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 NEW BORN CARE
Objectives
Describe the normal characteristics of a term newborn.
Assess a newborn for normal growth and development.
Formulate nursing diagnoses related to a newborn or the family of a newborn.
Identify expected outcomes for a newborn and family during the first 4 weeks of life.
Plan nursing care to augment normal development of a newborn, such as ways to aid parent-child bonding
Implement nursing care of a normal newborn, such as administering a first bath or instructing parents onhow to care for their newborn.
Evaluate expected outcomes to determine effectiveness of nursing care and outcomes achievement.
Use critical thinking to analyze ways that the care of a term newborn can be more family centered.
Integrate knowledge of newborn growth & development and immediate care needs with the nursing process to achieve quality maternal and child health nursing care.
The Neonate
From birth through the first 28 days of life
Also called “the newborn period”
Adaptation to extrauterine life requires rapid and profound physiologic changes
This includes aeration of the lungs, rerouting of the circulation and activation of the GI tract
Behavioral states: quiet sleep, active sleep, drowsy, alert, fussy, and crying
2/3 of all deaths that occur during the 1st year of life occur during this period; more than half occur inthe 1st 24 hours after birth---an indication of how hazardous this time is for an infant
How well a NB makes major adjustments depends on his or her:
o
Genetic composition
o
The competency of the recent intrauterine environment
o
The care received during the neonatal period
o
PRINCIPLES IN IMMEDIATE NEW BORN CARE1
st
day of life
1.initiation and maintenance of respiration
(used bulb syringe initiate a/w)
2.establishment of extra uterine circulation3.control of body temp4.intake of adequate nourishment5.establishment of waste elimination6.prevention of infection7.establishment of an infant parent relationship8.dev’t care that balances rest and stimulation or mental dev’t9.
Immediate care of the newborn.A-
airway (
most
neonatal deaths with in 24 h caused by inability to initiate a/w, lung function begins after  birth only)
B-
 body temperature
C-
check/asses the newborn
D-
determined identification
I. Establish and Maintain a Patent Airway / Effective Respiration
 Nursing Interventions:1.Wipe the mouth and nose secretions after delivery of the head2.Suction secretions from the mouth and nose properly.
Catheter Suctioning
1.) Place head to side to facilitate drainage2.)
Suction mouth 1
st
before nose-neonates are nasal breathers
3.) Period of time 
-5-10 sec suctioning, gentle and quick 
Prolonged and deep suctioning can lead to hypoxia, laryngo spasm, brady cardia due to stimulation vagal nerve4.) Evaluate for patency-cover nostril and baby struggles there’s a need for additional suctioning
1
 
“If not effective, requires effective laryngoscopy to open a/w. After deep suctioning an endotracheal tube can be inserted and oxygen can be administered by an (+) pressure bag and mask with 100% oxygen at 40-60b/m.” 
 Nsg alert:
 No smoking
Always humidify to prevent drying of mucosa
Over dosage of oxygen can lead to scarring of retina leading to blindness ( retro lentalfibrolasia or retinopathy of  prematurity)
When mecomium stained (greenish) never administer oxygen with pressure ( O2 pressure will push mecomium inside)
3.Stimulate the baby to cry if baby does not cry spontaneously or if baby’s cry is weak. 
“A crying infant is a breathing infant. Effective cry means
effective breathing 
”
Do not slap the buttocks but rub the soles of the feet
Do not stimulate the NB to cry unless the secretions have been suctioned to preventaspiration
The normal infant cry is loud & lusty. Observe for the ff. abnormal cry:
High-pitched cry
: hypoglycemia, increased ICP
Weak cry
: prematurity
Hoarse cry
: laryngeal stridor 4.Oral mucus may cause the NB to choke, cough or gag during the first 12 to 18 hours of life. Place theneonate in a position that would promote drainage of secretions
Trendelenburg (contraindicated to Increased ICP)
Side-Lying5.Keep the nares patent. Remove mucus and other particles w/c can cause obstruction as newborns are“
obligatory nasal breathers
” until they are about 2-3 weeks old.6.Give O2 as needed. Oxygen should be given for 20-30 minutes when the neonate remains cyanotic or tachycardic after initial suctioning and stimulation.* asphyxiation → hypoxia → hypercapnia(↑ CO2) → acidosis → coma → death
•Observe precaution in giving oxygen
•
Do not give more than 40% O2 as this may lead to
retrolental fibroplasia
(blood vessels of the eyes becomespastic leading to blindness)•Use pulse oximeter and monitor O2 concentration every hour 
7.If the heart rate falls below 60 bpm, cardiac massage may need to be carried out.II.
Maintain Appropriate Body Temperature
 
Temp Regulation
goal in temp regulation is to maintain it not less than 97.7% F (36.5 C)
maintenance of temp is crucial on preterm and SGA (small for gestational age) - babies prone tohypothermia or cold stress
o
 Neonates have “physiologic resilience” wherein they tend to adopt or take temperature of their own environment. (poikilothermic)“cold stress
(hypothermia)
is more dangerous than hyperthermia”Effects of cold stressCold stress metabolic acidosis CNS depression Coma Death
o
Every NB is born slightly acidotic. Any new build-up of acid may lead to life-threateningmetabolic acidosis, which can be lethal even to normal newborn infants.
o
The average NB temp.@ birth is around 37.2°C.
o
 NB lose heat easily because:
They have immature temp.-regulating system
Of very little amount of subcutaneous fat to provide heat
They have a larger body surface area that results in more heat loss
They have little ability to conserve heat by changing posture and no ability to adjust its ownclothing
Methods of Heat Loss in Newborn
•
Convection
– the flow of heat from the NB’s body surface to cooler surrounding air; ex: windows,air conditioners•
Conduction
- the transfer of a body heat to a cooler solid object in contact with a baby; ex: baby placed on a cold counter •
Radiation
– the transfer of body heat to a cooler solid obj. not in contact with a baby; ex: coldwindow or air con2
 
•
Evaporation
– loss of heat through conversion of a liquid to a vapor; ex: after delivery, newbornsare wet, with amniotic fluid on their skin, tsb 
To Prevent Hypothermia1.Dry and wrap baby2.Mechanical pressure – radiant warmer pre-heated first isolette (or square acrylic sided incubator)3.Prevent an necessary exposure – cover baby4.Cover baby with tin foil or plastic
5.
Embrace the baby-
kangaroo care
6. Delay initial bath until temp. has stabilized for at least 2 hours.7. Maintain ambient temp. of nursery at 24°C or 75°F.8. Perform any extensive examination or procedure under radiant heat to prevent heat loss and expose only the part of the body to be examined.9. Note the presence of any cyanosis:2 types of cyanosis: a.) central cyanosisb.) peripheral cyanosis
 
hands & feet are cyanotic, due to cold environment and poor circulation
Characteristic of Newborn
The end of your journey has come after 40 weeks. The fruit of your labour (literally) will soon be in your hands.There are a few things you might want to know about your new arrival. Typically, a newborn baby has the followingcharacteristic appearance:
 
•
Weight
:
 
Average 2.8 kg for Indian babies (range 2.5 – 3.2 kg). Babies below 2.5 kg at birth are considered tobe low birth weight and need special evaluation.
•
Length
: Approximately 50 cm. Remember, small women have small babies and many genetic factors also play a role indetermining the length of the baby.
3
Effects of Hypothermia( Cold stress)1.) Hypoglycemia
- 45-55mg/dl normal50- borderline
2.) met acidosis
-catabolism of brown fats(best insulator of newborns body) will form ketones
3.) high risk forkernicterus
- bilirubin in brain leading to cerebral palsy
4.) additional fatigue toallergy stressful heart
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gchojn7338

excellent job.It, the best I found. thank you

reply11 / 10 / 2009
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