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Immediate Nursing Care of theNewborn
Prepared by:
Ms. Anafe B. Lanuzo RN
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Newborns undergo profound physiologic
changes at the moment of birth, as they are
released from a warm, snug, dark liquid-filed
environment that has met all of their basic
needs, into a chilly, unbounded, brightly lit,
gravity based outside world.
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Within minutes after being plunged into this
strange environment, a newborns body must
initiate respirations and accommodate a
circulatory system to extrauterine
oxygenation.
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How well the newborn makes these major
adjustments depends on his or her genetic
composition, the competency of the recent
intrauterine environment, the care received
during the labor and birth period, and the care
received during the newborn or neonatal
periodfrom birth through the first 28 days oflife. (Adele Pillitteri, 2007)
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Two thirds of all deaths that occur during the firstyear of life occur in the neonatal period. Morethan half occur in the first 24 hours after birth
an indication of how hazardous this time is for aninfant. Close observation of a newborn for thisindication of distress is essential during thisperiod (National Center for Health Statistics,
2005).
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Establish and Maintain a Patent Airway
1. Never stimulate a baby to cry unless secretionshave been drained out.
2. Mucus should be sustained from a newborns
mouth by a bulb syringe as soon as the head isdelivered.
3. As soon as an infant is born, he/she should beheld for a few seconds with the head lightly
lowered for further drainage of secretion.
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4 Suction the newborn properly:
1. Turn the babys head to one side
2. Suction gently and quickly.
3. Suction the mouth first before the nose.
4. Occlude one nostril at a time when testing for airway
patency.5. Record the first cry.
6. Maintain appropriate body temperature as chilling willincrease the bodys need for oxygen.
7. Newborn suffers large losses of heat because he is wet atbirth, the delivery room is cold he does not have enoughadipose tissues and does not know how to shiver.
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Keep Newborn Warm
Effects of Cold Stress
Metabolic acidosis
Hypoglycemia
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1. Dry the newborn immediately
2. Wrap him with a warm blanket but not too tightas not to compromise respiratory effort
3. Lay infant on his side in a warmed bassinet orplace under a droplight
4. Place a head cap to conserve heat especially ifthey are in an open crib.
5. All nursing care should be accomplished quicklyas possible to minimize exposure of the infant
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6 Apgar scorestandardized evaluation of the
newborns condition. Done at one minute
after birth to determine the general condition
and then at 5 minutes to determine how well
the newborn is adjusting to extrauterine life.
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1. Colorall infants appear cyanotic at birth and grow pinkwith or shortly after the first breath
2. Heart Rateauscultation of the newborns heart
3. Reflex irritabilityresponse to a suction catheter or
having the soles of their feet slapped.4. Muscle tonenewborn hold the extremity tightly flex.
They should resist any effort to extend their extremities
5. Respiratory efforta mature newborn usually criesspontaneously at about 30 seconds after birth. At one
minute, the infant is maintaining regular although rapidrespirations.
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Sign 0 1 2
Appearance: Color Pale, blue all over Pinky body, blue
extremities
Pink all over
Pulse: pulse rate absent Less than 100 More than 100
Grimace: reflex
irritability
Non response to
stimulation
Grimace/feeble cry
when stimulated
Sneeze/Coughs/Pull
s away when
stimulated; good
strong cry
Activity: Muscle
Tone
Limp, flaccid Some flexion of
extremities
Well-flexed
extremities
Respiration:
Breathing
Absent Weak or irritable Good, strong
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Scoring
0-3 pointsthe baby is serious danger and needimmediate resuscitation.
4-6 pointsthe babys condition is guarded andmay need more extensive clearing of the airwayand supplementary oxygen.
7-10 pointsare considered good and in the bestpossible health.
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Vital Statistics/Anthropometric
MeasurementsVital Statistic Average Low or arbitrary low
Weight 6.5 to 7.5 lbs Less than 5.5 lbs
Length 50 cms (20 in) 46 cms (18 in)
Head circumference 33 to 35 inches
Chest circumference 31-33 cms or 2cms less
than head circumference
Abdominal circumference 31 to 33 cms
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Vital signs
Vital sign Immediately at birth After birth
Temp 36.5 to 37.2 celcius
Pulse 180 beats/min 120-140 beats/min
Respiration 80 breaths/min 30-50 breaths/min
Blood pressure 80/46 mmHg 100/50 mmHg (by 10thday)
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Proper Identification and Charting
1. Proper identification of the newborn and footprints must be takenand kept in the chart.
2. Attach ID bracelet with a number that corresponds to themothers hospital number, mothers full name, sex, date and timeof birth.
3. Inspect for the presence of 2 arteries and 1 vein. Suspect acongenital anomaly if blood vessels are not complete.
4. Apply triple dye or Betadine for faster healing effect.
5. This is to cleanse the baby of blood mucus and vernix, and thenfollowed with sponge bath. Dry infant, wrap and keep him warm.
6. CredesProphylaxisprophylactic treatment of the newbornseyes against gonorrheal conjunctivitis aka opthalmia neonatarum,which the baby acquires as he passes through the birth canal ofthe mother who has untreated gonorrhea.
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Care of the Umbilical Cord Give Initial
Oil Bath Administer Eye Care
Procedure
1. Wipe the face dry.
2. Shade the eyes from light and open one eye at a
time by exerting gentle pressure on the upperand lower lids.
3. Apply Erythromycin/Terramycin Opthalmicointment from the inner to outer canthus of theeye. The antibiotic will eliminate gonorrhea andChlamydia as well.
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Administration of Vitamin K
Vitamin K facilitates production of the clotting
factor, thus preventing bleeding.
Method: Aquamephyton 1mg (Phytonadione), a
synthetic Vitamin K is injected IM into the lateral
aspect of the anterior thigh (vastus lateralis).
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Document Birth Record
Accomplish the form properly.
Continue Physical assessment
1. General Appearanceposition and activity
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2. Skin
1.a. Colorruddy complexion due to increased RBC concentration and
decreased subcutaneous fat which makes blood vessels more visible.
1. Acrocyanosis
2. Physiologic Jaundice
3. Textureslight desquamation for the first 2 to 4 weeks of life4. Skin Turgorgood elasticity
5. Vernix Caseosawhite cream-cheese like that serves as a skin lubricant
6. Miliapinpoint size white spots seen on the nose and chin due to
obstruction of the sebaceous glands.
7. Erythema Toxicumnewborn rash. It begins with a papule and
eventually to an erythematic appearance.
8. Lanugois the fine downy hair that covers a newborns shoulders, back
and upper arms.
9. Immature newborns have more lanugo than mature infant.
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9. Birthmarks
1. Hemangiomasare vascular tumors of the skin.
1. Nevus flammeusmuscular purple or dark red lesion.Generally appear on the face and thighs.
2. Strawberry hemangiomaselevated areas formed by
immature capillaries and endothelial cells.3. Cavernous hemangiomasthese are dilated vascularspaces.
4. Mongolian spotsslate gray patches across the sacrumor buttocks and consist of a collection of pigment cells.
5. Forceps marksthese are circular or linease contusionmatching the rim of the blade forceps on the infantscheeks.
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3. Headnewborns head is
disproportionately large
1. Fontanellesspaces or opening where the skullbones join
2. Moldingthe part of the infants head that engagesthe cervix. It is molded to fit the cervix contours.
3. Caput Succedaneumis edema of the scalp at thepresenting part of the head.
4. Cephalhematomais a collection of blood betweenthe periosteum of the skull bone and the bone itselfcaused by rupture of the periosteum capillary due tothe pressure of birth.
5. Craniotabesis a localized softening of the cranialbones.
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4. Eyesvision is present as evidence of blinking
reflex
5. Earshearing is present as soon as amnioticfluid is drained or is absorbed from the middle
ear.
6. Nosemay appear large for the face.7. Mouthshould open evenly when the baby
cries.
8. Neckis short and chubby, creased with skinfolds and head rotate freely.
9. Chestappear small in proportion to infants
head.
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1. Abdomencontour is slightly
protuberant (sticking out from the
surroundings)
2. Anogenital Areaanus should not be
covered by a membrane. Take note ofthe time meconium is first passed.
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1. Backthe spine appears flat in the lumbar and sacralareas
2. Extremities
1. Arms and legs appear short
2. Hands are plump and clinch into fists
3. Should move symmetrically
4. Fingernails are soft, smooth5. Good muscle tone, arms always in flexed position
6. Palm of hands should have three creases.
7. Legs are bowed as well short
8. Soles of the feet appears to be flat
9. Presence of crisscrossed lines on the soles of thefoot.
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3. Feeding
Provide Discharge Instructions
1. Breast-fed babies are fed immediately after birth and can be
fed on demand or at least every 2 hours for the first few days of
life. Advice to alternate both breast at 10-15 minutes each.
2. Bottle-fed babies routinely received an initial feeding of about
1oz of sterile water at 4-6 hours of age to be certain the infant
can swallow without gagging and aspirating. The newborn is
then fed every four hours.
1. Sleep patternsnewborns sleep 16-20 hours a day2.Bathingmay be given anytime convenient as long as it is
not within 30 minutes after feeding as handling might cause
regurgitation. Sponge baths are done until cord falls off.
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3. Cord Care
1. Dab rubbing alcohol (70% soln) two or threetimes a day for faster drying.
2. Fold down diapers so that cord does not get wet
during voiding.
3. Small, pink granulating area may be seen on the
day the cord falls off. If it remains moist or with
foul discharge, advise mother to bring baby to
the doctors clinic.4. Car Safety. Until a child reaches a weight of 20lbs,
the best type of car seat is an infant only seat that
faces the back of the car.
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References: Pillitteri, A. (2007).
Maternal and Child HealthNursing:Care of the Childbearing and
Childrearing Family. Winsconsin:Lippincott Williams & Wilkins.
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The end
Thank You!