N106 Nursing Care of the Newborn

1. N106Nursing Care of the Newborn

2. Immediate Baby Care • Airway - Clean mouth and nose • Thermoregulation - Warmth • APGAR • Gross assessment • Identification • Bonding – safety against infection • Medications

3. Fetus to Newborn: Respiratory Changes • Initiation of respirations • Chemicalsurfactant reduces surface tension 34-36wksdecrease in oxygen concentration • Thermalsudden chilling of moist infant • Mechanicalcompression of fetal chest during delivery normal handling

4. Nursing Process for Respirations • Assess for respiratory distress • Plan: Maintain patent airway • Interventions- Positioning infant – head lower - Suction secretions – bulb, keep near head, mouth first, avoid trauma to membranes • Evaluation – rate 30-60, no distress

5. Fetus to Newborn: Neurological adaptation: Thermoregulation Methods of heat loss Evaporation – wet surface exposed to air Conduction – direct contact with cool objects Convection- surrounding cool air - drafts Radiation – transfer of heat to cooler objects not in direct contact with infant

6. Convection Radiation Evaporation Conduction

7. Nonshivering thermogenesisThe distribution of brown adipose tissue (brown fat)

8. Nursing Care – Cold Stress • Preventing heat loss – radiant warmer • Providing immediate care - dry quickly, cover head with cap, replace wet blankets • Providing on going prevention - safety • Restoring thermoregulation – if becoming chilled - intervene

9. Effects of Cold Stress • Increased oxygen need • Decreased surfactant production • Respiratory distress • Hypoglycemia • Metabolic acidosis • Jaundice

10. APGAR • Heart rate – above 100 • Respiratory Effort – spontaneous with cry • Muscle tone – flexed with movement • Reflex response – active, prompt cry • Color – pink or acrocyanosis • 0-3 infant needs resuscitation • 4-7 Gentle stimulation – Narcan • 8-10 – no action needed

11. Early Assessments • Assess for anomalies • Head – anterior fontanelle closes 12-18 mo posterior fontanelle closes 2-3 months • Neck and claviclesfracture of clavicle – large infant, lump, tenderness, crepitus, decreased movement • Cord • Extremitiesflexed and resist extensionassess fractures, clubfeethipsvertebral column

12. Not crossing suture line Cephalhematoma is a collection of blood between the surface of a cranial bone and the periosteal membrane.

13. Crossing suture line Caput succedaneum is a collection of fluid (serum) under the scalp.

14. A, Congenitally dislocated right hip B, Barlow’s (dislocation) maneuver. C, Ortolani’s maneuver

15. Measurements • Weight – loss of 10% normal • Length • Head and chest circumference • Normal VStemp 97.7-99.5F axillaryapical pulse 120-160bpm respirations 30-60/min

16. head larger A, Measuring the head circumference of the newborn. B, Measuring the chest circumference of the newborn.

17. Assessment of Cardio-respiratory Status • History • Airway • Assessrateq 30minX2hrssymmetrybreath sounds - moisture for 1-2 hrs

18. Assessment of Thermoregulation • Check soon after birth • Set warmer controls • Take temp q 30 min until stable • Rectal for first temp • Insert only 0.5 inch • Axillary route rest of time

19. Axillary temperature measurement. The thermometer should remain in place for 3 minutes.

20. Assessment of Hepatic Function • Blood GlucoseSigns of hypoglycemia jitteriness respiratory difficulties drop in temp poor suckingTx- feed infant if glucose below 40-45 mg/dl • Bilirubinphysiologic jaundice peaks 2-4 days of lifeearly onset may be pathologic

21. Jaundice • Hemolysis of excessive erythrocytes • Short red blood cell life • Liver immaturity • Lack of intestinal flora • Delayed feeding • Trauma resulting in bruising or cephalhematoma • Cold stress or asphyxia

22. Potential sites for heel sticks. Avoid shaded areas to prevent injury to arteries and nerves in the foot.

23. Assessment of Neuro System • Reflexes • BabinskiGraspMoroRootingSteppingSuckingTonic neck reflex “fencing” • Cry • Infant response to soothing

24. Assessment of Gastrointestinal System • Mouth • Suck • Abdomen • Initial feeding • Stoolsmeconium – within 12-48 hours of birth dark greenish blackbreastfed – soft, seedy, mustard yellowformula-fed – solid, pale yellow

25. Assessment of Genitourinary System • Umbilical cord vessels • Urine – within 24 hours of birth • Voiding – 6 to 10 times a day after 2 days • Genitaliafemale – edema normal, majora covers minora, pseudomenstruationmale – pendulous scrotum, descended testes by 36 wks gest., placement of meatus

26. Assessment of Integumentary System • Vernix – white covering • Lanugo – fine hair • Milia • Erythema toxicum – red blotchy with white • BirthmarksMongolian spots – sacral areaTelangiectatic nevus “stork Bite” - blanches Nevus flammeus “port wine stain” - no blanchingNevus vasculosus “strawberry hemangioma” usually on head, disappears by school age

27. Port Wine Stain Erythema toxicum

28. Fetus to Newborn: Psychosocial adaptation • Periods of Reactivityactive – 30-60 minsleep – 2-4 hoursalert – 4-6 hours • Behavioral Statesquiet sleepactive sleepdrowsy statequiet alert – best for bondingactive alertcrying state

29. Gestational Age Assessment • Assessment tool – Dubowitz, Ballard • Weeks from conception to birth • Used to identify high risk infants • Neuromuscular characteristicsPosture – more flexionSquare window – more pliableArm recoil - activePopliteal angle - lessScarf Sign – less crossing Heel to ear – most resistance

30. Newborn maturity rating and classification

31. Gestational Age Assessment • Physical characteristicsSkin- deep cracking, no vessels seen, post-leatheryLanugo – less as agePlantar creases – more with ageBreasts – larger areola Eyes and Ears – stiff with instant recoilGenitals – deep rugae, pendulous, covers minora • Gestational Age & Size – may not correspondsmall SGA <10% for weight large LGA >90% for weightappropriate AGA between 10-90%

32. Classification of newborns based on maturity and intrauterine growth.

33. Classification of newborns by birth weight and gestational age.

34. Ongoing Assessment and Care • Bathing • Cord care • Cleansing diaper area • Assisting with feedings • Protecting infantidentifying infantpreventing infant abduction – alert to unusualpreventing infection • Review beige cue cards in center of book for teach

35. One method of swaddling a baby.

36. Common Breastfeeding Positions

39. Infant in good breastfeeding position : tummy-to-tummy, with ear, shoulder, and hip aligned.

40. LATCH was created to provide a systematic method for breastfeeding assessment and charting.

41. Infant teaching checklist is completed by the time of discharge.

42. Circumcision • Most common neonatal surgical procedure • Reasons for choosing • Reasons for rejecting – hypospadias, epispadias • Pain relief • Methods • Nursing care

43. Circumcision using a circumcision clamp.

44. Circumcision using the Plastibell.

45. Other Concerns • ImmunizationsHepatitis B – begin vaccine at birth • Screening testsHearingPhenylketonuria – by law

46. Further Assessments • Complications r/t poorly functioning placentahypoglycemiahypothermiarespiratory problems • Complications r/t LGA infanthypoglycemiabirth injury due to size

47. Shoulder Dystocia • Risk factorsdiabetes; macrosomic infantobesityprolonged second stageprevious shoulder dystocia • Morbidity- fracture of clavicle or humerus,brachial plexus injury • Management – generous episiotomy

48. Neonatal morbidity by birth weight and gestational age.

49. High Risk Infants • Preterm – before 38 weeks gestation • IUGR – full term but failed to grow normally • SGA - • LGA • Infants of Diabetic mothers • Post mature babies • Drug exposed

50. Preterm infants • Survive - Weight 1250 g -1500 g – 85-90%500-600g at birth 20% survive • Ethical questions • Characteristics – frail, weak, limp, skin translucent, abundant vernix & lanugo • Behavior – easily exhausted, from noise and routine activities, feeble cry