Sherpath: Newborn Care (N.332)
Which parental statement indicates a need for further sleep safety education?
"I cover my baby with a warm quilt at night."
Which parental statement would the nurse interpret as indicating a need for further education about newborn body processes?
"I will check my baby's temperature in his bottom when he is sick."
Which education would the nurse provide the mother of a newborn and 2-year-old who expresses concern about the baby's sleep schedule?
"Your baby will not be disturbed by other children during quiet sleep."
Which parental statements about umbilical cord care would the nurse interpret as indicating a need for further education?
- "I will pull off the stump in a few days to keep it from getting infected." - "I need to apply petroleum jelly to the cord with every diaper change." - "I should buy diapers one size larger to prevent irritation around the cord." - "I need to clean around the cord with alcohol swabs whenever I change the diaper."
patient education: urination
- A newborn should have at least one or two wet diapers a day during the first day or two of life. - By the fourth day of life, newborns should have at least six wet diapers a day. - Counting the number of wet diapers will help one know whether the baby is hydrated. - Urine should be pale yellow. - warning signs: Call the health care provider if the newborn has no wet diapers for more than 12 hours.
care seat safety
- Always use an approved car safety seat when traveling in a motor vehicle. - Rear-facing car safety seats are used until 2 years of age (or exceeding the seat's limits for height and weight). - Place the car safety seat in the back seat of the car. - Disable airbags if the car safety seat must be placed in a seat with airbags. - When carrying a baby in a car safety seat or infant carrier, never place the car safety seat or carrier on a table or counter. Always place the infant carrier on the floor where the baby can be seen. - Never place the infant in a car safety seat for a nap. - Remove bulky clothing when fastening car safety seat straps. - Fasten the car safety seat straps over the chest to ensure they are properly secured.
post-circumcision
- Attach the diaper loosely to prevent pressure and change at least every 4 hours. - Monitor for urination, bleeding, and signs of infection. - Clean the glans gently with warm water to remove urine or feces; do not use soap until the circumcision is healed (5 to 6 days). - Do not remove the yellow crust over the glans. - Gomco or Morgan Clamp only: apply petroleum jelly to the glans with each diaper change to prevent the diaper from adhering to the circumcision site. Some health care providers will also recommend a piece of gauze over the area as well.
patient education: thermoregulation
- Body temperature changes can be dangerous for newborns and lead to increased calorie and oxygen needs. - Dress the newborn as the parent would like to be dressed. Add a light receiving blanket, except in very hot weather. - Check the newborn's temperature during illness. - Measure temperature by placing the thermometer high in the armpit (without causing pain) and hold the arm down. - warning signs: Call the health care provider if the newborn has a temperature higher than 100°F (37.8°C) or lower than 97.7°F (36.5°C).
patient education: bowel elimination
- Breastfed newborns pass at least four soft, seedy stools that have a sweet-sour odor and are mustard-yellow each day. - Formula-fed newborns pass at least one stool daily that is pale yellow to light brown and formed. - Grunting and facial redness while passing a stool does not indicate constipation. - Constipation is best assessed by passage of small, hard, pebble-like stools that are fewer than usual. - Newborns with diarrhea pass more frequent stools that are more liquid than usual and may have abnormal color (green). - warning signs: Call the health care provider if the newborn has more than two diarrhea stools, because serious dehydration can occur quickly.
quiet sleep state
- Deep, non-REM (rapid eye movement) sleep; regular respiration - No facial or eye movement; no vocalizing - No spontaneous activity - Difficult to awaken - Feeding likely unsuccessful
Which actions would the nurse take to promote parent-infant bond?
- Encourage rooming-in after birth. - Encourage skin-to-skin contact for birth and nonbirth parents. - Recommend breastfeeding in the first 1 to 2 hours after birth.
umbilical cord care
- Ensure clamp is securely fastened and cord remains clean and dry. - Clean with water when necessary. - Fold diaper below cord to avoid urine contamination and irritation. - Monitor for signs of infection, including redness, drainage, edema, bleeding, and purulent drainage. - Cord turns brownish black within 2 to 3 days; separation typically occurs within 10 to 14 days.
what should the nurse do for the baby receiving phototherapy?
- Ensure newborn only wears a diaper and is positioned an appropriate distance from phototherapy device - Provide eye protection/shield if overhead lights used - Carefully monitor hydration (feedings, urinary output), stools, temperature - Reposition every 2 to 3 hours to maximize skin exposure - Support feeding and parental interactions
feeding as treatment for hyperbilirubinemia
- Feeding stimulates the passage of bilirubin in stools. - The nurse encourages early feeding and supports families in initiating feeding of their newborn. - Breastfed infants: breastfeed early (1 to 2 hours after birth) and often (every 2 to 3 hours). Alternative is to feed expressed colostrum. - Formula-fed infants: feed early and approximately every 3 hours.
treatment of hypoglycemia
- Feeding the newborn (breast milk or formula preferred over glucose water) - Monitoring blood glucose level per agency protocol and/or health care provider prescription - Assessing temperature and respiratory status - Discussing the plan of care with the family - For severe hypoglycemia, intravenous (IV) dextrose infusion may be prescribed by the health care provider.
Signs of illness in newborns may include
- Fever: axillary temperature >100.4°F (38°C) - Hypothermia: axillary temperature <97.7° F (36.5°C) - Poor feeding or little interest in food; particularly missing two consecutive feedings - Vomiting: forceful, projectile and/or frequent episodes - Diarrhea: consecutive watery stools - Decreased urination: fewer than six to eight wet diapers per day (for newborns 3 to 4 days and older) - Breathing: respiratory distress, labored breathing. Seek emergency care for color change (bluish skin, cyanosis), absence of breathing for >20 seconds - Lethargy: sleepiness, difficulty waking, excessive sleepiness (longer than 6 hours) - Inconsolable crying, continuous - Bleeding or purulent drainage from umbilical cord, circumcision - Drainage from the eyes - Or other concerns that are atypical for the newborn
diaper changes
- Gloves are worn to avoid contact with body fluids. - Diapers are changed often to avoid skin irritation from contact with urine and stool. - Plain water or mild soap is used to cleanse diaper area. - Meconium stools are thick and sticky, which means cleaning may be a challenge. - Diaper wipes should be free of alcohol and detergent.
behavioral signs of hypoglycemia
- High-pitched cry - Lethargy - Irritability - Poor sucking - Grunting
Critical Congenital Heart Disease (CCHD) screening
- Hypoxemia may be a sign of congenital heart defect. - Pulse oximetry is used to measure oxygen saturation in the right hand and one foot. - Normal result: Oxygen saturation >95% in extremities, <3% difference between upper and lower extremity readings. - Abnormal results may indicate critical congenital heart disease and should be evaluated. - Immediate evaluation needed if oxygen saturation is <90%.
vitamin K prophylaxis
- Infants lack the intestinal flora necessary to synthesize vitamin K, leading to clotting factor deficiency. - Typically newborns are able to produce vitamin K around 1 week of age. - Intramuscular administration of vitamin K is administered in the vastus lateralis shortly after birth to prevent hemorrhagic disease of the newborn.
active alert state
- Irregular respirations - Alert, active movements - Sensitive to stimuli, may be fussy - Signaling for change: consider feeding, repositioning - Less interactive
crying state
- Irregular respirations - Crying, grimace, color changes - May be sensitive to stimuli - Signaling for change - Consider consoling
drowsy state
- Irregular respirations - Unfocused eyes, delayed responsiveness - Variable activity - Sleep impending but easy to awaken - May be unsure if awake or asleep - If feeding, fully awaken first
physiologic signs of hypoglycemia
- Jitteriness, tremors - Poor muscle tone - Diaphoresis (excessive sweating) - Tachycardia - Tachypnea or dyspnea
Match the method of heat loss with the nursing action that would prevent it.
- Keep newborn dry and covered. = Evaporation - Place a blanket between the newborn and the examination table. = Conduction - Move the crib away from air vents. = Convection - Move the crib away from the window or outside wall. = Radiation
While caring for a formula-fed 2-day-old, which nursing interventions promote safe sleep?
- Keeping bassinet free of toys and supplies - Offering a pacifier during sleep - Dressing the newborn in a sleep sack
Which interventions would the nurse implement when caring for a newborn postcircumcision?
- Loosely attach diaper. - Carefully document urinary output. - Monitor for bleeding and signs of infection
patient education: respiration
- Newborns normally breathe about 30-60 times a minute. - Breathing rate and rhythm are variable and irregular. - Extra mucus is common after birth; sneezing helps to clear the airway. - Use a bulb syringe if the newborn has excessive mucus in the mouth or nose, or spits up milk. Squeeze the bulb before inserting in nose or mouth. - Avoid exposing the newborn to individuals who are sick or are exposed to smoke. - warning signs: Call the health care provider if the newborn develops yellow or green nasal drainage, nasal congestion, coughing, or decreased feeding. Seek emergent care if the newborn's skin becomes blue, the newborn stops breathing for more than 20 seconds, or the newborn has difficulty breathing.
eye prophylaxis
- Ophthalmia neonatorum (neonatal conjunctivitis) is inflammation caused by sexually transmitted bacteria acquired during birth. - Prophylaxis against Neisseria gonorrhoeae, an infection that may cause blindness, is recommended for all newborns. - Erythromycin 0.5% ophthalmic ointment is the recommended medication in the United States.
For which signs in a 5-day-old breastfed newborn would a nurse educate parents to contact the health care provider for further assessment?
- Passage of one stool per day - Brown stool with a consistency of paste explanation: Breastfed newborns usually stool at least four times per day. The parents should contact the health care provider if the newborn is passing only one stool per day. Breastfed newborns should have soft, seedy yellow stools; a brown, paste-like consistency is abnormal, and the parents should contact the health care provider should this occur.
phototherapy treatment for hyperbiliruibinemia
- Phototherapy is the primary treatment for newborns with severe hyperbilirubinemia. - Phototherapy uses light energy to convert unconjugated bilirubin into conjugated form to allow for excretion through urine and stool. - There are numerous phototherapy devices including lamps, blankets, pads, or cover-body devices. - The severity of hyperbilirubinemia will determine the phototherapy device, duration, and setting (home or hospital) based on national clinical practice guidelines.
Safe sleep practices are aimed at preventing SIDS
- Place newborns supine in bassinet. - The bassinet should be free of blankets, pillows, toys, and supplies such as diapers and wipes. - Bed-sharing increases the risk for suffocation and falls; encourage returning the newborn to the bassinet for sleep. - Pacifier use may decrease the risk for SIDS, but it may be delayed for a month until breastfeeding is established. - Avoid overheating during sleep.
risk factors for newborn hypoglycemia
- Preterm or late preterm - Small-for-gestational-age - Large-for-gestational-age - Born to a mother with diabetes - Perinatal stressors (asphyxia, cold stress, respiratory distress)
Which interventions would the nurse implement to maintain a neutral thermal environment?
- Promote skin-to-skin contact. - Examine under a radiant warmer. - Encourage early and frequent breastfeeding.
active sleep state
- REM sleep; irregular respiration - Facial and eye movement; may smile - Spontaneous activity common - Easier to awaken - Still sleeping; therefore feeding likely unsuccessful
quiet alert state
- Regular respirations - Attentive to surroundings - Inactive, minimal movement - Ideal time for engaging with baby - Most responsive in this state
screening and testing for hyperbilirubinemia
- Routine screening for hyperbilirubinemia is recommended for all newborns prior to hospital discharge. - Transcutaneous bilirubinometry (TcB) is a noninvasive device that estimates bilirubin level by directing white light into the skin and measuring the intensity of specific light wavelengths that are returned. TcB is the most common hyperbilirubinemia screening method. - Total serum bilirubin (TSB) is more invasive. TSB may be prescribed by the health care provider if TcB is elevated. - TcB and TSB interpretations are based on the newborn's age in hours. - Repeat testing is determined based on risk level, age, and progression of jaundice.
other signs of hypoglycemia
- Seizures - Coma - Cyanosis - Apnea - Low temperature
Which nursing interventions would the nurse perform immediately after birth to support the healthy newborn's respiration and thermoregulation?
- Skin-to-skin contact - clear secretions - drying - warming
pacifier use
- Sucking provides pleasure and is soothing to infants. - Evidence shows that pacifier use may help prevent SIDS. - Pacifiers should be cleaned often and replaced regularly. - Consider using a pacifier for infants when putting them to sleep. - If breastfeeding, consider waiting 1 month until breastfeeding is fully established before giving the newborn a pacifier.
bathing
- The first bath is given to remove blood and amniotic fluid soon after birth (once temperature stable). - Immersion in a tub is preferred, though sponge bath under a radiant warmer is an alternative. - Water temperature should be approximately 100.4°F (38°C). - Mild soap and shampoo are used to cleanse the skin after birth. - Only one bath may be given at birthing facility, with ongoing skin cleansing at diaper changes.
immunization: hepatitis B vaccine
- The hepatitis B vaccine is recommended for all newborns, regardless of maternal hepatitis B infection status. - After parental consent, hepatitis B is administered intramuscularly before discharge from the birthing facility. - Vastus lateralis (lateral thigh) is the preferred injection site.
universal newborn screening
- US law mandates universal newborn screening to facilitate early identification of numerous genetic conditions and inborn errors of metabolism. - Individual states determine which disorders are included in the newborn screening. - Common conditions included by states are hemoglobinopathies, inborn errors of metabolism, hypothyroidism, and severe combined immunodeficiency. - Capillary blood samples are collected via heelstick, with blood samples collected on specialized paper to be analyzed by the state laboratory. - The universal screening test should be performed after 24 hours of age and repeated at 1 to 2 weeks of age. - Normal results: if the state laboratory report indicates normal results for both samples, no further action needed. - Abnormal results: not diagnostic but warrant follow-up by pediatric health care provider.
exchange transfusion as treatment for hyperbilirubinemia
- Used when phototherapy is ineffective or in the case of extremely severe/critical hyperbilirubinemia (e.g., hemolytic disease, acute bilirubin encephalopathy) - Performed in intensive care setting; entails portion of infant's blood being replaced with donor blood
Which interventions would the nurse implement for a breastfed newborn who has lost 8% of his or her birth weight?
- Weigh the infant daily using same scale. - Evaluate feeding technique and positioning. - Demonstrate waking techniques for feeding a sleepy baby. - Evaluate the newborn suck and latch.
Nursing interventions for newborn weight loss include
- Weigh the infant daily, preferably at the same time of day with the same scale to ensure accurate measurement. - Encourage feeding early and often. - Teach the parents hunger cues and techniques for waking a sleepy baby to feed. - Breastfed newborns: Evaluate newborn's suck and latch, and mother's positioning during feeding. Recommend nursing every 2 hours. Recommend lactation consultation for mothers struggling to establish breastfeeding. Encourage and support continued breastfeeding. - Formula-fed newborns: Assist with bottle positioning and holding technique.
hypoglycemia in the newborn
- clamping of the umbilical cord ends the maternal source of glucose - Most newborns experience a transient decrease in glucose levels 1 to 2 hours after birth that does not require intervention - Early feeding promotes normal glucose levels - HCP is notified if newborn has a blood glucose between 40-50 mg/dL
treatments for hyperbilirubinemia include
- feeding - phototherapy - exchange transfusion
risk factors for severe hyperbilirubinemia include
- gestational age <38 weeks - exclusive breastfeeding - significant jaundice in a sibling - isoimmune or hemolytic disease - cephalohematoma - significant bruising - East Indian race
clinical signs of hyperbilirubinemia
- jaundice, or the yellowing of the skin and sclera - lethargy - poor feeding
Which intervention would the nurse implement for a 10-minute-old healthy newborn?
Administer vitamin K.
Which nursing intervention is aimed at preventing ophthalmia neonatorum?
Administration of erythromycin ointment
Which action would the nurse take first when caring for a newborn with poor muscle tone, low temperature, and lethargy?
Assess the newborn's blood glucose.
A breastfed newborn has lost 7% of its birth weight in the first 4 days of life. Which action would the nurse take?
Document the weight and reassure the parents that this is normal.
Which preventive intervention would the nurse implement for a newborn with numerous hyperbilirubinemia risk factors?
Encourage early feeding.
Which health care provider prescription would the nurse anticipate for a newborn whose heelstick reveals a glucose reading of 49 mg/dL?
Feed the newborn breast milk or formula.
Which intervention would a nurse take to prevent infection of the umbilical cord?
Fold the diaper below the umbilical cord.
hearing screening
Hearing screening is recommended for all newborns within 1 month of age and is preferred before discharge from the birthing facility. The evoked optoacoustic emissions (EOAE) test is most common, where a soft rubber earpiece that makes a clicking noise is placed in the baby's ear. Normal result: healthy ear "echoes" the click back to the EOAE microphone. Abnormal result is not diagnostic of hearing loss, but additional testing is needed.
Which education would the nurse provide the parents of a newborn born with plagiocephaly?
Plagiocephaly at birth is a positional deformity that often resolves without intervention.
checking for jaundice
Skin assessment is performed by blanching the skin of the forehead, nose, or sternum for several seconds; if the blanched area appears yellow, jaundice may be present. Note, jaundice typically develops on the face first; the higher the bilirubin level, the further down the body the jaundice may extend.
Which safety education would the nurse provide the parent of a newborn?
Support the newborn's head by keeping a hand behind the head and neck when holding.
Which noninvasive technique would the nurse use to best screen for suspected hyperbilirubinemia?
Transcutaneous bilirubinometry (TcB)
minimizing heat loss thru convection
avoid areas with drafts, such as hallway doors or air conditioners. Bathe in warm water.
minimizing heat loss thru evaporation
dry infants quickly after birth or bathing, change wet linens
minimizing heat loss thru radiation
position newborn bassinet away from walls or windows.
when bulb suctioning a newborn what area should you suction first?
the mouth
most newborns lose what percent of their birth weight and in what time frame?
they lose 5-10% of their birth weight within the first 3-5 days of life
minimizing heat loss thru conduction
warm objects (stethoscope, hands) before coming into contact with the infant.
