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    Newborn

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    Abdul Ghaffar Abdullah
    This document provides information on nursing care of the newborn. It discusses immediate care of the newborn including airway assessment, thermoregulation, APGAR scoring and identification. It also covers respiratory, neurological, thermal and cardiovascular adaptations from fetus to newborn. The document outlines the nursing process for newborn assessments including respiration, temperature, feeding and jaundice. It provides guidance on thermoregulation, positioning, feeding and bonding with the newborn. Risk factors and care for preterm infants is also reviewed.

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    Newborn

    Uploaded by

    Abdul Ghaffar Abdullah
    63 views72 pages
    This document provides information on nursing care of the newborn. It discusses immediate care of the newborn including airway assessment, thermoregulation, APGAR scoring and identification. It also covers respiratory, neurological, thermal and cardiovascular adaptations from fetus to newborn. The document outlines the nursing process for newborn assessments including respiration, temperature, feeding and jaundice. It provides guidance on thermoregulation, positioning, feeding and bonding with the newborn. Risk factors and care for preterm infants is also reviewed.

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    This document provides information on nursing care of the newborn. It discusses immediate care of the newborn including airway assessment, thermoregulation, APGAR scoring and identification. It also covers respiratory, neurological, thermal and cardiovascular adaptations from fetus to newborn. The document outlines the nursing process for newborn assessments including respiration, temperature, feeding and jaundice. It provides guidance on thermoregulation, positioning, feeding and bonding with the newborn. Risk factors and care for preterm infants is also reviewed.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    63 views72 pages

    Newborn

    Uploaded by

    Abdul Ghaffar Abdullah
    This document provides information on nursing care of the newborn. It discusses immediate care of the newborn including airway assessment, thermoregulation, APGAR scoring and identification. It also covers respiratory, neurological, thermal and cardiovascular adaptations from fetus to newborn. The document outlines the nursing process for newborn assessments including respiration, temperature, feeding and jaundice. It provides guidance on thermoregulation, positioning, feeding and bonding with the newborn. Risk factors and care for preterm infants is also reviewed.

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    N106

    Nursing Care of
    the Newborn

    Immediate Baby Care

    Airway - Clean mouth and nose


    Thermoregulation - Warmth
    APGAR
    Gross assessment
    Identification
    Bonding safety against infection
    Medications

    Fetus to Newborn:
    Respiratory Changes
    Initiation of respirations
    Chemical
    surfactant reduces surface tension 34-36wks
    decrease in oxygen concentration
    Thermal
    sudden chilling of moist infant
    Mechanical
    compression of fetal chest during delivery
    normal handling

    Nursing Process for Respirations


    Assess for respiratory distress
    Plan: Maintain patent airway
    Interventions
    - Positioning infant head lower
    - Suction secretions bulb, keep near
    head, mouth first, avoid trauma to
    membranes
    Evaluation rate 30-60, no distress

    Fetus to Newborn:
    Neurological adaptation:
    Thermoregulation
    Methods of heat loss
    Evaporation wet surface exposed to air
    Conduction direct contact with cool objects
    Convection- surrounding cool air - drafts
    Radiation transfer of heat to cooler objects
    not in direct contact with infant

    Convection

    Radiation

    Evaporation
    Conduction

    Nonshivering thermogenesis
    Thedistributionofbrownadiposetissue(brownfat)

    Nursing Care Cold Stress


    Preventing heat loss radiant warmer
    Providing immediate care - dry quickly,
    cover head with cap, replace wet blankets
    Providing on going prevention - safety
    Restoring thermoregulation if becoming
    chilled - intervene

    Effects of Cold Stress

    Increased oxygen need


    Decreased surfactant production
    Respiratory distress
    Hypoglycemia
    Metabolic acidosis
    Jaundice

    APGAR

    Heart rate above 100


    Respiratory Effort spontaneous with cry
    Muscle tone flexed with movement
    Reflex response active, prompt cry
    Color pink or acrocyanosis

    0-3 infant needs resuscitation


    4-7 Gentle stimulation Narcan
    8-10 no action needed

    Early Assessments
    Assess for anomalies
    Head anterior fontanelle closes 12-18 mo
    posterior fontanelle closes 2-3 months
    Neck and clavicles
    fracture of clavicle large infant, lump, tenderness,
    crepitus, decreased movement
    Cord
    Extremities
    flexed and resist extension
    assess fractures, clubfeet
    hips
    vertebral column

    Not crossing
    suture line

    Cephalhematomaisacollectionofbloodbetweenthe
    surfaceofacranialboneandtheperiostealmembrane.

    Crossing
    suture line

    Caputsuccedaneumisacollectionoffluid(serum)
    underthescalp.

    A,Congenitallydislocatedrighthip
    B,Barlows(dislocation)maneuver.
    C,Ortolanismaneuver

    Measurements

    Weight loss of 10% normal


    Length
    Head and chest circumference
    Normal VS
    temp 97.7-99.5F axillary
    apical pulse 120-160bpm
    respirations 30-60/min

    head larger

    A,Measuringtheheadcircumferenceofthenewborn.
    B,Measuringthechestcircumferenceofthenewborn.

    Assessment of Cardio-respiratory
    Status
    History
    Airway
    Assess
    rate
    q 30minX2hrs
    symmetry
    breath sounds - moisture for 1-2 hrs

    Assessment of Thermoregulation

    Check soon after birth


    Set warmer controls
    Take temp q 30 min until stable
    Rectal for first temp
    Insert only 0.5 inch
    Axillary route rest of time

    Axillarytemperaturemeasurement.The thermometer
    should remain in place for 3 minutes.

    Assessment of Hepatic Function


    Blood Glucose
    Signs of hypoglycemia
    jitteriness
    respiratory difficulties
    drop in temp
    poor sucking
    Tx- feed infant if glucose below 40-45 mg/dl
    Bilirubin
    physiologic jaundice peaks 2-4 days of life
    early onset may be pathologic

    Jaundice

    Hemolysis of excessive erythrocytes


    Short red blood cell life
    Liver immaturity
    Lack of intestinal flora
    Delayed feeding
    Trauma resulting in bruising or
    cephalhematoma
    Cold stress or asphyxia

    Potentialsitesforheelsticks.Avoidshadedareasto
    preventinjurytoarteriesandnervesinthefoot.

    Assessment of Neuro System


    Reflexes
    Babinski
    Grasp
    Moro
    Rooting
    Stepping
    Sucking
    Tonic neck reflex fencing
    Cry
    Infant response to soothing

    Assessment of Gastrointestinal
    System

    Mouth
    Suck
    Abdomen
    Initial feeding
    Stools
    meconium within 12-48 hours of birth
    dark greenish black
    breastfed soft, seedy, mustard yellow
    formula-fed solid, pale yellow

    Assessment of Genitourinary
    System

    Umbilical cord vessels


    Urine within 24 hours of birth
    Voiding 6 to 10 times a day after 2 days
    Genitalia
    female edema normal, majora covers
    minora, pseudomenstruation
    male pendulous scrotum, descended
    testes by 36 wks gest., placement of meatus

    Assessment of Integumentary System

    Vernix white covering


    Lanugo fine hair
    Milia
    Erythema toxicum red blotchy with white
    Birthmarks
    Mongolian spots sacral area
    Telangiectatic nevus stork Bite - blanches
    Nevus flammeus port wine stain
    - no blanching
    Nevus vasculosus strawberry hemangioma
    usually on head, disappears by school age

    Port Wine Stain

    Erythema toxicum

    Fetus to Newborn:
    Psychosocial adaptation
    Periods of Reactivity
    active 30-60 min
    sleep 2-4 hours
    alert 4-6 hours
    Behavioral States
    quiet sleep
    active sleep
    drowsy state
    quiet alert best for bonding
    active alert
    crying state

    Gestational Age Assessment

    Assessment tool Dubowitz, Ballard


    Weeks from conception to birth
    Used to identify high risk infants
    Neuromuscular characteristics
    Posture more flexion
    Square window more pliable
    Arm recoil - active
    Popliteal angle - less
    Scarf Sign less crossing
    Heel to ear most resistance

    Newborn maturity rating and classification

    Gestational Age Assessment


    Physical characteristics
    Skin- deep cracking, no vessels seen, post-leathery
    Lanugo less as age
    Plantar creases more with age
    Breasts larger areola
    Eyes and Ears stiff with instant recoil
    Genitals deep rugae, pendulous, covers minora
    Gestational Age & Size may not correspond
    small SGA <10% for weight
    large LGA >90% for weight
    appropriate AGA between 10-90%

    Classificationofnewbornsbasedonmaturityand
    intrauterinegrowth.

    Classificationofnewbornsbybirthweightand
    gestationalage.

    Ongoing Assessment and Care

    Bathing
    Cord care
    Cleansing diaper area
    Assisting with feedings
    Protecting infant
    identifying infant
    preventing infant abduction alert to unusual
    preventing infection
    Review beige cue cards in center of book for teach

    One method of swaddling a baby.

    Common Breastfeeding Positions

    Infantingoodbreastfeedingposition:tummytotummy,
    withear,shoulder,andhipaligned.

    LATCHwascreatedtoprovideasystematicmethodfor
    breastfeedingassessmentandcharting.

    Infantteachingchecklistiscompletedbythetimeof
    discharge.

    Circumcision
    Most common neonatal surgical
    procedure
    Reasons for choosing
    Reasons for rejecting hypospadias,
    epispadias
    Pain relief
    Methods
    Nursing care

    Circumcisionusingacircumcisionclamp.

    CircumcisionusingthePlastibell.

    Other Concerns
    Immunizations
    Hepatitis B begin vaccine at birth
    Screening tests
    Hearing
    Phenylketonuria by law

    Further Assessments
    Complications r/t poorly functioning placenta
    hypoglycemia
    hypothermia
    respiratory problems
    Complications r/t LGA infant
    hypoglycemia
    birth injury due to size

    Shoulder Dystocia
    Risk factors
    diabetes; macrosomic infant
    obesity
    prolonged second stage
    previous shoulder dystocia
    Morbidity- fracture of clavicle or humerus,
    brachial plexus injury
    Management generous episiotomy

    Neonatalmorbiditybybirthweightandgestationalage.

    High Risk Infants

    Preterm before 38 weeks gestation


    IUGR full term but failed to grow normally
    SGA LGA
    Infants of Diabetic mothers
    Post mature babies
    Drug exposed

    Preterm infants
    Survive - Weight 1250 g -1500 g 85-90%
    500-600g at birth 20% survive
    Ethical questions
    Characteristics frail, weak, limp, skin
    translucent, abundant vernix & lanugo
    Behavior easily exhausted, from noise
    and routine activities, feeble cry

    Nursing Care of Preterm Infants


    Inadequate respirations
    Inadequate thermoregulation
    Fluid and electrolyte imbalance dehydration
    sunken fontanels <1ml/kg/hr or over hydration
    bulging, edema and urine output >3ml/kg/hr
    Signs of pain high-pitched cry, >VS
    Signs of over stimulation - >P, >RR, stiff
    extended extremities, turning face away
    Nutrition signs of readiness to nipple
    resp <60/m, rooting, sucking, gag reflex

    Measuringgavagetubelength.

    Auscultationforplacementofgavagetube.

    Complications of Preterm Infants


    Respiratory Distress Syndrome -RDS
    Bronchopulmonary dysplasia chronic lung
    disease
    Periventricular-Intraventricular Hemorrhage
    30% infants <32 wk gest or <1500 g
    Retrolenthal fibroplasia visual impairment
    or blindness from O2 & ventilator
    Necrotizing Enterocolitis (NEC) distention,
    increased residual, Tx - rest bowel

    Respiratory Distress Syndrome

    RDS also know as hyaline membrane disease


    Cause besides preemie, C/S, diabetic mothers,
    birth asphyxia interfere with surfactant
    S&S
    tachypnea - over 60/min
    retractions- sternal or intercostal
    nasal flaring
    cyanosis- central
    grunting- expiratory
    seesaw respirations
    asymmetry

    Evaluationofrespiratorystatususingthe
    SilvermanAndersenindex.

    Therapeutic Management of RDS

    Surfactant replacement therapy


    Installed into the infants trachea
    Improvement in breathing occurs in minutes
    Doses repeated prn
    Other treatment
    mechanical ventilation
    correction of acidosis
    IV fluids

    Post Term Infants

    Born after 42 weeks


    Increase risk of meconium aspiration
    Hypoglycemia
    Loss of subcutaneous fat
    Skin peeling, vernix sparse, lanugo
    absent, fingernails long
    Focus on prevention due date
    Attention to thermoregulation & feeding

    Meconium Aspiration Syndrome


    Occurs most often post term infants,
    decreased amniotic fluid /cord compression
    Meconium enters lung obstruction
    S & S vary from mild to severe respiratory
    distress: tachypnea, cyanosis, retractions,
    nasal flaring, grunting
    Tx suction at birth, may need warmed,
    humidified oxygen, or ventilators

    Hyperbilirubinemia
    Pathologic jaundice occurs within first 24
    hours
    Bilirubin levels >12 in term or 10-14 preterm
    May lead to kernicterus brain damage
    Most common cause blood incompatibility of
    mother and fetus, Rh or ABO only occurs with
    mother negative Rh or O blood
    Treatment focus on prevention, assess
    coombs, monitor bilirubin levels, most common
    treatment is phototherapy, blood transfusions

    Conjugationofbilirubininthenewborn.

    Phototherapy for Hyperbilirubinemia


    Phototherapy bilirubin on skin changes
    into water-soluble excreted in bile & urine
    Bili lights placed inside warmer, need
    patches over eyes, infant wearing only
    diaper or fiberoptic phototherapy blanket
    against skin
    Side effects of phototherapy: freq, loose,
    green stools, skin changes
    Can use at home

    Other interventions for


    hyperbilirubinemia
    Exchange transfusions if lights not working
    Maintain neutral thermal environment not
    too hot or too cold
    Provide optimal nutrition hydrate
    Protecting the eyes from retinal damage
    Enhance therapy by expose as much skin as
    possible to light, remove all clothing except
    diaper, turn frequently

    Infant of a Diabetic Mother


    Macrosomia face round, red, body obese,
    poor muscle tone, irritable, tremors
    High risk for trauma during birth, congenital
    anomalies, RDS, hypocalcemia
    Hypoglycemia occurs 15-50% of time
    <40-45 mg/dl, test right after birth, q 2hX4,
    then q 4 hrX6 until stable
    Most frequent symptom: jitteriness or tremors
    Tx fed, gavage or IV if needed

    Hypoglycemia
    Serum glucose is below 40 mg/dL
    Tx: feed infant formula or breast milk and
    retest until glucose stable
    S & S: jitteriness, lethargy, poor feeding,
    high-pitched cry, irregular respirations,
    cyanosis, seizures
    Risk factors: DM, PIH, preterm, post term,
    LGA, cold stress, maternal intake of ritodrine
    or terbutaline

    Large for Gestational Age


    Infants weight is in the 90th % for neonates
    same gestational age, may be pre, post,
    or full term infants
    LGA does not mean post term
    Most common cause maternal diabetes
    Infant at risk: birth injuries, hypoglycemia,
    and polycythemia - macrosomia

    Small for Gestational Age

    Infant whose wt is at or below the 10 th %


    Results from failure to thrive
    Is a high risk condition
    SGA does not mean premature.
    Causes: anything restricting uteroplacental
    blood flow, smoking, DM, PIH, infections
    Complications: hypoglycemia, meconium
    aspiration, hypothermia, polycythemia

    Mother with Substance Abuse


    Use of alcohol or illicit drugs
    Tobacco and alcohol are most frequent
    Prenatal alcohol exposure is the most
    commons preventable cause of mental
    retardation
    Signs of maternal addition: wt loss, mood
    swings, constricted pupils, poor hygiene,
    anorexia, no prenatal care

    Drug Withdrawal in Infants


    Signs of drug exposure
    opiates 48-72 hours
    cocaine 2-3 days
    alcohol within 3-12 hours
    Symptoms: irritable, hyperactive muscle
    tone, high-pitched cry
    High risk for SGA, preterm, RDS, jaundice
    Obtain infant mec and urine sample for test

    Nursing Care of Drug-Exposed Infant


    Feeding more difficult may need to
    gavage
    Rest keep stimulation to minimum,
    reduce noise and lights, calm, slow
    approach
    Promote bonding
    Teach measures for frantic crying: rock,
    coo, dark room, avoid stimulation

    Phenylketonuria - PKU
    Genetic disorder causes CNS damage from
    toxic levels of amino acid phenylalanine
    caused by deficiency of the enzyme
    phenylalanine hydroxylase
    Signs- digestive problems, vomiting, seizures,
    musty odor to urine, mental retardation
    Tx low phenylalanine diet start within 2
    months
    Screening before 24-48 hours needs to be
    repeated for accuracy

    Signs Bonding Delayed

    Using negative terms describing infant


    Discussing infant in impersonal terms
    Failing to give name check culture
    Visiting or calling infrequently
    Decreasing length of visit
    Refusing to hold infant
    Lack of eye contact with infant

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