Nursing Care of the Newborn and Family

Care Management: Birth Through
the First 2 Hours

– Immediate care after birth
– Initial physical assessment
– General appearance
– Vital signs
– Baseline measurements of physical growth
– Neurologic assessment

APGAR score: performed at 1 and 5 minutes

– Appearance (skin color)
– Pulse (heart rate)
– Grimace (reflex irritability)
– Activity (muscle tone)
– Respiration

APGAR Score

– Score: 0 – 3
– Severe distress
– Score: 4 – 6
– Moderate difficulty
– Score: 7 – 10
– Minimal or no difficulty

Axillary Vitals

– Temperature: axillary
– 36.5°- 37.5°C, average 37°C (97.7°- 99.5°F, average 98.6°F)
– Respirations
– 30 - 60 breaths/minute
– Heart rate: apical pulse
– 110 - 160 beats/minute

Blood pressure

– Average systolic 60 - 80 mmHg
– Average diastolic 40 - 50 mmHg

Weigh & Head Circumference baseline

– Weight
– Normal 2500–4000 grams (5.5 – 8.8 pounds)
– Head circumference
– Normal 32–38 cm (12.6–14.7 inches
– Measured above eyebrows

Length baseline

– Normal 45-55 cm (17.7-21.7 inches)
– Measured from top of head to heel of foot

Gestational
Age Assessment

Neuromuscular maturity
Physical maturity

Newborn
Classification

– AGA: appropriate for gestational age
– between 10th and 90th percentile
– SGA: small for gestational age
– below 10th percentile
– LGA: large for gestational age/macrosomia
– above 90th percentile

Gestational Age Classifications

– Preterm – less than 37 weeks
– Late preterm – 34-36 6 7 weeks
– Early term – 37-38 6 7 weeks
– Full-term – 39-40 6 7 weeks
– Late term – 41 to 41 6 7 weeks
– Postterm – born after 42 week

Immediate Interventions

– Airway maintenance
– Maintaining adequate oxygen supply
– Maintaining body temperature
– Eye prophylaxis
– Vitamin K prophylaxis
– Promoting parent-infant interaction

Temperature Prevention

– Dry thoroughly after birth &
remove wet blankets
– Skin-to-skin contact
– Keep swaddled with hat on
– Delay bath
– Maintain NTE

Temperature Treatment

– Skin-to-skin contact
– Swaddle in warm blankets with hat on
– Place under radiant warmer
– Check for hypoglycemia
– Reassess temperature

Eye Prophylaxis

Eye prevention

Common newborn problems

– Birth injuries
– Physiologic problems: Hyperbilirubinemia

Hyperbilirubinemia- PhototherapyLoose stools can cause

– Convert unconjugated bilirubin
– Light placed 18-20 inches over infant
– Maximum skin surface area exposed to light
– Use eye shields for eye protection
– Monitor temperature

In Phototherapy loose stools can cause

– dehydration
– skin breakdown

Other therapies: Exchange transfusion

Hypoglycemia

Plasma glucose concentration less than
40-45 mg/dL

Hypoglycemia Risk Factors

– preterm or late preterm
– infant of diabetic mother (IDM)
– SGA or LGA
– low birth weight

Hypoglycemia Perinatal stress (Risk Factor)

– asphyxia
– cold stress
– respiratory distress

Hypoglycemia Symptoms

– jitteriness
– lethargy
– poor feeding
– high-pitched cry
– hypotonia
– temperature instability
– respiratory distress
– apnea
– seizures

Laboratory and Diagnostic Tests

– Universal newborn screening
– Newborn hearing screening
– Critical congenital heart disease (CCHD

Specimen collection

– Heelstick
– Venipuncture
– Urine specimen

Protective environment

– Environmental factors
– Infection control factors
– Preventing infant abduction
– Preventing newborn injury

Therapeutic and surgical
procedures

– Intramuscular injection
– Circumcision

Circumcision

– Removal of the foreskin of the penis
– Policies and recommendations

Parental decision Circumcision

– hygiene, religion, tradition, culture,
social norms
– Consent

Circumcision Procedure

– Gomco
– Mogen
– PlastiBell

Care of newly circumcised infant

– Pharma/Non-Pharma pain relief
– Frequent assessments
– Watch for first void
– Parent education

Neonatal Pain

– Neonatal responses to pain
– Assessment of neonatal pain
– Management of neonatal pain (Nonpharmacologic/Pharmacologic)

Discharge Planning and Parent
Education

– Temperature
– Respirations
– Feeding patterns
– Elimination
– Sleeping, positioning, and holding
– Rashes- diaper rash
– Clothing
– Car safety seat
– Nonnutritive sucking

Discharge Planning and Parent
Education cont.

– Bathing and umbilical cord care
– Infant follow-up care
– Cardiopulmonary resuscitation
– Practical suggestions for first weeks
at home
– Interpretation of crying and use of
quieting techniques
– Recognizing signs of illness