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The Normal Newborn

The Normal Newborn. Assessment and Care. Three transition phases. Phase One: the first hour Phase Two: from one to three hours Phase Three: from two to 12 hours. Care at birth (nurse’s job). Call out time of birth Receive the baby onto a warm clean towel and place on mother’s chest

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The Normal Newborn

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  1. The Normal Newborn Assessment and Care

  2. Three transition phases • Phase One: the first hour • Phase Two: from one to three hours • Phase Three: from two to 12 hours

  3. Care at birth (nurse’s job) • Call out time of birth • Receive the baby onto a warm clean towel and place on mother’s chest • Clamp and cut the umbilical cord • Dry the baby with a warm, clean towel or piece of cloth • Assess baby’s breathing while drying Steps 3

  4. Care at birth… • Wipe both eyes (separately) with sterile gauze pieces • Put the baby between mother’s breasts for skin-to-skin contact • Place an identity label on the baby • Cover mother and baby with warm cloth; put a cap on the baby’s head • Initiate breastfeeding 4 NC-

  5. Prevention of infections After delivery • Hand washing before handling the baby • Exclusive breastfeeding • Keep the cord clean and dry; do not apply anything • Use a clean cloth as a diaper/napkin • Hand wash after changing diaper/napkin 5 NC-

  6. Priorities in first hour • Cardiovascular assessment and support • Thermoregulation • Assessment and support of blood glucose • Identification • Observing urinary/meconium passage • Observing for major anomalies and for apparent gestational age concerns

  7. APGAR ASSESSMENT • One and five minutes • Meant to identify the need for neonatal resucitation

  8. APGAR SCORE

  9. Criteria 0 1 2 Color Blue or pale Acro-cyanotic CompletelyPink Heart Rate Absent Slow    (< 100/min) >100/min Reflex irritability No response Grimace Cough, sneeze, cry Muscle tone Limp Some flexion Active motion Respirations Absent Slow, irregular Good, crying APGAR SCORE

  10. Vital Sign Normals • 97.7-98.6 F (36.5-37 C) • 110-160 • A soundly sleeping baby can go to 80 bpm • A crying baby may be as high as 180

  11. Voids and Stools • Document from the moment of birth • Urination sometimes missed in early minutes • Generally expect both within the first 24 hours • One really wet diaper per day of age until milk is fully in.

  12. Quick Assessment of Gestational Age • Skin • Vernix • Hair • Ears • Sole Creases • Resting Posture

  13. Cracked Skin

  14. Abundant Lanugo

  15. Ear of a preterm infant

  16. Sole creases

  17. Comparison of resting posture

  18. Routine Medications • Erythromycin Eye Ointment • Aquamephyton (vitamin K) • First Hepatitis B vaccine

  19. Physical Characteristics During Phases Two and Three

  20. Nervous System: Reflexes • Head lag • Moro reflex • Rooting • Tonic Neck reflex • Dancing reflex • Magnet reflex • Rooting reflex • Suck • Hand and foot grasp • Babinski • Trunk incurvation • Observe for symmetry

  21. Head Lag

  22. Moro Reflex

  23. Tonic Neck Reflex

  24. Dancing Reflex

  25. Suck Reflex

  26. Hand Grasp

  27. Foot Grasp

  28. Head • Head circumference • Molding • Fontanelles • Anterior closes between 12-18 months • Posterior closes by the end of the 2nd month

  29. Eyes • Eye placement • Blink reflex • Discharge • Pupil reaction

  30. Hearing • Check overall response to sudden sound • Moro reflex • Check for placement of ears • Low set ears may indicate a congenital anomaly • Most infants receive hearing screening within the first week of life

  31. Respiratory and Cardiovascular • Ongoing assessment of cardio respiratory status that has occurred since birth • More thorough heart assessment • Murmur may be present until fetal openings have completely closed however they must be carefully verified by pediatrician • Femoral and brachial pulses • Abdominal breathing; nose breathers

  32. Femoral Pulses

  33. Brachial Pulses

  34. Assessment of Respiratory Status

  35. Musculoskeletal • Symmetry!! • Five finger and five toes!!! • Clavicles • Movement of arms • Hips for developmental hip dysplasia • Lower legs/feet for “club foot” • Back: curvatures, cysts or dimples

  36. Hip Check

  37. Hip Check Skin Folds

  38. Gastrointestinal • Passage of meconium • Abdomen should be soft and non tender • Round but not distended • Bowel sounds are present after first hour of birth • Umbilical cord inspection

  39. The Normal Newborn Care measures for the normal newborn plus a little more.

  40. Jaundice • Yellow coloring of an infants skin • Common and is caused by the natural breakdown of RBCs in the infant after birth • Is never considered normal in the first 24 hours.

  41. Physiologic Jaundice • Most jaundice in newborns is physiologic • It peaks between 48-72 hours • Usually disappears within a week • Usually benign • Can become elevated to a point of concern for the baby

  42. PHOTOTHERAPY

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