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WVU NSG 423 - Exam 3 Study Guide
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NSG 423 1st Edition Exam # 3 Study GuideDescribe four factors that are thought to stimulate the newborn to take its first breath.A newborns ability to breathe air immediately after birth appears to result from fetal breathing movements which are practiced intrauterine respiratory movements that begin at about 17-20 weeks gestation. The lungs convert from a fluid-filled organ to an air-filled organ capable of gas exchange. To maintain life, two changes must occur for the lungs to begin adequate functioning: Pulmonary ventilation must be established through lung expansion. A marked increase in the pulmonary circulation must occur. The first breath of life initiates the serial opening of the alveoli and so begins the transition from a fluid-fillled organ to an air-filled organ.Mechanical events:Fluid production expands the lungs almost completely filling the air spaces. In prep for birth, lung fluid production normall decreases and fetal breathing movement decreases 24-36 hours before onset of true labor. As the fetus experiences true labor there is a fetal gasp and active exhalation that initiates the removal of fluid from the lungs.-during the vaginal birthing process the fetal chest is compressed and during delivery the chest wall recoils to produce negative air pressure which then creates the thoracic squeeze. Labor is primarily responsible for the initial movement of the lung fluid out of the lungs.Chemical stimuli:Transitory asphyxia of the fetus and newborn is an important chemical stimulator that contributes to the onset of breathing. The first breath is an inspiratory gasp, result of central nervous system reactingto sudden pressure. Thermal stimuli- a decrease in ambient temperature after birh—from 37 degrees to 21-23.9 degrees results in sudden chilling of the moist newborn. Cold stimulates the skin sensory receptors and the newborn responds with rhythmic respirations. Excessive cooling may result in profound respiratory depression and evidence of cold stress.Sensory stimuli- during intrauterine life the fetus is in dark sound-dampended fluid filled environment.The environment changes after birth. Place baby skin to skin with mother.State four anatomic and physiologic changes that occur in the cardiovascular system during the transition from fetal to neonatal circulation. Increased aortic pressure and decreased venous pressure-clamping of the umbilical cord eliminates the placental vascular bed and reduces the intravascular space. Consequently, aortic blood pressure increases. Blood return via the inferior vena cava decreases, resulting in decreased right arterial pressure and a small decrease in pressure Increased systemic pressure and decreased pulmonary artery pressure- with the loss of the low-resistance placenta, systemic resistance increases resulting in GREATER systemic pressure. At the sametime, lung expansion increases pulmonary blood flow and the increased blood PO2 associated with initation of respirations dilates pulmonary blood vessels. The combo of vasodilation and increased pulmonary blood decreases pulmonary artery resistance. As the pulmonary vascular beds open, the systemic vascular pressure increases, enhancing perfusion to the other body systems.Closure of the foramen ovale- a function of changing arterial pressures. In utero, pressure is greater in the right atrium and the foramen ovale is open after birth, shunting blood from the right atrium to the left. There is an increased of pulmonary venous return into the left atrium. Closure of the ductus arteriosus.Closure of the ductus venosus. A newborns temperature drops when she is placed on the cool plastic surface of the weight scales. This is an example of heat loss by:conduction-loss of heat to a cooler surface by direct skin contact like scales, or stethoscopesWhat position do most newborns usually assume? Why?Newborns tend to stay in a flexed position on their back. This is normal for a full term infant. Describe physiologic jaundice. Include why the time of onset of the jaundice is important.Physiologic jaundice is caused by accelerated destruction of fetal RBC’s. impaired conjugation of bilirubin, increased bilirubin reabsorption from intestinal tract. This is a normal biologic response tonewborns. Jaundice that occurs before 24 hours is a sign of pathologic jaundice. Pathologic jaundice is a cause for concern and intervention. If jaundice appears after first day it will most likely only last untilday 3-5. List the normal range of values for the following newborn initial assessment:a) Temp 36.4-37.2b) Pulse-110-160c) Respirations- 30-60d) blood pressure- 50-70/30-45e) average wt. 2500-4000gramsf) Average length- 48-52 centimetersg) Circumference of head- 32-37 cmh) Circumference of chest- 30-35cmUsual weight loss within the first 3 to 4 days of life for a full-term newborn is 5-10% (due to the fluid shifts)Why does the newborn commonly exhibit a “physiologic weight loss”?Due to the fluid shifts and insufficient caloric intake for weight gain until the newborn can effectively feed and get the breast milk (3rd day) from mom. Typically resolved around 5-10 days old.Identify each of the following newborn skin variations, differentiating them by appearance, location, and significance:a) harlequin color changea deep color develops over one side of the newborns body while the other remains pale. The skin resembles a clown suit. This color change results from vasomotor disturbance in which blood vessels on one side are dilated and the other side they constrict. Lasts about 1-20 minutes. Clinically insignificant.b) erythema neonatorum toxicuman eruption of lesions in the area that surrounds a hair folice. They are firm, vary in size from about 1-3 mm and they have a white or pale yellow papule or pustule with an erythematous base. It is often called newborn rash or flea bite. Usually over the trunk or diaper area and will disappear in a few hours or days.c) telangiectatic nevi (stork bites)appears as pale pink or red spots and are frequently found on eyelids, nose, lower occipital bone, and nape of the neck. They have no clinical significance and usually fade by day 2.d) nevus flammeus (port-wine stain)capillary angioma directly below the epidermis. It is nonelevated, sharply demarcated, red to purple area of dense capillaries. Commonly appears on the face, it does not grow in size, does not blanch and does not fade in time.e) Mongolian spotsMacular areas of bluish black


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WVU NSG 423 - Exam 3 Study Guide

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