Immediate Newborn Care: MCN 1

• Maternal and Child Care Nursing (MCN 1) covers well-client nursing.

Immediate Newborn Care (NBC)

• Newborns experience significant physiological changes at birth.
• Basic needs are met by the placenta.
• Newborns must initiate respiration and adapt their circulatory system to extrauterine oxygenation within minutes.
• Within 24 hours, neurological, renal, endocrine, gastrointestinal, and metabolic functions should operate competently.
• Major dependencies include genetic composition, competency of the intrauterine environment, care during labor and birth, and care during the neonatal period (birth to first 28 days of life).
• 2/3 of all first-year deaths occur in the neonatal period.
• National health goals related to the initial days of life are essential.
• Nurses play a major role achieved as they provide NBC instructions to new parents.

Physiology of the Neonate

• The first 24 hours are a vulnerable time for major physiological adjustments to extrauterine life.

Apgar Scoring

• Testing performance on a newborn immediately after birth.
• Checks FHR, muscle tone, and other signs to determine need for extra medical or emergency care.
• Given twice: At 1 minute and 5 minutes after birth.
• Additional tests are performed if further concerns are seen.
• Each assessment point is scored 0, 1, or 2.
• Considers appearance (skin color), pulse (heart rate), grimace (reflexes), activity (muscle tone), and respiration (breathing rate and effort).
• A score of 7 or above signifies good health.
• A score of 4 to 6 is considered moderately abnormal.
• A score of 0 to 3 is concerning and mandates immediate medical attention.

Immediate Care of Newborn: Early Essential NBC

• Involves assessment of the period of reactivity.
• Review of systems and adaptation to extrauterine life.

Transitional Stages

• During postnatal transition, there are six overlapping stages:
• Stage 1: Receives stimulation during labor and when membranes rupture.
• Stage 2: Encounters stimuli like light, cold, gravity, and sound.
• Stage 3: Breathing initiates.
• Stage 4: Fetal circulation changes to neonatal circulation. Foramen ovale closes and oxygenated blood is delivered from the lungs.
• Stage 5: Changes in metabolic processes occur, the liver is activated and the gastrointestinal tract allows passage of meconium. Vitamin K is injected to prevent bleeding.
• Stage 6: Metabolic processes reach a steady level.

Respiratory Changes

• Factors initiate respiration, for example Mechanical changes.
• Pressure alteration from intrauterine life to extrauterine life induces stimulation for breathing.
• Chemical changes involves lowered O2 and increased CO2 levels, monitored using the APGAR scale
• Stimulation comes from sensory input as the infant is touched and dried.
• THERMAL DROP occurs in environment.
• FIRST BREATH needs maximum effort to gill collapsed alveoli
• Surface tension in the respiratory tract and resistance in lung tissue, thorax, diaphragm, & respiratory muscles must be overcome.
• Inspiration is caused created by diaphragm contraction.
• Rapid absorption of all fluid occurs if the pulmonary capillary blood flow is adequate.

Character Of Normal Respirations

• FIRST PERIOD OF REACTIVITY features vigorous movements alternating with relative immobility, occurring immediately after birth.
• RESPIRATIONS are frequently rapid, may reach 80 bpm, accompanied with tachycardia (140-180 bpm).
• RELAXATION & SLEEP happens the infant sleeps, neonates may awaken to a second period of activity. Oral mucus can be an issue.
• REDUCTION OF RESPIRATIONS are usually 35-50 bpm & becomes quiet & shallow, performed by diaphragm & abdominal muscles DYSPNEA & CYANOSIS occurs suddenly in is breathing normally, may indicate anomaly/pathologic condition
• APNEA is considered normal in the neonatal period & lasts 10-15 secs.

Circulatory Changes

• Anatomic changes occur
• Blood Volume is 85-100 mL/kg at birth.
• Factors influencing blood volume include maternal blood volume, placental function, uterine contractions during labor, and amount of blood loss at delivery.
• Placental transfusion at birth increases 60% if cord is clamped and cut after pulsation ceases.
• PERIPHERAL CIRCULATION : Acrocyanosis occurs up to 1-2 hours after birth due to sluggish circulations
• PULSE RATE follows with respiration. Accuracy of apical pulse rate is higher. Normal rate is 80-160 bpm.
• BLOOD PRESSURE is 10/45 mmHg at birth & rises to 100/50 mmHg by day 10.
• Systolic BP in the upper extremities, is over 20mmHG which is a sign of COARCTATION OF THE AORTA
• coagulation temporarily diminishes due to lack of bacteria in intestinal tract- contributes to synthesis of Vit. K: coagulation -3 to 4 times and bleeding- 2to 4 times.
• blod elements are hemoglobin 16-22 g

Temperature Regulation

• The is not since heat production is low- important to avoid hypothermia- decreases bilirubin/ brain damage
• infant respond ready to enviornments RADIATION CONVECTION EVAPORATION CONDUCTION
• blood vessels close to the skin increase heat loss _ infant development mechanisms

Heat Production By No Shivering

• SHIVERING THERMOGENESIS, elicited sympathetic
• fetal positions at flexed postion

Bassal Metabolism

• surface are is especially lage in comparison to wwight basal metabilm per kg higher than adults clorie is higher

Renal Functions

• low arterialBP
• decreas ability to concentrat
• excreting water
• electrolyte
• excretion of amounts

Heptic Function

-functiions a limit due to lack Gl tract activity limited blood supply conjugte bilirubin for pyshiologic jandice glucose regulated by hypoglycernia depend on vitamine K to perdisposition

Edocrine Function

• disturbances due to hormones may cause:
• vaginal discharge with blood in female infantis's bleeding Enlargement of mammary for breast feeding Pathology: Dm and inadeque iodine gastrointestinal is Proportional lylonger- elastic tissue Enzymes present
• low intake and absorption for poor health Limititations relate to structures and nuetrility Peristaltic motily slow Frequnt stoold Neurologic changes ad system immitature mechanistums due to developped anatony.

Reflexes

• protective nautre blink cough sneezze gag in protocetive inture Rootig suckign moro Extremitits Elxtremetirs for fractures
• examining tips to check dislocation
• Examining feet structural Integumentary is milia acne and dradle cap. Immune system breastmin and 6 month can shiver promoting health maintenance

Feedng Patters

• Mosts neonatesa eat 6-8 daily feeding
• caliries req high
• enzyme present imperfeect -immitity in reugurg

Slepping Patterns

Health Education

• Amnerican pediaactrics and Obstetrician
• family is inpportant-
• home health personelle is conducted

Health concerns

• thorough based nowledge
• potential compications
• Nursing int for post martum

Group Ages

• NB0-immediatly
• infany and toddler
• ertime- 3 to 6 yr old
• school age and adolescense
• adolescence is 217 or 13 yr olld to adultg

Definition of temrs

Abstract thoughts possisble the other way

• accomadatoin- changing it to fiix theri existing idea Animais, objects
• assmilation- to existing schemas converstaion- Discerns throug
• developmental -
• Erocentrism-
• Reveribility-
• Threory-

Waisys measurments

5 areas: pyhsical emoitial Infant acitivity from 1 years to 5

Adolescent stages

Principles Of Groth

• Continuous/ devleoppment
• developmment at patternn Cehalo - proximo General

All Aspects Of Growth

3 interrelated- correlated by each other 4 .countinous 5 accelerated - 6 grough

Each Phasse is development

11 is optimal time 11. Development - learn by partic

Manjor infulencing grouth

1. Genetic
2. Gender
3. Healtt
4. Intellignece 5 . Envioment-

Temeraments easy child, Difficult,

Categories of personlaity

• develoopmet mental-
• Strucuctreu is ID, ego Heredtity

Frueds psychicanalylc

Theories: develpoments of humasn Erikson'd pyhsico

Yound adylts

1 . intmiarion Vs isolatoin

• middle age
• older atdul-t

Pigefts thery cogintve dev

Compoentss are

Preadolescent vs school-ager