Chapter 11—NURSING CARE OF THE NEWBORN

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Chapter 11—NURSING CARE OF THE NEWBORN Powered By Docstoc
					Chapter 11—NURSING CARE OF THE NEWBORN
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Immediate care after birth: Phase 1 – birth to 1 hour old use of bulb syringe-compress the bulb syringe before inserting in the mouth then the nose. Injection of Aquamephyton IM Measurements-head, chest, wt, length Identification bands – must be the same number for infant & mother, significant other

IMMEDIATE CARE:
INITIAL CARE DIRECTED TOWARD:  1. Maintaining cardiorespiratory function  2. Maintaining thermoregulation  3. Ensuring identification and security  4. Assessing vital signs  5. Assessing gestational age to ID maturity and birth injuries or anomalies.  Prevention of hemorrhage/eye care
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Phase 2 – 1 to 4 hours
Infection prevention  Best method is proper handwashing  Signs of infection: Poor feeding, lethargy, periods of apnea  NB Screening: PKU, hearing tests  Hep B done soon after birth, 1 mo., 6 mos.
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GENERAL NURSING INTERVENTIONS:
SAFETY—  Never leave infant alone on bed/ table  Never prop bottle  Always leave side rails up in crib  Use a car seat  Place infant on back or side to sleep  Do not leave pillows, etc in crib
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GENERAL NURSING INTERVENTIONS
BONDING—  Teach NB interactions:  Hearing  Touch  Gaze  Eye contact  Facial expressions
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ROUTINE ASSESSMENT AND CARE
Encourage parents to participate in care  Assess infant q 4 – 8 hrs:  Vital signs, appearance of skin, color, fluid intake, voiding and stooling, infant’s activity, and parent-infant attachment.  Keep warm but do not overdress
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Phase 3 – Parent Education
The interactive bath - Skill 11-4  Plain water 1st 1 – 2 weeks  Sponge bath until cord falls off & healed; then may have tub bath  Avoid bath right after feeding or on empty stomach  Teach bathing to parent in hospital
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Cord Care
Clean with alcohol 2 or 3 times daily; with each diaper change  Cord falls off in 7 –10 days  Fold diaper down to keep dry of urine  Teach parent to report if cord:  Moist, reddened, foul odor, bleeding, or discharge
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Positioning/Holding Infant
Support head  Place on firm mattress, never in prone position when left alone= > SIDS  3 ways to hold, Fig. 11-9  Cradle—used for feeding  Upright hold—used for burping  Football hold—shampooing, breastfeed
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Nasal & oral suctioning – see fig 11-10 Temperature Assessment – axillary Stools & voiding – 6-8 voids per day; fast focus 11-4 Collection of urine from infant see procedure 11-4 Diapering – use clear water or premoistened wipes without chemicals/soap

Clothing – dress for weather  Circumcision – Gomco method or plastibell see fig 11-11  potential complications – infection & hemorrhage; box 11-11
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Caring for the Uncircumcised Penis
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Avoid forceful retraction of the foreskin  Use only plain water to wash during infancy; no need to retract the foreskin  Toddler age: gentle retraction may be done during bath. Always replace the foreskin to it’s normal position  School age: child can be taught to gently retract the foreskin weekly during bathing

Cultural beliefs influence the type of care given to newborns. If the beliefs are harmful to the newborn the nurse should try to educate the parents about concerns related to the practice  Discharge & follow up care – recommended f/u 7-10 days for infant  Nursing care plan 11-1
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