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Camarudin Rafsanjani Umpa Newsryn Ducay Genila Marie O. Bait-it Ma. Lorelyn Pendang Gwendolyn T. Mabaquiao Sheena Claire D. Gentallan Sheena Marie Aguilar
• • • • Objectives Introduction Definition of Terms Assesment -Initial Assessment -Transitional Assessment -Gestational Assessment -Physical Assessment: - General Measurement: Head to toe -Vital Signs - General Appearance -Skin -Head -Eyes -Ears -Nose -Mouth -Neck -Chest -Lungs -Heart -Abdomen -Female Genitalia -Male Genitalia -Back and Rectum -Extremities -Neuromuscular System • Anatomy and Physiology -Thermoregulation -Circulatory -Hemopoetic System -Fluid and Electrolytes
• • • • •
-Gastrointestinal System -Renal System -Integumentary System -Skeletal System -Respiratory System -Endocrine -Neurology -Sensory -Immune System Nursing Principles -Maintaining Patent Airway -Maintaining Stable Temperature -Identification -Protection from infection and injury -Medical Management -Bathing -Cord Care -Circumcision -Providing Optimum Nutrition -Promoting Parent infant bonding NCP HEP Discharge Plan Prognosis Presentation of Concept Map
OBJECTIVES At the end of this case study, students will be able to: 1. Describe the normal characteristics of a term newborn. 2. Describe the state of a newborn. 3. Perform newborn assessments such as the APGAR, Ballard and Silverman Test. 4. Implement nursing care to a normal newborn, such as administering a first bath or instructing parents on how to care for their newborn. 5. Describe the nursing management of the newborn: respirations, maintenance of temperature, prevention of infection, and optimal nutrition. 6. Discuss initial identification, registration, and screening procedure for the newborn. 7. Relate the importance of the bonding process to the newborn baby’s and parent’s adjustment to each other. 8. Develop a teaching plan for parents of a newborn specific to home care. 9. Discuss the importance of breastfeeding to the mother and family. 10. Apply correct nursing intervention necessary for newborn care. I INTRODUCTION NEWBORN – the first hour of life The primary focus at this time is the transition from intrauterine to extrauterine life, with an introduction to family members as the neonate’s condition warrants. The first 24 hours of life constitute a highly vulnerable time during which the infant must make several adjustments to uterine life. During this period of transition, 6 overlapping stages have been identified. Stage 1: Receives stimulation from the pressure of the uterine contractions during labor and from changes in pressure when the membranes rupture. In this stage, there is the transition from the intrauterine to extrauterine life. The fetus takes part in this process from the flexion until the expulsion of oneself. Nurses should take into consideration the risk factors that may be involved in such delivery, putting in mind the safety of the newborn.
Stage 2: Encounters a variety of foreign stimuli – light, cold, gravity, and sound. In this stage, the newborn is introduced to the extrauterine life. Certain factors such as these would stimulate the basic instinct of survival. These factors classified as the thermal and chemical factors, enables the infant to take in the first breath of life. Nurses should consider these factors and should provide adequate temperature to regulate the change from the intrauterine temperature to the extrauterine temperature change, protecting the newborn from these factors would help the newborn gradually adjust to such dramatic change. Stage 3: Initiates breathing. In this stage the first breath is taken in after the umbilical cord is cut. This stimulates the first inspiration. Nurse’ consideration, they should provide patent airway to prevent aspiration from fluids accumulated. This would facilitate the beginning process of respiration and circulation. Stage 4: Changes from fetal to neonatal circulation. Circulation begins right after the first breath has been taken in. The circulation of oxygen throughout the newborn allows the start of the metabolic processes within the body. Nurse should take into consideration the importance of circulation right after the first seconds of transition from intrauterine to extrauterine life. Stage 5: Undergoes alteration in metabolic processes with activation of liver, renal, and gastrointestinal tracts for passage of meconium. With the exchange of gas and the circulation of oxygen within the body, each organ begins their process of adjustment in the extrauterine life. Such metabolic process activates these major organs to promote vitality of life of the newborn. Nurse should take into consideration by assessing such changes, whether it is successful and able to adjust with such dramatic change. Stage 6: Achieves a steady level of equilibrium in metabolic processes. Taking into consideration the production of enzymes, increased blood oxygen saturation, decrease in acidosis associated with birth, and recovery of the neurologic tissues from the trauma of labor and delivery. It is in this stage the newborn takes into the final adjustment period of ones life independently. This stage is crucial hence the nurse should give importance of making sure such level of equilibrium be maintained at such time the newborn will be finally discharged together with his/her family.
an angle of the wrist between the hypothenar prominence and forearm. Square window . Normothermic . Range of state – measure of general arousal level or arousability of infant.DEFINITION OF TERMS: Habituation . the sum total of any particular automatic response mediated by the nervous system.abnormally rapid heart rate Apnea . with a decreasing response.a normal state of temperature. and people. Bradycardia is one of the two types of arrhythmia Tachycardia . Regulation of state – how infant responds when aroused.a reflected action or movement.a slow heart rate. the sum total of any particular automatic response mediated by the nervous system.a reflected action or movement. It is used as a reference point for estimating the gestational age of a newborn. place.the gradual adaptation to a stimulus or to the environment. Motor Performance – quality of movement and tone. Orientation . Posture . Reflexes .awareness of one's environment with reference to time.Temporary absence or cessation of breathing . Autonomic stability – signs of stress related to homeostatic adjustment of the nervous system. Bradycardia .
a severe.has been used in the control of tuberculosis in cattle but has many disadvantages. by the use of contaminated needles and instruments. sometimes fatal disorder of adipose tissue occurring chiefly in preterm. or in utero. sick. boardlike. brown to grayish blue nevus. containing lamellated keratin and often associated with vellus hair follicles. usually of the face. Milia .eduction in mineralization of the skull. Miliaria . The hands and feet turn blue because of the lack of oxygen.an unnatural paleness or absence of color in the skin. The virus is transmitted by transfusion of contaminated blood or blood products. usually affecting the occipital and parietal bones along the lambdoidal sutures. a hepa and virus. Pallor . and inflexible. Scelerema . Prognosis .a prediction of the probable outcome of a disease based on the condition of the person and the usual course of the disease as observed in similar situations. by sexual contact with an infected person.abnormally rapid rate of breathing. causing the skin to become cold. such as that associated with high fever. Plethora . Vitamin K . typically found at birth in the sacral region in Asians and dark-skinned races. BCG vaccination . Acrocyanosis . with abnormal softness of the bone. .a smooth. Decreased blood supply to the affected areas is caused by constriction or spasm of small blood vessels.a viral hepatitis caused by the hepatitis B virus (HBV). and is not recommended for use unless the prevalence of the disease is very high.Tachypnea .An excess of blood in the circulatory system or in one organ or area.a cutaneous condition with retention of sweat.s a decrease in the amount of oxygen delivered to the extremities. it usually disappears during childhood. mottled. yellowish white. manifested by induration of the involved tissue.any of a group of structurally similar fat-soluble compounds that promote blood clotting.a tiny spheroidal epithelial cyst lying superficially within the skin. which is extravasated at different levels in the skin Mongolian spot . debilitated infants. consisting of an excess of melanocytes. Craniotabes . especially interference with tuberculin testing. Hepa B vaccine .
which causes one or both eyes to turn Hypotelorism . Strabismus . Vertical nystagmus occurs much less frequently than horizontal nystagmus and is often. This defect is the result of obstruction of the omphalomesenteric vessels during development. Torticollis .is a type of abdominal wall defect in which the intestines and sometimes other organs develop outside the fetal abdomen through an opening in the abdominal wall. Frenulum .he pointed process of cartilage.abnormal enlargement of the heart. About half are born with the condition. Xiphoid process .bleeding from the uterus that resembles menstruation but is not associated with the usual changes in endometrial tissues . Candidiasis . a sign of serious brain damage. its presence can portend other significant medical problems.Nystagmus . but not necessarily. connected with the posterior end of the body of the sternum. Gastroschisis .is a gelatinous substance within the umbilical cord. an ultrasound scan of the abdomen and direct removal of the fluid by needle or paracentesis. The to-and-fro motion is generally involuntary. composed of cells that originate in the original egg and sperm of conception.occurs in 2-5% of all children.is an infection caused by a species of the yeast Candida. oscillating motions of the eyes are called nystagmus. Although most commonly due to cirrhosis and severe liver disease.Rhythmic. supported by a core of bone. Pseudomenstruation . It is largely made up of mucopolysaccharides Ascites . Diagnosis of the cause is usually with blood tests.s an accumulation of fluid in the peritoneal cavity.a small fold of integument or mucous membrane that limits the movements of an organ or part. Wharton’s Jelly .is a disorder defined as a separation of the rectus abdominis muscle into right and left halves.abnormally decreased distance between two organs or parts. Nystagmus can be a normal physiological response or a result of a pathologic problem.is a type of movement disorder in which the muscles controlling the neck cause sustained twisting or frequent jerking. Diastasis recti . usually Candida albicans Cardiomegaly .
Syndactyly . Startle .A relatively minor seismic shaking or vibrating movement. Hemimelia .congenital absence of the proximal portion of a limb or limbs.the state of being hypotonic. Hydrocele .circumscribed collection of fluid. Pupillary . Chordee . so that they are more or less completely fused together. but more often in the male. irregularly shaped bone. Hypertonia . occurring in both sexes.the state of being hypertonic. Tremors . the hands or feet being attached to the trunk by a small.Of or affecting the pupil of the eye Glabellar .the presence of supernumerary digits on the hands or feet.a developmental anomaly characterized by absence of all or part of the distal half of a limb. tremulous movement. Polydactyly .downward bowing of the penis.The smooth area between the eyebrows just above the nose Extrusion .ongenital absence of the upper wall of the urethra.The act or process of pushing or thrusting out.Epispadias . rapid. with the urethral opening somewhere on the dorsum of the penis. Tremors often precede larger earthquakes or volcanic eruptions.To shake with a slight.any of a genus of rodlike Gram-negative bacteria that live in soil and decomposing organic matter: many species are pathogenic to plants and a few are pathogenic to man . Hypotonia . Phocomelia . especially in the tunica vaginalis of the testis or along the spermatic cord.persistence of webbing between adjacent digits of the hand or foot.To cause to make a quick involuntary movement or start Pseudomonas . Quivering . due to a congenital anomaly or to urethral infection.
Attachement – is the mode of contact between baby’s mouth and the mother’s breast during the act of breastfeeding.inflammation of the urinary meatus. Conduction – is the transfer of body heat to a cooler solid object in contact with a baby. Radiation – is the transfer of body heat to a cooler solid object not in contact with the baby. Kangaroo Mother Care . and support to the mother infant dyad. occurs in bulls in which the urethra lies superficially near its end.Prevention of or protective treatment for disease Cirrhosis . such as a fruit. Evaporation – is loss of heat through conversion of a liquid to vapor. A fistula may affect the discharge of semen from the normal meatus sufficiently to cause infertility. exclusive breastfeeding.is a baby who is 4 weeks old or younger. represents a time when changes are very rapid. but in particular for premature babies.A universally available and biologically sound method of care for all newborns. Neonatal Period . to release its contents Meatitis . It can result from alcohol abuse. . or sporangium. Newborn Resuscitation – a series of action taken to establish normal breathing in a newborn with depressed vital signs.A chronic disease of the liver characterized by the replacement of normal tissue with fibrous tissue and the loss of functional liver cells. Neonate . Urethral fistula . nutritional deprivation. DTP .diphtheria and tetanus toxoids and pertussis vaccine.due to trauma. anther. or infection especially by the hepatitis virus Dehiscence . and many critical events can occur. Convection – is the flow of heat from the newborn/s body surface to cooler surrounding air. with t three components : skin-to-skin contact.Prophylaxis .he spontaneous opening at maturity of a plant structure.the first 4 weeks of a child's life.
sneeze Completely pink .is the most frequent in assessing the newborn’s immediate adjustment to extra uterine life (Papile. weak cry Some flexion of extremities Grimace Body pink. skilled observation to ensure a satisfactory to extra-uterine life. extremities blue 2 Beats / min Good. strong cry Well flexed Cry.Positive Pressure Ventilaiton (PPV) . 4 phases of physical assessment after delivery • The initial assessment • The transitional assessment • The assessment of gestational age • The comprehensive and systematic physical examination INITIAL ASSESSMENT includes APGAR scoring • APGAR SCORING METHOD SIGNS Heart rate Respiratory effort Muscle Tone Reflex Irritability Color SCORES 0-3 4–6 7 – 10 Severe Distress Moderate Difficulty Absent in Difficulty . < 100 beats / min Irregular. usually using a baby valve mask or mechanical ventilator.refers to the process of forcing air into the lungs of a (usually apneic or dyspneic) patient. ASSESSMENT The new born requires thorough. 2001) 0 Absent Absent Limp No response Blue. slow. Pale 1 Slow.
↓ mucus production . cries vigorously. which is normal and indicate lack of stress.Temperature may decreased slightly After this initial stage of alertness and activity. the infant enters the second stage of the first reactive period.Mucus secretion are increased .↓ heart and respiratory rate . respiration. . .the neonates eyes are usually open .↓ temperature . . Physiologically the respiratory rate can be: . motor activity.Bowel sounds are active . During newborn’s initial 24 hours.Heart rate may reach 180 breaths / min.Crackles may be heard . mucus production. may suck his or her fingers or fist and appears interested in the environment.TRANSITIONAL ASSESSMENT Newborn exhibits behavioral and physiological characteristics that can at first appear to be signs of stress. . For 6 to 8 hours after birth the newborn is in the first period of reactivity .During the first 30 min. the infant is alert.Urine and stool usually not pass The infant is in a state of sleep and relative calm and avoid undressing or bathing the infant during this time. .grasp the nipple quickly This is important to remember because after this initial highly active state the infant may be sleepy and uninterested in sucking. predictable sequence. changes in heart rate. and bowel activity occur in an orderly.As high as 80 breaths / min. color.has vigorous suck reflex .
on upper arms. It assigns a score to various criteria. the sum of all of which is then extrapolated to the gestational age of the baby.↑ gastric and respiratory secretions .Infant is alert and responsive . This scoring allows for the estimation of age in the range of 26 weeks-44 weeks. Muscle tone and degree of flexion increase with maturity. or Ballard Scale is a commonly used technique of gestational age assessment.After this stage is a period of stabilization of physiologic system and vacillating patterns of sleep and activity GESTATIONAL ASSESSMENT includes Ballard Scale The Ballard Maturational Assessment. Posture - with infant quiet and in a supine position.Passage of meconium occurs . hold for 5 seconds.The second period of reactivity begins with the infant wakes from the deep sleep it last about the 2-5 hours . apply gently pressure index and third fingers on dorsum of hand without rotating infant’s wrist. The New Ballard Score is an extension of the above to include extremely pre-term babies. These criteria are divided into Physical and Neurological criteria. fully flex both forearms.Gag reflex is active . observe degree of flexion in arms and legs. Score: full flexion of the arms and legs = 4 with thumb supporting back of arm below wrist. Measure angle between base of Square window with thumb and forearm Score: Full flexion (hand lies flat on ventral surface of forearm) = 4 Arm recoil .↑ heart and respiratory rate . pull down on hands to fully extend and . Ballard Score.with infant supine.
Measure degree of angle behind knee (popliteal angle). Score: knees flexed with a popliteal angle of less than 10 degrees. Score: elbow does not reach midline = 4 .With infants supine and pelvis flat on a firm surface. Score. Observe rapidity and intensity of recoil to state of flexion. Scarf sign Heel to ear . flex lower leg on thigh and then flex thigh on abdomen. use other hand to pull infant’s arm across the shoulder so that infant’s hand touches shoulder. Determine location of elbow in relation to midline. extend lower legs with index finger of other hand.with infant supine. pull foot as far as possible up toward ear on same side measure distance of foot from ear and degree of knee flexion (same as popliteal angle). Popliteal angle numb and .rapidly release arms.with infant supine and pelvis flat on a firm surface. support head in midline with one hand. . While holding knee with and index finger. an angle of less than 90 degree = 5.
Depending on feeding method Birth weight <10th or> 90th percentile VITAL SIGNS Temperature.5-33cm (12-13 in) Crown-to-rump length: 31-35cm (12. axillary 36. oscillometric 65/41 mmHg in than Arm and calf Oscillometric systolic pressure in calf 6-9 mmHg less in upper extremity (sign of coarctation aorta) .9°-98°F) Heart rate. MINOR ABNORMALITIES POTENTIAL SIGNS OF DISTRESS MAJOR ABNORMALITIES GENERAL MEASUREMENTS Head circumstance: 33-35 cm (13-14 in) 1in About 2-3cm (1 in) larger than chest circumference Chest circumference 30. rate up to 190 Bpm Crying increasing respiratory rate. apical:120-140 beats/min Crying increasing body temperature slightly Radiant warmer falsely increasing axillary temperature Crying increasing heart rate. regained in 10-14days. sleep decreasing respiratory rate During 1st period of reactivity (6-8hr). rate up to 80 Bpm Crying and activity increasing BP Placing cuff on thigh agitates ionfant Thigh BP higher then arm or calf BP by 4-8mmHg Hypothermia Hypothermia Bradycardia: Resting reate below 80-100 Bpm Tachycardia: Rate above 160-180 Bpm Irregular rhythm Tachypnea: Rate >60 Bpm Apnea: 20 sec or more Respiration 30-60 Bpm Blood pressure (BP).5°-37°C (97.5-14in). sleep decreasing heart rate During 1st period of reactivity (6-8hr). Approximately equal to head circumference Head-to-heel length: 48-53cm (19-21in) Birth Weight: 2700-4000g (6-9 lb) Molding after birth altering head circumference Head and chest circumference equal for first 1-2days after birth Head Circumference <10th or> 90th percentile Loss of 10% of birth weight in first week.SUMMARY OF PHYSICAL ASSESSMENT OF NEWBORN USUAL FINDINGS COMMON VARIATIONS.
smooth 2nd-3rd day. lower half of body becomes pink and upper half is pale. molding after vaginal delivery third sagital (parietal) fontanel bulging fontanel because of crying or coughing caput succedaneum: edema of soft scalp tissue cephalhematoma: hematoma between periosteum and skull bone Limp posture: Extension of Extremities Progressive jaundice especially in first 24hr Generalized cyanosis Pallor Mottling Grayness Plethora Hemorrhage. flasky. which rest On chest and abdomen SKIN At birth. And scrotum or labia Acrocyanosis: Cyanosis of hands and feet Cutis marmorata: Transient mottling when infant is Exposed to decreased temperature Frank breech: Extended legs. Flattened occiput. and abdomenl May appear in 24-48 hr and resolve after several days Erythema toxicum: pink popular rash with vesicles superimposed on thorax. 0. Talengiectatic nevi (stork bite): flat. not suture to suture EYES Lids usually oedematous fused sutures bulging or depressed fontanels when quiet widened sutures and fontanels craniotabes: snapping sensation along lambdoid sutures that resembles indentation of ping-pong ball epicanthal folds in asian infants pink color of iris . abducted and fully rotated thighs. seen predominantly in newborn of African. asian. face. back. buttocks. especially on face Erythema toxicum: Ping popular rash with vesicles superimposed on thorax. ecchymoses. buttocks. native American. feet. or blisters café au lait spot: light brown spots nevus flammeus: port-wine stain HEAD Anterior fontanels: Diamond shape: size varies form barely palpable to 4-5 cm Posterior fontanels: triangular. bright red. pink. soft. Harlequin Color change: clearly outlined color change as infant lies on the side. and abdomen may appear in 24-48 hrs and resolve after several days. Mongolian spots: irregular areas of deep blue pigmentation usually in sacral and gluteal regions. extended neck Neonatal jaundice after first 24hr Ecchymoses or petechiae caused by birth trauma Milia: Distended sebaceous glands that appear as tiny white papules on cheeks. or petechiae that persist Sclereme: Hard and stiff skin Poor skin turgor Rashes. or Hispanic descent. puffy. pustules. dry Vernix caseosa Lanugo Edema around eyes.GENERAL APPEARANCE Posture: Flexion of head and extremities. chin. back. and nose Milaria or sudamina: Distended sweat (eccrine) glands that appear as minute vesicles. dorsa of hands. deep pink localized areas usually seen on back of neck. legs. and firm Widest part of fontanel measured from bone to bone.5-1cm Fontanels flat.
usually at limbus purulent discharge upward slunt in non-asians hypertelorism hypotelorism congenital cataracts constricted or dilated fixed pupil absence of red reflex Absence of papillary or corneal reflex Inability to follow object or bright light to midline Yellow sclera low placement of ears absence of startle reflex in response to loud noise minor abnormalities possible signs of various syndrome especially renal EARS Position: top of pinna on horizontal line with outer canthus of eye Startle reflex elicited by loud. absent or other abnormal nasal teeth: teeth present at bith. dark blue. high-arched palate Uvula in midline Frenulum of tongue Frenum of upper lip Sucking reflex: strong and coordinated Rooting reflex Gag reflex Extrusion reflex Absent or minimum salivation cry Vigorous cry NECK Short. and buccal surfaces Inability to pass nasogastric tube Hoarse. sudden noise Pinna flexible. bloody nasal discharge Flaring of nares (alae nasi) Copious nasal secretions or stuffiness (may be minor) cleft lip cleft palate large. brown Absence of tears Presence of red reflex Corneal reflex in response to touch Pupillary reflex in responsing to light Blink reflex in response to light or touch Rudimentary fixation on objects and ability to follow to midline searching nystagmus or strabismus subconjuctival (sclera) hemorrhage: ruptured capillaries. palate. weak. benign but may be associated with congenital defects Epstein pearls: Small. thick. adherent patches on tongue. usually sorounded by skin folds Tonic neck reflex inability to visualize tympanic membrane because of filled aural canals pinna flag against head Irregular shape or size Pits or skin tag Flattened and bruised Nonpatent canals Thick. cartilage present NOSE Nasal patency Nasal discharge: Thin white mucus Sneezing MOUTH AND THROAT Intact. high-pitched.Color: slate gray. protruding tongue or posterior displacement of tongue profuse salivation or drooling Candidiasis (thrush): white. white epithelial cysts along midline of hard palate Torticollis (wry neck): head held to one side with chin pointing to opposite side Excessive skin folds Resistance to flexion Absence of tonic neck reflex .
8 in) above Umbilical hernia Diastasis recti: Midline gap between recti muscles Wharton jelly: unusual thick umbilical cord . medium.8 in) below right Costal margin Spleen: Tip palpable at end of 1st week of age Kidneys: palpable 1-2 cm (0. or coarse crackles Wheezing Diminished breath sounds Peristaltic bowel sounds on one side. with diminished Sounds on same side Dextrocardia: Heart on right side Displacement of apex. periodic breathing Crackles shortly after birth HEART Apex: 4th-5th intercostals space. muffled Cardiomegaly Abdominal shunts Murmur Thrill Persistent central cyanosis Hyperactive precordium abdominal distention Localized bulging Distended veins Absent bowel sounds Enlarged liver and spleen LUNGS Respirations chiefly abdominal Cough reflex absent at birth.4 to 0.8 to 1.Fractured clavicle. crepitus CHEST Anteroposterior and lateral diameters equal Slight sterna retractions evident during inspiration Xiphoid process evident Breast enlargement Funnel chest (pectus excavatum) Pigeon chest (pectus carinatum) Supernumerary nipples secretion of milky substance from breast (witch’s milk) Depressed sternum Marked retractions of chest and intercostals apaces during respiration Asymmetric chest expansion Redness and firmness around nipples Wide-spaced nipples Inspiratory stridor Expiratory grunt Retractions Persistent irregular breathing Periodic breathing with repeated apneic spells Seesaw respirations (paradoxical) Unequal breath sounds Persistent fine.lateral to left sterna Border S2 slightly sharper and higher in pitch than S1 Sinus arrhythmia: Heart rate increasing with inspiration and decreasing with expiration Transient cyanosis on crying or straining ABDOMEN Cylindric in shape Liver: palpable 2-3 cm (0. present by 1-2 days Bilateral equal bronchial breath sounds Rate and depth of respirations may be irregular.
usually deeply pigmented in dark-skinned ethnic groups Smegma Urination within 24 hours Urethral opening covered by prepuce Inability to retract foreskin Epithelial pearls: Small.Umbilicus Umbilical cord: Bluish white at birth with 2 arteries And vein Femoral pulse: equal bilaterally Ascites Visible peristaltic waves Scaphoid or concave abdomen Moist umbilical cord Presence of only one artery in cord insertion site Periumbilical erythema Palpable bladder distension after scant voiding Absent femoral pulses Cord bleeding or hematoma Omphalocele or gastroschisis:Protrusion of abdominal abdominal wall defect contents FEMALE GENITALIA Labia and clitoris usually edematous Urethral meatus behind clitoris Vernix caseosa between labia Urination within 24 hours. frim. and covered with rugae. edematous. white lesions at tip of prepuce Erection of priapism Testes palpable in inguinal canal Scrotum Hypospadia: urethral opening on ventral surface of penis Epispadias: urethral opening on dorsal surface of penis Chordee: ventral curvature of penis Testes not palpable in scrotum or inguinal canal No urination within 24 hrs Inguinal hernia Hypoplastic scrotum Hydrocele: Fluid in scrotum Masses in scrotum Meconium from scrotum Discoloration of testes Ambiguous genitalia Bladder exstrophy . Pseudomenstruation: Blood-tinged or mucoid discharge Hymenal lag Enlarged clitoris with urethral meatus at tip Fused labia Absence of vaginal opening Meconium from vaginal opening No urination within 24 hours Masses in labia Ambiguous genitalia Bladder exstrophy MALE GENITALIA Urethral opening at tip of glans penis Testes palpable in each scrotum Scrotum usually large. pendulous.
Anal fissures or fistulas Imperforate anus Absence of anal reflex No meconium within 36-48 hrs Pilonidal cyst or sinus Tuft of hair along spine Spina bifida (any degree) Partial syndactyly between 2nd and 3rd toes 2nd toe overlapping into 3rd toe wide gap between 1st (hallux) and 2nd toes Deep crease on plantar surface of foot between 1st and 2nd toes Asymmetric length of toes Dorsiflexion and shortness of hallux Polydactyly: extra digits Syndactyly: fused or webbed digits phocomelia: hands or feet attached close to trunk Hemimelia: Absence of distal part of extremity Hyperflixibility of joints Persistent cyanosis of nail beds Yellowing of nail beds Sole covered with creases Fractures Decrease or absenceusually of range of motion(ROM) Unequal muscle tone or ROM NEUROMUSCULAR SYSTEM Extremities usually in some degrees of flexion Extension of extremity followed by previous position of flexion Head lag while sitting.BACK RECTUM Spine intact. arms and hands tightly flexed. ASSESSMENT OF REFLEXES IN THE NEWBORN . with transient cyanosis immediately After bith Creases on anterior 2/3 of sole Sole usually flat Symmetry of extremities Equal muscle tone bilaterally. but momentary ability to hold head erect Quevering or momentary tremors Hypotonia: Floppy. especially resistance to Opposing flexion Equal bilateral brachial pulses Green liquid stools in infant under phototherapy Dekayed passage of meconium in very-low-birth weight neonates. legs stiffly extended. twitches and myclonic jerks Marked head lag in all positions. masses. poor head control. extremities limp Hypertonia: Jittery. no opening. or prominent curves Trunk incurvation reflex Anal reflex Patent anal opening Passage of meconium within 48 hrs EXTREMITIES 10 fingers and toes Nail beds pink. startles easily Assymmetric posturing (except tonic neck reflex) Opisthotonic posturing: Arched back Signs of paralysia Tremors.
Touching or stroking cheek along side of mouth causes infant to turn head toward that side and begin to suck. should disappear at about age 3-4 months but may persist for up to 12 months. Nasal passages respond spontaneously to irritation or obstruction. persists throughout life. Pupil constricts when bright light shines toward it. persists throughout life. disappears as fixation develops. palmar grasp lessens after age 3 months to be replaced by voluntary movement. Infant begins strong sucking movements of circumoral area in response to stimulation. indicates neurologic damage. even without stimulation. persists throughout life. When tongue is touched or depresses. or passage of tube causes infant to gag. infant responds by forcing it outward. Tapping briskly on glabella (bridge of nose) causes eyes to close tightly. plantar grasp lessens by 8 months of age. if persists. usually present after 1st day of birth. As head is moved slowly to right or left. Irritation of mucus membranes of larynx or tracheobronchial tree causes coughing. eyes lag behind and do not immediately adjust to new position of head. such as during sleep.REFLEXES LOCALILZED Eyes Blinking or corneal reflex Pupillary Doll’s eye Nose Sneeze Glabellar Mouth and Throat Sucking Gag Rooting Extrusion Yawn Cough EXETREMITIES Grasp EXPECTED BEHAVIORIAL RESPONSES Infant blinks at sudden appearance of bright light or at approach of object toward cornea. disappears by age 4 months. persists throughout life. Touching palms or soles near base of digits causes flexion of hands and toes. suction. persists throughout life. . Infant has spontaneous response to decreased oxygen by increasing amount of inspired air. Stimulation of posterior pharynx by food. persists throughout infancy. persists throughout life.
eventually no beats should be felt. Sudden jarring or change in equilibrium causes sudden extension and abduction of extremities and fanning of fingers. Placing When infant is held upright under arms and dorsal side of foot is briskly placed against hard object. leg lifts as if foot is stepping on table. Startle Perez Asymmetric tonic neck When infant’s head is turned to one side. infant responds by crying. disappears by age 4 months. ANATOMY AND PHYSIOLOGY . legs may weakly flex. and opposite arm and leg flex. infant makes crawling movements with arms and legs. followed by flexion and adduction of extremities. to be replaced by deliberate movement. age of disappearance varies. stimulating walking. disappears after age 3-4 weeks. disappears after age 1 year. to be replaced by symmetric positioning of both side of body. Sudden loud noise causes abduction of arms with flexion of elbows. defecation and urination may occur. usually strongest during first 2 months. infant may cry. flexing extremities. lordosis of spine. and elevating pelvis and head. Crawl When place on abdomen. Briskly dorsiflexing foot while supporting knee in partially flexed position results in 1-2 oscillating movements (“beats”). hands remained clenched. Trunk incurvation (Galant) reflex Striking infant’s back alongside spine cause hips to move toward stimulated side. Dance or step If infant is held so that sole of foot touches hard surface. such as table. disappears after age 3-4 months. there us reciprocal flexion and extension of leg.Babinski Ankle clonus MASS Moro Stroking outer sole of foot upward from heel and across ball of foot causes toes to hyperextend and hallux to dorsiflex. disappears by age 4-6 months. disappears by age 3-4 months. disappears at about age 6 weeks. disappears by age 4 weeks. arm and leg extend on that side. While infant is prone on firm surface and thumb is pressed along spine from sacrum to neck. with index finger and thumb forming a C shape.
and Increasing Acidosis First Breath Decreased Pulmonary Artery pressure Increased PO2 Closer of Foramen Ovale (pressure in the left side of hearth greater than in right side) Closure of Ductus Arteriosus Closure of Ductus Venosus and Umbilical arteries and Vein due to decreased flow . decreased PO2.CIRCULATORY Drying and Clamping of the Umbilical cord and stimulation of cold receptors. Increased PCO2.
the newborn’s mechanism for producing heat. 300 ml. 2nd. the newborn’s thin layer of subcutaneous fat.) Radiation Is the transfer of body heat to a cooler solid object not in contact with a baby. 1st. the newborn’s large surface are relative to his or her weight facilitates heat loss to the environment. after birth total blood volume. such as a cold window or air conditioner. Mechanism of Heat loss a. . blood volume of the full-term infant. d.THERMOREGULATION Is a process of maintaining balance between heat loss and heat production. b.) Evaporation Is the loss of heat through conversion of a liquid to a vapor. HEMOPOEITIC SYSTEM 80 – 85 ml/kg.) Conduction Is the transfer of body heat to a cooler solid object in contact with a baby.) Convection Is the flow of the heat from the newborn’s body surface to cooler surrounding air. 3rd. c.
affecting the conjugation of bilirubin with glucuronic acid. The liver is the most immature of the gastrointestinal organs. CHANGE IN STOOLING PATTERNS OF NEWBORNS MECONIUM . GASTROINTESTINAL SYSTEM: The newborn’s ability to digest. which may be prevented by early and effective feeding. Salivary glands are functioning at birth. The activity of the enzyme glucuronyl transferase is reduced. Newborns who breast-feed usually have more frequent feedings and more frequent stools than infants who receive formula. especially breast-feeding. and metabolize food is adequate but limited in certain functions. especially with ingestion of foods that have high saturated fatty acid content. The liver stores less glycogen at birth glycemia. Extracellular fluid volume. The liver is also deficient in forming plasma proteins. but deficient production of pancreatic amylase impairs utilization of complex carbohydrates (polysaccharides).4 kg]). absorb. Human milk. such as cow’s milk. which likely plays a role in the edema usually seen at birth. which assist in digestion. Prothrombin and other coagulation factors are also law. which contributes to physiologic jaundice of the newborn. but the majority do not begin to secrete saliva until about 2 to 3 months. Enzymes are available to catalyze proteins and simple carbohydrates (monosaccharides and disaccharides). The stomach capacity is limited to about 90 ml I in an average-sized full-term infant(7. when drooling is common. despite it’s high fat content. A deficiency of pancreatic lipase limits the absorption of fats. Intracellular fluid volume. is easily digested and absorbed because it contains enzymes such as lipase.5 pounds [3.FLUID AND ELECTROLYTES Changes occur in the total body water volume. thus the infant requires frequent small feedings.
the epidermis and dermis. composed of amniotic fluid and it’s constituents. Total volume of urinary output per 24 hours is about 200 to 300 ml by the end of the first week. intestinal secretions. MILK STOOLS o These usually appear by fourth day. o In formula-fed infants stools are pale yellow to light brown. they are greenish brown to yellowish brown. RENAL SYSTEM: • • • • All structural components are present in the renal system. The bladder involuntarily empties when stretched by a volume of 15 ml. which later in life anchor the epidermis to the dermis.o This is the infant’s first stool. resulting in as many as 20 voidings per day. such as from rapid removal of tape. Rete pegs.020. and have an odor similar to that of sour milk. such as dehydration or a concentrated solute load. although it may be delayed up to 10 days in very-low-birth-weight infants. are firmer in consistency. are not developed. but the kidney has a functional deficiency in it’s ability to concentrate urine and to cope with fluid and electrolyte fluctuations. but many of the functions of the integument are immature. The first voiding should occur within 24 hours. are pasty in consistency. The two layers of the skin. INTEGUMENTARY SYSTEM: At birth all structures within the skin are present. are loosely bound to each other and are very thin. shed mucosal cells. and possibly blood. Slight friction across the epidermis. can cause separation of these layers and blister formation or loss of the epidermis. . The urine is colorless and odorless and has a specific gravity of approximately 1. thin. o In breast-fed infants stools are yellow to golden. TRANSITIONAL STOOLS o These usually appear by the third day after initiation of feeding. and less sticky than meconuim and may contain some milk curds. and have a more offensive odor. o Passage of meconium should occur within the first 24 to 48 hours.
The six skull bones are relatively soft and not yet joined. the newborn’s endocrine system is adequately developed. but its functions are immature. which inhibits dieresis. The effect of maternal sex hormones is particularly evident in the newborn. Female newborns may have pseudo menstruation (more often seen as a milky secretion rather than actual blood) from a sudden drop in progesterone and estrogen levels. and the retention of sweat may result in milia. ENDOCRINE SYSTEM Ordinarily. although the process of ossification is fairly rapid during the first year. The eccrine glands produce sweat in response to higher temperatures than those required in adults. For example. and the genitalia and produced the grayish white. This renders the newborn highly susceptible to dehydration. Observing palmar sweating is helpful in assessing pain. infants are more susceptible to the harmful effects of ultraviolet light such as the sun. Growth in the size of muscular tissue is caused by hypertrophy. . are functional at birth. MUSCULOSKELETAL SYSTEM At birth the skeletal system contains larger amounts of cartilage than ossified bone. face. rather than hyperplasia. sweat glands that develop as attachments to hair follicles. and the breasts in both sexes may be engorged and secrete milk (witch’s milk) during the first few days of life to as long as 2 months of age. During the first few months the synchrony between hair loss and re-growth is disrupted. The nose. The growth phases of hair follicles usually occur simultaneously at birth. The labia are hypertrophied. Unlike the skeletal system. The apocrine glands. is predominantly cartilage at birth and is frequently by the force of delivery. and there may be over-growth of hair or temporary alopecia The amount of melanin is low at birth. In full-term infants the transitional zone between the cornified and living layers of epidermis is effective in preventing fluid from reaching the skin surface. or vasopressin. remain small and non-functional until puberty. for example. The sebaceous glands are active late in fetal life and in early infancy because of high levels of maternal androgens. of cells. Consequently. They are most densely located on the scalp. greasy vernix caseosa that covers the infant at birth. The sinuses are incompletely formed as well. the posterior lobe of the pituitary gland produces limited quantities of antidiuretic hormone. newborns are lighter skinned than they will be as children. and by 3 weeks of age palmar sweating on crying reaches levels equivalent to those of anxious adults. the muscular system is almost completely formed at birth. which produce sweat in response to heat or emotional stimuli. The eccrine glands.
fluid is squeezed from the lungs through the nose and mouth. Low oxygen 2. Most neurologic functions are primitive reflexes. Chemical factors: 1.RESPIRATORY SYSTEM The most critical and immediate physiologic change required of the newborn is the onset of breathing. Descent through the birth canal and normal handling during delivery such as drying the skin. Acceptable methods of tactile stimulation include slapping or flicking the soles of the feet or gently rubbing the newborn’s back. help stimulate respiration in uncompromised infants. This abrupt change in the temperature excites sensory impulses in the skin that are transmitted to the respiratory center. and extrapyramidal. brisk recoil of the thorax occurs. As the chest emerges from the birth canal. The initial entry of air into the lungs is opposed by the surface tension of the fluid that filled the fetal lungs and alveoli. Myelination of the nervous system follows the cephalocaudal-proximodistala (head-to-toe-center-to-periphery) laws of development and is closely related to the observed mastery of fine and gross motor skills. High carbon dioxide 3. This accounts for the acute . Myelin is necessary for rapid and efficient transmission of some. In the alveoli. Tactile stimulation may assist in initiating respiration. NEUROLOGIC SYSTEM At birth. Tracts that develop myelin earliest are the sensory. After complete emergence of the neonate’s chest. the fluid’s surface tension is reduced by surfactant. trunk or extremities. Low pH The primary thermal stimulus is the sudden chilling if the infant. The autonomic nervous system is crucial during transition because it stimulates initial respirations helps maintain acidbase balance. Slapping the newborn’s buttocks or back is a harmful technique and should not be done. and partially regulates temperature control. who leaves a warm environment and enters a relatively cooler atmosphere. cerebellar. Air enters the upper airway to replace the lost fluid. The stimuli that help initiate respiration are primarily chemical and thermal. a substance produced by the alveolar epithelium that coats the alveolar surface. nervous system is immature and incomplete integrated but there is a sufficient development to sustain extrauterine life. Some fetal lung fluid is removed during the normal forces of labor and delivery. but not all nerve impulses along the neural pathway.
Visual acuity is reported to be between 20/100 and 20/400. • Vision. SENSORY FUNCTIONS The newborn’s sensory functions are remarkably well developed and have a significant effect on groth and development. black-and-white contrasting patterns. In fact. especially geometric shapes and checkerboards. Smell Newborns react to strong odors such as alcohol or vinegar by turning their heads away. limiting the eyes’ ability to accommodate and fixate on an object for any length of time. complex objects. the eye is structurally incomplete. All cranial nerves are myelinated except the optic and olfactory nerves. The newborn has the ability to momentarily fixate on a bright moving object that is within 20 cm (8 inches) and in the midline of the visual field. and reflecting objects over dull ones. large objects with medium complexity rather than small. Hearing Once the amniotic fluid has drained from the ears. The newborn is able to detect a loud sound of about 90 dB and reacts with a startle reflex. and the corneal reflex is activated by a light touch. metronome. such as heartbeat. whereas the latter elicits an alerting reaction. tends to decrease an infant’s motor activity and crying.senses of taste. Tear glands usually do not begin to function until 2-4 weeks of age. including attachment process. smell. Breast-fed infants are able to smell breast milk and will cry for their mothers when the breasts are leaking. Taste • • • . The newborn’s response to sounds of low frequency and high frequency differs the former. Infants are also able to differentiate their mother’s breast milk from that of other women by smell. the infant’s ability to fixate or coordinate movement is greater during the first hour of life than during the succeeding several days. or lullaby. depending on the vision measurement techniques. as well as the perception of pain. The ciliary muscles are also immature. The infant also demonstrates visual preferences: medium colors over dim or bright colors. the blink reflex is responsive to minimum stimulus. and hearing. The fovea centralis is not yet completely differentiated from the macula. the infant probably has auditory acuity similar to that of an adult. Maternal odors are belived to influence the attachment process and successful breast-feeding. Unnecessary routine washing of the breasts may interfere with establishment of early breast-feeding. in the newborn. The pupils react to light. At birth.
D. a sour solution causes the usual puckering of the lipsl and a bitter liquid produces an angry. hands. E. Once the regular breast milk starts to flow. By drinking breast milk. the first thing secreted from the breasts is actually the colostrum. Over time. elicit an upset response. It is a thick. IMMUNE SYSTEM • At the time of birth. the newborns must receive further immune system help via the breast milk. the colostrum is packed with antibodies to give the newborn a first package of other. although the face. painful stimuli. Now. upset expression. adaptive immunoglobulin types. In fact. Thus. babies receive doses of immunoglobulins A. babies still have the high amount of IgG in their bloodstream. its immunity is not yet strong enough to protect it from harm. the newborn's germ-fighting system begins making its own antibodies when the child is 2-3 months old. yet their overall immunity to germs is still not completely developed. and soles of the feet seem to be most sensitive. When a child is newly born. this does not mean that the immunoglobulin doesn't fight germs-it just means that the mother has transferred active immunity to her child ("passed" it on). The production of antibodies does not reach a normal adult rate until the baby is about six months of age. a sweet solution elicits an eager suck and a look of satisfaction. such as pinprick. Sufficient evidence now shows that touch and motion are essential components in the attachment process and in normal growth and development. Additionally. • Touch The newborn perceives tactile sensation in any part of the body. However.The newborn can distinguish between tastes. and more IgG. • • • . doctors and hospitals should be very careful with allowing newborns to come into contact with things that can cause possible birth infections. the mother gives less and less immunity to the baby via the breast milk. Gentle patting of the back or rubbing of the abdomen usually elicits a calming response from the infant. This is called passive immunity. A tasteless solution elicits no facial expression. and various types of solutions elicit differing facial reflexes. M. it also contains necessary immune system components. However. carbohydrate-rich substance that is easier for a baby to digest. Newborns prefer the sweet taste of glucose and water to sterile water. However.
position the infant to facilitate drainage of secretions. Suctioning. • • MAINTAIN A STABLE BODY TEMPERATURE • Conserving the newborn’s body heat is an essential nursing goal. Loss of heat through radiation increases as these solid objects become colder and closer to the infant. because even when the temperature of the ambient air is optimum. This is a critical point to remember when attempting to maintain a constant temperature for the infant. Use of the proper –sized catheter and correct suctioning technique is essential to prevent mucosal damage and edema. Another source of heat loss is radiation. Used bulb syringe should be replaced every 24 hours in the hospital and boiled for 10 minutes after use in the home to prevent bacterial contamination. the loss of heat through moisture. When the newborn is supine. The amniotic fluid that bathes the infant’s skin favors evaporation. especially when combined with the cool atmosphere of the delivery room. Heat loss through evaporation is minimized by rapidly drying the skin and hair with a warmed towel and placing the infant in a heated environment. If nasal suctioning is necessary. The temperature of ambient air in the incubator essentially has no effect on loss of heat through radiation. if needed. may be done with a bulb syringe. • . Gentle suctioning is necessary to prevent laryngospasm. Vital signs are closely monitored. The stomach may be emptied to remove amniotic fluid. At birth a major cause of heat loss is evaporation. and any indication of respiratory distress is immediately reported. the infant can become hypothermic. the loss of heat to cooler solid objects in the environment that are not in direct contact with the infant. a neutral neck position (avoiding neck flexion or hyperextension) is critical to achieving and maintaining a patent airway. After feeding. it must be done after oral suctioning to minimize the possibility of aspiration of oropharyngeal contents. reflex bradycardia and other cardiac arrythmias from vagal stimulation.NURSING PRINCIPLES MAINTAIN A PATENT AIRWAY • • Establishing a patent airway is the primary objective in the delivery room. passing a catheter to the stomach may also rule out esophageal atresia.
5%) ophthalmic ointment or drops. vitamin k is administered as a single intramuscular dose of 0.• • • An example of radiant heat loss is the placement of the incubator close to a close window or air conditioning unit.5 to 1 mg to prevent hemorrhagic disease of the newborn. PROTECTION FROM INFECTION AND INJURY: • EYE CARE (CREDE’S PROPHYLAXIS) Prophylactic eye treatment against opthalmia neonatorum. or (3) tetracydine (1%) ophthalmic ointment or drops (preferably in single-dose ampules or tubes). covered surface rather than directly on a cool hard table and by providing insulation with clothes and blankets. bathing and care of the circumcision. mother’s admission number. Convection is similar to conduction. The cold from either source will cool the incubator walls and subsequently the neonate’s body. vitamin K is synthesized by the intestinal flora. placing the infant in the direct flow of air from a fan or air conditioning vent causes rapid heat loss through convention. Protect from Infection and Injury The most important practice fro preventing cross-infection is thorough hand washing by al individuals involved in the infant’s care. windows or ventilating units. For example. However. except that heat loss is aided by surrounding air currents. is physically beneficial in terms of observing newborn heat and fostering maternal attachment and breastfeeding. Normally. infectious conjunctivitis of the newborn. Heat loss can also occur through conduction ad convection. Other procedures to prevent infection include eye care. the incubator is placed as far as away as possible from walls. sex. because the infant’s intestine is presumably sterile at birth and because breast milk contains . (2) erythromycin (0. • • IDENTIFICATION Proper identification of the newborn is essential. umbilical care. • VITAMIN K ADMINISTRATION Shortly after birth. Transporting the neonate in a crib with solid sides reduces airflow around the infant. The nurse must verify that identifying bands are securely fastened on the newborn and verify the information (name. it is minimized by placing the infant on a padded. To prevent this. Placing the newborn nested close to the mother. includes the use of (1) silver nitrate (1%) solution. date and time of birth) against the birth records and the child’s actual gender. such as in her arms or on her abdomen immediately after delivery in skinto-skin contact(kangaroo care). Conduction involves loss of body heat from direct skin contact with a cooler solid object.
The major function of vitamin K is to catalyze the synthesis of prothrombin in the liver. or list anaphylaxis or at: may inhibit GI anaphylactoid absorption of reactions. Other: mineral oil. • HEPATITIS B VACCINATION To decrease the incidence of hepatitis B virus (HBV) in children and its serious consequences.negative mothers. Side effects & Adverse effects CNS: dizziness CV flushing. Cholestyramine. Monitor patient closely. erythema Drug interaction Anticoagulant: may cause temporary resistance to prothrombindepressing coagulants. . usually oral Vitamin K. DRUG STUDY Brand name General or action Generic name Aquamephat Vitamin K on is used for or the Phytonadion prophylaxi e s and treatment of hemorrha gic disease of the newborn. the first 3 doses of HBV vaccine is recommended between birth and 2 months of age for all newborns born to hepatitis B surface antigen (HBsAg). since this site is associated with a better immune response. cirrhosis ad liver cancer. drug therapy or excessive Vitamin A dosage. The vastus lateralis muscle is the traditionally recommended injection site. in adulthood.low levels of vitamin K. dosage • Prophylax is. • 1 to 2 mg intramusc ular or subcutan eous • • To prevent hypoprothrombinemia related to Vitamin K deficiency in long term parenteral nutrition. Skin: diaphoresis. Route. especially when large doses of phytonadione are used. rapid and weak pulse. The injection is given in the vastus lateralis muscle. Frequency. which is needed for blood clotting. the supply is inadequate for at least the first 3 days to 4 days. transient hypotension after IV administration. treatment for hemorrha gic disease. Hypoprothrobinemia caused by effects of oral coagulant • To prevent hemorrhagic disease of the newborn Mechanism of action An antihemorrhagi c factor that promotes hepatic formation of active coagulation factor.5 to 10 mg IM one time immediat ely after birth. It is a necessary componen t for the productio n of Indication • Hypoprothrombinemia cause by Vitamin K malabsorption.0.
Phytonadione therapy for hemorrhagic disease in infants’ causes fever adverse reactions than other Vitamin K analogues. condition may progress to shock. daily. . use together cautiously.C use. for infants. and restriction.M administration on adults and other children. separate doses if possible. Vitamin K doesn’t reverse the anticoagulant effects of heparin. pain. S. swelling and hematoma in injection site.certain coagulatio n factors (II.C route is preferred to avoid hematoma transition. If severe bleeding occurs. VII.1 mg/L Vitamin K in breast milk or milk substitutes. give in upper outer quadrant of buttocks. For I. weakness. tachycardia and hypotension. Monitor patient or INR to determine dosage effectiveness. give in anterolateral aspect of thigh and deltoid region. If unavailable. IX and X) produced by microorga nism in the intestinal tract. don’t delay after measures such as administration of fresh frozen plasma of whole blood. Check brand name labels for administration.M or S. Anticipate order for wkly addition of 5 to 10 mg of phytonadione to total parenteral nutrition solution. Watch for flushing. after excessively rapid IV administration. route. Nursing considerations: • • • • • • • • • • To prevent hypoprothrombinemia in infants receiving less less than 0. Allergic reactions may also occur after I.
Frequenc y. don’t use in infection of unknown cause. blurred vision itching and burning eyes. Drug is used in neonates born either vaginally or by Caesarian section. • Indication Mechanism of action Inhibit protein synthesis. .5-1 cm in each eye. Use drug only when sensitivities studies show it’s effective against infecting microorganisms. Skin: urticaria. • Chlamydial ophthalmic infection • To prevent opthalmia neonatorum caused by Nesseiria gonorrhea Side effects & Adverse reactions EENT: slowed corneal wound healing. making it the drug of choice for eye prophylaxis at birth.Brand name or Generic name Ilotycin or Erythromycin (ophthalmic ointment) General action Erythromycin. other eye infection. an antibiotic. dermatitis Other: overgrowth of non-susceptible microorganisms with long term use Drug interactio n None significant Route. apply ointment not later than 1 hour after birth. usually bacteriostatic but may be bactericidal in high concentrations or against highly susceptible microorganisms. Store drug at room temperature in tightly closed. Acute and chronic conjunctivitis. light resistant container. is effective against gonorrhea and Chlamydia microorganisms. Nursing considerations: • • • To prevent opthalmia neonatorum. dosage 0. Gently massage eyelids for 1 minute to spread ointment.
05 ml right arm IM.5 ml Thigh (vastus lateralis) Storage temp 2-8 degree celcius in body of ref 2-8 degree celcius in body of ref -15 to -25 degree celcius (freezer) 2-8 degree celcius in body of ref Type/form of vaccine Freeze dried. 0.Newborn screening is ideally done on the 48th hour or at least 24 hours from birth. 8 weeks interval from 2nd to 3rd dose Minimum interval between doses Route. 2 drops Mouth IM. endocrinologic.toxin Live attenuated virus RNA recombinant • NEWBORN SCREENING FOR DISEASE a.Most babies with metabolic disorders look normal at birth. 0. Some disorders are not detected if the test is done earlier than 24 hours. . metabolic and hematologic diseases. b. c.EXPANDED PROGRAM ON IMMUNIZATION (EPI) For the Baby Vaccine BCG DPT OPV Hepa B Minimum age at 1st dose Birth or anytime after birth 6 weeks 6 weeks At birth # of Doses 1 3 3 3 4 weeks 4 weeks 6 weeks interval from 1st dose to 2nd dose. One will never know that the baby has the disorder until the onset of signs and symptoms and more often ill effects are already irreversible. What is newborn screening? -Is the process of testing newborn babies for treatable genetic. When is newborn screening done? . Dosage.killed bacteria T. live attenuated bacteria D. The baby must be screened again after 2 weeks for more accurate results.weakened toxin P. Why is it important to have newborn screening? .5 ml Thigh (vastus lateralis) Oral. 0. Site ID.
j. Congenital Hypothyroidism (CH) CH results from lack or absence of thyroid hormone. A negative screen mean that the result of the test is normal and the baby is not suffering from any of the disorders being screened. The DOH Advisory Committee on Newborn Screening has approved a maximum allowable fee of P50 for the collection of the sample. i. Should there be no specialist in the area. h. Accumulation of excessive galactose in the body can cause many problems. When are newborn screening results available? -Newborn screening results are available within seven working days to three weeks after the NBS Lab receives and tests the samples sent by the institutions. 3. the baby's physical growth will be stunted and she/he may suffer from mental retardation. In case of a positive screen. How much is the fee for newborn screening? -P550.1.Newborn screening is a simple procedure. Babies with this deficiency may have hemolytic anemia resulting from exposure to certain drugs. g. If babies are delivered at home. the sugar present in milk. 5. babies may die within 7-14 days. . Congenital Adrenal Hyperplasia (CAH) CAH is an endocrine disorder that causes severe salt lose.d. The blood is dried for 4 hours and sent to the Newborn Screening Laboratory (NBS Lab). Rural Health Units and Health Centers). foods and chemicals. 2. Where is newborn screening available? . Excessive accumulation of phenylalanine in the body causes brain damage. 4. brain damage and cataracts. babies may be brought to the nearest institution offering newborn screening.Newborn screening is available in participating health institutions (hospitals. BATHING . If the disorder is not detected and hormone replacement is not initiated within (4) weeks. a midwife or medical technologist. How is new born screening done? . If not detected and treated early. What should be done when a baby is tested a positive NBS result? -Babies with positive results should be referred at once to the nearest hospital or specialist for confirmatory testing and further management. e. f. the NBS secretariat office will assist its attending physician. Who will collect the sample for newborn screening? -Newborn screening can be done by a physician. a nurse. Results are released by NBS Lab to the institutions and are released to your attending birth attendants or physicians. Galactosemia (GAL)GAL is a condition in which the body is unable to process galactose. dehydration and abnormally high levels of male sex hormones in both boys and girls. Using the heel prick method. which is essential to growth of the brain and the body. What are the disorders included in the newborn screening package? Define each. lying-ins. Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD Def)G6PD deficiency is a condition where the body lacks the enzyme called G6PD. including liver damage. Phenylketonuria (PKU)PKU is a metabolic disorder in which the body cannot properly use one of the building blocks of protein called phenylalanine. the NBS nurse coordinator will immediately inform the coordinator of the institution where the sample was collected for recall of patients for confirmatory testing. Parents may seek the results from the institutions where samples are collected. a few drops of blood are taken from the baby's heel and blotted on a special absorbent filter card.
nurses should wear gloves when handling the newborn until blood and amniotic fluid are removed by bathing. A diaper is applied after bath and the infant is clothed appropriately to prevent heal loss. care consists of keeping the base clean and dry and observing for any signs of infection. type of delivery. Bathing is usually performed after the vital signs have stabilized. or no treatment (natural healing). alertness and muscular activity. Cleansing should proceed in the cephalocaudal direction. Parents are instructed regarding stump deterioration and proper umbilical care. soap and water. Cord separation time is influenced by a number of factors. although some experts advocate the use of alcohol alone. sterile water.• • • • Bath time is an opportunity for the nurse to accomplish much more than general hygiene. and other perinatal events. especially the temperature. During this time. The bath time provides an opportunity for the nurse to involve the parents in the care of their child. as part of Standard Precautions. The stump deteriorates through the process of dry gangrene. The average cord separation time is 10 to 14 days. Common methods include the use of an antimicrobial agent such as bacitracin or triple dye. Vigorous rubbing to remove vernix is unnecessary and may cause more harm than good. CIRCUMSICION Risks and Benefits of Neonatal Circumcision RISKS (COMPLICATIONS) Hemorrhage • Infection • Dehiscence (separation of approximated edges of skin) • Meatitis (from loss of protective foreskin) • Adhesions • Concealed penis . povidone-iodine. CARE OF THE UMBILICUS • • Because the umbilical stump is an excellent medium for bacterial growth. to teach correct hygiene procedures and to help them learn about their infant’s individual characteristics. The diaper is placed below the cord to avoid irritation and wetness on the site. It takes a few more weeks for the cord base to heal completely after cord separation. Because of the possibility of blood and body fluid contagions. It is an excellent time for observing the infants behavior. state of arousal. various methods of cord care practiced to prevent infection. including type of cord care.
Breastfed babies are constantly exposed to a variety of tastes through their mother's milk. Breastfed children are at less risk for chrohn's disease (also known as granulomatous. and vomiting. and colitis. 3. The World Health Organization of the United Nations makes it clear that the healthiest option for babies is for them to be exclusively breastfed for the first six months and for breastfeeding to be supplemented with solid foods until the age of two. is an inflammatory disease of the intestines that may affect any part of the gastrointestinal tract from mouth to anus) and juvenile diabetes. fats. SIDS (Sudden Infant Death Syndrome) is less common in breastfed babies. 5. breastfed babies are rarely constipated. 7. 4. breastfed babies tend to have less incidence of or less pronounced symptoms of ear infections. and sugars needed for the human infant at various stages of his growth. minerals. allergies. Due to the anti-infective properties of breastmilk. vitamins. ADVANTAGES OF BREASTFEEDING 1. The stools of breastfed babies are mild-smelling. 2. enzymes. Infant milk powder (‘formula’) should be used when medical practitioners recommend it based on the health of the mother.• • • • Urethral fistula Meatal stenosis Pain in unanesthesized infants It should not be performed immediately after delivery because of the neonate’s unstable physiologic status and increased susceptibility to stress BENEFITS • Prevention of penile cancer and posthitis (inflammation of prepuce) • Decreased of incidence of balanitis (inflammation of glans) and possibly. despite the health benefits of doing so. Breast milk is constantly changing in its composition to meet the changing needs of the baby. It has the exact combination of protein. diarrhea. UTI in infants as some STDs in later life • Prevention of complications associated with later circumsicion • Preservation of male’s body image that is consistent with peers PROVIDE OPTIMUM NUTRITION Only 16% of mothers in the Philippines breastfeed their babies. . Due to the digestibility of breastmilk. 6. respiratory illness.
Cramer explore fully the role of body language in attaching parents and infants: "When a mother holds her newborn in a comfortable. IQ levels are an average of 8 points higher in children who were breastfed. the infant lifts his or her head to scan the room. legs adjusting to fit her body. 3. Berry Brazelton and Bertrand G. Give newborn infants no food or drink other than breast milk. Promoting and Supporting Breastfeeding: The Special Role of Maternity Services. 7. a joint WHO/UNICEF statement published by the World Health Organization. Help mothers initiate breastfeeding within half an hour of birth. Drs. unless medically indicated.24 hours a day. Have a written breastfeeding policy that is routinely communicated to all health care staff. 4." John Bowlby writes. For biblio: Protecting.” From the first touch. Adult daughters who were breastfed are at less risk for breast cancer. Children who were breastfed need speech therapy less often than those who were bottle-fed. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants. Ten Steps to Successful Breastfeeding Every facility providing maternity services and care for newborn infants should: 1. Train all health care staff in skills necessary to implement this policy. 6. Show mothers how to breastfeed. 9. 10. and how to maintain lactation even if they should be separated from their infants. a newborn will burrow harder into her neck. 8. All of these responses say to her. Inform all pregnant women about the benefits and management of breastfeeding. parents and children begin to create a bond. Encourage breastfeeding on demand. cuddled position. then settles a soft. Adults who were breastfed have a lower risk for high cholesterol and asthma. An infant's softness and appearance is appealing to parents. T. The bond between mother and child seems to be enhanced with breastfeeding.that is. 12. 10. "It is fortunate for their survival that babies are so designed by nature that they beguile and enslave mothers. 5. In "The Nature of the Child's Tie to His Mother. allow mothers and infants to remain together . the infant molds into her body. As she automatically pulls the infant to her. molding his or her body against hers.8. In their book The Earliest Relationship. 2. 9. On her shoulder. fuzzy scalp into the crook of her neck. They also seem to have better overall dental health than formula-fed children. PROMOTE INFANT-PARENT BONDING (ATTACHEMENT) • • • An infant comes into the world with certain abilities which will encourage his attachment to his parents. Children who were breastfed are less likely to need orthodontic work such as braces due to the unique sucking action required with breastfeeding. 11. Practice rooming-in . 'You are doing .
Instruction for infant care is a combined responsibility of the medical and nursing staffs. teach the parent infant feeding technique 1. prevent and due exposure. wash trunk and extremities quickly to avoid chilling the infant 6. place infant on right side or abdomen following feeding. 24°-31°C (75°-88°F). wash the infants head using the gentle circular motion. Provide ample opportunity for parent contact. Written formula with instructions for preparation is provided to parents. inspect umbilical cord. bath water.room temperature. never leave the infant alone 2.safer position should be regurgitate B. Eyes are wiped from inside corner outward 4. formula should be at room temperature for feeding 4.7°C (98°-100°F) 3. bubble the infant (upright position) following feeding and during feeding if he appears to be getting air with the feeding 6. A drying agent such as 70% alcohol is applied several times daily. 36. 7. teach the parent infant bathing technique 1.6°-37. Finding it the newborn's face brightens as if to say. use a mild soap 5. face and outer ear. do not prop the bottle. leaking of milk into infants ear can results in infection 5. as if to say. preparation of formula and infant feeding. the baby turns to her voice and looks for her face. hold and talk to the infant while feeding 3. Checked area for bleeding or foul odor. cleanse genital area of male infant a. The first step is recognizing individual differences and explaining to parents that such characteristics are normal."' Nurses can positively influence the attachment of parent and child. Parent teaching A. 'I know you already and you are important to me. Instruction is given concerning infant bathing and care.• the right thing. retract foreskin gently for cleansing . Dressings are not usually used. Discharge Planning for Newborn Preparation for home care. 'There you are!' A newborn will choose a female voice over a male. use cotton balls or soft disposable wash cloths to wipe eyes. allow the infant to feed on demand 2. Early attachment results in improved parent-child relationship.' If she leans down to speak in one ear.
Observe for bleeding. teach the parents to the infant’s temperature take axillary temperature by placing thermometer in axilla and pressing the infants arm gently but firmly against it for 3 minutes. irritability.Adequate latch-on demonstrated for breast-feeding newborn. ways in which environmental changes. teach the parents to recognize reportable signs and symptoms 1. pallor or cyanosis 2. response to soothing attempts 4. sleeping pattern 2. no evidence of jaundice in first 24 hours . separate labia c. successfully feeding at least 1 to 2 ounces of formula every 3 to 4 hours with minimal spitting or absence of vomiting Elimination. E. Diarrhea 3. tone of voice and approaches to soothing may enhance the infants responses D. change after voiding.Voiding every 4 to 6 hours or more often.Evidence of voiding.Pink centrally and buccal mucosa moist. response to environmental stimuli 3. use wet cotton ball b. stool.keep area clean. Position the infant and diaper to avoid friction. no bleeding circumcision (does not require pressure) Color.one stool passed in first 24 to 48 hours Circumcision. discuss with the parents the infant’s behavioural responses 1. Place sterile petrolatum gauze over area for 1st 24 hours.b. fever. circumcision care. abnormal respiration 4. or hypothermia Early Newborn Discharge Checklist Feeding. cleanse genital area of female a. anorexia. lethargy. vomiting. wipe from front to back and discard cotton ball C. 8.
Pink to ruddy when cry8ing. ABO/Rh problem suspected). no apnea Activity.stable heart rate. voiding as above.Successful latch-on and feeding every 1. decreased activity.Cord.heart rate 120-140 beats/minute at rest. poor feeding. drying.physiologic jaundice (not appearing in 1st 24 hours). granting. yellow exudate forming nonbleeding. no drainage. or nasal flurring. Cord. Jaundice. or two to three per day (breast-feeding) Color. respiratory rate 30-55 at rest without evidence of sternal retractions.Successfully. temperature 36. Position of sleep.kept above diaper line. taking at least 1 to 2 ounces every 3 to 4 hours Circumcision. periumbilical area nonerythematous. pink centrally when at rest or asleep Activity.3 to 37 degrees Celsius axillary.5 to 3 hours daily Formula feeding. respiratory rate and temperature for at least 8 to 12 hours.At least one every 48-72 hours(bottle-feeding). Plastibell intact 48 hours Stools. and stooling as noted above or practitioner notification for suspicion of pathologic jaundice (appears within 24 hours of birth.6 to 10 per day Breast-feeding.Cleansing/antibacterial agent applied per unit protocol Vital signs.has four to five wakefull period per day and alerts to environmental sounds and voices. moves all extremities Home visit/primary practitioner visit. Vital signs.Wakeful periods before feedings.back .Appointment made within 2 to 3 days after discharge Newborn Home Care After Early Discharge Wet diapers. feeding. voiding.Wash with warm water only. dark orange skin color persisiting 5th day in light-skinned newborn.
*Instruct the mother not to give pacifiers to breast-feeding infants. *Stress to parents the importance of Newborn Screening. *Encourage mother that the infant must have a complete immunizations as prevention. *Instruct the mother not to give food or drink other than breast milk. Use soap and water with the baby lying in the bassinet. Stress also the benefits of breastfeeding. Rest Diet Follow-up Check-ups . To provide basic knowledge regarding the importance of newborn care. *Teach the mother to wash the infant’s hair daily with the bath. Materials needed: Visual aids General Health Teachings Hygiene Specific Health Teachings *Teach the mother that bathing should proceed from the cleanest to the most soiled areas. 3. To promote sense of independence to the mother regarding in fulfilling the needs for her baby. 2. To provide information to the mother regarding the specific nutritional diet necessary for the infant.HEALTH EDUCATION PLAN (HEP) Objectives: 1. *Encourage the mother to breastfeed the infant. *Stress to parents that a newborn should be positioned on the back for sleep to prevent Sudden infant death syndrome. to promote mother and child bonding.
. non-time bound. As a result. and vitamin K administration. The DOH has also recently launched the Essential Newborn Care (ENC) Protocol.7. skin-toskin contact followed by cord clamping. DOH data has shown that 50 percent of neonatal deaths occur during the first two days of life. routine separation of newborns for observation. weighing and washing. complications of prematurity (30%) and severe infection (19%). Unnecessary procedures include routine suctioning.Reference: * Maternal and Child Health Nursing: Care of the Childbearing and Childbearing Family by Pillitteri PROGNOSIS: First. Non-time bound interventions include immunizations. include immediate drying. which aims to reduce neonatal deaths. and foot printing. The top three causes include birth asphyxia (31%). or unnecessary. The protocol classifies procedures as time bound. Time-bound interventions. which should be routinely performed first. administration of glucose water or formula. or deaths of infants within the first 28 days of life. the good news: infant and child mortality rates have decreased dramatically over the past two decades. The protocol will guide health workers and medical practitioners in providing evidence-based essential newborn care. there is a high probability of meeting the goal of reducing infant and child mortality to 19 and 26. and breastfeeding initiation. no separation of newborn from mother. by 2015 according to the Philippines Midterm Progress Report on the Millennium Development Goals (MDGs). eye care. respectively.
Statistics at a glance of the Philippines’ Progress based on the MDG indicators. . Maternal and Child Health Nursing 5th ed Vol 1. Newborn and Women’s Health Nursing. National Statistical Coordination Board. Scott. 2005-19. Number of newborn deaths to drop soon --. Philippines: Lippincott Williams and Williams. Vulnerability and Family Size: Evidence from the Philippines.gov.DOH Press Release. Ltd. Philippines: Lippincott Williams and Williams. nscb. Available: http://portal. Electronic sources: Department of Health.asp.ph/econreports_dbs/MDGs/midterm/01-96%20UNDP_final. Philippines Midterm Progress Report on the Millenium Development Goals. 2009. (2007).neda. Wong’s Nursing Care of Infants and Children 8th ed Vol 1. Philippines: Community Health Nursing Section. Pillitteri. S. Integrated management of Childhood Illness. (2007). Nursing Drug Guide.pdf. PIDS Discussion Paper SERIES NO. (2007). (as of October 2009).. Hockenberry/Wilson. Available: http://www. (2008). Philippines: Lippincott Williams and Williams. December 7. Karch. (2005). et al. Community Health Nursing Services in the Philippines 9th ed. J.doh. Reyala. Nurse’s Pocket Guide 11th ed. et al. Poverty. (2007). A. Essentials of Maternity. (2000). MDGWatch. (2009). Orbeta AC.ph. M. Taiwan: iGroup Press Co.gov.BIBLIOGRAPHY Books: Doenges. Philippines: Elsevier. A. Available: http://www. NEDA-UNDP.ph/stats/mdg/mdg_watch.gov.
Available:http://apps.jsp?countries=[Location].Members. neonataldeaths in RP. 2010. United Nations Population Fund. (2009).pia.org/public/News/pid/2452 World Health Organization Statistical Information System..gov. Philippines. Accessed on January 16. Available: http://www.ph/? m=12&r=&y=&mo=&fi=p090918. .htm&no=59.unfpa..int/whosis/data/Search.who. (2009). Available: http://www. DOH.Philippine Information Agency.Detailed database search. Philippines: Maternal Mortality Rates Not Making Sufficient Progress to Meet MDGs. global partners move to reduce maternal.
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