newborn

Preventing Transmission of Infection- before 1st bath

Do not handle a newborn without gloves until after the bath.

Preventing Infection- agents used

0.5% erythromycin in 1st hour

Composition of Breast Milk

3 to 5 days after birth

Nutritional Needs of the Woman Who Breastfeeds

300 to 500 kcal/day, plenty of fluids

Disadvantages- contraindications for breast-feeding

Active untreated tuberculosis Human immunodeficiency virus infection

Returning to Work or School- exclusively breastfeed

After 6 weeks, if she has established a good milk supply and the newborn is nursing well, she should introduce one feeding per day of expressed breast milk

Down Syndrome- Clinical Manifestations

Brachycephaly, Upward and outward slanted eyes, Short, flattened bridge of the nose, Thick, fissured, protruding tongue, short broad fingers with a curved fifth finger, Greater susceptibility to leukemia than that of the general population

Bathing newborn

Do not use harsh soaps when bathing newborns because they can irritate the skin. Hexachlorophene in particular should not be used because it can be absorbed through the skin and cause central nervous system damage. washing off all traces of blood don't scrub off vernix.

Newborn of a Mother With Substance Abuse Clinical Manifestations

Hyperactive and irritable, tremors, LBW, short eye lids, flattened nasal bridge

Retinopathy of Prematurity

Immature retinal blood vessels grow abnormally, often resulting in retinal scarring or detachment. These events lead to varying degrees of blindness. always assess infant vision.

A Word of Caution Is in Order

It takes oxygen to produce heat

Ongoing Cardiac and Respiratory Monitoring

Keep the bulb syringe in the bassinet with the newborn at all times. Turn the newborn on the side and suction frequently. mouth before nose.

Newborn of a Mother with Diabetes Clinical Manifestations

LGA, plump and full faced with bulky shoulders, and coated with vernix caseosa. placenta and the umbilical cord are oversized.

Nursing Care Focus- Implementations for Preventing injury- ICP

LOC q2-4h, check pupils, observe for shrill cry, measure head circumference daily, keep baby flat

Reflexes

Moro reflex- startle reflex, they extend the arms and legs away from the body and to the side. arms come back toward each other with the fingers spread in a "C" shape

Handling the Newborn

SIDS- teach mom to let baby sleep on its back, don't use pillows or stuffed animals

Ortolani Sign

Sign is positive if a clicking or clunking sound is felt or heard. A positive sign indicates possible dislocation of the hip

supplements

Supplements give the newborn a feeling of fullness causing them to not nurse as frequently, which may in turn decrease the woman's milk supply. don't give water

Neonatal abstinence Syndrome

Swaddle neonate, avoid strong fragrances, provide a calm environment, ensure adequate nutrition

Light Easily Identifies a Hydrocele

Take a penlight and hold it against the scrotal sac. If fluid is present (hydrocele), the light will transilluminate the scrotum

Skin, Hair, and Nails

Vernix caseosa- white cheese like substance that covers the body of the fetus during the second trimester, is normally found only in creases of the newborn

circumscised newborn

Wash the penis with warm water squeezed gently from a washcloth at each diaper change. Reapply petroleum jelly at each diaper change for the first 24 to 48 hours. Call the health care provider if a Plastibell does not fall off within 5 to 8 day. cover glans w vaseline. inspect for excess bleeding.

Hypospadias- Surgical repair

ages of 6 and 18 months, chordee extends from the scrotum to the penis, pulling the penis downward in an arc. 1 stage

after birth

baby wrapped in warm dry blanket

cold stress

can lead to RR distress

Nursing Focus - Spica Cast

comfort and maintaining skin integrity are major concerns. too tight if vomiting

Initial Admitting Examination

completed by 2hr of birth.

Thermoregulatory Adaptation

convection- heat loss from air current (fan)

PKU

musty urine

Diaphragmatic Hernia

displaced into the left chest through an opening in the diaphragm

Monitoring the Breast-Feeding Session

evaluate the effectiveness of the latch and sucking. correctly latched onto the breast will resist being pulled off the breast. if mom is having contractions

Implementations for Promoting Skin Integrity- spica cast

first 24 to 48 hours after application of a cast, place the infant on a firm mattress, and support position changes with firm pillows.

bringing the newborn to mother for feeding

first check the identification bands of both the newborn and the mother and make sure they match. After confirming identity, provide privacy by pulling a curtain around the bed or closing the door. Then, assist the woman into a comfortable position

advantages of breast feeding- long term

for the woman include decreased incidence of ovarian and premenopausal breast cancers. have a lower risk for coronary artery disease, breast and ovarian cancers, and hypertension.

maternal diabetes

if not managed baby can be large for gestational age

The Postterm Newborn Nursing Care- blood glucose

increase risk of hypoglycemia. prioritize BG checks

hepatic adaption

jaundice- report to RN. 1st 24hr yellow staining on baby head and face.

newborn surface contact

keep all surfaces warm

Characteristics of a Preterm Newborn - Thermoregulation (loss of body heat)

lose heat and fluids more quickly and have fewer compensatory mechanisms than does the term newborn

ventricular septal defect

loud hard murmur

Respiratory Distress Syndrome

lungs are too immature. deficient in surfactant and thus collapse after each breath.

Esophageal atresia- Clinical Manifestations

mucus or fluid that a newborn swallows enters the blind pouch of the esophagus. This pouch soon fills and overflows, usually resulting in aspiration. frothing, choking, cyanosis

Maintaining Thermoregulation- skin to skin

newborn is skin-to-skin with the family caregivers and both are covered with blankets (kangaroo)

Variations in Size and Gestational Age

newborn whose weight, length, or head circumference falls below the 10th percentile for gestational age (SGA) LGA cause- maternal diabetes

Erythema Toxicum- Newborn Rash

normal

Hydrocephalus- noncommunicating type

obstruction occurs, and CSF is not able to pass between the ventricles and the spinal cord

Clinical Manifestations - Spina bifida with meningocele

part of the spinal meninges protrudes through the bony defect and forms a cystic sac

Characteristics of a Preterm Newborn- Lanugo

plentiful over the extremities, back, and shoulders.

Ballard scale- Neuromuscular Maturity

posture, arm recoil, heel to ear, scarf sign

Maintaining Thermoregulation

prevent cold stress

Clinical Manifestations -Spina bifida with myelomeningocele

protrusion of the spinal cord and the meninges, with nerve roots embedded in the wall of the cyst

Behavioral exam

quiet alert state- eyes are open and is attentive to people and things, good time for the parents to interact.

Tachypnea

rapid breathing- more common w c-section

Maintaining Safety- jaundice

report any yellow tint

Characteristics of a Preterm Newborn - Respiratory system

respirations are shallow, rapid, and irregular with periods of apnea- most critical concerns

Ballard scale- Physical Maturity

skin, breast, plantar creases, lanugo

Hydrocephalus- Treatment

surgery; VP shunt, drained from a lateral ventricle in the brain to peritoneum

keeping the new born safe

tach parents to check employee badge.

Preventing Infection- reason for use

to prevent severe eye infection contracted from the birth canal of a woman with gonorrhea or chlamydia

Potential for Hemorrhage

vitamin K -intestines of the newborn are sterile as symbiotic bacteria have not yet colonized it. 0.5-1mg 1st hour. provides clotting factor.

Football Hold

woman is in a sitting position, and the newborn lies on their back on a pillow beside her. supports the infant's back with her arm. supports the head with the palm of her hand