Study Guide for Unit 6.docx - Study Guide for Unit 6 Ch 23 24 25 Ch 23 Physiologic Behavioral Adaptations of the NB 1 Discuss the physiologic

Study Guide for Unit 6.docx - Study Guide for Unit 6 Ch 23...

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Study Guide for Unit 6: Ch. 23, 24, & 25Ch. 23: Physiologic & Behavioral Adaptations of the NB1.Discuss the physiologic adaptations that the NB must make during the period of transition to extrauterine life (pg. 529-545)Respiratory system:Initiation of breathing: At birth the lungs must be established as the site of gas exchange. Initiation of breathing in NBs is the result of a combo of chemical, thermal, & sensory factors. Chemical factors:Activation of chemoreceptors in the carotid arteries & the aorta results from the relative state of hypoxia at birth. LOW Po2 & HIGH levels of Pco2 stimulate the respiratory center in the medullaProstaglandin levels (can inhibit respirations in utero) ↓ after the cord is clampedMechanical factors:Changes in intrathoracic pressure resulting from compression of the chest during vaginal birth=negative intrathoracic pressure=helps draw air into the lungs after NB passes through birth cana Crying ↑ distribution of air in the lungs & promotes llexpansion of alveoliThermal factors: The profound change from the warm intrauterine to the extrauterine environment stimulates receptors in the skin further stimulating the respiratory center inthe medullaSensory factors: Handling the NB by physician/ midwife, suctioning the mouth & nose, drying by the nurses, pain, lights, sounds, & smells are all involved in stimulation of the respiratory systemS/S of respiratory distress:Nasal flaring GruntingIntercostal or subcostal retractions Bradypnea: <30 breaths/ min. (w/NB at rest)Tachypnea: >60 breaths/ min. (w/NB at rest)Apnea: Apneic periods > 20 secs indicative of pathologic processCardiovascular system:1stbreath: NB’s 1stbreaths inflate the lungs & decrease pulmonary vascular resistance to the pulmonary blood flow from the pulmonary arteries. Pulmonary artery pressure ↓, RA pressure ↓. ↑ pulmonary blood flow from the left side of heart ↑ pressure in LA causing a functional closure of the foramen ovale. Ductus arteriosus functionally closes w/in 1sthrs after birth. Clamping & severing of the cord functionally closes the umbilical arteries, the umbilical vein, & the ductus venous.Cardiopulmonary adaptation (see fascinating handout)Heart rate & sounds:Resting HR btw 100 & 160 beats/ min. Can ↑ to 180 beats/ min. W/crying
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In term NBs, range is 85-100 beats/ min. During sleep & 120-160 beats/ min. While awakeHR>160 beats/ min. Or <100 beats/min. Should be reevaluated in 30 min. To 1 hr1stsound S1 typically louder & duller than the 2ndsound S2 which is sharpBP:Varies according to wt & gestational age *Avg systolic BP 60-80 mm Hg, avg diastolic 40-50 mm HgBlood volume:NB ~ 80-85 ml/kg of body wt. Immediately after birth=total blood vol. ~300ml but can ↑ by 100ml, depending on the length of time before the cord is clamped/ cut.
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  • NB,  LOW Po2

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