Factors affecting adaptation to extrauterine life: Prenatal : Mother’s health – emotional...
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Factors affecting adaptation to extrauterine life:
Prenatal : Mother’s health – emotional problemsnutritional statuscomplications of PG ie: toxemia, placental
problems,diabetes, wt. gain, infection
Intrapartum: length of lavor - long ; precipitatelength of time membranes rupturedmedications given – type & when ie: Demerol found in
urine 2 wks latertype of delivery - forceps, vacuum extraction, C-Section
(transient tachypnea),
Immediate care: Airway assess respirations - head lower than body
If meconium stained What do you do?Circualtion ie fetal circulation vs neonatal circulationWarmth - from 98.6 to 72 degree, brown fat if full term
dry- skin to skin on mom, use warm blanket over bothInfection prevention – no protective skin flora, triple dye to cord
eyes - crede triple ung. , silver nitrate )gonococcal opthalmia neonatorium
Identification Measure & weigh
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APGAR: 1 & 5 MINUTES
7 – 10 = normal newborn
4 – 6 moderately depressed may need ventilation support KEEP WARM
0 – 3 or 4 severely depress. endotracheal intubation, inflation of lungs with O2 use of cardiac stumulantes correction of metabolic acidlosis & hypoglycemia KEEP WARM
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Chest circumference =Or 2 cm less than head
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Interactionof stimuliin initiationof neonatalrespiration
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Neonates areNOSE breathers
Shallow & respirations are irregular 30-60, apnea lessThan 15 seconds
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Heart sounds: remember closures are functional NOTpermanent.
Blood pressure 78/42 often drops to 62/40 first hours of lifeVaries day to day first month, crying will increase BP
Blood volume 10% greater than adults, 20-30% increase in RBC, decrease of 20% plasma. Late cord clamping may Increase blood volume as much as 40-60%.80-110ml.
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RBC’s = 5 to 5.8, decrease to 4.2-5.2 by end of first month
Hemoglobin at birth 80% = fetal hemoglobin BUT fetalhemoglobin has shorter life span, by 5 weeks only 5%.15-18g/100cc. What is norm adult? 12-16
WBC = 18,000 at birth, 23-24,000 first day, 11,500 afterffirst few days.
Platelets – essentially same as adult exception those that tookaspirin
Blood groups established early in fetal life, but become evenmore pronounce after birth
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IMPERFORATED ANUS
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Renal system: void 12-24 hours. Immature kidneys; therefore, decrease ability to excrete meds =buildup, toxicity.40% of body weight = ECF; therefore more susceptible to fluid & electrolyte imbalance. Void 6-10 / day. I & O = weigh diapers, 1gm = 1cc
GI: intestines sterile, VITAMIN K ?Stomach holds 15cc at birth, by second day up to 2-3 oz.
Right side placement for best digestion
Stools difference between breast and formula fed
Wt. Lose 5 – 10% of body loss
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Hypoglycemia can compromise CNS, brain dependenton glucose, increase RDS. S&S: tremors, cyanosis, seizures, apnea, irregular resp.
hi-pitched weak cry, hypothermia, poor feedingBS falls rapidly – stabilizes at 6-12 hours after birth
Increase demand due to metabolic energy because:establish respirationsincrease muscular activitymaintenance thermoregulations
Increase incidence:preterm (decrease glycogen stores)IUGRcold stressedperinatal stress, asphyxia
` IDM – insulin dependent motherRH incompatibility
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Physiologic hyperbilirubinemia or NORMAL jaundiceIn 50% term, 80-90% of preterm
Icterus Neonatorum = jaundice of the newbornIf noted before 24hours of age – breakdown started in utero
usually RH or ABO incompatibility or infection
See usually 48-72 hours after birth
Visible in nose at 3mg, face at 5mg, chest 7mg, abd 10my legs 12mg, palms at 20mg.
Hypoglycemia, hypothermia, apshaxia cause acidosis, whichincrease fatty acid, this decreases albumin binding of bilirubinsince fatty acids bind with albumin.
Cephalhemotma or bruising will increase jaundice WHY??Kernicterus = most serious complication
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Psudomenstration = female
Swelling of breast = either sexSmegma = either sex, from sebaceous glands
white cheesy secretions
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Acrocyanosis
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Mongolian Spot
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LANUGO
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Molding
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Bilateral Cephalhematoma
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Desquamation
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Nevus FlammeusPort Wine Stain - permanent not elevated; 3:1000 newbornsdoesn’t blanch with pressure
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Stork bite or Nevus simplex or angel kissRed pigment, blanches with pressureFades in 1-3 years. Often at nape of neck, forehead occiput, eyelid or nose.
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Strawberry hemangioma or Nevus vasculosus1 – 3 % born with another 10% develop within 1-4 wks.These may continue to grow but then disappear by school age. Usually do not take off surgically unless on eyelid or lips & interferes with everyday life
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Milia
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Erythema Toxicum or Newborn Rash
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candidias
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Candida albicans - thrush
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Dermatitis
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Neuromuscular:CNS is immature only some nerves are mylinated; therefore,
movement is uncoordinatedBrain is growing fast requires glucose and O2Newborn shows remarkable sensory development, ability for
self organization and social interactionTransient tremors& uncoordinated movement are normal
BUT if more severe check glucose level
REFLEXES check for absence, lag of response or most VIP SYMETRY
Absence, lag or asymmetrical response can be due to neuro (CNS) damage, injury, retardation or severe prematurity.
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TONIC NECK
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STEPPING OR DANCING REFLEX
GRASP
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BABINISKI
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MORO REFLEX - WITH SUDDEN MOVEMENT OR CHANGE OF EQUILIBRIUMSTARTLE - WITH SUDDEN LOUD SOUND
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GRASP
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Rooting
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