immediate nursing care of the newborn

8/13/2019 Immediate Nursing Care of the Newborn

1/29

Immediate Nursing Care of theNewborn

Prepared by:

Ms. Anafe B. Lanuzo RN


2/29

Newborns undergo profound physiologic

changes at the moment of birth, as they are

released from a warm, snug, dark liquid-filed

environment that has met all of their basic

needs, into a chilly, unbounded, brightly lit,

gravity based outside world.


3/29

Within minutes after being plunged into this

strange environment, a newborns body must

initiate respirations and accommodate a

circulatory system to extrauterine

oxygenation.


4/29

How well the newborn makes these major

adjustments depends on his or her genetic

composition, the competency of the recent

intrauterine environment, the care received

during the labor and birth period, and the care

received during the newborn or neonatal

periodfrom birth through the first 28 days oflife. (Adele Pillitteri, 2007)


5/29

Two thirds of all deaths that occur during the firstyear of life occur in the neonatal period. Morethan half occur in the first 24 hours after birth

an indication of how hazardous this time is for aninfant. Close observation of a newborn for thisindication of distress is essential during thisperiod (National Center for Health Statistics,

2005).


6/29

Establish and Maintain a Patent Airway

1. Never stimulate a baby to cry unless secretionshave been drained out.

2. Mucus should be sustained from a newborns

mouth by a bulb syringe as soon as the head isdelivered.

3. As soon as an infant is born, he/she should beheld for a few seconds with the head lightly

lowered for further drainage of secretion.


7/29

4 Suction the newborn properly:

1. Turn the babys head to one side

2. Suction gently and quickly.

3. Suction the mouth first before the nose.

4. Occlude one nostril at a time when testing for airway

patency.5. Record the first cry.

6. Maintain appropriate body temperature as chilling willincrease the bodys need for oxygen.

7. Newborn suffers large losses of heat because he is wet atbirth, the delivery room is cold he does not have enoughadipose tissues and does not know how to shiver.


8/29

Keep Newborn Warm

Effects of Cold Stress

Metabolic acidosis

Hypoglycemia


9/29

1. Dry the newborn immediately

2. Wrap him with a warm blanket but not too tightas not to compromise respiratory effort

3. Lay infant on his side in a warmed bassinet orplace under a droplight

4. Place a head cap to conserve heat especially ifthey are in an open crib.

5. All nursing care should be accomplished quicklyas possible to minimize exposure of the infant


10/29

6 Apgar scorestandardized evaluation of the

newborns condition. Done at one minute

after birth to determine the general condition

and then at 5 minutes to determine how well

the newborn is adjusting to extrauterine life.


11/29

1. Colorall infants appear cyanotic at birth and grow pinkwith or shortly after the first breath

2. Heart Rateauscultation of the newborns heart

3. Reflex irritabilityresponse to a suction catheter or

having the soles of their feet slapped.4. Muscle tonenewborn hold the extremity tightly flex.

They should resist any effort to extend their extremities

5. Respiratory efforta mature newborn usually criesspontaneously at about 30 seconds after birth. At one

minute, the infant is maintaining regular although rapidrespirations.


12/29

Sign 0 1 2

Appearance: Color Pale, blue all over Pinky body, blue

extremities

Pink all over

Pulse: pulse rate absent Less than 100 More than 100

Grimace: reflex

irritability

Non response to

stimulation

Grimace/feeble cry

when stimulated

Sneeze/Coughs/Pull

s away when

stimulated; good

strong cry

Activity: Muscle

Tone

Limp, flaccid Some flexion of

extremities

Well-flexed

extremities

Respiration:

Breathing

Absent Weak or irritable Good, strong


13/29

Scoring

0-3 pointsthe baby is serious danger and needimmediate resuscitation.

4-6 pointsthe babys condition is guarded andmay need more extensive clearing of the airwayand supplementary oxygen.

7-10 pointsare considered good and in the bestpossible health.


14/29

Vital Statistics/Anthropometric

MeasurementsVital Statistic Average Low or arbitrary low

Weight 6.5 to 7.5 lbs Less than 5.5 lbs

Length 50 cms (20 in) 46 cms (18 in)

Head circumference 33 to 35 inches

Chest circumference 31-33 cms or 2cms less

than head circumference

Abdominal circumference 31 to 33 cms


15/29

Vital signs

Vital sign Immediately at birth After birth

Temp 36.5 to 37.2 celcius

Pulse 180 beats/min 120-140 beats/min

Respiration 80 breaths/min 30-50 breaths/min

Blood pressure 80/46 mmHg 100/50 mmHg (by 10thday)


16/29

Proper Identification and Charting

1. Proper identification of the newborn and footprints must be takenand kept in the chart.

2. Attach ID bracelet with a number that corresponds to themothers hospital number, mothers full name, sex, date and timeof birth.

3. Inspect for the presence of 2 arteries and 1 vein. Suspect acongenital anomaly if blood vessels are not complete.

4. Apply triple dye or Betadine for faster healing effect.

5. This is to cleanse the baby of blood mucus and vernix, and thenfollowed with sponge bath. Dry infant, wrap and keep him warm.

6. CredesProphylaxisprophylactic treatment of the newbornseyes against gonorrheal conjunctivitis aka opthalmia neonatarum,which the baby acquires as he passes through the birth canal ofthe mother who has untreated gonorrhea.


17/29

Care of the Umbilical Cord Give Initial

Oil Bath Administer Eye Care

Procedure

1. Wipe the face dry.

2. Shade the eyes from light and open one eye at a

time by exerting gentle pressure on the upperand lower lids.

3. Apply Erythromycin/Terramycin Opthalmicointment from the inner to outer canthus of theeye. The antibiotic will eliminate gonorrhea andChlamydia as well.


18/29

Administration of Vitamin K

Vitamin K facilitates production of the clotting

factor, thus preventing bleeding.

Method: Aquamephyton 1mg (Phytonadione), a

synthetic Vitamin K is injected IM into the lateral

aspect of the anterior thigh (vastus lateralis).


19/29

Document Birth Record

Accomplish the form properly.

Continue Physical assessment

1. General Appearanceposition and activity


20/29

2. Skin

1.a. Colorruddy complexion due to increased RBC concentration and

decreased subcutaneous fat which makes blood vessels more visible.

1. Acrocyanosis

2. Physiologic Jaundice

3. Textureslight desquamation for the first 2 to 4 weeks of life4. Skin Turgorgood elasticity

5. Vernix Caseosawhite cream-cheese like that serves as a skin lubricant

6. Miliapinpoint size white spots seen on the nose and chin due to

obstruction of the sebaceous glands.

7. Erythema Toxicumnewborn rash. It begins with a papule and

eventually to an erythematic appearance.

8. Lanugois the fine downy hair that covers a newborns shoulders, back

and upper arms.

9. Immature newborns have more lanugo than mature infant.


21/29

9. Birthmarks

1. Hemangiomasare vascular tumors of the skin.

1. Nevus flammeusmuscular purple or dark red lesion.Generally appear on the face and thighs.

2. Strawberry hemangiomaselevated areas formed by

immature capillaries and endothelial cells.3. Cavernous hemangiomasthese are dilated vascularspaces.

4. Mongolian spotsslate gray patches across the sacrumor buttocks and consist of a collection of pigment cells.

5. Forceps marksthese are circular or linease contusionmatching the rim of the blade forceps on the infantscheeks.


22/29

3. Headnewborns head is

disproportionately large

1. Fontanellesspaces or opening where the skullbones join

2. Moldingthe part of the infants head that engagesthe cervix. It is molded to fit the cervix contours.

3. Caput Succedaneumis edema of the scalp at thepresenting part of the head.

4. Cephalhematomais a collection of blood betweenthe periosteum of the skull bone and the bone itselfcaused by rupture of the periosteum capillary due tothe pressure of birth.

5. Craniotabesis a localized softening of the cranialbones.


23/29

4. Eyesvision is present as evidence of blinking

reflex

5. Earshearing is present as soon as amnioticfluid is drained or is absorbed from the middle

ear.

6. Nosemay appear large for the face.7. Mouthshould open evenly when the baby

cries.

8. Neckis short and chubby, creased with skinfolds and head rotate freely.

9. Chestappear small in proportion to infants

head.


24/29

1. Abdomencontour is slightly

protuberant (sticking out from the

surroundings)

2. Anogenital Areaanus should not be

covered by a membrane. Take note ofthe time meconium is first passed.


25/29

1. Backthe spine appears flat in the lumbar and sacralareas

2. Extremities

1. Arms and legs appear short

2. Hands are plump and clinch into fists

3. Should move symmetrically

4. Fingernails are soft, smooth5. Good muscle tone, arms always in flexed position

6. Palm of hands should have three creases.

7. Legs are bowed as well short

8. Soles of the feet appears to be flat

9. Presence of crisscrossed lines on the soles of thefoot.


26/29

3. Feeding

Provide Discharge Instructions

1. Breast-fed babies are fed immediately after birth and can be

fed on demand or at least every 2 hours for the first few days of

life. Advice to alternate both breast at 10-15 minutes each.

2. Bottle-fed babies routinely received an initial feeding of about

1oz of sterile water at 4-6 hours of age to be certain the infant

can swallow without gagging and aspirating. The newborn is

then fed every four hours.

1. Sleep patternsnewborns sleep 16-20 hours a day2.Bathingmay be given anytime convenient as long as it is

not within 30 minutes after feeding as handling might cause

regurgitation. Sponge baths are done until cord falls off.


27/29

3. Cord Care

1. Dab rubbing alcohol (70% soln) two or threetimes a day for faster drying.

2. Fold down diapers so that cord does not get wet

during voiding.

3. Small, pink granulating area may be seen on the

day the cord falls off. If it remains moist or with

foul discharge, advise mother to bring baby to

the doctors clinic.4. Car Safety. Until a child reaches a weight of 20lbs,

the best type of car seat is an infant only seat that

faces the back of the car.


28/29

References: Pillitteri, A. (2007).

Maternal and Child HealthNursing:Care of the Childbearing and

Childrearing Family. Winsconsin:Lippincott Williams & Wilkins.


29/29

The end

Thank You!

immediate nursing care of the newborn

Documents