Nursing Care of a Family With a Newborn PDF

Module 2.4 Nursing Care of a Family With a Newborn Lecture Slides in PPT Modified by Sheila Mae L. Manlegro Learning Objectives ❖Differentiate between the terms growth and development ❖Describe principles related to growth and development ❖Describe the normal characteristics of...

Module 2.4 Nursing Care of a Family With a Newborn Lecture Slides in PPT Modified by Sheila Mae L. Manlegro Learning Objectives ❖Differentiate between the terms growth and development ❖Describe principles related to growth and development ❖Describe the normal characteristics of a term newborn. ❖Assess a newborn for normal growth and development. Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Growth: Physical change and increase in size. Copyright © 2018 Wolters Kluwer · All Rights Reserved  Indicators: 🞂 Height, Weight, Bone size, Dentition, Sensory adaptation, and Development of sexual organs and characteristics. 🞂 Very rapid growth rate during prenatal, neonatal, infancy and adolescence. Copyright © 2018 Wolters Kluwer · All Rights Reserved 🞂 Increase in complexity of function and skill progression. Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved 1. Growth and development are continuous processes from conception until death. 2. Growth and development proceed in an orderly sequence. 3. Children pass through the predictable stages at different rates. 4. All body systems do not develop at the same rate. 5. Development is cephalocaudal. Copyright © 2018 Wolters Kluwer · All Rights Reserved 6. Development proceeds from proximal to distal body parts. 7. Development proceeds from gross to refined skills. 8. There is an optimum time for initiation of experiences or learning. 9. Neonatal reflexes must be lost before development can proceed. 10. A great deal of skill and behavior is learned by practice. Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved  Genetics Gender Health Intelligence Temperament Copyright © 2018 Wolters Kluwer · All Rights Reserved Profile of a Newborn #1 Copyright © 2018 Wolters Kluwer · All Rights Reserved Heat Loss in the Newborn Copyright © 2018 Wolters Kluwer · All Rights Reserved Profile of a Newborn #2 ❖Physiologic function o Cardiovascular system ▪ Blood values ▪ Blood volume – 300 mL ▪ Hgb – 17 to 18 g/100mL ▪ Hct – 45% - 50% ▪ RBCs – 6 million cells/mm3 ▪ WBCs – 15,000 to 30,000 cells/mm3 ▪ Blood coagulation ▪ Vitamin K o Respiratory Copyright system © 2018 Wolters Kluwer · All Rights Reserved Profile of a Newborn #4 ❖ Physiologic function—(cont.) o Gastrointestinal system ▪ Stools Usually passed within 24 hours Consist of meconium o Urinary system ▪ Newborn voids within 24 hours after birth ▪ Specific gravity – 1.008-1.010 (1.010 to 1.020, normal in adults) ▪ Urinary output 30 to 60 mL (1 to 2 days) 300 mL (1st week) o Immune system ▪ Born with Passive antibody – IgG Copyright © 2018 Wolters Kluwer · All Rights Reserved Profile of a Newborn #5 ❖Physiologic function—(cont.) o Neuromuscular system ▪ Blink reflex ▪ Rooting reflex ▪ Sucking reflex ▪ Swallowing reflex Copyright © 2018 Wolters Kluwer · All Rights Reserved Profile of a Newborn #6 ❖Physiologic function—(cont.) o Neuromuscular system—(cont.) ▪ Extrusion reflex ▪ Palmar grasp reflex ▪ Step-in-place reflex ▪ Placing reflex ▪ Plantar grasp reflex Copyright © 2018 Wolters Kluwer · All Rights Reserved Palmar Grasp Reflex Copyright © 2018 Wolters Kluwer · All Rights Reserved Step-in Place Reflex Copyright © 2018 Wolters Kluwer · All Rights Reserved Profile of a Newborn #7 ❖Physiologic function—(cont.) o Neuromuscular system—(cont.) ▪ Tonic neck reflex Also called boxer or fencing reflex ▪ Moro reflex Also called startle reflex ▪ Babinski reflex ▪ Magnet reflex ▪ Crossed extension reflex ▪ Trunk incurvation reflex o Magnet, crossed extension and trunk incurvation reflexes are tests of spinal cord integrity Copyright © 2018 Wolters Kluwer · All Rights Reserved Tonic Neck Reflex Copyright © 2018 Wolters Kluwer · All Rights Reserved Moro Reflex Copyright © 2018 Wolters Kluwer · All Rights Reserved Babinski Reflex Copyright © 2018 Wolters Kluwer · All Rights Reserved Trunk Incurvation Reflex Copyright © 2018 Wolters Kluwer · All Rights Reserved  Profile of a Newborn #8 ❖Physiologic function—(cont.) o Neuromuscular system—(cont.) ▪ Landau reflex ▪ Deep tendon reflex Patellar reflex Biceps reflex Both a patellar and a biceps reflex are intact in a newborn Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved  Profile of a Newborn #9 ❖ Senses o Hearing ▪ Becomes acute within hours after birth as soon as AF is absorbed from the middle ear by way of eustachian tube ▪ NB appears to recognizes mother’s voice o Vision ▪ Pupillary reflex is present from birth ▪ NB cannot follow objects past the midline and focuses on black and white objects at 9 to 12 in distance o Touch ▪ Well developed at birth o Taste ▪ NB has the ability to discriminate taste o Smell ▪ Sense of smell is present in NB as soon as the nose is cleared from secretions Copyright © 2018 Wolters Kluwer · All Rights Reserved Profile of a Newborn #10 Copyright © 2018 Wolters Kluwer · All Rights Reserved Assessing a Newborn #1 Copyright © 2018 Wolters Kluwer · All Rights Reserved Assessing a Newborn #5 Appearance of a Newborn ❖Skin o Color ▪ Cyanosis ▪ Hyperbilirubinemia ✓Physiologic jaundice ✓Kernicterus or acute bilirubin encephalopathy ▪ Pallor ▪ Harlequin sign Copyright © 2018 Wolters Kluwer · All Rights Reserved Assessing a Newborn #6 ❖Skin—(cont.) o Birthmarks ▪ Hemangiomas ▪ Mongolian spots Copyright © 2018 Wolters Kluwer · All Rights Reserved Types of Hemangioma Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Assessing a Newborn #8 ❖Skin—(cont.) o Vernix caseosa – white, cream cheese-like substance o Lanugo – fine, downy hair o Desquamation – dryness in the NB skin o Milia – pinpoint white papule on cheeks or across the bridge of the NB’s nose o Erythema toxicum ▪ Skin rash of most term NBs ▪ Also called flea-bite rash o Forceps marks o Skin turgor – NB skin should feel resilient if the underlying tissue is well hydrated Copyright © 2018 Wolters Kluwer · All Rights Reserved Milia Copyright © 2018 Wolters Kluwer · All Rights Reserved Erythema Toxicum Copyright © 2018 Wolters Kluwer · All Rights Reserved Forceps Marks Copyright © 2018 Wolters Kluwer · All Rights Reserved Lanugo Copyright © 2018 Wolters Kluwer · All Rights Reserved Desquamation Copyright © 2018 Wolters Kluwer · All Rights Reserved Vernix Caseosa Copyright © 2018 Wolters Kluwer · All Rights Reserved  Assessing a Newborn #9 ❖Head o Fontanelles o Sutures o Molding o Caput succedaneum – edema of the scalp o Cephalohematoma – collection of blood between periosteum of a skull bone o Craniotabes ▪ Localized softening of the cranial bones ▪ Normal in NBs Copyright © 2018 Wolters Kluwer · All Rights Reserved Molding Copyright © 2018 Wolters Kluwer · All Rights Reserved Caput Succedaneum and Cephalohematoma Copyright © 2018 Wolters Kluwer · All Rights Reserved Assessing a Newborn #10 ❖Eyes o Subconjunctival hemorrhage ❖Ears o Low set ears indicates chromosomal abnormalities ❖Nose o Test for choanal atresia (blockage at the rear of the nose) ❖Mouth o Epstein pearls o Thrush – white or gray patches on the tongue and sides of the cheeks caused by a Candida infection o Nasal teeth ❖Neck o Short with creased skin folds in NBs o Head lag is common ❖Chest o Witch’s milk o Retraction should not be present Copyright © 2018 Wolters Kluwer · All Rights Reserved Epstein Pearls Copyright © 2018 Wolters Kluwer · All Rights Reserved Subconjunctival hemorrhage Copyright © 2018 Wolters Kluwer · All Rights Reserved Sternal retractions Copyright © 2018 Wolters Kluwer · All Rights Reserved Assessing a Newborn #11 ❖Abdomen o Slightly protuberant ❖Anogenital area o Male genitalia ▪ Assess for cryptorchidism (undescended testes), epispadias (tip of the penis is on the dorsal surface), and hypospadias (tip of the penis is on the ventral surface) o Female genitalia ▪ Pseudomenstruation – caused by maternal hormones ❖Back o Inspect for the position, spine, dermal sinus or spina bifida occulta ❖Extremities o Assess for simian crease, syndactyly, polydactyly, clonus, clubfoot Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Simian Crease Copyright © 2018 Wolters Kluwer · All Rights Reserved Syndactyly Copyright © 2018 Wolters Kluwer · All Rights Reserved Polydactyly Copyright © 2018 Wolters Kluwer · All Rights Reserved Clubfoot Copyright © 2018 Wolters Kluwer · All Rights Reserved Assessing a Newborn #12 ❖Laboratory studies (Dependent on health agency policy) o Hematocrit ▪ Normal – 50% to 55% at 1 hour of life o Hemoglobin ▪ Normal – 17 to 18 g/100 mL o Hypoglycemia ▪ Glucose levels higher than 40 mg/100 mL is considered normal in NB Copyright © 2018 Wolters Kluwer · All Rights Reserved Assessing Family Readiness to Care for Newborn at Home ❖Daily home care ❖Sleep patterns ❖Crying ❖Parental concerns related to breathing ❖Health maintenance ❖Car safety Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Nursing Care of a Newborn at Birth #1 ❖Identification and registration o Identification band o Birth registration o Birth record documentation Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Copyright © 2018 Wolters Kluwer · All Rights Reserved Nursing Care of a Newborn at Birth #2 ❖Ineffective thermoregulation o Keep infant warm and dry o Skin-to-skin contact ❖Ineffective airway clearance o Promote adequate breathing pattern o Prevent aspiration o Record first cry Copyright © 2018 Wolters Kluwer · All Rights Reserved Nursing Care of a Newborn at Birth #3 ❖Risk for infection o Inspect, care of umbilical cord o Administer eye care o Infection precautions Copyright © 2018 Wolters Kluwer · All Rights Reserved  Nursing Care of Newborn and Family in the Postpartal Period ❖Initial feeding ❖Bathing ❖Sleeping position o Place infant on the back to sleep ❖Diaper area care ❖Metabolic screening tests Copyright © 2018 Wolters Kluwer · All Rights Reserved Nursing Care of Newborn and Family in the Postpartal Period ❖Hepatitis B vaccination ❖Vitamin K administration ❖Circumcision o Surgical removal of the foreskin of the penis o Except for a baby with phimosis (constriction) of the foreskin Copyright © 2018 Wolters Kluwer · All Rights Reserved Nursing Diagnoses: Newborn Period ❖Ineffective airway clearance related to mucus in the airway ❖Ineffective thermoregulation related to heat loss from exposure in the birthing room ❖Imbalanced nutrition, less than body requirements, related to poor sucking reflex ❖Readiness for enhanced family coping related to birth of planned infant ❖Health-seeking behaviors related to newborn needs Copyright © 2018 Wolters Kluwer · All Rights Reserved Outcomes: Newborn Period ❖Infant establishes respirations of 30 to 60 breaths/min. ❖Infant maintains temperature at 97.8° to 98.6°F (36.5° to 37°C). ❖Infant breastfeeds well with a strong sucking reflex. Copyright © 2018 Wolters Kluwer · All Rights Reserved  Reference ❖Silbert-Flagg, J. & Pillitteri, A. (2018). Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. 8th Edition. Wolters Kluwer. Copyright © 2018 Wolters Kluwer · All Rights Reserved Thank You. Copyright © 2018 Wolters Kluwer · All Rights Reserved