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Newborn Adaptation

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by

Cathy Hartt

on 24 October 2012

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Transcript of Newborn Adaptation

photo (cc) Malte Sörensen @ flickr Newborn Adaptation Transition to Extrauterine Life Human Resilience
in Action! Many people are exposed to loss or potentially traumatic events at some point in their lives, and yet they continue to have positive emotional experiences and show only minor and transient disruptions in their ability to function. What is Human Resilience? Resilience represents a distinct trajectory from the process of recovery Resilience in the face of loss or potential trauma is more common than is often believed There are multiple and sometimes unexpected pathways to resilience Adapting to Life! The Amazing Newborn Physiologic Adaptations
of the Newborn Chapter 24 Student Learning Outcomes
1. Critical Thinking: Utilize critical thinking skills in the application of the nursing process to provide safe quality care by incorporating evidence-based practice.
2. Communication: Demonstrate effective communication utilizing technology, written documentation, and verbal expression.
3. Caring: Incorporate empathetic, compassionate, and caring interventions and behaviors while providing care.
4. Diversity: Demonstrate sensitive professional nursing care to culturally diverse clients across the lifespan.
5. Quality Improvement (Assessment): Utilize data to ensure quality improvement and support of evidence-based practice. Didactic
1. Describe the changes in the biologic system of the neonate during the transition to extrauterine life
2. Describe the sequence to follow in assessment of the newborn
3. Compare and contrast the four types of heat loss in a neonate and describe how to prevent heat loss
4. Describe the behavioral adaptations of the newborn including periods of reactivity and sleep-wake states. Objectives First period of reactivity
Lasts up to 30 minutes after birth
Newborn’s heart rate increases to 160 to 180 beats/min
Decreases after 30 minutes
Decrease in motor activity after period Transition to Extrauterine Life Second period of reactivity
Occurs 4 to 8 hours after birth
Tachycardia, tachypnea occur
Meconium passed
Increased muscle tone, changes in skin color, and mucous production Transition to Extrauterine Life—cont’d Respiratory system
Initiation of breathing (reflex by pressure changes)
Signs of respiratory distress
Maintaining adequate oxygen supply
Cardiovascular system
Heart rate and sounds
Blood pressure ( What is a normal blood pressure)
Blood volume Physiologic Adaptations Hematopoietic system
Red blood cells and hemoglobin
Higher in newborns
Leukocytes
WBC 18,000
Platelets
No difference in adult an newborn
Blood groups
How is the blood group determined? Physiologic Adaptations—cont’d Thermogenic system
Thermogenesis
Heat loss
Convection
Radiation
Evaporation
Conduction
Temperature regulation
How does it differ from an adult?
Renal system
40ml urine in full term infant bladder Physiologic Adaptations—cont’d Fig. 24-1. Effects of cold stress. When an infant is stressed by cold, oxygen consumption increases and pulmonary and peripheral vasoconstriction occur, thereby decreasing oxygen uptake by the lungs and oxygen to the tissues; anaerobic glycolysis increases; and there is a decrease in Po2 and pH, leading to metabolic acidosis. Gastrointestinal system
Digestion
Stools
Meconium
Feeding behaviors Physiologic Adaptations—cont’d Hepatic system
Iron storage
Store iron in utero
Last up to 4-6 months
Carbohydrate metabolism
Glycogen stores decrease quickly
Jaundice
Coagulation
Lack of bacteria to synthesize vitamin K
Immune system
Passive immunity-1st 3 months Physiologic Adaptations—cont’d Integumentary system
Caput succedaneum
Cephalhematoma
Subgaleal hematoma
Sweat glands
Desquamation
Mongolian spots
Nevi
Erythema toxicum Physiologic Adaptations—cont’d Fig. 24-3. A, Caput succedaneum. B, Subgaleal hemorrhage. C, Cephalhematoma. Fig. 24-4. Mongolian spot. Fig. 24-5. A, Telangiectatic nevi (stork bite). B, Erythema toxicum. Reproductive system
Female
Male
Swelling of breast tissue Physiologic Adaptations—cont’d Skeletal system
At birth more cartilage then ossified bone
Neuromuscular system
Newborn reflexes
Neurologic assessment Physiologic Adaptations—cont’d Fig. 24-7. Molding. A, Significant molding after vaginal birth. B, Schematic of bones of skull when molding is present. Fig. 24-8. Signs of developmental dysplasia of the hip. A, Asymmetry of gluteal and thigh folds with shortening of the thigh (Galeazzi sign). B, Limited hip abduction, as seen in flexion (Ortolani test). C, Apparent shortening of the femur, as indicated by the level of the knees in flexion (Allis sign). D, Ortolani test with femoral head moving in and out of acetabulum (in infants 1 to 2 months old). General appearance
Vital signs
Baseline measurements of physical growth
Weight and length
Head circumference
Neurologic assessment Physical Assessment Sleep-wake states
Other factors influencing behavior of newborns
Gestational age
Time
Stimuli
Medication Behavioral Characteristics Sleep-wake states
Other factors influencing behavior of newborns
Gestational age
Time
Stimuli
Medication Behavioral Characteristics Sensory behaviors
Vision
Hearing
Smell
Taste
Touch Behavioral Characteristics—cont’d Response to environmental stimuli
Temperament
Habituation
Consolability
Cuddliness
Irritability
Crying Behavioral Characteristics—cont’d Fig. 24-11. Newborn sleep-wake states. A, Deep sleep. B, Light sleep; C, Drowsy. D, Quiet alert.
E, Active alert. F, Crying. Term infant’s various anatomic and physiologic systems have reached development and function that permits physical existence apart from mother
Infant has sensory capabilities that indicate state of readiness for social interaction
Appearance of jaundice during first day or persistence of jaundice for more than 7 days indicates a pathologic process Key Points Heat loss in newborn may exceed capacity to produce heat and lead to metabolic and respiratory complications that threaten newborn’s well-being
Assessment of newborn requires data from the prenatal, intrapartal, and postpartal periods
Assessment proceeds systematically so each system is thoroughly evaluated Key Points—cont’d Some reflex behaviors are important for newborn’s survival
Personalities and behavioral characteristics of infants play major role in the ultimate relationship between infants and parents
Each full-term newborn has predisposed capacity to handle multitude of stimuli in external world Key Points—cont’d
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