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1

Neonatal period

Birth to 28 days

2

Nursing care for neonate

Body heat
Respiratory function
Infection
Nutrition, hydration
Assist parents

3

Transitional phase

First 6-12 hrs of life

4

4th stage

Birth-4hrs

5

Respiratory mechanical changes

30 mL forced out of lungs into lymphatic system
PULMONARY arteries dilate and receive blood

6

Respiratory chemical

Mild hypoxia and acidosis produced by labor-stimulate breathing center in medulla
-sensory stimulation

7

Ability to establish functional residual capacity

Depends on surfactant in alveoli

8

Normal respiration in newborn

Irregular, shallow, diaphragmatic, moist

9

Periods of apnea in newborn

>15 seconds should be noted
<30 seconds- side effect of drugs
>60 seconds- respiratory distress

10

Signs of respiratory distress

Cyanosis
Apnea, tachypnea
Retractions of chest wall
Grunting
Flaring nostrils
Hypotonia

11

Assess newborn

Every 30 minutes for first hour
Every hour up to 4 hours
Once per shift> 4 hours old

12

Respiratory distress cause

Lack of surfactant
Pneumothorax
Bronchopulmonary hypertension
Hypoglycemia
Patent ductus arteriosus
Transient tachypnea ( common in c/s, delay lung clearance)

13

Pathophysiology of respiratory distress- preterm

Surfactant starting at 24-28 weeks
Phospholipid (70-80%)

14

PG test
Phosphatidylglyerol

Represents advanced fetal PULMONARY maturity

15

LS ratio
Lecithin/sphingomyelin

Are the lungs mature?

16

Atelectasis

May be caused by hypoxemia, hypercarbia, right to left shunt, metabolic acidosis

17

Complications of respiratory distress

Necrotizing enterocolitis
Bronchopulmonary dysplasia- chronic lung problem from treatment of ventilation

18

Respiratory distress nursing actions

Patent airway- assess e.g. tube
O2, CPAP, ventilation
Maintain neutral thermal environment
VS, O2 sats, suction, blood gases
Claiming measures

19

Circulatory system

Transition occurs within seconds of clamping cord

Influenced by respiratory system

20

Three physiologic shunts during fetal life

Foreman ovale
Ductus arteriosus
Ductus venosus

21

Foramen ovale

Opening between right and left atrium- hole allows reddest blood go from right atrium to left atrium, then left ventricle and out aorta. Blood with most O2 goes to brain

22

Ductus arteriosus

Connects PULMONARY artery and aorta
Closes within 15 hours after birth
PULMONARY resistance less than vascular resistance
Left to right shunt
Closes ductus arteriosus

23

Ductus venosus

Connects umbilical vein to inferior vena cava
Closes by day 3 of life, becomes a ligament
Blood flow stops when cord is clamped

24

Circulatory system nursing actions

Birth to 1st hour
Cyanosis/hr every 30 mins
1-4 hours old
Cyanosis/ Hr every hour
4-24 hours old
HR once/ shift

25

Factors that negatively affect thermoregulation

Little subcutaneous fat
Little brown fat
Loss of heat
Large body surface

26

Neutral thermal environment

Environment that maintains body temperature with minimal metabolic changes or changes in oxygen consumption

27

Brown adipose tissue

Dense adipose tissue
No shivering thermogenesis
Neck, thorax, axillary, kidney

28

Brown adipose tissue promotes

Increase metabolism
Heat production
Heat transfer to peripheral system
Reserves rapidly depleted during cold stress
Preterm have limited amount

29

Evaporation

Water on skin converted to vapors - bathing, birth

30

Conduction

Heat to cooler surfaces
Cold hands/bed