Chapter 22 - Normal Newborn Adaptation - Test #4 Material

NUR 390: Maternal, Newborn, and Women's Health - Mississippi College

what are the 6 physiologic changes that occur in the neonatal period?

• establish/maintain RR

• adjust to circulatory changes

• regulate temp

• ingest, retain, and digest nutrients

• eliminate waste

• regulate waste

what are the 3 behavioral changes that occur in the neonatal period?

• establish regulated behavioral tempo independent of mother

• process, store, and organize multiple stimuli 

• establish relationship with caregivers and environment 

what are some chemical factors of the physiologic adjustments of the respiratory system?

decreased O2 and increased CO2 stimulate respiratory center in the medulla

what are some mechanical factors of the physiologic adjustments of the respiratory system?

• pressure on the chest during birth

• cry

what are some thermal factors of the physiologic adjustments of the respiratory system?

change in environmental temperature stimulates receptors in the skin

what are some sensory changes in the physiologic adjustments of the respiratory system?

environmental factors (lights, sounds, smells) stimulate respiratory system

why is a catecholamine surge is important?

promotes fluid clearance from the lungs

what is a surfactant?

protein that lowers surface tension that helps establish residual lung capacity

what are some characteristics of respirations specific to the neonatal period?

• shallow an irregular 

• 30-60 breaths/minute 

• obligate nose breathers 

• breath sounds: loud, clear, and equal bilaterally 

• fine rales for the first few hours after birth is normal 

• abdominal breathing 

what are some signs of respiratory distress?

• nasal flaring

• retractions

• grunting with respirations

• paradoxical respirations

• RR less than 30 or greater than 60

• apneic episodes

• tachypnea

• change in color

what is acrocyanosis?

• bluish discoloration of hands and feet

*this is a normal finding in the 1st 24 hours after birth

what is central cyanosis?

• lips and mucus membranes are bluish 

*this is abnormal and signifies hypoxemia. this is a late sign of distress.

what are some common respiratory complications affecting neonates?

• respiratory distress syndrome (RDS)

• meconium aspiration

• pneumonia

• persistent pulmonary hypertension of the newborn (PPHN)

• congenital defects

• blood incompatibilities - leads to excessive buildup of fluids in tissues and organs (edema)

• hydrops fetalis

transition from fetal to neonatal circulation: increase in _____ _____ level with RR

blood oxygen

shifts in pressure in the heart and lung: _____ systemic vascular resistance after clamping of the umbilical cord and _____ pulmonary vascular resistance with first breath

increase; decrease

closure of the _____ _____, _____ _____, _____ _____, and _____ _____

umbilical vessels, foramen ovale, ductus venosus, and ductus arteriosus

what is the normal heart rate for a neonate?

120-160 beats/minute

what is the normal heart rate for a neonate during sleep?

80-100 beats/minute

what is the normal heart rate for a neonate who is crying?

180 beats/minute or higher

greater than 160 or less than 100 should be reevaluated in _____ minutes

30

where is PMI located?

4th intercostal space to the left of midclavicular line 

MAP should be equivalent to what?

number of weeks gestation

what are some signs of cardiovascular problems in a neonate?

• persistent tachycardia

• persistent bradycardia

• unequal, absent, or bounding pulses

• hypo/hypertension

• pallor, cyanosis, and jaundice

• congenital heart defects

what is neonatal tachycardia?

>160 beats/min

what is neonatal bradycardia?

<80 beats/min

what is the normal range for neonatal RBCs?

4.6-5.2 million/mm³

what is the normal range for neonatal hemoglobin?

14-24 g/dL

what is the normal range for hematocrit in neonates?

12-20 g/dL

what is the normal range for leukocytes in a neonate?

9000-30,000/mm³ initially

*stabilizes around 12,000/mm³

what is the normal range for platelets?

150,000-300,000/mm³

cord blood can be used to identify infant’s blood type and _____ status 

Rh

what is thermoregulation?

the maintenance of balance between heat loss and heat production

hypothermia or hyperthermia (select one) is common

hypothermia

why are neonates at risk for heat loss (4 factors)?

• thin layer of subcutaneous fat

• blood vessels close to skin surface 

• larger body surface-to-body weight ratio than children and adults

• changes in environmental temps 

what is the goal of care for neonatal heat loss?

neutral thermal environment

what are some ways to control heat loss?

• drying infant quickly after birth

• skin-to-skin contact

• radiant warmer

what are some signs of hypothermia?

• temp drop = vasoconstriction 

• infant appears pale, mottled, with cool skin

• leads to cold stress in untreated 

what are some signs and symptoms of hyperthermia?

• body temp >99.5 degrees F

• possibly could lead to neurologic injury, increased risk for seizures, heat stroke, and death in severe cases

what is the bladder volume at birth?

40 mL ± present in term infant

what is the normal neonatal urine output?

15-60 mL/kg/day

what is the normal neonatal frequency of voiding?

• day 1 and 2 of life: voids 2-6 times/day

• past day 4: 6-8 voids/day

what is “brick dust”?

pink-tinged uric acid crystals which is normal of the first week

_____ _____ can result in a 5-10% loss of the birth weight of the first 3-5 days

fluid loss

neonate should regain the birth weight within _____-_____ days

10-14

_____% body weight is total body water at term

75%

daily fluid requirement for neonates weighing more than 1500 g: Day 1 and 2

60-80 mL/kg

daily fluid requirement for neonates weighing more than 1500 g: days 3-6

100-150 mL/kg/kg/day

daily fluid requirement for neonates weighing more than 1500 g: days 8-30

120-180 mL/kg/day

nursing assessment: renal system

• note first void 

• monitor urine color, amount, and frequency 

• watch weight changes to ensure proper fluid intake (hydration status)

what is digestion?

able to digest carbs, fats, and proteins

what is meconium?

• baby’s first stool

• greenish-black and tarry

what are some feeding behaviors?

hunger cues

what are some signs of GI problems?

• failure to pass meconium 

• passage of meconium from vagina or urinary meatus 

• abdominal distension 

• scaphoid (sunken) abdomen with bowel sounds heard in chest 

• projectile vomiting 

• large volume vomiting 

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