NURSING CARE OF A

FAMILY WITH A
NEWBORN

JOIE S. OLIVEROS BSN, RN, MN

 PSYCHOLOGICAL CHANGES OF THE
POSTPARTAL PERIOD
❑The POSTPARTUM or also known as
“Postnatal Period” begins immediately after
delivery of the baby until 6 weeks.
➢Hormonal changes: Progesterone and Estrogen
decline.
➢Physical changes: Uterine Involution
❑It is a time of transition during which a couple
gives up concepts such as “CHILDLESS” or
“PARENTS OF ONE”
PSYCHOLOGICAL CHANGES OF THE
POSTPARTAL PERIOD

• How can a PROFESSIONAL

NURSE manage this woman’s life
event?

❑ Opening channels for communication.

❑ Anticipating new needs.
❑ Highlighting potential gains.
 PSYCHOLOGICAL CHANGES OF THE
POSTPARTAL PERIOD

BEHAVIORAL ADJUSTMENT

❑PHASES OF PUERPERIUM:
1. Taking- In Phase
2. Taking- Hold Phase
3. Letting- Go Phase
NURSING CARE OF
A FAMILY WITH A
NEWBORN
 PROFILE OF A NEWBORN
INITIAL OBSERVATION
• Initial inspection includes:
❑Attitude and position
❑Body proportion
❑Ease of movement
❑Respiratory effort
❑Presence of gross anomalies
❑Color
 PROFILE OF A NEWBORN
INITIAL OBSERVATION

• Normal posture of newborn:

COMPLETE FLEXION
• Premature infants: Frog legs
• Breech infants: Extended legs
• Brow infants: Arched back
 PROFILE OF A NEWBORN
The Important Measurements
• Head Circumference
➢ Normal: 34-35 cm (13.5-14 inches)
➢ Vaginal delivery may reduce circumference
due to molding.
➢ Occipitofrontal circumference (OFC)
➢ Greater than chest circumference (CC) by
2 cm.
➢ ¼ of total body length
 PROFILE OF A NEWBORN
The Important Measurements
❑Chest Circumference
➢Normal: 30.5 cm to 33 cm (12-13 inches)
➢Usually 2 cm less than HC
➢Measured at level of nipple using tape measure
➢Abnormal findings:
➢ Less than 30cm: Prematurity
➢ Left side larger may indicate cardiac enlargement
 PROFILE OF A NEWBORN
The Important Measurements
• Abdominal Circumference
• The measurement is approximately the
same as the chest circumference.
• It is measured just above the level of the
umbilicus.
• It is no longer recommended
to measure AC below the level of the
umbilicus.
 PROFILE OF A NEWBORN
The Important Measurements
• Length
• Measured from top of the head to heel
using tape measure while extending the
legs to fullest extension.
• Abnormal findings:
• Length of less than 45 cm indicates
prematurity
 PROFILE OF A NEWBORN
The Important Measurements: VITAL SIGNS
• TEMPERATURE: 37.2 degree celsius
➢Newborns lose heat because of:
• Immature temperature regulating system
(incapable of shivering)
• Very little SC fat
• Tendency to take on temperature of environment
➢Newborn conserve heat by: Constricting blood vessels
 PROFILE OF A NEWBORN
The Important Measurements: VITAL SIGNS
• TEMPERATURE:
• Newborns produce heat by:
• Increasing muscular activity such as in kicking
and crying.
• Metabolizing brown fat
• Increase BMR (may cause hypoglycemia and
hypoxemia)
 PROFILE OF A NEWBORN
The Important Measurements: VITAL SIGNS
➢ Hypothermia: Immediate interventions:
• Inform doctor
• Remove wet clothes
• Place under heat source (ex. Droplight)
• Encourage breastfeeding
• Start oxygen administration if with
distress or cyanosis
• Avoid hot water bottles
 PROFILE OF A NEWBORN
The Important Measurements: VITAL SIGNS

• Hyperthermia: Immediate interventions.

• T > 37.5 C
• Signs:
• Irritability and Lethargy
• Abdomen and extremities warm to touch
• Red, flushed skin - Hot, dry skin
• Stupor, coma, convulsion for temperature
above 41
 PROFILE OF A NEWBORN
The Important Measurements: VITAL SIGNS

• Hyperthermia: Immediate Interventions:

❑Place in cool environment
❑Undress partially or fully
❑Breastfeed frequently
❑Monitor temperature
❑TSB
❑Examine for infection
 PROFILE OF A NEWBORN
The Important Measurements: VITAL SIGNS

• RESPIRATORY RATE:

• Normal range: 30-60 cpm

• Sometimes irregular and shallow
• Increases with sensory and tactile
stimulation
• Newborns are obligate nose breathers
 PROFILE OF A NEWBORN
The Important Measurements: VITAL SIGNS

• HEART RATE:
• Normal range: 110-160 bpm
• HR may be less than 80 bpm when asleep and
greater 160 when crying.
• Taken most accurately in the apical area
(auscultated).
• Taken before temp to prevent agitation of
infant
 PROFILE OF A NEWBORN
The Important Measurements: VITAL SIGNS

• BLOOD PRESSURE:
• Normal range:
✓ 80/46 mmHg to 100/50 mmHg
• Abnormal Finding
• Popliteal pressure 6-9 mmHg less than
systolic pressure in upper extremities
may be indicative of coarctation of the
aorta
BODY SYSTEMS
 NEWBORN’S BODY SYSTEMS
CARDIOVSCULAR SYSTEM

• BLOOD VOLUME:
• At birth: 80 to 110 mL/kg
• Approximately 50-100 mL of blood is
transfused to the newborn .
• Advantages: decreased incidence of
respiratory distress
• Disadvantages: hyperbilirubenemia
and possible circulatory overload
 NEWBORN’S BODY SYSTEMS
CARDIOVSCULAR SYSTEM

• BLOOD VALUES
• RBC: 5,800,000 cells/cu.mm
• Hemoglobin: 16-18.5 mg/100mL
• Hematocrit: 33-53%
• WBC: up to 28,000 cells/cu.mm
• Iron: 10-200 mcg/100mL
 NEWBORN’S BODY SYSTEMS
RENAL SYSTEM

• Fetal kidneys produce urine by 4th month in

utero.
• Newborn should void within 24 hours
• 1st urine may be pinkish due to uric crystals
• Kidneys of newborn immature – urine is
dilute.
 NEWBORN’S BODY SYSTEMS
RENAL SYSTEM
• Bladder capacity at birth: 35- 38 mL
• Daily urinary output: 30-60 mL during
first few days then 300 mL after a week
• Urine output per voiding: 10- 15 mL
• Frequency of voiding: 5-6 during the first
week then 15-20 times
 NEWBORN’S BODY SYSTEMS
RESPIRATORY SYSTEM
• Initiation of Respiration
• Lungs filled with amniotic fluid must be emptied
to use as organ for gas exchange
• Mechanisms:
• Compression of chest as fetus passes through
narrows pelvic space.
➢Remaining fluid absorbed by lymphatic and
lung vessels
 NEWBORN’S BODY SYSTEMS
RESPIRATORY SYSTEM
• FIRST BREATH IS INITIATED BY:
• Thermal stimulus
• Decreased environmental temperature compared to
mother’s womb
• Chemical stimulus
• Low oxygen in blood & High carbon dioxide in blood
• Other stimulus
• Reflex response due to pressure, noise, light, etc.
 NEWBORN’S BODY SYSTEMS
GASTROINTESTINAL SYSTEM

• Immature at birth; full maturity by 2-3 years

• GIT is sterile at birth; normal flora present by
1 week
• Vitamin K
(aquamephyton/aquamenadione) is given
to prevent bleeding
• Most immature organ is liver
 NEWBORN’S BODY SYSTEMS
GASTROINTESTINAL SYSTEM

• Salivary glands functional by 2-3

months
• Immature cardiac sphincter =
regurgitation
• Gastric capacity up to 90 mL by birth –
small frequent feedings
 NEWBORN’S BODY SYSTEMS
GASTROINTESTINAL SYSTEM
• Stools
• Meconium
• First stool
• Should be passed within 24 hours
• Odorless, greenish black, viscous,
has occult blood
 NEWBORN’S BODY SYSTEMS
GASTROINTESTINAL SYSTEM
• Transitional stool: 2nd to 4th day
• Brownish to yellow green, watery, thin, slimy
• Normal stool: After 4 days
• (Breastfed) pleasant smell, golden or bright
yellow, loose
• (Bottle-fed) unpleasant odor, brownish, more
formed
 NEWBORN’S BODY SYSTEMS
SPECIAL SENSES: VISION
• Eyes structurally complete at birth but weak
extraocular muscles causing strabismus and
nystagmus
• Newborns can see at birth
• Lacrimal gland functions at 2 weeks
• Detects color at 2 months
 NEWBORN’S BODY SYSTEMS
SPECIAL SENSES: VISION
• Prefers to look at:
• Black and white patterns than plain
• Medium colors like yellow, green and
pink over bright and dark colors like
red, orange and blue
• Reflecting objects than dull
 NEWBORN’S BODY SYSTEMS
SPECIAL SENSES: TASTE

• Newborn has well-developed sense

of taste

• Can discriminate different tastes

• Prefers sweet-tasting substances

 NEWBORN’S BODY SYSTEMS
SPECIAL SENSES: HEARING

• Well developed hearing at birth

• Tends to stop crying and relax at low-
pitched sounds
• Prefer sounds with regular rate and rhythm
(accustomed to hearing maternal heartbeat
in utero)
 NEWBORN’S BODY SYSTEMS
SPECIAL SENSES: HEARING

• Normal reactions to sound: cessation

of activity, eye movement, generalized
body movement, and startle reflex
 NEWBORN’S BODY SYSTEMS
SPECIAL SENSES: SMELL
• Newborn has well-developed sense of smell
• Demonstrated when:
• Turns head away from strong odors like
alcohol
• Turns to mother’s breast because he
recognizes smell of milk
 NEWBORN’S BODY SYSTEMS
SPECIAL SENSES: SMELL

• Can differentiate the smell of their

mother or primary caregiver from other
women
 NEWBORN’S BODY SYSTEMS
SPECIAL SENSES: TOUCH

• Most highly developed among all senses

• Sense of touch demonstrated by rooting,
sucking, Babinski and palmar grasp
• Parts of body most sensitive to touch are:
face, hands and soles of feet
 NEWBORN’S BODY SYSTEMS
NEUROMUSCULAR SYSTEM

• Brain is 10% of total body weight at birth

• NMS immature at birth but newborn has
reflexes important for protection and survival
• Myelinization is complete at 6-12 months –
disappearance of reflexes as voluntary control
is developed.
 NEWBORN’S BODY SYSTEMS
NEUROMUSCULAR SYSTEM

Intact nervous system demonstrated by

state of alertness, resting posture, cry,
muscle tone and motor activity
INFANT REFLEXES
 INFANT REFLEXES
MORO REFLEX
• Moro Reflex
• Stimulus: support infant in
supine then drop slightly
• Reaction: arms and legs draw
outward then inward
• Duration: 32 weeks (AOG) to
4-5 months after birth
 INFANT REFLEXES
MORO REFLEX
• Abnormal Reactions:
• Absence of reflex – possible brain
damage
• Asymmetric movement –
paralysis, fracture, dislocation
• Persistence
 INFANT REFLEXES
BABINSKI REFLEX
• Babinski Reflex
• Stimulus: stroke lateral soles in
inverted J-curve
• Reaction: Fanning of toes
• Duration: birth to 3 months
• Abnormal Reaction: Persistence &
Abnormal movement
 INFANT REFLEXES
PALMAR GRASP REFLEX
• Palmar Grasp Reflex
• Stimulus: place finger or object on
palms
• Reaction: fingers will grasp
• Duration: 28 weeks (AOG) to 6
weeks after birth
 INFANT REFLEXES
NECK RIGHTING

• Neck-Righting Reflex
• Stimulus: infant in supine, turn head to
one side
• Reaction: shoulder and trunk follow
head
 INFANT REFLEXES
ROOTING REFLEX

• Rooting Reflex
• Stimulus: stroke cheek with finger
• Reaction: opens mouth and turn
toward side
 INFANT REFLEXES
SUCKING REFLEX
• Sucking Reflex
• Stimulus: Touch lips of infant
• Reaction: Sucking
• Duration: 32 weeks (AOG) to
birth.
 INFANT REFLEXES
EXTRUSION REFLEX

• Extrusion Reflex
• Stimulus: place sterile object on
anterior tongue
• Reaction: tongue extrusion
• Duration: birth to 4 months
 INFANT REFLEXES
STEPPING REFLEX

• Stepping Reflex
• Stimulus: infant on standing position
• Reaction: stepping motions
• Duration: birth to 3 months
 INFANT REFLEXES
CRAWLING REFLEX

• Crawling Reflex
• Stimulus: prone position
• Reaction: crawling movement
• Duration: birth to 6 weeks