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Newborn Nursing. The Newborn. Nursing Assessment of the Normal Newborn. Assessment of the newborn is imperative immediately after birth followed by an assessment within 1 to 4 hours and continued assessment procedures during the first 24 hours of life. - PowerPoint PPT Presentation

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Page 1: Newborn Nursing

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Newborn NursingNewborn Nursing

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Nursing Assessment of the Normal Newborn

Assessment of the newborn is imperative Assessment of the newborn is imperative immediately after birth followed by an assessment immediately after birth followed by an assessment

within 1 to 4 hours and continued assessment within 1 to 4 hours and continued assessment procedures during the first 24 hours of life.procedures during the first 24 hours of life.

Initial Assessment immediately following birthInitial Assessment immediately following birth Need for resuscitation Need for resuscitation

APGAR scoring APGAR scoring Heart rateHeart rate

Respiratory effortRespiratory effort Muscle toneMuscle tone

Reflex responseReflex response ColorColor

Cry – strong and lustyCry – strong and lusty

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Nursing Assessment of the Nursing Assessment of the Normal NewbornNormal Newborn

Initial assessment (continued)Initial assessment (continued) Newborn responses to birthNewborn responses to birth Assessment and care of the newbornAssessment and care of the newborn Check for congenital anomalies Check for congenital anomalies

especially cardiovascular, pulmonary especially cardiovascular, pulmonary and neurologicand neurologic

If stable, place with parents for initial If stable, place with parents for initial bonding and early breastfeedingbonding and early breastfeeding

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Newborn’s Immediate Newborn’s Immediate NeedsNeeds

AirwayAirway BreathingBreathing CirculationCirculation WarmthWarmth

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Initial newborn assessmentInitial newborn assessment

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

together whenever possible

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NEWBORN PERIOD & NEONATAL TRANSITION

Newborn period: birth to 28 days Neonatal transition: first 6-8 hours after

birth Establishment of respiratory gas

exchange & circulatory system Nurse must be aware of normal

physiologic & behavioral adaptations, as well as deviations from the norm to ensure safety of the newborn

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The NewbornThe Newborn Neonatal transition: 1Neonatal transition: 1stst few hours few hours

after birth newborn stabilizes after birth newborn stabilizes respiratory and circulatory functions.respiratory and circulatory functions.

When the cord is clamped, placental When the cord is clamped, placental gas exchange ceases.gas exchange ceases.

These changes stimulate carotid and These changes stimulate carotid and aortic chemoreceptors which send aortic chemoreceptors which send impulses to the respiratory center in impulses to the respiratory center in the medulla.the medulla.

A brief period of asphyxia stimulates A brief period of asphyxia stimulates respirations.respirations.

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Dry the BabyDry the Baby

Hypothermia is commonHypothermia is common Wet newborns rapidly lose Wet newborns rapidly lose

heatheat Use a warm, dry, soft towelUse a warm, dry, soft towel Any absorbent material:Any absorbent material:

ShirtShirt T-shirtT-shirt SocksSocks Battle dressingsBattle dressings

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Replace the Wet TowelsReplace the Wet Towels Then let the Then let the

mother hold the mother hold the babybaby

Her body heat Her body heat will help keep will help keep the baby warmthe baby warm

Cover the head Cover the head to prevent heat to prevent heat lossloss

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Position the BabyPosition the Baby

Keep the baby on its’ back or Keep the baby on its’ back or side, not on its’ stomachside, not on its’ stomach

Neither extend nor flex the head. Neither extend nor flex the head. Either may obstruct the airway.Either may obstruct the airway.

Newborn babies normally make Newborn babies normally make this adjustment themselves. If this adjustment themselves. If depressed, however, you may depressed, however, you may need to position the head to get need to position the head to get a good airway.a good airway.

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Suction the AirwaySuction the Airway

May need to help them clear May need to help them clear mucous and amniotic fluid from mucous and amniotic fluid from the airwaythe airway

Use a bulb syringeUse a bulb syringe Use it gentlyUse it gently If bulb syringe is not available, If bulb syringe is not available,

use any suction device, including use any suction device, including a small hypodermic syringe a small hypodermic syringe without the needle.without the needle.

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Ventilate if NecessaryVentilate if Necessary If not breathing following If not breathing following

brief stimulation, ventilatebrief stimulation, ventilate Ideally, bag/mask, 100% Ideally, bag/mask, 100%

oxygen, pressure gauge, oxygen, pressure gauge, flow control valveflow control valve

May need to use mouth-May need to use mouth-to-mouthto-mouth

Cover nose and mouthCover nose and mouth Use shallow puffs to Use shallow puffs to

ventilateventilate

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Evaluate the BabyEvaluate the Baby BreathingBreathing ColorColor Heart RateHeart Rate Tactile stimulation Tactile stimulation

(rubbing) with a (rubbing) with a towel. may towel. may effectively effectively stimulate a mildly stimulate a mildly depressed babydepressed baby

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Keep the Baby WarmKeep the Baby Warm

Keep the airway open Keep the airway open Keep the head coveredKeep the head covered Use any available cloth or Use any available cloth or

heat-retaining materialheat-retaining material Check temp several Check temp several

times: 97.7-99.3F axillarytimes: 97.7-99.3F axillary

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TemperatureTemperature At birth-warmth, keep the baby in At birth-warmth, keep the baby in

skin to skin contact with the motherskin to skin contact with the mother

EN-Teaching Aids: ENC 16

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Apgar Score Apgar Score Assesses the infants Assesses the infants

cardiopulmonary cardiopulmonary adaptations to adaptations to extrauterine lifeextrauterine life

Provides a quick Provides a quick evaluation on how evaluation on how the heart and lungs the heart and lungs are adaptingare adapting

5 items to be 5 items to be assessed 1 and 5 assessed 1 and 5 minutes after birth.minutes after birth.

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Apgar ScoreApgar Score Heart rate, respiratory rate, muscle tone, reflex irritability and Heart rate, respiratory rate, muscle tone, reflex irritability and

colorcolor Score of 0 – 2 for each item, then totaled. Score of 0 – 2 for each item, then totaled. Apgar Score 8 or higher no interventionApgar Score 8 or higher no intervention Apgar Score 4 – 8 gentle rubbing, oxygenApgar Score 4 – 8 gentle rubbing, oxygen Apgar Score 0 – 4 resuscitation Apgar Score 0 – 4 resuscitation

Points GivenPoints Given 00 11 22

AA Activity/Activity/muscle tonemuscle tone

Limp/flaccidLimp/flaccid Some Some motion/fleximotion/flexionon

Active Active motion/well motion/well flexedflexed

PP Pulse RatePulse Rate Absent Absent <100 <100 bts/minbts/min

>100 bts/min>100 bts/min

GG Grimace/Grimace/Reflex Reflex IrritabilityIrritability

No No ResponseResponse

GrimaceGrimace Cry, cough, Cry, cough, sneezesneeze

AA Appearance/ Appearance/ Skin ColorSkin Color

Blue, PaleBlue, Pale Body pink, Body pink, extremities extremities blueblue

Pink all overPink all over

Absence of Absence of cyanosiscyanosis

RR Respiration Respiration Absent Absent Slow weak Slow weak crycry

Good CryGood Cry

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Nursing Assessment of the Normal Newborn

Second physical assessment – within first 4 Second physical assessment – within first 4 hours of lifehours of life

General appearanceGeneral appearance Measurements: weight, length, head & chest Measurements: weight, length, head & chest

circumferencecircumference Temperature (axillary not rectal)Temperature (axillary not rectal)

Respiration: Normal 30 – 60 (average 40s)Respiration: Normal 30 – 60 (average 40s) Heart: Normal 120 – 160. Temporary murmur Heart: Normal 120 – 160. Temporary murmur from open ductus arteriosus common. Brachial from open ductus arteriosus common. Brachial

and femoral pulses strong and equal.and femoral pulses strong and equal. Blood Pressure not routinely assessedBlood Pressure not routinely assessed

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Vital SignsVital Signs Temperature - range 36.5 to 37 axillary (97.7-98.6)Temperature - range 36.5 to 37 axillary (97.7-98.6) Axillary vs Rectal about 0.2 to 0.5 differenceAxillary vs Rectal about 0.2 to 0.5 difference

Common variationsCommon variations Crying may elevate temperatureCrying may elevate temperature Stabilizes in 8 to 10 hours after deliveryStabilizes in 8 to 10 hours after delivery

Heart rate - range 120 to 160 beats per minute Heart rate - range 120 to 160 beats per minute Apical pulse for one minuteApical pulse for one minute

Common variationsCommon variations Heart rate range to 100 when sleeping to 180 when cryingHeart rate range to 100 when sleeping to 180 when crying Color pink with acrocyanosisColor pink with acrocyanosis Heart rate may be irregular with cryingHeart rate may be irregular with crying

Respiration - range 30 to 60 breaths per minuteRespiration - range 30 to 60 breaths per minute Blood pressure - not done routinely Blood pressure - not done routinely

Ranges between 60-80 mm systolic and 40-45 mm Ranges between 60-80 mm systolic and 40-45 mm diastolicdiastolic..

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Nursing Assessment of the Nursing Assessment of the Normal NewbornNormal Newborn

Estimation of gestational age through Estimation of gestational age through physical assessment physical assessment

Physical maturity characteristics – skin, Physical maturity characteristics – skin, lanugo, plantar creases, breasts, lanugo, plantar creases, breasts, ear/eye, genitals characteristicsear/eye, genitals characteristics

Neuromuscular characteristics: resting Neuromuscular characteristics: resting posture, arm recoil, popliteal angle, scarf posture, arm recoil, popliteal angle, scarf sign, heel to ear and square window sign, heel to ear and square window signssigns

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Gestational Age Relationship to Intrauterine Gestational Age Relationship to Intrauterine GrowthGrowth

Normal range of birth weight for each week Normal range of birth weight for each week of gestation.of gestation.

Birth weight is classified as follows:Birth weight is classified as follows: Large for gestational age (LGA): weight falls Large for gestational age (LGA): weight falls

above the 90above the 90thth percentile for gestational percentile for gestational ageage

Appropriate for gestational age (AGA): Appropriate for gestational age (AGA): weight falls between the 90weight falls between the 90thth and 10 and 10thth percentile for gestational agepercentile for gestational age

Small for gestational age (SGA): weight Small for gestational age (SGA): weight falls below the 10falls below the 10thth percentile for percentile for gestational agegestational age

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Intrauterine Growth GridIntrauterine Growth Grid

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Nursing Assessment of the Normal Newborn

Skin characteristicsSkin characteristicsAcrocyanosisAcrocyanosis

MottlingMottlingHarlequinHarlequinJaundiceJaundice

Erythema toxicum – “Newborn rash”Erythema toxicum – “Newborn rash”MiliaMilia

Skin turgorSkin turgor

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Nursing Assessment of the Normal Newborn

Skin CharacteristicsSkin Characteristics (continued) (continued)Vernix caseosaVernix caseosa

Ruddy colorRuddy colorCracked and peeling skinCracked and peeling skin

LanugoLanugoForceps or vacuum marksForceps or vacuum marks

BirthmarksBirthmarksCafé-au-laitCafé-au-lait

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Skin Skin Expected findingsExpected findings Skin reddish in color, smooth and Skin reddish in color, smooth and

puffy at birthpuffy at birthAt 24 - 36 hours of age, skin flaky, dry At 24 - 36 hours of age, skin flaky, dry and pink in colorand pink in color

Edema around eyes, feet, and genitalsEdema around eyes, feet, and genitals Vernix caceosaVernix caceosa Lanugo (baby hair)Lanugo (baby hair) Turgor good with quick recoilTurgor good with quick recoil Hair silky and soft with individual Hair silky and soft with individual

strandsstrands

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Common Normal Variations Common Normal Variations Acrocyanosis - result of sluggish Acrocyanosis - result of sluggish

peripheral circulation.peripheral circulation. Mongolian SpotsMongolian Spots: Patch of purple-black : Patch of purple-black

or blue-black color distributed over or blue-black color distributed over coccygeal and sacral regions of infants coccygeal and sacral regions of infants of African-American or Asian descent. of African-American or Asian descent.

MiliaMilia: Tiny white bumps papules : Tiny white bumps papules (plugged sebaceous glands) located (plugged sebaceous glands) located over nose, cheek, and chin. over nose, cheek, and chin.

Erythema toxicumErythema toxicum: : Most common newborn Most common newborn rash. Variable, irregular macular patches. rash. Variable, irregular macular patches. Lasts a few days.Lasts a few days.

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ColorColor Most newborns have Most newborns have

acrocyanosis (body is acrocyanosis (body is centrally pink, but centrally pink, but hands and feet are hands and feet are blueblue

Cyanosis requires Cyanosis requires treatment:treatment: OxygenOxygen AirwayAirway VentilationVentilation

Pink

Acrocyanosis

Cyanosis

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Color of the babyColor of the baby

Normal vs. Abnormal EN-Teaching Aids: ENC 30

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Erythema toxicum, acrocyanosis, milia Erythema toxicum, acrocyanosis, milia and mongolian spotsand mongolian spots

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VernixVernix Cheesy-whiteCheesy-white NormalNormal Antibacterial Antibacterial

propertiesproperties Protects the Protects the

newborn skinnewborn skin

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Hyperbilirubinemia Hyperbilirubinemia Physiologic JaundicePhysiologic Jaundice =Appears 24 hours =Appears 24 hours

after birth peaks at 72 hrs.after birth peaks at 72 hrs. Bilirubin may reach 6 to 10 mg/dl and resolve Bilirubin may reach 6 to 10 mg/dl and resolve

in 5 to 7 days. in 5 to 7 days. Due to Unconjugated bilirubin circulating in Due to Unconjugated bilirubin circulating in

the blood stream that is deposited in the skin. the blood stream that is deposited in the skin. Immature liver unable to conjugate bilirubin Immature liver unable to conjugate bilirubin

released by destroyed RBC.released by destroyed RBC. Pathologic JaundicePathologic Jaundice =Not appear until after =Not appear until after

24 hrs leads to Kernicterus (deposits of bili in 24 hrs leads to Kernicterus (deposits of bili in brain).brain).

Bilirubin >20mg/dlBilirubin >20mg/dl The most common cause is The most common cause is RhRh incompatibility. incompatibility.

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Nursing Assessment of the Nursing Assessment of the Normal NewbornNormal Newborn

General appearance of the headGeneral appearance of the head Cephalhematoma – bleeding between Cephalhematoma – bleeding between

the periosteum and the cranial bonethe periosteum and the cranial bone Caput succedaneum – localized Caput succedaneum – localized

edema from pressureedema from pressure Molding – movement of the cranial Molding – movement of the cranial

bones during birthbones during birth FontanelsFontanels

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The Head and The Head and ChestChest

The HeadThe Head:: Anterior Anterior fontanel diamond shaped fontanel diamond shaped 2-3 - 3-4 cms2-3 - 3-4 cms

Posterior fontanel Posterior fontanel triangular 0.5 - 1 cmtriangular 0.5 - 1 cm

Fontanels soft, firm and Fontanels soft, firm and flatflat

head circumference is 33 head circumference is 33 – 35 cm– 35 cm

The head is a few The head is a few centimeters larger than centimeters larger than the chest!!!!the chest!!!!

The Chest:The Chest: circumference circumference is 30.5 – 33 cmis 30.5 – 33 cm

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Anterior and Posterior Anterior and Posterior FontanellesFontanelles

Anterior diamond shaped Anterior diamond shaped 2-3 - 3-4 cms2-3 - 3-4 cms

Posterior triangular 0.5 - 1 Posterior triangular 0.5 - 1 cmcm

Fontanels soft, firm and Fontanels soft, firm and flatflat

Molding is shaping Molding is shaping of fetal head to of fetal head to adapt to the adapt to the mothers pelvis mothers pelvis during labor.during labor.

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Caput succedaneumCaput succedaneum

Swelling of the soft Swelling of the soft tissue of the scalp tissue of the scalp caused by pressure of caused by pressure of the fetal head on a the fetal head on a cervix that is not fully cervix that is not fully dilated. dilated.

Swelling is generalized. Swelling is generalized. may cross suture line may cross suture line and decreases rapidly and decreases rapidly in a few days after in a few days after birth. Requires no birth. Requires no treatmenttreatment

2 – 3 days disappears 2 – 3 days disappears

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Cephalohematoma Cephalohematoma

Collection of blood Collection of blood between the between the periosteum and skull periosteum and skull of newborn.of newborn.

Does not cross suture Does not cross suture lineslines

Caused by rupturing of Caused by rupturing of the periosteal bridging the periosteal bridging veins due to friction veins due to friction and pressure during and pressure during labor.labor.

Lasts 3 – 6 weeksLasts 3 – 6 weeks

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Caput succedaneum vs. Caput succedaneum vs. cephalohematomacephalohematoma

Normal vs. Abnormal

EN-Teaching Aids: ENC 40

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The normal resting The normal resting posture of a baby born posture of a baby born

breech breech

EN-Teaching Aids: ENC 41

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ABNORMAL ABNORMAL position of position of arm and handarm and hand

EN-Teaching Aids: ENC 42

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Nursing Assessment of the Nursing Assessment of the Normal NewbornNormal Newborn

FaceFace SymmetrySymmetry EyesEyes NoseNose MouthMouth EarsEars

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Nursing Assessment of the Nursing Assessment of the Normal NewbornNormal Newborn

NeckNeck Chest Chest CardiacCardiac Peripheral vascularPeripheral vascular AbdomenAbdomen

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Check the HeartbeatCheck the Heartbeat

Normal newborn rate is Normal newborn rate is >100>100

Palpate umbilical cord or Palpate umbilical cord or brachial arterybrachial artery

If pulse <100, ventilate If pulse <100, ventilate the baby, using whatever the baby, using whatever skills and equipment you skills and equipment you havehave

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CARDIOVASCULAR CHANGES AT BIRTH

Onset of respirations stimulates changes in cardiovascular system of newborn

Closure of fetal shunts Foramen ovale Ductus venosus Ductus arteriosus: functionally closes

within 24 hours of birth, but may take several weeks to permanently close

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Nursing Assessment of the Nursing Assessment of the Normal NewbornNormal Newborn

Umbilical cord Umbilical cord Examined for 2 arteries, 1 vein. Examined for 2 arteries, 1 vein. Will dry up and detach in 10 to 14 daysWill dry up and detach in 10 to 14 days Cord Care: alcohol, soap & waterCord Care: alcohol, soap & water

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Umbilical Cord CareUmbilical Cord Care Clean & dryClean & dry Alcohol wipe once a dayAlcohol wipe once a day Topical antiseptic only in Topical antiseptic only in

contaminated areascontaminated areas

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The umbilicus: Which one is The umbilicus: Which one is normal?normal?

Normal vs. Abnormal

EN-Teaching Aids: ENC 50

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Nursing Assessment of the Nursing Assessment of the Normal NewbornNormal Newborn

GenitalsGenitals Female may have thick white mucousy Female may have thick white mucousy

vaginal dischargevaginal discharge

Male evaluate for the position of the Male evaluate for the position of the urinary meatus, scrotum, testiclesurinary meatus, scrotum, testicles

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Nursing Assessment of the Nursing Assessment of the Normal NewbornNormal Newborn

Anus – verify patencyAnus – verify patency Arms and hands- count fingers, Arms and hands- count fingers,

evaluate palmar creases and position of evaluate palmar creases and position of the armsthe arms

Legs and feet – count toes, legs of equal Legs and feet – count toes, legs of equal length and check for hip dislocation (hip length and check for hip dislocation (hip click) click)

Back – Spine straight, no spina bifidaBack – Spine straight, no spina bifida

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Nursing Assessment of the Nursing Assessment of the Normal NewbornNormal Newborn

Neurologic StatusNeurologic Status AlertnessAlertness Resting postureResting posture CryCry Muscle tone and activityMuscle tone and activity

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RootingRooting SuckingSucking ExtrusionExtrusion Palmar graspPalmar grasp Plantar graspPlantar grasp Tonic neckTonic neck

MoroMoro GallantGallant SteppingStepping Babinski’sBabinski’s Crossed Crossed

extension reflexextension reflex PlacingPlacing

Nursing Assessment -Nursing Assessment -Normal NewbornNormal Newborn

Reflexes: indicate neurological integrityReflexes: indicate neurological integrity

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Rooting ReflexRooting Reflex

Birth to 3-4monthsBirth to 3-4months Rooting reflex: A

reflex seen in newborn babies, who automatically turn their face toward the stimulus and make sucking (rooting) motions with the mouth when the cheek or lip is touched. The rooting reflex helps to ensure breastfeeding

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Sucking ReflexSucking Reflex

Birth to 10 monthsBirth to 10 months The sucking reflex is initiated The sucking reflex is initiated

when something touches the when something touches the roof of an infants mouth. roof of an infants mouth. Infants have a strong sucking Infants have a strong sucking reflex which helps to ensure reflex which helps to ensure they can latch onto a bottle they can latch onto a bottle or breast. The sucking reflex or breast. The sucking reflex is very strong in some infants is very strong in some infants and they may need to suck and they may need to suck on a pacifier for comfort. on a pacifier for comfort.

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ExtrusionExtrusion reflexreflex

Extrusion Reflex or Tongue-Thrust Extrusion Reflex or Tongue-Thrust ReflexReflex

A newborn baby is not developmentally A newborn baby is not developmentally ready to eat solid foods. Her throat muscles ready to eat solid foods. Her throat muscles will not be developed enough to swallow will not be developed enough to swallow solid foods until she is at least four months solid foods until she is at least four months old. It is roughly around this time that she old. It is roughly around this time that she will be able to use her tongue to transfer will be able to use her tongue to transfer food from the front to the back of the mouth food from the front to the back of the mouth to swallow safely. To see this in action, touch to swallow safely. To see this in action, touch her tongue -- she should react by pushing her tongue -- she should react by pushing her tongue outward or forward to resist.her tongue outward or forward to resist.

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Palmer Grasping ReflexPalmer Grasping Reflex

Birth to 4 months. Birth to 4 months. This is always a fun This is always a fun one to see. If you one to see. If you place your finger into place your finger into the palm of your the palm of your baby's hand, his baby's hand, his fingers will grasp your fingers will grasp your finger and hold on finger and hold on tightly. It's as if he tightly. It's as if he were born knowing were born knowing that he wanted to that he wanted to hold your hand! hold your hand!

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Tonic Neck Reflex (FENCING)Tonic Neck Reflex (FENCING)

EXTENDS arm & leg on the EXTENDS arm & leg on the side that the face points.side that the face points.

Flexes opposite arm & legFlexes opposite arm & leg 6-8 wks to 6 months6-8 wks to 6 months

The tonic neck reflex is demonstrated in infants who are placed on their abdomens. Whichever side the child’s head is facing, the limbs on that side will straighten, while the opposite limbs will curl

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Startle/Moro ReflexStartle/Moro Reflex Moro ReflexMoro Reflex Birth to 4-6 monthsBirth to 4-6 months Infants will respond to Infants will respond to

sudden sounds or sudden sounds or movements by throwing movements by throwing their arms and legs out, their arms and legs out, and throwing their and throwing their heads back. Most infants heads back. Most infants will usually cry when will usually cry when startled and proceed to startled and proceed to pull their limbs back into pull their limbs back into their bodies. their bodies.

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Galant ReflexGalant Reflex

You can see this reflex by placing You can see this reflex by placing your baby face down across your lap. your baby face down across your lap. If you run your finger down the left If you run your finger down the left side of his spine, you will see him side of his spine, you will see him seem to curl in sideways to the left. seem to curl in sideways to the left. The same should happen on the right The same should happen on the right side as well. side as well.

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Stepping ReflexStepping Reflex

If you hold your baby upright and If you hold your baby upright and place her feet on a flat surface, she place her feet on a flat surface, she will place one foot in front of the will place one foot in front of the other and appear to "walk." Of course other and appear to "walk." Of course without strength, coordination, and without strength, coordination, and balance, she could never really walk balance, she could never really walk at this point. This reflex should at this point. This reflex should disappear after around three months. disappear after around three months.

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Babinski ReflexBabinski Reflex Babinski Reflex is (+)Babinski Reflex is (+) This is Normal This is Normal Birth to after walkingBirth to after walking 12-18 months age12-18 months age

You can see this newborn reflex in action by You can see this newborn reflex in action by running your finger down the center of the running your finger down the center of the bottom of your baby's foot. His toes will bottom of your baby's foot. His toes will spread apart and the foot will turn slightly spread apart and the foot will turn slightly inward. If you do the same thing to an adult's inward. If you do the same thing to an adult's foot, you will see the opposite happen. The foot, you will see the opposite happen. The toes should clench together tightly. toes should clench together tightly.

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Placing reflexPlacing reflex

When:When:This occurs from birth until This occurs from birth until about 6 weeks of age of normal baby about 6 weeks of age of normal baby milestones.milestones.

What:What:When the baby is held upright When the baby is held upright and the top (dorsum) of the foot is and the top (dorsum) of the foot is brushed against the edge of a table, brushed against the edge of a table, the baby will lift the foot and place it the baby will lift the foot and place it on the table. on the table.

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Neural Tube DefectsNeural Tube Defects 3 types: 3 types: Spina Bifida OccultSpina Bifida Occult: failure of the vertebral : failure of the vertebral

arch to close. Has arch to close. Has dimpledimple on the back with a on the back with a tuft of hair. No treatment required.tuft of hair. No treatment required.

MeningoceleMeningocele: saclike protrusion along the : saclike protrusion along the vertebral column filled with cerebrospinal vertebral column filled with cerebrospinal fluid and meninges. Surgery required.fluid and meninges. Surgery required.

MyelomeningoceleMyelomeningocele: saclike protrusion : saclike protrusion along the vertebral column filled with spinal along the vertebral column filled with spinal fluid meninges, nerve roots, and spinal cord fluid meninges, nerve roots, and spinal cord = paralysis. Surgical repair required.= paralysis. Surgical repair required.

Sterile saline dressing. Sterile saline dressing. hydrocepalushydrocepalus

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Spina bifida occultaSpina bifida occulta meningocelemeningocele

Spina bifida OccultaSpina bifida Occulta myelomeningocelemyelomeningocele

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Nursing Care of the Normal Nursing Care of the Normal NewbornNewborn

IdentificationIdentification MedicationsMedications

Vitamin KVitamin K ErythromycinErythromycin

ThermoregulationThermoregulation FeedingsFeedings

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Prophylactic CareProphylactic Care Vitamin K –to prevent hemorrhagic Vitamin K –to prevent hemorrhagic

disorders – vit k (clotting process) is disorders – vit k (clotting process) is synthesized in intestine requires food synthesized in intestine requires food for this process. Newborn’s stomach for this process. Newborn’s stomach is sterile has no food. aquaMEPHYTONis sterile has no food. aquaMEPHYTON

Hepatitis B vaccination –within the Hepatitis B vaccination –within the first 12 hoursfirst 12 hours

Eye prophylaxis –(Erythromycin Eye prophylaxis –(Erythromycin Ointment) to prevent ophthalmia Ointment) to prevent ophthalmia neonatorum – gonorrhea/chlamydianeonatorum – gonorrhea/chlamydia

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Newborn: Intramuscular Newborn: Intramuscular injectioninjection

aquaMEPHYTON (Vit.K)aquaMEPHYTON (Vit.K) 1 mg/0.5 ml IM lateral thigh1 mg/0.5 ml IM lateral thigh Vastus lateralisVastus lateralis

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Nursing Care of the Normal Nursing Care of the Normal NewbornNewborn

Infant protection Infant protection Parent teachingParent teaching

PositioningPositioning Cord careCord care CircumcisionCircumcision Car seat safetyCar seat safety

Screening tests, immunizations and other Screening tests, immunizations and other proceduresprocedures

Assessing and supporting bondingAssessing and supporting bonding

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Bathing the NewbornBathing the Newborn No tub bath until No tub bath until

after the cord has after the cord has fallen off and fallen off and healing is complete.healing is complete.

Newborn’s first bath- Newborn’s first bath- the nurse needs to the nurse needs to wear gloves to wear gloves to prevent infection.prevent infection.

What is wrong with What is wrong with this nursing action?this nursing action?

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Circumcision Circumcision Circumcision is considered an elective Circumcision is considered an elective

procedureprocedure Anesthesia should be provided.Anesthesia should be provided. Parents must give written consentParents must give written consent Full term health infantsFull term health infants Aftercare: Check hourly for 12 hoursAftercare: Check hourly for 12 hours Check for bleeding and voidingCheck for bleeding and voiding Before dischargeBefore discharge:: Newborn goes home within the first 12 hours Newborn goes home within the first 12 hours

after procedureafter procedure Bleeding should be minimal and infant must Bleeding should be minimal and infant must

voidvoid Ensure that parents know how to care for the Ensure that parents know how to care for the

circumcision.circumcision.

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Breastfeeding Breastfeeding Colostrum is rich in immunoglobulins to Colostrum is rich in immunoglobulins to

protect newborn GI tract from infection; protect newborn GI tract from infection; laxative effect.laxative effect.

Breast milk in 2 weeks sufficient nutrients Breast milk in 2 weeks sufficient nutrients 20 kcal/oz (infant’s nutritional needs)20 kcal/oz (infant’s nutritional needs)

To support Breastfeeding: Mother needs to To support Breastfeeding: Mother needs to consume extra 500 calories per day.consume extra 500 calories per day.

Feeding length: should be long enough to Feeding length: should be long enough to remove all the foremilk (watery 1remove all the foremilk (watery 1stst milk from milk from breast high in lactose - skim milk & effective breast high in lactose - skim milk & effective in quenching thirst)in quenching thirst)

Hindmilk: higher in fat content leads to Hindmilk: higher in fat content leads to weight gain and more satisfying.weight gain and more satisfying.

Breastfeeding time approximately 30 Breastfeeding time approximately 30 minutesminutes

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Infant FormulaInfant Formula Formula 7.5 ml to 15 ml at feeding Formula 7.5 ml to 15 ml at feeding

gradually increase to 90 ml to 120 ml gradually increase to 90 ml to 120 ml at each feeding in 2 weeks.at each feeding in 2 weeks.

Formula preparation: mixing must be Formula preparation: mixing must be accurate to provide the 20 kcal/ozaccurate to provide the 20 kcal/oz.. (newborn nutritional need)(newborn nutritional need)

Burping: is needed to expel air Burping: is needed to expel air swallowed when infant sucks.swallowed when infant sucks.

Should be done about ½ way through Should be done about ½ way through feeding for bottle feeders and when feeding for bottle feeders and when changing breasts for breast feeders.changing breasts for breast feeders.

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Respiratory DistressRespiratory Distress 2 types: Respiratory Distress Syndrome (RDS) and 2 types: Respiratory Distress Syndrome (RDS) and

Transient Tachypnea of the Newborn (TTN)Transient Tachypnea of the Newborn (TTN) RDS: preterm infants/surfactant deficiencyRDS: preterm infants/surfactant deficiency Hypoxia, respiratory acidosis and metabolic Hypoxia, respiratory acidosis and metabolic

acidosisacidosis Surfactant is produced by alveoli - lung maturity Surfactant is produced by alveoli - lung maturity L/S ratio 2:1 is a test done before birth to L/S ratio 2:1 is a test done before birth to

determine fetal lung maturitydetermine fetal lung maturity TTN: AGA, near term infantsTTN: AGA, near term infants Intrauterine or intrapartum asphyxia Intrauterine or intrapartum asphyxia Newborn unable to clear airway of lung fluid, Newborn unable to clear airway of lung fluid,

mucous or amniotic fluid aspiration.mucous or amniotic fluid aspiration. Expiratory grunting nasal flaring, tachypnea with Expiratory grunting nasal flaring, tachypnea with

respirations as high as 100 to 140 breaths/minute.respirations as high as 100 to 140 breaths/minute.

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Infants of DM mothers (IDM) Infants of DM mothers (IDM) ComplicationsComplications

Hypoglycemia:Hypoglycemia: maternal glucose maternal glucose declines at birth. Infant has high level of declines at birth. Infant has high level of insulin production= decreases infant’s insulin production= decreases infant’s blood glucose within hours after birth.blood glucose within hours after birth.

Respiratory Distress: Respiratory Distress: less mature lungs less mature lungs due to insulin due to insulin

HyperbilirubinemiaHyperbilirubinemia: hepatic immaturity, : hepatic immaturity, increased hematocrit, bruising due to increased hematocrit, bruising due to difficult delivery.difficult delivery.

Birth traumaBirth trauma: large size of infant: large size of infant Congenital birth defectsCongenital birth defects: birth defects – : birth defects –

Patent Ductus Arteriosus, Ventricular Patent Ductus Arteriosus, Ventricular Septal Defect and more.Septal Defect and more.

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Newborn infants need:

easy access to the mother

appropriate feeding

adequate environmental temperature

a safe environment

prgilbert/mc-99

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Newborn infants need: Cont’d…

parental care cleanliness observation of body signs by somebody who cares and can take action if necessary access to health care for suspected or manifest complications

prgilbert/mc-99

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Newborn infants need: Cont’d…

nurturing, cuddling, stimulation protection from

• disease• harmful practices• abuse/violence

prgilbert/mc-99

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Newborn infants need: Cont’d…

Acceptance of

• sex• appearance• size

prgilbert/mc-99

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Newborn infants need: Cont’d…

recognition by the state (vital registration system).

prgilbert/mc-99