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Low risk neonatal PPT

Terms in this set (33)

Respiratory Transition
Respirations begin and continue effectively

fluid is cleared from airways; transition made from fluid to gas
Respiratory Transition: prenatal preparation
fetal lung development:
-surfactant
--begins 28 wks, peaks at 35 wks
--maintains alveolar stability
--enables the establishment of functional residual capacity
respiratory transition: fetal breathing movements
essential for developing chest wall muscles and the diaphragm
what factors induce respirations
mechanical:
-fetal chest compression and recoil

chemical:
-chemoreceptor stimulation
-decreased PO2 and increased PCO2

Thermal:
-sudden cooling stimulates sensory receptors

sensory:
handling and drying; tactile stimulation

Hormonal:
-Increased norepinephrine & epinephrine stimulate cardiac output, surfactant release and promotion of pulmonary fluid clearance
Newborn respiratory patterns: expected assessment findings
nose breathers
shallow and irregular
short periods of apnea
count full minute for neonate

rate 30-60

airway noises common -> still clearing fluid out, upper airway noises

c section babies -> no opportunity to have labor process compression their chest, vulnerable to airway noises
signs of respiratory distress
persistent nasal flaring
retractions
expiratory grunting
increased use of intercostal muscles

tachypnea
cyanosis
Circulatory transition
goals:
systemic vascular resistance must increase

blood must circulate through the lungs
--dilation of the pulmonary artery
--pulmonary vascular resistance must decrease

fetal shunts must close
--dependent on a decrease in PVR
Circulatory transition to extrauterine life
placental circuit shut off when the umbilical cord is clamped

ductus venosus: closes by 3 days, liver takes over placental functions

foramen ovale: closes as the pulmonary blood flow from the left side of the heart increases pressure in the left atrium

ductus arteriosus: constricts as pulmonary circulation & arterial oxygen tension increases
-spontaneous closure: 90% newborns by 48 hrs of age;
-permanent anatomic closure by 3 weeks to 3 months
Thermoregulatory transition
newborns tolerate a narrower range of environmental temperatures and are extremely vulnerable to both under and overheating

will attempt to regulate via flexed position, peripheral vasoconstriction, increased metabolic rate, and metabolism of brown fat
Factors that predispose a newborn to heat loss
thin skin with vessels close to surface

shivering mechanism rarely operable

limited stores of glucose, glycogen, fat

large body surface area relative to body weight

lack of subcutaneous fat

limited voluntary activity or ability to change posture

can't communicate 'too hot', 'too cold'
Consequences of cold stress
oxygen consumption and energy will be diverted from maintaining normal brain/cardiac function to thermogenesis for survival

Depleted brown fat stores, increased oxygen needs, increased glucose consumption leading to hypoglycemia, metabolic acidosis, jaundice, hypoxia and decreased surfactant production
overheating
limited ability to sweat

immature CNS system

large body surface
Newborn thermoregulation: expected findings
newborn temperature will remain between 36.5-37.2 (97.7-99.4) axillary

balance achieved between heat loss and heat generation

nursing interventions that prevent cold stress: EBP
Benefits of skin-to-skin contact (SSC)
Minimizes crying, HR surges

stabilizes temp

improves interaction

increases rate of BF initiation

promotes uterine involution

improves infant neurobehavioral development and self regulation
Feeding
ability to take nourishment from breast or bottle

coordinated sucking, swallowing and breathing
Elimination renal:
void within 24 hours (93%)
average # diapers = # days old
By 4 days of age, 6-8 voids/ 24 hours
Elimination: stools
most passed within 8-24 hours
meconium
-dark and tarry

transitional stool
-greenish after meconium passed

milk stool
great variation in frequency
Immune system adaptation
immature immune system & lack of exposure to organisms make the newborn vulnerable to infection
-immature leukocyte function

immunoglobulins contribute passive immunity
-IgG: passed to fetus from mom via placenta, protects newborn against infections via mom's antibodies

IgA: does not cross placenta; present in colostrum

IgM: does not cross placenta, if elevated in NB, may indicate intrauterine infection (TORCH)
Physical assessment of the newborn
immediate post delivery
-anticipate and prepare
--maternal history, intrapartal history
-caregiver trained in neonatal resuscitation available for all births

ongoing assessments following stabilization
Nurturing and attachment: psychosocial adaptation
periods of reactivity
newborn behavioral and sensory capabilities
--visual, auditory, olfactory, taste, tactile

newborn temperament
neonatal pain
parent/newborn attachment
Identification bands
time of birth, mother's name, birthdate, matching numbers for mom and baby

medical ID number for baby
Safety in the hospital setting
matching bands

'hugs' tags

visitor ID and check in; closed units

rolling bassinet

parent education

postpartum care
Expected assessment findings: weight
5Ib 8oz - 8Ib 13 oz
Expected assessment findings :length
45-53cm (19-21 inches)
Expected assessment findings: head
33-35.5cm (13-14 inches)
Expected assessment findings: chest
30.5-33cm (12-13 inches)
newborn medications
Erythromycin ointment
-prevention of gonococcal opthalmis neonatorum and chlamydial conjunctivitis

mandated in most states

vitamin K
-given to prevent vitamin-k dependent hemorrhagic disease of the newborn

newborns at risk first week or life due to immature liver and sterile GI tract

vitamin K stimulates liver to synthesize factors II, VII, IX, X

hepatitis B vaccine
Physical exam
within first 2 hours after birth
-skin, head, neck, respiratory, cardiovascular, abdomen, musculoskeletal, genitalia neurogolical (reflexes)

transitional period:
-TPR, skin color, LOC, muscle tone, activity level evaluated and documented at least once q 30 minutes until stable for 2 hrs
Hyperbilirubinemia (neonatal jaundice)
occurs in as many as 60% of newborns, more severe in preterm

physiologic (non pathologic) appears 2-3 days after birth; pathologic <24 hrs after birth

caused by presence of unconjugated bilirubin released with the breakdown of RBCs
-increased fetal RBC's with a shortened life span
-liver immaturity

Bilirubin: pigment derived from breakdown HgB

Concern:
-acute bilirubin encephalopathy: neurological dysfuntion associated with elevated levels of bilirubin
-Kernicterus: chronic manifestation of ABE
Assessing jaundice
bilirubin:
-appears in cephalocaudal manner

-visual assessment has been found to be unreliable and leads to under-detection of hyperbilirubinemia, particularly in darkly pigmented infants
Bilirubin screening
hour specific bilirubin nomogram
-findings should be interpreted according to the infant's age in hours

Bilirubin levels
-should peak at 5-8 mg/dl at 72 hrs of age
Management of hyperbilirubinemia
appropriate follow up based on time of discharge and risk assessment

phototherapy
-interaction of light with bilirubin causes photochemical change that facilitates excretion
-eyes must be covered to prevent retinal damage

Exchange transfusion
Infants at risk for severe hyperbilirubinemia
TcB levels in high risk zone

jaundice with the first 24 hours after birth

ABO incompatibility

gestational age between 35-36 weeks

Previous sibling who received phototherapy

cepalhematoma or significant bruising

east asian

sub optimal breastfeeding (inadequate intake and dehydration that slows bilirubin elimination)
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