newborn physiology

which is not a factor related to the initiation of breathing? - temperature of 72 degrees - increase level of O2 (PO2) during delivery - infant having chest wall expand following the delivery of the trunk - infant being exposed to bright lights and sounds immediately after delivery

PO2 during delivery- PCO2 goes up during delivery which stimulates more respirations to increase O2 levels

A nurse is explaining the benefits of breastfeeding to a new mother. Which of the following immunoglobulins does breast milk contain that boost a newborn's immune system as opposed to formula? a. IgD b. IgE c. IgM d. IgA

D

newborn respirations rate, characteristics

- 30-60 - diaphragmatic, shallow, irregular - abdominal movement synchonous with chest (no see saw) - periodic breathing, pauses last 5-15 seconds preferential nose breather

at birth normal heart rate of baby normal heart rate sleeping and awake how do we assess heart rate?

- at birth 160-180 - sleeping: 100 - 120-160 normal awake auscultate for FULL MINUTE

ways hypothermia happens

- convection--> cooler air currents - radiation--> near a cold object evaporation--> when liquids vaporize from the skin (ex. after birth or bath) conduction--> direct contact with colder objects

when baby is born, how do respirations effect cardiovascular changes?

- decrease in pulmonary vascular resistance, bloodflow to lungs increases now that baby is breathing in air - oxygenated blood can reach the heart without the need of placenta, so decrease in placental blood flow

neonatal hypothermia when does temperature usually stabilize itself?

- first 28 days of life with a temperature below 97.7 - temperature usually stabilizes itself within first 6 hours of life

pulmonary changes at birth

- lungs filled with fluid throughout birth - during contractions fluid begins to decrease getting ready for birth - as baby is delivery fluid is squeezed out - rest of fluid will be coughed out by baby

initiation of breathing (4)

- mechanical--> as baby is born chest is compressed then filled with air, stimulates cry - chemical--> decreased oxygen and increased carbon dioxide, stimulates brain to respirate thermal--> rapid temperature change, from womb to environment, much colder sensory stimuli--> environment changes, lights, noise, rahter than qiuet and dark in the womb

a term infant at 1 hour of life born via C/S has the following assessment features: - RR: 78/min - grunting, substernal and intercostal retractions, and nasal flaring - circumoral cyanosis and acrocyanosis what is the primary cause of this respiratory distress syndome? mechanical/chemical/thermal/sensory AND WHY

- mechanical--> don't get mechanical compression from vaginal birth, still have higher amount of liquid in lungs

Prior to starting the nursing assessment on a newborn at 24 hours of age, the nurses notes the following behavior that demonstrates the infant ability to self-quiet: a. movements of the legs b. hyperactivity c. movements of head and eyes d. hand-to-mouth movements

D

The nurse is completing a newborn assessment on a neonate at 1 hour of life. Which of the following respiratory patterns would be an expected finding? a. deep respirations with regular rhythm b. diaphragmatic with chest retraction on respiration c. chest breathing and nasal flaring on inspiration d. synchronous abdominal and chest movements with respiration

D

urine specific gravity normal in newborn normal urine looks like in newborn

1.001-1.02 (very low) should usually urinate shortly after birth pink staining in diaper caused by urates pseudomenstruation- females can have a period from rise in hormones

a newborn male has been designated as large for gestational age. His mother was diagnosed with gestational diabetes late in her pregnancy. You should be alert for signs of hypoglycemia. Which of the following assessment findings would be consistent with a diagnosis of hypoglycemia? a. tachycardia b. edema of extremities c. abdominal distention d. unstable body temperature

D

which of the following newborn is at a greater risk for cold stress? a. an infant at 40 4/7 weeks gestation who is formula fed b. an infant at 41 6/7 weeks gestation whose mother had an induction of labor c. an infant at 39 0/7 weeks gestation who is large for gestational age d. an infant at 36 5/7 weeks gestation who is breast fed

D

Cord pulses for ________ after birth/it's been cut

2 mins

iron intake for babies is stable from mom for ___________ then after __________ should provide ___________ to prevent __________________

5 months after 6 months should be giving iron supplements or foods containing iron to prevent anemia

blood glucose at birth- what happens? what helps?

70-80 at birth from cord blood drops dramatically after not having supply from mom anymore and stabilizes at 40-60 - feedings help stabilize blood sugar

term infants pass meconium within ____-_____ hours with what kind of appearance? Milk stools

8-24 hours, thick, tarry, black appearance - by 4th day usually see change to milk stools - yellow, pasty, laxative effect

blood pressure of newborn normal preterm going to be higher or lower?

80-60/40-50 72/47= normal preterm is going to be lower

A newborn is having some respiratory difficulty in the first hour of life. The mother asks why her baby is having trouble. Which is the best response for the nurse to provide? a. newborn babies have weak intercostal muscles and that cause them to struggle a little b. newborn babies have a low diaphragm and that can cause her to struggle a little c. newborn babies have a vertically slanting rib cage and that causes them to struggle a little d. newborn babies have a small abdomen and that can cause them to struggle a little

A

A nurse is caring for a five-hour-old newborn. The physician has asked the nurse to maintain the newborn's temperature between 97.7 and 99.5 degrees Fahrenheit (36.5 - 37.5 degrees Celsius). What nursing intervention should the nurse perform to maintain the temperature within the recommended range? a. place the newborn skin-to-skin with mother b. place the newborn close to the outer wall in the morther's room c. avoid measuring the weight of the infant as the scales may be cold d. use stethoscope over the baby's shirt

A

An infant at 14 days of life has a return office visit with the pediatrician. She has been breastfed since birth, had facial jaundice at day 5 that has completely resolved by this office visit, and demonstrates a return to birth weight at today's visit. The mother asks what her babies stool should look like at this point because she is concerned. What should this infant's stools look like? a. unformed, soft, and yellowish gold color b. tan and formed in consistency c. unformed thick and tarry in appearance d. brown and watery in consistency

A

The nurse assessing a newborn knows that the most critical physiologic change required of the newborn is: a. initiation and maintenance of respirations b. closure of fetal shunts in the circulatory system c. maintenance of stable temperature d. perfusion of oxygenated blood to the extremities

A

a newborn girl is 12 hours old and is being prepared for early discharge. which of the following assessment findings could delay discharge? a. yellowish tinge in sclera and on face b. blood glucose level 55 c. rust stain on diaper after urination d. dark green-black stool, tarry in consistency

A

what is cold stress? - a cascade of physiological events caused by the infant's use of chemically medicated thermogenesis in attempt to increase the core temperature - a neonate whose temperature is consistently below 97.8 degrees - a condition in which the neonate increases O2 consumption to prevent hypothermia - a situation in which the neonate develops lactic acid formation as a result of glycolysis for brown fat metabolism

A - B,C,D are components of a cold stress event

A neonate at 2 hours of life has a baseline axillary temperature of98.0 o F (36.6 o C). Which of the following interventions can a nurse perform to maintain a neutral thermal environment for this newborn? a. avoid skin-to-skin contact with the mother b. promote early breast feeding c. allow the mother to jeep the infant undressed for long periods of time d. avoid bathing the newborn for the first 24 hours

B

At 6 hours of age, the nurse hears a murmur over the right and left auricles of the newborn's heart. The nurse concludes that this may represent a patent: a. ductus arteriosus b. foramen ovale c. ductus venosus d. umbilical vein

B

Four babies with the following conditions are in the well-baby nursery. The baby with which of the conditions is at high risk for jaundice? a. caput sucedaneum b. cephalhematoma c. mongolian spotting d. molding of the skull

B

The nurse is assessing a infant born at 37 weeks gestation. He finds the infant is dressed in several layers of blankets and clothing and has an axillary temperature of 99.4 o F (37.4o C). Which of the following factors increase the risk of overheating in this newborn? a. the underdeveloped lungs from preterm birth b. the limited availability for diaphoresis through perspiration c. the lack of brown fat to promote thermoregulation d. the small surface area in relation to body weight

B

The nurse reports to the mother that her baby had a positive direct coombs test result. The mother asks how that would affect the baby and the nurse explains... a. her babies liver is immature b. her baby has had some the mother's antibodies in its circulation c. her baby is showing a response to the Rho gam that mom received during pregnancy d. her baby is less likely to develop jaundice

B

Which of the four events that occur to initiate fetal breathing also causes the "squeezing" out of the fluid in the fetal lungs during delivery? a. thermal b. mechanical c. chemical d. sensory

B

a newborn, at 5 hours old, wakes from a sound sleep and becomes very active. He exhibits the following signs when assessed. Which one would require further assessment? a. an apical heart rate of 160bpm b. two apneic episodes lasting 25 and 30 seconds duration c. the passage of meconium stool d. pink skin color of body and extremities

B

A 2-day-old baby's blood values are: Blood type O- (negative) Direct Coombs, negative Hematocrit, 50% Bilirubin, 1.5 mg/dL The mother's blood type is A+ What is the appropriate action for the nurse at this time? a. assess the baby for opisthotonic posturing b. administer rhogam to the mother per doctor's order c. do nothing because the results are within normal limits d. call the doctor for an order to place the baby under bili lights

C

The nurse performs a newborn assessment on an Caucasian female infant at 14 hours post delivery. The nurse identifies that the infant has yellow colored eye sclera and a yellowing of the skin on her face. No yellowing extends lower than the face. Infant with cephalohematoma from vacuum delivery Maternal blood type A+ Infant blood type A+ Breastfeeding initiated at delivery with a total of 4 feedings each feeding lasting 8-10 minutes since birth The mother asks about this yellow coloring. What is the correct response from the nurse? a. This is probably from a G6PD deficiency. We will need to have the baby tested for this genetic disorder. Has anyone in your family had this issue that you of? b. this is likely caused by incompatility between your blood type and your babies. We will need to perform some testing on the baby c. this is likely pathologic jaundice. we will need to do a blood test and then I will contact the pediatrician d. this is fairly common for the newborn. it's called physiologic jaundice and should resolve in 5-10 days

C

you decide to use a radiant warmer to help a newborn male stabilize his temperature. which care measure should you implement? a. set the control panel between 95-100.4 degrees b. place the thermostat prob on the left side of his chest just below his nipple c. undress the infant before placing him under the warmer d. take a rectal temperature Q1HR while under the radiant warmer

C

Hg/Hct in newborn glucose WBC sodium

Hg: 15-20 Hct: 43-61% WBC: 10,000-30,000 glucose: 40-97 sodium: 120-156

at what point would it be concerning to not see urine output in a newborn?

after 48 hours

normal newborn transitional physiology found

closure of foramen ovale (1-2 hours) closure of ductus arteriosus closure of ductus venosus with liver perfusion

the primary loss of heat for an infant who is placed on a cool mattress in an unheated warmer is...

conduction

usually newborn position

extremities partially flexed, legs near abdomen

Why do we delay clamping?

fulfill's placenta's blood volume and supplies more to the baby before clamping, helps with many systems H/H most accurate in cord blood

which is a normal finding for an infant in the first 10 minutes of life? - heart murmur - blood glucose 95 - umbilical cord continues to pulsate - foramen ovale completely closed

heart murmur a normal glucose is lower, umbilical cord is only pulsing for 3 min, takes 1-2 hours for foramen to close completely

_____________ is a better indicator of infection than _______________

hypoglycemia, fever

what is considered cold stress? how should you go about treating?

hypoglycemia, hypothermia, respiratory distress - start with warming up baby, then other interventions

why is hypothermia bad in an infant?

oxygen consumption and energy are used for thermogenesis to survive instead of maintaining normal cardiac and brain function

best time to feed a neonate during which behavioral state?

quiet alert

drug positive babies will have different _________________ patterns, and ________________

sleeping and eating patterns, low birth rate