Chapter 18: Nursing Management of the Newborn

1. Chapter 18: Nursing Management of the Newborn

2. Initial Newborn Assessments • Signs indicating a problem • Nasal flaring, chest retractions • Grunting on exhalation, labored breathing • Generalized cyanosis, flaccid body posture • Abnormal breath sounds, abnormal respiratory rates • Abnormal heart rates, abnormal newborn size

3. Initial Newborn Assessments (cont.) • Apgar scoring (see Table 18.1) • Length and weight, vital signs (see Table 18.2) • Gestational age assessment (see Figure 18.3) • Physical maturity (skin texture, lanugo, plantar creases, breast tissue, eyes and ears, genitals) • Neuromuscular maturity (posture, square window, arm recoil, popliteal angle, scarf sign, heel to ear)

4. Apgar Scoring A = appearance (color) P = pulse (heart rate) G = grimace (reflex irritability) A = activity (muscle tone) R = respiratory (respiratory effort)

7. Gestational Age • Preterm or premature: prior to 37 weeks’ gestation • Term: 38 to 42 weeks’ gestation • Postterm or postdates: after week 42 gestation • Postmature: after week 42 gestation/placental aging • Small for gestational age (SGA) • Appropriate for gestational age (AGA) • Large for gestational age (LGA)

8. Physical Maturity Assessment (Ballard) • Skin texture • Lanugo • Plantar creases • Breast tissue • Eyes and ears • Genitals

9. Neuromuscular Maturity • Posture • Square window • Arm recoil • Popliteal angle • Scarf sign • Heel to ear

10. Question Is the following statement True or False? Arm recoil is one measure of assessing a newborn’s physical maturity. a. True b. False

11. Answer b. False Arm recoil is a measure of a newborn’s neuromuscular maturity. An example of an assessment of physical maturity is skin texture.

12. Nursing Interventions: Immediate Newborn Period • Maintaining airway patency • Ensuring proper identification • Administering prescribed medications (see Drug Guide 18.1) • Vitamin K • Eye prophylaxis • Maintaining thermoregulation

13. Newborn Physical Examination • Prenatal history • Newborn physical examination • Anthropometric measurements: length, weight, head circumference, chest circumference • Vital signs • Skin: condition and color; common skin variations (see Figure 18.12) • Head: size, fontanels; variations in head size and appearance (see Figures 18.13 and 18.14); abnormalities in head or fontanel size

14. Newborn Physical Examination (cont.) • Face: nose, mouth, eyes, ears • Neck, chest • Abdomen • Genitalia (see Figure 18.16) • Extremities and back • Neurologic status • Alertness, posture, and muscle tone • Reflexes (see Table 18.4 and Figures 18.17 and 18.18)

15. Common Skin Variations in Newborns • Vernix caseosa • Stork bites or salmon patches • Milia • Mongolian spots • Erythema toxicum • Harlequin sign • Nevus flammeus • Nevus vasculosus

16. Variations in Head Size and Shape in the Newborn • Variations • Molding • Caput succedaneum • Cephalhematoma • Abnormalities • Microcephaly • Macrocephaly • Large, small, or closed fontanels

18. Common Concerns During Newborn Transition • Transient tachypnea of the newborn • Oxygen therapy • Physiologic jaundice (Hyperbilirubinemia) • Phototherapy • Hypoglycemia • Rapid acting glucose source

19. Nursing Interventions for Transient Tachypnea • Providing oxygen • Ensuring warmth • Observing respiratory status frequently • Allowing time for pulmonary capillaries and the lymphatics to remove the remaining fluid

20. Selected Screening for Newborns • PKU • Congenital hypothyroidism • Galactosemia • Sickle cell anemia

21. Nursing Management: Early Newborn Period: Nursing Interventions • General newborn care • Bathing and hygiene (see Teaching Guidelines 18.1 and Nursing Procedure 18.2) • Gloves • Plain water on face and eyes; mild soap for rest of body • Elimination and diaper area care • Urine characteristics • Stool pattern • Diaper area care

22. Nursing Management: Early Newborn Period: Nursing Interventions (cont.) • Cord care (see Teaching Guidelines 18.2) • Circumcision care • Safety (see Teaching Guidelines 18.3) • Prevention of abduction • Car safety • Infection prevention • Sleep promotion • Bonding

23. Nursing Management: Early Newborn Period: Nutrition • Physiologic changes • Nutritional needs • Calories • Fluid requirements • Feeding method choice • Feeding the newborn • Frequency • Measures to decrease air swallowing

24. Nursing Management: Early Newborn Period: Breast-Feeding • Composition • Assistance • Positioning • Education • Storage and expression • Concerns • Sore nipples • Engorgement • Mastitis

25. LATCH Method for Assessing Breast-Feeding Sessions • L: How well infant latches onto the breast • A: Amount of audible swallowing • T: Nipple type • C: Level of comfort • H: Amount of help mother needs

26. Question An infant typically requires how many calories per kilogram per day during the first 3 months? a. 80 b. 95 c. 110 d. 150

27. Answer c. 110 During the first 3 months, an infant needs 110 to 120 calories/kg/day.

28. Nursing Management: Early Newborn Period: Bottle-Feeding • Types of formula • Assistance • Positioning • Education • Weaning and introduction of solid foods

29. Nursing Management: Early Newborn Period: Discharge Preparation • Preparing for discharge • Education • Cultural considerations • Follow-up care • Return visit • Warning signs and symptoms • Immunization information