nursing care of newborns and family

NRS 400

What is the title of this lecture?

Nursing Care of the Newborn & Family (NRS 400).

What are the two immediate priorities immediately after birth?

Assure an open airway/establishment of respirations and maintain thermoregulation.

How can the nurse stimulate a newborn to establish respirations?

Rub the newborn's back and soles of the feet.

When is oxygen indicated immediately after birth according to the lecture?

If the newborn has central cyanosis.

When is CPR indicated for a newborn?

When indicated by the newborn's condition/resuscitation guidelines.

What are key interventions for newborn thermoregulation immediately after birth?

Dry quickly, use a pre-warmed environment, provide skin-to-skin contact, and cover the head.

What are the continued immediate newborn-care priorities?

Determine APGAR score, maintain thermoregulation, and perform vital-sign assessment.

What methods can be used to maintain newborn temperature?

Cover the head and keep the newborn dry, skin-to-skin contact, radiant warmer, and warm blankets/two blankets.

What does APGAR stand for?

Appearance, Pulse, Grimace/reflex response, Activity, and Respiratory effort/ability to cry.

What does the A in APGAR assess?

Appearance or color.

What does the P in APGAR assess?

Pulse/heart rate.

What does the G in APGAR assess?

Grimace, reflex response, or irritability.

What does the second A in APGAR assess?

Activity, degree of extremity flexion, or muscle tone.

What does the R in APGAR assess?

Respiratory effort or ability to cry.

How many points can each APGAR category receive?

0, 1, or 2 points.

What earns 0 points for APGAR appearance?

Blue/pale/gray color.

What earns 1 point for APGAR appearance?

Body is pink with blue extremities.

What earns 2 points for APGAR appearance?

Completely pink.

What earns 0 points for APGAR pulse?

Absent pulse.

What earns 1 point for APGAR pulse?

Heart rate less than 100 bpm.

What earns 2 points for APGAR pulse?

Heart rate greater than 100 bpm.

What earns 0 points for APGAR grimace?

No response.

What earns 1 point for APGAR grimace?

Grimace.

What earns 2 points for APGAR grimace?

Cry.

What earns 0 points for APGAR activity?

Flaccid.

What earns 1 point for APGAR activity?

Some flexion of extremities.

What earns 2 points for APGAR activity?

Well flexed.

What earns 0 points for APGAR respirations?

Absent respirations.

What earns 1 point for APGAR respirations?

Slow or weak cry.

What earns 2 points for APGAR respirations?

Good cry.

What does an APGAR score of 0–3 indicate?

Severe distress.

What does an APGAR score of 4–6 indicate?

Moderate distress.

What does an APGAR score of 7–10 indicate?

Minimal to no difficulty.

What is the purpose of the APGAR score?

It provides a rapid assessment of the newborn's transition to extrauterine life and helps guide when to begin resuscitation.

When is APGAR assessed in the practice examples?

At 1 minute and/or 5 minutes after birth, depending on the scenario.

A newborn at 1 minute has HR 128, vigorous crying, cries with suction, flexed extremities, and blue/pale color throughout. What is the APGAR score?

7: pulse 2, grimace 2, activity 2, respirations 2, appearance 0.

A newborn at 1 minute has HR 80, weak cry, flaccid extremities, blue color, and grimaces with stimulation. What is the APGAR score?

4: pulse 1, respirations 1, activity 0, appearance 0, grimace 1.

A newborn at 5 minutes has HR 120, vigorous crying, well-flexed extremities, cries with suction, pink body with blue hands/feet. What is the APGAR score?

9: pulse 2, respirations 2, activity 2, grimace 2, appearance 1.

What should be promoted during the newborn's first hour?

Bonding, early breastfeeding when possible, secure identification, appropriate glucose assessment if indicated, cord pH if indicated, anomaly appraisal, measurements, and newborn medications.

What should the nurse provide for bonding during the first hour?

Private family time.

When should breastfeeding begin according to the lecture if possible?

Within the first 30–60 minutes.

How should the newborn and parents be identified?

With numbered identification bracelets on the baby and parents.

When should a nurse never give a baby to another person?

When the person does not have a matching identification bracelet.

Are newborn footprints used for identification?

No. They are for the family and are not used for newborn identification.

When is newborn glucose assessed during the first hour?

Within the first hour of life if applicable.

What glucose range is listed as normal in the lecture?

40–120 mg/dL.

What newborn glucose value requires intervention according to the lecture?

Less than 40 mg/dL.

Why should nurses know hospital glucose protocols?

Protocols may vary between hospitals.

When might a cord pH be obtained?

If indicated by fetal distress during labor or a low APGAR.

What is included in the newborn's overall anomaly appraisal?

Weight and measurements plus assessment for abnormalities.

What newborn medications may be given during the first hour?

Eye prophylaxis, vitamin K, and hepatitis B vaccine depending on hospital protocol.

What is the highest priority for a newborn at birth according to the lecture quiz?

Assess for adequate respirations.

What should be performed during the first 2 hours of newborn life?

Physical assessment, vital signs, gestational-age assessment, major reflex assessment, symmetry/intactness assessment, and evaluation for variations from expected findings.

What references does the lecture identify for newborn physical assessment?

Table 24-1 for the initial assessment and Table 24-3 for the thorough head-to-toe assessment.

When is a more complex newborn examination performed?

After parents have been given time with the infant.

What are normal general-appearance findings for a term newborn?

Well-flexed extremities, clenched hands/fists, symmetric extremity movement, fine/slight tremors when crying, a lusty/strong cry, and central pink coloration.

What is a preterm newborn?

A newborn born before 37 weeks' gestation.

What is a late-preterm newborn?

A newborn born between 34 and 36 6/7 weeks.

What is a term newborn according to the lecture?

Born between 37 0/7 weeks and 42 6/7 weeks.

What is a postterm newborn?

Born after completion of week 42, beginning at 43 0/7 weeks.

What baseline physical measurements are obtained for newborn growth?

Weight, height/length, chest circumference, and head circumference.

What is the typical newborn birth-weight range listed?

2,500–4,000 g.

What is the approximate pound equivalent of 2,500–4,000 g?

Approximately 5.5–8.5 lb.

What minimum weight does the lecture list for fitting in a car seat?

At least 4 lb.

How much weight can a newborn normally lose during the first week?

Up to 10% of birth weight.

By when should the infant be back to birth weight?

By 10–14 days of age.

Where is head circumference measured?

At the brow line.

Why may a newborn's head shape look different after birth?

Positioning during labor can temporarily alter head shape.

Where is chest circumference measured?

At the nipple line.

How is newborn length measured?

From the top of the head to the heel.

How should the newborn be positioned when measuring length?

Knees completely flat and the baby fully stretched out.

What should be avoided if a blanket or paper is used to measure length?

Folds; marks should be kept in a straight line.

When can a newborn bath be performed?

Once the newborn's temperature is stabilized to prevent hypothermia and further complications.

What PPE should be worn during the newborn bath?

Gloves should be worn until the bath is completed.

When does Methodist Women's current policy say to bathe a stable newborn?

At 12 hours of age.

What is the minimum age for bathing in the NICU according to the lecture?

24 hours old.

What bathing timing is recommended by AWHONN and WHO in the lecture?

12–24 hours after birth.

Why should bathing be delayed until temperature is stable?

To prevent hypothermia and further complications.

What does the lecture say about newborn medications under Nebraska law?

They are required by Nebraska state law but are still optional; parental consent is needed not to perform them.

What is the purpose of erythromycin ophthalmic prophylaxis?

To prevent ophthalmia neonatorum.

What is ophthalmia neonatorum described as in the lecture?

Inflammation and scarring of the conjunctiva that can cause permanent blindness from gonorrheal infection.

How long can erythromycin administration be delayed to promote bonding?

Up to 1–2 hours.

What concentration of erythromycin is commonly used?

0.5%.

What is the purpose of vitamin K in the newborn?

To prevent bleeding by promoting formation of clotting factors in the liver.

What route is vitamin K given by according to the lecture?

Intramuscularly (IM).

Is an oral version of vitamin K available?

Yes.

Why are newborns at risk for low vitamin K availability?

The newborn intestinal tract is sterile at birth, so gut bacterial flora have not yet developed to produce vitamin K.

How much vitamin K does breastmilk provide according to the lecture?

It passes some vitamin K to the baby.

Does formula contain vitamin K?

Yes, the lecture notes that formula has some supplementation.

Which leg is used for vitamin K according to the lecture mnemonic?

Left leg (JKL = Left Leg).

What is the purpose of the hepatitis B vaccine?

To immunize against hepatitis B virus.

What route is the hepatitis B vaccine given?

Intramuscularly (IM).

Is parental consent required for hepatitis B vaccination?

Yes.

What does a newborn receive if the mother is hepatitis B positive?

Hepatitis B vaccine and immunoglobulin within 12 hours of birth.

Which leg is used for hepatitis B according to the lecture mnemonic?

Right leg (Be Right = Right leg).

When is newborn glucose checked if indicated?

1 hour after birth or 40 minutes after feeding.

Are glucose checks performed on every newborn?

No.

How are newborn laboratory blood samples commonly obtained for glucose checks?

Heel sticks.

What does the lecture emphasize about heel-stick positioning?

Positioning can affect the baby's life.

What is the newborn developmental task in Erikson's theory?

Trust versus mistrust.