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