Normal Newborn by MCoJgM

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									Marlene Meador RN, MSN, CNE

NORMAL NEWBORN
Surfactant-
 What is this?
 Why is it necessary?

 When is it formed?
Respiratory Changes

                 Mechanical


Initiation        Chemical
     of
  Breathing        Thermal


                      Sensory
Factors in Initial Respiration
   Mechanical – chest recoil
   Chemical- respiratory acidosis
   Thermal- decrease in
    environmental temp
   Sensory- tactile, auditory, and
    visual influences stimulate
    activation of the first breath
Fetal Circulation (p246-247)
Ductus arteriosus- blood flow from
 pulmonary artery to aorta
Ductus venosus-blood flow from
 umbilical vein into the inferior
 vena cava
Foramen ovale- blood flow from
 right atrium to left atrium
Neonatal Circulation
Ductus arteriosus- closes after birth triggered by
  pressure changes and pO2
    (transient murmurs normal in first 24 hours)
Ductus venosus- closes at clamping of
  umbilical cord
Foramen ovale- closes at first breath
Cardiovascular/Cardiopulmonary
          Adaptations
   Increased aortic pressure and decreased
    venous pressure (clamping of cord)
   Systemic pressure and pulmonary artery
    pressure (expanding of the lungs)
   Closure of foramen ovale (atrial pressure changes)
   Closure of ductus arteriosus
    (PO2 triggers constriction of ductus arteriosus)
   Closure of ductus venosus            (clamping of cord)
Thermoregulation
             Thermoregulation
   Contributing factors to neonatal heat
    loss
       Size
       Loss of heat source
       Loss of glucose supply
       Metabolic rate
Temperature Regulation
   Convection
   Radiation
   Evaporation
   Conduction
      How does the NB maintain body
                temperature?
Neonatal methods of
producing heat
   Basal metabolic rate
   Muscular activity
   Non-shivering thermogenesis (NST)


Why is heat regulation vital to
 the neonate’s survival?
What nursing interventions
assist the neonate to maintain
adequate thermoregulation?
   Drying
   Swaddling (blankets)
   Cap
   Skin to skin contact (cuddling)
Hematopoietic System
Lifespan of neonatal RBC:
80-100 days (2/3 lifespan of adult’s RBC)

Factors effecting blood volume:
Delayed cord clamping
Shift of plasma to extra-vascular spaces
Gestational age
Prenatal or postnatal hemorrhage
Neonatal Lab Values          (p498)

   Hemoglobin 14-20g/dl
   Hematocrit 48-69%
   WBC 10,000 – 30,000mm3
   Glucose 40-60mg/dl first 24 hr
    then 50-90mg/dl
   Low blood sugar 40-45mg/dl requires
    treatment
Clinical judgment:
Why is Vitamin K
 AquaMEPHYTON ®
administered to the
 newborn?
GI Function:
   What is the significance of meconium?

 What is the priority nursing intervention
  regarding GI assessment?
Presence of bowel sounds and patency of
  the anus
Hepatic Function
   What is the function of the liver in the neonate?

   What is physiologic jaundice?

   What is the difference between conjugated and
    unconjugated bilirubin?

   What is the long-term consequence of elevated
    bilirubin levels?
Normal Lab Values

   Bilirubin levels for a term NB<3mg/dl

   Elevated bilirubin levels depend on NB’s age- peak
    levels reached between day 3 and 5 in the term
    infant.

   Toxic levels approximately – 20mg/dl
Nursing Interventions: to
decrease physiologic jaundice
   Maintain NB’s core temperature

   Monitor stool frequency and characteristics

   Encourage early feeding

   Encourage bowel elimination

   Prevent dehydration
Urinary System of the NB
   What is the normal number of voids in a
    24 hour period?
       For first 48 hours- 1 or 2 daily
       Following 48 hours- 6 times daily


   What is brick-dust staining?
Immunologic Adaptations:
   Active acquired immunity- the mother
    forms antibodies in response to illness or
    immunization – passed through breast milk


   Passive acquired immunity- transfer of
    immunoglobulins to the fetus in utero (IgG
    production begins at 20 weeks gestation)
Behavioral States of the NB
p. 665 & 872 CHART



   Sleep States:
        Deep or quiet sleep
        Active or REM sleep
   Alert States:
        Drowsy
        Wide awake
        Active awake
        Crying
Critical thinking…


   Which of the behavioral states is
    optimal for maternal-infant bonding?
Senses in the Neonate:
   Visual
   Auditory
   Olfactory
   Taste
   Tactile
Apgar Scoring
Sign               0              1                2
 Heart rate      Absent      Slow-below       Above 100
                                100
Respiratory      Absent     Slow- irregular   Good Crying
  effort
Muscle tone      Flaccid    Some flexion of      Active
                              extremities        motion
   Reflex        None          Grimace        Vigorous cry
 irritability
    Color       Pale blue   Body pink, blue   Completely
                              extremities       pink
Apgar Score:
assigned at 1 & 5 minutes.
A score below 8 may require resuscitative
efforts.
0-3 poor     4-6 fair       7-10 positive
condition    condition      (good
                            condition)
Quick review!
   What measures should the nurse take
    to ensure a patent airway in the NB?
   Why is it important to maintain a
    neutral thermal environment?
   What nursing interventions assist to
    maintain the NB’s core temp? (prevent
    cold stress)
Assessment of the Neonate
Vital Signs:
   Pulse

   Respirations

   Temperature

   Blood pressure
Average size for term
   Weight
   Length
   FOC

   Which measurement is priority for on-
    going assessment?
Assessment of NB skull/scalp
   Fontanelles
       Anterior
       Posterior
   Suturelines
       Frontal
       Coronal
       Sagittal
       Lambdoidal
Assessing the Head:
   Molding

   Caput succedaneum

   Cephalhematoma
Assessing the Face:
 Eyes
 Ears

 Mouth

What is the significance of
 variations? (nursing interventions)
Assessment of the NB’s Eyes:
   Color
   Size
   Reaction to light/blink
   Conjunctival hemorrhages
   Transient strabismus or nystagmus
Assessment of the NB’s ears:
   Level
   Shape/ malformation
   Flexibility
   What body system must the nurse
    carefully monitor if anomalies occur
    with the ears?
Assessment of the NB’s
mouth:
   Lips
   Palate
   Hydration
   Reflexes
   Additional normal findings:
       Epstein’s pearls
       Precocious teeth
       Short fernulum of tongue
Why is it important to assess
the umbilical stump?
   How many vessels will you find in the
    umbilical cord?
       ___ Arteries
       ___ Veins


   What is Wharton’s jelly? (p. 246)
Assessment of the Abdomen
   What is the general shape
   What is the ratio of FOC to abdominal
    size?
   What organs must be assessed in the
    abdomen?
Extremities:
 Upper
   Hands

 Lower

   Hips

   Feet
Neurological Assessment/
Reflexes
   Moro or Startle      Babinski

   Palmer grasp         Plantar grasp

   Rooting              Tonic neck

   Sucking
Assessing the genitalia of the
NB:
   Female                     Male
       Labia                      Penis
       Clitoris                        Penial raphe
                                         Urethral meatus
       Vaginal opening              



            Hymeneal tag          Scrotum-testes
            Secretions            Anus
       Anal opening
Skin Assessment:
   Color and thickness
   Birthmarks (telangiectatic nevi, flammeus, Mongolian)
   Harlequin sign
   Jaundice
Assessment of NB skin
   Acrocyonosis
   Mottling
   Erythema toxicum
   Vernix caseosa
   Telangiectatic nevi
   Mongolian spots- Why is it important to
    carefully document these birth marks?
Gestational Age:
   Neuromuscular and physical maturity

   Newborn Maturity Rating &
    Classification (P. 525)
       Dubowitz tool
       Ballard Score
Gestational Age Assessment
   Posture, reflexes, size, skin characteristics and fat
    distribution (pages 526-530)
   Dubowitz scale
   Ballard score
   Neuromuscular maturity- posture, square window (wrist) arm
    recoil, popliteal angle, scarf sign, heal to ear maneuver
   Physical maturity- skin condition, lanugo, plantar surface, breast
    buds, earl and genital development.
Neonatal Medications
   Administered within 1 to 2 hours of
    birth
   AquaMEPHYTON ®- vitamin K

   Erythromycin ointment
   When is best time to administer?
Newborn Identification
   Footprints

   Identification bands
       Newborn
       Mother
       Designated “other”
What would you include in a transfer
of care report for the neonate to the
transition nursery?
What would you include in a transfer
of care report for the neonate to the
transition nursery?

   Apgar scores
   Resuscitative efforts
   Time of birth, weight and length
   Labor analgesia or anesthetic
   L&D history
   Maternal history
Circumcision: (p 549)
   What factors are involved in the
    parent’s decision to have their male
    newborn circumcised?
   What assessments must the nurse
    include after circumcision?
Circumcision Care: pre-op &
post -op
   Informed consent
   Comfort measures
   Risk of ______?
   Infection prevention
   Parent teaching and discharge planning
Discharge teaching for the NB:
   Safety
   Elimination
   Genitalia care
   General
   Feeding
   Signs of illness
   NB behavior
   Immunization schedule
   Return appointment schedule
Please contact me with any questions or
  concerns.

Marlene Meador RN, MSN, CNE
Mmeador@austincc.edu
512-422-8749

								
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