Maternal Newborn - Exam 2 (Newborn)

Front 1

6 physiologic adaptions of the newborn

Back 1

repiratory

circulatory changes

thermo regulation

digestion

elimination

weight regulation

Front 2

behavioral adaptions of the newborn

Back 2

self regulation of arousal and sleep patterns

processing of stimuli

forming relationships with others & environment

Front 3

Fetal Breathing Movements (FBM)
-definition

-function

-in preparation for first breath, FBM _____ during labor, and ______

Back 3

definition: intrauterine practice of respiratory movements (begin around 20 wks)

function: allow newborn to breathe air immediately after birth, condition/develop chest wall muscles, diaphragm, alveoli (filled with amniotic fluid in utero)

in preparation for first breath, FBM -slow- during labor, and fluid is absorbed

Front 4

fetal lung maturity is marked by

1)

2)

Back 4

fetal lung maturity is marked by

1) thinness of alveoli (allows for better gas exchange)

2) production of surfactant (peaks at 35 weeks, hold alveoli open during respiration)

Front 5

initiation of breathing

Newborns first breath (inspiratory gasp) happens as a result of

1)

2)

3)

4)

5)

Back 5

1st breath

1) exaggerated response to change in pressure (after 1st inspiration - the newborn exhales/cries, creating positive intrathoracic pressure distributing inspired air throughout alveoli, establishing functional residual capacity)

2) chilling of skin

3) lights

4) noises

5) tactile stimulation

Front 6

most newborns are able to initiate breathing independently, however ____% require some assistance

Back 6

10% of newborns require some assistance in initiating / maintaining breathing

Front 7

newborn' respiratory drive is influenced by

Back 7

decrease in oxygen tension in the blood

increase in CO2 tension in the blood

Front 8

lung's ability to maintain oxygenation and ventilation (O2 / CO2 exchange) is influenced by: 1)

2)

Back 8

1) lung compliance

2) airway resistance

(p 483-484)

Front 9

newborn immediately after birth and for the next 1 - 2 hours after first initiation of breathing ______ breaths per minute

normal newborn respiratory rate by the end of the first hour

________ breaths per minute (at rest)

Back 9

immediately after birth and for first 1-2 hours - 60-70 breaths per minute = normal

by the end of the first hour, respirations should be around

30-60 breaths / min

Front 10

characteristics of newborn's respirations

Back 10

1) rapid

2) shallow

3) irregular - periodic breathing / periods of apnea lasting 5-15 seconds

4) may be noisy at first

Front 11

what does it mean that newborns are

diaphragmatic breathers &

obligate nose breathers

Back 11

diaphragmatic breathers meaning that newborns chest and abdomen rise and fall simultaneously

obligate nose breathers - nasal route is primary route of air entry - important to keep nose and throat clear to avoid resp distress

Front 12

7 signs of respiratory distress...notify physician

Back 12

1) respirations below 30 or exceeding 60-70 while infant is at rest

2) nasal flaring

3) sternal retractions

4) use of accessory muscles

5) expiratory grunting

6) see-saw respirations

7) cyanosis

Front 13

cadiovascular adaptions

the onset of respiration triggers _______

the greater blood volume contributes to _________

Back 13

onset of respiration triggers increased blood flow to the lungs

the greater blood volume contributes to - conversion from fetal to neonatal circulation-

Front 14

foramen ovale connects ________

Back 14

foramen ovale - L and R atrium

Front 15

ductus arteriosus connects ___________

Back 15

ductus arteriosus connects
pulmonary artery and aorta

Front 16

foramen ovale and ductus arteriosus detour fetal blood away from the the lungs

they close functionally close within_______

anatomically close within ________

close because of _____

Back 16

functionally close within 24 hours

anatomically closed in several weeks

close because of increased pressure in the L side of heart & decreased pressure in the R side of the heart

Front 17

average resting heart rate in first week of life

Back 17

110-160 bpm (resting)

Front 18

heart rate while awake/crying

Back 18

180 bpm

Front 19

newborn's heart rate during deep sleep

Back 19

85-100 bpm

Front 20

blood pressure - normal ranges

-1st hour

-with crying

Back 20

50-70 systolic

30-45 diastolic

1st hour- 15 mm less

crying- can increase 20 mm

Front 21

assess newborns heart rate:

murmurs...

Back 21

apical pulse for full minute, preferably while sleeping.... newborns heart rate is often irregular

murmurs may involve incomplete closure of D.A. or F.O. ... should resolve after transition period (48 hours)

always follow up!

auscultation of a murmur is often most common way of recognizing cardiac abnormalities/disease

Front 22

Blood volume varies depending on (2 factors)

Back 22

BV varies according to
1) gestational age

2) amount of blood tranfered from placenta - depends when cord was clamped

Front 23

normal blood volume range for term infants

Back 23

generally 80-85 mL/kg (~300 mL)

newborn 8 lb (3.6 kg) has blood volume of 306 mL

Front 24

allowing the cord to stop pulsating on its own increases (3) factors

Back 24

BP, resp rate, size of heart -- all increase if cord is allowed to stop pulsating on its own

Front 25

acrocyanosis

Back 25

normal within first 12 hours

Front 26

central cyanosis

Back 26

not normal -- infant requires supplemental O2

Front 27

cardiovascular symptoms requiring further investigation

Back 27

1) persistent bradycardia or tachycardia

2) persistent murmur

3) abnormal pulses

4) central cyanosis

BP in lower extremities is usually higher than BP in upper extremities

Front 28

hematopoietic adaptins

fetus: requires _____ RBC.... lifepan

hemoglobin affinity

Back 28

fetal life requires MORE RBCs because there is less O2 in fetal environment

fetal RBC lifespan is short - 80 days

fetal hemoglobin has HIGH affinity for O2.... takes oxygen up easily/quicly.... letting go of O2 is more difficult

Front 29

Hg level of newborn______ during first 2 months of life

Back 29

Hg declines during first 2 mo of life, = physiologic anemia of the newborn - r/t nutritional status (needs folic acid, vit E, iron), and due to decrease in RBC mass, RBC lifespan is shorter, and production takes longer

Front 30

leukocyte range for newborns

newborn WBC count r/t infection?

Back 30

10,000-30,000

newborn WBC count is NOT a reliable indicator of infection/sepsis

WBC may decrease with infection

Front 31

S/S of infection in newborns (3)

Back 31

1) elevated CRP

2) positive blood cultures

3) other presenting symptoms associated with infection

Front 32

newborn platelets

Back 32

"similar to adult levels"

Front 33

Blood groups are present at birth and become stronger during neonatal period

if Mom is Rh (?) , cord blood is tested at birth to determine newborns blood type

Back 33

if mom is Rh - NEGATIVE - cord blood is tested at birth to determine newborns blood type

Front 34

during birth of the placenta, fetal/maternal blood may mix.... if mom is Rh- and baby is Rh +...

Back 34

Rh- mom may become sensitized to (+) positive blood type

could later pass those antibodies to future fetus

Front 35

thermoregulation of newborn - closely related to

1)

2)

Back 35

1) oxygen consumptom

2) rate of metabolism