Immediate Care of Newbor1

8/9/2019 Immediate Care of Newbor1

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Thigh muscles VASTUS LATERALIS (best site)

RECTUS FEMORIS (alternate site)

6. Weighing and taking of Other Anthropometric

Measurements

Weight: 3000g 3,400g (7 7.5 lbs.) Internationalstandard

: 6 6.5 lbs. average birth weight of a Filipino

newborn

> lower limit normal : 2,500g

Height : 19 21 inches (ave. 50 cm)

HC : 33 35 cm/13 14 inches

CC : 31 33 cm/12 13 inches

AC : 31 33 cm/12 13 inches

7. Vital signs

Checking when infants is asleep/quietGentle, minimal handling and watchful eyes

PHYSIOLOGIC CHANGES IN THE NEWBORN

1. Weight Loss : 7 10 days

5% to 10% of BW (6 10 oz)

After day 10, weight gain of 1 lb per month from 1 6

months

BW is doubled at 6 months and tripled at 1 year

2. Jaundice : 2 7 days for full terms and 3 10 days forpreterm

Because of liver immaturity and fetal increase in RBCs

(polycythemia)

Expose to morning sunlight

3. Fever : 2 4 days

Primarily because of dehydration

4. Anemia : 4 6 months

NEWBORN SKIN MARKS

1. LANUGO - fine, downy hair, more in preterms2. VERNIX CASEOSA - whitist, cheesy, odorless usually on

folds of the skin; more in full term

protects skin and prevents heat loss

3. MILIA - white, pinpoint papules on the

nose/chin/cheecks

disappears as early as 2 weeks or 3 4 weeks

4. MONGOLIAN SPOT - grayish blue patch at the lower

back from accumulation of the pigment cells

melanocytes

disappears by school age

5. NEVI(STORK BITES) - red spots found at the back of

the neck and above eyelids

disappears spontaneously before 1 year

6. ERYTHEMIA TOXICUM NEONATORUM - newborn rash

pink papular rash appearing on the body within 24 48

hours after birth; harmless

disappears within a few days

SIGNIFICANT NEWBORN REFLEXES

A. FEEDING REFLEXES

Rooting if the cheeck or the corner of the mouth is

touched, hr turns to that side; for food location

Diasappears at 3 4 months when he can follow moving

objectsLast period of disappearance : 7 months

2. Sucking anything that touches the lips is sucked;

present even before birth

disappears at 6 months

3. Extrusion or spitting up anything that touches the

anterior tongue is extruded, protects infant from

swallowing inedible substances

- disappears at 4 6 months

Swallowing swallows anything that touches the

posterior tongue

B. PROTECTIVE REFLEXES

Sneezing and coughing protect and clear the air

passages

Yawning protects cells from depleted oxygen

Blinking protects eyes from objects coming near it

C. MORO or STARTLE embracing motion of the arms in

response to loud noise, jarring of the crib and falling

sensation

Best index of CNS integrity; absence indicates BRAIN

DAMAGEDisappears by the end of 4th or 5th month

D. TONIC NECK REFLEX/FENCING when head is turned

to one side, the arm and leg on that side extend and

opposite arm and leg flex

disappears at 3 4 months

E. BABINSKI fanning or hyperextension of the toes

when the sole is stroked from the heel upwards

F. DARWIN dancing reflex; few quick alternating stepswhen the newborn is held upright and his feet touch a

hard surface

Disappears at 4 weeks

G. MAGNET If pressure is applied on the soles of the

feet while infant lies supine, he pushes back against the

pressure

A test of spinal cord integrity

H. CROSSED EXTENSION if one leg of a newborn lying

supine is extended and the sole is irritated by rubbing it

with a sharp object, he will raise the other leg and

extend it as if trying to push away the hand irritating the

first leg.

A test of spinal cord integrity

SKIN DISORDERS IN INFANT

1. DIAPER DERMATITIS

1. Diaper rash/contact dermatitis : inflammation of the


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skin caused by irritants moisture, heat and chemical

substances

Erythemia in the genital signals the beginning of the

rash

Progresses from macules and papules to eroded, moist

or crushed lesions

2. Ammonia dermatitis: diffuse erythema in the perianaland gluteal areas caused by breakdown of urea in the

urine to ammonia by bacteria in the feces.

Progresses to shiny, red and excoriated skin.

3. INTERTRIGO: maceration of any two skin surfaces in

close opposition/chafing of the skin.

Common in obese infants in gluteal and neck folds due

to poor ventilation, high humidity and poor hygiene.

4. Nursing responsibilities: provide health teachings

Meticulous skin/care hygiene particularly along skin

creases

Keeping areas involved well ventilated and free ofirritating substances, use loose diaper/clothing

Quickly changing diapers after soiling after washing the

area with water or bland soap and water if needed. Pat

dry areas with soft cloth or towel; expose to air for few

minutes before dipering

II. MILARIA/HEAT RASH/PRICKLY HEAT

A. Fine; erythematous papular rash over shoulders neck

and skin folds due to warm weather or overdressing.

B. Intervention frequent bathing with cool plain water

avoiding soap; light dressing. Keeping environment cool,

application of bland dusting powder and calamine lotionIII. SEBORRHREA DERMATITIS

A. Common recurrent skin disease called CRADLE CAP in

neonates, dermatitis of the scalp in infants and dandruff

in other children.

Cause accumulation of sweat, sebum and dirt causing

flat, adherent and greasy scales with pruritus, crushing

usually indicates a secondary infection.

C. Prevention Keeping involved areas clean, dry and

cool and free of irritants.

Treatment mineral oil, ointment or lotion to soften the

scales before shampooing.IV. IMPETIGO

Bacteria infection of the superficial layers of the skin

invaded by streptococci, staphylococci, or pneumococci,

commonly found on the face

Causes: poor skin care, overcrowding, malnutrition

Characteristics: macules, papules, pustules, crusts

Treatment: meticulous hygiene of skin,

hexachlorophene scrubbing of lesions to prevent

nephritis and rheumatic fever.

V. BOILS/FURUNCLES

Bacterial infection of hair follicles common face, neck,

axila, buttocks

Progresses from papules to pustules than hard tender,

hot nodless which form a pus point.

Treatment personal hygiene, no squeezing, topical

neomycin cream and diet high in protein, low in fats and

carbohydrates.

VI. ORAL MONILIASIS

Also called oral thrush

Fungi infection of the mouth

Cause Candida Albicans

Seen and white patches on the tongue

Prevented by oral hygiene, care of maternal nipples,

proper sterilization of feeding bottles/nipples

Treatment Mycostatin or Nystatin oral paint

SELECTED NEWBORN CONDITIONS

I. HYPOGLYCEMIA low blood sugar

less than 30 mg % in the first 72 of the full term and less

than 45 mg % after 72

less than 20 mg % in the preterm

A. Etiologic factors prematurity, postmaturity, SGA,

birth injuries, congenital defects, low APGAR,

inadequate intake, stresses (cold stress, CS)

B. Danger Signs jitteriness, apnea, tachypnea, irregular

breathing plus signs of increased intracranial pressure:

tense, bulging fontanel

lethargy

high-pitch shrill cry

projectile vomiting

absent MORO reflex

tremors/convulsion

C. Nursing implementation

Give oral glucose

Administer ordered 10 % - 25 % IV glucose, monitor rate

of flow strictly to prevent hyperglycemia

Keep warm

Prevent infection: handwashing best measure

Prevent convulsion: decrease environmental stimuli

Monitor VS, behavior, serum glucose

Handle gently

II. HYPOTHERMIA low body temperature less than 36.5C

A. Etiologic Factor prematurity, postmaturity, SGA,

malnourished newborn

absence of adequate brown fat to burn

B. Danger Signs low body temperature, mottling,

cyanosis, crying, increased activity, tachypnea

C. Nursing Implementation

* Keep warm: maintain in incubator (best place for

maintaining body warmth)

Prevent heat loss

Oxygenate PRN

Monitor temperature per axila

III. HYPERBILIRUBINEMIA Increased serum bilirubin

more than 12 13 mg %


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- Normal serum bilirubin in newborn: 2 6 mg %

A. Etiologic factors Rh and ABO incompatibility,

infection, prematurity, drugs, breastfeeding (because of

pregnanedial), polycythemia

B. Assessment/Findings -

pathologic jaundice (present in first 24)dark, concentrated urine

lethargy, poor feeding

pallor

signs of increased urine

C. Treatment: phototherapy and exchange transfusion

D. Nursing responsibility: Detect and report early

pathologic jaundice

HEMOLYTIC DISEASE OF THE NEWBORN

ERYTHROBLASTOSIS FETALIS

A. Blood incompatibility characterized by:

hemolytic anemia

hyperbilirubinemia

B. Types: Rh incompatibility and ABO incompatibility

Rh incompatibility is more severe: does not usually

affect the first child.

C. Danger Signs severe paleness at birth and

pathologic jaundice (appears in the first 24)

Newborn is not jaundiced at birth because there isplacental excretion of excess bilirubin.

D. Diagnosis: COOMBS TEST

- Direct Coombs test uses newborn blood mix with

Coombs reagent whereas indirect Coombs test uses

maternal blood mixed with Rh (+) blood.

Positive result: with RBC agglutination, mother has

produced antibodies (+ isoimmunization)

Negative result: without RBC agglutination; mother has

not produced antibodies yet (- isoimmunizatiion)

E. Prevention: RhoGAM

RhoGAM is given to an Rh (-) mother, with Rh (+) fetus,

abortus or ectopic pregnancy, with (_) COOMBS test.

Action destroys fetal antigens (fetal RBCs) before

mother produces antibodies.

Given intramuscularly in the first 72 after delivery of a

fullterm, abortus or ectopic pregnancy.

F. Treatment: phototherapy and exchange transfusion

PHOTOTHERAPY decreases serum bilirubin

Nursing responsibilities:

Undress infant leaving diapers

Cover eyes with eye shield

Have light 16 inches away from infant

Turn gently every 2 hours

Give sterile water in between regular milk feedings

Monitor temperature, I & O, serum bilirubin, jaundice

and side effects: rise in temperature, dehydration,

priapism (painful penile rection), bronze skin, dark and

concentrated urine, loose and green stools.

Retinal damage if eyes are not shielded, sterility if

genitalia is not covered .

EXCHANGE TRANSFUSION decreases serum bilirubin

and maternal antibodies, and elevates hemoglobin

Nursing responsibilities:

Have appropriate blood ready: Rh (-) and type (O), fresh,

at room temperature with hematocrit 50 % + and pH 7.1

or as specified by the physician, heparinized

Check VS before and after 15 minutes during specially

CR.

NPO 3 4 hours before or aspirate stomach to preventvomiting and aspiration

Have resuscitation equipment ready

Place infant on his back with arms and legs restrained

and under radiant warmer

Albumin (1 gm/kg) maybe given 1 2 hours before to

allow more binding sites for bilirubin making exchange

more effective.

Note and record the time of exchange more effective

Note and record time of exchange, monitor exchanges

10 % calcium gluconate maybe given after each 100 ml

of blood exchanged to prevent hypocalcemia.Protamine sulfate maybe given after the exchange

transfusion to prevent bleeding.

After transfusion, leave umbilical catheter with IV plug

for a repeat exchange or remove catheter, small

pressure dressing applied and site observed for

bleeding.

V. RESPIRATORY DISTRESS SYNDROME/HYALINE

MEMBRANE DISEASE

Pulmonary condition common in preterms andcharacterized by hyaline membrane formed in the

alveoli causing atelectasis.

Etiologic Factors: prematurity, hypothermia, acidosis,

hypoxia.

Main pathologic finding: inadequate surfactant

Major Assessment Findings:

*Expiratory grunting -Tachypnea (more than72 minutes)

* Flaring

*See-saw breathing - Chest retractions and Lower chest

THE PREMATURE AND POSTMATURE INFANT

PREMATURE INFANT POSTMATURE INFANT

a. Born at 36 weeks or less a. Born at 43 weeks or over

b. Low birth-weight, poorly b. low birth-weight with

placental


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developed muscles and insufficiency from aging process

fatty tissues

c. Weak, lethargic, with poor c. wide awake, mentally

alert

muscle tone and reflexes

d. Skin: red, wrinkled, transparent d. Skin: greenish

(meconiumto translucent with visible stained, lethery

desquamating

capillaries, less subcutaneous parchment-like, absent or

slight

fats, MORE LANUGO, LESS lanugo and vernix caseosa

VERNIX CASEOSA

PREMATURE INFANT POSTMATURE INFANT

e. Associated Problems e. Associated Problems

1. Respiratory Distress Syndrome 1. Meconium

aspiration

2. Hypothermia 2. Hypothermia

3. Hypoglycemia 3. Hypoglycemia

4. Hyperbilirubinemia 4. Polycythemia =

Hyperbilirubinemia

5. Infection 5. Infection

6. Rickets and anemia

7. Mental retardation from kenicterus

8. Retrolental Fibroplasia

NURSING RESPONSIBILITIES FOR LOW BIRTH-WEIGHT

INFANTS

A. Establish and maintain airway.

Resuscitation mostly necessary at birth because of poor

APGAR.

Suction using a sterile catheter and brief suctioning LESSTHAN 5 SECONDS per suctioning time as necessary.

Safe use of oxygen to prevent oxygen toxicity.

B. Keep warm inside ISOLETTE/INCUBATOR = the best

place to keep him warm

Monitor temperature per axilla

Maintain heat and humidity

C. Prevent infection

Hand washing is the BEST way to prevent and its spread.

Masking is the LEAST.(NOSOCOMIAL NURSERY INFECTIONS are hospital

acquired infection and the MOST COMMON CAUSE is

staphylococcus aureus).

D. Monitor respiration, color, VS, I & O and weight

E. Maintain hydration and nutrition to promote rapid

growth.

Usually led by NGT or GAVAGE because sucking and

swallowing are poor; adhere to safety rules in gavage

feeding

F. Gentle and minimal handling

G. Support parents; encourage verbalization, allowparenteral care as much as possible AFTER

APPROPRIATE TEACHING.

H. PREVENT maturity or low birth-weight conditions

early and regular PRENATAL CARE is the best prevention

to complications of pregnancy, labor and puerperium

are also the best way to prevent high-risk newborn.

Immediate Care of Newbor1

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