Nurs 371 Exam 3

What physiological adjustments do newborns go through in the first 6-8 hours of life?

Respirations, circulatory changes, temperature stability, nutritional needs, elimination, and regulating weight

What does the first period of reactivity after birth look like?

Respirations can be between 60-80 with crackles, HR can increase to 160-180, the baby will have eyes open and looking around, responsive to light, sounds, smell, and touch

30 mins after birth, the baby is crying and the HR is 190. What should be done?

Continue assessing. This is normal value for baby crying

When does the period of decreased responsiveness occur after birth?

60-100 minutes after birth

What will be seen in the period of decreased responsivess?

Decrease in activity, HR and RR decrease, infant is pink, shallow/rapid respirations, crackles should not be present, bowel sounds present

When does the second period of reactivity occur?

2-8 hours after birth

What is seen in the second period of reactivity?

brief periods of tachycardia/tachypnea, acrocyanosis improves, mucous production, increased muscle tone, meconium typically passed

What are the different factors of initiation of breathing? Describe

Chemical factors: low O2 and inc CO2

Mechanical factors: chest compressed during birth and released after

Thermal factors: temp is lower outside uterus = resp center stimulated

Sensory factors: shock factor, interventions, etc

What is the difference between c section and vag birth in initiation of breathing in the newborn?

The c-section patient has not released the catecholamine surge, therefore there is no chemical factors. More fluid in the lungs makes it more difficult to transition

What will the newborn do when there is decreased surfactant?

Grunting and nasal flaring

What does surfactant do?

Makes alveoli stronger and more stable and decreases amount collapsing

What are signs of respiratory distress in the newborn?

Nasal flaring, intercostal/subcostal retractions, grunting, acrocyanosis, central cyanosis, TTNB, stridor, paradoxical respirations, respirations less 30, apnea longer 20 secs, tachypnea

What is transient tachypnea of the newborn (TTNB)?

Usually shows in 1-2. Resolves in 24-48 hrs

Why might the ductus arteriosus open?

It can open in response to low O2 levels in the blood associated with hypoxia, asphyxia, and prematurity

Which side of the heart has greater pressure after birth?

Left

What marks the beginning of newborn circulation?

Left atrial pressure increases. This aids in the closure of the foramen ovale

What is the normal BP for a term infant?

60-80 / 40-50

MAP should = weeks of gestation

What is the newborns blood volume at birth?

300 mL; 400 mL with delayed cord clamping

What are signs of risk for cardiovascular problems?

Persistent tachycardia or brady cardia, pallor, cyanosis

What could persistent tachycardia in the newborn indicate?

Anemia, hypovolemia, hyperthermia, sepsis

What could persistent bradycardia in the newborn indicate?

Congenital heart block or hypoxemia

What could a change in skin color in the newborn indicate?

Prolonged cyanosis: respiratory/cardiac problems

Jaundice: ABO, Rh factor incompatibility

What are the normal RBC, Hgb, and Hct levels after birth?

RBC: 4.6 - 5.2

Hgb: 14-24

Hct 40-65%

What are the normal leukocyte levels after birth in the newborn?

Around 18000. Range is 9000 to 30000.

Rapid drop to 12000

Why arent leukocytes the first sign of infection in newborns?

They are slow to respond to infection. Temp is first sign

What are normal platelet levels in the newborn after birth?

150000-300000

What is polycythemia in the newborn?

> 65% Hct

How is temperature maintained in a newborn?

Dry off after birth, skin to skin, swaddle, hats

How is heat lost in the newborn?

Convection, radiation, evaporation, and conduction

Describe convection heat loss and how to prevent it.

Flow of heat from the body to cooler air. Prevent by swaddling, hat, and controlling room temp

Describe radiation heat loss and how to prevent it.

Loss of heat from the body surface to a cooler solid surface NOT in direct contact but in relative proximity. Prevent by keeping away from cold windows

Describe evaporation heat loss and how to prevent it.

Loss of heat that occurs when a liquid is converted to vapor. Prevent by drying off after birth and bath.

*most significant cause of heat loss in first few days of life*

Describe conduction heat loss and how to prevent it.

Loss of heat from the body surface to cooler surfaces in direct contact. Prevent with skin to skin, placing blanket on cold scale or bed

How do babies regulate their own temperature?

Crying, flexing, and being active

What does a hypothermic baby look like?

Pale, mottled, skin cool

Will progress to cold stress if not corrected and RR increases

If a baby is hyperthermic related to environmental factors, what will it look like?

Flushed skin, extremities warm, posture extension, flaccid

If a baby is hyperthermic related to sepsis, what will it look like?

Appear stressed, vessels in skin constricted, pale, hands/feet cool

What can hyperthermia cause in a newborn?

Neurologic injury and increased risk for seizure

What is the frequency of voiding in the newborn?

2-6 times a day. After day 4 it is 6-8 times a day

What will a newborn's urine look like?

Straw-colored and odorless, mucous strands

If a newborn has not urinated within the first 24 hours of birth, what needs to be done?

Further assessment

If a newborn has not voided within 48 hours of life it may indicate what?

Renal impairment

If uric acid crystals occur after the first week, what could this be a sign of?

Inadequate intake. May cause brick dust stains

What are the fluid requirements for infants weighing more than 1500 grams?

60-80 mL/kg in the first 2 days. In 3-7 days the requirement is 100-150 mL/kg/day

What are signs of renal system problems in the infant?

Lack of steady stream, enlarged/cystic kidneys

What is the stomach capacity of an infant in the first 1-3 days of life?

30-90 mL

What GI problems are newborns prone to?

Regurgitation, vomiting, and gastroesophageal reflux

Why do newborns absorb and digest fats less efficiently?

Inadequate pancreatic amylase and lipase

When is amylase produced by the salivary glands and pancreas in the newborn?

Salivary glands: 3 months

Pancreas: 6 months

When is lipase produced by the pancreas in the newborn?

After 6 months of age

What are signs of hunger in newborns?

Hand to mouth movements and sucking of fingers

Because the GI mucosa barrier is not fully mature in the newborn, what are they at risk for?

They are more at risk for pathogens and infections (especially bottle fed babies)

What can newborns digest?

Simple carbs and proteins with the assistance of enzymes. There is difficulty digesting fats because of the decreased amylase and lipase

Where can amylase be found?

In large amounts of breast milk

What are signs of GI problems in the newborn?

Failure to pass meconium, fullness or sunken abdomen, watery stools, and vomiting

when should meconium be passed?

12-24 hours

If meconium is not passed, what could this indicate?

Obstruction

What could abdominal fullness indicate in a newborn?

Hepatomegaly, duodenal atresia, ruptured viscus, or overfeeding

What could watery stools indicate in a newborn?

Dehydration

What does bright green meconium indicate?

Bile involvement (biliary)

What should the glucose be in a newborn?

40

When should the first feeding be initiated after birth?

Within the first hour to initiate stabilizing glucose

What are signs of hypoglycemia in a newborn?

Jitteriness, lethargy, poor feeding

What factors predispose newborns to hyperbilirubinemia?

Large number of RBCs, accelerated rate of destruction, immature liver, fewer albumin binding sites, and recirculated unconjugated bilirubin

What is one of the most significant risk factors of hyperbilirubinemia?

Prematurity

What bilirubin levels indicate jaundice?

more than 5-6 mg/dL

When does physiologic jaundice occur?

AFTER 24 hours

Describe physiologic jaundice.

It is the most common, related to an immature liver, occurs after 24 hours, resolves without treatment, and levels are usually less

Describe pathological jaundice.

It is seen immediately, related to ABO/Rh incompatibilities, occurs within the first 24 hours, levels are around 15 mg/dL, and it usually does not resolve without treatment

What nursing measures should be put in place for physiological jaundice?

Assess by gently pressing area, maintain temp, early frequent feedings will dec jaundice, and educate parents on discharge

If pathological jaundice is left untreated, what can it lead to?

Acute bilirubin encephalopathy

What is kernicterus?

irreversible, long-term consequences like hearing loss and cerebral

What is breastfeeding associated jaundice?

Breastfeeding is not the cause, but the lack of effective breastfeeding contributes to the hyperbilirubinemia

Describe breastfeeding associated jaundice.

early onset, begin 2-5 days of life, lessened stools, bilirubin is reabsorbed back into the bloodstream from the intestines

Describe breastmilk jaundice.

Late onset, 5-10 days of life, breastmilk is the problem

How do you assess jaundice?

Apply pressure over a bony area like the nose. If jaundice, the blanched area will appear yellowish before refill occurs.

What are the risk factors for jaundice?

Prematurity, breastfeeding difficulties, hemolytic disease, and birth trauma

What is the first line of treatment for jaundice?

Phototherapy

Describe phototherapy.

Light energy to help convert the bilirubin to a conjugated form

What are the different types of phototherapy?

Lights/lamps, fiberoptic blanket

What is exchange transfusion?

Therapy for jaundice that is used when phototherapy is not effective or if it is severe

Infants blood is replaced with a combo RBCs mixed with 5% albumin or fresh frozen plasma

What interventions need to be incorporated with phototherapy?

Protect eyes with a mask to prevent retinal damage. Monitor the temp closely, hydrations status/urinary output, skin breakdown, turn 2-3 hours

Why do male infants need to receive vitamin K prior to a circumcision?

To prevent bleeding problems

Describe IgG antibody for newborns

Passive acquired immunity, transferred primarily in the third semester, is most prevalent, and protects against bacteria and infection

Describe IgM antibody for newborns

important against blood-borne infections, the major immunoglobulin synthesized during the first month, newborn is capable of producing by the 8th week

Describe IgA antibody for newborns

it is missing from the resp, urinary, and GI tract (unless breast fed). Acts in intestine to neutralize bacterial and viral pathogens. Can lessen the risk of allergies and food intolerance

What are the s/s of infection in a newborn?

Temp instability, hypothermia, poor feeding

What is the greatest risk for infection?

Prematurity

What is the optimal state if arousal for a newborn?

Quiet alert state

What is state modulation?

The ability to transition smoothly between states

Where can babies see best after birth?

8-12 inches, They like faces and complex patterns

What are some examples of birth injuries?

Retinal and subconjunctival hemorrhages, soft-tissue injuries like erythema, ecchymosis, petechia, ledema, trauma secondary to dystocia, and accidental lacerations

What are the at risk infants for hypoglycemia?

SGA, LGA, IDM, late preterm

What is defined as hypocalcemia in a newborn?

8 term

7 preterm

When does hypocalcemia occur in the newborn?

Usually the first 24-48 hours

When does hypocalcemia resolve in the newborn?

Usually on its own in 1-3 days

What are the signs and symptoms of hypocalcemia in newborns?

Jitteriness, high pitched cry, irritability, apnea, intermittent cyanosis, abd distention

With what newborn patients will you see hypocalcemia?

Critically ill NB, infants of diabetic mothers, perinatal asphyxia, trauma, low-birth weight, preterm infants, and infants whose mother was on anticonvulsants

What facial features will you see in a newborn in pain?

Brows lowered and drawn together, bulge between brows, raised cheeks, nose broadened and bulging, mouth open and squarish, nasolabial fold deepened, and eyes tightly closed

What are some nonpharmacologic managements for neonatal pain?

Swaddling, pacifier, oral glucose, skin-to-skin, breastfeeding, massage, rocking