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Changes in the cardiovascular systems
- Ductus arteriosus =ligamentum arteriosum
- Foramen ovale – closes and becomes fossa ovalis
- Ductus venosus constricts and becomes ligamentum venosum
- Umbilical vein – becomes ligamentum teres
- Proximal portions of the umbilical arteries persist.
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Central cyanosis
- indicative of low blood O2
- a blue hue to the lips, tongue and central trunk.
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acrocyanosis
blue hue to the hands and feet related to perfusion.
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APGAR
0/1/2
- Activity
- Pulse
- Grimace
- Appearance
- Respiration
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Cold stress of the newborn?
hypothermia can lead to increased respirations causing increased need for O2, glucose, acidemia and surfactant production is impaired
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New born medications
- erythromycin ophthalmic ointment-prophylactic treatment for ophthalmia neonatorum=one time dose
- vitamin K=stimulates liver formation clotting factors. Eye prophylaxis and vitamin K are required by law in most states
- Hep B vaccine administered within 12 hours of birth.
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Baby heat loss
- radiation
- convection
- conduction
- evaporation
- maintain warm environment
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newborn screening for metabolic disorders
- Phenylketonuria
- Cystic fibrosis
- Galactosemia
- Congenital hypothyroidism
- Sickle cell trait
- in oregon newborns are screened for 36 disorders.
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Neonate hyperbilirubinemia
- Unconjugated bilirubin-by product of RBC breakdown-not in an excretable form-must be converted by liver.
- Kernicterus-bilirubin encephalopathy
- Total bilirubin serum is checked on newborns
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Kernicterus
- caused by too much bilirubin in the newborn
- jaundice can appear 24 hours or more after birth. caused by RBC breakdown and the inability of the liver to process, lack of intestinal bacteria, hydration
Treatment: phototherapy and hydration
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Hemolytic disease of the newborn
- seen at birth or up to 24 hours after
- Mom with blood type O (ABO Incompatibility)
- Rh negative mom and a positive baby
Treatment: exchange transfusion
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Breast milk jaundice
- bilirubin levels rise in the first week of life of the newborn
- breast milk is high in free fatty acids-bilirubin will drop in 24-48 hours after cessation of breastfeeding.
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Neonatal hypoglycemia
- glucose less than 40mg/dl
- feeding will reverse this or possible D10 IV infusion
- baby S&S-poor feeding, irritability, tremors, apnea, seizures, hypothermia, hypotonia-floppy baby syndrome
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Alert stages of neonate
- alert
- drowsy
- quit alert-most cooperative
- active alert
- crying
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