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44 Cards in this Set

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What is one of the natural ways that fluid is pushed out of the lungs for a newborn?
The pressure of the wringer squeeze or thoracic squeeze on the baby pushes out 1/3 of the fetal lung fluid as it comes down the birth canal. The rest is absorbed to make room for air breathing.
What stimulate the release of a special detergent-like lipoprotein in the alveoli?
Lung expansion after birth stulates the release of surfactant, which allows a decreased surface tension within the alveoli, which allows for alveolar re-expansion after each exhalation. But it is only produced in sufficient amounts by the 34th and 36th weeks. If the child is preterm they run the risk of RDS (resp. distress syndrome that can lead to atelectasis.
4 factors initiate the newborn's first breath. What are each of these factors and what do they stimulate?
The following internal/external factors: Chemical (internal): (Low pH, CO2-acidosis, hypoxia-low O2, and hypercarbia); Sensory (external): sensory overload of the new tactile/visual environment; Thermal (external): drastic change of surrounding environment temp at 98.6 to 70-75 degrees; and Mechanical (external): fetal chest compression in "the wringer" creates intrathoracic pressure that helps push fluid out of lungs, which causes recoil in chest after delivery making the newborn's trunk create a negative intrathoracic pressure or small space for an inspiration of air filling where fluid once was. These external/internal factors stimulate the respiratory center located in the medulla. As the newborn takes in more air each breath, the rest of the fetal lung fluid will be reabsorbed into lymph/circ. within a few hours. There are exceptions like Caesarean births, which can have crackles, that can take up to 24 hours.
What are these 2 abreviations? RDS and TTN in reference to newborns?
RDS is an abnormal condition, a developmental disorder of the respiratory system that begins at birth or very soon afterwards, occuring in infants w/ immature lungs, usually in preterm babies. They do not have sufficient amounts of surfactant and have progressive atelectasis, and loss of fuctional residual lung capacity leading to alterations in the ventilation perfusion ratio and poor lung compliance. TTN or Transient Tachypnea of the Newborn can happen in caesarean newborns where they have rapid breathing because they are trying to blow off excess CO2/ low O2, and excess water, it is transient and usually on lasts up to 24 hours.
What is the hole that forms at 4 weeks gestation that shunts blood from the right atrium to the left atrium? What is this passageway in lieu of?
In the fetus w/out functioning lungs, this hole supplies oxygenated blood to the right atria, (in adults it would come from the pulmonary veins from the lungs), so that it will be sent on to the aorta and out to the brain and heart. It accounts for 1/3 of the fetal cardiac output. This shunt stops once the umbilical cord has been cut, which causes the ventricular and aortic pressure in the left side of the heart to rise. An opposite pressure that forms from pulmonary airways opening which causes the foramen ovale to shut-eventually becoming fossa ovalis.
Through which shunt does 2/3 of the fetal blood flow cross? And what purpose does this pathway serve?
The ductus arteriosus is the pathway between the pumonary artery and the descending aorta on out to the systemic vascularity. Once the umbilical cord is clamped, and the placental blood flow has ceased, there will be an increase in systemic bp and and vascular resistance, which will cause the lungs to oxygenate the blood, and the increase of pco2 will stimulate closure of the ductus arteriosus, eventually forming the ligamentum arteriosum at 3-4 wks.(fossilized ligament in place of old shunt).
Which blood volume increases as the newborn switches from fetal to neonatal circulation?
Pulmonary blood volume increases, or should be, so immediate assessment is vital.
What is the first initial observation we make in proof of pulmonary circulation adaptation?
We look for a baby that is pinked up! Good core color, not too worried about acrocyanosis (blue at hands and feet) for the first 24 hours.
When the newborn makes the transition from fetal to neonatal circulation what system increases/decreases are expected in regards to onset of respirations?
At the onset of respiration there is an increase of O2, which causes a decrease in pulmonary vascular resistance, and an increase in pulmonary blood flow. An increase of pressure in the left atrium, but a decrease of pressure in the rt. atrium=closure of the foramen ovale. At the same time there is an increase in system vascular resistance, a decrease in vena caval return, a decrease in blood flow from the umbilical vein eventually causing closure of the ductus venosus becoming ligamentum venosum. Pressure in the aorta increases closing ductus arteriosus becoming (ligamentum arteriosum).
If there isn't adequate oxygen happening in transition of fetal circulation to neonatal circulation, what can happen?
Patent ductus arteriosus, and patent foramen ovale. They can reopen at a later time.
What are the abnorms and norms of the newborn's heartbeat?
Normal: Should be >100. If it gets as low as 60, start CPR. Can be as high as 160-180 at birth, but should come down to between 120-160 bpm within 30 minutes of birth.
How do you check systemic circulation
The systemic circ is considered adeequate if the nb has brisk cap refill and stable bp. Cap refill in less than 3 secs is considered adequate. A refill time of greater than 4 might indicate hypoxia or cardio problems, or dehydration, could lead to hypovolemic shock. NB will look gray and floppy. As an intervention nurses will give the baby IV fluids, which usually produces good results.
What are the first 2 assessments in a NB cardiovasc. transition?
Heart rate and Cap refill.
What does it mean to be homeothermic?
Babies will attempt to maintain to regulate their internal core temp inspite of the external factors.
What is and NTE or neutral thermal environment?
It is the range of external temp in which a nb body temp can be maintained with minimal metabolic demands and O2 consumption. This may require the nb to make vasomotor adjustments, (vasoconstriction or vasodilation) to conserve or release heat.
What happens with nb metabolism in response to excess heat or cold?
They will increase demand for more glucose and more O2.
What are all the factors to consider that are related to cold stress in a baby.
Infant's body size/gestational age: 1) Even a term nb has 1/2 the amount of subcu fat of adults. 2)Flexion position help to maintain body heat/preterm don't have,;3) external temp of birthing area can make NB's core temp fall by .5 a degree a minute, up to 5.5 degrees before leaving birthing area. They lose these through evap,cond., convect, radia,.4) Thin skin w/blood vessels close to the surface. 5) Limited ability to shiver, so they must use NST, non-shivering thermogenesis to maintain body heat. 6)If low temp is detected, symp. syst. utilizes body's stores of BAT to provide heat. Highly vascular BAT formation starts at 26-30 wks gest, located in midscap, neck, axillae, treachea, esophagus, abdom. aorta, kidneys, adrenals and heart. The problem from triggering BAT is the acceleration of triglyceride metabolism in order to create heat. The relase of these fatty acids can lead to metabolic acidosis, as the fatty acids are released into the blood stream. Less O2 is available to the tissues or in the lungs, increasing metabolic acidity from body switching to anaerobic glycolysis (lactic acid) as well.
Which mechanism of neonatal heat loss is responsible for insensible water loss or IWL?
Out of the 4 mechanisms responsible for heat loss, (radia, convec, conduct, and evap), evaporation is the heat loss that occurs when water is converted to vapor. If the baby isn't adequately dried after birth, the neonate loswes heat through the evap of amniotic fluid on the skin.
Give examples of the 4 mechanisms responsible for heat loss in the infant.
Evaporation: heat loss when amniotic fluid on skin comes into to contact wih dry air, and is converted into vapor; Conduction: loss of heat to a cooler surface when a baby is placed on a cold scale, mattress, or examining table; Convection: loss of heat from body surface to cooler air currents from drafts of windows, or doors, or cooler circulating air; Radiation: loss of heat transfered through other objects that are not in direct contact with the baby, like the walls of the nursery, or incubator that aren't directly touching the skin.
How do you prevent hyperthermia in a baby.
Neonates can sweat, but not that well. They use vasodilation and IWL as a way of coping. They will increase O2 and glucose consumption. Need to make sure that warming equipment is working properly and isn't overheating baby.
What it normal blood volume for a nb and what effect does the umbilical cord have on nb blood volume?
Nb blood volume average is 80-90 ml/kg or 254-286 ml for a 7lb/3.18kg baby. Within 15 seconds after birth, the plancenta delivers 1/4 of the blood volume and by 1 min, 1/2 of blood volume. The umbilical cord delivers around 75-125mls of blood and can continue delivering blood if waiting to clamp. Advantages to waiting are iron stores, but disadvantages can be polycythmia which can lead to jaundice.
Explain erythrocytes, hemoglobin, and hematocrit in the nb.
The nb has a greater number of rbc higher hemoglobin,& higher hematocrit than that of an adult. Hematocrit is defined as the % of rbc within a certain volume of blood. The normal range is 48-64%. 65% or higher indicates polycythemia or too many rbc, which increases viscosity of blood cells leading to problems. In gestation fetal hemoglobin, which carries more O2 than adult's, starts in liver, but eventually switches to bone marrow. In gestation the fetal hg slowly is replaced by adult, but will still show up higher at birth. The normal nb level for hg is 17.18.4 g/dL.
Explain leukocyte levels of the newborn.
They are generally elevated the first 12 hours after birth. They average from 9000-30000, with an avergae of 18,000/mm. If there was an infection there would be a decrease in leukocyte count/ with an increase of immature leuckocytes.
Explain platelets and clotting in the nb.
Platelet levels are the same as an adults with average of 150000-300000. But because the infant has absence of vitamin K normally found in the gut, they are given an IM shot of vK to help with clotting.
What 4 components are involved in hepatic adaptation?
The liver accounts for 40% of the total abdominal area of the nb. No wonder, it is responsible for regulating blood glucose, iron storage, bilirubin conjugation, and coagulation of blood.
Explain hepatic adaptation in regards to blood glucose maintenance
Most of pregnancy the fetus gets glucose from the placenta whatever mom is eating at the time, but during the last 4-8 wks it is stored as glycogen in the liver. The stresses of birth use up all of the extra glucose the baby had on had so then the liver is called on by catecholamines to release glycogen (glycogenolysis), to give glucose to brain and other organs. Within 1st 3 hours of life 90% of glycogen will be used until nb starts to receive exogenous glucose. After birth, glucose is depleted, but in normal cases should climb to an norm of 40-80mg/dL If there aren't sufficient amounts of glycogen stores, (among other things), babies can have too much insulin in ratio to glucose, which can lead to hypoglycemia. Stressors like cold and hypoxia can lead to hypoglycemia as well.
Explain the iron storage component of hepatic adaptation.
Iron is stored in the liver of nb until needed for production of new rbcs. At birth the nb has 270mg of iron w/140-170 mg of it contained in hemoglobin. Breast fed babies get sufficient iron through 6mos, formula fed get it from formula.
Explain the conjugation of bilirubin in the liver.
A major function of the liver in which conversion of yellow lipid-soluble bilirubin pigment is conjugated w/ help of gluconeride and enzymes, into a water soluble pigment (no longer bilirubin). Jaundice, a yellow looking skin color from build up of bilirubin, happens when bilirubin is not being conjugated and is showing up in the blood (hyperbilirubinemia). This condition can happen in 60% of F/T infants and 80% of P/T. Bilirubin pigment is produced by breakdown of rbc, where heme is broken into iron, co, and biliverdin which breaks into fat-sol bilirubin. If the levels of unconjugated bilirubin rise then it means it isn't being excreted (no watersoluble "direct bilirubin") so it remains in lipid form and starts to deposit in the brain and spinal cord.
What would be the signs in a baby is they are hypoglycemic?
You could have an apneic, comatose, diaphoretic, dyspneic,high-pitched crying,hypotonic, irritated, jittery,lethargic, poor-sucking, respiratorally distressed, seizured, tachycardied, unstabled-decreased temp baby! or they could be ASYMPTOMATIC.
When do pathologic and physiological jaundice manifest?
Pathological jaundice will be present or occuring at birth or within the first 24 hours, physiological transient jaundice doesn't manifest until after the first 24 hours of birth, and when levels reach greater than 5-7mg
What factors will influence bilirubin levels in the neonate?
Cultural background: chin,jap,kor,na, are usually higher/last longer bilirub; perinatal events: delay cord cut, breech, use of pitocin; prematurity, maternal diabetes, xcess bili prod., delay feeds, liver immature, birth trauma, h/o family jaundice, nb complications: asphyxia, cold stress, hypoglycemia.
What is early-onset and late onset jaundice?
Early onset is associated with breastfeeding jaundice referring to poor feeding practices (like supplementation with other things) instead of breast feeding only. Happens between 2nd and 4th days of life. Late-onset jaundice is breast milk jaundice and occurs in f/t infant between 2-4% and usually occurs after the first week of life peaking at 2-3 weeks, usually asymptomatic otherwise, and usually works itself out or recommend stopping bf for 48 hours or use phototherapy,until bilirubin levels decline.
What is the one pancreatic enzyme that infants are lacking at birth?
Amylase, which is necessary for digesting fats. Infants are also low in other fat digesting enzymes when they are born, but they gradually increase after a few weeks from birth
When should the first meconium stool pass and if it doesn't what does it mean?
Usually first meconium is passed within 8-24 hours of birth. If there isn't by 72 hours there could be a bowel obstx called a midgut volvolus or malrotation twisted intestines) and you might have green emesis. Meconium is particles from amniotic fluid like vernix, skin cells, that are greenish-black and viscous. They gradually change to yellowish-brown.
What are the important values and things to know for urine function of the neonate?
Kidney function
Bladder capacity 6-44 mL
Fluid requirements—60-80 mL/kg
Urine output 1-3 mL/kg/hour
Nursing assessments
Careful monitoring of I&O
Assess appearance of urine
Should pee within first 24 hours and let other hc providers know.
What are the important things to remember about the immune system of the newborn.
Newborns have a very immature immune system. The only way that they receive any immunity is through or natural active and natural passive. The mother can pass on natural active immunities, (these help stimulate production of IgM immunoglobulin), as she is exposed to certain illnesses and immunizations that help prompt antibodies, or she can pass on natural passive immunoglobulins like IgA, and IgG through the milk and placenta respectively.
What can be expected as part of the psychosocial development of the nb?
Early stages of activity: First period of reactivity “Quiet alert” 30 min- 2 hrs; very alert; Important to BF & bond NOW! ; Then Period of inactivity & sleep Tired! Sleep 2-4 hours.; Then Second period of reactivity. Ready to eat, ↑ saliva, gaggy. Teach parents bulb syringe
May have first urine or meconium.
In which of the 3 distinct stages of psychosocial adaptation after birth would you expect the following milestones: 1st urine/meconium, bonding with the mother, sleeping for 2-4 hours, increased gagginess & saliva?
1st urine/meconium might be likely in 2nd period of reactivity along with gagginess and saliva; sleeping for 2-4 hours would happen in period of Inactivity (happens after 1st period of reactivity and before second period of reactivity; and bonding with the mother would happen in first period of reactivity, which is considered the quiet alert state.
What are the 4 parts of being alert as a newborn?
Surprisingly, drowsy-semi-dozing is considered alert, along with active awake (thrusting of extremities), wide awake (fixated eyes, no motor movement), and crying.
What is entailed in the sleep cycle of the nb?
They have 50 minute intervals of sleep that include 45% REM and 45% Deep quiet sleep, with 10% transitional time between these 2 states.
When does fetus become an abdomino fetus instead of pelvic fetus?
At 12 weeks
Baby has been breastfeeding for 36-48 hours what test would they get at this time?
PKU, glucose stick, or vitamin K,

Answer is PKU because they would have enough phenyalanine in their system to check o
When is the baby 1st called a fetus?
Baby is first called a fetus at 8wks. Beforehand up to 2 weeks is called an embryo and up till 2 weeks called a blasteocyte.
Define the different types of jaundice and their specific time frames.
Pathological jaundice happens within the first 24 hours of birth, and bilirubin levels that are increasing at a rate of 0.5mg. per hour or 5mg per day. It can happen in premies or rH incompatibility, or infection, or polycythemia...; Physiological Jaundice happens after 24-48hours of life and will show itself when serum bilirubin levels are at greater than 5mg and rising. Usually the levels will rise until about 5-7 days and finally decline at about 10-14 days. Physiological can happen because of keeping the cord on too long, decreased calorie intake, an immature liver; Breastfeeding jaundice happens because there is a decrease of intake of breastmilk/passage of meconium, and occurs between 48 & 96 hours of life. Usulally peakig at around 15 mg at 72 hours. Usually poor feeding practices are to blame. Breatmilk jaundice (latee onset) usually appears about a week after birth and has to do wth the has to do with make up of the breast milk.