NUR 227MN Oxygenation Notes.odt/GUIDE TO SCORE A

NUR 227 MN Oxygenation Notes.odt Extrauterine Transition of the Respiratory System Step 1: In Utero o In utero gas exchange occurs via the placenta. o Lungs are not working for gas exchange. Increased amount of RBCs ...

NUR 227 MN Oxygenation Notes.odt Extrauterine Transition of the Respiratory System Step 1: In Utero o In utero gas exchange occurs via the placenta. o Lungs are not working for gas exchange. Increased amount of RBCs get oxygen to vital organs. o The lungs will mimic normal respiratory movement in preparation for transition. Baby “practices” breathing by swallowing amniotic fluid. Step 2: During Labor & Delivery o Normal labor causes hypercapnia (excessive carbon dioxide in the bloodstream, typically caused by inadequate respiration.), hypoxia (deficiency in the amount of oxygen reaching the tissues), and acidosis (respiratory acidosis occurs when the lungs can't remove enough carbon dioxide) to stimulate respirations. o During labor all blood flow to baby is cut off at the peak of a contraction; While moving through birth canal, no air supply; Both leading to mild asphyxia. The respiratory control center of the brain is stimulated. o During a vaginal birth, when the chest is compressed, the pressure then released, and the baby inhales air into the lungs. This allows the amniotic fluid in the lungs to be expelled. The fluid goes out through the pulmonary capillaries and lymphatic system. Step 3: At Birth o Crying at birth continues to promote positive pressure, air in the lungs, and therefore alveoli expansion. o Gasping reflex stimulated from noise, light, cooler temperature, increased CO2, decreased O2, handling. Newborn Respiratory Assessment o Count Respiratory Rate – Assess one full minute – 30-60 bpm – Listen or watch rise and fall of cord – Infant must be resting quietly! o Breath Sounds – Expected: Clear, Equal Bilaterally, Fine Crackles possible in first few hours after birth – Deviations: Unequal, Rales, Rhonchi, Wheezing, Stridor o Oxygen Saturation – Expected: 95%-100% o Pattern – Expected: Regular (Irregular is regular!), Periodic Breathing, Shallow – Deviations: Prolonged Apnea o Chest Expansion – Expected: Symmetrical – Deviations: Retractions o Mucous Membranes – Expected: Pink, Moist – Deviations: Cyanosis, Pallor o Periodic Breathing – Apnea less than 5 seconds okay – Apnea 5-10 seconds “periodic”, okay if tactile stimulation converts to normal pattern and no color or heart rate changes present – Apnea greater than 20 seconds ABNORMAL o Signs of Respiratory Distress – Retractions – Grunting – Tachypnea at Rest – Nasal Flaring – Labored – Cyanosis (Late sign) Transient Tachypnea of the Newborn o Mild respiratory distress caused by a delay in lung fluid clearance that resolves in 24-72 hours. o Risk factors: – Mom heavily sedated during labor and delivery – Born via cesarean section. o Symptoms: – Tachypnea – Grunting – Mild intercostal retractions – Decreased breath sounds due to reduced air entry – Labored respirations – Nasal flaring – Mild cyanosis o Diagnosis: – Chest x-ray – ABG (arterial blood gas)- degree of gas exchange and acid-base balance. o Nursing Management: Supportive care based on symptoms. – Adequate oxygenation (O2 via NC or hood for good O2 sat) – May need IV fluids or gavage feedings; PO feeds ONLY if respiratory rate WNL – Neutral thermoenvironment – Minimal stimulation to minimize O2 demand Respiratory Distress Syndrome Resulting from lung immaturity and lack of alveolar surfactant (reduces surface tension and prevents collapse of alveoli). Self-limiting, symptoms decline after 72 hrs. o Risk factors: (All impact surfactant production!) – Preterm birth – Perinatal asphyxia – Neonatal sepsis – Born via cesarean section – Male gender – Maternal diabetes o Symptoms are shown at birth or within a few hours: – Grunting – Nasal flaring – Retractions – Seesaw respirations – Cyanosis – Tachycardia – Crackles – Tachypnea o Diagnosis: o Presenting symptoms o Chest x-ray o Rule out any underlying causes such as infection, sepsis o Nursing Management: Supportive based on symptoms o O2 with mechanical vent, CPAP, NC, PEEP, surfactant therapy o Maintain body temperature o Maintain fluid balance o Provide nutrition o Maintain circulation for tissue perfusion o Monitor O2 saturation o Suction via bulb syringe or deep suction o Cluster care Antenatal Glucocorticoid Therapy MEDICATION / DOSE / ROUTE CLASS / ACTION SIDE EFFECTS NURSING IMPLICATIONS Betamethasone (Celestone) 12 mg IM for two doses 24 hours apart (Oxygenatio n) Corticosteroid: *Stimulates fetal lung maturity by promoting release of enzymes that induce production or release of lung surfactant *To prevent or reduce respiratory *May worsen maternal conditions such as DM or HTN *Give deep IM in ventral gluteal or vastus lateralis muscle *Assess blood glucose *Administer two doses intramuscularly 24 hr apart. distress for fetuses b/n 24-34 weeks *Monitor for maternal infection or pulmonary edema. *Educate parents about potential benefits of drug to preterm infant. Assess maternal lung sounds and monitor for signs of infection.