2 Leifer, G. (2011) Introduction to maternity and pediatric nursing Leifer, G. (2011) Introduction to maternity and pediatric nursing. (6th edition. Philadelphia: Saunders.Ministry of Health Tamariki Ora Health Book
3 The aims of the assessment of the newborn are to: -ensure adaptation to the environment outside the uterus-to identify any abnormalities early so interventionmay begin
5 At birth, the following is completed: -the time of birth is recorded -Apgar score completed -cord clamp -identification labels (if appropriate) -baby dried -baby’s weight is recorded ( kg) -a full top to toe and systems assessment Rationale / reason….why these assessments are performed…………
7 Assessment of the newborn is on going. A “head to toe assessment”follows a logical format-allows the observation ofgeneral appearance, normalneonatal characteristics,vital signs and reflexes
8 A combination of both assessments is very thorough Systems approachAn assessment which focuses on body systems ensures the newborn has adapted to the new extra uterine environment.A combination of both assessments is very thorough
9 -head circumference 34-35 cms Head to toe assessmentGeneral appearance: colour, activity…. prioritiseHead-head circumference cms-size and shape, symmetry-fontanelles ( anterior, posterior)soft and flat-cephal hematoma-caput succedaneum-molding
20 Care of the cord.-assess any ooze or bleeding, redness….-there is debate as to whether the cord should be left alone or cleaned with an alcohol base solution-the clamp is usually removed after 48+ hours
23 Weight-normal variation kilograms-when weighing babies important aspects include:-warmth of the area-consistency of the scales(scales vary)-clothing eg. singlet or not-documentation-involvement of the family
25 Physiological weight loss Weight loss which is normal and expected in the newborn following birth.-usually approximately 10% of the initial weight after birth.-regained by 10 days to 2 weeks
26 Length-crown to heel-average 50cm (47-53 cm)Head circumference-normal cm-taken from above the ears and eyes in theoccipito-frontal plain.This may change due to molding (moulding) of the newborns head following birth
28 The measurements of weight, length and head circumference are plotted together on a standardised growth chart.All 3 measurements should be within the same percentileThe first measurements = baseline
37 Cephalhematoma-subcutaneous swelling containing blood found on the head of an infant several days after birth.-usually disappearswithin a few weeksto 2 months.
38 Caput succedaneum-swelling or edema occurring in or under the fetal scalp during labour.
39 Physiological jaundice Physiological jaundice. -a harmless condition in the new born caused by the normal reduction of red blood cells following birth. -occurring 48 hours after birth, peaking at day 5 and then disappearing by the 10th day -the newborn has a “yellowish” appearance to its skin colour. -the newborn may be sleepy and lethargic, but feeding must be regular -lying the baby in the sunshine helps.
41 Examination of the hips (-refer to the picture in the book of readings)Abduction maybe limited in congenital dislocation of the hips. One hand stabilises the pelvis.With the other hand, the flexed thigh is gently pushed posteriorly and then abducted. During abduction a displaced hip relocates with a “clunk”“Hip click test”
42 Newborn screening for several inborn errors of metabolism is done through a small blood test usually after 48 hours of feeding.The Guthrie test uses a small amount of blood (obtained through a heel prick) to saturate a piece of filter paper.
43 The metabolic conditions tested for include: PKU (phenylketonuria), Cystic Fibrosis, Galactosaemia, hypothyroidism, Maple syrup Urine Disease (MSUD), Biotinidase deficiency and congenital hyperplasia (CAH)
44 Priority assessments / on going and for the days and weeks following birth : -general appearance-respirations and heart rate-colour, skin, cord, eyes-temperature-passing urine-passing meconium / stools-presence of sucking and swallowing /-feeding patterns-top to toe and systems assessment know the rationalereason why?
45 At each ongoing assessment of the newborn / baby the child health nurse (plunket nurse) will assess -general appearance, skin, colour, cord, eyes, -feeding patterns, -patterns of elimination urine, bowel actions -sleeping patterns -general wellbeing, patterns of crying -hearing and vision -developmental milestones
46 -work with the mother and family to assist in providing a safe and stimulating environment for the baby, infant. -provide education regarding the introduction of solid foods, immunisations, dental health , vision and hearing assessments, availability of support services in the area…..type of car seat,