Presentation on theme: "Nursing Care of the Newborn"— Presentation transcript:
1Nursing Care of the Newborn Newborns undergo many profound physiologic and psychological changes.They are released from a warm, close, dark, liquid filled environment that met all needs, into a chilly, unbound, brightly lit, gravity based, outside world.Within minutes respirations are initiated and circulatory accommodation are made.Within 24 hours neurologic, renal, endocrine, GI, and metabolic functions must operate.
2Nursing Care of the Newborn Newborn or neonatal period is the first 28 days of life.2/3 of deaths occur in the 1st year½ occur in the 1st 24 hoursAssessmentMother’s pregnancy historyPhysical exam of the newbornLab reportsBonding
3Profile of the Newborn All newborns are different. Vital Statistics Weight:Plot on neonatal graph (Appendix E)Average weight R/T gestational ageWhite female 7.5 lbs.– 3.4 kg.White male 7.7 lbs.-3.5 kg.Other races-0.5 lbs lessLimits-5.5 lbs to10 lbs (17 lbs largest)Newborn loses 5 to 10 % of birth weight ( 6 to 10 oz. during first few days.
4Profile of the NewbornLoss due to salt and fluid retaining maternal hormones. Voiding and stool, and diuresis.After wt. loss then 1 day of stable wt. then recaptures birth weight within:Breastfed 10 daysFormula fed 7 daysWill gain 2 lb/month (6 to 8 oz/week) for first 6 months.Length:Female-53 cm in.Male-54 cm. –21.3 in.
5Profile of the Newborn Limits 18 in. to 23 in. Head Circumference: 34 to 35 cm. (13.5 to 14 in.)Limits-less than 33 cm. or greater than 37 cm.Measure with tape drawn across center of forehead and around the most prominent portion of the posterior head.
6Profile of the Newborn Chest Circumference: About 2 cm. less than head circumference (0.75 to 1 in.).Measure at level of the nipples.Viral Signs:Temp 99 F at birthNewborns lose heat by:ConvectionConductionRadiationEvaporation
7Profile of the NewbornThey have little subcutaneous fat for insulation. Shivering is rare.They have brown fat – helps to conserve or produce body heat by increasing metabolism.Quickly dry and wrap newborns and place under radiant heat source or place directly against mothers skin.Newborn with a bacterial infection will have a subnormal temperature.
8Profile of the Newborn Pulse: Immediately after birth 180 bpm. Within 1 hour- 120 to 140 bpm.Irregular and transient murmurs due to immaturity of the cardiac regulatory center in the medulla and closure of the shunts.Sleeping – 90 to110 bpm.Always check apical for 1 full minuteCheck femoral pulse for coarctation.
9Profile of the Newborn Respiration: 30 to 60 breaths / min. Rate, depth, and rhythm may be irregular with short periods of apnea (without cyanosis) called periodic respirations.Observe movement of the abdomen.Coughing and sneezing clear the airway.Newborns are nose breathersShort periods of crying are beneficial.
10Profile of the Newborn Blood Pressure: 80/46 mm Hg at birth 10th day 100/50 mm HgCuff 2/3 the length of upper arm or thigh.Physiologic FunctionCardiovascular System:Figure 23.3 p. 634Peripheral circulation is sluggish for 1st 24 hours.Common to see cyanosis of the feet and hands (acrocyanosis) cold to touch.
11Profile of the Newborn Blood values: Blood volume-300 mL Increased erythrocyte count-will decrease after 3 days. Breakdown of these cells cause an increase bilirubin >4 mg/100mLAt 7 mg/ml tissue is jaundice. Physiological jaundice R/T brusing, cephalhematoma, dehydration, or intestinal obstruction.Treat at phototherapy, fluids, >20 neuro kernicterus (permanent cell damage)Hgb 17-18
12Profile of the NewbornHct 45-50% (use warm cloth on heel to increase sluggish circulation to get a more accurate value).WBC increased due to stress of birth.Blood Coagulation:Prolonged coagulation or prothrombin time for 24 hours because of low vitamin K level.Infant intestine is sterile at birth.Administer Vitamin K (AquaMephyton) 1 hour after birth in lateral anterior thigh.
13Profile of the Newborn Respiratory: First breath initiated by Cold receptorsLowered PO2 (15 mm Hg)Increased PCO2 (70 mm Hg)Surfactant allows the alveoli to inflate more easily.1/3 of fluid is forced out of the lungs with the pressure of delivery.Within 10 min. a good residual volume is established.
14Profile of the Newborn Gastrointestinal System: Sterile tract for 1st 24 hoursStomach holds 60 to 90 mLDecreased ability to digest fat and starchRegurgitation due to immature cardiac sphincter between stomach and esophagus.Lower glucose and protein serum levels due to immature liver.Stools – meconium 1st 24 hours. Sticky, tarlike, blackish green, odorless.
15Profile of the NewbornIf no meconium in hours possibility of ileus, imperforate anus, or bowel obstruction.Transitional stool- day 2-3 becomes green and loose.Day 4 breastfed will pass 3-4 light yellow stools per day.Bright green is due to increased bilirubin.Watery and loose or mucus may be a milk allergy.Gray clay stool – bile duct obstruction.
16Profile of the Newborn Urinary System Voids within 24 hours Light color and odorless; kidneys do not concentrate urine well and no reabsorption.6 voids /day 15 to 50 mLBy 1st week total daily volume is 300 mLImmune System:Unable to form antibodies the 1st 2 months.Has passive immunity from the motherHepatitis B vaccine during 1st 12 hours.
17Profile of the Newborn Neuromuscular System: Reflex Maneuvers: Blink reflexRootingSuckingSwallowingExtrusionPalmar GraspStep-Walk in PlacePlacing
18Profile of the Newborn Plantar Grasp Tonic Neck Moro Babinski Magnet Crossed ExtensionTrunk IncurvationLandauDeep Tendon
19Profile of the Newborn Senses: Hearing in utero Vision see immediately, blink, follow objectsTouch well developedTaste likes glucose and avoids saltSmell breast milkAdjustment to Extrauterine LifeTable 23.1 p. 639
20Appearance of the Newborn SkinColor:Ruddy due to increased concentration of RBC in blood vessels and decreased fat. Fades slightly over the 1st month.Cyanosis-lips, hands, feetCentral cyanosis is a great concernSuction mouth before the nose because suctioning the nose may trigger a reflex gasp, possibly leading to aspiration.
21Appearance of the Newborn Hyperbilirubinemia leads to jaundice or yellowing of the skin.Occurs on day 2 or 3 in 50% of all newborns due to breakdown of fetal RBC.Indirect bilirubin > 7mg/100 mLEarly feeding promotes intestinal movement and helps prevent bilirubin build up.Pallor due to anemia.Excessive blood loss when cord was cut.Inadequate flow of blood from cord into infant at birth.
22Appearance of the Newborn Fetal maternal transfusionLow iron storesBlood incompatibilityInternal bleed in the babyCNS damageHarliquin Sign-newborn lying on side and it will appear red on the dependent side of the body and pale on the upper side, changing positions will make it fade.
23Appearance of the Newborn BirthmarksHemangiomas-vascular tumors of the skin.Nevus flammeus-port-wine stainMacular purple or dark red lesionAppears on face or thighThose above the bridge of the nose fadeCan be covered by cosmetics, remover surgically, or by laser therapy.Stork’s beak marks – at nape of neck, lighter pink patches. More frequent in females. Do not fade.
24Appearance of the Newborn Strawberry Hemangiomas:Elevated areas formed by immature capillaries and endothelial cells.Appear at birth or 2 week later.Due to high estrogen levels50 to 75% may disappear by age 7Mark may grow in size.Surgery not recommended due to scarring
25Appearance of the Newborn Cavernous Hemangiomas:Dilated vascular spacesRaised and resemble a strawberry hemangioma but does not disappear.Surgically removed.Mongolian Spots:Collection of pigment cells (melanocytes) that appear slate-gray patches on sacrum or buttocks S/T arms and legs.Asian, Southern European, or AfricanDisappear by school age.
26Appearance of the Newborn Vernix Caseosa:White, cream cheese-like substance that serves as a skin lubricant.Lanugo:Fine hair, covers newborn’s shoulders, back, and upper arms. Forehead and ears.By age 2 weeks it has disappeared.Desquamation:Dry skin on palms of hands and soles of feet.
27Appearance of the Newborn Milia:Pinpoint white papule found on cheek or across bridge of nose.Disappear by 2 to 4 week as sebaceous glands mature.Erythema Toxicum (flea-bite rash):Rash, appears 1st to 4th day up to 2 weeks of age.Lacks pattern and will last only hours.Due to eosinophils reacting to environment.
28Appearance of the Newborn Forceps Marks:May have a circular or linear contusion matching the rim of the blade on infants cheek.Disappears in 1 to 2 daysAssess facial nerve while at rest and crying.Skin Turgor:Feels elastic, smooth if well hydrated.
29Appearance of the Newborn Head:Appears large, 1/4th total length, forehead large and prominent.Chin receding, quivers easily.Full-body of hair if well nourishedPinpoint ulcer where monitor was attached.Fontanelles:Openings where skull bones joinAnterior fontanelleJunction of parietal and frontal bones.
30Appearance of the Newborn Diamond shaped-2 to 3 cm. width and 3 to 4 cm. length.Closes at 12 to 18 monthsPosterior fontanelleTriangle shaped-1 cm. length.Closed at 2 months.Sutures:May override at birth.Molding:Infant’s head (vertex) engages the cervix.
31Appearance of the Newborn After birth, appears prominent and asymmetric.Will restore to normal shape in a few days.Caput Succedaneum:Edema of the scalp at the presenting part of the head.Crosses the suture line, will be absorbed and disappear by the 3rd day.Cephalhematoma:Collection of blood between periosteum of
32Appearance of the Newborn the skull bone and bone itself caused by rupture of periosteum capillary at birth.Occurs 24 hours after birth, severe swelling, black and blue, egg shape.Swelling stops at suture line.Takes weeks to be absorbed.Craniotabes:Localized softening of the cranial bones.Indents easily with touch of the finger.Corrects after a few months.
33Appearance of the Newborn Eyes:Usually tearless, lacrimal ducts mature at 3 months.Irises-gray or blueSclera-blue due to thinness.Permanent eye color between 3 to 12 mo.Erythromycin ointment EES-for chlamydia and gonorrheaSubconjunctival hemorrhage-red spot on sclera or red ring around cornea. Absorbed in 2 to 3 weeks.
34Appearance of the Newborn Edema around orbit or on eyelid. Will remain for 2-3 day until kidneys remove the fluid.Ears:External not completely formed.Top part in line with inner canthus of eye.Test hearing by ringing a bell 6 in. from ear.Nose:Appears large.Assess by closing mouth and compress one naris.
35Appearance of the Newborn Mouth:Open evenly, tongue appears large.Palate intact, check for cysts.No teeth (1-2 natal teeth sometimes).Neck:Short, chubby, skin folds, rotates freely.May try to raise head but lacks control.Chest:Breast appear engorged, may secrete a thin, watery fluid (witch’s milk). 1 wk to subside
36Appearance of the Newborn 2 in. less than head.Lungs have rhonchi due to mucus for first 24 to 48 hours. Alveoli open slowly.Abdomen:Slightly protuberantBowel sounds within 1 hour.Liver palpable 1 to 2 cm below right costal margin.Umbilical cord-white, gelatinous structure with red and blue streaks. Count veins and arteries.
37Appearance of the Newborn Inspect cord clamp, within 1 hour cord begins to dry and shrink and turns brown. Day 2 to 3 will turn black.Day 6 to 10 breaks free and new granulating area will heal in next week.Assess abdomen by stroking each quadrant and observe umbilicus to move or wink in that direction.Anogenital Area:Check for patency.
38Appearance of the Newborn Male Genitalia:Scrotum edematous and has rugae.Penis 2 cm., check prepuce (foreskin).CircumcisionFemale Genitalia:Vulva swollen due to effect of maternal hormones.Mucus vaginal secretion, sometimes blood tinged.
39Appearance of the Newborn Back:Flat in lumbar and sacral areas.Back rounded, arms and legs flexed on abdomen and chest.Extremities:Appear short, hands plump,clinched and palmar crease.Fingernails soft, smooth and long.Muscle tone- unflex arm and immediately returns flexed.Fingertips cover proximal thigh.
40Appearance of the Newborn Legs bowed and short, feet turn inward.ROMOrtolani’s sign-clunk of femur head striking the shallow acetabulum.Barlow’s sign-hip slips in socket.Lying on abdomen newborns bring arms and legs underneath them and rise their stomach off the bed.
41Assessment of the Newborn Apgar Scoring:1 minute and 5 minutes after birth (Table 23.2 p. 650) Rated 0,1,or 2 then added together.Score of 4-6 = guarded, 7-10 = good.Heart rate-auscultate with stethoscope.Respiratory effort-cries spontaneously at 30 seconds after birth.Muscle tone-extremities tightly flexed.Reflex irritability-suctioning or sole of feet slapped.
42Assessment of the Newborn Color-cyanotic at birth, pink shortly after first breath.Respiratory EvaluationHighest priority in newborn care.Physical ExaminationGiven immediately after birth, very quicklyHeight and WeightNude, also head, chest and abdominal circumferences.Weight daily at same time.
43Assessment of the Newborn Laboratory StudiesHeel stick for H&H and hypoglycemia (< 40mg/100 mL)Gestational AgeTable 23-4 p. 654Ballard’s assessment (figure p. 655)Behavior CapacityPhysically active and emotionally prepared to interact with people.Brazelton Neonatal Behavioral Assessment Scale
44Assessment of the Newborn Evaluates newborn’s behavioral capacity or ability to respond to stimuli.Care of the Newborn at BirthEquipment-radiant heat table, warm soft blankets, O2, resuscitation, suction, eye care, identification, scales.Handle gentlyNewborn ID and RegistrationIDKidnapper profile- recently lost a pregnancy
45Care of the Newborn at Birth or had an infant stillborn and who desires an infant very much.Familiar with hospital, pretends to be a volunteer or unlicensed health care worker and says she needs to take the baby out of the nursery.ID Band (one arm and one leg)Plastic bracelet, number corresponds to the mother’s hospital number, mother’s full name, sex,date and time of infant’s birth.
46Care of the Newborn at Birth Has built in sensor unit that alarms if baby is transported beyond set boundaries.Foot prints are taken and placed on chart.Registration filed with the Bureau of Vital Statistics of the state of birth.Infant’s name, mother’s name, father’s name if mother chooses, birth date and place.Important because it provides eligibility for school, voting, social security benefits, passports.
47Care of the Newborn at Birth Birth Record Documentation:Time of birthTime the infant breathedWhether respirations were spontaneous or aidedApgar at 1 and 5 minutes of lifeWhether eye prophylaxis was givenWhether vitamin K was administeredGeneral condition of the infantNumber of vessels in umbilical cord
48Care of the Newborn at Birth Whether cultures were takenWhether infant(1)voided and (2) passed stool.Nursing InterventionsKeep Newborn Warm:Reassess temp in 1 hour then q 4-8 hours.Promote Adequate Breathing Pattern and Prevent Aspiration:Suction with bulb syringeRecord First Cry:Aided or unaided
49Care of the Newborn at Birth Inspect and Care for Umbilical CordHazeltine or Kane clampCount vesselsApply triple dyeCoed falls off 7 to 10th day. Do sponge bath.Apply alcohol to cord site.Administer Eye CareErythromycin ointmentGeneral Infection PrecautionsWash up to elbows between babies, gown
50Care of the Newborn at Birth Personnel with infections excluded until clear.Isolate with contagious illness.Postpartal PeriodInitial Feeding:May breastfed immediatelyFormula fed in 2-4 hoursOn demand schedule may be q 2 hours
51Care of the Newborn in Postpartal First bath within 1 hourSupervise parents with 1st bath, cleanest to most soiled. No soap on face.Football holdSleeping PositionOn back due to SIDSDiaper Area CareWash with clear water and dry.A&D may be applied to buttocks
52Care of the Newborn in Postpartal Metabolic Screening TestsPKU-phenylketonuria-disease of defective protein metabolismHypothyroidism3 drops from heel stick on special filter paper.Hepatitis B VaccinationWithin 12 hours after birth, second dose due in 1 month and 3rd due at 6 months.
53Care of the Newborn in Postpartal Vitamin K AdministrationNewborn’s are at risk for bleeding disordersSingle dose 0.5 to 1.0 mg IM of vitamin K is administered within 1 hour after birth.CircumcisionSurgical removal of penis foreskin1st or 2nd day of lifeCheck q 15 min for 1 hour for bleeding, document voiding after the procedure.Petrolatum for 3 days.
54Readiness To Care For Newborn Assess how prepared each family is to care for the newborn.Infants wake up during the night for 1 or more feedings for about the 1st 4 months.Numerous questions to ask to assess for an adequate and safe home.Daily care:Some consistencySatisfy the infantSense of well-being and contentment
55Readiness To Care For Newborn Sleep PatternsSleeps 16 of 24 hours in 1st week at 4 hour intervalsBy 4 months 15 hours of 24 and through the night.Crying2 hours of every 24 for 1st 7 weeks. Peaks at 6 to 7 weeks then tapers off.Most typical wakeful time is between 6pm to 11 pm.Pacifier is up to parents.
56Readiness To Care For Newborn Cleanliness is a concernParental Concerns Related to BreathingStuffy nose or making snorting noises in sleep, have mucus for 2 weeksBreath irregularlyContinued Heath Maintenance for NewbornAppointment with PCP in 2 to 6 weeksParents need to judge the infants state of health, appearance, eating, activity, disposition.
57Readiness To Care For Newborn Car SafetyMeets federal guidelinesHealth Dept or Red Cross has info.Place in back seat may use a blanket to support the head. Facing the back.