Inherited Surfactant Disorders - Associates in Newborn Medicine
NORMAL NEWBORN Fall 2011. Surfactant- What is this? Why is it necessary? When is it formed?
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Transcript of NORMAL NEWBORN Fall 2011. Surfactant- What is this? Why is it necessary? When is it formed?
NORMAL NEWBORN
Fall 2011
Surfactant-
What is this? Why is it necessary? When is it formed?
Respiratory Changes
InitiationInitiation ofof BreathingBreathing
Mechanical
Chemical
Thermal
Sensory
Factors in Initial Respiration Mechanical – chest recoil Chemical- respiratory acidosis Thermal- decrease in
environmental temp Sensory- tactile, auditory, and
visual influences stimulate activation of the first breath
Fetal Circulation
Fetal Circulation (p246-247)
Ductus arteriosus- blood flow from pulmonary artery to aorta
Ductus venosus-blood flow from umbilical vein into the inferior vena cava
Foramen ovale- blood flow from right atrium to left atrium
Neonatal Circulation
Ductus arteriosus- closes after birth triggered by pressure changes and pO2
(transient murmurs normal in first 24 hours)
Ductus venosus- closes at clamping of umbilical cord
Foramen ovale- closes at first breath
Cardiovascular/Cardiopulmonary Adaptations Increased aortic pressure and decreased
venous pressure (clamping of cord)
Systemic pressure and pulmonary artery pressure (expanding of the lungs)
Closure of foramen ovale (atrial pressure changes) Closure of ductus arteriosus (PO2 triggers constriction of ductus arteriosus)
Closure of ductus venosus (clamping of cord)
Thermoregulation
Thermoregulation Contributing factors to neonatal
heat loss Size Loss of heat source Loss of glucose supply Metabolic rate
Temperature Regulation Convection Radiation Evaporation Conduction
How does the NB maintain body temperature?
Neonatal methods of producing heat Basal metabolic rate Muscular activity Non-shivering thermogenesis (NST)
Why is heat regulation vital to the neonate’s survival?
What nursing interventions assist the neonate to maintain adequate thermoregulation? Drying Swaddling (blankets) Cap Skin to skin contact (cuddling)
Hematopoietic System
Lifespan of neonatal RBC:
80-100 days (2/3 lifespan of adult’s RBC)
Factors effecting blood volume:Delayed cord clamping
Shift of plasma to extra-vascular spaces
Gestational age
Prenatal or postnatal hemorrhage
Neonatal Lab Values (p498)
Hemoglobin 14-20g/dl Hematocrit 48-69% WBC 10,000 – 30,000mm3 Glucose 40-60mg/dl first 24 hr
then 50-90mg/dl Low blood sugar 40-45mg/dl
requires treatment
Clinical judgment:
Why is Vitamin K AquaMEPHYTON ®
administered to the newborn?
GI Function: What is the significance of
meconium?
What is the priority nursing intervention regarding GI assessment?
Presence of bowel sounds and patency of the anus
Hepatic Function What is the function of the liver in the neonate?
What is physiologic jaundice?
What is the difference between conjugated and unconjugated bilirubin?
What is the long-term consequence of elevated bilirubin levels?
Normal Lab Values
Bilirubin levels for a term NB<3mg/dl
Elevated bilirubin levels depend on NB’s age- peak levels reached between day 3 and 5 in the term infant.
Toxic levels approximately – 20mg/dl
Nursing Interventions: to decrease physiologic jaundice
Maintain NB’s core temperature
Monitor stool frequency and characteristics
Encourage early feeding
Encourage bowel elimination
Prevent dehydration
Urinary System of the NB What is the normal number of
voids in a 24 hour period? For first 48 hours- 1 or 2 daily Following 48 hours- 6 times daily
What is brick-dust staining?
Immunologic Adaptations: Active acquired immunity- the
mother forms antibodies in response to illness or immunization
Passive acquired immunity- transfer of immunoglobulins to the fetus in utero (IgG production begins at 20 weeks gestation) or to the infant via breastmilk
Behavioral States of the NBp. 665 & 872 CHART
Sleep States: Deep or quiet sleep Active or REM sleep
Alert States: Drowsy Wide awake Active awake Crying
Critical thinking…
Which of the behavioral states is optimal for maternal-infant bonding?
Senses in the Neonate: Visual Auditory Olfactory Taste Tactile
Apgar Scoring
Sign 0 1 2Heart rate Absent Slow-below
100Above 100
Respiratory effort
Absent Slow- irregular
Good Crying
Muscle tone
Flaccid Some flexion of
extremities
Active motion
Reflex irritability
None Grimace Vigorous cry
Color Pale blue Body pink, blue
extremities
Completely pink
Apgar Score: assigned at 1 & 5 minutes.
A score below 8 may require resuscitative efforts.
0-3 poor condition
4-6 fair condition
7-10 positive (good condition)
Quick review! What measures should the nurse take
to ensure a patent airway in the NB?
Why is it important to maintain a neutral thermal environment?
What nursing interventions assist to maintain the NB’s core temp? (prevent cold stress)
Assessment of the Neonate
Vital Signs: Pulse Respirations
Signs of Respiratory Distress Temperature Blood pressure
Average size for term Weight Length FOC
Assessment of NB skull/scalp Fontanells
Anterior Posterior
Suture lines Frontal Coronal Sagittal Lamdoidal
Assessing the Head:
Molding
Caput succedaneum
Cephalhematoma
Assessing the Face:
EyesEarsMouthWhat is the significance of
variations? (nursing interventions)
Assessment of the NB’s Eyes: Color Size Reaction to light/blink Conjunctival hemorrhages Transient strabismus or nystagmus
Assessment of the NB’s ears: Level Shape/ malformation Flexibility What body system must the nurse
carefully monitor if anomalies occur with the ears?
Assessment of the NB’s mouth: Lips Palate Hydration Reflexes Additional normal findings:
Epstein’s pearls Precocious teeth Short fernulum of tongue
Why is it important to assess the umbilical stump? How many vessels will you find in
the umbilical cord? ___ Arteries ___ Veins
What is Wharton’s jelly? (p. 246)
Assessment of the Abdomen What is the general shape What is the ratio of FOC to
abdominal size? What organs must be assessed in
the abdomen?
Extremities:
Upper Hands
Lower Hips Feet
Neurological Assessment/ Reflexes Moro or Startle
Palmer grasp
Rooting
Sucking
Step
Babinski
Plantar grasp
Tonic neck
Assessing the genitalia of the NB: Female
Labia Clitoris Vaginal opening
Hymeneal tag Secretions
Anal opening
Male Penis
Penial raphe Urethral meatus
Scrotum Testes Rugae
Skin Assessment: Color and thickness Birthmarks Harlequin sign Jaundice
Assessment of NB skin Acrocyonosis Mottling Erythema toxicum Vernix caseosa Telangiectatic nevi Mongolian spots- Why is it important
to carefully document these birth marks?
Gestational Age: Neuromuscular and physical maturity Newborn Maturity Rating &
Classification (P. 525-530)
Dubowitz tool Ballard Score
Posture, reflexes, size, skin characteristics and fat distribution
Neonatal Medications Administered within 1 to 2 hours of
birth AquaMEPHYTON ®- vitamin K Erythromycin ointment When is best time to administer?
Newborn Identification Footprints
Identification bands Newborn Mother Designated “other”
What would you include in a transfer of care report for the neonate to the transition nursery?
What would you include in a transfer of care report for the neonate to the transition nursery?
Apgar scores Resuscitative efforts Time of birth, weight and length Labor analgesia or anesthetic L&D history Maternal history
Circumcision: (p 549)
What factors are involved in the parent’s decision to have their male newborn circumcised?
What methods of pain relief may be implemented?
What assessments must the nurse include after circumcision?
Circumcision Instruments
Circumcision Care: pre-op & post -op Informed consent Comfort measures Risk of ______? Infection prevention Parent teaching and discharge
planning
Discharge teaching for the NB: Safety Elimination Genitalia care General Feeding Signs of illness NB behavior Immunization schedule Return appointment schedule
Required Newborn Screening for Texas: www.dshs.state.tx.us/lab/nbsHCRes.shtm
Early detection and treatment of inborn metabolic disorders (29 conditions)
Two screening times 24-48 hours after birth 1-2 weeks of age
Hearing screening
Nursing interventions for screening the neonate: Obtain specimen
Preparation of neonate Comfort measures
Inform parents Provide information for obtaining
results