NEONATAL NURSING QUESTIONS WITH
COMPLETE SOLUTION
Neonatal Period
-Defined as the first 28 days after birth
-Newborn adapts to a brighter & cooler environment
-Physiologic & behavioral changes occur quickly
-The nurse & parents must be aware of any deviations from the norm for early
identification & prompt interventions
Assessment Findings
-Transition
-6-10 hours
-Physiological changes
-Periods of reactivity
-Physical assessments
-Reflexes
Umbilical cord
Vein carries oxygenated blood from placenta to uterus
Ductus Venosus
permits most of umbilical vein blood to bypass liver & merge with blood in vena cava
-Reaches heart sooner
Foramen ovale
allows blood entering right atrium to cross to left atrium
Ductus Arteriosus
connects the pulmonary artery to the aorta, allowing for bypass of the pulmonary circuit
,Placenta
supplies oxygen, nutrients & removes waste products
Cardiovascular Adaptations
At birth
-Fetal circulation must convert to newborn
-Placental pulmonary exchange
-Release of epinephrine & norepinephrine
-Stimulate increased cardiac output
Cont..
-Umbilical cord is clamped
-First breath taken & lungs begin to function
-Pressure changes occur
-Left atrium> right atrium
-Foramen ovale closes
-Oxygenated & non-oxygenated blood no longer mixes
Cont..
-Ductus Arteriosus becomes functionally closed within the first few hours after birth
-Closure is signaled by high oxygen content of aortic blood
-Results from gas exchange in the lungs
-Pulmonary vascular resistance decreases
-Pulmonary blood flow increases & oxygen exchange occurs in the lungs
Cont..
-Ductus Venosus closes within a few days after birth
-Due to activation of functional liver
-Liver takes over functions of placenta
-Two umbilical arteries & one vein constrict at birth & become ligaments
Additional CV Changes
,After birth
-Heart Rate- 120-180bpm
-Will decrease to 120-130bpm
-Crying, movement & wakefulness will cause an increase in HR & blood pressure
Cont..
-Difficulty compensating
-Tachycardia may reflect:
-Dehydration, CV disease, drug withdrawal
-Bradycardia may reflect:
-Apnea, hypoxia
-Delayed cord clamping may improve newborn's CV/pulmonary adaptation
Respiratory Adaptations
-Hypercapnia, hypoxia & acidosis from normal labor trigger 1st breath & subsequent
respirations
-Also environmental factors e.g. noise & light
-Surfactant provides the lungs with stability for gas exchange
-Tension-reducing lipoprotein
-Prevents alveolar collapse
-Reduces the risk of atelectasis
Cont...
-Chest wall is "floppy"
-Passage through birth canal helps to eliminate amniotic fluid in lungs
-Thorax is intermittently compressed
-If fluid is not removed, will result in tachypnea
-RR> 60bpm
-E.g. Cesarean Section
After birth
-Respirations are shallow & irregular
-30-60bpm (may have short period of apnea; <15 sec.)
-More active= the higher the RR
, Signs of Respiratory Compromise
-Cyanosis
-Tachypnea
-Expiratory grunting
-Sternal retractions
-Nasal flaring
-Labored breathing
Periodic Breathing
cessation of breathing that lasts 5-10 seconds without other s/s
Requires close monitoring
Thermoregulation
-Process of maintaining balance between heat loss & heat production
-Newborns at greatest risk within 12 hours of life
-Pre-term greater risk
-Range:
36.5-37.5°C
97.9-99.7°F
Heat Loss
-Lack inability to shiver
-Limited use of voluntary muscles
-Large body surface area
-Lack subcutaneous fat
-Unable to change position (can't conserve heat)
-Inability to communicate temperature extremes
-Limited metabolic stores (e.g. fat)
Conduction
Heat fluctuation between body surface when in contact with another
-e.g. cold mattress
-Use blankets
COMPLETE SOLUTION
Neonatal Period
-Defined as the first 28 days after birth
-Newborn adapts to a brighter & cooler environment
-Physiologic & behavioral changes occur quickly
-The nurse & parents must be aware of any deviations from the norm for early
identification & prompt interventions
Assessment Findings
-Transition
-6-10 hours
-Physiological changes
-Periods of reactivity
-Physical assessments
-Reflexes
Umbilical cord
Vein carries oxygenated blood from placenta to uterus
Ductus Venosus
permits most of umbilical vein blood to bypass liver & merge with blood in vena cava
-Reaches heart sooner
Foramen ovale
allows blood entering right atrium to cross to left atrium
Ductus Arteriosus
connects the pulmonary artery to the aorta, allowing for bypass of the pulmonary circuit
,Placenta
supplies oxygen, nutrients & removes waste products
Cardiovascular Adaptations
At birth
-Fetal circulation must convert to newborn
-Placental pulmonary exchange
-Release of epinephrine & norepinephrine
-Stimulate increased cardiac output
Cont..
-Umbilical cord is clamped
-First breath taken & lungs begin to function
-Pressure changes occur
-Left atrium> right atrium
-Foramen ovale closes
-Oxygenated & non-oxygenated blood no longer mixes
Cont..
-Ductus Arteriosus becomes functionally closed within the first few hours after birth
-Closure is signaled by high oxygen content of aortic blood
-Results from gas exchange in the lungs
-Pulmonary vascular resistance decreases
-Pulmonary blood flow increases & oxygen exchange occurs in the lungs
Cont..
-Ductus Venosus closes within a few days after birth
-Due to activation of functional liver
-Liver takes over functions of placenta
-Two umbilical arteries & one vein constrict at birth & become ligaments
Additional CV Changes
,After birth
-Heart Rate- 120-180bpm
-Will decrease to 120-130bpm
-Crying, movement & wakefulness will cause an increase in HR & blood pressure
Cont..
-Difficulty compensating
-Tachycardia may reflect:
-Dehydration, CV disease, drug withdrawal
-Bradycardia may reflect:
-Apnea, hypoxia
-Delayed cord clamping may improve newborn's CV/pulmonary adaptation
Respiratory Adaptations
-Hypercapnia, hypoxia & acidosis from normal labor trigger 1st breath & subsequent
respirations
-Also environmental factors e.g. noise & light
-Surfactant provides the lungs with stability for gas exchange
-Tension-reducing lipoprotein
-Prevents alveolar collapse
-Reduces the risk of atelectasis
Cont...
-Chest wall is "floppy"
-Passage through birth canal helps to eliminate amniotic fluid in lungs
-Thorax is intermittently compressed
-If fluid is not removed, will result in tachypnea
-RR> 60bpm
-E.g. Cesarean Section
After birth
-Respirations are shallow & irregular
-30-60bpm (may have short period of apnea; <15 sec.)
-More active= the higher the RR
, Signs of Respiratory Compromise
-Cyanosis
-Tachypnea
-Expiratory grunting
-Sternal retractions
-Nasal flaring
-Labored breathing
Periodic Breathing
cessation of breathing that lasts 5-10 seconds without other s/s
Requires close monitoring
Thermoregulation
-Process of maintaining balance between heat loss & heat production
-Newborns at greatest risk within 12 hours of life
-Pre-term greater risk
-Range:
36.5-37.5°C
97.9-99.7°F
Heat Loss
-Lack inability to shiver
-Limited use of voluntary muscles
-Large body surface area
-Lack subcutaneous fat
-Unable to change position (can't conserve heat)
-Inability to communicate temperature extremes
-Limited metabolic stores (e.g. fat)
Conduction
Heat fluctuation between body surface when in contact with another
-e.g. cold mattress
-Use blankets
