Nursing Care of the Newborn

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Chapter 25

• Nursing Care of the Newborn

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Birth Through the First 2 Hours

• Assessment and nursing diagnoses
• Initial assessment and Apgar score
• Initial physical assessment
• External
• Chest
• Abdomen
• Neurologic
• Other observations

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Birth Through the First 2 Hourscontd

• Implementation
• Airway maintenance
• Body temperature maintenance
• Eye prophylaxis
• Vitamin K prophylaxis
• Promoting parent-infant bonding

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From 2 Hours After BirthUntil 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

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From 2 Hours After BirthUntil Dischargecontd

• 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

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From 2 Hours After BirthUntil Dischargecontd

• 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

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From 2 Hours After BirthUntil Dischargecontd

• Common newborn problems
• Physical injuries
• Soft-tissue injuries
• Skeletal injuries
• Lacerations

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From 2 Hours After BirthUntil Dischargecontd

• Common newborn problems
• Physiologic problems
• Conjugation of bilirubin
• Physiologic jaundice
• Jaundice associated with breastfeeding
• Hypoglycemia
• Hypocalcemia (blood calcium levels less than 7
  mg/dl)

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From 2 Hours After BirthUntil Dischargecontd

• Laboratory and diagnostic tests
• Routine testing
• Blood glucose
• Bilirubin levels
• Newborn genetic screening
• Newborn hearing screening

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From 2 Hours After BirthUntil Dischargecontd

• Collection of specimens
• Heel stick
• Venipuncture
• Obtaining a urine specimen
• Restraining the infant

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From 2 Hours After Birth Until Dischargecontd

• Implementation
• Protective environment
• Environmental factors
• Measures to control infection
• Safety factors

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From 2 Hours After BirthUntil Dischargecontd

• Supporting parents in care of their infant
• Social interaction
• Infant feeding
• 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

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From 2 Hours After BirthUntil Dischargecontd

• Therapeutic and surgical procedures
• Intramuscular injection
• Therapy for hyperbilirubinemia
• Phototherapy
• Exchange transfusion
• Parent education

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From 2 Hours After BirthUntil Dischargecontd

• Therapeutic and surgical procedures
• Circumcision
• Procedure
• Procedural pain management
• Care of newly circumcised infant

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Discharge Planning and Teaching

• Temperature
• Respirations
• Feeding schedules
• Elimination
• Positioning and holding
• Rashes
• Clothing

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Discharge Planning and Teachingcontd

• Use of car seats
• Nonnutritive sucking
• Bathing
• Cord care
• Skin care
• Infant follow-up
• Immunizations

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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

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Key Pointscontd

• 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

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Key Pointscontd

• 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