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Newborn Nursing

Newborn Nursing. The Newborn. Nursing Assessment of the Normal Newborn. Assessment of the newborn is imperative immediately after birth followed by an assessment within 1 to 4 hours and continued assessment procedures during the first 24 hours of life.

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Newborn Nursing

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  1. Newborn Nursing

  2. The Newborn

  3. Nursing Assessment of the Normal Newborn Assessment of the newborn is imperative immediately after birth followed by an assessment within 1 to 4 hours and continued assessment procedures during the first 24 hours of life. Initial Assessment immediately following birth Need for resuscitation APGAR scoring Heart rate Respiratory effort Muscle tone Reflex response Color Cry – strong and lusty

  4. Nursing Assessment of the Normal Newborn Initial assessment (continued) • Newborn responses to birth • Assessment and care of the newborn • Check for congenital anomalies especially cardiovascular, pulmonary and neurologic • If stable, place with parents for initial bonding and early breastfeeding

  5. Newborn’s Immediate Needs • Airway • Breathing • Circulation • Warmth

  6. Initial newborn assessment • Stimulate & dry infant • Assess ABCs • Encourage skin-to-skincontact • Assign APGAR scores • Give eye prophylaxis &vitamin K • Keep newborn, mother, &partner together wheneverpossible

  7. NEWBORN PERIOD &NEONATAL TRANSITION • Newborn period: birth to 28 days • Neonatal transition: first 6-8 hoursafter birth • Establishment of respiratory gasexchange & circulatory system • Nurse must be aware of normalphysiologic & behavioral adaptations,as well as deviations from the normto ensure safety of the newborn

  8. The Newborn • Neonatal transition: 1st few hours after birth newborn stabilizes respiratory and circulatory functions. • When the cord is clamped, placental gas exchange ceases. • These changes stimulate carotid and aortic chemoreceptors which send impulses to the respiratory center in the medulla. • A brief period of asphyxia stimulates respirations.

  9. Dry the Baby • Hypothermia is common • Wet newborns rapidly lose heat • Use a warm, dry, soft towel • Any absorbent material: • Shirt • T-shirt • Socks • Battle dressings

  10. Replace the Wet Towels • Then let the mother hold the baby • Her body heat will help keep the baby warm • Cover the head to prevent heat loss

  11. Position the Baby • Keep the baby on its’ back or side, not on its’ stomach • Neither extend nor flex the head. Either may obstruct the airway. • Newborn babies normally make this adjustment themselves. If depressed, however, you may need to position the head to get a good airway.

  12. Suction the Airway • May need to help them clear mucous and amniotic fluid from the airway • Use a bulb syringe • Use it gently • If bulb syringe is not available, use any suction device, including a small hypodermic syringe without the needle.

  13. Ventilate if Necessary • If not breathing following brief stimulation, ventilate • Ideally, bag/mask, 100% oxygen, pressure gauge, flow control valve • May need to use mouth-to-mouth • Cover nose and mouth • Use shallow puffs to ventilate

  14. Evaluate the Baby • Breathing • Color • Heart Rate • Tactile stimulation (rubbing) with a towel. may effectively stimulate a mildly depressed baby

  15. Keep the Baby Warm • Keep the airway open • Keep the head covered • Use any available cloth or heat-retaining material • Check temp several times: 97.7-99.3F axillary

  16. Temperature At birth-warmth, keep the baby in skin to skin contact with the mother Teaching Aids: ENC 16 EN-

  17. Apgar Score • Assesses the infants cardiopulmonary adaptations to extrauterine life • Provides a quick evaluation on how the heart and lungs are adapting • 5 items to be assessed 1 and 5 minutes after birth.

  18. Apgar Score • Heart rate, respiratory rate, muscle tone, reflex irritability and color • Score of 0 – 2 for each item, then totaled. • Apgar Score 8 or higher no intervention • Apgar Score 4 – 8 gentle rubbing, oxygen • Apgar Score 0 – 4 resuscitation

  19. Nursing Assessment of the Normal Newborn Second physical assessment – within first 4 hours of life General appearance Measurements: weight, length, head & chest circumference Temperature (axillary not rectal) Respiration: Normal 30 – 60 (average 40s) Heart: Normal 120 – 160. Temporary murmur from open ductus arteriosus common. Brachial and femoral pulses strong and equal. Blood Pressure not routinely assessed

  20. Vital Signs • Temperature - range 36.5 to 37 axillary (97.7-98.6) • Axillary vs Rectal about 0.2 to 0.5 difference Common variations • Crying may elevate temperature • Stabilizes in 8 to 10 hours after delivery • Heart rate - range 120 to 160 beats per minute • Apical pulse for one minute Common variations • Heart rate range to 100 when sleeping to 180 when crying • Color pink with acrocyanosis • Heart rate may be irregular with crying • Respiration - range 30 to 60 breaths per minute • Blood pressure - not done routinely • Ranges between 60-80 mm systolic and 40-45 mm diastolic.

  21. Nursing Assessment of the Normal Newborn • Estimation of gestational age through physical assessment • Physical maturity characteristics – skin, lanugo, plantar creases, breasts, ear/eye, genitals characteristics • Neuromuscular characteristics: resting posture, arm recoil, popliteal angle, scarf sign, heel to ear and square window signs

  22. Gestational Age Relationship to Intrauterine Growth • Normal range of birth weight for each week of gestation. • Birth weight is classified as follows: • Large for gestational age (LGA): weight falls above the 90th percentile for gestational age • Appropriate for gestational age (AGA): weight falls between the 90th and 10th percentile for gestational age • Small for gestational age (SGA): weight falls below the 10th percentile for gestational age

  23. Intrauterine Growth Grid

  24. Nursing Assessment of the Normal Newborn Skin characteristics Acrocyanosis Mottling Harlequin Jaundice Erythema toxicum – “Newborn rash” Milia Skin turgor

  25. Nursing Assessment of the Normal Newborn Skin Characteristics (continued) Vernix caseosa Ruddy color Cracked and peeling skin Lanugo Forceps or vacuum marks Birthmarks Café-au-lait

  26. Skin • Expected findings • Skin reddish in color, smooth and puffy at birthAt 24 - 36 hours of age, skin flaky, dry and pink in color • Edema around eyes, feet, and genitals • Vernix caceosa • Lanugo (baby hair) • Turgor good with quick recoil • Hair silky and soft with individual strands

  27. Common Normal Variations • Acrocyanosis - result of sluggish peripheral circulation. • Mongolian Spots: Patch of purple-black or blue-black color distributed over coccygeal and sacral regions of infants of African-American or Asian descent. • Milia: Tiny white bumps papules (plugged sebaceous glands) located over nose, cheek, and chin. • Erythema toxicum: Most common newborn rash. Variable, irregular macular patches. Lasts a few days.

  28. Color Pink • Most newborns have acrocyanosis (body is centrally pink, but hands and feet are blue • Cyanosis requires treatment: • Oxygen • Airway • Ventilation Acrocyanosis Cyanosis

  29. Color of the baby • Normal vs. Abnormal Teaching Aids: ENC 30 EN-

  30. Erythema toxicum, acrocyanosis, milia and mongolian spots

  31. Vernix • Cheesy-white • Normal • Antibacterial properties • Protects the newborn skin

  32. Hyperbilirubinemia • Physiologic Jaundice =Appears 24 hours after birth peaks at 72 hrs. • Bilirubin may reach 6 to 10 mg/dl and resolve in 5 to 7 days. • Due to Unconjugated bilirubin circulating in the blood stream that is deposited in the skin. • Immature liver unable to conjugate bilirubin released by destroyed RBC. • Pathologic Jaundice =Not appear until after 24 hrs leads to Kernicterus (deposits of bili in brain). • Bilirubin >20mg/dl • The most common cause is Rh incompatibility.

  33. Nursing Assessment of the Normal Newborn General appearance of the head • Cephalhematoma – bleeding between the periosteum and the cranial bone • Caput succedaneum – localized edema from pressure • Molding – movement of the cranial bones during birth • Fontanels

  34. The Head and Chest • The Head: Anterior fontanel diamond shaped 2-3 - 3-4 cms • Posterior fontanel triangular 0.5 - 1 cm • Fontanels soft, firm and flat • head circumference is 33 – 35 cm • The head is a few centimeters larger than the chest!!!! • The Chest:circumference is 30.5 – 33 cm

  35. Anterior and Posterior Fontanelles • Anterior diamond shaped 2-3 - 3-4 cms • Posterior triangular 0.5 - 1 cm • Fontanels soft, firm and flat • Molding is shaping of fetal head to adapt to the mothers pelvis during labor.

  36. Caput succedaneum • Swelling of the soft tissue of the scalp caused by pressure of the fetal head on a cervix that is not fully dilated. • Swelling is generalized. may cross suture line and decreases rapidly in a few days after birth. Requires no treatment • 2 – 3 days disappears

  37. Cephalohematoma • Collection of blood between the periosteum and skull of newborn. • Does not cross suture lines • Caused by rupturing of the periosteal bridging veins due to friction and pressure during labor. • Lasts 3 – 6 weeks

  38. Caput succedaneum vs. cephalohematoma • Normal vs. Abnormal Teaching Aids: ENC 40 EN-

  39. The normal resting posture of a baby born breech Teaching Aids: ENC 41 EN-

  40. ABNORMAL position of arm and hand Teaching Aids: ENC 42 EN-

  41. Nursing Assessment of the Normal Newborn Face • Symmetry • Eyes • Nose • Mouth • Ears

  42. Nursing Assessment of the Normal Newborn • Neck • Chest • Cardiac • Peripheral vascular • Abdomen

  43. Check the Heartbeat • Normal newborn rate is >100 • Palpate umbilical cord or brachial artery • If pulse <100, ventilate the baby, using whatever skills and equipment you have

  44. CARDIOVASCULARCHANGES AT BIRTH • Onset of respirations stimulates changesin cardiovascular system of newborn • Closure of fetal shunts • Foramen ovale • Ductus venosus • Ductus arteriosus: functionally closes within24 hours of birth, but may take several weeksto permanently close

  45. Nursing Assessment of the Normal Newborn • Umbilical cord • Examined for 2 arteries, 1 vein. • Will dry up and detach in 10 to 14 days • Cord Care: alcohol, soap & water

  46. Umbilical Cord Care • Clean & dry • Alcohol wipe once a day • Topical antiseptic only in contaminated areas

  47. The umbilicus: Which one is normal? • Normal vs. Abnormal Teaching Aids: ENC 50 EN-

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