous surfactant, nutritional support
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| caused by prolonged mechanical ventilation, high oxygen with PEEP or continuous positive airway pressure (CPAP) | bronchopulmonary dysplasia (BPD)
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| signs and symptoms of bronchopulmonary dysplasia include | ventilator dependency, prolonged oxygen requirement, increased WOB/air hunger, cor pulmonale, irritability
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| treatment of bronchopulmonary dysplasia | wean oxygen, prevent infection, adequate nutrition, bronchodilators and diuretics, family support
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| caused by asphyxia, hypoxia, mechanical obstruction(meconium aspiration) | persistent pulmonary hypertension of the newborn (PPHN)
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| signs and symptoms of persistent pulmonary hypertension of the NB include | deteriorating respiratory function, oxygen and ventilator required, DA and FO reopens, lung infiltrates present, falling oxygen levels and BP
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| treatment of persistent pulmonary hypertension of the NB | NTE & little stimulation, sedate & paralyze, high O2 level, rapid ventilatory rate, maintain pH at 7.45-7.55, BP support with dopamine and dobutamine, pulmonary vasodilators
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| stress results in the release of _____ | norepinephrine
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| _____ leads to acidosis | hypoxia
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| pathologic jaundice occurs | in first 24 hrs of life
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| physiologic jaundice occurs | after the first 24 hrs of life
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| herniation of the abdominal contents into the umbilical cord or failed closure of the abdominal wall | omphalocele & gastroschisis
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| excess CSF in the cerebral ventricles & impaired circulation of CSF | hydrocephalus
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| caused by hypoxia and respiratory distress syndrome, pulmonary edema, and CHF | patent ductus arteriosis
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| signs and symptoms of patent ductus arteriosus include | murmur, visible pulsation, bounding pulses, tachycardia, tachypnea, pulmonary edema
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| treatment of patent ductus arteriosus | adequate oxygenation, restricted fluids, digoxin, diuretics, indomethacin, surgery
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| caused by fragility or germinal matrix, fluctuating pO2 and BP, fluid volume changes, coagulopathy, ventilator pressure, vagal response to startle reflex | intraventricular hemorrhage
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| signs and symptoms or intraventricular hemmorhage include | lethargy, bradycardia, apnea, declining Hct, rising bG, full, tense fontanelles, seizures possible
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| treatment of intraventricular hemorrhage | monitor pO2 &pCO2, monitor platelet status, decrease stimulus, decrease BP variations, treat seizures, limit excessive motor activity
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| caused by iatrogenic damage to developing retinal vasculature, oxygen status changes, sepsis, & vitamin E deficiencies | retinopathy of prematurity
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| signs and symptoms of retinopathy of prematurity include | ID by eye exam
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| treatment of retinopathy of prematurity | opthamology follow up
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