Show Recommended textbook solutions
 The Human Body in Health and Disease7th EditionGary A. Thibodeau, Kevin T. Patton 1,505 solutions
Clinical Reasoning Cases in Nursing7th EditionJulie S Snyder, Mariann M Harding 2,512 solutions
Diversified Health Occupations7th EditionLouise M Simmers 195 solutions
Essentials of Strength Training and Conditioning4th EditionG Haff, N Triplett 121 solutions How do catecholamines assist with transition of the newborn? -Shortly before the onset of labour there is a catecholamine surge that seems to promote fluid clearance from the lungs, which continues during labour." What is the key regulatory hormone that aids in the neonate's transition to extrauterine life? Cortisol Cortisol aids in: -Lung maturation (anatomy and surfactant) The major adaptations associated with transition occur during the first ______ hours of life 6-8 The most critical adaptation required is the establishment of ________ ____________. effective respirations The initiation of respirations is triggered by a combination of: chemical, mechanical, thermal, and sensory factors -Chemical factors include a progressive decline in pO2 during labour and a drop in prostaglandin levels that results from clamping of the cord. -Mechanical factors relate to the squeezing of
the chest during vaginal delivery. What are the key physiological changes that occur during transition? -expansion of lungs with air Describe persistent pulmonary hypertension of the newborn. During the stabilization period, which occurs over several hours, the pulmonary vessels remain very responsive to the effects of hypoxia. Hypo-expansion of the lungs, hypoxemia, and persistent acidosis result in high pulmonary vascular resistance, delayed clearance of lung fluid, and persistent right to left shunting. What are the initial steps of NRP? dry, warm, and stimulate the infant and ensure there is an open airway. This can all be done with the infant skin to skin on the mother's chest. What factors stimulate the newborn to take his/her first breath? Chemical: factors in a newborn's blood (low oxygen, high carbon dioxide, and low pH) which stimulate respiratory center in brain. Thermal: change in temperature from intrauterine environment to extrauterine environment stimulate skin receptors which stimulate respiratory center. Mechanical: release of pressure on a baby's chest, as the chest is born, may stimulate breathing and chest expansion. Sensory: stimulation from drying, lights, sounds, smells all involved in stimulation of respiratory center. What are the major changes that take place in a newborn's cardiopulmonary system during the transition to extrauterine life? -the lungs become the primary organ of gas exchange (instead of the placenta); the lungs inflate, fluid is cleared from the alveoli, pulmonary vascular resistance decreases rapidly and there is increased pulmonary blood flow. -The pressure gradient in the newborn's heart shifts. Right sided pressure which was high in fetal circulation decreases, and left sided pressures which were low now increases. As a result the foramen ovale closes. -Rising pO2 causes smooth muscle cells in the ductus arteriosus to constrict thereby closing the shunt. -Removal of the low pressure placental system increases the pressure in a newborn's circulation which increases circulation and pulmonary perfusion. What is the role of lung surfactant? Surfactant lowers the surface tension of the alveoli thereby reducing the pressure required to keep the alveoli open. Decreased surface tension also results in increased lung compliance. When the initial steps of NRP are complete a rapid assessment of 5 parameters is performed then scored at one and five minutes. The assessment and number assigned make up the Apgar score. The 5 parameters include: Appearance (color) Apgar Chart A score of 7 or above at one minute indicates infant is making a good adjustment to extrauterine life. A score of 4 to 6 at one minute indicates infant is having some difficulty A score of 3 or less at one minute indicates severe distress. An Apgar of 7 or less at 5 minutes warrants another assessment of the five parameters at 10 minutes. You are assessing Marnie's baby. At one minute post-delivery you make the following assessments: 9 At one minute post-delivery you make the following assessments: 6 Transition: Periods of Reactivity initial reactivity, sleep, and second reactivity - are typical patterns for normal, healthy, term newborns. First period of reactivity Within minutes after birth and lasting for 30-60 minutes. In this period, infants are in a quiet alert state: eyes wide open and capable of responding to their environment. Healthy infants are in an optimal state for the important first meeting with their parents. Heart rate increases to 160-180 bpm, then settles to 100-120 bpm by 30 minutes of age. Respirations may be irregular and fine crackles may be audible on auscultation of lung fields. Transitory grunting, nasal flaring, and chest retractions may be evident. Sleep Following this initial period of reactivity, infants generally go into a deep sleep, lasting for 60-100 minutes. During this deep sleep, many physiologic needs stabilize: temperature regulation and adequate oxygenation and circulation. Respirations may be rapid but not labored. Second period of reactivity this takes place approximately between two to six hours after birth and can last from 10 minutes to several hours. There may be brief periods of tachycardia and tachypnea, increased muscle tone, and skin color changes. Meconium is usually passed in this period. The neonatal benefits of skin to skin care include: -stabilizing respirations and oxygen saturation Maternal benefits of skin to skin care include: -Increased self-confidence, competence, and self esteem As the neonate adapts to the extrauterine environment he/she must also accomplish behavioral tasks including: -Establishing a regulated behavioral tempo independent of the mother infants progress through as they adapt to their environment. The 4 levels of adaptation include: First
level: regulate their physiologic functions: heart rate, respiration, and temperature. An infant who is able to regulate physiologic functioning, maintain good tone, modulate states, and interact with their environment can be described as ___________. organized An infant who is unable to manage these things due to gestational age or health status can be described as _______________. disorganized The ability to regulate sleep/wake states is essential for ________________ and is affected by health status and gestational age. Neurodevelopment The ability to transition smoothly between states is known as _____ __ __________. state of modulation How many sleep/wake states are there? six Deep Sleep (Quiet) -Breathing
is regular. Light Sleep (Active) -Breathing is irregular. Drowsy -Breathing
is irregular. Quiet Alert -Breathing is regular. Active Alert -Breathing is irregular. Crying -Breathing is irregular. Sleep/wake states can be affected by: -room temperature (the warmer the
room, the longer an infant sleeps) What state is the best time to initiate breast feeding? the quiet alert state Marnie's baby is breathing regularly, has wide open eyes while gazing at Marnie, and is lying quietly on Marnie's chest. What sleep/wake state is Marnie's baby in? Marnie's baby is in a quiet alert state. What does state modulation mean? What factors affect it? This means an infant should transition between states smoothly. State modulation is affected by health status and gestational age. The Neonatal Behavioural Assessment Scale (NBAS) is an interactive examination performed as a research or diagnostic tool to assess an infant's ability for social interaction. Habituation, orientation to auditory and visual stimuli, motor maturity, state regulation, self-consoling ability, and social behaviours make up the six categories of the NBAS Alerting Eyes widened and brightened, The infant focuses attention on stimuli whether audio, visual or objects to be sucked. Optimal state: Caregiving: Visual Response Newborns have pupillary responses to differences in brightness. Infants can focus on objects or faces about 8-12 inches away. Newborns have preferences for more complex patterns, human faces, and moving objects. Optimal State: Caregiving: Auditory Response
Reaction to a variety of sounds, especially in the human voice range. Infants can hear sounds and locate the general direction of the sound if the source is constant and remains coming from the same direction. Optimal State: Caregiving:
Habituation The ability to lessen one's response to repeated stimuli. For instance, this is seen when the Moro response is repeatedly elicited. If a noise is continually repeated, infants will no longer respond to it in most cases Optimal State: Caregiving: Cuddliness Infant's response to being held. Infants nestle and work themselves into the contours of caregivers' bodies versus resisting being held. Optimal State: Caregiving: Consolability Measured when infants have been crying for at least 15 seconds. The ability of infants to bring themselves or to be brought by others to a lower state. Optimal
state: Caregiving: Self-Consoling Maneuvers used by infants to console themselves and move to a lower state: hand-to-mouth
movement Optimal State: Caregiving: Consoling by Caregivers After crying for longer than 15 seconds, the caregivers may try to: show face to infant Optimal State: Caregiving: Motor Behaviour and Activity Spontaneous movements of extremities and body when stimulated versus when left alone. Smooth rhythmical movements versus jerky ones. Optimal State: Caregiving: Irritability How easily infants are upset by loud noises, handling by caregivers, temperature changes, removal of blankets or clothes, etc Optimal State: Caregiving: Readability The cues infants give through motor behaviour and activity, looking, listening, and behaviour patterns. Optimal State: Caregiving: Smile Ranging from a faint grimace to a full-fledged smile. Reflexive. Optimal state: Caregiving: What is sensory threshold? Sensory threshold is the level of tolerance for stimuli within which the infant can respond appropriately. Stress Cues Irritable Disorganized sleep-wake states Gaze aversion Frowning Sneezing Yawning Hiccupping Irregular respirations Apnea Increased oxygen requirements Heart rate changes Finger splaying Arching/stiffening Stability Cues Smooth movements Quiet alert state Clear sleep states Focused gaze Dilated pupils Regular respirations Regular heart rate Rhythmic sucking Reaching or grasping Hand to mouth movements (self-consoling behaviour) Can be consoled easily Rhythmic, robust crying What is developmentally supportive care? Developmentally supportive care (DSC) is an approach that provides individualized care of infants to maximize neurological development and reduce long term cognitive and behavioural problems DSC -is based on the fact that infant behavioral cues communicate the infant's needs, feelings, and overall neurologic status -is based on the fact that infants continually interact with their environment -involves altering the neonatal environment to nurture each of the infants' sensory processes (tactile/kinesthetic, auditory, visual, and olfactory/gustatory) -guides our decision making when providing care to infants -creates an environment that nurtures brain growth and minimizes brain injury for optimal overall development What does habituation mean? Habituation means the infant is able to tune out and decrease their response to a stimuli. What is the primary method used for communication by infants? Infants primarily use behaviours to communicate with their parents/care providers. Marnie wants to know if her baby can see her. What can you tell her? Infants can see objects as far away as 2 feet, but clearest visual distance is 8-12 inches. They prefer faces and can recognize their mother's face. What are four stress cues a newborn may exhibit?
Hiccoughing, finger splaying, arching/stiffening, apnea, frowning, sneezing, gaze aversion, irritable, sneezing. What are 4 interventions or care practices that support developmentally supportive care? Skin to skin care, encouraging parents to talk to their infant, decreasing noise when feeding infant, reading infant behavioural cues, swaddling infant, gentle touch to calm infants. Goals of care for infants include Pink, Warm, Sweet, Organized, Attached, Clean (PWSOAC) framework Pink -at birth, the lungs must take on the role of gas exchange. Neonates are primarily nasal breathers and the normal respiratory rate of the newborn is 30-60 breaths per minute. Respirations are initially shallow and irregular with occasional pauses lasting less than 20 seconds -Some newborns still have mucus to clear from their respiratory tract and may require suctioning in the first 24 hours after birth. -Assessing an infant's respiratory rate, color, tone, and heart rate are important ongoing assessments related to oxygenation. Color should be pink, tone should be flexed, and the normal heart rate for a newborn is 100-160 bpm. The three cardinal signs of respiratory distress in the newborn are: nasal flaring, indrawing or retractions, and grunting. Warm Heat regulation is critical to the neonate's survival. The normal temperature for a newborn should be between 36.5 and 37.4 degrees Celsius axilla. Newborns are vulnerable to heat loss and during the first 48 hours, the newborn is still trying to achieve thermal balance or thermoregulation. Newborns have specific characteristics which make them vulnerable to heat loss including: -Thin layer of subcutaneous fat Sweet At birth when the umbilical cord is cut, the newborn no longer receives the maternal source of glucose. Therefore, in order to maintain a normal blood sugar, infant feeding should be established in the first few hours of life. Clinical signs of hypoglycemia in the newborn include glucose of 2.6 What are the normal heart rate, respiratory rate and temperature for a newborn? Normal heart rate is 100-160 bpm, normal respiratory rate is 30-60 breaths per minute and normal temperature is 36.5-37.4 degrees Celsius. What does thermoregulation mean? Thermoregulation is the maintenance of balance between heat loss and heat production. Name two factors that contribute to an infant's vulnerability to heat loss. Infants are vulnerable to heat loss because they have a thin layer of subcutaneous fat, their blood vessels are close to the surface of the skin, changes in environmental temperature alter blood temperature which impact temperature regulation centers in the hypothalamus, and they have a larger surface-to-body weight ratio. How would a nurse prevent heat loss in an infant? Immediate drying at time of delivery, keeping the infant skin to skin with the mother, placing a hat on the infant's head, keeping the infant off of cool surfaces and away from drafts, ensuring the infant is bundled when not skin to skin with a parent. Marnie wants to know how she will know her baby is hungry. The infant may bring her hand or fist to her mouth, she may turn her head towards the breast or if her cheek is stroked, and she may make sucking motions with mouth or tongue. Is there anything in Marnie's pregnancy, labour or birth story that would increase the risk of hypoglycemia in her newborn? No, Marnie had a healthy pregnancy, no risk factors, and a normal labour and birth. Her infant is term, normal weight, and was placed skin to skin at delivery. Organized -Stable heart rate, color Disorganized -Fluctuations in heart rate and respiratory rate. May experience bradycardias and/or apnea -Inability to tolerate feeds, increased stooling What assessments data would indicate to you that Marnie and Ted's infant is organized? Marnie and Ted's infant is a healthy term infant which is the first assessment that supports organization. I would assess physiologic function by assessing vital signs. If the infant is organized I would observe, stable vital sign, good tone, smooth transition between sleep/wake states, an ability of the infant to self-console (hand to mouth movements), and evidence that their infant is interacting with eye contact and grasping their fingers. Attached attachment is a process in the brain that motivates infants to seek proximity and communication with parents and other primary caregivers. Attachment is crucial for the infant's physical, psychological, and emotional health and survival Attachment is developed and maintained by proximity and interaction with the infant, through which the parent becomes acquainted with the infant, identifies the infant as an individual and claims the infant as a member of the family Clean All newborns are at risk of infection in the first few months of life due to generalized hypo-functioning of the immune response. Newborns do not typically respond with a fever but instead will show signs of hypothermia or temperature instability. Other signs of infection include lethargy, irritability, poor feeding, pale or mottled skin, respiratory symptoms, vomiting or diarrhea, and decreased reflexes Preterm Infants -defined as any birth after 20 weeks and before 37 weeks gestation. Late Preterm Infants Late preterm infants are those born between 34 and 37 completed weeks of gestation (34 weeks and 0 days to 36 weeks and 6 days) at increased risk of problems related to respiratory function, thermoregulation, hypoglycemia, feeding issues, sepsis, and hyperbilirubinemia Post term Infants pregnancies continue 14 days or more past term. Infants born after 42 weeks gestation may be referred to as post term or post mature. An infant who is born after 42 weeks gestation but does not show any signs of reduced placental functioning; meaning they continue to grow in utero, is considered a post term infant. Whereas a post mature infant has experienced placental insufficiency which results in a loss of subcutaneous fat, dry cracked skin, and increased risk of meconium being present in the amniotic fluid. Post mature infants are at increased risk of perinatal mortality related to intrauterine hypoxia What factors make pulmonary transition challenging for the preterm infant? Preterm infants have a decreased number of functioning alveoli, deficient surfactant, smaller lumen in respiratory system, weak or absent gag reflex, greater collapsibility or obstruction of respiratory passages, and immature and friable capillaries in the lungs. What factors increase vulnerability to heat loss in the preterm infant? Minimal subcutaneous fat, limited stores of brown fat, decreased or absent shiver response, inadequate muscle mass activity, poor muscle tone resulting in more body surface area being exposed to environment, and immature temperature regulation center in the brain. Why are preterm infants more susceptible to infection? Preterm infants have a shortage of maternal immunoglobulins and immature immune system. They are also exposed to more care providers, and more invasive procedures such as respiratory support and intravenous therapy. What are some challenges to maintaining adequate nutrition in the preterm infant? Preterm infants may have weak or absent suck, swallow, and gag reflexes, they may have difficulty coordinating sucking and swallowing, they have small stomach capacity, and immature digestive and enzyme systems. What is the difference between a post term infant and a post mature infant? Both are born after 42 weeks gestation but the post mature infant has experienced placental insufficiency resulting in increased risk of perinatal mortality/morbidity. SGA infants are more vulnerable to: Perinatal asphyxia LGA infants are more vulnerable to: Birth injuries Cecile is two days old. She was born at 25 weeks gestation and her weight is 900 grams. Answer: Cecile is both preterm and AGA Jemal is four days old. He was born at 35 weeks gestation and his weight is 2100 grams. Answer: Jemal is late preterm and SGA Aaron is twelve hours old. He was born at 38 weeks gestation and his weight is 3970 grams. Answer: Aaron is term and LGA Emily was born at 42 weeks plus 2 days (42+2), gestation and weighed 3800 gm. Answer: Emily is post term and AGA Newborn Screening All newborns in British Columbia are routinely screened for 22 different disorders (Metabolic, Endocrine, and Blood disorders as well as Cystic Fibrosis). Newborn screening is ideally done between 24 to 48 hours of birth. PKU and MCAD require collection after 24 hours for optimal test sensitivity. What would be a useful nursing strategy you could use with Marnie and her daughter to reduce pain and crying when blood for newborn screening is drawn? Skin to skin and breastfeeding. Newborns exhibit stress and stability cues. Stress cues include Gaze aversion, irregular respirations, finger splaying, hiccupping Once the cord is cut and the infant takes the first breaths the arterial P02 Increases An infant born at 41 weeks is Term Habituation can be described as the ability to decrease responses to stimulation The initiation of respirations is triggered by Chemical, mechanical, thermal, and sensory factors Providing individualized care of infants to maximize neurological development and reduce long term cognitive and behavioural problems is known as Developmentally supportive care An infant who is able to regulate physiologic functioning, maintain good tone, modulate states, and interact with their environment can be described as Organized One of the most effective ways to support neonatal transition is skin to skin An infant whose weight is below the 10th percentile is referred to as SGA The ability of a newborn to transition smoothly between states is known as state modulation During the first few hours of life, rising pO2 causes smooth muscle cells in the ductus arteriosus to ________ constrict
Tremors, jitteriness, irritability, lethargy, pallor, temperature instability and breathing difficulties are signs of hypoglycaemia The normal newborn respiratory rate is 30-60 An infant born at 37 weeks plus 5 days is Term Sleep wake states are not affected by gestational age False What are the primary factors that contribute to the initiation of the newborns respirations?A number of factors have been implicated in the initiation of postnatal breathing: decreased oxygen concentration, increased carbon dioxide concentration and a decrease in pH, all of which may stimulate fetal aortic and carotid chemoreceptors, triggering the respiratory center in the medulla to initiate respiration.
What initiates breathing in a newborn infant?Any delay in the onset of lung gas exchange causes a rise in arterial PCO2 and fall in pH which would stimulate breathing probably via stimulation of the central chemoreceptors. Since an impairment of CO2 elimination is usually observed after birth, a rise in arterial PCO2 likely stimulates breathing in the newborn.
What makes the infant take the first breath quizlet?What is the stimulus for the baby's first breath? The stimulus to breathe results primarily from the accumulation of carbon dioxide in the blood after the umbilical cord is cut.
What is the probable cause of respiratory difficulty in the first few hours of an infant's life?Newborn respiratory distress syndrome (NRDS) happens when a baby's lungs are not fully developed and cannot provide enough oxygen, causing breathing difficulties. It usually affects premature babies. It's also known as infant respiratory distress syndrome, hyaline membrane disease or surfactant deficiency lung disease.
|
