NRS 3026 Chapter 21 Care of Normal Newborn

vitamin k (phytonadione)

administer within 1hr of birth, can be delayed

give IM

erythromycin ophthalmic ointment

prophylactic treatment to prevent ophthalmia neonatorum

administer 1-2hrs of birth

remove drainage with sterile saline and cotton

thermoregulation assessment

assess temperature shortly after birth and every 30 mins until stable

blood glucose

test blood on the side of the heel

sx of hypoglycemia: jittery, glucose <45

how often do you assess the newborn?

every 4-8hours

provide skin care, bathing, cord care, cleansing diaper area, assist feeds, position for sleep

circumcision

pain relief: lidocaine 1% and tylenol

methods

1. mogen clamp

2. platibelle

   1. gomco clamp

immunizations

hepatitis B as routine childhood vaccination

for an infant of mother who has acute or chronic infection

• give vaccine (IM vastus lateralis), give hepatitis B immune globulin, give globulin within 12hrs of birth

newborn screening tests

critical congenital heart defect (CCHD) → test opposite hand and foot for 02 levels and they should be a less than 3% difference

hearing test

newborn screen: PKU, hypothyroidism, galactosemia, hemaglobinopathies, congenital adrenal hyperplasia

early discharge

at 24hrs of age with appropriate gestational age, VS WNL, feeding successfully, passed urine and stool, mother competent to care for infant

follow up with pediatrician within 1-2 days of discharge

early infant problems

infant crying

colic: shaken baby syndrome

sleep: rest when baby is sleeping

what increases the risk for SIDS?

smoking

acne

small red bumps on the face around 2-4weeks

drooling or spit-up rash

rash around the mouth and chin (onset anytime)

skin injury from birth process

from forceps, scale electrode or birth canal (present at birth)

milia

tiny white bumps on the nose and cheeks present at birth

mongolian spots

bluish-green birthmark, often on the buttock present at birth

stork bites (pink birthmarks)

on back of neck or bridge of nose present at birth

strawberry hemangiomas

raised red birthmarks onset 2-4weeks

port-wine stains

dark red or purple flat birthmarks present at birth

newborn rash or erythema toxicum

affects half of newborns and begins a few hours after birth

red patches on the skin with white or yellow pimples that develop anywhere on the body but mostly the trunk (never on the soles of the feet)

do not pop because it can increase infection risk

disappears at 3-4weeks old

regurgitation: spitting vs vomit

spitting: easy flow of stomach contents through mouth with a burp (keep baby upright for 30 mins after feeds)

vomiting: forceful flow, shooting out increase rather than dribbling from the mouth (green or lime color needs a follow up)

when can babies have solid foods

4-6 months of age

extrusion reflex continues until this ago

increase solid food = naturally decreases milk

call 911 if

blue lips or difficulty breathing

SIDS (sudden infant death syndrome): usually suffocation

call PCP if

temperature <97.5º or >100.4º

yellowing of the skin or eyes

eating poorly or refusing food

repeated vomiting

no wet diaper for 12 hours

no stool for 48hrs

low energy, changes in behavior

unusual high-pitched cry

uncommon or severe rash

white patches in baby’s mouth

redness, drainage, foul odor from umbilical cord

frequent bowel movements with excess fluid, mucous of foul odor

signs of dehydration

dry or cracked lips

dry skin

dry or rough tongue

increased sleepiness or irritability

the nurse’s initial action when caring for an infant with a slightly decreased temperature is to:

notify PCP immediately

skin to skin or wrap infant in two warmed blankets and place cap on head (recheck temp in 30 mins)

tell mother that infant must be kept in nursey and observed for the next 4 hours

change the formula because it is a sign of intolerance

skin to skin or wrap infant in two warmed blankets and place cap on head (recheck temp in 30 mins)

Based on the nurse’s knowledge of the extrusion reflex, the nurse informs the new parents to feed their baby solids when he or she…

is about 2 weeks old and is not sleeping at night

no longer pushes his tongue against anything that touches it, usually 4-6 months of age

is nursing or drinking too much breast milk or formula

has regained weight loss after birth

no longer pushes his tongue against anything that touches it, usually 4-6 months of age