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Newborn Nursing Care

Newborn Nursing Care

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Published by edenpearlcastillo

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Published by: edenpearlcastillo on Sep 06, 2010
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06/07/2014

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NURSING CAREOF NEWBORNNeonate – first 28 days of life1st 24 hours to first 28 days of life most crucial period for the newbornASSESSMENT – should start immediately after birth and should be continued every contactI.PROFILE OF THE NEWBORNA.Vital Statistics1.Weight-Average weight = 2.5 3.5 kg4-7 kg suspect of maternal illness such as DM-Loses 5- 10 % of BW (6-10%) during the first few days after birth (signthat newborn is adjusting)-Additional weight loss as diuresis begins to remove a part of their highfluid load during the 2nd to 3rd day of life-Newborn voids and passes stool which is approximately 75- 90% of the newborn’s weight is fluidRegain weight gain within 10 days (breastfeeding) because of colostrums which has laxative effect and relatively to caloric contentMilk formula regains within 7 days-Begins to gain about 2lbs/ month (6-8 oz/wk) for the 1st 6 months of life-Birth weight doubles at 6 months and triples at 1 year-Factors that influence birth weight:a.Raceb.Nutritional intake of the mother during pregnancyc.Intrauterine environmentd.Genetic factors2.Length 46- 54 cms.3.Head circumference – 34- 35 cms (37 and above should be carefully investigated for neurologic involvement)-Measured with tape measure drawn across the center of the forehead and around the most prominent portion of the posterior head (occiput)Birth weight, height and head circumference should fall within the same percentile for the same childExample:-Weight and height is 50% and head circumference is 90% will have abnormal head growth-Weight and head circumference is 50% and height is 30- 35% will have growth problem4.Chest circumference – should be 2 cms (0.75- 1 inch) less than the head circumference-Measured at the level of the nipples5.Vital signsa.Temperature-Should be 37.2 C at the moment of birth-There is a rapid fall of temperature because of heat loss, immaturity ofthe thermoregulating mechanisms, temperature of the birthing room-Subnormal body temperature (indications of infection)-Site:axillaryRectal (to test for the patency of anus; may cause rectal wall perforation)-Mechanism of Heat Loss in Newborn:1.Convection2.Conduction3.Radiation
 
4.Evaporation-Prevention of Heat Loss:1.Baby should be dried immediately2.Any wet items should be removed and replaced with clean prewarmed linens3.Dry the newborn’s face and hair. The head, a large surface area in newborncan be responsible for a great amount of heat loss. Covering the hair with a cap after drying further reduce the possibility of evaporation4.Placing them under a radiant heat source (droplight)
KANGAROO CARE
BROWN FATNewborns exposed in cold environment usually kicks and cry to increase metabolicrate to produce heat which in turn increase the need to oxygen thus increase inRRImmature newborn – with poor lung developmentUnable to increase RRAnaerobic catabolism of body cellsRelease acid (newborn is slightly acidic)New build up of acidAcidosis (life- threatening)b.Pulse-Intrauterine (120- 160 bpm immediately after birth)-Hour after- heart stabilizes to an average of 120- 140 bpm; usually irregular due to immaturity of the cardioregulating center in the medulla-Transient murmur – results from incompetent closure of fetal circulation shunts-Crying-Sleep-Femoral pulses should be palpatedc.Respiration-Newborn in first few minutes of life maybe as high as 80 breaths per average of 30- 60 bpm when the child is at rest-Respiratory depth, rate and rhythm are irregular at short periods of apnea (without cyanosis)-Newborns are obligatory nose breathersd.Blood Pressure-Newborns BP is approximately 80/ 46 mmHg at birth-10th day- it rises to about 100.50 mmHgII.PHYSIOLOGIC FUNCTION1.Cardiovascular System – changes in the cardiovascular system are necessaryat birth because the lungs now must oxygenate the blood that was formerly oxygenated by the placentaACROCYANOSIS –Circulatory events at BirthDrying or clamping of the umbilical cord and stimulation of cold receptors
 
Increase CO2, decreased O2 and increasing acidosisFirst breathDecreased pulmonary artery pressureIncrease PO2Closure of foramen ovale (pressure in left side of heart greaterthan in right side)Closure of ductus arteriosusClosure of Ductus venosus and umbilical arteries and vein due to decreased flowBlood Values-A newborn’s blood volume is 80-110 ml/kg of body weight or about 300 ml-Fetal blood has greater quantity of oxygen bound to hemoglobin and partial pressure of oxygen than newborn resulting to:a.Erythrocyte count around 6 million per cubic millimeterb.Hemoglobin level has an average of 17-18 g/ 100 ml of bloodc.Hct level is between 45-50%Indirect bilirubin level at birth is1-4 mg/100 ml – increase over this amount reflects the release of bilirubin as excessive red blood cells begin the breakdownd.WBC – at birth about 15,000 – 30, 000 cells/ cubic mm up to 40,000 cells/ cubic mm if birth was stressfulBlood Coagulation-Vit.K is synthesized through the action of intestinal flora, which is necessary for the formation of Factor II (prothrombin), factor VII (proconvertin),factor IX (plasma thromboplastin component), and factor X (Stuart-Power Factor)2.Respiratory System-The first breath of a newborn is initiated by a combination of cold receptors, a lowered PO2 and an increased PCO2Cold receptors, decrease PO2 and increase CO23.Gastrointestinal System-GI tract is usually sterile at birth-Newborns stomach holds about 60-90 ml-Regurgitation of previously ingested milk is secondary to immature cardiac sphincter (between stomach and esophagus)-Lowered glucose and CHON serum result from immature liver functionsSTOOLSMeconium-1st stool; passed within 24 hours after birth-2nd or 3rd day – newborn will have TRANSITIONAL STOOL characterized as green in color and loose-4th day- breastfed babies pass 3 or 4 light yellow stools per day-Milk formula fed – 2 to 3 bright yellow/ day with more noticeable odor-Newborn under phototherapy light will have bright green stools because of increased bilirubin excretion (a treatment for jaundice)-If with mucus or stools is watery or loose, milk allergy or lactose intolerance or some other irritant should be suspected-Bile duct obstruction will have a clay- colored (gray) stools because bile pigment do not enter the intestinal tract-Blood- streaked-Imperforate anus-Stool is black and tarry4.Urinary system-The average newborn voids within 24 hours after birth-If newborn does not void within this time, check for possibility of uret

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