NEW BORN CARE

Objectives

Describe the normal characteristics of a term newborn. Assess a newborn for normal growth and development. Formulate nursing diagnoses related to a newborn or the family of a newborn. Identify expected outcomes for a newborn and family during the first 4 weeks of life. Plan nursing care to augment normal development of a newborn, such as ways to aid parent-child

bonding Implement nursing care of a normal newborn, such as administering a first bath or instructing parents on how to care for their newborn.
Evaluate expected outcomes to determine effectiveness of nursing care and outcomes achievement. Use critical thinking to analyze ways that the care of a term newborn can be Integrate knowledge of newborn growth & development and

more family centered.

immediate care needs with the

nursing process to achieve quality maternal and child health nursing care.
The Neonate

From birth through the first 28 days of life Also called the newborn period 2/3 of all deaths that occur during the 1st year of life occur during this period; more than half occur

in the 1st 24 hours after birth---an indication of how hazardous this time is for an infant How well a NB makes major adjustments depends on his or her:
o

Genetic composition
o

The competency of the recent intrauterine environment

o

The care received during the neonatal period

PRINCIPLES IN IMMEDIATE NEW BORN CARE 1st day of life

1. initiation and maintenance of respiration (used bulb syringe initiate a/w) 2. establishment of extra uterine circulation

3. control of body temp 4. intake of adequate nourishment 5. establishment of waste elimination 6. prevention of infection 7. establishment of an infant parent relationship 8. devt care that balances rest and stimulation or mental devt
Immediate care of the newborn. A-airway (most neonatal deaths with in 24 h caused by inability to initiate a/w, lung function begins after birth only) B-body temperature C-check/asses

the newborn D-determined identification

I. Establish and Maintain a Patent Airway / Effective Respiration

Nursing Interventions: 1. Wipe the mouth and nose secretions after delivery of the head 2. Suction secretions from the mouth and nose properly.
Catheter Suctioning

1.) Place head to side to facilitate drainage 2.)Suction mouth 1st before nose
-neonates are nasal breathers

3.) Period of time

-5-10 sec suctioning, gentle and quick

1
Prolonged and deep suctioning can lead to hypoxia, laryngo spasm, brady cardia due to stimulation vagal nerve 4.) Evaluate for patency -cover nostril and baby struggles theres a need for additional suctioning
If not effective, requires effective laryngoscopy to open a/w. After deep suctioning an endotracheal tube can be inserted and oxygen can be administered by an (+) pressure bag and mask with 100% oxygen at 40-60b/m.

Nsg alert: No smoking Always humidify to prevent drying of mucosa Over dosage of oxygen can lead to scarring of retina leading to blindness ( retro lentalfibrolasia or retinopathy of prematurity) When mecomium stained (greenish) never administer oxygen with pressure ( O2 pressure will push mecomium inside)

3. Stimulate the baby to cry if baby does not cry spontaneously or if babys cry is weak.
A crying infant is a breathing infant. Effective cry means effective breathing

Do not slap the buttocks but rub the soles of the feet Do not stimulate the NB to cry unless the secretions have been suctioned to prevent

aspiration The normal infant cry is loud & lusty. Observe for the ff. abnormal cry: High-pitched cry : hypoglycemia, increased ICP Weak cry: prematurity Hoarse cry: laryngeal stridor 4. Oral mucus may cause the NB to choke, cough or gag during the first 12 to 18 hours of life. Place the neonate in a position that would promote drainage of secretions Trendelenburg (contraindicated to Increased ICP) Side-Lying 5. Keep the nares patent. Remove mucus and other particles w/c can cause obstruction as newborns are obligatory nasal breathers until they are about 2-3 weeks old. 6. Give O2 as needed. Oxygen should be given for 20-30 minutes when the neonate remains cyanotic or tachycardic after initial suctioning and stimulation. * asphyxiation hypoxia hypercapnia( CO2) acidosis coma death
Observe precaution in giving oxygen Do not give more than 40% O2 as this may lead to retrolental fibroplasia (blood vessels of the eyes become spastic leading to blindness) Use pulse oximeter and monitor O2 concentration every hour

7. If the heart rate falls below 60 bpm, cardiac massage may need to be carried out. II. Maintain Appropriate Body Temperature
Temp Regulation

goal in temp regulation is to maintain it not less than 97.7% F (36.5 C) maintenance of temp is crucial on preterm and SGA (small for gestational age) - babies prone to hypothermia or cold stress
o

Neonates have physiologic resilience wherein they tend to adopt or take temperature of their own environment. (poikilothermic) cold stress(h yp othermia) is more dangerous than hyperthermia Effects of cold stress Cold stress metabolic acidosis CNS depression Coma Death
o

Every NB is born slightly acidotic. Any new build-up of acid may lead to life-threatening metabolic acidosis, which can be lethal even to normal newborn infants.
o

The average NB temp.@ birth is around 37.2C.

o

NB lose heat easily because:

They have immature temp.-regulating system Of very little amount of subcutaneous fat to provide heat They have a larger body surface area that results in more heat loss They have little ability to conserve heat by changing posture and no ability to adjust its

own clothing
Methods of Heat Loss in Newborn

Convection the flow of heat from the NBs body surface to cooler surrounding air; ex: windows, air conditioners Conduction- the transfer of a body heat to a cooler solid object in contact with a baby; ex: baby placed on a cold counter Radiation the transfer of body heat to a cooler solid obj. not in contact with a baby; ex: cold window or air con Evaporation loss of heat through conversion of a liquid to a vapor; ex: after delivery, newborns are wet, with amniotic fluid on their skin, tsb
To Prevent Hypothermia 1. Dry and wrap baby 2. Mechanical pressure radiant warmer pre-heated first isolette (or square acrylic sided incubator) 3. Prevent an necessary exposure cover baby 4. Cover baby with tin foil or plastic

5.Embrace the baby- kangaroo care

6. Delay initial bath until temp. has stabilized for at least 2 hours. 7. Maintain ambient temp. of nursery at 24C or 75F.

3
Effects of Hypothermia ( Cold stress) 1.) Hypoglycemia- 45-55

mg/dl normal 50- borderline 2.) met acidosiscatabolism of brown fats (best insulator of newborns body) will form ketones
3.) high risk for kernicterus- bilirubin

in brain leading to cerebral palsy

4.) additional fatigue to allergy stressful heart

Intercostal Retraction

none Just visible Marked

Xiphoid Retraction

none Just visible Marked

Nares Dilatation

none minimal Marked

Expiratory Grunt

none Audible by stethoscope Audible by unaided ear Silvermann and Anderson Scoring Interpretation

0 : no respiratory distress

4-6 : moderate respiratory distress

7-10 : severe respiratory distress

IV. Proper Identification of the Newborn

Proper Id is made in the delivery room before mother and baby are seperated.
o

Identification Band
o

Footprints
o

Others fingerprints, crib card, bead bracelet Birth certificate A final identification check of the mother and infant must be performed before the infant can be allowed to leave the hospital upon discharge to ensure that the hospital is discharging the right infant.
V. Preventing Infection
Ophthalmia neonatorum

Any conjunctivitis with discharge occuring during the first two weeks of life. It typically appears 2-5 days after birth, although it may appear as early as the first day or as late as the 13th.
silver nitrate (used before) 2 drops lower conjunctiva (not used now) Administering Erythromycin or Tetracycline Ophthalmic Ointment

These ointments are the ones commonly used nowadays for eye prophylaxis because they do not cause eye irritation

and are more effective against Chlamydial conjunctivitis. Apply over lower lids of both eyes, then, manipulate eyelids to spread medication over the eyes. Wipe excess ointment after one minute sterile cotton ball moistened sterile water.
Principles of cleanliness at birth:

Clean hands

Clean perineum Nothing unclean to be introduced into the vagina Clean delivery surface Cleanliness in cutting the umbilical cord Cleanliness for cord care of the newborn baby
Handwashing

5
Credes Prophylaxis Dr. Crede

-prevent opthalmia neonatorum or gonorrheal conjunctivitis - how transmitted mom with gonorrhea
drug: erythromycin ophthalmic ointment- inner to outer

*It is part of the routine care of the NB to give prophylactic eye treatment against gonorrheal conjunctivitis or ophthalmia neonatorum within the first hour after delivery. * Neisseria gonorrhea, the causative agent,maybe passed on to the fetus when infected vaginal and cervical secretions enter the eyes as the baby passes the vaginal canal during delivery. This practice was introduced by Crede, German gynecologist in 1884. Silver Nitrate, erythromycin and tetracycline ophthalmic ointments are the drugs used for this purpose.

Before entering the nursery or caring for a baby In between newborn handling or after the care of each baby Before treating the cord After changing soiled diaper Before preparing milk formula.
VI. Preventing Hemorrhage As a preventive measure, 0.5mg (preterm) to 1m g (full term) Vit. K or Aquamephyton is injected IM in the NBs

vastus lateralis (lateral anterior thigh)muscle Vit-K to prevent hemorrhage R/T physiologic hypoprothrombinemia Aquamephyton, phytomenadione or konakion
.1ml term IM, vastus lateral or lateral ant thigh .05ml preterm baby

Vit K synthesized by normal flora of intestine Vit K meds is synthetic due intestine is sterile
Care of the Cord

The cord is clamped and cut approx. within 30 sec after birth. In the DR, the cord is clamped twice about 8 inches from the abdomen and cut in between. When the NB, is brought to the nursery, another clamp is applied to 1 in from the abdomen and the cord is cut a second time. The cord and the area around it are cleansed w/ antiseptic solution. The manner of cord care depends on hospital protocol or the discretion of the birth attendant in home delivery, what is impt. Is that principles are followed. Cord clamp is removed after 48 hours when the cord has dried. The cord stump usually dries and falls off within 7-10 days leaving a granulating area that heals on the next 7-10 days. Leave cord exposed to air. Do not apply dressing or abdominal binder over it. The cord dries and seperates more rapidly if it is exposed to air. Report any unusual signs & symptoms that indicate infection:
o

Foul odor in the cord

o

Presence of discharge
o

Redness around the cord

o

The cord remains wet and does not fall off within 7-10 days
o

Newborn fever 6 Procedure for vitamin K injection. Cleanse area thoroughly with alcohol swab and allow skin to dry. Bunch the tissue of the upper outer thigh (vastus lateralis muscle) and quickly insert a 25-gauge 5/8-inch needle at a 90-degree angle to the thigh. Aspirate, then slowly inject the solution to distribute the medication evenly and minimize the babys discomfort. Remove the needle and gently massage the site with an alcohol swab.

Tetanus microorganism thrives in anaerobic environment so you actually prevent infection if cord is exposed to air.
3 cleans in community
o

clean hand
o

clean cord
o

clean surface to clean cord check AVA, then draw 3 vessel cord
betadine or povidone iodine If 2 vessel cord- suspect kidney malformation

- leave about 1 of cord

- if BT or IV infusion leave 8 of cord best access - no nerve - check cord every 15 min for 1st 6 hrs bleeding .> 30 cc of blood bleeding of cord Omphalagia suspect hemophilia Cord turns black on 3rd day & fall 7 10 days

Faiture to fall after 2 weeks- Umbilical granulation

Mgt: silver nitrate or catheterization

- clean with normal saline solution not alcohol - dont use bigkis air - persistent moisture-urine, suspect patent uracus fistula bet bladder and normal umbilicus dx:
nitrazine paper test yellow urine

mgt: surgery
Immediate Care of the Newborn

A irway B ody temperature C heck/ assess the newborn D etermine identification

Stimulate & dry infant Assess ABCs Encourage skin-to-skin contact Assign APGAR scores Give eye prophylaxis & Vit. K Keep newborn, mother, & partner together whenever

7
Full bath safely given when cord fall Dressing the Umbilical Cord strict asepsis to prevent tetanus
Bathing

- oil bath initial - to cleanse baby & spread vernix caseosa Fx of vernix caseosa 1. insulator 2. bacterio- static Babies of HIV + mom immediately give full bath to lessen transmission of HIV - 13 39% possibly of transmission of HIV
Newborn Assessment and Nursing Care Physical Assessment

Temperature - range 36.5 to 37 axillary Common variations

o

Crying may elevate temperature Stabilizes in 8 to 10 hours after delivery

o

Temperature is not reliable indicator of infection A temperature less than 36.5

Temp: rectal- newborn

to rule out imperforate anus

- take it once only, 1 inch insertion Imperforate anus 1. atretic no anal opening 2. agenetialism no genital 3. stenos has opening 4. membranous has opening Earliest sign: 1. no mecomium 2. abd destention 3. foul odor breath 4. vomitous of fecal matter 5. can aspirate resp problem Mgt: Surgery with temporary colostomy
Heart Rate
range 120 to 160 beats per 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 Although murmurs may be due to transitional circulation-all murmurs should be followed-up and referred for medical evaluation Deviation from range Faint sound

Cardiac rate: 120 160 bpm newborn Apical pulse left lower nipple Radial pulse normally absent. If present PDA Femoral pulse normal present. If absent- COA - coartation of aorta
Respiration
- range 30 to 60 breaths per minute Common variations

Bilateral bronchial breath sounds

Moist breath sounds may be present shortly after birth

Signs of potential distress or deviations from expected findings

Asymmetrical chest movements Apnea >15 seconds Diminished breath sounds 8

Seesaw respirations Grunting Nasal flaring Retractions Deep sighing Tachypnea - respirations > 60 Persistent irregular breathing Excessive mucus Persistant fine crackles Stridor
Breathing ( ventilating the lungs)

check for breathlessness if breathless, give 2 breaths- ambu bag 1 yr old- mouth to mouth, pinch nose < 1 yr mouth to nose force different between baby & child infant puff
Circulation

Check for pulslessness :carotid- adult Brachial infants CPR breathless/pulseless Compression inf 1 finger breath below nipple line or 2 finger breaths or thumb CPR inf 1:5 Adults 2:30 Blood Pressure

-not done routinely Factors to consider

Varies with change in activity level Appropriate cuff size important for accurate reading 65/41 mmHg
General Measurements
o

Head circumference - 33 to 35 cm
o

Expected findings

Head should be 2 to 3 cms larger than the chest

o

Abdominal circumference 31-33 cm

o

Weight range - 2500 - 4000 gms (5 lbs. 8oz. - 8 lbs. 13 oz.)

o

Length range - 46 to 54 cms (19 - 21 inches) Anthropometic measurement normal length- 19.5 21 inch or 47.5 53.75cm, average 50 cm head circumference 33- 35 cm or 13 14
Hydrocephalus - >14

Chest 31 33 cm or 12 13 Abd 31 33 cm or 12 13
Signs of increased ICP

1.) abnormally large head 2.) bulging and tense fontanel 9

New Born Care

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neffritirileft a comment thks you 04 / 23 / 2009