Transcript Document 7396528

Chapter 25
Nursing Care of the
Newborn
Birth Through the First 2 Hours
• Assessment and nursing diagnoses
– Initial assessment and Apgar score
– Initial physical assessment
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External
Chest
Abdomen
Neurologic
Other observations
Birth Through the First 2 Hours—
cont’d
• Implementation
– Airway maintenance
– Body temperature maintenance
– Eye prophylaxis
– Vitamin K prophylaxis
– Promoting parent-infant bonding
From 2 Hours After Birth
Until Discharge
• Assessment
– Gestational age assessment
• Newborn classification by gestational age and
birth weight
– Large for gestational age: above
90th percentile
– Appropriate for gestational age
– Small for gestational age: below 10th percentile
From 2 Hours After Birth
Until Discharge—cont’d
• Late preterm infant
– Often the size and weight of term infant
– 34 to 36 6/7 weeks of gestation
– Have risk factors because of physiologic
immaturity
– Respiratory distress, temperature
instability, feeding difficulties,
hyperbilirubinemia
From 2 Hours After Birth
Until Discharge—cont’d
• Umbilical cord care
– Hospital protocol determines technique for
cord care
– Cochrane review of 21 studies: no
difference in dry cord compared with those
treated with antiseptics
– Natural healing, soap and water, alcohol,
or povidone-iodine
– Clamp is removed once the stump is dry
From 2 Hours After Birth
Until Discharge—cont’d
• Common newborn problems
– Physical injuries
• Soft-tissue injuries
• Skeletal injuries
• Lacerations
From 2 Hours After Birth
Until Discharge—cont’d
• Common newborn problems
– Physiologic problems
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Conjugation of bilirubin
Physiologic jaundice
Jaundice associated with breastfeeding
Hypoglycemia
Hypocalcemia
(blood calcium levels less than 7 mg/dl)
From 2 Hours After Birth
Until Discharge—cont’d
• Laboratory and diagnostic tests
– Routine testing
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Blood glucose
Bilirubin levels
Newborn genetic screening
Newborn hearing screening
From 2 Hours After Birth
Until Discharge—cont’d
• Collection of specimens
– Heel stick
– Venipuncture
– Obtaining a urine specimen
– Restraining the infant
From 2 Hours After Birth
Until Discharge—cont’d
• Implementation
– Protective environment
– Environmental factors
– Measures to control infection
– Safety factors
From 2 Hours After Birth
Until Discharge—cont’d
• Supporting parents in care of their
infant
– Social interaction
– Infant feeding
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May be put to breast shortly after birth
At least within first 4 hours of life
On-demand feeding
Encourage feeding every 2 to 3 hours
From 2 Hours After Birth
Until Discharge—cont’d
• Therapeutic and surgical
procedures
– Intramuscular injection
– Therapy for hyperbilirubinemia
• Phototherapy
• Exchange transfusion
• Parent education
From 2 Hours After Birth
Until Discharge—cont’d
• Therapeutic and surgical procedures
– Circumcision
• Procedure
• Procedural pain management
• Care of newly circumcised infant
Discharge Planning and
Teaching
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Temperature
Respirations
Feeding schedules
Elimination
Positioning and holding
Rashes
Clothing
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Discharge Planning and
Teaching—cont’d
Use of car seats
Nonnutritive sucking
Bathing
Cord care
Skin care
Infant follow-up
Immunizations
Key Points
• Assessment of newborn requires data
from prenatal, intrapartal, and postnatal
periods
• Knowledge of biologic and behavioral
characteristics is essential for guiding
assessment and interpreting data
Key Points—cont’d
• Providing a protective environment is key
responsibility of nurse
– Careful identification procedures
– Protection from abduction
– Support of physiologic functions
– Measures to prevent infection
• Maintaining adequate ventilation includes
ensuring open airway and body
temperature within normal range
Key Points—cont’d
• Parent education is a major responsibility
of nurse and includes involvement of
parents
• Newborn has social and physical needs
• Circumcision is elective surgical procedure
• Parents appreciate anticipatory guidance
in care of newborn