NCM 107 MATERNAL AND CHILD NURSING

TOPIC: NURSING CARE OF A FAMILY WITH A NEWBORN

NAME: Garcia, Jairus Aztrid M. DATE: Nov

3, 2020
SECTION: BSN 2A MELODY R. ALCANTARA, MAN, RN

SEARCH THE FOLLOWING:

The Profile of a newborn.
a. Vital Statistics
Weight - The birth weight of newborns varies depending on the racial, nutritional,
intrauterine, and genetic factors.
 Male- 2.5 – 3.5 kg
 Female- 2.5 – 3.4 kg
 If a newborn weighs more than 4 kg, it is said to be macrosomic, a
condition that occurs in conjunction with a gestational diabetes of a
mother.
Length - 
 Male- 46 – 50 cm
 Female- 46 – 49 cm
Head Circumference- 34 – 35 cm
Chest Circumference- 32 – 33 cm
b. Vital Signs
Temperature – 37. 2 °C
Pulse –
 Heart rate of a fetus- 110 – 160 beats/minute
 Heart rate of a newborn at birth– 110 – 180 beats/minute
 Heart rate of a newborn (within 1 hour after birth) – 120 – 140
beats/minute
 Heart rate of a newborn (when crying) – 120 – 180 beats/minute
 Heart rate of a newborn (when sleeping) – 90 – 110 beats/minute
Respiration –
 Respiratory rate of a newborn at birth – 30 – 90 breaths/minute
 Respiratory rate of a newborn (within 1 hour after birth) – 30 – 60
breaths/minute
Blood Pressure-
 Blood pressure of a newborn at birth- 80/46 mmHg
 Blood pressure of a newborn (within the infant year)- 100/50 mmHg
c. Physiologic Functions
Cardiovascular System - Changes in the cardiovascular system are necessary after
birth because now, the lungs are responsible for oxygenating blood that was formerly
oxygenated by the placenta. As soon as the umbilical cord is clamped, which stimulates
a neonate to take in oxygen through the lungs, fetal cardiovascular shunts begin to
close. With the first breath, blood pressure decreases in the pulmonary artery (the
artery leading from the heart to the lungs). As this pressure decreases, the ductus
arteriosus, the fetal shunt between the pulmonary artery and aorta, begins to close. At
the same time, increased blood flow to the left side of the heart causes the foramen
ovale (the opening between the right and left atria) to close because of the pressure
against the lip of the structure (permanent closure does not occur for weeks). With the
remaining fetal circulatory structures (umbilical vein, two umbilical arteries, and ductus
venosus) no longer receiving blood from the placenta, the blood within them clots and
closes them, and the vessels atrophy over the next few weeks.
Blood values- A newborn’s blood volume is 80 to 110 ml/kg of body weight or about
300 ml total. A newborn’s hemoglobin level averages 17 to 18 g/100 ml of blood. A
newborn’s hematocrit is between 45% and 50%. A newborn’s red blood cell count is
about 6 million cells/mm(cube). A newborn’s indirect bilirubin level is between 1 and 4
mg/100 ml. A newborn’s white blood cell count is 15,000 to 30, 0000 cells/mm(cube), or
40, 000 cells/mm(cube), if the birth was stressful.
Blood Coagulation- Vitamin K, synthesized through the action of intestinal flora, is
responsible for the formation of factor II (prothrombin), factor VII (proconvertin), factor
IX (plasma thromboplastin component), and factor X (Stuart-Prower factor) in the
clotting sequence. Because a newborn’s intestine is sterile at birth unless membranes
were ruptured more than 24 hours, it will take about 24 hours for flora to accumulate
and for ongoing vitamin K to be synthesized. This causes most newborns to be born with
a lower than usual level of vitamin K, leading to a prolonged coagulation or prothrombin
time. Because almost all newborns can be predicted to have this diminished blood
coagulation ability, vitamin K (AquaMEPHYTON) is usually administered intramuscularly
into the lateral anterior thigh, the preferred site for all injections in newborns,
immediately after birth. Vitamin K is given to prevent serious bleeding, such as
hemorrhagic disease of newborns. If parents object to an injection, vitamin K can be
administered orally, although it is not as effective. Whether giving this orally or by
injection, be certain the administration doesn’t interfere with parent bonding or
beginning breastfeeding as these are also vitally important in the first hours after birth
Respiratory System-A first breath requires a tremendous amount of pressure (about
40 to 70 cm H2O) for a newborn to be able to inflate alveoli for the first time. The reflex
to breathe is initiated by (1) a combination of cold receptors, (2)a lowered partial
pressure of oxygen (PO2 ), from 80 mmHg to 15 mmHg, and an increased partial carbon
dioxide pressure (PCO2 ), which rises as high as 70 mmHg. Some fluid present in the
lungs from intrauterine life makes a newborn’s first breath possible because fluid eases
surface tension on alveolar walls and allows alveoli to inflate more easily than if the lung
walls were dry. About one third of this fluid is forced out of the lungs by the pressure of
vaginal birth. The rest of the fluid is quickly absorbed by lung blood vessels and
lymphatics after the first breath. Once the alveoli have been inflated this first time,
breathing becomes much easier for a baby, requiring only about 6 to 8 cm H2O
pressure. Within 10 minutes after birth, most newborns have established easy
respirations as well as a good residual volume. By 10 to 12 hours of age, vital capacity is
established at newborn proportions. A baby born by cesarean birth does not have as
much lung fluid expelled at birth as one born vaginally and so typically has more
difficulty establishing respiration because excessive fluid blocks air exchange space.
Preterm newborn alveoli may collapse each time they exhale (because of the lack of
pulmonary surfactant). As a result, they also have difficulty establishing effective
residual capacity and respirations.
Gastrointestinal System- Although the gastrointestinal tract is usually sterile at
birth, bacteria may be cultured from the tract in most babies within 5 hours after birth
and from all babies at 24 hours of life. Most of these bacteria enter the tract through
the newborn’s mouth from airborne sources. Others may come from vaginal secretions
at birth, from hospital bedding, and from contact at the breast. The accumulation of
bacteria is helpful because bacteria in the gastrointestinal tract are necessary for
digestion through probiotics and for the synthesis of vitamin K. Although a newborn
stomach holds about 60 to 90 ml, a newborn has limited ability to digest everything
taken in, especially fat and starch because the pancreatic enzymes, lipase and amylase,
remain deficient for the first few months of life. Also, because the cardiac sphincter
between the stomach and esophagus is immature, a newborn tends to regurgitate
easily. Immature liver function can lead to a tendency toward lowered glucose and
protein serum levels.
Stool- The first stool of a newborn is usually passed within 24 hours after birth. It
consists of meconium, a sticky, tar-like, blackish-green, odorless material formed from
mucus, vernix, lanugo, hormones, and carbohydrates that accumulated in the bowel
during intrauterine life. If a newborn does not pass a meconium stool by 24 to 48 hours
after birth, the possibility of some problem such as meconium ileus, imperforate anus,
or volvulus should be suspected. About the second or third day of life, newborn stool
changes in color and consistency. Termed a transitional stool, bowel contents appear
both loose and green; they may resemble diarrhea to the untrained eye. • By the fourth
day of life, breastfed babies pass three or four light yellow stools per day that have a
soft consistency. They are not foul smelling because breast milk is high in lactic acid,
which reduces the number of putrefactive organisms in the stool. • A newborn who
receives formula usually passes two or three bright yellow stools a day of soft
consistency. These have a more noticeable odor, compared with those of breastfed
babies. • A newborn placed under phototherapy lights as therapy for jaundice will have
bright green stools because of increased bilirubin excretion. • Newborns with bile duct
obstruction have clay-colored (gray) stools because bile pigments cannot enter the
intestinal tract. • Blood-flecked stools usually indicate an anal fissure.
Occasionally, a newborn has swallowed some maternal blood during birth and either
vomits fresh blood immediately after birth or passes a black tarry stool after two or
more days. Whether bleeding is caused by ingestion of maternal blood at birth or
newborn bleeding may be differentiated by a dipstick Apt Downey test. If stools remain
black or tarry, this suggests newborn intestinal bleeding rather than swallowed blood. •
If mucus is mixed with stool or the stool is watery and loose, a milk allergy, lactose
intolerance, or some other condition interfering with digestion or absorption is
suspected.
Urinary system- The average newborn voids within 24 hours after birth. A newborn
who does not take in much fluid for the first 24 hours may void later than this, but the
24-hour point is a general rule. Newborns who do not void within this time need to be
assessed for the possibility of urethral stenosis or absent kidneys or ureters. The kidneys
of newborns do not concentrate urine well, making newborn urine usually light colored
and odorless. The infant is about 6 weeks of age before much control over reabsorption
of fluid in tubules and concentration of urine becomes evident. A single voiding in a
newborn is only about 15 ml and may be easily missed in an absorbent diaper. Specific
gravity ranges from 1.008 to 1.010. The daily urinary output for the first 1 or 2 days is
about 30 to 60 ml total. By week 1, total daily volume rises to about 300 ml. The first
voiding may be pink or dusky because of uric acid crystals that were formed in the
bladder in utero; this looks a lot like blood in urine but is an innocent finding. If tested
for protein, a small amount may be normally present in voidings for the first few days of
life until the kidney glomeruli are more mature. Diapers can be weighed to determine
the amount and timing of voiding, which is done when there is a concern. The possibility
of obstruction in the urinary tract can also be assessed by observing the force of the
urinary stream in both male and female infants. Males should void with enough force to
produce a small projected arc; females should produce a steady stream, not just
continuous dribbling. Projecting urine farther than normal may signal urethral
obstruction because it indicates urine is being forced through a narrow channel.
Immune System- Newborns have limited immunologic protection at birth because
they are not able to produce antibodies until about 2 months (the reason most
immunizations are not administered until 2 months of age). Newborns are, however,
born with passive antibodies (immunoglobulin G) passed to them from their mother
that crossed the placenta. In most instances, these include antibodies against
poliomyelitis, measles, diphtheria, pertussis, chickenpox, rubella, and tetanus.
Newborns are routinely administered a hepatitis B vaccine before they leave their birth
setting to promote antibody formation against this disease. Because the newborn has
little natural immunity against herpes simplex, healthcare personnel with herpes
simplex eruptions (cold sores) should not care for newborns until the lesions have
crusted. Without antibody protection, herpes simplex type 2 infections can become
systemic or create a rapidly fatal form of the disease in a newborn.
Neuromuscular System
Reflexes-
 Blink Reflex- to protect the eye from any object coming near it by rapid eyelid
closure
 Rooting Reflex- If a newborn’s cheek is brushed or stroked near the corner of the
mouth, the infant will turn the head in that direction. It serves to help a newborn
find food. It disappears at about the sixth week. E.g. when a mother holds the
child and allows her breast to brush the newborn’s cheek, the reflex causes the
baby to turn toward the breast.
 Sucking Reflex- When a newborn’s lips are touched, the baby makes a sucking
motion. It helps a newborn find food. It disappears at about the sixth months. It
can be maintained by offering a pacifier.
 Swallowing Reflex- Food that reaches the posterior portion of the tongue is
automatically swallowed.
 Extrusion reflex- In order to prevent the swallowing of inedible substances, a
newborn extrudes any substance that is placed on the anterior portion of the
tongue. If newborns are offered solid food before this reflex fade at 4 months, it
will look as if they are rejecting the food.
 Palmar Grasp Reflex- Newborns grasp an object placed in their palm by quickly
closing their fingers on it. This reflex disappears at about 6 weeks to 3 months.
 Step-in-Place Reflex- Newborns who are held in a vertical position with their feet
touching a hard surface will take a few quick, alternating steps. This reflex
disappears at 3 months.
 Placing reflex- elicited by touching the anterior lower leg against a surface
such as the edge of a table. The newborn makes a few quick lifting leg motions,
as if to step onto the table.
 Plantar Grasp Reflex- When an object touches the sole of a newborn’s foot at the
base of the toes, the toes grasp. This reflex disappears at about 8 to 9 months.
 Tonic Neck Reflex- When the arm and leg on the side toward which the head is
turned extend, the opposite arm and leg contract. This reflex disappears at about
2 to 3 months.
 Moro reflex- response to sudden stimulation or abrupt change in
position. This reflex disappears at about 4 to 5 months. E.g. it can be elicited
with a loud noise or by jarring the cradle.
 Babinski Reflex- When the sole of a newborn’s foot is stroked in an inverted “J”
curve from the heel upward, a newborn spread the toes. This reflex disappears
at about 3 months.
 Magnet Reflex- If pressure is applied to the soles of the feet of a newborn lying
in a supine position, he or she pushes back against the pressure.
 Crossed Extension Reflex- When a newborn is lying supine, if one leg is extended
and the sole of that foot is irritated by being rubbed with a sharp object, the
infant raises the other leg and extends it as if trying to push away the hand
irritating the first leg.
 Trunk Incurvation Reflex- When a newborn lying in a prone position and is
touched along the paravertebral area on the back by a probing finger, the
newborn flexes the trunk and swings the pelvis toward the touch.
 Landau reflex- When a newborn is supported in a prone position by a hand, the
newborn should demonstrate some muscle tone.
 Deep Tendon Reflexes- Both a patellar and a biceps reflex are intact in a
newborn
 The Senses
Hearing- Newborns appear to recognize their mother’s voice almost
immediately and calm to the sound since they have heard it in utero. In fact, by 25 to 27
weeks gestation, hearing is functional and the fetus can hear the mother’s heartbeat
and voice. As soon as amniotic fluid drains, hearing becomes acute. Newborns respond
with generalized activity to a sound such as a bell. However, they appear to have
difficulty locating where a sound is coming from.
Vision- A pupillary reflex or ability to contract a pupil is present from birth,
as well as blink reflex (was formed by 26 weeks gestation). A newborn appears
to lose track of objects easily.
Touch- Newborns quiet down at a soothing touch, cry at painful stimuli, and
show sucking and rooting reflexes that are elicited by touch.
Taste- A newborn has the ability to discriminate taste because taste buds are
developed and functioning even before birth. A fetus in utero, for example, will swallow
amniotic fluid more rapidly than usual if glucose is added to sweeten its taste. The
swallowing decreases if a bitter flavor is added. After birth, a baby continues to show a
preference for sweet over bitter tastes.
Smell- The sense of smell is present in newborns as soon as the nose is clear of
amniotic fluid. Newborns probably turn toward their mothers’ breasts partly out of
recognition of the smell of breast milk and partly as a manifestation of the rooting
reflex.
d. Appearance of a newborn.
Skin- 
Color
 Cyanosis- skin appears blue due to lack of oxygen, poor circulation, and
mucus obstruction
 Lips and extremities are likely to appear blue due to immature peripheral
circulation (Acrocyanosis), a normal finding at birth through the first 24 to
48 hours after birth
 Central cyanosis- indicates decreased oxygenation in the trunk that could
be occurring as the result of a temporary respiratory obstruction and also
could reflect a serious underlying respiratory or cardiac disease.
 Hyperbilirubinemia – excess bilirubin in blood
 Physiologic jaundice- the skin and sclera of a newborn begin to appear
yellow as a result of a breakdown of RBCs, which releases indirect
bilirubin into the blood.
 Pallor- result of anemia
 Harlequin Sign- a newborn who has been lying on his or her side appears red on
the lower side of the body and pale on the upper side. The odd coloring fades
immediately if the infant’s position is changed or the baby kicks or cries.

Birthmarks-
 Hemangiomas- vascular tumors of the skin
  Nevus flammeus (port-wine stain)- formed of a plexus of newly formed
capillaries in the papillary layer of the corium. It is deep red to purple,
does not blanch on pressure, and does not fade with age.
 Nevus flammeus (telangiectasia or stork beak mark)- commonly occurring
on nape of neck. It blanches on pressure; although it does not fade, it is
not noticeable as it becomes covered by hair.
 Strawberry hemangiomas- consist of dilated capillaries in entire dermal
and subdermal layers. They continue to enlarge after birth but usually
disappear by age 10 years
 Mongolian spots- collection of pigment cells (melanocytes) that appear as gray
patches across the sacrum or buttocks and possibly on the arms and legs of
newborns.
 Vernix caseosa- white, cream cheese–like substance that serves as a skin
lubricant in utero. A fatty layer around the skin of a newborn that serves as an
insulation, and thus preventing hypothermia and infection.
 Lanugo- fine, downy hair that covers a term newborn’s skin. Usually disappears
at 2 weeks.
 Desquamation- newborn’s skin begin to dry, especially on the palm of the hands
and soles of the feet, and thus peeling occurs.
 Milia- white papules (unopened sebaceous glands) that are found on a
newborn’s cheeks or nose. It disappears at 3-4 weeks.
 Erythema Toxicum/Flea-bite rash- occurs sporadically, and begins with small
papules, then it becomes erythematous by the 2nd day, and disappears by the 3rd
day.
 Forceps marks- commonly found in newborns born by forceps. Such marks are
transient and disappear in a day or two.
 Skin Turgor- A newborn is hydrated if the skin turgor is elastic or returns
smoothly. While, a newborn is dehydrated if the skin turgor is decreased or
retains elevation.

Head –
 Fontanelles- spaces or openings where the skull bones join
 Anterior fontanelle – diamond-shaped, located at the junction of
parietal bones and frontal bone. It usually closes at 12 to 18
months. It is soft. If it is indented (sign of dehydration). If it is
bulging (sign of increased intracranial pressure). It may
normally bulge if a newborn is straining to pass a stool, crying
vigorously, and lying supine.
 Posterior fontanelle- triangular-shaped, located at the junction
of parietal bones and occipital bone. It usually closes at 2
months.
  Sutures- separating lines of the skull. It may overlap at birth because of the
extreme pressure exerted on the head during vaginal birth. Wide separation
suggests increased intracranial pressure because of abnormal brain formation,
abnormal accumulation of cerebrospinal fluid in the cranium (hydrocephalus), or
an accumulation of blood from a birth injury such as subdural hemorrhage.
Fused suture lines also are abnormal; they require X-ray confirmation and
further evaluation because this will prevent the head from expanding with brain
growth.
 Molding- part of the infant’s head that engaged the cervix, molds to fit the cervix
contours during labor.
 Caput succedaneum- edema of the scalp that forms on the presenting
part of the head.
 Cephalohematoma- a collection of blood between the periosteum of a
skull bone and the bone itself, is caused by rupture of a periosteal
capillary because of the pressure of birth.
 Craniotabes- softening of the cranial bones probably caused by pressure
of the fetal skull against the mother’s pelvic bone in utero.
Eyes –
 It’s rare to see tears in a newborn because their lacrimal ducts do not fully
mature until about 3 months of age.
 Irises of the eyes look gray or blue, yet will assume its permanent color between
3 and 12 months of age.
 Sclera may appear light blue
 Eyes should appear clear, without redness or purulent discharge
 Pressure during birth sometimes ruptures a conjunctival capillary of the eye,
resulting in a subconjunctival hemorrhage on the sclera. This appears as a red
spot on the inner aspect of the eye, or as a red ring around the cornea.
Ears – 
 Newborn’s external ear is not as completely formed as it will be eventually, so
the pinna tends to bend forward easily. However, the pinna should be strong
enough to recoil after bending.
 The level of the top part of the pinna should be even to the inner and outer
canthus of the eyes, as well as the back across the head.
 A small tag of skin is sometimes found just in front of an ear.
Nose – 
 Has milia present and tends to appear large for the face.
 Always test for choanal atresia (blockage at the back of the nose) when
examining a newborn by closing the infant’s mouth while compressing one naris
at a time with your fingers.
Mouth – 
 tongue may appear short or “tongue tied” because the frenulum membrane is
attached close to the tip.
  Occasionally, one or two small round, glistening, well-circumscribed cysts
(Epstein pearls) can be seen on the palate from extra calcium that was deposited
in utero.
 Thrush, a Candida infection, which appears on the tongue and sides of the
cheeks as white patches and requires treatment with an antifungal drug such as
nystatin.
 Small, white Epithelial pearls (benign inclusion cysts) may be noticed on the gum
margins.
 Sometimes one or two (called natal teeth) will have erupted.
 If the mouth is filled with so much mucus that the neonate seems to be blowing
bubbles, suspect a tracheoesophageal fistula.
Neck – 
 Appears short with creased skin folds
 If the neck is rigid, Congenital torticollis, caused by injury to the
sternocleidomastoid muscle during birth.
 Not strong enough to support the total weight of the head but in a sitting
position, a newborn should make a momentary effort at head control.
 Trachea usually appears prominent on the front of the neck. The thymus gland
also appears enlarged
Chest –
 Supernumerary nipple (usually found below and in line with the normal nipples)
may be present.
 In both female and male infants, the breasts may be engorged because of the
influence of maternal hormones during pregnancy.
 May secrete a thin, watery fluid popularly termed Witch’s milk.
 Retraction (drawing in of the chest wall with inspiration) should not be present.
 Abdomen –
 looks slightly protuberant
 a sunken appearance suggests missing abdominal contents or a diaphragmatic
hernia (abdominal organs positioned in the chest instead of the abdomen).
Anogenital Area – 
 Anus must be patent and present. If not, imperforated anus is present.
Male genitalia-
 The scrotum is edematous and has rough rugae on the surface.
 If one or both testicles are not present (cryptorchidism), referral is needed to
further investigate the problem. This condition could be caused by agenesis
(absence of the testes), ectopic testes (the testes are present in the abdomen
but cannot enter the scrotum because the opening to the scrotal sac is closed),
or undescended testes (the vas deferens or artery is too short to allow the testes
to descend).
 The penis of newborns appears small, approximately 2 cm long.
 Be certain the urethral opening is at the tip of the glans, not on the dorsal
surface (epispadias) or on the ventral surface (hypospadias).
 Female genitalia-
 The vulva in female newborns may appear swollen because of the effect of
maternal hormones during intrauterine life. Some female newborns also have a
mucus vaginal secretion, sometimes blood tinged (pseudomenstruation), which
is also caused by maternal hormones.
The Back – 
 The spine of a newborn typically appears flat in the lumbar and sacral areas
The Extremities – 
 The arms and legs of a newborn appear short.
 The hands seem plump and are typically clenched.
 Newborn fingernails feel soft and smooth and extend over the fingertips.
 short arms may signify achondroplasia (dwarfism)
 Syndactyly- webbing between the fingers
 Polydactyly- missing or extra fingers
 The sole of the foot is flat because of an extra pad of fat in the longitudinal arch.
The foot of a term newborn has many crisscrossed lines on the sole, covering
approximately two thirds of the foot. If these creases cover less than two thirds
of the foot or are absent, it suggests the infant is preterm.
 The feet may turn in (varus deviation) because of their former intrauterine
position.