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Continuing Care. Mary P. Martinasek, RRT Director of Clinical Education Hillsborough Community College. Homeostatic Thermoregulation. Defined as the maintenance of equality between: Heat dissipation and heat production Core body temp of 37 degrees C. Heat Production.

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Continuing care

Continuing Care

Mary P. Martinasek, RRT

Director of Clinical Education

Hillsborough Community College


Homeostatic thermoregulation
Homeostatic Thermoregulation

  • Defined as the maintenance of equality between:

  • Heat dissipation and heat production

  • Core body temp of 37 degrees C


Heat production
Heat Production

  • Adult - can be produced by metabolic and physical activity (shivering)

  • Infant - has diminished shivering response and relies on metabolism of brown fat for heat production.

    • The breakdown of brown fat is called nonshivering thermogenesis


Methods of heat loss
Methods of Heat Loss

  • Radiant

  • Conductive

  • Convective (ambu bag air blowing on pt.)

  • Evaporative


Goal of thermoregulation
Goal of Thermoregulation

  • Maintain an environmental temperature such that the neonate’s core body temperature is maintained between 36.5 and 37.5 degrees C


Thermoregulation
Thermoregulation

  • Incubator

    • Controlled environment (less convective heat loss)

    • Barrier to excessive handling

    • Quieter environment

  • Radiant Warmer (open bed)

    • Easier patient access (critical care)

    • Easier to attach probes and electrodes


Fluid and electrolyte balance
Fluid and Electrolyte Balance

  • Distribution of Body Water

    • 80% of total body weight of term infant

    • Decreases with aging

  • Distribution of Solutes

  • Fluid Deficit

    • Anterior fontanelles

  • Electrolyte Balance


Distribution of solutes

Extracellular

Major

Sodium

Chloride

Minor

Potassium

Calcium

Magnesium

Bicarbonate

Protein

Intracellular

Major

Potassium

Magnesium

Phosphate

Minor

Sodium

Bicarbonate

Distribution of Solutes


Insensible water loss
Insensible Water Loss

  • IWL - water lost by evaporation from the skin and respiratory tract

  • Factors that increase insensible water loss

    • Premie

    • Respiratory distress

    • High environmental temperature

    • High body temperature

    • Break in skin

    • Radiant warmer

    • Phototherapy

    • Increased activity


Neonatal jaundice
Neonatal Jaundice

  • Physiologic vs. Pathologic

    • Physiologic is common (25-50% of all newborns)

    • Pathologic

      • Caused by RH or ABO incompatibility

      • Bacterial or viral infections

      • Hemorrhaging in fetal body

      • IDM

      • Breast fed infants

      • Determined to be pathologic by certain criteria


Exchange transfusion
Exchange Transfusion

  • Used in an attempt to rid the neonatal body of factors causing hemolysis

  • Replaces about 87% of patient’s blood volume

  • Corrects severe anemia

  • Treats hemolytic disease by removing antibody-coated RBC

  • Removes excessive amounts of unconjugated bilirubin


Necrotizing enterocolitis nec
Necrotizing Enterocolitis (NEC)

  • Idiopathic disorder characterized by ischemia and necrosis of the intestine

  • Etiological Factors include:

    • Mucosal wall injury

    • Bacterial invasion into the damaged intestinal wall

    • Formula in the intestine


Clinical signs and treatment
Clinical Signs and Treatment

  • Guaiac-positive stools (presence of blood)

  • Poorly tolerated feedings

  • Abdominal distension

  • Bile residuals

  • Signs of sepsis (lethargy and increased O2 requirements)

  • Tx= avoid factors that lead to presence


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