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Nursing Care of the Normal Newborn

Nursing Care of the Normal Newborn. THE NEWBORN. “ I had heard about the negatives---the fatigue, the loneliness, loss of self. But nobody told me about the wonderful parts: holding my baby close to me, seeing his first smile, watching him grow and become more

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Nursing Care of the Normal Newborn

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  1. Nursing Care of the Normal Newborn

  2. THE NEWBORN “I had heard about the negatives---the fatigue, the loneliness, loss of self. But nobody told me about the wonderful parts: holding my baby close to me, seeing his first smile, watching him grow and become more responsive day by day.....For the first time I cared about somebody else more than myself, and I would do anything to nurture and protect him.”

  3. Transition to Extrauterine Life

  4. Newborns undergo profound physiologic changes at the moment of birth. Within minutes after birth, a newborn has to initiate respirations, and adapt a circulatory system to extrauterine oxygenation. Within 24 hours, neurologic, renal, endocrine, and gastrointestinal functions must be operating competently for life to be sustained.

  5. Respiratory Adaptation

  6. Surfactant • What is the function of surfactant? • When is it produced? • When it is sufficient to support extrauterine life?

  7. Respiratory Changes What part do each of these factors play in initiation of respirations in the neonate? Mechanical Initiation of Breathing Chemical Sensory/ Thermal

  8. Chemical Events 1. With cutting of the cord, remove oxygen supply 2. Asphyxia occurs 3. CO2 and O2 and pH = ACIDOSIS 4. Acidotic state-- stimulates the respiratory center in the medulla and the chemoreceptors in carotid artery to initiate breathing

  9. As the chest passes through the birth canal the lungs are compressed Subsequent recoil of the chest wall produces passive inspiration of air into the lungs Mechanical Events Fluid expelled Air Enters

  10. Mechanical Events • About 60-110 ml. of fluid is squeezed out of the lungs as the chest is compressed • The remaining fluid evaporates or is reabsorbed by the blood vessels and lymphatics surrounding the lungs. • **When a baby is delivered in a presentation other than vertex, it takes longer for the lungs to rid themselves of the fluid

  11. Sensory / Thermal Events Thermal--the decrease in environmental temperature after delivery is a major stimulus of breathing Tactile--nerve endings in the skin are stimulated Visual--change from a dark world to one of light Auditory--sound in the extrauterine environment stimulates the infant

  12. Answer this ! • When a baby is born by cesarean delivery, which of the mechanisms to initiate breathing does it lack? Answer This!

  13. Cardiovascular Changes

  14. Fetal CirculationWhat is the flow of blood through the fetal heart? • ____________ • ____________ • ____________ • ____________ LA RA LV RV

  15. Fetal Circulation Why does blood flow In this route?

  16. Fetal Circulation • What is the stimulus for the change in circulation? • What are the changes in circulation from Intrauterine to Extrauterine?

  17. Intrauterine to Extrauterine 1. Infant takes first breath and the lungs inflate ______________ pulmonary vascular resistance Increased ______________ blood flow & pulmonary artery pressure _________. 2. Increase pressure in ____ atrium, ____ pressure in right atrium _________ of foramen ovale 3. The ______ arteriosus and ductusvenosus close related to pressure changes and  ______ levels.

  18. Cardiovascular Changes 3. Ductus Arteriosus begins to constrict 2. Blood flows to the lungs 4. Pressure in the LA increases RT Flow of blood from the lungs 1. Pressure in RA decreases 5. Increase pressure in the LA forces the foramen ovale to close

  19. True / False • An infant’s first breath results in reduced pulmonary vascular resistance, decreased left atrium pressure, and increased right atrium pressure • Increase CO2 , decreased O2, and increased pH help trigger initial breathing

  20. Temperature Regulation

  21. Temperature Regulation • Why is the newborn at a DISADVANTAGE in maintaining a normal temperature ?

  22. Minimizing Heat Loss in the Newborn is IMPERATIVE

  23. Four Avenues of Heat Loss • Conduction--Loss of heat to a cooler surface by direct skin contact • Convection--Loss of heat to cooler air currents • Radiation--loss of heat to cooler surfaces and objects not directly in contact with the skin • Evaporation-- loss of heat when water is converted to a vapor. • What are nursing interventions to decrease each of these?

  24. Heat Production 1. Increase in Muscular activity--shown by crying and restlessness = increases BMR 2. Non-Shivering Thermogenesis - unique to newborns. Uses the infants stores of brown fat. Brown fat is found in the midscapular area, around the neck, in the axillas, and around the trachea, kidneys, and adrenal glands

  25. Non Shivering Thermogenesis 1. Skin receptors perceive a drop in environmental temperataure 2. Transmit impulses to the central nervous system 3. Which stimulates the sympathetic nervous system 4. Norepinephrine is released at local nerve endings in the brown 5. Metabolism of brown fat 6. Release of fatty acids 7. Release of HEAT!

  26. Peripheral Vasoconstriction Subcutaneous Fat Heat Maintenance Curl up in fetal position

  27. Hematologic Adaptation

  28. Blood Changes • At birth, an infant has more RBC’s and higher hemoglobin and hematocrit levels than an adult • Once proper oxygenation is established, the need for the high RBC’s diminishes

  29. Lab values for Newborn • hemoglobin – 14-20 g/dl • hematoctrit – 43-63% • WBC – 10,000-30,000/mm3 • glucose – 45-96 mg/dl

  30. Gastrointestinal Adaptation

  31. Gastrointestinal Changes • By 36-38 weeks of fetal life, the GI system is fully mature and ready to digest simple carbohydrates, fats, and protein. • What is the capacity of the newborns stomach? • What is meconium? Why is it important for the newborn to pass this?

  32. Hepatic Adaptation

  33. Hepatic and LiverFunctions • iron storage and RBC production • carbohydrate metabolism • conjugation of bilirubin

  34. Coagulation--coagulation factors are under the influence of vit. K. The absence of normal flora needed to synthesize vit. K results in low levels of vitamin K and creates a transient blood coagulation alteration between the second and fifth day after birth. Vitamin K is given prophylactically to combat potential clinical bleeding problems

  35. Physiological Jaundice • What is Physiological Jaundice? • What is the main cause?

  36. Conjugation of Bilirubin • Where do we get bilirubin? • What is the difference in Unconjugated bilirubin and conjugated bilirubin? • Why does it need to be conjugated?

  37. Conjugation of Bilirubin is a conversion of Fat Soluble Water Soluble to Unconjugated Conjugated by ___________________________________?

  38. Physiological Jaundice • About 50% of all infants exhibit signs in 2 - 3 days after birth • Bilirubin levels at birth are about 3 mg./dl and should not exceed 12 mg. Peak bilirubin levels are reached between days 3 & 5 in the term infant. Toxic levels are approximately 20mg/dl. • Nursing Care: • Keep well hydrated • Promote elimination • early feedings tend to keep bilirubin levels down by stimulating intestinal activity thus removing the contents and not allowing reabsorption

  39. Intrauterine Urine if formed in utero and some excreted into the amniotic fluid Excretion of wastes is the function of the placenta Extrauterine GFR is low --decrease ability to excrete drugs Limited ability to reabsorb Sodium Decreased ability to concentrate urine Bladder capacity is 6 - 44 ml Void within the first 24 hrs. and should void 6 - 10 times per day Renal / Kidney Changes

  40. Immunologic Adaptation • Active acquired immunity • Pregnant woman forms antibodies herself • Passive acquired immunity • Mom passes antibodies to the fetus • Lasts from 4-8 months • Newborn begins to produce own immunity about 4 weeks of age

  41. Behavorial / Sleep - Awake States • Sleep States: • Deep or quiet sleep • Active rapid eye movement/ light sleep • Alert States: • Drowsy • Wide awake/quiet alert • Active awake/ active alert • Crying

  42. Which state is optimal for parent-infant interaction? Quiet Alert

  43. Sensory • Visual • Can follow and fixate on visual stimuli for short period of time • Hearing • Alert to and searches for auditory stimulus • Olfactory • Able to select people by smell • Taste • Able to respond to different tastes • Tactile • Sensitive to touch, cuddling, and being held

  44. Nursing Assessment of the Newborn

  45. Immediate Care of the Newborn • Ensure a Patent Airway • Position on side • Suction mouth then nares • supply warmed oxygen is necessary **Always have bulb suction in view !

  46. Clamping of the Cord • Cord should be clamped off about 1” from base of cord. • Inspect the cord for 2 arteries and 1 vein.

  47. Maintain Body Temperature • Dry off • Place in warmer • Skin to skin contact

  48. Apgar Score • Scoring system to appraise the newborn • Done at 1, 5, and 10 minutes after birth

  49. Apgar Score 0 1 2 Heart Rate is the most important !

  50. Apgar Score • Score of 7 - 10 = Good Condition • Score of 4 - 6 = Fair Condition • Score of 0 - 3 = Poor Condition

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