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The Normal Newborn: Needs and Care

The Normal Newborn: Needs and Care. Assessment Data: Condition of the Infant. Apgar scores at 1 and 5 minutes Resuscitative measures Physical examination Vital signs Voidings Passing of meconium. Newborn Care. Assessment Data: Infant Complications. Excessive mucus

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The Normal Newborn: Needs and Care

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  1. The Normal Newborn: Needs and Care

  2. Assessment Data: Condition of the Infant • Apgar scores at 1 and 5 minutes • Resuscitative measures • Physical examination • Vital signs • Voidings • Passing of meconium

  3. Newborn Care

  4. Assessment Data: Infant Complications • Excessive mucus • Delayed spontaneous respirations or responsiveness • Abnormal number of cord vessels • Obvious physical abnormalities

  5. Assessment Data: Labor and Birth • Duration and course • Status of mother and fetus • Analgesia or anesthesia

  6. Assessment Data: Labor and Birth Complications • Prolonged rupture of membranes • Meconium-stained amniotic fluid • Nuchal cord • Precipitous birth • Use of forceps or vacuum extraction assisted device • Fetal distress

  7. Assessment Data: Maternal Complications • Preeclampsia • Spotting • Illness • Recent infections • Rubella status • Serology results

  8. Assessment Data: Maternal Complications (continued) • Hepatitis B screen results • Exposure to group B streptococci • History of maternal substance • Human immunodeficiency virus (HIV) test result

  9. Assessment Data: Family • Parents’ interactions with their newborn • Their desires regarding infant care • Information about other children in the home • Available support systems • Patterns of interaction within each family unit

  10. Physiologic Alterations • Respiratory distress • Pallor • Hypothermia • Alterations in feeding and elimination

  11. Nursing Care: Assessment • Airway clearance • Vital signs • Body temperature • Neurologic status • Ability to feed • Evidence of complications

  12. Nursing Care: Assessment (continued) • Review of prenatal and birth information • Gestational age • Newborn’s adaptation to extrauterine life • Weight and measurement • Vital signs every 30 minutes • Assessment of Hct or blood glucose if warranted

  13. Admission Procedures • Newborn bath • Vitamin K • Eye prophylaxis • Observation for distress • Initiate feeding • Facilitate parental-infant attachment

  14. Daily Assessments • Vital signs • Weight • Overall color • Intake and output • Umbilical cord • Circumcision

  15. Daily Assessments (continued) • Newborn feeding • Attachment

  16. Daily Newborn Care • Assist with feedings • Thermoregulation • Skin care • Cord care • Prevention of infection • Security

  17. Common Concerns • How to pick up a newborn • Holding and feeding the infant • Changing the diaper • Interpreting newborn cues • Bathing the newborn

  18. Common Concerns (continued) • Cord and circumcision care • Normal voiding and stooling pattern

  19. Circumcision using the Yellen or Gomco clamp. A, The prepuce is drawn over the cone

  20. The clamp is applied. Pressure is maintained for 3 to 4 minutes, and then excess prepuce is cut away.

  21. Circumcision using the Plastibel. The bell is fitted over the glans. A suture is tied around the bell’s rim, and the excess prepuce is cut away. The plastic rim remains in place for 3 to 4 days until healing occurs. The bell may be allowed to fall off; it is removed if still in place after 8 days.

  22. Parent Education • Periods of reactivity and expected newborn responses • Normal physical characteristics of the newborn • The bonding process • The infant’s capabilities for interaction • The role of touch in facilitating parent-infant interaction • Comforting techniques

  23. Parent Education (continued) • Progression of infant behaviors • Information about available educational materials and support

  24. Family Education • Newborn care videos • Newborn care classes • Individual instruction • Observation of parent-infant interaction • Role modeling

  25. Discharge Education • Safety measures • Voiding and stool characteristics • Circumcision care • Cord care • Waking and quieting the newborn • Car safety

  26. Discharge Education (continued) • Immunizations • Signs of illness

  27. Signs of Illness • Temperature above 38oC or below 36.6oC axillary • Continual rise in temperature • Forceful or frequent vomiting • Refusal of two feedings in a row • Difficulty in awakening baby • Cyanosis with or without a feeding

  28. Signs of Illness (continued) • Absence of breathing longer than 20 seconds • Inconsolable infant or continuous high-pitched cry • Discharge or bleeding from umbilical cord, circumcision, or any opening • Two consecutive green watery or black stools, or increased frequency of stools • No wet diapers for 18 to 24 hours • Fewer than 6 to 8 wet diapers per day after 4 days of age • Development of eye drainage

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