Professional Documents
Culture Documents
• The process of taking in and utilizing food substances to generate energy and supply materials used in
body processes.
Oxygenation
• Provision of oxygen, through gas exchange, to all cells and tissues of the body.
Protection
• That which prevents the body from suffering harm or injury; mechanisms of protection include skin
integrity, the immune system and the inflammatory response.
Perfusion
• A normal physiological process that requires the heart to generate sufficient cardiac output to transport
blood through patent blood vessels for distribution in the tissues throughout the body. Tissue perfusion
refers to the flow of blood through the arteries and capillaries, delivering nutrients and oxygen to cells, and
removing cellular waste products.
CONCEPTS
ENCOURAGE FAMILY CARE AND BONDING
Period of decreased
responsiveness
• 1-2 hours
Second period of
reactivity
• 10 minutes to several hours
A After the 2nd Apgar Score, at
5 minutes post delivery
WHEN
WOULD BE B Immediately after delivery,
A GOOD before the cord is cut
TIME TO
INITIATE C After the mother has
BREAST recovered, at 3 hours post
FEEDING? delivery
D After the neonate has
received Vitamin K, at 2 hours
post delivery
ADJUSTMENT TO EXTRAUTERINE LIFE
RESPIRATORY SYSTEM
CIRCULATORY SYSTEM
Breathing leads to
closure of foramen Murmurs common Clamping of the
Acrocyanosis
ovale cord
subsequent
increases in arterial
pressure cord clamping
• closure of the ductus
arteriosus and ductus
venosus
blood volume
THERMOGENIC REGULATION
Convection
Air
Radiation
Surface within close proximity
Evaporation
Liquid to vapor
Conduction
Surface to surface
WHY DO NEWBORNS LOOSE HEAT QUICKLY?
Neonates have an
immature central
nervous system
Nursing Care
Special Considerations Related to Gestational
Age
Preterm
Late preterm
Term
Postterm
WEIGHT
Vernix caseosa
Posture
VITAL SIGNS
Heart Rate
120-160
http://newborns.stanford.edu/PhotoGallery/HeartNL1.html
Temperature
36.5-37.2C
Respiratory Rate
30-60
http://newborns.stanford.edu/PhotoGallery/RespNL1.html
Blood pressure
50-75/30-45
Pain scale
I&O
MILIA
Blocked sebaceous
glands
No clinical significance
ERYTHEMA TOXICUM
Rash of no known
cause appearing within
48 hours of birth
Resolves spontaneously
MONGOLIAN SPOT
Primarily in nonwhite
Stork bite
Natural deposit of
pigmentation
Easily blanchable
Reddish, flat,
discoloration of the
face or neck
PETECHIAE
Molding
Anterior and
posterior fontanels
Circumference
CEPHALOHEMATOMA
Edema of the
scalp
Crosses suture
lines
FACE
Round with symmetrical
movement
Ear pinna in line with
eyes
Mouth and tongue
midline, appropriate
size
Palate
Epstein pearls
Teeth
CHEST
Barrel shaped
Symmetric
Smaller than head
Clavicles
Nipples
ABDOMEN
Protrudes
Bowel sounds
Three vessel cord
2 arteries, 1 vein
GENITALS
Male
Penis straight with urethral
opening at end
Testes palpable in scrotum
Female
May have vaginal
discharge
Labia, urethra, clitoris
Pseudomenses
Brick Urine
OUTPUT
Meconium passage
within 24-48 hours
Transitional Stool
Milk stool
Void
Pseudomenses
Brick Urine
EXTREMITIES
Symmetry
Creases on palm (3)
Simian Crease
Spine is straight, midline
Sacral dimple or tuft of
hair
Ortalani maneuver
Digits
NEUROLOGICAL ASSESSMENT
Rooting
Sucking
Tonic neck
Watch
Stepping
Babinski
Grasp
Moro
COMMON PROCEDURES/ INTERVENTIONS
Immunizations
Hepatitis B
Consent
Procedure
Circumcision
Consent
Procedure
Post procedural assessment
Parental education
Laboratory and Diagnostic Testing
Universal newborn screening
Newborn hearing screening
Glucose screening
Normal range Hypoglycemia Risk factors Symptoms Nursing Care
BLOOD GLUCOSE
PRIORITIZING NURSING CARE
NUTRITION FOR THE
NEONATE
• Breast Feeding
• Formula Feeding
SUCCESSFUL BREAST FEEDING
Prevent infection
Clean bottles and nipples, store and discard of
excess formula as directed
Feeding every 3-4 hours
Average infant takes 15-30ml per feeding first
day or two and increases to 2-3 oz over 2 weeks
No Bottle Propping
Mixing Formulas according to manufacturer
BPA Free Bottles
Acquired disorders
Congenital disorders
Typically occur at, or
soon after, birth Present at birth; usually due to some
type of malformation occurring
during the antepartal period
May result from problems
or conditions experienced
by the woman during her Typically involve some problem
pregnancy or at birth with inheritance
There may be no
Majority have a complex etiology
identifiable cause for the
disorder
CONGENITAL CONDITIONS OF THE
NEWBORN
Congenital heart disease
ACQUIRED
CONDITIONS OF THE
NEWBORN
TRANSIENT TACHYPNEA
• Respiratory distress within 24 hours of
delivery that resolves within 48 hours
• Manifestations
• Grunting on exhalation
• Listen
• Nasal Flaring
• Intercostal Retractions
• Hypotonia
• RR apnea or >60
• Listen
• Cyanosis
RESPIRATORY DISTRESS SYNDROME
Breathing disorder
Leads to increased
caused by lack of Manifestations Risk factors
work of breathing
alveolar surfactant
• LS ratio isn’t 2:1 until • Use of accessory • Grunting • Prematurity
35-36 weeks gestation muscles • Flaring
• Retractions
• Apnea or Increased
respiratory rate
• Cyanosis
FACTORS PLACING THE NEWBORN AT
RISK FOR BIRTH INJURY
Pathophysiology
Clinical Manifestations
Diagnostic Evaluations
NECROTIZING ENTEROCOLITIS
(NEC)
Description
Pathophysiology
Clinical Manifestations
Diagnostic Evaluations
W = Wakefulness
I = Irritability
T = Temperature variation, tachycardia, tremors
H = Hyperactivity, high-pitched cry, hyperreflexia, hypertonus
D = Diarrhea, diaphoresis, disorganized suck
R = Respiratory distress, rub marks, rhinorrhea
A = Apneic attacks, autonomic dysfunction
W = Weight loss or failure to gain weight
A = Alkalosis (respiratory)
L = Lacrimation
http://newborns.stanford.edu/PhotoGallery/Jittery3.html
HYPERBILIRUBINEMIA
• Abnormally high level of unconjugated
bilirubin in the blood
• Jaundice develops from the deposit of
bilirubin in tissue
• Moves from top to bottom, inner to
outer
• Total serum bilirubin level rises
approximately 5mg/dl per day
• Coombs Test
• Measurement of antibodies on
RBC’s
Fetal circulation less efficient at oxygen exchange
HYPERBILIRUBINEMIA
PHYSIOLOGICAL PATHOLOGICAL
JAUNDICE JAUNDICE
Encourage frequent
feedings
Monitor stools
Obtain bilirubin levels
per protocol
Possible phototherapy
Blood transfusions may
be necessary for
pathological jaundice
SEPSIS
Risk Factors
GBS Positive
Prolonged rupture of membranes
TEACHING
NEVER STOP ASKING QUESTIONS