OB Exam 3
Neonatal Period - ANS first 28 days of life
Transition to Neonatal Period Begins When - ANS the umbilical cord is clamped & cut & when the
neonate takes his/her first breath
Nursing Focus During Transition to Extrauterine Life - ANS - maintain respirations
- maintain heat
- decrease risk of infection
- provide adequate nutrition & hydration
- assist parents in caring for baby
Establishment of Respirations - ANS - most important physiological change to occur
- initiated by chemical & mechanical stimuli
Mechanical Stimuli for Respirations - ANS - loss of amniotic fluid from the lungs
- negative pressure in the lungs causes passive inspiration
- air enters alveoli
- lymph system absorbs excess fluid
- crying leads to positive pressure
- lungs remain open
Chemical Stimuli for Respirations - ANS - cessation of placental flow leads to hypoxia
- acidosis results from retained carbon dioxide
- this stimulates the respiratory center
- breathing occurs
,2 Factors that Negatively Affect Respirations - ANS 1. low levels of surfactant - preterm or early term
infants suffer with this
2. persistent hypoxemia & acidosis
Approximately _____ of infants need some degree of assistance with respirations - ANS 10%
Signs of Respiratory Stress - ANS - cyanosis
- acrocyanosis
- abnormal pattern (apnea or tachypnea)
- nasal flaring
- grunting
- intercostal or subcostal retractions
- hypotonia
Cyanosis - ANS central bluish gray mucous membranes
Acrocyanosis - ANS - bluish tinge to hands & feet
- occurs if there is no delayed cord clamping
- most common during the first 2-6 hours after birth
- lasts first 24 hours
Transition to Neonatal Circulation - ANS 1. ductus venosus
2. foramen ovale
3. ductus arteriosus
,Ductus Venosus - ANS - connects umbilical vein to inferior vena cava
- closes with cessation of blood flow from placenta to umbilical cord
Foramen Ovale - ANS - opening between the right atrium & left atrium
- closes when left atrial pressure exceeds right atrial pressure
Ductus Arteriosus - ANS - connects pulmonary artery with the aorta
- closes within 15 hours in most term infants, permanent closure within 3 months
- can remain open or reopen when lungs fail to expand
Thermoregulation - ANS - maintained by amniotic fluid in utero
- baby must adapt to changes in the environment once born
- baby at risk for hypothermia & cold stress
Neutral Thermal Environmental - ANS - needed to support the infant during this transition
- maintains body temp with minimal oxygen consumption & decreased metabolic rate
- decreases possible complications of the neonate's limited ability to respond to environmental temp
changes
How does a baby respond to cold? - ANS - increasing metabolic rate
- increasing muscle activity (restlessness or crying)
- peripheral vascular constriction (mottling, acrocyanosis, or pallor)
- metabolism of brown adipose tissue (BAT)
Methods of Heat Loss - ANS - evaporation
- convection
, - conduction
- radiation
Evaporation - ANS loss of heat when water is converted to a vapor
Convection - ANS loss of heat from a warm body surface to cooler air currents
Conduction - ANS loss of heat to a cooler surface by skin contact
Radiation - ANS heat loss occurs when body heat rises to cooler surfaces & objects NOT in direct contact
with the skin
Why do we care if a baby gets cold stress? - ANS - hypoglycemia
- metabolic acidosis
- decreased surfactant production
- respiratory distress that can lead to death
- hypoxemia
- increased direct bilirubin
- delayed transition from fetal to neonatal circulation
- weight loss
Cold Stress S+S - ANS - temp below 97.7 axillary
- cool skin
- lethargy
- pallor
- tachypnea
Neonatal Period - ANS first 28 days of life
Transition to Neonatal Period Begins When - ANS the umbilical cord is clamped & cut & when the
neonate takes his/her first breath
Nursing Focus During Transition to Extrauterine Life - ANS - maintain respirations
- maintain heat
- decrease risk of infection
- provide adequate nutrition & hydration
- assist parents in caring for baby
Establishment of Respirations - ANS - most important physiological change to occur
- initiated by chemical & mechanical stimuli
Mechanical Stimuli for Respirations - ANS - loss of amniotic fluid from the lungs
- negative pressure in the lungs causes passive inspiration
- air enters alveoli
- lymph system absorbs excess fluid
- crying leads to positive pressure
- lungs remain open
Chemical Stimuli for Respirations - ANS - cessation of placental flow leads to hypoxia
- acidosis results from retained carbon dioxide
- this stimulates the respiratory center
- breathing occurs
,2 Factors that Negatively Affect Respirations - ANS 1. low levels of surfactant - preterm or early term
infants suffer with this
2. persistent hypoxemia & acidosis
Approximately _____ of infants need some degree of assistance with respirations - ANS 10%
Signs of Respiratory Stress - ANS - cyanosis
- acrocyanosis
- abnormal pattern (apnea or tachypnea)
- nasal flaring
- grunting
- intercostal or subcostal retractions
- hypotonia
Cyanosis - ANS central bluish gray mucous membranes
Acrocyanosis - ANS - bluish tinge to hands & feet
- occurs if there is no delayed cord clamping
- most common during the first 2-6 hours after birth
- lasts first 24 hours
Transition to Neonatal Circulation - ANS 1. ductus venosus
2. foramen ovale
3. ductus arteriosus
,Ductus Venosus - ANS - connects umbilical vein to inferior vena cava
- closes with cessation of blood flow from placenta to umbilical cord
Foramen Ovale - ANS - opening between the right atrium & left atrium
- closes when left atrial pressure exceeds right atrial pressure
Ductus Arteriosus - ANS - connects pulmonary artery with the aorta
- closes within 15 hours in most term infants, permanent closure within 3 months
- can remain open or reopen when lungs fail to expand
Thermoregulation - ANS - maintained by amniotic fluid in utero
- baby must adapt to changes in the environment once born
- baby at risk for hypothermia & cold stress
Neutral Thermal Environmental - ANS - needed to support the infant during this transition
- maintains body temp with minimal oxygen consumption & decreased metabolic rate
- decreases possible complications of the neonate's limited ability to respond to environmental temp
changes
How does a baby respond to cold? - ANS - increasing metabolic rate
- increasing muscle activity (restlessness or crying)
- peripheral vascular constriction (mottling, acrocyanosis, or pallor)
- metabolism of brown adipose tissue (BAT)
Methods of Heat Loss - ANS - evaporation
- convection
, - conduction
- radiation
Evaporation - ANS loss of heat when water is converted to a vapor
Convection - ANS loss of heat from a warm body surface to cooler air currents
Conduction - ANS loss of heat to a cooler surface by skin contact
Radiation - ANS heat loss occurs when body heat rises to cooler surfaces & objects NOT in direct contact
with the skin
Why do we care if a baby gets cold stress? - ANS - hypoglycemia
- metabolic acidosis
- decreased surfactant production
- respiratory distress that can lead to death
- hypoxemia
- increased direct bilirubin
- delayed transition from fetal to neonatal circulation
- weight loss
Cold Stress S+S - ANS - temp below 97.7 axillary
- cool skin
- lethargy
- pallor
- tachypnea
