Download - The Neonatal Period (N2)
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THE NEONATAL PERIOD
HUMAN DEVELOPMENTVanessa M. Manila, RN
UP Manila College of Nursing
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1. Describe the newborn’s transition to extrauterine life.a. Intrauterine Life
b. Physiologic Adaptations
2. Describe the neonatal physical characteristics
3. Describe the neonate’s behavioral responses and developmental tasks
4. Discuss appropriate nursing care of the newborn
OBJECTIVESOBJECTIVES
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Transition from intrauterine Transition from intrauterine to to
extrauterine lifeextrauterine life
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I. Intrauterine Life
Placental Function:Placental Function:- transfer of gases (lungs)
- transport of nutrients (gastrointestinal tract)
- excretion of wastes (kidneys)- transfer of heat (skin)
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I. Intrauterine LifePlacental Function:Placental Function:
- conjugation of drugs and hormones (liver)
- production of various protein and steroid hormones (endocrine
gland)
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II. Physiologic Adaptations
“ The most profound physiologic change
required of the neonate is
transition from fetal or placental
circulation to independent
respiration…” (Whaley and Wong,
1989)
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II. Physiologic Adaptations
A. Respiratory adaptationsB. Cardiovascular adaptationsC. Temperature regulationD. Urinary AdaptationsE. Gastrointestinal AdaptationF. Hepatic AdaptationG. Immunologic SystemH. Neurologic and Sensory/ Perceptual
Functioning
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II. Physiologic Adaptations
most critical: first 24 hoursthe most critical and immediate physiologic change required of the newborn is the onset of breathing
slapping the infant’s feet/ buttocks has no beneficial
effect
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- shallow and irregular depth and rhythm- Primarily abdominal and synchronus with
the chest mov’t- Short periods of apnea are to be expected- Pauses lasting 5- 15 secs, called periodic
breathing, may occur
Characteristics:- Normal rate: 30- 60
breaths per minute
II. Physiologic Adaptations
A. Respiratory adaptations
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Characteristics:Heart rate: 100 bpm when asleep; 120- 150 when awake
- Rates as high as 180 while crying may be normal
- Apical pulse rates should be obtained by auscultation for a full minute
BP: resting: 74/47 mmHg- Crying may cause elevation
II. Physiologic Adaptations
B. Circulatory adaptations
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Neonatal Characteristics affecting thermal adaptation:- decreased subcutaneous fat and thin epidermis- blood vessels are closer to the skin- large body surface area- flexed posture - presence of Brown Adipose Tissue
II. Physiologic Adaptations
C. Thermogenic Adaptations
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Thermogenesis in newborn:- increased muscular activity and positional changes- chemical thermogenesis (non-shivering thermogenesis); increased basal metabolic rate- vasomotor control
II. Physiologic Adaptations
C. Thermogenic Adaptations
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First voiding should occur within 24 hoursUnable to concentrate urineUsually straw- colored and almost odorlessPseudo- menstruation in female infant
II. Physiologic Adaptations
D. Renal System
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II. Physiologic Adaptations
Loss of fluid, through urine, feces, lungs, increased metabolic rate and limited fluid
intake results in 5- 10% loss of body weight. This usually occurs during the
first 3-5 days. The infant usually regains the birth weight within 14 days after birth
At birth the total weight of the infant is 73% fluid as compared to 58% in
the adult
The infant has a proportionately higher ratio of
extracellular fluid than the adult
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II. Physiologic Adaptations
E. Gastrointestinal System
The ability to digest, absorb, and metabolize food stuff is adequate but limited in certain functions.
(Whaley and Wong, 1989)
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II. Physiologic Adaptations
E. Gastrointestinal System
A special mechanism coordinates breathing, sucking, and swallowing reflexes necessary for oral feedingSucking in newborn takes place in small bursts of 3- 8 sucks at a timeUnable to move food
from the lips to the pharynx
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III. Physiologic Adaptations
F. Hepatic Regulation
Liver is immature
Plays an important role:1. conjugation of bilirubin2. blood coagulation
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II. Physiologic Adaptations
G. Immunologic System
Cells that provide the infant with immunity are developed early in fetal lifeNot activated for several monthsFirst 3 months: passive immunity from the mother
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III. Physiologic Adaptations
G. Immunologic System
Breast- fed infants receives passive immunity through colostrums and breast milkSepsis: respiratory distressBest protection: hand hygiene
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II. Physiologic AdaptationsH. Neurologic and Sensory/
Perceptual Functioning
Neither anatomically nor physiologically developedAll neurons are presentUncoordinated in movementLabile in temperature regulationHave poor control over their musculature
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II. Physiologic AdaptationsH. Neurologic and Sensory/
Perceptual Functioning
Vision- the least
mature at term- development
continues for the first 6 months
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II. Physiologic AdaptationsH. Neurologic and Sensory/
Perceptual Functioning
Hearing- as soon as amniotic fluid is drained
from the ear, hearing is similar as to that of an adult
- react to high frequency sound with a startle
- reacts to low- frequency sound by decreasing motor activity or stopping crying
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II. Physiologic AdaptationsH. Neurologic and Sensory/
Perceptual Functioning
Smell- highly developed- by the 5th day, can recognize
mother’s smell- breastfed infants are able to smell
breastmilk and can differentiate their mother from other lactating women
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II. Physiologic AdaptationsH. Neurologic and Sensory/
Perceptual Functioning
Taste- tasteless solution: no response- sweet: eager sucking- sour: puckering of lips- bitter: grimace- newborns prefer glucose water to plain water
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II. Physiologic AdaptationsH. Neurologic and Sensory/
Perceptual Functioning
Touch- responsive to all
parts of the body- face, hands, and soles
of the feet appear to be the most sensitive
- touch and motion are essential to normal
growth and development