NR 327 Exam 3
1. Atony •Lack of muscle tone that results in failure of the uterine muscle fibers to contract
firmly around blood vessels when the placenta separates. The relaxed muscles
allow rapid bleeding from the endometrial arteries at the placental sire, bleeding
continues until the uterine muscle fibers contract to stop the flow of blood.
• Risks: overdistention of the uterus from any cause (multiple gestations, large
infant, or
hydramnios) makes it more diflcult for the uterus to contract with enough
firmness to prevent excessive bleeding. Multiparity results in muscle fibers that
have been stretched repeatedly and these flaccid muscle fibers may not remain
contracted after birth. Intrapartum factors include contractions that were barley
ettective, resulting in prolonged labor, contractions that were excessively vigorous,
resulting in precipitate labor and labor that was induced or augmented with
oxytocin. Retention of a large segment of the placenta does not allow the uterus
to contract firmly and therefore can result in uterine atony
• Manifestations: uterine fundus that is diflcult to locate, soft or boggy feel when
the fundus is located, uterus that becomes form as it is massaged but loses its
tone when massage is stopped, fundus that is located above the expected level,
excessive lochia especially if it is bright red, excessive clots expelled with or without
massage, saturation of one peripad in 15 minutes.
2. Surfactant Surfactant is a complex substance containing phospholipids and a number of
apoproteins. This fluid is produced by the Type II alveolar cells, and lines the
alveoli and smallest bronchioles. Surfactant reduces surface tension throughout
the lung. It is also important because it stabilizes the alveoli.That is, at a constant
surface tension, small alveoli will generate bigger pressures within them than
will large alveoli. Smaller alveoli would therefore be expected to empty into
larger alveoli as lung volume decreases. This does not occur, however, because
surfactant ditterentiallyreduces surface tension, leading to alveolar stability and
reducing the likelihood of alveolar collapse. If the lungs did not secrete surfactant,
this surface tension would be much higher and it would not be able to inflate
, NR 327 Exam 3
normally.Surfactant is formed relatively late in fetal life; thus premature infants
born without adequate amounts experience respiratory distress syndrome which
is caused by lack of surfactant and may die. It is commonly suttered by premature
babies born before 28-32 weeks of gestation.
3. With a nor- At birth and again at five minutes
mal delivery
and healthy
baby -how of-
ten should AP-
GAR scores be
taken?
4. What does AP- COLOUR, HEARTRATE, GRIMACE, ACTIVITY, RESPIRATIONS
GAR assess?
5. Newborn Charac- *Thin Skin
teristics that lead *Blood vessels close to the surface
to Heat Loss Little subcutaneous fat so little insulation Preterms even less
*Newborns have 3x more body surface area vs. their weight compared with
adults
*Lose heat 4x faster than adults
*Cannot shiver like adults
Term newborns flex to conserve heat Preterms can't flex so lose heat
6. Methods of Heat Evaporation
Loss Conduction
Convection
Radiation
7. Methods of Heat Definition:
Loss Wet surfaces exposed to air
Evaporation
, NR 327 Exam 3
Occurs:
*Immediately p birth
*During baths
Prevention:
*Dry quickly, wrap, and place hat on baby at birth
*During baths wrap baby while washing head
*Wrap and hat baby p bath to allow baby temperature to stabalize
8. Methods of Heat Definition:
Loss Loss of heat via direct contact with cold surface
Conduction
Occurs:
*Scales, NIC Bed, Warmer not preheated at birth, Cold stethoscopes, Cold hands
Prevention:
*Prewarm Warmer Unit at birth
*Place blanket on cold scale and zero out
*Warm Stethoscope and hands
9. Methods of Heat Definition:
Loss Loss of heat from body surface to cooler air currents
Convection
Occurs:
*Removal from incubator for procedures
*Ceiling air vents, drafty doorways or windows
*Oxygen unheated or moisturized
Prevention:
Perform necessary procedures eflciently, Keep baby well wrapped & capped,
Moisturize & heat O2
10.
, NR 327 Exam 3
Methods of Heat Definition:
Loss Loss of heat via transfer of heat from body surface to cooler surfaces and objects
Radiation not in direct contact with the body
Occurs:
*Walls of a room, a window, even an incubator, ice for blood draws
Prevention:
*Line incubator with blanket to insulate from incubator side
*Keep away from drafts and walls
11. special features brown color
of brown fat (5) principal function
sympathetic innervation
use of uncoupling protien 1
found more in newborns than in adults
12. Why is a preterm Preterm infant has less of a brown fat reserve.
or sick newborn
at risk for heat
loss/cold sure?
13. How does brown Brown fat had a richer vascular and nerve supply than ordinary fat. A preterm
fat help main- infant can have less of a reserve of brown fat at birth.
tain body tem-
perature? Un-
der what circum-
stance can new-
borns have inad-
equate brown fat
and why.
14.
1. Atony •Lack of muscle tone that results in failure of the uterine muscle fibers to contract
firmly around blood vessels when the placenta separates. The relaxed muscles
allow rapid bleeding from the endometrial arteries at the placental sire, bleeding
continues until the uterine muscle fibers contract to stop the flow of blood.
• Risks: overdistention of the uterus from any cause (multiple gestations, large
infant, or
hydramnios) makes it more diflcult for the uterus to contract with enough
firmness to prevent excessive bleeding. Multiparity results in muscle fibers that
have been stretched repeatedly and these flaccid muscle fibers may not remain
contracted after birth. Intrapartum factors include contractions that were barley
ettective, resulting in prolonged labor, contractions that were excessively vigorous,
resulting in precipitate labor and labor that was induced or augmented with
oxytocin. Retention of a large segment of the placenta does not allow the uterus
to contract firmly and therefore can result in uterine atony
• Manifestations: uterine fundus that is diflcult to locate, soft or boggy feel when
the fundus is located, uterus that becomes form as it is massaged but loses its
tone when massage is stopped, fundus that is located above the expected level,
excessive lochia especially if it is bright red, excessive clots expelled with or without
massage, saturation of one peripad in 15 minutes.
2. Surfactant Surfactant is a complex substance containing phospholipids and a number of
apoproteins. This fluid is produced by the Type II alveolar cells, and lines the
alveoli and smallest bronchioles. Surfactant reduces surface tension throughout
the lung. It is also important because it stabilizes the alveoli.That is, at a constant
surface tension, small alveoli will generate bigger pressures within them than
will large alveoli. Smaller alveoli would therefore be expected to empty into
larger alveoli as lung volume decreases. This does not occur, however, because
surfactant ditterentiallyreduces surface tension, leading to alveolar stability and
reducing the likelihood of alveolar collapse. If the lungs did not secrete surfactant,
this surface tension would be much higher and it would not be able to inflate
, NR 327 Exam 3
normally.Surfactant is formed relatively late in fetal life; thus premature infants
born without adequate amounts experience respiratory distress syndrome which
is caused by lack of surfactant and may die. It is commonly suttered by premature
babies born before 28-32 weeks of gestation.
3. With a nor- At birth and again at five minutes
mal delivery
and healthy
baby -how of-
ten should AP-
GAR scores be
taken?
4. What does AP- COLOUR, HEARTRATE, GRIMACE, ACTIVITY, RESPIRATIONS
GAR assess?
5. Newborn Charac- *Thin Skin
teristics that lead *Blood vessels close to the surface
to Heat Loss Little subcutaneous fat so little insulation Preterms even less
*Newborns have 3x more body surface area vs. their weight compared with
adults
*Lose heat 4x faster than adults
*Cannot shiver like adults
Term newborns flex to conserve heat Preterms can't flex so lose heat
6. Methods of Heat Evaporation
Loss Conduction
Convection
Radiation
7. Methods of Heat Definition:
Loss Wet surfaces exposed to air
Evaporation
, NR 327 Exam 3
Occurs:
*Immediately p birth
*During baths
Prevention:
*Dry quickly, wrap, and place hat on baby at birth
*During baths wrap baby while washing head
*Wrap and hat baby p bath to allow baby temperature to stabalize
8. Methods of Heat Definition:
Loss Loss of heat via direct contact with cold surface
Conduction
Occurs:
*Scales, NIC Bed, Warmer not preheated at birth, Cold stethoscopes, Cold hands
Prevention:
*Prewarm Warmer Unit at birth
*Place blanket on cold scale and zero out
*Warm Stethoscope and hands
9. Methods of Heat Definition:
Loss Loss of heat from body surface to cooler air currents
Convection
Occurs:
*Removal from incubator for procedures
*Ceiling air vents, drafty doorways or windows
*Oxygen unheated or moisturized
Prevention:
Perform necessary procedures eflciently, Keep baby well wrapped & capped,
Moisturize & heat O2
10.
, NR 327 Exam 3
Methods of Heat Definition:
Loss Loss of heat via transfer of heat from body surface to cooler surfaces and objects
Radiation not in direct contact with the body
Occurs:
*Walls of a room, a window, even an incubator, ice for blood draws
Prevention:
*Line incubator with blanket to insulate from incubator side
*Keep away from drafts and walls
11. special features brown color
of brown fat (5) principal function
sympathetic innervation
use of uncoupling protien 1
found more in newborns than in adults
12. Why is a preterm Preterm infant has less of a brown fat reserve.
or sick newborn
at risk for heat
loss/cold sure?
13. How does brown Brown fat had a richer vascular and nerve supply than ordinary fat. A preterm
fat help main- infant can have less of a reserve of brown fat at birth.
tain body tem-
perature? Un-
der what circum-
stance can new-
borns have inad-
equate brown fat
and why.
14.
