NM717 Module 5 Newborn Midwifery Care of the Newborn Kelsey review guide|100% verified|120 pages

NM717 Module 5 Newborn Midwifery Care of the Newborn Kelsey review guide Immediate extrauterine newborn transition Answer —immediate transition from intrauterine to extrauterine life Immediate extrauterine newborn transition depends on changes in four major areas: Answer —respiration, —circulation, —thermoregulation, and —glucose regulation Biochemical Factors in initiation of respiration Answer —relative hypoxia at the end of labor Physical stimuli Factors in initiation of respiration Answer —cold, gravity, pain, light, noise Physiologic Factor in initiation of respiration Answer Recoil from pressure on thorax while passing through vagina Sustained respiration depends on coordinated response of the following Answer a. Central nervous system (CNS) respiratory center b. Aortic and carotid chemoreceptors c. Thoracic mechanoreceptors d. Diaphragm and respiratory muscles Initial breathing serves the following purposes Answer a. Assist in conversion from fetal to extrauterine circulation b. Clear lungs of fluid c. Establish lung volume and expand alveoli Characteristics of normal newborn respiration Answer a. Respiratory rate 30 to 60 breaths per minute b. Irregular/fluctuating pattern c. Diaphragmatic and abdominal breathing d. Obligate nose breathing e. Absence of nasal flaring, grunting, and retractions Circulatory changes Answer Transition from fetal to adult circulation begins with clamping of the umbilical cord and continues throughout the first weeks of life Characteristics of fetal circulation Answer a. Low-pressure system, including placenta (low-resistance circuit) b. Minimal circulation to lungs; bypassed via foramen ovale and ductus arteriosus c. Foramen ovale favors circulation of most oxygen-rich blood to the brain Transition from fetal to neonatal circulation Answer a. Increased systemic resistance due to loss of placental circuit b. Increased pressure in left atrium causes functional closure of foramen ovale c. Initial respiration opens pulmonary vasculature, favoring circulation to lungs d. Increased oxygenation of circulating blood causes constriction and functional closure of ductus arteriosus e. Absence of placental circulation closes ductus venosus Thermoregulation *Mechanisms of neonatal heat loss* Answer a. Convection b. Conduction c. Radiation d. Evaporation Thermoregulation *Neonate creates heat in three ways:* Answer a. Shivering (inefficient) b. Muscle activity (limited benefit) c. Thermogenesis by metabolism of brown adipose tissue (BAT) High risks infants with ineffective Thermogenesis Answer (1) BAT stores are decreased in *preterm and growth-restricted fetuses* (2) *Hypoglycemia* decreases efficiency of BAT metabolism Thermoregulation *Consequences of cold stress* Answer a. Increased oxygen consumption, leading to relative hypoxia and acidosis b. Metabolism of BAT and release of fatty acids decreases pH c. Increased use of glucose, depletion of glycogen stores, and hypoglycemia d. Worsening hypoglycemia and acidosis may result in respiratory distress Thermoregulation *Management/Interventions to promote* Answer a. Skin-to-skin contact on mother's chest or abdomen with blanket over both b. Prewarm blankets and resuscitation area c. Dry the newborn immediately and replace wet blankets d. Regulate room temperature and minimize exposure to air convection e. Postpone newborn bath at least two hours f. Keep newborn warm and wrapped Glucose regulation *Glycogen stores* Answer a. Predominantly in liver b. Accumulated in third trimester Glucose regulation *Risk factors for neonatal hypoglycemia* Answer a. Infants of diabetic mothers b. Small for gestational age (SGA) or large for gestational age (LGA) c. Preterm or post-term d. Intrapartum—perinatal acidemia, beta-agonist tocolysis, IV glucose administration e. Maternal substance abuse Glucose regulation *in the healthy neonate* Answer a. Normal physiologic decrease in blood glucose appears to be essential to stimulate physiologic processes promoting glucose production (1) Lowest at 1-1.5 to 5 hours after birth (2) Stabilizes at three to four hours after birth (3) neonate hypoglycemia definition is controversial. Guidelines underscore the need to measure glucose levels as soon as possible in symptomatic infants; if symptomatic and 40 mg/dl, IV glucose is recommended for treatment. (4) Infants without symptoms, ideally infants should feed within one hour of birth, and glucose should be screened 30 minutes after feeding; by 4-24 hours of age, blood glucose levels should remain ≥ 45 mg/dl Glucose regulation *Indications for treatment with intravenous dextrose* Answer (1) Symptomatic infants 40mg/dl, or those with initial serum glucose less than 25 mg/dL even without symptoms (2) Asymptomatic infants with persistent serum glucose less than 45 mg/dL Glucose regulation *Signs and symptoms of hypoglycemia* Answer a. Weak cry b. Jitteriness c. Cyanosis d. Apnea e. Lethargy f. Poor feeding Glucose regulation *hypoglycemia Management* Answer a. Encourage feeding as soon as possible b. Observe for signs/symptoms of hypoglycemia c. Assess glucose levels if signs/symptoms or risk factors are present