Neonatal Nursing Care: Part 3 Nursing Care of Normal Newborn Developed by D. Ann Currie, RN MSN

Assessment Data: Condition of the Infant Apgar scores at 1 and 5 minutes Resuscitative measures Physical examination Vital signs Voidings Passing of meconium

Apgar Score

Care of the Newborn immediately after birth Maintain respirations Provide and maintain warmth Apgar score Physical assessment Newborn identification Facilitate attachment

Signs of Newborn Transition

Neonatal Distress

Newborn Care Positioning Feeding Elimination Safety Issues- Newborn identification Newborn abduction Bonding Cord Care Circumcision Care/Uncircumcision Care

When to Call for Help

Assessment Data: Infant Complications Excessive mucus Delayed spontaneous respirations or responsiveness Abnormal number of cord vessels Obvious physical abnormalities

Assessment Data: Labor and Birth Duration and course Status of mother and fetus Analgesia or anesthesia Prolonged rupture of membranes Meconium-stained amniotic fluid Nuchal cord Precipitous birth Use of forceps or vacuum extraction assisted device Fetal distress

Assessment Data: Maternal Complications Preeclampsia Spotting Illness Recent infections Rubella status Serology results Hepatitis B screen results Exposure to group B streptococci History of maternal substance Human immunodeficiency virus (HIV) test result

Assessment Data: Family Parents’ interactions with their newborn Their desires regarding infant care Information about other children in the home Available support systems Patterns of interaction within each family unit

Physiologic Alterations Respiratory distress Pallor Hypothermia Alterations in feeding and elimination

Nursing Care: Assessment Airway clearance Vital signs Body temperature Neurologic status Ability to feed Evidence of complications

Nursing Care: Assessment Review of prenatal and birth information Gestational age Newborn’s adaptation to extrauterine life Weight and measurement Vital signs every 30 minutes Assessment of Hct or blood glucose if warranted

Daily Assessments Vital signs Weight Overall color Intake and output Umbilical cord Circumcision Newborn feeding Attachment

Daily Newborn Care Assist with feedings Thermoregulation Skin care Cord care Prevention of infection Security

Cord Care

Common Concerns How to pick up a newborn Holding and feeding the infant Changing the diaper Interpreting newborn cues Bathing the newborn Cord and circumcision care Normal voiding and stooling pattern

Parent Education Periods of reactivity and expected newborn responses Normal physical characteristics of the newborn The bonding process The infant’s capabilities for interaction The role of touch in facilitating parent-infant interaction Comforting techniques Progression of infant behaviors Information about available educational materials and support

Discharge Education Safety measures Voiding and stool characteristics Circumcision care Cord care Waking and quieting the newborn Car safety Immunizations Signs of illness

Wrapping Newborn

Infant car restraint for use from birth to about 12 months of age

Signs of Illness Temperature above 38oC or below 36.6oC axillary Continual rise in temperature Forceful or frequent vomiting Refusal of two feedings in a row Difficulty in awakening baby Cyanosis with or without a feeding Absence of breathing longer than 20 seconds Inconsolable infant or continuous high-pitched cry Discharge or bleeding from umbilical cord, circumcision, or any opening Two consecutive green watery or black stools, or increased frequency of stools No wet diapers for 18 to 24 hours Fewer than 6 to 8 wet diapers per day after 4 days of age Development of eye drainage

Documentation of Discharge Teaching How Checking of ID Bands With whom Condition at discharge Where

The End of Part III