Chapter 22 The Normal Newborn: Nursing Care Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Early Care of the Normal Newborn  Administering vitamin K  Prevents bleeding problems  Providing eye treatment  Erythromycin ophthalmic ointment  Cardiorespiratory status  Positioning infant  Suctioning secretions  Close observation 2Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Question  The nurse administers vitamin K to the newborn for what reason? A. Most mothers have a diet deficient in vitamin K, which results in the infant being deficient. B. Vitamin K prevents the synthesis of prothrombin in the liver and must be given by injection. C. Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract. D. The supply of vitamin K is inadequate for at least 3-4 months, and the newborn must be supplemented. 3Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

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Continuing Care of the Normal Newborn  Thermoregulation  Preventing heat loss  Restoring thermoregulation  Performing expanded assessments  Interventions  Keep infant dry and covered  Avoid contact with cold surfaces  Keep away from drafts 5Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

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Performing Expanded Assessments  Blood glucose  Assess all infants for risk factors and signs of hypoglycemia.  Perform screening test for blood glucose.  Maintain safe levels per institutional policies.  Bilirubin  Assess risk for jaundice.  Ensure infant is feeding well.  Explain the condition to parents. 7Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Ongoing Newborn Assessment and Care  Providing skin care  Bathing  Providing cord care  Cleansing diaper area  Assisting with feedings 8Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

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Positioning the Infant  Safe sleep (SIDS)  The American Academy of pediatrics recommends all infants be placed supine to sleep.  Avoid overheating.  Pacifier use in infants over 1 month of age  Not to sleep in a bed or couch with adults  Plagiocephaly  Supervised periods of lying prone each day 10Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Protecting the Infant  Identification  Identification bands were placed on the mother, the infant, and the father or other support person at birth.  Infant abduction  The nurse's role includes teaching parents how to safeguard their infants from abduction.  Preventing infection  Scrupulous handwashing 11Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

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Question  The parents of a 3-month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurse's response should be based on knowledge that this is __________.  unacceptable because of the risk of sudden infant death syndrome (SIDS)  unacceptable because it does not encourage achievement of developmental milestones  acceptable because it encourages fine motor development  acceptable because it encourages head control and turning over 14Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Circumcision  Reasons parents choose circumcision include:  To prevent certain conditions  Religious reasons  Parental preference  Lack of knowledge about care of the foreskin  Reasons parents reject circumcision:  A belief that uncommon conditions do not necessitate surgery and pain in the infant 15Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Risks of Circumcision  Hemorrhage  Infection  Unsatisfactory cosmetic effect  Urinary retention  Urethral stenosis or fistula  Adhesions  Necrosis  Injury to the glans  Pain during and after surgery 16Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

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Signs of Complications After Circumcision  Bleeding more than a few drops with first diaper changes  Failure to urinate  Signs of infection  Fever or low temperature,  Purulent or foul-smelling drainage  Displacement of PlastiBell 20Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Screening Tests  Hearing loss  Metabolic screening  Phenylketonuria  Hypothyroidism  Galactosemia  Hemoglobinopathies  Other tests as determined by the State Department of Health 21Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.

Discharge and Newborn Follow-up Care  Discharge  48 hours after vaginal birth, 96 hours after cesarean birth  Normal vital signs, feeding well, passed urine and stool, no bleeding from circumcision  Follow-up care  American Academy of Pediatrics (AAP) recommends follow-up within 48 hours  Home visits, clinic visits, telephone counseling 22Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc.