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Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Essentials of Maternity, Newborn, and Women’s Health
Nursing
Chapter 18Nursing Management of the
Newborn
Essentials of Maternity, Newborn, and Women’s Health
Nursing
Chapter 18Nursing Management of the
Newborn
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Initial Newborn Assessments Initial Newborn Assessments
• Signs indicating a problem
– Nasal flaring, chest retractions
– Grunting on exhalation, labored breathing
– Generalized cyanosis, flaccid body posture
– Abnormal breath sounds, abnormal respiratory rates
– Abnormal heart rates, abnormal newborn size
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Initial Newborn Assessments (cont’d.)Initial Newborn Assessments (cont’d.)
• Apgar scoring (see Table 18.1)
• Length and weight, vital signs (see Table 18.2)
• Gestational age assessment (see Figure 18.3)
• Physical maturity (skin texture, lanugo, plantar creases, breast tissue, eyes & ears, genitals)
• Neuromuscular maturity (posture, square window, arm recoil, popliteal angle, scarf sign, heel-to-ear)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Apgar ScoringApgar Scoring
A = appearance (color)
P = pulse (heart rate)
G = grimace (reflex irritability)
A = activity (muscle tone)
R = respiratory (respiratory effort)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Gestational AgeGestational Age
• Preterm or premature: prior to 37 weeks’ gestation
• Term: 38 to 42 weeks’ gestation
• Postterm or postdates: after week 42 gestation
• Postmature: after week 42 gestation/placental aging
• Small for gestational age (SGA)
• Appropriate for gestational age (AGA)
• Large for gestational age (LGA)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Physical Maturity Assessment (Ballard)Physical Maturity Assessment (Ballard)
• Skin texture
• Lanugo
• Plantar creases
• Breast tissue
• Eyes and ears
• Genitals
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Neuromuscular MaturityNeuromuscular Maturity
• Posture
• Square window
• Arm recoil
• Popliteal angle
• Scarf sign
• Heel to ear
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
Is the following statement True or False?
Arm recoil is one measure of assessing a newborn’s physical maturity.
a. True
b. False
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
b. False
Arm recoil is a measure of a newborn’s neuromuscular maturity. An example of an assessment of physical maturity is skin texture.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Interventions: Immediate Newborn PeriodNursing Interventions: Immediate Newborn Period
• Maintaining airway patency
• Ensuring proper identification
• Administering prescribed medications (see Drug Guide 18.1)
– Vitamin K
– Eye prophylaxis
• Maintaining thermoregulation
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Newborn Physical ExaminationNewborn Physical Examination• Prenatal history
• Newborn physical examination
– Anthropometric measurements: length, weight, head circumference, chest circumference
– Vital signs
– Skin: condition and color; common skin variations (see Figure 18.12)
– Head: size, fontanels; variations in head size and appearance (see Figures 18.13 and 18.14); abnormalities in head or fontanel size
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Newborn Physical Examination (cont’d.)Newborn Physical Examination (cont’d.)
• Face: nose, mouth, eyes, ears
• Neck, chest
• Abdomen
• Genitalia (see Figure 18.16)
• Extremities and back
• Neurologic status
– Alertness, posture, and muscle tone
– Reflexes (see Table 18.4 and Figures 18.17 and 18.18)
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Common Skin Variations in NewbornsCommon Skin Variations in Newborns
• Vernix caseosa
• Stork bites or salmon patches
• Milia
• Mongolian spots
• Erythema toxicum
• Harlequin sign
• Nevus flammeus
• Nevus vasculosus
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Variations in Head Size and Shape in the NewbornVariations in Head Size and Shape in the Newborn
• Variations
– Molding
– Caput succedaneum
– Cephalhematoma
• Abnormalities
– Microcephaly
– Macrocephaly
– Large, small, or closed fontanels
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Common Concerns During Newborn TransitionCommon Concerns During Newborn Transition
• Transient tachypnea of the newborn
• Physiologic jaundice
• Hypoglycemia
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Interventions for Transient Tachypnea Nursing Interventions for Transient Tachypnea
• Providing oxygen
• Ensuring warmth
• Observing respiratory status frequently
• Allowing time for pulmonary capillaries and the lymphatics to remove the remaining fluid
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Selected Screening for NewbornsSelected Screening for Newborns
• PKU
• Congenital hypothyroidism
• Galactosemia
• Sicke cell anemia
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Management: Early Newborn Period: Nursing Interventions Nursing Management: Early Newborn Period: Nursing Interventions • General newborn care
• Bathing and hygiene (see Teaching Guidelines 18.1 and Nursing Procedure 18.2)
– Gloves
– Plain water on face and eyes; mild soap for rest of body
• Elimination and diaper area care
– Urine characteristics
– Stool pattern
– Diaper area care
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Management: Early Newborn Period: Nursing Interventions (cont’d.)Nursing Management: Early Newborn Period: Nursing Interventions (cont’d.)• Cord care (see Teaching Guidelines 18.2)
• Circumcision care
• Safety (see Teaching Guidelines 18.3)
– Prevention of abduction
– Car safety
• Infection prevention
• Sleep promotion
• Bonding
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Management: Early Newborn Period: NutritionNursing Management: Early Newborn Period: Nutrition
• Physiologic changes
• Nutritional needs
– Calories
• Fluid requirements
• Feeding method choice
– Feeding the newborn
– Frequency
– Measures to decrease air swallowing
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Management: Early Newborn Period: Breast-FeedingNursing Management: Early Newborn Period: Breast-Feeding• Composition
• Assistance
• Positioning
• Education
• Storage and expression
• Concerns
• Sore nipples
• Engorgement
• Mastitis
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
LATCH Method for Assessing Breast-Feeding SessionsLATCH Method for Assessing Breast-Feeding Sessions
• L: How well infant latches onto the breast
• A: Amount of audible swallowing
• T: Nipple type
• C: Level of comfort
• H: Amount of help mother needs
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
An infant typically requires how many calories per kilogram per day during the first 3 months?
a. 80
b. 95
c. 110
d. 150
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
c. 110
During the first 3 months, an infant needs 110 to 120 calories/kg/day.
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Management: Early Newborn Period: Bottle FeedingNursing Management: Early Newborn Period: Bottle Feeding
• Types of formula
• Assistance
• Positioning
• Education
• Weaning and introduction of solid foods
Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Management: Early Newborn Period: Discharge PreparationNursing Management: Early Newborn Period: Discharge Preparation
• Preparing for discharge
– Education
– Cultural considerations
• Follow-up care
– Return visit
– Warning signs and symptoms
– Immunization information