Newborn Lecture - PowerPoint PPT Presentation

1 / 48
About This Presentation
Title:

Newborn Lecture

Description:

Expansion of lungs with first breath and decrease pulmonary vascular resistance ... Breast Milk Jaundice. 1-5% develop breastfeeding jaundice. Levels may reach ... – PowerPoint PPT presentation

Number of Views:4112
Avg rating:5.0/5.0
Slides: 49
Provided by: camdenR
Category:

less

Transcript and Presenter's Notes

Title: Newborn Lecture


1
Newborn Lecture
  • Binnece Green MSN APNC
  • www.avc.edu
  • K. Frame DNSc RN

2
Goals of Newborn Care
  • To establish and maintain airway and
  • Support respirations
  • Maintain warmth and prevent hypothermia
  • To identify actual or potential problems

3
Newborn Transition to Extrauterine Life
  • Respiratory System
  • Fetus practices respirations or breathing
    patterns in utero
  • O2 in utero is supplied via the placenta and
    fetal circulation
  • Initial respiratory efforts serve no real purpose
    (lungs are not functional in utero)
  • During a vaginal delivery, thorax is squeezed and
    most of fluid retained in lungs during
    intrauterine life is forced out Mucus and me
    conium if present can be inhaled.

4
Newborn Transition to Extrauterine Life
  • Respiratory System (cont)
  • Small amount of fluid retained in lungs is
    absorbed
  • When the chest wall expands after delivery, the
    first breath of air is inhaled
  • Causes an increase in alveolar PO2 with
    subsequent relaxation of pulmonary arteries
  • Pulmonary vascular resistance decreases, allowing
    increased pulmonary vascular flow
  • Results in oxygenation of newborn tissues

5
Newborn Transition to Extrauterine Life
  • Respiratory System (cont)
  • Surfactant
  • Decreases the surface tension of alveolar sacs
  • Allows these sacs to fill with air
  • Prevents them from collapsing wit expiration
  • Aids them in maintaining functional residual
    capacity
  • Sufficient amount is not usually present until 36
    weeks gestation
  • Converting from fetal to adult respirations is a
    major step.
  • Observe Newborn closely during the first few
    hours of life to determine that this adaptation
    has been made.

6
Initiation of Breathing
  • Mechanical Event
  • Chemical Stimuli
  • Thermal Stimuli
  • Sensory Stimuli

7
Maintaining Respiratory Function
  • Influenced by lung compliance,
  • Airway resistance
  • Large abdomen encroaches on diaphragm.

8
Newborn Transition to Extrauterine Life
  • Cardiovascular System
  • Onset of respirations stimulates changes
  • Clamping of the umbilical cord and stimulation of
    cold receptors
  • Increased PCO2, and decreased PO2 and increasing
    acidosis
  • Leads to first breath
  • Decreased pulmonary artery pressure

9
Cardiopulmonary Physiology
  • Causes increased PO2 and closure of foramen ovale
    (pressure in left side of heart right side)
    Foramen ovale is opening between two atria
  • Increased PO2 leads to closure of ductus
    arteriosus (opening between pulmonary artery and
    aorta)

10
Cardiovascular Adaptation
  • Closure of ductus venosus( opening between the
    umbilical vein and inferior vena cava) and
    umbilical arteries/vein r/t decreased flow.
    Closes when cord is clamped.
  • Peripheral circulation is sluggish, causing
    acrocyanosis (cyanosis of hands, feet and mouth)
  • Pulse 120-160 awake 100 while asleep
  • Bp 72/47 (newborn), 64/39 (preterm)

11
Fetal-Newborn Transition
  • Increased pulmonary resistance forces most of the
    blood through the ductus arteriosus into the
    descending aorta
  • Most heart murmurs heard in young babies are not
    serious and disappear in short time.
  • Umbilical cord contains two arteries and one vein.

12
Review of Changes
  • Expansion of lungs with first breath and decrease
    pulmonary vascular resistance and increases
    pulmonary blood flow
  • Increased aortic pressure and decreased venous
    pressure
  • Increased systemic pressure and decreased
    pulmonary artery pressure
  • Closure of foramen ovale, which is open after
    birth.permanent closure occurs within 6 months.
  • Closure of ductus arteriosus occurs within 15
    hours
  • Closure of ductus venosa

13
Oxygen Transport
  • Conditions that affect the transport of oxygen
  • Alkalosis
  • Hypothermia
  • Acidosis
  • Hypercarbia
  • Hyperthermia
  • HbF fetal hemoglobin 70-90
  • HbA-adult hemoglobin

14
Characteristics of NewbornRespirations
  • Normal breathing30 to 60 breaths/min
  • Periodic breathingpauses lasting 5-15 seconds,
    has no prognostic significance
  • Greater than 20 second pause is abnormal

15
Normal Blood Values .
  • Hg 15-20g/dl
  • Hct 43-61
  • Wbc 10,000-30,000
  • Neutrophils 40-80
  • Immature WBC 3-10
  • Sodium 124-156
  • Potassium 5.3-7.3
  • Chloride 90-111
  • Calcium 7.3-9.2
  • Glucose 40-97

16
Hepatic Adaptations
  • Iron storage and re blood cell production
  • Carbohydrate metabolism
  • Conjugation of bilirubin
  • Physiologic jaundice
  • Breast milk jaundice
  • Coagulation

17
Iron Storage and Red Blood CellProduction
  • If mothers iron intake was adequate, iron will
    be stored to last 5 months
  • After 6 months, food containing iron or iron
    supplements must be given to prevent anemia.

18
Conjugation of Bilirubin
  • Total serum bilirubin sum of conjugated
    (conversion of yellow lipid-soluble pigment into
    water soluble pigment) and unconjugated
    (breakdown product).
  • Liver is immature and unable to break down
    bilirubin. Infant has increased bilirubin at
    birth, during the first week there is further
    breakdown of hemoglobin, thereby decreasing
    bilirubin, immature liver cant handle this, so
    jaundice appears on skin and sclera and urine

19
Physiologic Jaundice
  • Caused by an accelerated destruction of fetal
    RBCs, impaired conjugation of bilirubin, and
    increased bilirubin reabsorption from the
    intestinal tract.
  • 50 full term newborns
  • 80 preterm newborn
  • Skin and sclera yellow in color
  • Level 4-6mg/dl

20
Physiologic Jaundice
  • Maintain newborns skin
  • Monitor stools
  • Encourage early feedings, increase water
  • Natural/ bili light (shield eyes)
  • If jaundice occurs before day 2, or if bilirubin
    rises above 18020mg/100ml, there could be another
    cause ie ABO or RH incompatibility.

21
Breast Milk Jaundice
  • 1-5 develop breastfeeding jaundice
  • Levels may reach 20 to 25mg/dL
  • Mother should pump and express mild during the
    interrupted nursing period.

22
Coagulation
  • Newborn bleeding problems are rare
  • Injection of Vitamin K is given prophylactically
    on the day of birth to combat potential bleeding
    problem.
  • Note It is given IM in the lateral aspect of the
    thigh.

23
Newborn Transition to Extrauterine Life
  • Endocrine System
  • Luteal, lactogenic, and estrogenic maternal
    hormones cross placental barrier
  • Causes temporary physical changes in the breast
    of the newborn
  • Swelling
  • Secretion
  • Nervous system
  • Immature nervous system leads to rapid and
    diffuse movements

24
Newborn Transition to Extrauterine Life
  • Nervous system
  • Any response to stimuli is a reflex
  • Development of peripheral nervous system and
    muscular control progresses from head to toe
  • Newborn reflexes
  • Maintain life
  • Provide protection until the nervous system
    matures
  • Present during first 3 months of life
  • Nursing function assess the presence/absence of
    these reflexes

25
Newborn Transition to Extrauterine Life
  • Review of reflexes
  • Sucking
  • Swallowing
  • Rooting
  • Gag
  • Tonic neck
  • Babinski
  • Moro
  • Startle
  • Stepping
  • grasp

26
Behavioral Capacities
  • Auditory capacity newborn hears sounds,
  • heart rate rises, startle reflex
  • Olfactory Capacity newborns are able to select
    people by smell at one week
  • Taste and sucking sugar increases sucking,
  • Breast vs. Bottle
  • Do not discourage nonnutritive sucking
  • Swaddle
  • Cuddle

27
Newborn Transition to Extrauterine Life
  • Urinary System
  • Monitor urinary output of newborn
  • Note time of first voiding
  • Occurs within 4-6 hours of birth
  • Urine is present in bladder at time of birth
  • Renal system is initially unable to concentrate
    urine r/t kidney immaturity (3 months)
  • Most void 2-6X per day for first 1-2 days
  • After void 5-20 times

28
Newborn Transition to Extrauterine Life
  • Gastrointestinal System
  • Fetus in utero receive nutrition via placenta
  • Fetus practices swallowing in utero
  • This indicates that gastric emptying and
    intestinal peristalsis are present before birth
  • Digestive system does not function until after
    birth
  • Stomach of newborn has a capacity of approx. 2 oz
  • Gastric emptying start within few mins after
    feeding and takes 2-4 to be completed

29
Newborn Transition to Extrauterine Life
  • Gastrointestinal System
  • Regurgitation is r/t immature nervous system
    control of cardiac sphincter
  • Newborn should pass meconium within 24-48 hours
    after birth
  • Meconium is formed in utero from swallowed
    amniotic fluid
  • Passage of meconium is followed by transitional
    stools (loose, greenish yellow for breast fed,
    formula formed and pale yellow)

30
Newborn Transition to Extrauterine Life
  • Gastrointestinal System
  • Transitional stools are greenish-brown and looser
    than meconium
  • Within 1-2 days after transitional stools, fecal
    matter from digestion of formula or milk will be
    passed
  • Normal stool pattern for each newborn is
    individual (one every 2-3 days or as many as 10
    daily), breast fed every 5-7 days.

31
Newborn Transition to Extrauterine Life
  • Immune System
  • Fetuses receive passive immunity when IgG crosses
    placenta
  • Primarily during 3rd trimester
  • Receive passive immunity to bacteria and viral
    infections to which mother has formed specific
    antibodies
  • Period of immunity varies from 4-6 months to 4-6
    weeks

32
Immunologic Adaptation
  • Active acquired immunity pregnant woman forms
    antibodies in response to illness and
    immunization
  • Newborn acquires passively immunity from IgG from
    the mother and receives additional antibodies in
    colostrum and breast milk
  • Infant will develop its own antibodies during
    first three months, but is at risk for infection
    during first 6 weeks.

33
Immunologic Adaptation
  • Passive acquired immunity when antibodies are
    transferred to the fetus in utero from the mother
  • Maternally induced antibodies to tetanus,
    diphtheria, smallpox, measles, mumps,
    poliomyelitis.

34
Immediate Care of Newborn
  • Apgar scoring
  • Perform gestational age assessment
  • Assess vital signs and physical assessment of
    newborn
  • Head circumference chest circumference
  • Review gestational age lecture

35
Nursing Assessment of the Newborn
  • Estimation of gestational age
  • Assessment of neuromuscular maturity
    characteristics
  • Physical assessment
  • Neurological assessment status
  • Brazelton's neonatal behavioral assessment

36
Estimation of Gestational Age
  • Resting posture
  • Skin
  • Lanugo
  • Sole (plantar) creases
  • Areola and Breast bud tissue
  • Ear form and cartilage distribution
  • Male genitals, female genitals

37
Gestational Age (cont.)
  • Vernix
  • Hair
  • Skull firmness
  • Nails

38
Assessment of Neuromuscular Maturity
Characteristics
  • Recoil
  • Popliteal angle
  • Scarf sign
  • Head to Ear extension
  • Ankle dorsiflexion
  • Head lag
  • Ventral suspension
  • Major reflexes such as
  • Sucking
  • Rooting
  • Grasping
  • Moro
  • Tonic Neck
  • Babinski

39
Physical Assessment
  • General appearance
  • Weight and Measurement
  • Temperature
  • Skin Characteristics

40
Skin Characteristics
  • Acrocyanosis
  • Mottling
  • Harlequin sign
  • Jaundice
  • Erthema Toxicum
  • Milia
  • Skin Turgor
  • Vernix Caseosa
  • Forceps or Vacuum
  • Extractor marks

41
Birth Marks
  • Telangiecctatic nevi
  • Mongolian spots
  • Nevus fammeus
  • Nevus Vasculosus

42
Head
  • General appearance
  • Cephalhematoma
  • Caput succedaneum

43
Assessments
  • Eyes
  • Nose
  • Mouth
  • Ears
  • Neck
  • Chest
  • Cry
  • Respirations
  • Heart
  • Abdomen
  • Umbilical cord
  • Genitals
  • Anus
  • Extremities
  • Back

44
Neurological Assessment
  • Tonic neck
  • Grasp reflex
  • Moro reflex
  • Rooting reflex
  • Sucking reflex
  • Babinski reflex
  • Galant reflex

45
Brazeltons Neonatal BehavioralAssessment
  • Provides guidelines for assessing the
  • Newborns state, changes, temperament,
  • and individual behavioral patterns.

46
Nursing Plan and Implementation
  • Initiation of admission procedure
  • Maintenance of a clear airway and stable vital
    signs
  • Maintenance of thermal environment
  • Prevention of complications of hemorrhagic disease
  • Prevention of eye infection
  • Assessment of neonatal distress
  • Initiate first feeding
  • Facilitate parent-newborn attachment.

47
Nursing Care in the Birthing Unit
  • Maintain cardiopulmonary function
  • Maintain a neutral thermal environment
  • Promote adequate hydration and nutrition
  • Promote skin integrity
  • Prevent complications and promote safety
  • Circumcision
  • Enhancing parent-newborn attachment

48
Nursing Plan and Preparation for Discharge
  • Parent teaching
  • General newborn care
  • Nasal and oral suctioning
  • Wrapping the newborn
  • Sleep and activity
  • Safety
  • Newborn screening and immunizations
Write a Comment
User Comments (0)
About PowerShow.com