NB_lecture-1 - 3 Basic Nursing Goals for Newborn 1 Meet...

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3 Basic Nursing Goals for Newborn 1. Meet physiologic needs of the newborn 2. Observation for abnormalities 3. Facilitate relationship between parents and newborn
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Systemic Adaptations to Birth Respiratory System Breathing begins in utero, fetal lung fluid helps stretch lung tissue lungs must be mature
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Type II alveolar cells produce surfactant. maturity determined by L:S ratio of 2:1 Developed pulmonary vascular bed for adequate gas exchange Intact CNS to initiate and coordinate resp. efforts
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4 Types of Stimuli for Respiration Chemical Stimuli - have transient asphyxia. Have decreased PaO2, increased PaCO2 decreased pH which stimulates the resp. center in the medulla
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Sensory Stimuli - come from warm, dark, wet to bright, cold noisy delivery room. causes stimulation of resp. center Thermal Stimuli - cold very powerful way to stimulate respirations profound cooling may lead to resp depression
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Mechanical Stimuli - squeeze out fetal lung fluid during delivery. Have some chest wall recoil which draws in air. This doesn’t happen with c/section babies
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Factors Opposing First Breath Alveolar surface tension lung fluid viscosity lung compliance
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With first breath have: increased alveolar O2 tension which causes: dilation of pulmonary arteries decreased pulmonary vascular resistance increased pulmonary perfusion which facilitates O2-CO2 exchange
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Hypoxemia and Acidosis - have constriction of pulmonary arteries leading to decreased pulmonary perfusion and respiratory distress
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Cardiovascular Adaptations Review of fetal circulation 1.pulmonary arteries dilate, have decreased pulmonary vascular resistance and decreased pressure in right side of heart have rise in pressure in left side of heart with functional closure of foramen ovale
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2. PaO2 increases with 1st breath., ductus arteriosis constricts. Have functional closure in 15 hours, permanent in 3 weeks. Hypoxemia - patent ductus and shunting of blood
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3. Ductus venosis closes as a result of clamping umbilical cord. Fibrosis occurs within 1 week - have increased systemic blood pressure leading to increased systemic resistance. Have decreased venous blood pressure due to decreased blood return via the inferior vena cava
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Neurological Adaptations infant brain is 25% of adult size, incomplete myelinization of nerve fibers have primitive reflexes that disappear with cns development infants startle very easily ANS and brain stem coordinate resp and cardiac function normal newborns are hypertonic, flexed arms and legs drawn up to abdomen
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Arms well flexed
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neurological dysfunction may be indicated by weak, high pitched, or no cry or decreased muscle tone and flaccidity neuromuscular control is limited
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Reflexes Tonic neck - head is turned to one side, extremities on that side straighten, opposite side flex Grasping reflex - stimulation of newborn’s palm Moro reflex - startle - forms a “C” with arms
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Rooting reflex - touch side of mouth or cheek
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