nursing care of newborn baby
The umbilical cord area and any broken skin should be assessed daily for redness, warmth, or purulent discharge. The tape should not be pulled out from under the infant to avoid giving a paper cut. When a newborn is feeding poorly, determine the reasons and intervene appropriately. Nicholas will maintain a patent airway and show no signs of respiratory distress throughout the birth facility stay as demonstrated by respiratory rates of 30 to 60 breaths per minute, clear breath sounds, and no cyanosis, retractions, flaring, or grunting. It is given intramuscularly in the midanterior thigh (the vastus lateralis muscle) where the muscle development is adequate. Interpret instructions for parents about newborn stools and voiding patterns. 2. If possible, each trainer and each participant should be given a copy of the Reference Manual for use during the training and to keep afterwards. Show her how to look at him and change his diaper while exposing only small areas of his body at a time.This helps decrease heat loss by convection and radiation. Parents will identify methods of preventing or reducing jaundice when at home. Assess the infant’s response to interventions by taking his axillary temperature every 30 minutes until it is once again stable for 2 hours.Frequent assessment determines if further interventions are needed. Remove the tape by rolling or lifting the newborn. Answer parents’ questions about bilirubin testing and care. 3. If using a self-adjusting electronic scale, ensure the readout is at zero. What expanded assessments are necessary? A new born baby is very delicate and needs special attention and care. 11. Compare measurements with normal range for a term newborn: head, 33 to 35.5 cm (13 to 14 inches); chest, 30.5 to 33 cm (12 to 13 inches). 8. • Caregivers should wash their hands again before touching the common nursery equipment or another newborn to avoid cross-contamination. Compress the bulb before inserting it into the mouth. Assist formula-feeding mothers to give the bottle. • Describe the care of circumcised and uncircumcised male infants. Appearance • Describe collaborative interventions for hypoglycemia. Prophylaxis against gonococcal ophthalmia neonatorum, an infection that can cause blindness, is required for all newborns. Until the 1970s, preemies were identified mainly by birth weight. The hands must always be cleaned, with either soap and water or an alcohol-based hand sanitizer, before and after contact with a newborn or any soiled surface. Some newborns are fat and short while some are long and thin. Skin-to-skin (, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window). A healthy infant's lungs are developed at birth. Discuss the nursing responsibilities concerning the care of the newborn infant. Assess the temperature more often if it is abnormal. Place tape under the head and over the prominent part of the occiput and above the ear and eyebrows. Signs of newborn infection include poor feeding, lethargy, and periods of apnea. Before the birth, prepare a neutral thermal environment with a radiant warmer to use during initial assessments (Figure 22-2). Although nurses know that regurgitation, gagging, and brief episodes of cyanosis are normal during this time, these may be very frightening to the mother. Coordinate with social worker or case manager to determine family home needs and support system. Help mothers wake sleepy infants to feed, and encourage them to spend extra time with an infant with a poor suck. Assessment of the newbornimmediately starts the moment he or she is delivered, and there are a lot of standard assessments used to evaluate them rapidly. 4. Caregivers should wash their hands again before touching the common nursery equipment or another newborn to avoid cross-contamination. Teach both parents how to use the bulb syringe correctly. Provide reassurance for Vicki.This will help allay her worry that something is wrong. This Care of the Newborn Training Guide is based on the Care of the Newborn Reference Manual (referred to as the “Reference Manual”). Glucose water alone is not recommended for newborns because the rapid rise in glucose results in increased insulin production, causing a further drop in blood glucose. Explain to Vicki why newborns have problems with thermoregulation. Many facilities require all personnel who have direct contact with newborns to perform a 3-minute scrub (hands to elbow) procedure at the beginning of each shift. Implement nursing care of a normal newborn, such as administering a first bath or instructing parents on how to care for their newborn. Three phases of newborn care are discussed that span from the immediate neonatal period until the infant has stabilized in the transition to extrauterine life. It is best that infants be on a demand feeding schedule, not a routine schedule. • Explain the types and importance of newborn screening tests. What are the nursing priorities in this situation? Assist the breastfeeding mother with the first feeding. Continue to observe Nicholas for signs of respiratory distress. One dose of vitamin K intramuscularly within the first hour after birth, prevents bleeding problems until the infant is able to produce the vitamin independently. Demonstrate and explain use of the bulb syringe. Hold the tube in a horizontal rather than a vertical position to prevent injury to the eye from sudden movement. Describe pain assessment and control in the newborn. Suction and apply oxygen if needed.Cold stress increases oxygen need. 6. Assess for jaundice every 8 to 12 hours along with vital signs. Although the injection is usually given within an hour, it can be delayed until the infant has finished breastfeeding in the delivery room (American Academy of Pediatrics [AAP] & American College of Obstetricians and Gynecologists [ACOG], 2007). Nursing Considerations: Cleanse the infant’s eyes as needed before application. Untreated pain in the preterm or term newborn or in early infancy can have long-term effects because pain pathways and structures required for long-term memory are well developed by 24 weeks’ gestation. The infant’s axillary temperature rises to 37° C (98.6° F) and remains stable during his birth facility stay. New Born Baby Care. Immediate care of a newborn following delivery is a must. The infant may be unwrapped or wearing wet clothing. An electronic scale displays weight both in pounds and ounces and in grams. About 80% of newborn baby’s require minimal care. • Discuss important considerations in parent teaching. Rooming in promotes better emotional bondage, and establishes breastfeeding easily. Continue teaching her about thermoregulation while she holds the baby. Note the barrier placed under the newborn and the nurse’s hand held above the newborn for safety. Nurses must intervene before this happens. Discuss the nursing responsibilities concerning the care of the newborn infant. Vicki uses the bulb syringe to suction the infant appropriately within 4 hours of t he birth. Assess the infant’s response to interventions by taking his axillary temperature every 30 minutes until it is once again stable for 2 hours. Cold stress is discussed in Chapter 9. Balance scale to zero after a barrier is placed on the scale. Effective within 1 to 2 hours. Cord care is completed with every diaper change per facility protocol. But remember this while you are nursing your newborn the first week and things are a little challenging: You and your baby are just meeting for the first time. Ninety-nine percent of all births were registered on official birth certificates in 1998 (Northam & Knapp, 2006). Discuss care of the circumcised and uncircumcised penis. (See Chapter 38 for administration of injections to infants.). After transfer to an open crib, assess Nicholas’ temperature every 30 to 60 minutes until it is stable. *Some hospitals use triple dye, alcohol, or other solutions per facility policy. An electronic scale displays weight both in pounds and ounces and in grams. • Describe methods to protect newborns by proper identification. This is transient soit will typically resolve itself within 24 to 48 hours. There are a lot of things that go into the care of the child when just born- the breathing of the child, sleeping, baby’s first breath and more. The newborn is wrapped warmly and placed in a bassinet. Send the syringe home with the infant so the parents can use it if the infant experiences a problem. A clinical pathway indicates specific care given over a specified period that is related to a planned outcome. Newborns are at greater risk for hypothermia than adults are because they have a higher body surface area to body mass ratio, higher metabolic rate with limited metabolic stores, and immature thermoregulation mechanism. Pay particular attention to preterm and late preterm infants because parents may not realize the increased risk for jaundice. If the mother is infected, the infant needs additional antibiotics because routine prophylactic treatment may not completely prevent infection. Cover the scale with a barrier, such as a paper pad, to prevent conductive heat loss from a cool surface; this also helps prevent cross-contamination. Document in newborn’s medical record. Absorption: Readily absorbed after intramuscular injection. 3. Hypothermia can cause increased cell metabolism, increased oxygen consumption, hypoglycemia, and other complications in the newborn and should be actively prevented. 11. Infants who need treatment for hyperbilirubinemia are discussed in Chapter 30. Several pain assessment tools are available: CRIES: A 10-point scale used postoperatively in newborns at 32 or more weeks’ gestation that assesses facial expression, cry, movement of arms and legs, consolability, and oxygen saturation (C= cry; R = requires oxygen; I = increased vital signs; E = expression on face; S = sleeplessness), PIPP: A preterm infant pain profile based on scales similar to the CRIES scale, NIPS: A neonatal infant pain profile based on scales similar to the CRIES scale, N-PASS: A neonatal pain, agitation, and sedation scale that considers the above criteria in addition to behavior and is a reliable and valid assessment tool, even for preterm infants on ventilators. Ineffective Airway Clearance related to excessive cheek secretions in airways. Suction the mouth first to avoid aspiration if the infant gasps when the nose is suctioned. 2. The ointment is placed so that it reaches all areas of the conjunctival sac (see Skill 7-9). 14. The weight of newborns varies according to their race, genetics, and nutritional factors. • Explain the risks and benefits of circumcision. • Any person who has an infection should not be admitted to the maternal-newborn area. Place Nicholas, wearing only a diaper and a cap, next to Vicki’s skin. Notifying the physician about signs of hypoglycemia, or following hospital protocol and then notifying the physician. 5. Infants with severe hypoglycemia may need intravenous feedings to provide glucose rapidly. Show her how to look at him and change his diaper while exposing only small areas of his body at a time. Healthy newborns (age birth to 1 month) and infants (age 1 month to 1 year) need good care to ensure their normal development and continued health. If Nicholas becomes jittery or lethargic, check blood sugar according to birth facility routine.Nonshivering thermogenesis may cause hypoglycemia. 1. Explain that giving water to jaundiced infants does not stimulate stool excretion and should be avoided. This method is useful when the newborn is extremely active. Vicki will verbalize and practice methods of preventing heat loss by the end of the first day. If the condition of your baby is getting complicated then its recommended to take the baby for instant medication right away. If the blood sugar is low, help the mother breastfeed him or use formula.Feeding provides calories for heat production. Avoiding cross-contamination is an important objective in newborn care. Infants often gasp when the nose is suctioned and might aspirate secretions in the mouth if it is not cleared first. Observe Vicki’s use of the bulb syringe and make suggestions as needed. Adverse Reactions: Burning, itching. Demonstrate and explain use of the bulb syringe. For most infants, breastfeeding or giving formula is sufficient. 2. Can parents describe what they will look for regarding jaundice and when to call the caregiver? If you have just delivered a baby and is in search of a trained and trustworthy newborn nursing care then do get contact with us. 9. Although hypothermia can be a sign of a central nervous system (CNS) infection or metabolic anomaly, about 20% of all normal newborns are seen with hypothermia, and about 50% of newborns have one or more episodes of hypothermia in the first 72 hours of life (Li, Sun, & Neubauer, 2004). Then, placing a finger and thumb near the edge of each lid, the nurse gently presses against the periorbital ridges to open the eyes, avoiding pressure on the eye itself. Keep the bulb syringe in the crib near the infant’s head, where it is available if needed quickly. Do not compress the bulb while it is in the infant’s mouth or secretions in the bulb will be expelled back into the mouth. Warm stethoscopes and clothing before using them. Gently insert the syringe tip into the side of the infant’s mouth. Reinforce teaching about identification of jaundice and importance of feedings and stooling. The introduction of objective measures to assess the newborn premature baby further refined approaches to care. accuracy of the initial measurement. Appropriate assessment of the newborn is crucial immediately if there is a concern or can wait until initial hour of skin to skin; Nursing Points GENERAL. Provide Women, Infants, and Children (WIC) or clinic referral and lactation consultant. Give it time. Any discharge from the eyes, especially if it is purulent, should alert the nurse to the possibility of infection. Keep the physician or nurse practitioner aware of the newborn’s status. Continue teaching her about thermoregulation while she holds the baby.Skin-to-skin contact warms the infant. His mother frequently removes his blankets to admire him and leaves him unwrapped after changing his diaper. Radiant warmers allow easy access to the infant without increasing heat loss caused by exposure. The major early assessments and care of the hepatic system are related to blood glucose levels and bilirubin conjugation. 1. Then the upcoming 24 Hours are a vital time in which the baby adjusts all operating systems of his body like the neurological system, metabolism, etc. There are some practical safety tips available from HealthyChildren.org, including: Verify that the infant car seat is properly installed. Some electronic scales will read “stable” when an accurate weight is obtained. Wrap infants in blankets, and use a stockinette or insulated hat to prevent heat loss from the large surface area of the head. Position the infant’s head to the side to allow secretions to pool in the cheek and suction with a bulb syringe as needed. Note the length at the bottom of the newborn’s heel. Erythromycin (0.5%) ophthalmic ointment (Figure 22-1) is most commonly used. Our normal newborn respirations are 30-60 so these babies breathe over 60 per minutes. APGAR scoring; Unless the baby is unstable, the newborn should be placed skin to skin with the mother immediately after delivery; ASSESSMENT.