Lecture 5: Physiological Adaptations/Nursing Care of the Newborn

studied byStudied by 2 people
0.0(0)
learn
LearnA personalized and smart learning plan
exam
Practice TestTake a test on your terms and definitions
spaced repetition
Spaced RepetitionScientifically backed study method
heart puzzle
Matching GameHow quick can you match all your cards?
flashcards
FlashcardsStudy terms and definitions

1 / 98

encourage image

There's no tags or description

Looks like no one added any tags here yet for you.

99 Terms

1

What 4 things is the newborn’s first breath triggered by?

  • light

  • cold

  • noise

  • decreased pO2 / increased pCO2

New cards
2

What does an APGAR score tell us?

an assessment of how a newborn is doing as they transition to the extrauterine environment

New cards
3

What are the 5 things we assess for in APGAR?

  • activity (muscle tone)

  • pulse

  • grimace

  • appearance

  • respirations

New cards
4

What are the three scores for activity (muscle tone)?

  • 0: Flaccid

  • 1: some flexion

  • 2: well flexed

New cards
5

How does crying help help the transition to extrauterine life?

  • increased positive pressure

  • air to the lungs

  • inflation of alveoli

New cards
6

What are the 4 factors that help stimulate the initiation of breathing?

  • mechanical

  • sensory

  • thermal

  • chemical

New cards
7

What does surfactant do?

decrease surface tension and maintain alveolar stability

New cards
8

Why is the patency of the baby’s nares significant?

newborns are obligate nose breathers

New cards
9

What causes cardiovascular adaptations to begin?

cord clamping and first breath

New cards
10

What 3 structures close with cord clamping?

  • ductus arteriosus

  • ductus venosus

  • foramen ovale

New cards
11

Name 2 other cardiovascular adaptations.

  • increased blood flow to lungs and liver

  • increased O2 to periphery

New cards
12

The transition to extrauterine life is characterized by ____________.

predictable periods of instability

New cards
13

Describe what happens during the first period of reactivity.

  • quiet alert state

  • HR decreased from 160-180 to consistent baseline of 100-160 bpm

  • RR irregular and there may be audible fine crackles, grunting, nasal flaring, and retraction of the chest (should cease by 1 hour of life)

New cards
14

Describe what happens during the second period of reactivity.

HR, RR, muscle tone, GI activity all increase

New cards
15

What happens between the first and second periods of reactivity.

sleep period

New cards
16

What are the sleep states?

  • deep sleep

  • light sleep

New cards
17

What are the wake states?

  • drowsy

  • quiet alert

  • active alert

  • crying

New cards
18

What is the optimal state of arousal?

quiet alert state

New cards
19

Describe vision at birth.

  • eye is structurally incomplete

  • muscles are immature

New cards
20

What happens to vision accommodation over the first 3 months of life?

improves

New cards
21

How is vision at 6 months?

as acute as in adults

New cards
22

Describe hearing at birth.

  • similar to an adult as soon as he amniotic fluid drains from the ears

  • infants respond readily to the mother’s voice

New cards
23

Smell at birth in response to breastmilk?

breastfed infants can smell breast milk and can differentiate their mother from other lactating women based on the smell

New cards
24

How do children react to different tastes?

facial expressions

New cards
25

What tastes do newborns favour?

sweet tastes

New cards
26

What parts of newborns are the most sensitive?

  • face

  • hands

  • soles of the feet

New cards
27

What is erythromycin administered to prevent?

ophthalmia neonatorum

New cards
28

What is ophthalmia neonatorum?

inflammation of the eyes caused by a gonorrhea and chlamydia infection

New cards
29

How soon is erythromycin administered?

within 2 hours of birth

New cards
30

What is vitamin K administered to prevent?

hemorrhagic disease of the newborn

New cards
31

Why is the administration of vitamin K important?

newborns do not have the intestinal flora to produce vitamin K in the first week after birth and it promotes the formation of clotting factors in the liver

New cards
32

How much vitamin K is administered for babies >1500 g?

1 mg

New cards
33

How much vitamin K is administered for babies <1500 g?

0.5 mg

New cards
34

What 5 things should you assess for in the general appearance of a newborn?

  • posture

  • activity

  • anomalies

  • bruising

  • state of alertness

New cards
35

What pulse should be obtained on all newborns? How?

apical pulse; auscultation for a full minute

New cards
36

What state should a newborn be in when auscultating the apical pulse?

quiet alert state

New cards
37

Normal newborn heart rate?

110 - 160 bpm

New cards
38

Normal newborn respiratory rate?

30 - 60 breaths per minute

New cards
39

Where are respirations found? How are they counted?

abdominal; observing

New cards
40

Normal newborn temperature?

36.5 - 37.5 degrees celsius

New cards
41

What does newborn bradycardia often indicate?

congenital heart block

New cards
42

What does newborn tachycardia often indicate?

  • RDS

  • pneumonia

  • fever

New cards
43

What does newborn bradypnea often indicate?

  • birth trauma

  • maternal narcosis from analgesics or anesthetics

New cards
44

What does newborn tachypnea often indicate?

  • RDS

  • TTN

  • CDH

New cards
45

What does newborn subnormal temperature often indicate?

  • infection

  • dehydration

New cards
46

What does newborn increased temperature often indicate?

  • infection

  • chemical dependence

  • diarrhea

  • dehydration

New cards
47

Thermogenesis in infants?

  • fetal position

  • brown fat

    • protects the organs and structures

    • breakdown increases heat production

  • glycogen stores

New cards
48

What is convection?

heat loss to air

New cards
49

What is radiation?

heat loss to cold solid surface nearby

New cards
50

What is evaporation?

heat loss to vaporization of moisture from skin

New cards
51

What is conduction?

heat loss directly to a cold surface

New cards
52

Name 5 reasons why newborns are at higher risk of getting cold.

  • unable to shiver

  • large surface area to comparison to weight

  • born wet into a cold room

  • blood vessels are superficial

  • low energy stores

New cards
53

What can result from cold stress in newborns?

  • hypoglycemia

  • decreased pulmonary perfusion

  • respiratory distress

  • return to fetal circulation

  • hyperbilirubinemia

New cards
54

How does cold stress cause hypoglycemia?

increased energy expenditure

New cards
55

How does cold stress cause decreased pulmonary perfusion, respiratory distress, and return to fetal circulation?

increased oxygen consumption

New cards
56

How does cold stress cause hyperbilirubinemia?

increased metabolic rate which results in glycolysis and acidosis

New cards
57

Interventions to prevent heat loss in newborns?

  • place baby skin-to-skin uninterrupted with mom or dad/other parent/family member

  • dry baby immediately and thoroughly at birth

  • place a warm hat on baby

  • minimize skin exposure

  • loosely swaddle baby in warm blankets if not skin-to-skin

New cards
58

When do most newborns need to be weighed?

at birth and at discharge

New cards
59

When may a newborn need to be weighed more often? How much more often?

newborns who are small for gestational age; daily weights

New cards
60

What is the birth weight of term newborns?

2500 - 4000 g

New cards
61

Normal skin variations (10).

  • mottling

  • Harlequin sign

  • plethora

  • acrocyanosis

  • Nevus simplex

  • Erythema toxicum neonatorum

  • Congenital dermal melanocytosis

  • milia

  • petechiae

  • ecchymoses

New cards
62

Name the 5 steps to assessing the neck.

  • palpate the head

  • inspect the shape and size

  • palpate, inspect, and note status of fontanels

  • palpate sutures

  • inspect and palpate the neck for movement, flexibility, masses, bruising

New cards
63

What is caput succedaneum?

  • generalized and identifiable edematous area of the scalp

  • present at birth

  • extends across the suture lines of the skull

  • disappears spontaneously within 3 to 4 days

New cards
64

How is caput succedameum caused?

compression of local vessels resulting in slowed venous return which causes an increase in tissue fluids within the skin of the scalp

New cards
65

What kinds of infants commonly have caput succedaneum?

vacuum-assisted delivery infants

New cards
66

What is a cephalohematoma?

  • collection of blood between a skull bone and its periosteum

  • soft, fluctuating, irreducible fullness

  • does not bulge when the newborn cries

New cards
67

How quickly does a cephalohematoma resolve?

3 - 6 weeks

New cards
68

How are cephalohematomas caused?

pressure against the maternal bony pelvis or forceps extraction

New cards
69

Main differentiating factor between cephalohematoma vs. caput succedaneum?

cephalohematoma does not cross cranial suture lines

New cards
70

What is a subgaleal hemorrhage?

bleeding into the subgaleal compartment

New cards
71

What are subgaleal hemorrhages associated with?

difficult operative vaginal births (ex. vacuum-assisted)

New cards
72

Signs of subgaleal hemorrhage?

  • boggy scalp

  • pallor

  • tachycardia

  • increased head circumference

New cards
73

What 3 assessments do we do for the eyes?

  • check placement on face

  • check for symmetry in size of shape

  • assess for discharge from the eyes

New cards
74

What assessments do we do for the nose?

  • observe for shape, placement, patency, configuration

    • midline

    • preferential nose breathers

    • sneezing to clear nose

New cards
75

What 3 assessments do we do for the ears?

  • observe size, placement on head, amount of cartilage, and open auditory canal

  • assess hearing; wake state influences response

  • ensure newborn hearing screening is completed to identify defiicts

New cards
76

What 3 assessments do we do for the face and mouth?

  • observe overall appearance and symmetry of face

    • rounded and symmetrical; influenced by birth type or moulding

    • positional deformities associated with intrauterine positioning and cranial moulding may be noted

  • assess mouth and palate to ensure they are intact

  • assess for reflexes (rooting and sucking)

New cards
77

What 4 assessments do we do for the chest?

  • inspect and palpate; circular/barrel shaped

  • observe respiratory movements

  • evaluate clavicles to ensure they are intact

  • assess the rib cage; should by symmetrical, intact, and move with respirations

New cards
78

Signs of respiratory distress.

  • nasal flaring

  • head bobbing

  • tracheal tug

  • intercostal or subcostal retractions

  • grunting

  • stridor

  • tachypnea

  • centralized cyanosis and duskiness

New cards
79

What is mild transient tachypnea of the newborn?

signs of respiratory distress during the first 1 to 2 hours after birth as baby transitions

New cards
80

Signs of TTN?

  • grunting

  • nasal flaring

  • mild retractions

New cards
81

Treatments for TTN?

supplemental oxygen and/or noninvasive ventilator support

New cards
82

Serious respiratory problems signs/symptoms?

  • more pronounced and last beyond the first 2 hours after birth

  • RR may exceed 120 breaths per minute

  • retractions, grunting, pallor, central cyanosis may occur

  • hypotension, temperature instability, hypoglycemia, acidosis, and signs of cardiac problems

New cards
83

Name 4 examples of respiratory complications.

  • respiratory distress syndrome

  • meconium aspirate syndrome

  • pneumonia

  • persistent pulmonary hypertension of the newborn

New cards
84

What assessments do we do for the abdomen?

  • inspect and palpate the umbilical cord

    • two arteries, one vein

  • inspect the size of the abdomen and palpate the contour

    • rounded, prominent, and dome-shaped

  • assess colour and observe movement with respirations

  • auscultate bowel sounds and note number, amount, character of stools

New cards
85

How soon should bowel sounds be heard after birth?

minutes

New cards
86

How soon does meconium stool pass after birth?

24 - 48 hours

New cards
87

What assessments do we do for the genitalia/GU system?

  • inspect and assess for general appearance

    • female genitalia may be edematous

    • male testes should be palpable on each side

  • voiding within 24 hours of birth

New cards
88

How often should voids happen after birth?

1 time per day for each day of life

New cards
89

What assessments do we do for the extremities?

  • inspect and palpate for

    • attitude of general flexion

    • full range of motion and spontaneous movements

    • muscle tone

    • colour

    • intactness

    • appropriate placement

  • count number of fingers and toes

  • evaluate joints for full range of motion

  • assess reflexes (palmar and plantar)

New cards
90

What assessments do we do for the back?

  • assess anatomy

  • inspect and palpate the spine, shoulders, scapulae, and iliac crests

  • assess base of spine

New cards
91

What should the spine look like at birth?

spine straight and easily flexed

New cards
92

What 3 assessments do we do for the anus and stools?

  • inspect and palpate placement and patency of anus

    • passage of meconium within 24-48 hours after birth

  • observe the frequency. colour, and consistency of stools

    • meconium is followed by transitional and soft yellow stool

New cards
93

What is biliary atresia?

condition where bile from liver does not get to the gallbladder/intestines

New cards
94

Signs and symptoms of biliary atresia?

  • pale stool, dark urine

  • jaundice lasting >2 weeks

  • irritability

  • weight loss

  • abdominal distension

New cards
95

Treatment for biliary atresia?

surgical

New cards
96

What assessments do we do for the neurological system?

  • assesses newborn reflexes

  • provides information about the newborn’s nervous system and state of the neurological maturation

New cards
97

Tests done prior to discharge?

  • bilirubin level

  • newborn screening

  • critical congenital heart disease screening

  • teaching (ex. feeding, SIDS, tummy time, etc.)

New cards
98

When does discharge teaching begin?

at admission

New cards
99

Name 4 elements of discharge teaching.

  • self care and signs of complications

  • sexual activity and contraception

  • prescribed medications

  • coping with visitors

New cards

Explore top notes

note Note
studied byStudied by 64 people
213 days ago
4.7(3)
note Note
studied byStudied by 26 people
891 days ago
5.0(1)
note Note
studied byStudied by 25 people
514 days ago
5.0(1)
note Note
studied byStudied by 4 people
688 days ago
5.0(1)
note Note
studied byStudied by 16 people
903 days ago
5.0(1)
note Note
studied byStudied by 10 people
760 days ago
5.0(1)
note Note
studied byStudied by 67 people
701 days ago
5.0(4)
note Note
studied byStudied by 44 people
758 days ago
5.0(3)

Explore top flashcards

flashcards Flashcard (92)
studied byStudied by 11 people
841 days ago
4.0(1)
flashcards Flashcard (116)
studied byStudied by 10 people
800 days ago
5.0(1)
flashcards Flashcard (43)
studied byStudied by 15 people
3 days ago
5.0(1)
flashcards Flashcard (57)
studied byStudied by 17 people
750 days ago
5.0(2)
flashcards Flashcard (40)
studied byStudied by 2 people
177 days ago
5.0(1)
flashcards Flashcard (71)
studied byStudied by 42 people
385 days ago
5.0(4)
flashcards Flashcard (82)
studied byStudied by 41 people
88 days ago
5.0(1)
flashcards Flashcard (222)
studied byStudied by 29 people
646 days ago
5.0(1)
robot