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What are the physiologic changes in fetal life for cardiovascular, respiratory and thermoregulation?
Cardiovascular: cyanotic @ birth (see fetal circulation).
Respiratory: a fluid environment with no air exchange; crying replaces water.
Thermoreg: from mother.
What are the physio changes in fetal & extrauterine life for cardiovascular, respiratory, and thermoreg?
Cardio: (fetal) pressure is greater on the R side; (NB) pressure is greater on the L causing closure of foramen ovale.
Resp: (fetal) fluid-filled, high pressrue; (NB) air-filled, low pressure; closing of ductus A. caused by increased perfusion of O2 to lungs.
Thermo: (fetal) via mother; (NB) via flexed posture & brown fat.
What are the 3 fetal shunts?
Which closes @ 4 days at which closes @ 2 wks?
- 1st: D.A (closes @ 4 days)
- 2nd: F.O
- 3rd: D.V (closes @ 2 wks)
What are the physio changes for a newborn's hepatic system, renal system, immune, and neurologic system?
hepatic: RBCs short life (80-100 days); failure of liver cells to break down & excrete bilirubin can cause increased amt of bilirubin in the the bloodstream leading to jaundice.
renal: immature @ birth. Takes a lot of water to excrete what is not needed (75% of body is water).
Immune: weakest in lifespan, increases possibility of infection.
What are some immediate nursing actions of the newborn?
Assess success of the infant's transition.
Maintain airway patency and thermoreg.
Ensure proper ID, assess for risk factors.
What does the APGAR scale measure?
What is considered severely depressed, moderately depressed, and excellent condition?
- A: activity
- P: pulse
- G: grimace (reflex irritability)
- A: appearance (skin color)
- R: respiration
- 0-3: severely depressed
- 4-6: moderately depressed
- 7-10: excellent condition
What are the 4 methods of heat loss?
Conduction: xfer of heat form one ob. to another.
Convection: flow of heat from body surface to cooler surround air or to air circulating over a body surface (open doors, windows, fans).
Evap: loss of heat when liquid is converted to vapor (newborn loses heat from amniotic fluid is converted to vapor.
Radiation: loss of body heat to cooler, solid surfaces that are in proximity but not direct contact.
What are risk factors you should assess for?
- gestational age
- monitor for hypoglycemia
- phys. assessment
What are the "moro" and "rooting" reflex assessments for the newborn?
Moro is placing your hand behind newborn's head bringing it upwards and pulling newborn's hands together toward the stomach. The newborn's head is let go with hand still behind its head. The newborn's arms should flail upward indicating a good startle reflex.
Rooting involves using your forefinger on the newborn's cheek. The newborn should turn its head to the cheek that was swiped.
What are 3 newborn medications and its use?
VitK (within 1st hr): to prevent blood clots.
erythromycin ointment (drops) for preventing blindness caused by bacteria when newborn is delivered.
What is the considered HYPOglycemic (value) birth - 4 hours; 4 - 24 hours?
What is target value?
How can it be treated?
What is the action if <25 mg/dL?
- Birth - 4 hours: feed (retest after 30min.)
- 4h - 24h: continue feeds q2-3h
*Target is great than or equal to 45.
If <25: IV glucose.
What is the normal wt for newborns (lbs/oz. and grams)
What is considered SGA and LGA?
Normal: 2.5k - 5k g; 5 lb. 8 oz. - 8 lb. 13 ox.
SGA: < 2.5k grams (8 lb. 13); <10th percentile.
LGA: > 5k grams (8 lb. 13); >90th percentile.