1. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Chapter 17 Physiological Transition of the Newborn

2. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Adaptations of the Respiratory System  Intrapulmonary fluid  Reduces pulmonary resistance to blood flow  Facilitates initiation of air breathing  Surfactant  Decreases surface tension within alveoli

3. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley The First Breath  Internal stimuli  Chemical factors  External stimuli  Sensory factors  Thermal factors  Mechanical factors

4. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Cardiopulmonary Transitions  Increased pulmonary blood volume  Conversion from fetal to neonatal circulation  Immediate assessment necessary  Skin color  Respiratory rate; breathing pattern

5. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Cardiopulmonary Adaptation  Increased aortic pressure and decreased venous pressure  Increased systemic pressure and decreased pulmonary pressure  Closure of foramen ovale, ductus arteriosus, and ductus venosus

6. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Assessing the Cardiovascular Transition  Pulse  Within 30 minutes—120 to 160 bpm  Capillary refill  <3 seconds adequate  >4 seconds possible underlying problem

7. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Thermogenic Adaptation  Newborns are homeothermic  Neutral thermal environment  Cold stress  Large body area  Limited subcutaneous fat  Limited ability to shiver  Thin skin and blood vessels close to surface

8. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Adaptations to Increase Heat Production  Increased BMR and muscle activity  Peripheral vasoconstriction  Nonshivering thermogenesis  Brown adipose tissue

9. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Mechanisms for Neonatal Heat Loss  Evaporation  Insensible water loss  Conduction  Convection  Radiation

10. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Hematopoietic Adaptation  Blood volume  Blood components  Erythrocytes and hemoglobin  Hematocrit  Leukocytes  Platelets

11. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Hepatic adaptation  Glycogen and blood glucose maintenance  Iron storage  Conjugation of bilirubin  Coagulation of blood

12. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Hyperbilirubinemia  Physiologic jaundice—appears 24 to 48 hours after birth; transient  Pathologic jaundice—present at birth or within 24 hours  Breastfeeding jaundice—2 to 4 days  Breast milk jaundice—7 days; peaks at 10 days

13. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Gastrointestinal Adaptation  Stomach and digestive enzymes  Intestinal peristalsis  Meconium

14. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Genitourinary Adaptation  Kidney function  Bladder capacity 6 to 44 mL  Fluid requirements—60 to 80 mL/kg  Urine output 1 to 3 mL/kg/hour  Nursing assessments  Careful monitoring of I/O  Assess appearance of urine

15. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Immunological Adaptation  Active acquired immunity  Passive acquired immunity  Immunoglobulins

16. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Psychosocial Adaptation  Early stages of activity  First period of reactivity  Period of inactivity and sleep  Second period of reactivity

17. Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Maternal-Child Nursing Care Optimizing Outcomes for Mothers, Children, & Families Susan Ward Shelton Hisley Susan Ward Shelton Hisley Behavioral States  Sleep  Deep, quiet; REM  Alert  Drowsy/semidozing  Wide awake  Active awake  Crying