Fetal Circulation: The ______ circulatory system provides the _____ with _________ and ______ while removing ____ and ______ ______ from fetal circulation Steps of Fetal Circulation: The ________ pulls __________ blood from moms circulation to the _________ ____ Oxygenated blood flows to the _____ , where some of the blood will go the livers circulation through the hepatic portal, but most will be _______ by the ______ _______ to the _________ ____ ____ The blood from the inferior vena cava enters into the ________ _______, majority of this _____________ blood will be shunted through the _________ _______ to the ______ atrium Left side: ____________ blood continues from the ______ atrium to the left ________ then to the ______, Oxygenated blood circulates to the ______ extremities and _____ through the ascending ______, blood will return through the _________ _____ _____ to the right ______ Right side: From the _____ atrium blood goes to the ______ ventricle then to the ____________ __________, From the pulmonary arteries most of the blood will enter the ___________ _________ then go to the ______, a small amount of blood will travel to support the maturing ______, return is through the ___________ veins to the _______ ventricle, to the ______. Blood in the aorta will pass to ____________ aorta. Blood will continue down to the thoracic abdominal _____, then blood is supplied to the _______ body extremities, after blood supplies these areas it travels via _______ arteries into the _________ _______ arteries, then to the ___________ __________ to the _____, the placenta will then recirculate with ________ and _______ and the cycle will begin again *The ductus venosus is a shunt that allows _________ blood in the ________ ____ to bypass the ____ and continue straight to the heart via the ________ _____ ______, it is located within the _______. *The ductus arteriosus is a hole that allows blood to skip the circulation to the ______ , and it connects the _______ to the _________ _________, it is located/connected to the left ___________ ________ *The foramen ovale is a hole between the _______ and _______ atria, it allows blood to bypass the lungs and cross from one atria to another What happens at birth? Cord is __________, Lungs _______ _______ clear ________ blood pressure _________ pulmonary pressure Closure of ________ ___________ Increased _______ in the _______ _________ Closure of the __________ ________ Close of the _________ _________ and ________ ________ completes the transition of fetal circulation to newborn circulation THE NORMAL NEWBORN: The First Breath: Chemical Factors 1.) _______ causes _____ _______ _____ (Po2) to drop and __ to drop 2.) _____ ______ _______ (Pco2) begin to _____ and prompt the _______ to initiate ________ 3.) ____________ are activated 4.) _________ contracts 5.) Infant takes first breath Sensory Factors Newborns experience overwhelming _______ when leaving a comfortable warm environment to enter one filled with ________, ________, ________, and __________ stimuli. Newborns can be stimulated with ___________ rubbing, which awakens the infant and initiates breathing Thermal Factors After months of development in a warm (__._) fluid filled environment, the newborn enters an environment that ranges from ___ - ___, the drastic change in temperature helps _________ the initiation of respirations Mechanical Factors Removal of fluid from the ______ with the replacement of ______ (vaginal birth promotes the thoracic squeeze which ________ intrathoracic pressure and helps push _____ out of the _____ ______ expansion after delivery stimulated the release of __________, which is a ________ detergent like _____________ that causes a _______ surface tension within the _______, this allows ______________ within alveoli after each ___________ Cardiovascular Transition of Newborn: - Newborns skin presents with ______________ - Heart rate is ____ - ____ bpm immediately after birth (during crying rate can increase to ___bpm), 30 minutes after birth heart rate is at ___ - ____bpm - Respiratory rate is ___ - ___ breaths per minute, ______, diaphragmatic, _______, periodic breathing brief pauses __-__ seconds, __________ and _____ movements are ____________, apnea cessation more than __ seconds should be reported ___________!!! - Capillary refill is ____ _____ _ seconds Thermogenic Adaptation: Is closely related to the infants rate of __________ consumption and ________. The neutral thermal environment is an environment in which the infant uses the _________ amount of ______ to maintain a _________ body temperature. Nonshivering Thermogenesis (NST) is a cold-induced _________ increase in ______ production, not associated with ________ activity of shivering, it is a __________ process located primarily in _________ ________ tissue (baby fat). Monitor newborn closely for ____________ (temperature less than __._) Normal Axillary temperature is the _________ method for temperature check normal ranges are __._ - __._ Normal Rectal temperature is the _____ core temperature, but not typically done, normal ranges are __._ - ___._ Heat Loss & Preventing Cold Stress: Evaporation: is a _____ of _____ that occurs when ______ is converted into ______. - Nursing interventions: placing ___ on _____, remove all _____ ________, thoroughly ___ newborn Conduction: is a _____ of _____ to a ______ surface through _______ skin contact such as ______ _______, _____ - Nursing interventions: placing infant on ___-______ radiant warmer, _____ to ______ will regulate temperature, using ______ _______ and voiding _____ _______ Convection: is the _____ of heat from the ____ body surface to a ________ ____ currents. Occurs with ______ in room fans, near windows - Nursing interventions: ______ newborn from draft areas, also put ________ on to prevent _______ to drafts Radiation: ______ loss occurs when there is a ________ between ______ that are ____ in ________ _______ with each other - Nursing Interventions: ___-_____ radiant warmer present at ______ and ______ from cold area Hematopoietic Adaptation: Blood volume: varies according to ___________ age (full term is __-__ ml/kg of body weight) Blood components: - _______________ and _____________ have a ________ number than adults at birth - _____________ is the percentage of ___ = __-__% - Polycythemia is ___________ high ___ greater than __%, can place infant at high risk for ________ or _____ ________ - Leukocytes are _________ in ___, the average WBC in term infant is _,___-__,___mm3) - Platelets ___,___ - ___,___mm3 - Vitamin _ helps with clotting Hepatic Adaptation: Pathological/Physiological Jaundice: Pathological: occurs within __ hours of life, results from discord that cause excessive _______ of ___ leading to increased production of ________ Physiological: occurs after the first __-__ hours of life. Peak _rd to _th day in full term infant. - Becomes visible when total serum bilirubin levels (TSB) reaches _-_ mg/dl - Moves ________ when total serum bilirubin levels reaches _-_mg/dl *normal bilirubin at birth is _mg/dl or less Gastrointestinal Adaptation: - Stomach capacity is _ml/kg at birth and __mls by the end of the first week of life - Bottle feeds Q _-_ hr and breastfeed is Q _-3 hrs/day ( _-__ feedings/day) - ________ is the primary ________ in breast milk and is ________ digested - Bowel sounds are present at __-__ minutes of life - First stool “_________” at _-__ hours of life is a _________ - ______ and ______. Absence of meconium by __ hours may be a ______ ______ or a __________ anus - Transitional stool is a ________ consistency and changes from greenish to ______ or __________ brown - Breast fed infants expel a _______ _____ colored ____ stool “_______” consistency - Bottle fed infants expel a _______ to _____ “________ or _____” consistency due to ____ in the formula Genitourinary Adaptation: - Bladder capacity is _-__ml - Fluid requirements __-__ml/kg increase to ___-___ ml/kg - Urine output _-_ ml/kg/hour increase to _-_ml/kg/hour - Specific gravity is _.___-_.___ - First void should be within __ hours **NOTIFY MD IF NO VOID - By day _ of life should have _-_ voids/day - By day _ of life should have _ or moe voids/day - First void may be _______ from ______ or contain ______ crystals - Weigh ______ if concerned Immunological Adaptation: ___ (passive acquired immunity) - ______ immunoglobulin that ______ through the _______ - Primarily in the ______ trimester - Preterm infants born before __ weeks are at greater risk for ______ ___ (passive acquired immunity) - Important to ______ infant against ________________ and ____________ infections - __________ and breast milk are important sources of IgA ___ are produced in response to ______, ________, ______, an increased IgM at birth is suggestive of ________ to a maternal ________ Psychosocial Adaptation: First Period of Reactivity Birth to __ minutes after birth, newborn is _______, active, may appear ________, ________, lip ________ (good time to _____) Period of Decreased Responsiveness May last _-_ hours, periods of _____ and/or decreased _______ (good time to have mom _____) Second Period of Reactivity May last ________ to _______ hours, newborn _______ and shows increase interest to stimuli (elevation of ______ _____ and adjustments after birth with _________, and increase ______ Expected Reference Ranges: Head circumference = __ - __._ cm (__._ - __._ inches) Chest circumference = __._ - __ cm (__-__ inches) Newborn length= __-__ cm (__-__ inches) Abdominal circumference= __._ - __ cm (__-__ inches) * measured directly _____ the _________ (should be the same as _____ circumference in the normal newborn) Weight = (_._ - _.__lb) *are preformed starting at ______ - Large for gestational age (LGA) = weight ____ the __th percentile at ___ week - Small for gestational age (SGA) = weight falls ____ the __th percentile for the infants ___ Initial Medications Given: ____ and _____ - Vitamin _ is given __ at the _______ _________ (thigh) - The erythromycin ophthalmic ointment is given in _____ eyes after _______ Hepatitis B Vaccine: To prevent Hepatitis B virus - First dose is given within __ hours of birth - _._ml IM, middle third of the anterior _____ ______ (preferred in newborns) - _________ ________ is necessary - Series of _ total injections → #1 given at _______ → #2 at _-_ months → #3 at _ months Car seat Testing: - < __ week gestation - Low birth weight < ____ gms (_._lbs) - _________ muscle tone - Requiring _______ - Monitor for period ______ or ___________ while sitting in a car seat prior to discharge Skin Variations: - Stork: birthmark on the ______ of the ______, may ______ or lighten - Milia: small, _______ spots/cysts on skin - Mongolian spots: flat _________ to ____ skin marking usually on ____ - Erythema Toxicum: baby _____ - Nevus Flammeus: is on ____ side, ___ birthmark - Strawberry Hemangioma: a clump of tiny _____ _______ that form under the skin, may get _______ or small Newborn Reflexes: - Moro/Startle reflex: Sudden _______ or __________ when startled newborns _______ its back and throw back its ________ - Magnet: Applying _______ to soles of _____, newborn will ______ back against ________ - Stepping: baby appears to take _____, when held _______ with his/her ______ on the ground - Tonic Neck/Fencing: When your baby is _______ _______ and their head is turned to the ______ or ______ , the _____________ arm _______ while the other arm _______ next to their head - Galant/Trunk Incurvation: holding the newborn and stroking along _____ the newborn to should _______ - Crawling: appears as the infant is _________ while on _______ - Suckling/Rooting: when something touches babies _________ he/she should start to _____ it - Extrusion: newborn will ______ ______ any substance placed on the ________ protective reflex prevents the swallowing of inedible stuff. - Palmar grasp: an involuntary _______ -_________ movement involving the ______ and _______ - Plantar: ________ and ________ of all ____, as if the toes were firmly grasping the stimulating object - Crossed Extension: allows the body to _________ on ____ side for a _______ on another Abnormal Findings: Heart Murmurs: - Often heard first __-__ hours of life - Evaluation after the first __ hours to rule out ___________ disorder Tachycardia: - Resting heart rate _________ than ___ bpm Bradycardia: - Resting heart rate ________ than ___ bpm CCHD testing: - O2 sat to see if ___ vs. ____ ductal are _____
