NURS 3330 Chapter 7: Chapter 7 Outlines

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Chapter 7: Newborns and Infants
The human infant less than 28 days old is a newborn, or neonate. The term
newborn refers to any preterm, term, or postmature child. The infancy
period is that period from 1 moth of age to 1 year of age.
Gestation is the duration, in weeks, of pregnancy
o Average full-term baby: born after 38-42 weeks of pregnancy
o Preterm infant: born before 37 weeks of pregnancy
o Postmature infant: born after 42 weeks of pregnancy
Care associated with the majority of full-term infants >38 weeks gestation is
primarily to protect and support the neonate during its physiological
transition to extraterine life
Immediate needs of the newborn: Nurse’s predominant role is to assess the
newborn in the transition period, protect the physical well-being of the
infant, and promote a family-centered environment
o Clearing of the airway: wipe mouth and nose with the delivery of the
head. If suctioning, suction mouth first, then nose to remove mucus
and blood with bulb syringe. Depress the bulb first and them insert
into the orifice to remove secretions.
Apgar scoring system
o Evaluates a neonate’s ability to adapt during the birthing process
o Determines the need for resuscitation, the effectiveness of the
resuscitation, and the neonate’s morbidity and mortality risks
o Measures face areas: respiratory rate, heart rate, muscle tone, color,
and reflex irritability
o A higher score indicates adequate adaptation
o The Apgar scare at  minute indicated the neonate’s ability to
transition to extrauterine life, factors occurring during the birthing
process, and whether resuscitation is needed.
o The Apgar score at  minutes indicates the neonate’s status and the
effectiveness of resuscitative efforts, as well as neurological deficits
and long-term morbidity and mortality
o In depressed infants, the scoring is repeated every 5 minutes
Maintain thermoregulation with immediate drying and removal of wet linens
Chilling increases oxygen consumption and metabolism by evaporation
Band infants with on-demand or barcode on arm and leg with corresponding
bands applied to the mother and significant other if present in the delivery
rooms
Baby prophylactic medications
o Vitamin K: newborns are born with a sterile intestinal tract and do not
have the bacteria that is necessary for the production of vitamin K
o Newborns have decreased levels of vitamin K, the nutrient
responsible for clotting and preventing hemorrhages
o Erythromycin eye ointment: prevents serious eye infections and
should not be washed away
o Hepatitis B immunizations to prevent hepatitis
Protect the physical well-being of the newborn
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Maternal History
Review of prenatal history, including past pregnancies, complications, and
genetic factors in both mother, father, and previous pregnancies
Infections- prenatal as well as past exposures
Screening tests and risk factors
Labor and delivery problems or risk factors
Transition to Extrauterine Life
Begins in utero as the fetus prepares to transition to extrauterine life
Intrauterine changes
o Changes are dependent upon gestational age, maternal health factors,
condition of the placenta, and/or defects and congenital abnormalities
o In utero, the lungs are filled with amniotic fluid and the placenta is the
organ of respiration and waste removal
o Fetus produces surfactant (at 34 weeks gestation)
Produced in the alveoli of the lungs
Decreases surface tension and allows the alveoli sacs to remain
partially open upon expiration
Permits a decreased amount of pressure and energy needed to
take the next breath
The fetus practices breathing in utero
Fetus has depositions of brown fat
Fetus stores and converts glycogen to glucose in the liver to
meet metabolic needs.
Respiratory System Transition
o Occurs when the umbilical cord is clamped and the infant takes the
first breath. All body systems of the neonate transition to extrauterine
life, but most significant are the respiratory and circulatory system
transition
The cord is cut and placent is no longer the organ of
respiration
Several factors influence the first breath
o Internal stimuli such as chemical changes due to
hypoxia and increasing carbon dioxide levels
o External stimuli such as thermal changes,
sensory changes, or mechanical changes due to
delivery process
The first breath begins to clear amniotic fluid and fill the
lungs with oxygen, which does the following:
o Increases alveoli oxygen tension which dilates
the pulmonary artery, decreases pulmonary
vascular resistancem increases pulmonary blood
flow, and increases oxygen and carbon dioxide
exchange
Alterations in the system’s transition result from
insufficient production of surfactant owing to
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prematurity, hypoxia, and acidosis, all of which increase
pulmonary vascular resistance
Newborn Respiratory Assessment and Development
o Asses the nose for patency
o Chest wall symmetry/asymmetry can be a result of pneumothorax
o Respiratory pattern is normally very irregular, sporadic, shallow, and
diaphragmatic
o Respiratory rate decreases with age
o Average rate at birth is 40- 60 breaths/minute, count for a full minute
o Newborns are obligate nose breathers, but after several months they
become nose-and-mouth breathers
o Acrocyanosis (bluish color of hands and feet) is normal in the term
infant in the first 24 hours. After 24 hours, this may be an indication of
cardiac disease
o In dark-skinned infants, cyanosis is better assessed through the
mucus membranes
o Older infants become diaphragmatic breathers
Circulatory System Transition and Assessment
o Transition occurs with the clamping of the cord and the first breath
o The successful transition is directly influenced by the changes that
occur in the respiratory and thermoregulation systems
o Three fetal structures maintain fetal circulation: the ductus arterious
(PDA), between the pulmonary artery and the aorta; the foramen
ovale, the connection between the right and left atrium; and the
ductus venosus in the hepatic system
o As pulmonary vascular resistance decreases, there is a decrease in
placental secretion of prostaglandins
o Three vessels should be present in the umbilical cord: two arteries
and one vein
The presence of only two vessel cords may indicate renal
agenesis or lack of development
Cord blood may be obtained from an Ph-negative mom or o
blood group
Blood gases may be obtained if oxygen levels are decreased or
Apgar scores are depressed at 5 minutes of age
o Heart rate decreases as infant ages
o Newborn heart rate averages 100 to 160 beats/minute at rest, but can
increase with crying
o Four extremity blood pressures are indicated with heart murmur
Thermoregulatory System Transition and Assessment
o Necessary for sustain hemostasis
o Is dependent on external and internal factors
o Neutral Thermal Environment (NTE): the temperature that the infant
requires to minimize metabolic and oxygen needs, prevent metabolic
acidosis, and arrest brown fat depletion
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