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MATERNAL & NEWBORN NURSING

MATERNAL & NEWBORN NURSING. Care of the Newborn Unit 5. Adaptation to extrauterine life. Establish & maintain respirations Ingest, retain & digest food Eliminate wastes Regulate temperature Regulate weight. Normal Reddish pink & smooth Vernix & lanugo Milia Fingernails/Toenails

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MATERNAL & NEWBORN NURSING

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  1. MATERNAL & NEWBORN NURSING Care of the Newborn Unit 5

  2. Adaptation to extrauterine life • Establish & maintain respirations • Ingest, retain & digest food • Eliminate wastes • Regulate temperature • Regulate weight

  3. Normal Reddish pink & smooth Vernix & lanugo Milia Fingernails/Toenails No perspiring Mongolian spots Abnormal Caput succedaneum Cephalhematoma Forcep marks Nevus flammeus Molding Integumentary System

  4. Normal Good tone Extremities flexed Develops as exercises As neuro matures, muscles strengthen allowing muscle control Bones soft / pliable Abnormal “Rag doll” appearance Decreased / absent movement Unusual alignment Unequal lengths Skin folds over buttocks & thighs Musculoskeletal System

  5. Normal Quiet breathing Nasal breathing; little effort Rate changes with activity; 30 – 50 bpm; irregular rhythm Abnormal Grunting Unequal breath sounds Retractions Mouth breathing Dilation of nares R > 60 or < 20 bpm Unequal rise & fall of chest Respiratory System

  6. Normal Umbilical cord = 2 arteries & 1 vein HR 120-160bpm Vitamin K given Physiological jaundice Abnormal Cyanosis/pallor mucous membranes or trunk; “dusky” Resting HR > 160bpm Jaundice of skin / sclera before 48 hrs Circulatory System

  7. Normal Meconium Transitional stool Yellow & soft Pasty vs. more solid Lack of abd. muscles Lips, cheeks, palate complete Saliva @ 2-3 months Small regurgitations Abnormal 1st 24 hrs no meconium Hard or watery stools Absence of lip tissue Hole in palate Choking/resp. distress when eating Excessive drooling Abdominal distention Absence of anal opening Repeated vomiting Gastrointestinal System

  8. Normal Void within 1st 24 hrs Lg amt uric acid = 1st void a rusty red stain on diaper Avg 6 wet diapers Circumcision after 12 hrs old Abnormal No void 1st 24 hrs **notify Dr. if no void in 8 hrs Voiding from an abnormal opening Urinary System

  9. Normal Coordinates suck, swallow, breath Cough, sneeze, gag Jerky, poor coordinated movement 2 fontanels Sleep 15-20 hrs / day Ax temp: 96.5 – 98.6F. Reflexes Lose 5-10% birth wt. in 1st 3-4 days of life Abnormal High pitch cry Weak cry Poor sucking reflex Choking/difficult swallowing Absence of reflexes Hyperactive responses & irritability Neurological System

  10. Endocrine System • 2 special assessments • PKU (phenylketonuria) • Not able to metabolize phenylalanine – amino acid in protein food • After ingested protein from milk for 24 hrs blood is drawn; 2-3 days of age • Excessive amt in body causes mental retardation • T3/T4 • Hypothyroidism = mental retardation

  11. Normal Vision limited Hearing can distinguish mom’s voice in 1st days of life Taste bitter turns away; accepts sweet Smell present when amniotic fld cleared from nares Abnormal Eyes/ears drainage Poorly shaped ears Dull or cloudy eye appearance Failure to react to bright lights or loud noises Sensory System

  12. Proper care of the neonate • Maintain a safe environment • Provide emotional needs of the infant • Provide physical care to the infant

  13. At risk neonates • At risk neonates – have potential problems but are not sick • Have normal VS but need frequent observations & interventions IE – Abn. maternal hx. or L & D hx., pre or post term, LGA or SMA

  14. Sick neonates • Sick neonates – abnormal VS or activity • Requires close observation & changes may necessitate immediate action

  15. Preterm Neonates • Born before 38 weeks • Determined by gestational age & additional observations • Level of maturation determined by ability of organs to function • Usually about 2 yrs. to “catch up”

  16. Pre-term potential problems • Respiratory Distress Syndrome (RDS) due to immature lungs if expected to have pre-term - corticosteriods given to help develop lungs surfactant deficiency 30% of all neonatal deaths

  17. Hypoglycemia (BS < 40) low sugar stores = CNS depression, resp. depression, & decreased CO. Observe lethargy, tachypnea, tachycardia, low temp Hypothermia “cold stress” - heat rapidly lost = use all extra energy to keep warm Observe & act increased resp & apnea provide environmental temperature Potential problems (cont)

  18. Retinopathy of prematurity High O2 levels in arterial blood = separation of retina = blindness Observe O2 sat Feeding difficulties < 32-34 gest. age often cannot coordinate suck, swallow, breathe = aspiration risk Intervention feed / G-tube Potential problems (cont)

  19. Anemia Intervention blood transfusion Necrotizing Enterocolitis acute inflammation of bowel, decreased blood flow to bowel = necrosis Assessment & action distention, bloody stools, diarrhea, bilious vomitous; AB, parenteral nutrition, surgery Potential problems (cont)

  20. Apnea Interventions O2, stimulate breathing (rub feet/back) Hyperbilirubinemia liver is immature = not help with getting rid of bilirubin = jaundice & if untreated = kernicterus – neuro complication causing brain damage Intervention phototherapy Potential problems (cont)

  21. Post Term Neonates • Born after 42 weeks • May be at increase risk of illness d/t deteriorating / aging placenta • Dry peeling skin

  22. Asphyxia may require resuscitation Hypoglycemia sugar stores low = CNS depression, resp. depression, decreased CO Respiratory distress aspirated meconium = pneumonia Post-term potential problems

  23. Hypothermia When cold the metabolic rate, increases = hypoglycemia, acidosis, & hypoxia Assess & action check temp regulate temp with external equipment Hyperthermia At risk when in incubators, radiant heat, phototherapy lights Assess & action increased resp, pulse, metabolic rate skin probe for temp Hypothermia vs. Hyperthermia

  24. Measuring Temperature • Axillary best method–37⁰ C (98.6⁰ F) • Rectalnot until anal patency determined

  25. Elevated bilirubin level (20mg/dl) Kernicterus Physiologic cause Undersecretion from immature liver &/or sluggish excretion from GI tract Hemolytic cause Maternal antibody causes faster than normal breakdown of RBC’s Sepsis Infection & liver functions poorly Treatment Phototherapy, transfusion, hydration Hyperbilirubinemia

  26. Congenital heart disease • Structural abnormality present at birth = interference with normal oxygenation • Signs & symptoms • Cyanosis • Tachypnea • Tachycardia, murmurs • Activity intolerance • Failure to thrive

  27. Types of Congenital Heart Disease • Patent Ductus Arteriosus (PDA) • Ductus arteriosus not closed forcing oxygenated blood from aorta back to pulmonary circulation = increased left ventricle workload & pulmonary blood pressure

  28. Types of Congenital Heart Disease (cont) • Ventricular Septal Defect (VSD) • Opening between the 2 ventricles = disturbance dependent on size & position

  29. Types of Congenital Heart Disease (cont) • Tetralogy of Fallot • Presence of 4 classic features • VSD • Pulmonary stenosis • Overriding aorta • Right ventricular hypertrophy

  30. Types of Congenital Heart Disease (cont) • Transposition of Great Vessels • Pulmonary artery originates from left ventricle & aorta arises from right ventricle = 2 classic features – CHF & cyanosis

  31. Signs & Symptoms of Respiratory Distress • Signs & symptoms • Tachypnea • Intercostal retractions, nasal flaring, grunting • Cyanosis • Assessments • VS, Hct, BS, WBC, ABG, CXR

  32. Obstructive problems Mucus Choanal atresia (congenital obstruction of nasal passage) Associated resp problems Pneumothorax Diaphragmatic hernia Primary lung problem RDS most common Surfactant deficiency Nonpulmonary causes Anything that causes abnormally high or low blood flow to lungs; an increased demand for O2, or a decreased number RBC’s Causes of Respiratory Distress

  33. Respiratory Distress • Treatments • Stabilize VS • O2 • NG, NPO • Handle infant as little as possible

  34. Neonatal Neurological Disorders • Hydrocephalus • Increase of CSF within the brain ventricles = pressure changes in the brain & enlarge head • Shunt to drain

  35. Neonatal Neurological Disorders • Spina Bifida - imperfect closure of spinal vertebrae • Meningocele = contains portions of membranes & CSF • Meningomyelocele = more serious protrusion of membranes & spinal cord through the opening • Treatment = surgery

  36. Musculoskeletal Disorders • Congenital hip dysplasia • Limited abduction of leg on affected side • “click” sound when rotating hips • Treatment = maintain abduction of the legs which may be as simple as triple diapers or a harness or traction if not detected until child walking

  37. Neonatal GI Distress • To gain weight - need patent & functioning GI system • Entire tract patency not proven until stool composed of digested formula is observed • 2 common problems = cleft lip & palate • Surgical repair

  38. Neonates with Infection • Reasons • Immature defense mechanisms • Not yet developed specific bacteria antibodies • Early signs & symptoms are subtle & nonspecific • Antibody levels may be low • Prevention

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