Chapman Maternal-Newborn Nursing Ch 15

Neonatal Period

is from birth through the first 28 days of life. The neonate transitions from intrauterine to extrauterine life and adapts to a new environment

Breastfeeding stool

is yellow and semi formed. Later is becomes a golden yellow with a pasty consistency and has a sour odor

Social behaviors

respond to cuddling and holding

Heat loss through evaporation can be reduced by

drying the neonate

Male circumcision is an

elective surgery to remove the foreskin of the penis

A neutral thermal environments NTE is an

environment that maintains body temperature with minimal metabolic changes and/or oxygen consumption

Orientation

focus on visual or auditory stimuli

The 3 major fetal structures that undergo changes after delivery are

-ductus venosus -foramen ovale -ductus arteriosus

Signs of respiratory distress

-Cyanosis -Abnormal respiratory pattern such as apnea and tachypnea -Retractions of the chest wall -Grunting -Flaring of nostrils -Hypotonia

Two factors that negatively affect the transition to extrauterine respiration

-Decreased surfactant levels related to immature lungs -Persistent hypoxemia and acidosis that leads to constriction of the pulmonary arteries

Two devices to remove foreskin in circumcision

-Gomco clamp and plastibell

The Dubrowitz Neurological exam is a standardized tool that assesses 33 responses in four areas

-Habituation (response to repetitive sound or light) -Movement and muscle tone -Reflexes -Neurobehavioral items

Neonates are at higher risk for thermoregulatory problems related to

-Higher body surface area to body mass ratio -Higher metabolic rate -Limited and immature thermoregulatory abilities

Focus of nursing care during the neonatal period is

-Maintain body heat -Maintain respiratory function -Decreasing risk for infection -Assisting parents in providing appropriate nutrition and hydration -Assisting parents in learning to care for their newborn

Two types of auditory screening

-Otoacoustic emissions OAE -Auditory brain stem response ABR

Approximately _____% of neonates require extensive resuscitation

1%

Approximately ____% of neonates require some degree of assistance with respiration at the time of delivery.

10%

Transitional stool begins around the

3rd day and can continue for 3 to 4 days. The stool transitions from black to greenish black, to greenish brown, to greenish yellow. This phase is the same for bottle or breast fed babies

Breastfeeding neonates have ____ to _____ stools per day

4-8

Gastric capacity for the first few days is

40-60 mL. It increases to 90 mL around day 4

Meconium stool begins to form during the

4th gestational month and is the first stool eliminated by the neonate. It is sticky, thick, black and odorless. It is first passed within 24-48 hours

In utero the lungs are filled with

amniotic fluid. Approximately 30mL of amniotic fluid is forced out of the lungs during the delivery process

You are caring for a newborn girl who weighs 3,800 grams with an estimated gestational age of 41 weeks. During your assessment at 1 hour of age, you note that the newborn is jittery and irritable. Your first nursing action is

Assess the blood glucose level

Sleep / wake states

Deep or light sleep Drowsy, Alert, Eyes open, Crying

The most critical physiological change required of neonates during the transition from intrauterine to extrauterine life is

Initiation and maintenance of respiratory function

Routine newborn screening began in the 1960's with

PKU phenylketonuria screening

This assists in keeping the alveolar sacs partially open at the end of exhalation, which decreases the amount of pressure and energy required on inspiration

Surfactant

In the birth suite during the initial newborn assessment, the new father seems concerned and asked why his baby girl is so hairy. The best response is

This is called lanugo which covered the baby while inside the mother. It will fall out in a few months.

Extrauterine respiration is initiated by

compression of the thorax, lung expansion, increase in alveolar oxygen concentration, and vasodilation of the pulmonary vessels

Indirect bilirubin

a fat soluble substance is produced from the breakdown of red blood cells

Self quieting ability

ability to quiet and comfort self

Large for gestational age LGA is a term used for neonates whose weight is

above the 90th percentile for gestational age.

Small for gestational age SGA is a term used for neonates whose weight is

below the 10th percentile for gestational age

Heat is produced by intense lipid metabolic metabolism of the

brown fat

The ductus venosus which connects the umbilical vein to the inferior vena cava will

close by day 3 of life and become a ligament. Blood flow through the umbilical vein stops once the cord is clamped.

The foramen ovale which is an opening between the right atrium and the left atrium will

close when the left atrial pressure is higher than the right atrial pressure.

The ductus arteriosus which connects the pulmonary artery with the descending aorta will

close within 15 hours post birth

Motor maturity

control and coordinate motor activity

Habituation

decreased sensitivity to repeated stimulus such as light or sound. It is a protective mechanism against overstimulation

The nurse would expect the stools of a 3 day old breastfed newborn to be

greenish brown to greenish yellow

Hyperbilirubinemia

high levels of bilirubin in neonates blood due to immature liver function

Brown fat also referred to as brown adipose tissue or non-shivering thermogenesis, is a

highly dense and vascular adipose tissue that is unique to neonates

Cold Stress

is a term that describes excessive heat loss that leads to hypothermia and results in the utilization of compensatory mechanisms to maintain the neonate's body temperature

Formula fed stool

is drier and more formed that breastfed stools. It is a paler yellow or brownish yellow and has an unpleasant odor.

Preterm infants have _______ brown fat

limited

Diarrhea stool is

loose and green

Convection

loss of heat from the neonate's warm body surface to cooler air currents such as air conditioners or oxygen masks

Evaporation

loss of heat that occurs when water on the neonate's skin is converted to vapors such as during bathing or directly after birth

The primary factors that initiate extrauterine respiration are

mechanical and chemical stimuli

Brown fat is located in the neonates

neck, thorax, axillary area, intrascapular areas and around the adrenal glands and kidneys

The Brazelton Neonatal Behavioral Assessment Scale BNBAS is used to assess the

neonate's neurobehavioral systems

The Ballard Maturational Score BMS is calculated by assessing the

physical and neuromuscular maturity of the neonate

Radiation

transfer of heat from the neonate to cooler objects that are not in direct contact with the neonate such as cold walls of the isolette or cold equipment near the neonate

Conduction

transfer of heat to cooler surface by direct skin contact such as cld hands of caregivers or cold equipment

The transition to extrauterine life begins at birth when the

umbilical cord is clamped and the neonate takes his first breath

Direct bilirubin is a

water soluble substance converted from indirect bilirubin by liver enzymes. It can be excreted in the urine and stool