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Exam 2 Study Guide - Summary Maternity and Pediatric Nursing
Exam 2 Study Guide - Summary Maternity and Pediatric Nursing Chapter 17, 18
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11/19/23, 9:30 AM Exam 2 Study Guide - Summary Maternity and Pediatric Nursingabout:blank 1/30
Exam 2 Study Guide
Chapter 17
Cardiov ascular S ystem Change s:
KNOW REFLEXE S AND WHEN THEY GO A WAY
SPINA BIFID A (2 DIMPLES?)
GALLANT REFLEX
SKIN T O SKIN BENEFITS
DEHYDRA TED BAB Y= SUNCK IN FONT ANELS
ACROCYANOSIS
WHEN FEET ARE MORE BL UE THAN HANDS BAB Y IS COLD
HEAR T RATE: 120-160
SLEEPING BAB Y: HEART RA TE COULD DROP AS LO W AS 100
SKIN T AGS ARE NORMAL BUT SHOULD PROMPT FUR THER INVESIGA TION
BILIRUBIN: TRAU MA, BLOOD COMPENT S, CONJUGA TION
IGA, IGG, IGM
SKIN: FIRS T LINE OF DEFENSE, TEMP ERATURE, PREVENTS DEHYDRA TION
BLACK W OMEN CAN HA VE WHITE BABIES
108 K CAL DA Y OPTIMAL DIET FOR NEWBORN
-The umbilical v ein carries o xygenat ed blood from the placent a to the fe tus
-The ductus venous al lows f or the majority of the blood to bypass the liver and mer ge with blood moving thr ough the vena ca va bringing it to t he heart sooner . The for amen ovale allo ws the blood from the right a trium to move to the left atri um which bypasses the pulmonary cir culation (lungs). -The ductus arteriol es connects the pulmonary art ery to the aorta which also skip s the pulmonary circ uit (lungs)
-Only a small amount o f blood goes to t he lungs f or perfusion purposes
-At birth the newborn cir culation and placent al oxy gen ex change must switch to pulmonary g as exc hange (lungs)
-The changes must include increas ed pulmonary blood flow , remova l of the placent a, closure of the f oramen ovale (the opening betwee n the right and le ft atrium) and c losure of the v enou s ductus and ductus art erioles -The str esses of birth release cat echolamine’ s that are critical for the tr ansition into e xtraut erine life. - The increas ed levels of e pi and norepi s timulate incr eased cardiac output an d contr actility; stimulat e surf actant release ( needed f or oxy gen and gas e xchange) and pr omotion of lung fluid clearance 11/19/23, 9:30 AM Exam 2 Study Guide - Summary Maternity and Pediatric Nursing
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Fetal to neona tal Circula tion Changes:
-Circula tion changes as soo n as the fe tus separat es from th e placenta
-When the cor d is clamped is when the fir st breat h is tak en and lungs begin to func tion
-Systemic vascular r esistance increases and blood return via inf erior vena ca va decreases -Decrease in pulmo nary vascular r esistance and incr ease in pulmonary blood flow
-Fore man ovale closes with a decr ease in pulmonary vascular resis tance decreasing rig ht sided heart pr essures. It closes when left at rial pressu re increases and right a trium pressure decr eases. Normally functionally c loses at birth and permant antly closes in sever al weeks.
-The ductus arteriol es and venous ductus a re no longer needed and turn in to lig aments over time.
-With closure of th e for amen ovale o xygenat ed blood and deo xygenated bl ood now become se para ted
-During f etal lif e the ductus arterio les protected the lungs from cir culatory overl oad by shunting blood right to left into th e descending aorta t o the rest of the body
-Patency of the ductus arterioles is pr otected by pr ostaglandins E2 during fetal lif e
-Ductus arterioles func tionally close a f ew hours aft er birth and its closur e depends on increased o xygenation resulting fro m aera tion of the lungs after birth
-The venous ductus clos es within a f ew days aft er birth because it ’s shunting of blood is no l onger needed w ith the activation of t he liver . The liver now t akes ov er the function of the placenta
-The umbilical v essels (1 vei n, 2 arteries) begi n to co nstrict and are no longer nee ded, also becoming lig aments (One aret ery is associat ed with ren al and GI abnormalities)
Heart Rate :
-During firs t few minut es after birth the inf ant’s heart r ate is be tween 110-160 but then decreases to an a verage of 120-130.
-The newborn is depe ndent on the heart r ate f or maint ance of car diac output and blood pressure.
-BP normally plat eaus a week aft er birth
-Cardiac de fects can be de termined thr ough a thorough phy sical assessment of the newb orns cardio vascular system. The nurs e should be able to iden tify any a bnormalities because this c ould lead to early detection and treat ment.
-A tr ansient functional c ardiac murm ur may be heard duri ng the neonatal p eriod as a res ult of car diovas cular changes.
-Fluctuations of heart r ate and blood pr essure mimic baby ’s behavior al state. (If baby is agit ated th e heart ra te and blood pressur e will be elevat ed)
-Tachy cardia may be f ound as a res ult of fluid volume loss, c ardio respir atory disease, drug withdr awal and hypert hyroidism.
-Brady cardia is f ound with apnea and hypo xia 11/19/23, 9:30 AM Exam 2 Study Guide - Summary Maternity and Pediatric Nursing
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Blood volume:
-The amount of bloo d the baby has depends on the amount of blood tr ansferre d to the in fant from t he placent a at birth.
-Late clam ping (after 3 mi nutes) is bett er than early clamping (30-40 seconds). La te clamping impr oves the inf ants cardi opulmonary adaption, prev ents iron deficie nt anemia without incr easing risk of hypervolemia, i ncreases blood pressur e, improves o xygen tr ansport, and increases red blo od cell flow . -Cord blood “na ture’ s firs t stem cell tr ansplant ”
Blood Components:
-Fetus has more r ed blood cells at birth. They ar e larger in siz e and have a gr eater affinity f or oxygen. After birth the
RBC count incr eases and the RBC decreases in siz e. This is due the RBC now living in an en vironment wher e there is much more pulmonary o xygenatio n. -An inf ant’s hemoglobin initially declines as a res ult of a decr ease in neonat al red blood cell mass
-Leuk ocytosis (increased whit e blood cell coun t) is presen t after birth due to th e trauma of birth. -The newborns pla telet aggr egation and platelet c ount are the same as adults
-Blood test results of the ne wborn re dep endent of wher e the blood is draw n from, c apillary blood has higher levels of hemogl obin and hemat ocrit compar ed to venous blood, placent al transfusion ( early vs. lat e cord clamping), ges tational age (incr eased age is ass ociated with increased RBC an d hemoglobin)
NORMAL NEWBORN BL OOD V ALUES
Hemoglobin- 16-18
Hematocrit - 46-68%
Platele ts- 150,000-350,000
RBC 4.5-7.0 (1,000,000)
WBC 10-30000
Respir atory Sy stem Adapta tions:
-Lung aera tion leads to the est ablishment of functio nal residual c apacity allowing for g as excha nge to begi n
-The firs t brea th results in the lungs filling increasi ng pulmonary pressu re which pushes the di aphragm down
-While the mom is in labor she is br eathing rapi dly (hyper capnia), hypo xic, and acidodic, all of these help initiat e the baby to br eath
-Inspira tion of air and ex pansion of lungs increase tidal volume
-Surfact ant preven ts alveolar collapse a t the end of ex piration and loss of lung volume
-Normal lung function depends on sur factant which perm its a decrease in s urface t ension at the end of expir ation to pre vent atelect asis
-The newborns ches t wall is floppy due t o the high cartilag e content and poorly devel oped musculatur e
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