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What role does surfactant play in the lungs?
What role does surfactant play in the lungs?
What is the approximate respiration rate of a normal newborn?
What is the approximate respiration rate of a normal newborn?
What is the consequence of reduced surfactant production in infants born before 32 weeks?
What is the consequence of reduced surfactant production in infants born before 32 weeks?
What is a sign of abnormal newborn respiration?
What is a sign of abnormal newborn respiration?
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What promotes fluid clearance from the lungs after birth?
What promotes fluid clearance from the lungs after birth?
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What structure in fetal circulation bypasses the liver?
What structure in fetal circulation bypasses the liver?
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What is necessary to establish functional residual capacity (FRC) in a newborn's lungs?
What is necessary to establish functional residual capacity (FRC) in a newborn's lungs?
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What could indicate airway obstruction in a newborn?
What could indicate airway obstruction in a newborn?
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What initiates the respiratory adaptation of a neonate after birth?
What initiates the respiratory adaptation of a neonate after birth?
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What role do uterine contractions play in neonatal respiratory adaptation?
What role do uterine contractions play in neonatal respiratory adaptation?
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What is the effect of thermal factors on a neonate after birth?
What is the effect of thermal factors on a neonate after birth?
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Which factor is NOT involved in initiating breath after birth?
Which factor is NOT involved in initiating breath after birth?
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How does crying contribute to neonatal respiration?
How does crying contribute to neonatal respiration?
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What physiological process occurs first in the neonate for independent breathing?
What physiological process occurs first in the neonate for independent breathing?
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What mechanical factor assists in air intake for a neonate?
What mechanical factor assists in air intake for a neonate?
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What is a major physiological adaptation that occurs during the neonatal transition immediately after birth?
What is a major physiological adaptation that occurs during the neonatal transition immediately after birth?
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Why is it important for lung functions to activate right after birth?
Why is it important for lung functions to activate right after birth?
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Which of the following best describes the state of organization in newborn behavioral development?
Which of the following best describes the state of organization in newborn behavioral development?
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What is the primary reason for a newborn's need for thermoregulation after birth?
What is the primary reason for a newborn's need for thermoregulation after birth?
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What is a critical adjustment in the circulatory system that neonates must make after birth?
What is a critical adjustment in the circulatory system that neonates must make after birth?
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Which reflex is commonly assessed to understand a newborn's neurological condition?
Which reflex is commonly assessed to understand a newborn's neurological condition?
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What is one of the key nutritional needs of neonates in their first few days of life?
What is one of the key nutritional needs of neonates in their first few days of life?
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In the context of neonatal care, what is one potential consequence of hyperthermia in a neonate?
In the context of neonatal care, what is one potential consequence of hyperthermia in a neonate?
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What is the main focus of neonatal screening in healthcare?
What is the main focus of neonatal screening in healthcare?
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What is the average blood pressure range for a resting full-term newborn over 3 kg?
What is the average blood pressure range for a resting full-term newborn over 3 kg?
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At what age does fetal hemoglobin transition to trace amounts in infants?
At what age does fetal hemoglobin transition to trace amounts in infants?
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Which of the following is a recommended medication at birth to prevent vitamin K deficiency bleeding?
Which of the following is a recommended medication at birth to prevent vitamin K deficiency bleeding?
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What blood volume is approximately present at birth in term infants?
What blood volume is approximately present at birth in term infants?
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What is a significant indicator that further testing may be needed in assessing a newborn's health?
What is a significant indicator that further testing may be needed in assessing a newborn's health?
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What is the expected normal axillary body temperature range for newborns?
What is the expected normal axillary body temperature range for newborns?
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What is the range of hematocrit levels expected in newborns at birth?
What is the range of hematocrit levels expected in newborns at birth?
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What is the initial white blood cell count range for newborns after birth?
What is the initial white blood cell count range for newborns after birth?
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What happens to the foramen ovale at birth?
What happens to the foramen ovale at birth?
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What is the primary role of the ductus arteriosus in neonatal circulation?
What is the primary role of the ductus arteriosus in neonatal circulation?
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How long does it typically take for the umbilical arteries to close after birth?
How long does it typically take for the umbilical arteries to close after birth?
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What change occurs in the systemic vascular resistance after cord clamping?
What change occurs in the systemic vascular resistance after cord clamping?
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What is a common heart condition observed during the neonatal period?
What is a common heart condition observed during the neonatal period?
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Which of the following statements is true regarding the ductus venosus?
Which of the following statements is true regarding the ductus venosus?
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What physiological change prompts the transition from fetal to neonatal circulation?
What physiological change prompts the transition from fetal to neonatal circulation?
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What change occurs in heart rate during the first week after birth?
What change occurs in heart rate during the first week after birth?
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What is the maximum time frame to administer Hepatitis B immunoglobulin (HBIG) IMI to a newborn if the mother is Hepatitis B positive?
What is the maximum time frame to administer Hepatitis B immunoglobulin (HBIG) IMI to a newborn if the mother is Hepatitis B positive?
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What is the primary purpose of antibiotic eye ointment given to newborns immediately after birth?
What is the primary purpose of antibiotic eye ointment given to newborns immediately after birth?
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What is classified as low birth weight (LBW) for newborns?
What is classified as low birth weight (LBW) for newborns?
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Which of the following is an appropriate intervention to promote bonding immediately after birth?
Which of the following is an appropriate intervention to promote bonding immediately after birth?
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What is the normal range for respiratory rate in newborns?
What is the normal range for respiratory rate in newborns?
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Which assessment should be made regarding a newborn's temperature?
Which assessment should be made regarding a newborn's temperature?
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What is considered a sign of respiratory distress in a newborn?
What is considered a sign of respiratory distress in a newborn?
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What is the first stool a newborn should pass, and within what timeframe?
What is the first stool a newborn should pass, and within what timeframe?
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What is the significance of using a baby hat immediately after birth?
What is the significance of using a baby hat immediately after birth?
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Which assessment is true about a healthy newborn's heart rate?
Which assessment is true about a healthy newborn's heart rate?
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What is a typical body temperature range for a newborn at birth?
What is a typical body temperature range for a newborn at birth?
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Which measurement is used to assess the neonatal head circumference?
Which measurement is used to assess the neonatal head circumference?
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How should the infant be positioned during the weighing process?
How should the infant be positioned during the weighing process?
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What is the expected weekly weight gain of a newborn after the first week?
What is the expected weekly weight gain of a newborn after the first week?
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Study Notes
Neonatal Assessment and Care (Part 1-3)
- This is a study guide for BSN-3 Childbearing Family Nursing
- The course covers neonatal assessment and care, specifically focusing on Part 1-3.
- Covers the first 6-8 hours after birth.
- Dr. Shirley Lo is the instructor for this course offered at the Hong Kong Polytechnic University.
Learning Outcomes
- Students will be able to describe physiological and behavioral adaptations during the transition from intrauterine to extrauterine life.
- Understand thermoregulation in newborns, including hypo- and hyperthermia.
- Students will be able to describe a systematic process, using a "head-to-toes" approach for evaluating newborns.
- Students will be able to identify normal and abnormal reflex responses in newborns.
- Describe nutritional needs for newborns, including the immunization program and neonatal screening in Hong Kong.
- Students will be able to analyze and explain cases, with management strategies for neonatal jaundice.
- Discuss care essentials for neonates at health risk (e.g., infections) and their associated managements.
Outline of NN Lectures
- Major neonatal adaptations: Physiological and behavioral development
- Nursing assessments and care: Immediately after delivery and then subsequent assessments.
- Neonatal needs: Nutritional needs, neonatal screening & neonatal jaundice.
Newborn Adaptation to Extra-uterine Life
- Neonatal period: from birth through the 28th day of life.
- Physiological adaptations: occur in the first 6-8 hours after birth
- Behavioral adaptations: Period of reactivity, state of organization & sleep patterns
- A. Physiological adaptations:
- Establishing and maintaining respirations
- Adjusting to circulatory changes
- Regulating body temperature
- Endocrine adaptations
- Hepatic adaptations
- Immunologic adaptation
- Taking in, retaining, and digesting nutrients
- Eliminating waste
- Regulating body weight
- Sensory / neurological system
- B. Behavioral development:
- Period of reactivity
- State of organization
- Sleep-wake pattern
Physiological Adaptations (Details)
- To survive extra-uterine life, newborns must breathe on their own and initiate the first breath.
- Factors influencing the first breath:
- Chemical factors (uterine contractions, cord clamping; decreased oxygen, increased CO2).
- Mechanical factors (chest compression, fluid expulsion).
- Thermal factors (significant drop in temperature)
- Sensory factors (handling, suctioning, and other stimuli)
Lung Functions
- Surfactant production helps prevent alveolar collapse, especially important for premature infants born before 32 weeks.
- Lung compliance facilitates air entry or expansion.
- Airway resistance has to be overcome to open the lungs.
Successful Sustaining of Respiratory Adaptations
- Reabsorption of fluid from the lungs (with inspiration and expiration), enabling efficient air distribution.
- Increasing fluid flow from alveoli to capillaries and lymphatic circulation is crucial.
- Suctioning may be required.
- Catecholamines (hormones) promote fluid clearance from the lungs is important
Normal Newborn Respiration
- Respiratory rate (RR) is approximately 30-60 breaths per minute(bpm).
- Initially, respiration is shallow and irregular.
- Breathing is diaphragmatic with synchronized abdominal movements.
- Respiration is through the nose.
Abnormal Newborn Respiration
- RR < 30 or > 60 bpm at rest.
- Apnea (>20 seconds)
- Tachypnea (inadequate lung fluid clearance).
- Retractions (ribs).
- Cyanosis (blue skin/lips). - Nasal flaring.
- Expiratory grunting.
- Stridor or gasping (airway obstruction).
- Seek medical help for above indications.
Fetal Circulation
- Blood bypasses the lungs during fetal development.
- Umbilical vein: carries oxygenated blood.
- Foramen ovale: allows blood to shunt from right atrium to left atrium.
- Ductus arteriosus: connects pulmonary artery to descending aorta.
- Umbilical arteries: return deoxygenated blood to placenta.
Cardiovascular Adaptations
- A series of changes occur at birth, leading to the transition to neonatal circulation.
- The umbilical blood vessels close, helping to regulate blood flow to and from placenta.
- The Ductus arteriosus closes, leading to increased pulmonary vascular resistance.
- The Foramen ovale closes, leading to increased blood flow.
- Cardiac and blood pressure adjustments help sustain physiological functions.
Blood
- Blood volume at term.
- Hemoglobin and hematocrit levels.
- Red Blood Cell (RBC) levels. - White Blood Cell (WBC) levels.
- Platelets levels.
- Vitamin K levels.
Cord Management
- Immediate cord clamping (delaying the clamping) has benefits (increased blood volume, decreased risk of anemia) in some instances
- Delayed cord clamping (immediate clamping) is not recommended unless the neonate is asphyxiated and requires immediate resuscitation (moderate quality evidence).
Neonatal Thermoregulation
- Normal axilla temperature: 36.4-37.2°C.
- Neonatal hypothermia: axilla temperature < 36.5°C.
- Body temperature is controlled by the hypothalamus, and brown adipose tissue plays a major role in regulating temperature.
Heat Production (Thermogenesis)
- Increase in muscle activity.
- Increase in cellular metabolic activity (brain, heart, and liver).
- Peripheral vasoconstriction.
- Nonshivering thermogenesis.
Heat Loss From a Newborn
- Convection: air currents
- Radiation: cooler surfaces.
- Conduction: direct skin contact - Evaporation: moisture conversion to vapor.
Neonatal Hypothermia
- The 10-step recommendations to regulate the temperature of neonates, include preparing a 'warm chain' at the delivery suite.
Other observations
- Airway
- Chest wall movement
- Abdomen
- Skin
- Genitalia
- General
Head-to-toe assessments
- General appearance: head, neck, chest, hips, muscles, extremities, hands
- Assessment of the general appearance and physical characteristics.
Newborn Measurements
- Weight: 2.5-4 kg (37-41 weeks).
- Physiological weight loss: 5-10% in first 3-4 days
- Head circumference: 32-37 cm.
- Chest circumference
- Length
Physical Assessment of the Newborn.
- Head symmetry: large, 1/4 of body size.
- Head circumference.
- Soft Spots (anterior & posterior fontanels).
- Face: symmetry, hair, Milia, facial nerve palsy.
- Eyes: symmetry, eyelids, eyeballs.
- Ear: symmetry, position & shape.
- Neck: short, creased and soft.
- Chest - cylindrical & symmetric.
- Abdomen - cylindrical & protruding.
- Extremities: movement, symmetry
Physiological Neonatal Jaundice, Breast Milk Jaundice
- Onset, bilirubin levels.
- Causes.
- Treatment.
- Management of babies with Physiological Jaundice
Pathological Neonatal Jaundice
- Suspects.
- Additional criteria.
Prevention of NNJ
- Neonatal screening is essential.
- Efficient care of the newborn.
- Early detection.
Management of Neonatal Jaundice
- Phototherapy.
- Exchange blood transfusion
Phototherapy
- Maximize baby's skin exposure to the light.
- Cover only the eyes.
- Vital signs & SB monitoring.
- Extra fluid.
Preparing for Discharge
- Health education.
- Client-centered approach.
- Providing information and arranging follow-up with resources.
- Including immunization, follow-up checks, and family planning considerations
Neonatal Nutrition
- Needs
- Breastfeeding
- Formula feeding
- Important considerations
- How to determine if newborn is getting enough nutrition.
Elimination
- Pass urine/meconium within 12 hours.
- Monitor stool & urine
- Abnormal appearance of stools/urine
Hygiene
- Care for eyes. - keeping of cord clean & dry.
Neonatal Immunizations
- Vaccination schedule (Hong Kong)
Assessment of Maturity
- Estimation of gestational age, neurological maturity, musculoskeletal, external physical characteristics, and assessment tools
Assessment of Neuromuscular Maturity.
- Determining neurologic function
- Common newborn reflexes: reflex testing
- Estimations of gestational age: posture, square window (wrist), arm recoil, popliteal angle and scarf sign.
Transitional Period
- Stages of reactivity
- Period of inactivity to sleep phase.
- Second period of reactivity.
Normal Newborn: Needs and Care
- Aims of nursing care: maintain neutral thermal environment, identify physical problems and abnormal functions, promote hydration and nutrition, protect from injuries and infections, enhance parent knowledge.
Observation
- Observing general appearance, vital signs (temperature, respiration, pulse, blood pressure), eyes, nose, mouth, cord conditions, nutrition, elimination (urine, stool), sleep-wake cycle.
Additional Important Notes
- The content of this document is a summary of the provided materials. Further research and study for each concept listed are recommended.
- The information may include information from multiple sources and are specific to neonatal assessments in Hong Kong.
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