Nursing Care of the Newborn + Profile of the Newborn

1. to promote physical well being of newborn

2. to enhance establishment of a well functioning family unit

two broad goals of nursing care during this period

90

Immediate Newborn care myst be performed in the first __ minutes.

6

Essential Newborn care from 90 minutes to __ hours

False: 25-28 degrees celsius

True or False: Ensure that the delivery area is draft-free and between 37-30 degrees celsius using a room thermometer.

False: Double Gloves

True or False: In order to save gloves, only one pair is used just before delivery.

True

True or False: Within the first 30 seconds, call out the time of birth

• Reposition, suction , ventilate

• clamp, cut cord

• transfer to warm, firm surface

• inform mother of situation

• start resuscitation protocol

What to do if after 30 seconds of thorough drying, the newborn is not breathing or is gasping.

• Do skin to skin contact

• avoid any manipulation

• place NB prone on mother’s abdomen / chest skin-to-skin

• turn newborn’s head to one side

• cover NB’s back with a blanket and head with a bonnet (to keep temp ar optimal range of 36.4-37.2 C to avoid metabolic acidosis, hypoxia, shock)

• place identification band on ankle

What to do if 30 of thorough drying, newborn is breathing or crying

• Do non-immediate or appropriately timed cord clamping.

• Clamp & cut the cord after cord pulsations have stopped typically at 1-3 minutes

• Apply a sterile plastic clamp or tie at 2 cm and the second clamp at 5 cm from the umbilical base

• cut close first clamp with sterile scissors

• observe for oozing blood. it should have 2 arteries & vein .

• do control cord traction with counter traction & gentle uterine massage.

Time Band 1-3 Minutes

• provide support for initiation of breastfeeding

• do eye care

• Leave newborn on mother’s chest skin-to-skin contact

• observe NB for feeding cues

• counsel on position and attachment. Looking for signs of good attachment and suckling.

• administer erythromycin or tetracycline ointment or 2.5% providone-iodine drops to both eyes after the newborn has located the breast.

Time Band: 90 Minutes of age

False: Do not wash away eye antimicrobial.

True or False: Antimicrobial might harm inner eye of NB, wash away immediately upon administration.

Kangaroo Mother Care

care of preterm infants/low-birth-weight infants carried skin-to-skin with the mother

Wiping with a damp cloth but only after 6 hours

How to ensure hygiene of small baby

use warm blanket or radiant warmer.

if mother cannot provide skin-to-skin contact,

• keep nB in room with the mother (Rooming In)

• check for birth injuries, malformations, or defects

• weigh the NB

• get the head, chest, abdominal circumference, and length.

• give Vit. K prophylaxis (AquaMEPHYTON), middle third vastus lateralis or rectus femoris to prevent hemorrhagic dz; 0.5 - 1 mg single dose

• Inject Hepa B , BCG vaxx

• get vital signs

• perform cord care

  • dress the newborn

Time Band 90 minutes - 6 hours

• support unrestricted per-deman breastfeeding, day and night

• ensure warmth of the baby’s washing and bathing (hygiene)

• sleeping

• look for signs of serious illness, jaundice & local infection

• discharge instructions

Time Band: 90 minutes of age, prior to discharge

Swaddling

technique of wrapping up a newborn in a blanket to keep them calm and promote sleep

• changes in color or activity

• grunting or sighing sounds

• rapid breathing with chest retractions

• facial grimacing

Signs of Neonatal Distress

Temperature: axillary - 36.4-37.2

Respi: 30-60 cpm

Pulse: 120-160 bpm, apical for 1 full minute

Normal VS; monitored q30mins for 2 hours until stable

within 24 hours: voiding

within 48 hours passage of stools

• assess for abdominal distention, bowel sounds, hydration, fluid intake & temperature stability

Monitoring of output:

• same time of the day

• 10% of weight loss is normal - 1st week

Weighing of NB

True

True or false: 10% of weight loss is normal for first week3

Regained by 2 weeks.

When will 10% of weight loss of NB on 1st week be regained?

• colostrum

• transitional milk

• mature milk

Stages of milk

Colostrum

Milk:

× vellowish o rcreamy fluid

× thicker than mature milk

× contains more protein, fat-soluble vitamins & minerals

× high level of IgA

× replaced by transitional milk within 2-4 days after birth

Transitional Milk

× produced from the end of colostrums & production until approximately 2 weeks postpartum.

× contains lactose, water-soluble vitamins, elevated levels of fats, & more calories than colostrum.

Mature Milk

× 10% solids (carbohydrates, proteins, fats) for energy & growth; rest in the water, which is vital in maintaining hydration

foremilk

high in water content containing vitamins and proteins

hindmilk

release after the initial release of milk; has higher fat concentration

B - best for baby

R - reduces the incidence of allergies

E - economical, no cost & waste

A - antibodies, greater immunity to infections

S - satisfies infant’s nutritional needs

T - temperature always correct and constant

F - fresh milk-never spoils

E - emotional bonding

E - easy once established/convenient

D - digested easily

I - inhibits ovulation

N - no mixing required

G - gastroenteritis greatly reduce

BREASFEEDING acronym

1. Breastmilk can potentially cure cancer.

2. Breastmilk can 'sense' when your baby is sick.

3. On hot days, your breastmilk automatically becomes more 'watery'.

4. Breastmilk can fight bacteria.

5. Breastmilk cures acne.

6. It's a natural pain-relief medication. 7. It's the perfect pre-term baby milk.

PREPARATION OF BREAST

7 Surprising Superpowers of Breastmilk

False: Avoid the use of soap on nipples

True or False: Promote use of soap on nipples

True

True or False: Use of creams, nipple rolling pulling, & rubbing to ‘toughen’ nipples is not advisable

False: flat or inverted nipples

True or false: Women with rounded nipples may find breast shells (breast cups) useful

• w/the infant's head & body straight

• facing her breast. the infant's nose opposite her nipple

• infant's body close to her body

• supporting the infant while the body, not iust neck & shoulders.

Position of mother & baby when assisting with first feeding.

WOF cyanosis & choking

assessing infant’s response to feeding

• cradle

• football hold

• cross-cradle hold

• side-lying position

Feeding Positions

• chin touching breast

• mouth wide open

• lower lip turned outward

• more areola visible above than below the mouth

Signs of good attachment

• By inserting a finger into the corner of the infant's mouth between the gums.

• Mother should remove the breast quickly before the infant begins to such again.

• Indent the breast tissue with a finger near the infant's mouth & remove the infant when suction is released.

Removal from the breast

slow deep sucks & sometimes pausing

Sign of sucking effectively

2.5 kg - 3.5 kg (7.7 lbs)

average birth weight

10 min. & then increase the time of feeding in each breast

duration of breastfeeding

averages 1 quart but some women are producing more milk

volume of breast milk/day

average of 8-12 times in 24 hr period

frequency of breastfeeding

galactogogues

whole grains, dark green leafy veggies (spinach, broccoli, malunggay, camote tops), ginger, papaya, mussels, spices (cumin, anise, turmeric)

× Usually occurs on the 2nd day or 3rd day after birth.

when does engorgement (Temporary swelling or fullness of the breast when milk begins to "come in" or change from colostrums to transitional breast milk) usually occur

accumulation of milk, enlarged lymph glands & increased blood flow.

what causes breast engorgement

• application of heat &cold

• massage & proper breastfeeding techniques

• a well-fitting bra may be worn both day &night to help support breasts

• Pain for a minute or less.

• Usually peaks at the 3rd to 6th day & resolves soon afterward.

Tx for Nipple pain

• sustained pain

• appear red, cracked, blistered, or bleeding

Sign for nipple trauma

• Tx includes proper positioning, rotating used nipples, application of small amount of BM in affected nipples.

• Redness of breasts tissue, purulent discharge, fever, mastitis or breast abscess may require antibiotic treatment.

Tx for nipple trauma

Plugged ducts

• Localized edema & tenderness is present, &a hard area may be palpated

• Tiny, white area may be present on the nipple

mastitis

plugged ducts may progress into

mastitis

• inflammation of breast tissue

• caused by blocked milk ducts or milk excess

• hand held

• electric or battery operated

2 types of breast pumps

3-4 hours

how long can breast milk last if not refrigerated

up to 3 days , stored in a clean plastic container

how long can breast milk last if refrigerated

• Executive order no. 51 - Philippine Code of Marketing of Breast Milk Substitutes

• Republic Act no. 7600 - The Rooming Breastfeeding act of 1992

2 policies in the promotion of BM

• bathing

• cleaning of buttock and perineal area

• diaper change

• cord care

• burping

promotion of skin integrity

49 cm (19.2 in), 50 cm (19.6 in)

average birth length - female and male

34-35 cm (13.5-14 in)

average head circumference

about 2 cm less than the head circumference

average chest circumference

same as chest circumference

average abdominal circumference

37.2 C

temperature at birth

120-140 bpm, or as low as 90-110

average pulse

approx. 80/46 mmHg at birth. by 10th day, it rises to about 100/50 mmHg

normal bp

acrocyanosis

cyanosis in NB’s feet and hands

80-110 ml / kg or 300 ml in total

Blood volume of NB

True

True or False: NB has lower than normal level of Vit. K

6 million cells/cubic millimeter

How many RBC at birth

True

True or False: All NB have some fluid in the lungs from intrauterine life

True

True or False: A baby born by CS does not have as much lung fluid expelled at birth

60-90 mL

How much can the NB stomach hold

meconium

first stool usually passed within 24 hrs

transitional stool, green & loose

stool on 2nd or 3rd day of life

Normal lods, record time and characteristic.

You are assessing NB (has jaundice) that is receiving phototherapy. You were informed by the mother that the NB passed bright green stool. What is the appropriate nursing action?

False: 24 hours, colorless, odorless, about 15mL in single voiding

True or False: NB voids within 12 hours after birth, greenish and malodorous. About 10 mL in single voiding.

Normal

Normal or ABN: First voiding may be pink or dusky

about 30-60 ml in total

normal daily urinary output for the 1 or 2 days

Immunoglobulin G

Passive antibodies from mother that crossed the placenta

True

True or False: Infants have difficulty of forming antibodies against invading antigens until 2 months of age

Suggests narcosis, shock, or cerebral injury

What does limpness or total absence of muscular response to manipulation

1. rooting

2. sucking

3. swallowing

4. extrusion

5. moro

6. tonic neck

7. palmar grasp

8. stepping, placing or dancing

9. plantar grasp

10. babinski

11. other

11 reflexes seen in NB

moro reflex

is also called startle reflex, when infant hears a loud noise, disappears 6 months

• hearing

• vision

• touch

• tase

• smell

senses in newborn that are already developed at birth

vernix caseosa

white, cream cheese-like substance that serves as a skin lubricant. usually noticeable on a term newborn’s skin.

Green vernix - indicates meconium was present in amniotic fluid

Yellow vernix - implies that the amniotic fluid was yellow from bilirubin

What does a green vernix and a yellow vernix indicate?

lanugo

fine, downy hair that covers a newborn’s shoulders, back & upper arms

True

True or False: A baby born after 37-39 weeks of gestation has more lanugo than 40 weeks AOG

Desquamation

dryness particularly evident on the palms of the hands and soles of the feet

Milia

White pinpoint white papulae can be found on the cheek or across the bridge of the nose. Disappears by 3-4 weeks of age as sebaceous glands mature and the plugged ones drain,.

Erythema Toxicum

•A newborn rash; usually appears on the 1^st to 4^thday of life,may appear up to 2 weeks of age. Rash has no pattern. It is caused by a NB’s eosinophilsreacting to the environment as the immune system matures.

False: During infancy, the largest are of the body is the HEAD

True or False: During infancy the abdomen is the largest area of the body, and it remains disproportionate to the body until 5 years old

Caput Succedaneum

edema of the scalp at the presenting part of the head , absorbs and disappears about the 3rd day

cephalohematoma

collection of blood between the periosteum of a skull bone & itself ; caused by rupture of a periostal capillary due top pressure of birth

Craniotabes

Localized softening of cranial bones probably caused by pressure of fetal skull against the mother’s pelvic bone in utero.

3-12

permanent color of eyes usually between __ mos of age

alae nasi

flaring of ___ is a sign of increased respi effort

choanal atresia

blockage of rear of nose is refer to as