UNIT 4: Physiological and Behavioral Adaptations of the Newborn

Content on EXAM 2

What are some assessment findings that happen within the first 30 minutes of life for a newborn?

• Alert, crying

• RR irregular

• Fine crackles

• Tremors

• Meconium may be passed

What assessment findings happen during the period of decreased responsiveness 60-100 minutes?

• Pink skin

• RR rapid, shallow, unlabored

• Fine crackles

What assessment findings happen during the second period of reactivity (occurs between 4-6 hours after delivery)?

• Brief periods of tachypnea and tachycardia

• Increased muscle tone

• Mucus production

• Meconium is usually passed if it wasn’t already

What are newborn physiological adaptations?

• Chemical

  • Umbilical cord is clamped ~ creates mild state of hypoxia

• Mechanical

  • Squeeze through the birth canal

• Thermal

  • Moving from warm to environment where they are quickly losing heat

• Sensory

  • Suctioning, drying/stimulating, light, sounds, smells

What are characteristics of a newborn’s respirations?

• Normal respiratory rate 30–60 breaths/min

• Periodic breathing

  • Pauses in respirations lasting up to 20 seconds

• Nose breathers

• Acrocyanosis may be present

  • Bluish color of hands and feet

What are signs of respiratory distress in a newborn?

• Cyanosis

  • Circumoral and central

• Retractions of the chest wall

• Grunting

• Flaring of nostrils

• Abnormal pattern

  • Tachypnea and apnea

• Hypotonia

Foramen Ovale (FO)

blood directed from right atrium across foramen ovale

Ductus Arteriosus (DA)

60% of right ventricular output bypasses lungs to flow through ductus arteriosus

Ductus Venosis

portal access through the liver

What are cardiovascular system physiological changes in newborns?

• Average heart rate is 140 bpm

• HR Range in term infant – 110-160 bpm

• Murmurs are usually benign and disappear within 6 months

How long should the nurse auscultate the apical pulse on a newborn?

for a full minute

True or False: Hearing murmurs within the first 24-48 hrs of life is normal cardiopulmonary adaptation for a newborn/

True; it is typically benign during this period.

What are some newborn physiological adaptations for the thermogenic system?

• Thermoregulation (the balance between heat loss and heat production)

• Thermogenesis (newborn’s ability to produce heat)

• Nonshivering thermogenesis is accomplished by brown fat metabolism

  • Concentration around scapula, axilla, spine, neck

• Neutral Thermal Environment

Convection (thermogenic system)

loss of heat from the warm body surface to the cooler air currents

Radiation (thermogenic system)

losses occur when body heat rises to cooler surfaces and objects not in direct contact with the body. The walls of a room or of an incubator are potential causes of heat loss by radiation

Evaporation (thermogenic system)

is the loss of heat incurred when water is converted to a vapor.

Conduction (thermogenic system)

the loss of heat to a cooler surface by direct skin contact. Chilled hands, cool scales, cold examination tables, and cold stethoscopes can cause heat loss by conduction

What is the rationale behind the vitamin K injection at birth?

to promote clotting factors until newborn can synthesize their own vitamin K (1-2 weeks)

What are certain events that can increase the amount of RBC breakdown leading to jaundice in a newborn? (Total of 3)

• birth trauma

• asphyxia

• ABO incompatibility

What is the name of the first stool that is usually black and tarry that is passed within the first 24 hours of life?

Meconium

When does the first void of a newborn happen?

within the first 24 hours of life

True or False: Newborns are at risk for bacterial, viral infections that result in increased mortality.

True. Due to an immature immune system, newborns are vulnerable to infections, which can lead to serious health complications.

What does the mama produce as a form of active acquired immunity for a newborn?

the mama forms antibodies in response to illness, immunization

What are two types of passive acquired immunity for a newborn?

antibodies transferred to fetus in utero and breast feeding

What immunoglobulins are in breast milk?

all five immunoglobulins (IgG, IgA, IgE, IgM, IgD)

At approximately what time do infants start developing their own immune system?

around 2 to 3 months of age