Maternal Newborn Nursing: Newborn Care PDF

THE NEONATE Inge Luce, MSN/Ed, RN-C, Paramedic Week 13 Content Chapters 15-17  Postpartum Care of the Neonate Inge Luce, MSN/Ed, RN, NRP This Photo by Unknown Author is licensed under CC BY-SA-  The Neonate NEONATE: Birth-28 days Go...

THE NEONATE Inge Luce, MSN/Ed, RN-C, Paramedic Week 13 Content Chapters 15-17  Postpartum Care of the Neonate Inge Luce, MSN/Ed, RN, NRP This Photo by Unknown Author is licensed under CC BY-SA-  The Neonate NEONATE: Birth-28 days Goals of Neonatal Nursing Care: Infant 29 days- 1 year Maintain body heat and respiratory function Decrease risk of infection Teach and support parents Nutrition, Hydration, Care  Defining the neonate GESTATIONAL AGE SIZE RELATED TO AGE Preterm AGA- Appropriate Gestational Very premature 2500 g Very low birth weight >1500 g Post-term (postmature) Extremely low birth weight >1000 After 42 weeks g IMMEDIATE CHANGES AFTER BIRTH CHEST IS COMPRESSED CORD STOPS PULSATING RESPIRATIONS ARE STIMULATED TRANSITIONS FROM FETAL TO “NORMAL” CIRCULATION This period is also the beginning of transitioning from intrauterine to extrauterine life, or when extrauterine life “begins” Cold stress Hypothermia (less than 36.5) Will attempt to maintain temperature through Activity Vascular constriction Brown fat metabolism Hypoglycemia and hypothermia are interrelated Treat a glucose less than 40 Cold stress Hypoglycemia = capillary glucose 4500g) SGA/Preterm Hypothermia – Cold Stress Stress (illness, injury, CPR, respiratory distress) Signs/symptoms: Jittery, irritable, unstable temperature Lethargy, hypotonia, apnea PROPHYLAXIS Normal Neonatal Assessment FLEXED POSTURE PINK SKIN, ACROCYANOSIS FONTANELS FLAT OUTER CANTHUS OF EYE/EAR LUNGS: SCATTERED CRACKLES IRREG RESPIRATIONS 30-60 HEART: 110-160, REGULAR (slightly irreg ok) ABD: SOFT, ROUND, CORD (ava) RECTUM/GU PATENT (stool/urine) BACK: SPINE, GLUTEAL FOLDS, SACRUM REFLEXES  Respiratory Distress Tachypnea >60, tachycardia >180 Accessory muscle use, Other S/S to DANGER retractions See-saw/paradoxical Document and breathing SIGNS ! Nasal flaring, grunting Report Abdominal Gray/dusky skin distention Hypotonia No Meconium in 48 hours Cold Stress No urine in 24 Temp less than hours 97.7F/36.5C Jaundice in under Pale/gray, cool skin Lethargy/hypotonia/ 24 hours weak suck Tachypnea/grunting Hypoglycemia/ jitteriness Treat threats to ABC and get help circumcisio n Pain management: Sucrose and non-nutritive sucking Start 2 minutes before Lasts 5-7 minutes per dose Tylenol 1 hour before 24 hours afterwards Wound care: Vaseline gauze Monitor for bleeding or infection NEONATAL ABSTINENCE SYNDROME Swaddle Sway Sideways position Shush Suck  GROUP B STREP Screened at 35-37 weeks If treated= 24 hour obs If not treated= 48 hour obs MENINGITIS SEPTICEMIA Petechiae/Rash, Grunting, Fever, Tachycardia, Tachypnea, Hypoglycemia WBC to determine severity Blood culture for diagnosis Antibiotics to manage infection  Covid 19 Transmission—droplet Vertical transmission—rare Symptoms—usually mild or absent Treatment— Supportive Remdesivir– 28 days and older and at least 3 kg If hospitalized, or Not hospitalized but at high risk for severe illness Testing—at 24 & 48 hours if mom has suspected or confirmed Covid Isolation from mom—only if mom or baby are ill and unstable Precautions--if suspected or confirmed Covid, mom wears mask, education on spread of infection This Photo by Unknown Author is licensed under CC BY-SA-NC 16  Phenylketonuria (PKU) Unable to metabolize phenylalanine (phe) Can cause an accumulation of metabolites that result in BRAIN DAMAGE and DEATH Test after feeding is established (ideally 2- Newborn 5 days) Heel stick: Warm heel 10 minutes with moist cloth, use lateral aspects of heel (avoid nerves) screenin Tx: Lofenalac ® formula g- PKU lifelong dietary restrictions Monitor labs (phe levels) Medications: Kuvan (oral) and Palynziq (injection) NEWBORN SCREENING- JAUNDICE prematurity As & Bs of prematurity: APNEA and BRADYCARDIA Hypoxia= Acidosis= Bradycardia= Cardiovascular collapse and death Apnea monitors Prematurity apnea 10-15 seconds can be a normal finding (intermittent) Very premature may have apnea of >20 seconds- DANGER! Kangaroo care (skin to skin) promote early BF, temp stabilization, bonding  Respiratory Distress Syndrome (RDS) Neonatal Decreased surfactant and small alveoli = atelectasis problems Bronchopulmonary Dysplasia (BPD) associate Chronic lung d/o due to mechanical ventilation and oxygenation d with PPV and O2= pulmonary fibrosis, prematuri atelectasis, pulmonary edema is possible Retinopathy of Prematurity ty (ROP) Hemorrhage/Retinal detachment from oxygen, stress, injury, edema  Pulmonary surfactant Function of surfactant Test used to evaluate lung Pathophysiol maturity Respirato ogy Phosphatidylglycerol (PG) Lecithin/sphingomyelin (L/S) ry ratio Atelectasis Distress Syndrom e (RDS) Complication s of RDS Patent Ductus Arteriosus (PDA) Pathophysiolo Risk factors Complication gy for PDA s of PDA NECROTIZIN G ENTEROCOLI TIS MECONIUM ASPIRATIO N SYNDROM E DISCHARGE PLANNING AND TEACHING Preparing the parents for a successful transition to home FAMILY Discharge planning and teaching Teaching should be individualized and reflect the specific needs of the newborn and parents. Topics to be taught include nutrition/hydration, and newborn care Safety/Care: Abusive head trauma Bathing Never leave a child alone in/with/near any water! Circumcision and Cord care Diapering Feeding/sucking/soothing/swaddling Follow up  Breast Feeding Bottle Feeding Infants have growth spurts Prolactin- lactation Solids at 4-6 months Oxytocin- let down  Parents should be instructed to call the physician or seek medical care for: Temp above 100.4F Poor feeding Decreased stool or wet diapers Lethargy DANGER Green watery stools Vomiting SIGNS! Rash Bulging or sunken fontanels S/S of infection cord, circumcision site Fever, tachypnea, grunting, tachycardia See-saw or paradoxical breathing