The Newborn PDF

THE NEWBORN 081-NP03L008 ELO A · VERSION 2.0 THE TERM NEWBORN Introduction to Maternity and Pediatric Nursing, 8th Ed., pp. 157-160, pp. 223-231, and pp. 284-310 TERMINAL LEARNING OBJECTIVE Perform safe and effective nursing care for a term newborn ENABLING LEARNING OBJECTIVE: A Perform nursing care...

THE NEWBORN 081-NP03L008 ELO A · VERSION 2.0 THE TERM NEWBORN Introduction to Maternity and Pediatric Nursing, 8th Ed., pp. 157-160, pp. 223-231, and pp. 284-310 TERMINAL LEARNING OBJECTIVE Perform safe and effective nursing care for a term newborn ENABLING LEARNING OBJECTIVE: A Perform nursing care throughout the three phases of care that span from the immediate neonatal period until the infant has stabilized TRANSITIONAL PHASES  Directed toward promoting the physical well-being of the baby and supporting the family unit PHASE I – IMMEDIATE AFTER BIRTH Maintain thermoregulation Maintain cardiorespiratory function Observe for a document urination and passage of meconium Encourage familial bonding and breastfeeding THERMOREGULATION   Hypothermia in the newborn can lead to:  Hypoglycemia due to limited glucose stores needed for heat production  Cold stress which increases the metabolic rate leading to increased respiratory effort and oxygen consumption The first bath is normally delayed until the newborn’s temperature is stabilized between 36.5º-37º C (97.7º 98.6º F) SUPPORTING THERMOREGULATION   Hypothermia can cause:  Minimize heat loss  Hypoglycemia  Cover head  Respiratory distress  Swaddle Mechanisms of heat loss  First bath after temperature stabilization  Evaporation  Conduction  Convection  Radiation PREVENT HEAT LOSS  Drying the infant with warm blankets to prevent evaporative heat loss  Place a hat on the infant’s head after drying to minimize heat loss  Wrap the infant in a warm blanket or provide for skin to skin (kangaroo) contact with mother  Place the infant in a radiant warmer with a skin probe for continuous monitoring Kangaroo care CARDIORESPIRATORY FUNCTION  Clear airway of mucous and excess amniotic fluid  Mouth and throat first, then suction nose  Avoid stimulating gag reflex  Spontaneous breathing begins seconds after birth  Initially infant may appear cyanotic   Will turn pink once infant starts to cry Acrocyanosis – bluish color  Hands and feet, is normal for first few days of life SIGNS OF CARDIORESPIRATORY DISTRESS  Persistent cyanosis (other than the hands and feet)  Grunting respirations  Nasal flaring  Substernal retractions  Sustained respirations 60 bpm  Sustained heart rate 160 bpm OBTAIN AN APGAR SCORE  Evaluated at 1 minute and 5 minutes post-delivery  Evaluates overall condition of newborn  Five areas evaluated for Apgar scoring   Heart rate  Respiratory effort  Muscle tone  Reflex response  Skin color Identifies any resuscitative needs INFANT IDENTIFICATION  Identification band   Identical band placed on baby, mother, and father or other support person in the birthing room Umbilical clamp or identification wrist band with electronic sensor  Alarm if student is removed from unit  Band check by nurse and mother any time newborn is separated and returned to mother before discharge  Nurse and mother verify identification bands together URINE AND MECONIUM   Infant will not be discharged home until first void and passing of meconium  Newborns may not urinate in the first 24 hours  First stool (meconium) may take 12 to 24 hours to pass Urine and stool must be documented in health record prior to discharge BONDING AND BREASTFEEDING  Promote early bonding once newborn is stabilized  First hour of life infant is alert  Best time to initiate breastfeeding  Promote boding by placing infant in mother’s arms EYE CARE  Prevention of ophthalmia neonatorum  Erythromycin ointment   Neisseria gonorrhoeae  Chlamydia trachomatis 1 hour after birth   Allows time for the infant and mother to bond Eye care given and documented prior to infant leaving delivery room ADMINISTERING MEDICATIONS  Infant has decreased motor activity after first hour  Best time to administer medications  Intramuscular injections  Vitamin K  Vastus lateralis muscle CHECK ON LEARNING While in the nursery the staff nurse asks a nursing student to describe the procedure for administering erythromycin ointment to the eyes of the newborn. The nurse determines that the student needs to further research this procedure if the student states ____________. a. “I will clean the newborn’s eyes before instilling ointment.” b. “I will flush the eyes after instilling the ointment.” c. “I will instill the eye ointment into each of the conjunctival sacs within 1 hour after birth.” d. “Administration of the eye ointment may be delayed until an hour or so after birth so that eye contact and parentinfant attachment and bonding can occur.” CHECK ON LEARNING The mother asks the nurse why her newborn baby needs an injection of vitamin K. The nurse best explains with which statement? a. “Your newborn needs vitamin K to develop immunity.” b. “The vitamin K will protect your newborn from becoming jaundiced.” c. “Newborns are deficient in vitamin K. This injection prevents your baby from abnormal bleeding.” d. “Newborns have sterile bowels, and the vitamin K will colonize the bowel with the necessary bacteria.” PHASE II – CARE OF THE NEWBORN TRANSITION TO PHASE II CARE  1 to 3 hours after delivery  Detailed health assessment  Medications  Thermoregulation VITAL SIGNS NORMAL FREQUENCY Starts during initial bonding period Vitals are monitored every 15 to 30 minutes at first, then hourly, and every 4 to 8 hours when stable Respirations – 30 to 60 bpm Heart rate – 110 to 160 bpm Temperature – 36.6º - 37.2º C (97.8º - 98.9º F) Blood pressure – Systolic: 65 to 95 mmHg Diastolic: 30 to 60 mmHg PROVIDING UMBILICAL CORD CARE THE UMBILICAL CORD  Normal cord three vessels  Two arteries  One vein  Two-vessel cord associated with internal anomalies  Cord care aimed at infection prevention  Falls off between 8 and 10 days post-delivery HYPOGLYCEMIA  Brain is dependent on a steady supply of glucose for metabolism  Blood glucose  Falls after delivery  1 to 2 hours- Stabilizes at 40 mg/dL  3 hours – 50 to 80 mg/dL  Less than 45 mg/dL after 2 hours  hypoglycemia SIGNS OF HYPOGLYCEMIA  Jitteriness  Poor muscle tone  Respiratory difficulty  Hypothermia  Poor suck  High pitched cry  Lethargy  Seizures  Heel stick  Avoid the center of the heel SCREENING TESTS  31 are mandatory (variable by state)   Screening for physical abnormalities or mental disability Common screenings  Phenylketonuria (PKU)  Hypothyroidism  Sickle cell disease  Thalassemia  Hearing loss SKIN CARE Initial care Skin integrity Nurse must wear gloves until after first bath NURSING IMPLICATIONS Promote bonding an attachment Patient teaching Assessments Involve parents in care of baby Monitoring urine and stools Breast care for mother Feeding Follow up appointments CHECK ON LEARNING Following birth, the nurse prevents hypothermia due to evaporation in the newborn by ____________. a. Warming the crib pad b. Turning on the overhead radiant warmer c. Closing the doors to the room d. Drying the baby with a warm blanket CHECK ON LEARNING A nurse is planning to teach cord care to a new mother. The nurse plans to tell the mother that ____________. a. Cord care is done only at birth to control bleeding. b. Alcohol is the only agent used to clean the cord. c. The process of keeping the cord clean and dry will decrease bacterial growth. d. It takes 21 days for the cord to dry up and fall off. PHASE III – CARE OF THE NEWBORN Introduction to Maternity and Pediatric Nursing 8th Ed., pp. 284 – 310 NURSING ASSESSMENT  Physical characteristics  Assessment by body system  Identify  Expected normal findings  Variations of normal  Deviations from normal NERVOUS SYSTEM: REFLEXES  Assess presence and strength of reflexes  Note strength and symmetry  Absence of reflexes   Neurological abnormality Asymmetric responses  Trauma during birth  Paralysis  Fracture MORO REFLEX  Infant’s arms and legs extend and abduct  Fingers fanning open  Thumbs and forefingers form a C position TONIC NECK REFLEX  Supine position  Infant's head is quickly turned to one side  Arm and leg on that side extended  Opposite arm and leg will reflex  Present at birth and disappears between 5-7 months PALMAR GRASP REFLEX  Occurs when the infant’s palm is touched  Infant’s hand closes into a tight fist  Present at birth and disappears by approximately 3 months BABINSKI REFLEX  Elicited by stroking the lateral sole of the infant’s foot  Causes the toes to flare outward with dorsiflexion of big toe  Generally, disappears before infant begins walking ROOTING REFLEX  Stimulated by touching the side of the newborn's cheek  Infant turns head toward that side and opens the lips  Present at birth and disappears by 3-4 months of age SUCKING REFLEX  Stimulated by placing a nipple or gloved finger into the infant's mouth  The suck reflex is assessed for presence and strength  Present from birth to approximately 7-12 months of age DANCE/STEPPING REFLEX  Infant held upright with feet touching a solid surface  They lift one foot and then the other  Present at birth and disappears by 4-5 months of age HEAD ASSESSMENT  The newborns head is larger in comparison with the rest of the body  The circumference of the head is measured from the top of the eyebrow to the widest part of the occiput  Normal head circumference ranges from 32 to 36 cm (12.5 to 14.1 inches) HEAD ASSESSMENT  Palpate to assess shape and identify abnormalities  Molding  Caput Succedaneum  Cephalohematoma  Fontanelles MOLDING CAPUT SUCCEDANEUM & CEPHALOHEMATOMA FONTANELLES FACIAL ASSESSMENT FACE EYES Symmetry Abnormalities Features Inflammation Movement Symmetry Expression Strabismus Transient asymmetry EARS Placement Overall appearance Color Position Pupils Hearing Tears Edema Acuity PAIN ASSESSMENT  Newborns routinely experience invasive, painful procedures, such as blood collection, immunization, vitamin K injections, and/or circumcision  Unrelieved pain can lead to   Exhaustion and irritability Monitor for physiologic changes and behavior responses PAIN RELIEF MEASURES  Containment  Kangaroo care  Non-nutritive sucking  Oral sucrose  Rocking  Swaddling RESPIRATORY SYSTEM  Assessments of the respiratory and cardiovascular status are performed together because transitional changes take place in both systems at birth  The infants cry should be strong and healthy  Bulb suctioning may be required to clear mucous from the upper airway passages CIRCULATORY SYSTEM  Heart sounds  Functional murmurs  Organic murmurs  Pulses  Blood Pressure MUSCULOSKELETAL SYSTEM  The bones of the newborn are soft, flexible and composed mostly of cartilage with only a small amount of calcium  Movements are random and uncoordinated  Development of muscular control occurs in a predictable pattern  Cephalocaudal  Proximodistal GENITOURINARY SYSTEM   Urine  First void by 24 hours  Frequency Genitalia  Female: swollen, white discharge, pseudo menstruation  Male: inspect scrotum, palpate testicles, observe skin, meatus location CIRCUMCISION  Most common surgical procedure performed on males  Removal of foreskin the covers glans penis  Reasons for choosing circumcision   Reduction in penile cancer, urinary tract infections in first year of life  Religious, cultural, or social preferences Reasons for rejecting circumcision  Pan and risk of surgery  Considered cosmetic  Fear of complications Plastibell clamp circumcision NURSING CONSIDERATIONS  Post-procedure  Hold and soothe infant  Apply gentle pressure if bleeding  Infant should urinate 6 to 8 hours  Teach family circumcision care  Petroleum jelly to glans with Gomco clamp  No petroleum jelly with Plastibell Gomco clamp circumcision FEMALE GENITALIA  Normal assessment findings  Labia majora large and completely covers the clitoris and labia minora  Labia may be darker than surrounding skin  Edema of labia and white mucous vaginal discharge  Small amount of bleeding (pseudo menstruation) INTEGUMENTARY SYSTEM VERNIX CASEOSA LANUGO   Small amount of fine hair on the shoulders, upper back, forehead, sides of face Disappears during the first week of life  Cheese-like substance that covers the skin  Thought to protect the skin in utero MILIA  Pearly white pinpoint papules  Disappear without treatment  On face over the forehead, nose, cheeks, and chin INTEGUMENTARY SYSTEM EPSTEIN’S PEARLS  Pearly white papules in midline of hard palate  Must be assessed to distinguish from thrush MONGOLIAN SPOTS ACROCYANOSIS  Bluish or slate grey marks that resemble bruises  Bluish discoloration of the hands and feet  Sacral area   Newborns with dark skin Caused by reduced peripheral circulation Must distinguish from hematoma   Common during the first day  Only involves the extremities PHYSIOLOGICAL JAUNDICE  Icterus neonatorum  Not present during first 24 hours of life  Immature liver function  Bilirubin  Rises from birth  Peaks in 2 – 4 days  Normal after 5 – 7 days THE INTERACTIVE BATH  Initial skin care  Opportunity to further assess   Skin  General behavior  Muscle activity Parental bonding GASTROINTESTINAL SYSTEM ABDOMEN Soft, rounded, protrudes slightly Auscultate bowel sounds STOOL ASSESS Color, type and consistency MECONIUM STOOLS TRANSITIONAL STOOLS First stools are dark greenishblack, tarry, odorless Loose, greenish yellow with mucus on the 2nd or 3rd day Passed 8 to 24 hours after birth Breast fed infants, yellow stools 3 – 6 times a day DIGESTION  Initial feeding   Helps with assessment of ability to suck, swallow, and breathe Stomach capacity 90 mL (3 oz)  Breast fed infants placed near breast for psychological benefit and stimulation of breast milk  Bottle feeding start within 5 hours  Gastric emptying within 2 to 3 hours  Feeding helps to stimulate gastrocolic reflex  Aids in passing stool NUTRITION OF THE NEWBORN BREASTFEEDING  Advantages  Proportionate, full range of nutrients  Easily digested & promotes passage of meconium  Natural immunity  Convenient, economical, safe  Suckling encourages newborn mouth development & maternal uterine involution  Significantly improves newborn brain development & reduces change of childhood disease  Facilitates maternal weight loss  Promotes bonding BREASTFEEDING PRECAUTIONS  Infection Diet  Absolute contraindication in HIV, HTLV1, HTLV-2  Avoid  Herpes simplex virus or varicella zoster, only when lesions are present on the breast  Fish with high levels of mercury  Infant galactosemia is a contraindication to breastfeeding    Mothers with active TB must be isolated, but may continue to pump milk for their newborn Medications  Avoid   Cytotoxic drugs, drugs of abuse, radioactive compounds Caution  Psychotropics, anxiolytics, migraine medications PHYSIOLOGY OF LACTATION   Hormonal stimulation  Prolactin  Oxytocin Most breastmilk manufactured during feeding, changing from foremilk to hindmilk MILK PRODUCTION    Colostrum  Secreted in late pregnancy & first few days after delivery  Yellowish fluid rich in antibodies, protein, vitamins, minerals  Laxative effect promotes passage of meconium Transitional milk  Emerges approximately 7-10 days after birth  Increase in lactose, fat, & calories Mature milk  Emerges approximately 14 days after birth  Bluish milk with nutritional value of 20 kcal/oz ASSISTANCE WITH BREASTFEEDING   Skin-to-skin contact & breastfeeding should be initiated as soon as possible in the first few hours after delivery  Promotes maternal-newborn bonding  Aids in newborn thermoregulation  Oxytocin release helps to control postpartum bleeding Preparation  Wash breasts only with water, when needed  Manual expression or rolling the nipple between fingers helps to evert the nipple in preparation for feeding  Begin feeding with opposite breast from previous feeding POSITIONING FOR BREASTFEEDING  Newborn placed in chest-to-chest position with mother, keeping head & neck in alignment  Newborn is at the level of the nipple, with nipple centered to the newborn’s nose  Mother should hold breast in “C” position  Multiple different holds can be used  Cradle  Football  Side-lying LATCHING, FEEDING, & UNLATCHING LATCHING  Once properly positioned, brush nipple against newborn’s lower lip to stimulate opening of mouth, then bring newborn in close to the breast  Majority of areola should be in the newborn’s mouth, with lips flared outward & tongue under the nipple SUCKLING    Nutritive  Suckling patterns may differ throughout nursing session  Soft “ka” or “ah” sound indicates swallowing Nonnutritive  Fluttering sucking motions  Not associated with active feeding Noisy  Often in addition to cheek dimpling, indicative of an improper latch UNLATCHING  Break suction by inserting finger in corner of newborn’s mouth or indent breast near the mouth EVALUATING NEWBORN INTAKE  More difficult to assess when breastfeeding  Signs of successful breastfeeding & adequate intake:  Breast feels firm before feedings & softer after  Let-down reflex occurs  Audible swallowing  Newborn demands feeding & relaxes afterward  Newborn has 6-8 wet diapers & several stools per day  Newborn regains birth weight by day 14  Newborn nurses for minimum of 15 minutes per breast, every 2-3 hours PREVENTING PROBLEMS  Assistance with breastfeeding prevents pain, anxiety, & insecurity that inhibits the let-down reflex, leading to numerous breastfeeding issues  Lactation consultants, birth centers, & breastfeeding groups may be helpful  Parents should be taught to recognize early hunger cues in the newborn BABY-FRIENDLY HOSPITALS  Written breastfeeding policy & staff education  Parents educated about breastfeeding advantages & techniques throughout their stay  Breastfeeding or pumping initiated in delivery room  Newborn is fed only breastmilk  Mother & newborn room-in 24 hours a day  Pacifiers & artificial nipples are not used  Formula samples not distributed at discharge  Workplace support & support group referrals FREQUENCY AND DURATION OF FEEDINGS  Some may cluster feed at more frequent intervals in the first few weeks  Parents should be taught early hunger signs in the newborn  Early feedings should last at least 15 minutes  Burping  To burp, the newborn is placed in a sitting position on the mother’s lap or over her shoulder PREPARING THE NEWBORN FOR FEEDING Unwrap Unwrap from swaddle Change Change diaper Hold Hold newborn upright Speak Speak softly Gentle Gentle massage of back, palms, soles of feet Calm If fussy upon waking, calm first NIPPLE CONFUSION  Successful breastfeeding based on supply & demand  Nipple confusion and “imprinting” may occur when newborn is introduced to formula via artificial nipple BREAST CARE    Engorgement  Early, regular, frequent feedings help to prevent engorgement  Breast pump, manual expression, breast massage for relief Nipple Trauma  Proper position & latch helps to prevent trauma  Cracks, bleeding, blisters, & redness may occur Hygiene  Wear supportive bra 24 hours/day SPECIAL SITUATIONS MULTIPLE BIRTHS  Milk supply will adjust to greater demand  Two infants may be nursed simultaneously with proper positioning PREMATURE BIRTH  If newborn cannot nurse, pumped milk may be administered via gavage feeding  Cross-cradle position recommended for small newborns BREAST SURGERY  Incision around areola may affect breastfeeding if nerves or lactiferous ducts were damaged  Implants alone do not negatively impact breastfeeding USING A BREAST PUMP  Whenever feeding at the breast may be temporarily delayed, the mother should be taught how to pump, in addition to…  Assembly, disassembly, & cleaning pump  Frequency & duration  Every 3 hours for approximately 10 minutes on each breast  Proper positioning, equipment sizing, & suction  Begin with high speed, low suction until let-down  Adjust to medium speed & comfortable suction thereafter  Milk storage STORING BREASTMILK  Storage Container  Proportioned to amount of one feeding  Designed & approved for freezing  Labeled with time & date MATERNAL NUTRITION   Increase by about 500 calories per day beyond pre-pregnancy diet, using MyPlate guidelines  20-30% increase in vitamins & minerals  Double pregnancy needs of folic acid  40-50% increase in calcium & phosphorus  1 L noncaffeinated fluids Chocolate, cabbage, beans, & broccoli may alter taste of milk or cause infant to have gas WEANING  Should be done gradually  Eliminate one feeding at a time  Day time or when newborn is least interested in  Wait several days to eliminate another  Becomes easier as newborn transitions to solid foods  Approximately 6 months of age FORMULA FEEDING PREPARATION  Bottles & nipples are washed in hot, soapy water using a nipple brush  Ready-to-feed formulas do not require dilution  Concentrated liquid formulas & powdered formulas require measured dilution with tap water, per recommendations on the label  Water does not need to be boiled first unless safety is questionable  Well water, natural spring water, and natural mineral water should not be used FEEDING THE INFANT  Hold in cradle position, head slightly elevated  Touch lips with nipple & gently insert along tongue  Hold bottle so that nipple is always full of formula  Feed slowly  Burp newborn frequently throughout & at end of feeding CHECK ON LEARNING Cynthia, a 26-year-old, expects her first baby in about 12 weeks. She says that she is having a difficult time deciding whether to breastfeed or bottle-feed her baby. #1. What questions may help the nurse to understand the patient’s dilemma? CHECK ON LEARNING Cynthia, a 26-year-old, expects her first baby in about 12 weeks. She says that she is having a difficult time deciding whether to breastfeed or bottle-feed her baby. #2. What information should you provide Cynthia to help her make this decision? CHECK ON LEARNING Cynthia decides to breastfeed her baby. On the fifth day after birth, she phones the unit to say that her baby is not able to latch well because she has breast engorgement & her nipples are sore. Her left nipple has a small crack. What can the nurse teach Cynthia to help her cope with these issues? CHECK ON LEARNING The nurse notes that a new mother has several bottles of partly consumed formula on her bedside table. Choose the most appropriate nursing action. a. Recommend that she prepare bottles that contain only what the baby is likely to drink b. Inform her that the bottles cannot be used because they have not been refrigerated c. Tell her she may combine the leftover formula for the baby’s next feeding d. Check the room for other partially used bottles, then throw all of them in the trash CHECK ON LEARNING Which statements made by a new father indicate that additional discharge teaching is needed for this family, who had their first baby 24 hours ago? Select all that apply. a. “I bought my wife a couple of boxes of tampons to use until her postpartum bleeding stops.” b. “My wife wants to get the flu shot before she goes home.” c. “We will bring our baby to the pediatrician in 3 weeks.” d. “We will secure the baby’s car seat in the back seat of our vehicle in a rear-facing position.” e. “I will give the baby formula at night so my wife can rest. She will breastfeed during the day.” CHECK ON LEARNING During an assessment of an infant, you note that when the infant’s head is turned to the right side, the leg and arm on the right side will extend, while the leg and arm on the left side will flex. You document this as what type of reflex? a. Rooting Reflex b. Sucking Reflex c. Moro Reflex d. Tonic Neck Reflex CHECK ON LEARNING Scenario: Tess and her husband Luis are the proud new parents of twins. Their daughter, Sofia was admitted to the NICU accompanied by her father (Luis). After 1 hour in the delivery room, their son Marco is admitted to the postpartum unit with mom. Baby Marco’s weight is 3.19 kg, and he has one black-green tarry stool and one void since delivery. The cord clamp is in place, and the umbilical cord stump is clean and dry. He is circumcised at 12 hours of age and returned to the postpartum room with his mother, Tess. Tess says she is unsure how to care for the surgical site at home and has many other questions. Question: What will the nurse tell Tess about the care of the umbilical cord when she is at home? How should Tess modify the diapering technique while the umbilical cord stump is still in place? CHECK ON LEARNING Scenario: Tess and her husband Luis are the proud new parents of twins. Their daughter, Sofia was admitted to the NICU accompanied by her father (Luis). After 1 hour in the delivery room, their son Marco is admitted to the postpartum unit with mom. Baby Marco’s weight is 3.19 kg, and he has one black-green tarry stool and one void since delivery. The cord clamp is in place, and the umbilical cord stump is clean and dry. He is circumcised at 12 hours of age and returned to the postpartum room with his mother, Tess. Tess says she is unsure how to care for the surgical site at home and has many other questions. Question: What are the general principles of care of the newly circumcised penis that the nurse can explain to the mother? DISCHARGE PLANNING  Discharge planning begins on admission  Maternal self-care  Hygiene  Sexual intercourse  Diet and exercise  Danger signs  Newborn care  Car seat safety  Limit newborn exposure to crowds PREVENTING INFECTION  Infections that are harmless to adults may be fatal for the newborn  Immaturity of the immune system allows  Immunoglobulin G (IgG)  Immunoglobulin M (IgM)  Immunoglobulin A (IgA)  The umbilical cord can be a portal of entry for infection  Handwashing is the most reliable precaution IMMUNITY IMMUNOGLOBULIN G IMMUNOGLOBULIN M  Passed from mother to infant  Produced by the newborn  Passive immunity to infections of the mother  An elevation suggest presence of serious infection  Rarely lasts longer than 3 months IMMUNOGLOBULIN A  Newborn does not start producing this until about 1 month of age  Contained in breastmilk  Aids in providing resistance to infection  Gastrointestinal  Respiratory CAR SEAT SAFETY  Newborn should be placed in semi reclining position  Place in back seat of care  Rear facing until 2 years of age PATIENT TEACHING  Provide important phone numbers and instructions for return appointments.  Signs of potential problems and who to contact   Temperature greater than 38º C (100.4º F) axillary  Refusal of two or more feedings  Two or more green watery stools  Frequent or forceful vomiting  Lack of voiding or stooling Reassure the parents that staff is available 24 hours a day CHECK ON LEARNING Scenario: Tess and her husband Luis are ready to take Marco home for the first time but still have several questions regarding his care. Question Tess states that Marco must be cold because she sees his chin quiver and his hands are a bit blue, so she wants to delay bathing the baby. What can the nurse teach Tess about her baby's quivering chin, his blue hands, and how often baths should be given to newborn infants. CHECK ON LEARNING Scenario: Tess and her husband Luis are ready to take Marco home for the first time but still have several questions regarding his care. Question What can the nurse tell Tess about the normal changes in the appearance of her infant’s stool that she will see in the next week when she is at home? REVIEW OF MAIN POINTS  Perform immediate nursing care and stabilization of a healthy term newborn during Phase 1 care following delivery  Perform continuation of nursing care and assessment of a healthy term newborn during Phase 2 following delivery  Identify various physical characteristics of a term newborn while performing a comprehensive nursing assessment by body system during Phase 3 of care  Describe methods of preventing infections in newborns  Perform discharge teaching for the parents of a newborn QUESTIONS?