Chapter 17: Newborn Transitioning (Chapter Worksheet)
After birth, the nurse would expect which fetal structure to close as a result of increases in the pressure gradients on the left side of the heart? Foramen ovale Ductus arteriosus Ductus venosus Umbilical vein
Foramen ovale The foramen ovale is the fetal structure within the heart that allows blood to cross immediately to the left side and bypass the pulmonary circuit. When left side pressure gradients increase at birth, this opening closes, thereby establishing an extrauterine circulation pattern. The ductus venosus is not located in the heart; it is located between the umbilical vein and the inferior vena cava, and it shunts blood away from the liver during fetal life. The ductus arteriosus connects the pulmonary artery to the aorta to bypass the pulmonary circuit. It begins to constrict as pulmonary circulation and arterial oxygen tension increase. The umbilical vein, along with two umbilical arteries, is part of the umbilical cord that is cut at birth.
A nursing student questions the nursery nurse why they don't bathe the newborn immediately upon admission to the nursery observation area after birth. The nurse states that this would increase the risk of: Jaundice Infection Hypothermia Anemia
Hypothermia since newborns can rapidly become stressed by changes in environmental temperatures that bathing would cause through conduction. Postponing the newborn bath until the temperature has stabilized will help prevent newborn hypothermia. Responses "A," "B," and "D" are incorrect responses since there is no linkage between infection, jaundice, and anemia to infant bathing.
Which of the following newborns could be described as breathing normally? Newborn A is breathing deeply, with a regular rhythm, at a rate of 20 bpm. Newborn B is breathing diaphragmatically with sternal retractions, at a rate of 70 bpm. Newborn C is breathing shallowly, with 40-second periods of apnea and cyanosis. Newborn D is breathing shallowly, at a rate of 36 bpm, with short periods of apnea.
Newborn D is breathing shallowly, at a rate of 36 bpm, with short periods of apnea. Normal breathing can be described as shallow, at a rate of 36 bpm, with short periods of apnea.
The nurse performs a physical examination on a newborn 2 hours after birth. Which of the following findings indicate a need for a pediatric consultation? Select all that apply: Respiratory rate of 50 breaths per minute Intermittent episodes of apnea, lasting <10 seconds each Absent Moro reflex when startled Preauricular skin tag noted on left ear White raised bumps noted on nose and face Yellow blanching of the skin when pressure applied to the nose
Absent Moro reflex when startled Yellow blanching of the skin when pressure applied to the nose because they are abnormal findings that need further evaluation by the pediatrician. Absence of the Moro reflex might indicate a neurologic problem and yellow blanching of the skin over a bony prominence might indicate pathologic jaundice since it is before 24 hours old. Physiologic jaundice typically occurs after 24 hours old, but a pathologic jaundice occurs before 24 hours old. The remaining choices "A," "B," "D," and "E" are all normal findings in the newborn.
A nurse observes a 3-day-old term newborn that is starting to appear mildly jaundiced. What might explain this condition? Physiologic jaundice secondary to breast-feeding Hemolytic disease of the newborn due to blood incompatibility Exposing the newborn to high levels of oxygen Overfeeding the newborn with too much glucose water
Physiologic jaundice secondary to breast-feeding Physiologic jaundice typically starts after 72 hours of breast-feeding. There is an enzyme in breast milk that inhibits the breakdown of bilirubin, and it is reflected on the newborn skin as jaundice. Hemolytic disease of the newborn typically shows within 24 hours after birth due to the different types of blood between mother and newborn. Exposure to oxygen has no link to causing jaundice in the newborn. Glucose water is not a cause of jaundice, but it might promote more frequent bowel movements which assist in eliminating bilirubin.
After teaching a group of nursing students about thermoregulation and appropriate measures to prevent heat loss by evaporation, which of the following student behaviors would indicate successful teaching? Transporting the newborn in an isolette Maintaining a warm room temperature Placing the newborn on a warmed surface Drying the newborn immediately after birth
Drying the newborn immediately after birth Evaporation is the loss of heat as water is lost from the skin to the environment. Drying the newborn at birth and after bathing, keeping linens dry, and using plastic wrap blankets and heat shields will all prevent heat loss through evaporation. Placing the newborn on a warmed surface will prevent heat loss via conduction. Maintaining a warm room temperature will prevent heat loss via convection. Transporting the newborn in an isolette will prevent heat loss via radiation.
While in the nursery clinical setting, identify the period of behavioral reactivity (first, inactivity, or second period) for two newborns born at different times. Share your findings during the post conference for that clinical day.
First period of reactivity behavior: burst of rapid, jerky movements of the extremities; sucking activity; smacking and rooting; and fine tremors of the extremities. Second-period behavior: newborn's alertness gradually declines and he or she sleeps. Third period: newborns awaken and become more interactive with the environment. Movement is smoother compared with the first period of reactivity. Meconium may be passed during this period.
Dramatic changes occur in the cardiovascular system at birth. When the umbilical cord is clamped and the placenta is separated, there is a resultant increase in systemic blood pressure and changes to the three major fetal shunts (ductus venosus, foramen ovale, and ductus arteriosus) occur. Outline what happens to cause their functional closures during this period of transition.
Transition from fetal to adult circulation begins with clamping of the umbilical cord and continues through the first few weeks of life. There is an increase in systemic resistance due to the loss of the placental circuit. The increased pressure in the left atrium causes functional closure of the foramen ovale. Initial respiration opens pulmonary vasculature, favoring circulation to the lungs now. Increased oxygenation of circulating blood causes constriction and functional closure of the ductus arteriosus; and the absence of placental circulation closes the ductus venosus.
he most common mechanism of heat loss in the newborn is ___________________.
evaporation
When assessing a term newborn (6 hours old), the nurse auscultates bowel sounds and documents recent passing of meconium. These findings would indicate: Abnormal gastrointestinal newborn transition and needs to be reported An intestinal anomaly that needs immediate surgery A patent anus with no bowel obstruction and normal peristalsis A malabsorption syndrome resulting in fatty stools
A patent anus with no bowel obstruction and normal peristalsis The findings indicate a patent anus with no bowel obstruction and normal peristalsis.
Because the newborn's red blood cells break down much sooner than those of an adult, what might result? Anemia Bruising Apnea Jaundice
Jaundice since newborns produce bilirubin (red blood cell breakdown end product) at twice the rate of adults, their liver is not able to conjugate bilirubin as quickly as needed, this results in jaundice. Response "A" is incorrect since newborns typically have more red blood cells than needed, thus anemia wouldn't result. Responses "B" and "C" are not linked to the red blood cell breakdown and are incorrect responses.
When assessing the term newborn, the following are observed: newborn is alert, heart and respiratory rates have stabilized, and meconium has been passed. The nurse determines that the newborn is exhibiting behaviors indicating: Initial period of reactivity Second period of reactivity Decreased responsiveness period Sleep period for newborns
Second period of reactivity The behaviors demonstrated by the newborn, such as alertness, stabilized heart and respiratory rates, and passage of meconium are associated with the second period of reactivity. The first period of reactivity starts with a period of quiet alertness followed by an active alertness with frequent bursts of movement and crying. During the decreased responsiveness period, also called the sleep period, the newborn is relatively unresponsive and difficult to waken.
The newborn creates heat in three ways—shivering, muscle activity and through thermogenesis by the metabolism of brown adipose tissue. Which is the most effective?
Thermogenesis is the most effective way to produce warmth for the newborn by increasing cellular metabolic rate in skeletal muscle and brown fat, thereby increasing heat production. Brown fat, also called brown adipose tissue is a special kind of highly vascular fat in newborns with an ample supply of blood vessels that can generate heat. Shivering and muscle activity by moving are both ineffective methods to generate heat production.
