Notes for exam 2
Notes for exam 2 NURB 331
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This 4 page Class Notes was uploaded by Kelsey Forbeck on Wednesday September 28, 2016. The Class Notes belongs to NURB 331 at University of Indianapolis taught by Professor Rairdon in Fall 2016. Since its upload, it has received 8 views. For similar materials see Lifespan 1 in NURSING at University of Indianapolis.
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Date Created: 09/28/16
NURB 331: Lifespan 1 Exam 2 Adaptation of the Newborn Respiratory Adaptations o Babies undergo rapid and complex physiological changes o The heart is an open thing where the blood is just flowing around because they are getting it from mom o Blood skips the lungs o FIRST priority is to get the baby to initiate and maintain respirations o The first moment when baby breaths, there is a pressure change. o Initiation of Breathing: 1. Drying and clamping he cord and stimulate cold receptor 2. Increased PCOs, decreased PO2, and increase in acidosis 3. (1 breath) causes an increase in PO2 and closure of the foreman ovale (pressure in the left side of the heart) 4. Closure of the ductus venous and umbilical arteries and vein due to decreased flow o Maintaining Respiratory Function: Loud breath sounds to begin with Ribs articulate in a horizontal rather a downward slope (babies are abdominal breathers, not chest, because of the way their ribs are and they are weak) o Characteristics of newborn respirations: Breaths are shallow and irregular, ranging from 30-60 breaths with short periods of apnea Function largely as diaphragmatic breathing Short periods of apnea occur during the REM cycle Apnea over 15 seconds long should be reported Babies are nose breathers because they use their mouth to eat o Respirations The chest and abdomen rise with inspiration Seesaw respirations are ABNORMAL (when the chest goes up then the belly goes up) o Respiratory Distress Nasal Flaring Grunting respirations- usually means they still have fluid in the lungs Seesaw respirations Respiratory rate less than 30 or greater than 60 Retractions (looks like the skin is sucking into the rib cage) Cardiovascular Adaptations o Heart rate Averages 140 beats at birth with 110-150 during sleeping and waking states th PMI is at the 4 intercostal space and to the left of the mid clavicular line o Blood Pressure 72/47 is the average BP is highest right after birth because of the change to the body BP drops about 15 during the first hour of life (this is common) o Heart Murmurs More than half of murmurs disappear in 6 months We are also looking at other indications to make sure baby is cardiovascular stable Hematopoietic Adaptations o RBC’s and Hgb Because fetal circulation is less efficient at oxygen exchange than the lungs, the fetus needs additional RBC’s for transport of oxygen in utero RBC’s higher in newborn than adults o Leukocytes 18,000 about WBC count Marked change in WBC count Is unlikely because the baby’s immune system doesn’t know how to make WBC’s Sepsis is most often accompanied by a DECLINE in wbc Temperature Regulation o Temperature is the second most important thing behind respirations o Thermoregulation- is the maintenance of balance between heat loss and heat production o Hypothermia from excessive heat loss is a common and dangerous problem in neonates The cause of this is a cold environment Newborns thermal insulation is less than an adult because they do not have much fat and their blood vessels are closer to the surface of the skin Flexed position helps the baby guard against heat loss o Heat loss Convection- flow of heat from body surface to cooler ambient air Radiation- loss of heat from the body surface to a cooler solid surface not in direct contact Evaporation- loss of heat that occurs when a liquid is converted to a vapor DRY BABY AFTER BIRTH Conduction- loss of heat from the body surface to cooler surfaces in direct contact o Heat Production Thermogenesis is used to describe heat production Babies do not shiver so it means there is another problem if it looks like they are Brown fat is located in intrascapular region and axilla Brown fat has richer vascular and nerve supply then regular fat Burn this fat fast Hypothermia o Babies cannot change position to decrease amount of exposed skin o Cold stress- imposes metabolic and physiological demands on all newborns, regardless of gestational age and condition o Respiratory rate increased with increase need for oxygen o They can go to state of acidosis o Basal metabolic rate is increasing during cold stress o If cold stress lasts long, then they can cause an increase production of acids Hyperthermia o They will sweat o They will vasodilate causing them to look red o They will breath more rapid to blow off the heat o They have 6 times more sweat glands than adults but they don’t work o Heat can cause dehydration, heat stroke, and death. Renal System o Newborns may not void for 12-24 hours o After this time period they will urinate 6-10 times a day o Pink tinged stains may appear in the diaper (Caused by uric acid crystals this is normal) o Pseudo menstruation is caused by withdrawal of female hormones Integumentary System o Erythema Toxicun A rash that looks like little pimples with patchy redness. (this is normal as long as they are not clear liquid) o MIlia Tiny white spots that look like white heads This is normal o Nevus (stork’s bite) Vascular lesion one or more pale patches of skin on the neck This is normal o Mongolian Spots Usually on native Americans IF they are seen in Caucasian then they have some native American in them o Caput succedaneum Soft area of the scalp This is from vacuum extractor Will travel across the midline of the scalp This is normal o Cephalhematoma Collection of blood between the surface of the cranial bone and the periosteal membrane This looks like the McDonalds arches Will stop at the suture line Gastrointestinal System o Bowel sounds can be heard within the first hour after birth o Stomach can hold 60-80 ml o Bstteria isn’t in the infant’s GI tract o 1 meconium passed is sterile o You do not want the meconium to come out before birth because they can breathe it in Immune system o Immunity cells develop early in life but aren’t activated for several months o Infant is protected by the passive immunity by the mom for the first 3- 5 months of life
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