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Chapter 18

Chapter 18. Caring for the Normal Newborn. The Immediate Neonatal Assessment . Establish airway Suction Provide warmth Dry the infant Place on mother ’ s abdomen; heated blankets Place beneath radiant heater Cap. The Immediate Neonatal Assessment.

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Chapter 18

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  1. Chapter 18 Caring for the Normal Newborn

  2. The Immediate Neonatal Assessment • Establish airway • Suction • Provide warmth • Dry the infant • Place on mother’s abdomen; heated blankets • Place beneath radiant heater • Cap

  3. The Immediate Neonatal Assessment • Observe respiratory effort, color, muscle tone • Stimulate neonate to breathe deeply and cry • Assess heart rate, temperature • Note obvious abnormalities • Check and record number of umbilical cord vessels

  4. Apgar Score—1, 5 minutes • Assesses immediate adaptation • Five categories—each scored 0 to 2 • Respiratory effort • Heart rate • Muscle tone • Reflex irritability • Skin color

  5. Immediate Nursing Care • Mother–infant identification • Infection/injury prevention • Eye prophylaxis • Vitamin K injection • Hepatitis B vaccine (parental consent required) • Assess blood glucose • Hematocrit and hemoglobin

  6. The Later Neonatal Assessment • Body positioning • Skin color • Body size • Level of reactivity • Measurements and determination of gestational age • Ballard Gestational Age by Maturity Rating Tool

  7. Assessment of the Neonate: A Systems Approach

  8. Integumentary System • Inspect skin, scalp, nails, body hair • Color, texture, distribution, disruptions, eruptions, birthmarks • Well-lit room • Birth injuries

  9. Skin Assessment • Smooth and soft • Postterm infants—tough, leathery skin • Pustular melanosis • Milia • Erythema toxicum • Pigmentation—Mongolian spots, café-au-lait marks

  10. Birthmarks • Brown nevi—brown skin marks • Nevus flammeus—“port wine stain” • Telangiectatic nevus—“stork bite” • Nevus vasculosus—“strawberry mark”

  11. Assessment of the Infant’s Head • Symmetry • Eye shape, size, placement, and coordinated lid movement, red reflex, gross vision • Ears: shape, size, placement, hearing • Movement, color of the lips • Chin—appropriate size

  12. Head—Fontanels • Estimate size • Fullness without bulging—normal • Bulging and tense with large head circumference—increased intracranial pressure • Sunken—dehydration

  13. Head • Caput Succedaneum • Diffuse edema, crosses suture lines, disappears in few days • Cephalhematoma • Subperiosteal hemorrhage • Does not cross suture lines • Persists for weeks

  14. Assessment • Mouth • Epstein’s pearls • Teeth • Ability to suck • Hard and soft palate • Neck • Torticollis • Facial features

  15. Respiratory System Assessment • Symmetry in chest movement • Breast tissue • Nasal patency • Respiration rate, pattern, and use of accessory muscles • Auscultate lungs anterior and posterior

  16. Respiratory Assessment • Skin color • Capillary refill • Signs of distress • Retractions • Nasal flaring • Expiratory grunting

  17. Cardiovascular System Assessment • Inspection and auscultation • Point of maximum impulse • Heart rate • Capillary refill • Peripheral pulses • Auscultate all areas—murmurs

  18. Gastrointestinal System Assessment • Abdominal inspection, including umbilical cord • Auscultate bowel sounds, upper abdomen for gastric bubble, and heart sounds of the abdominal aorta • Palpation

  19. Conditions That Warrant Further Assessment • Abdominal distention • Absence of bowel sounds • Discharge from umbilical cord/site • Abdominal mass

  20. Genitourinary SystemAssessment • Hips abducted • Palpate and inspect scrotum, testes, and penis • Male—retract foreskin • Palpate and inspect female genitalia • Anus and anal wink reflex

  21. Common Findings—Male Infants • Scrotal swelling • Smegma • Hypospadius • Epispadius

  22. Common Findings—Female Infants • Hymenal tags • Vernix caseosa on labia • Pseudomenstruation

  23. Conditions That Warrant Further Assessment • Undescended testicles • Micropenis • Ambiguous genitalia • Imperforate hymen • Imperforate anus

  24. Musculoskeletal System Assessment • Observe infant’s movements in crib • Inspect for differences in extremity length and size • Assess muscle tone and symmetry • Gentle passive ROM to assess joint rotation • Assess head lag • Skin folds on thighs

  25. Common Findings • Torticollis • Developmental dysplasia of the hip • Asymmetry of hip folds • Barlow maneuver • Ortolani maneuver • Crepitus • Unusual positions of foot

  26. Conditions That May Warrant Further Assessment • Fractured clavicle • Polydactyly • Syndactyly • Simian crease

  27. Neurological System Assessment • Reflexes • Major—gag, Babinski, Moro, Galant • Minor—palmar grasp, plantar grasp, rooting and sucking, head righting, stepping, tonic neck

  28. Conditions That Warrant Further Assessment • Shoulder dystocia • Erb’s palsy • Cerebral palsy • Spina bifida

  29. Teaching About Newborn Care • Temperature assessment • Bathing • Nail Care and umbilical cord care • Clothing • Diapering • Attachment

  30. Newborn Care • Circumcision • Ensuring optimal nutrition • Discharge planning for the infant and family • Child care • Newborn metabolic screening tests

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