Chapter 11NURSING CARE OF THE NEWBORN

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Chapter 11NURSING CARE OF THE NEWBORN

• Immediate care after birth Phase 1 birth to 1
  hour old
• use of bulb syringe-compress the bulb syringe
  before inserting in the mouth then the nose.
• Injection of Aquamephyton IM
• Measurements-head, chest, wt, length
• Identification bands must be the same number
  for infant mother, significant other

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IMMEDIATE CARE

• INITIAL CARE DIRECTED TOWARD
• 1. Maintaining cardiorespiratory function
• 2. Maintaining thermoregulation
• 3. Ensuring identification and security
• 4. Assessing vital signs
• 5. Assessing gestational age to ID maturity and
  birth injuries or anomalies.
• Prevention of hemorrhage/eye care

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Phase 2 1 to 4 hours

• Infection prevention
• Best method is proper handwashing
• Signs of infection Poor feeding, lethargy,
  periods of apnea
• NB Screening PKU, hearing tests
• Hep B done soon after birth, 1 mo., 6 mos.

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GENERAL NURSING INTERVENTIONS

• SAFETY
• Never leave infant alone on bed/ table
• Never prop bottle
• Always leave side rails up in crib
• Use a car seat
• Place infant on back or side to sleep
• Do not leave pillows, etc in crib

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GENERAL NURSING INTERVENTIONS

• BONDING
• Teach NB interactions
• Hearing
• Touch
• Gaze
• Eye contact
• Facial expressions

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ROUTINE ASSESSMENT AND CARE

• Encourage parents to participate in care
• Assess infant q 4 8 hrs
• Vital signs, appearance of skin, color, fluid
  intake, voiding and stooling, infants activity,
  and parent-infant attachment.
• Keep warm but do not overdress

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Phase 3 Parent Education

• The interactive bath - Skill 11-4
• Plain water 1st 1 2 weeks
• Sponge bath until cord falls off healed then
  may have tub bath
• Avoid bath right after feeding or on empty
  stomach
• Teach bathing to parent in hospital

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Cord Care

• Clean with alcohol 2 or 3 times daily with each
  diaper change
• Cord falls off in 7 10 days
• Fold diaper down to keep dry of urine
• Teach parent to report if cord
• Moist, reddened, foul odor, bleeding, or discharge

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Positioning/Holding Infant

• Support head
• Place on firm mattress, never in prone position
  when left alone gt SIDS
• 3 ways to hold, Fig. 11-9
• Cradleused for feeding
• Upright holdused for burping
• Football holdshampooing, breastfeed

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• Nasal oral suctioning see fig 11-10
• Temperature Assessment axillary
• Stools voiding 6-8 voids per day fast focus
  11-4
• Collection of urine from infant see procedure
  11-4
• Diapering use clear water or premoistened wipes
  without chemicals/soap

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• Clothing dress for weather
• Circumcision Gomco method or plastibell see fig
  11-11
• potential complications infection
  hemorrhage box 11-11

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Caring for the Uncircumcised Penis

• Avoid forceful retraction of the foreskin
• Use only plain water to wash during infancy no
  need to retract the foreskin
• Toddler age gentle retraction may be done
  during bath. Always replace the foreskin to its
  normal position
• School age child can be taught to gently
  retract the foreskin weekly during bathing

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• Cultural beliefs influence the type of care given
  to newborns. If the beliefs are harmful to the
  newborn the nurse should try to educate the
  parents about concerns related to the practice
• Discharge follow up care recommended f/u 7-10
  days for infant
• Nursing care plan 11-1