Chapter 012 lo

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  • Discuss how genetic background affects the newborn’s adjustment to life. Discuss the effects of prenatal care, labor, and delivery on the newborn.
  • What is the nurse’s role in providing sensory and physical stimuli to assist the newborn in breathing?
  • Describe each of the reflexes listed.
  • Describe each reflex. What is the nurse’s role in assessing the newborn’s reflexes?
  • Refer to Figure 12-5 on page 284 and discuss caput succedaneum and cephalhematoma. Why is the newborn’s head circumference measured?
  • Describe each phase of the sleep-wake cycle. Discuss each of the patterns of reactivity listed.
  • What is the nurse’s role in assessing pain in the newborn?
  • Discuss the CRIES 10-point scale, the PIPP profile, the NIPS scale, and the NPASS scale.
  • What are some examples of conditioned responses?
  • How can this scale help new parents?
  • What is the nurse’s role in maintaining a patent airway in the newborn?
  • Describe proper suctioning with a bulb syringe.
  • Give an example of how to measure the Apgar score. What are the implications of sternal retractions and the nurse’s role in managing this urgent situation? Audience Response Question #1 An Apgar score of 5 at 5 minutes indicates the neonate is in: 1. Good condition 2. Fair condition 3. Poor condition 4. Critical condition
  • Discuss the difference between neonatal circulation from that of a fetus. Describe the location and pathophysiology of the foramen ovale and ductus arteriosus.
  • How can you ensure the newborn is kept warm? Hands and feet are not used as a guide to determine warmth because the extremities tend to be cooler than the rest of the body.
  • Discuss proper methods to count respiratory and pulse rates. How would you describe noisy respirations, nasal flaring, and chest retractions? Audience Response Question #2 A neonate's vital signs are assessed as follows: axillary temperature 96.5° F, pulse 125 bpm, respirations 44. The nurse is aware that: 1. these are within normal limits. 2. pulse is elevated. 3. respirations and temperature are normal. 4. temperature is decreased.
  • What is another reason for swaddling a newborn besides temperature control?
  • Audience Response Question #3 Average newborn length is19-21.5 inches. What is the average newborn weight? 1. 6 lb. - 7.5 lb. 2. 6 lb. - 9 lb 3. 7.5 lb. - 9.5 lb 4. 7 lb -10 lb
  • Why is it important to weigh the newborn daily?
  • Discuss the rationale regarding the importance of the first void. Why should the nurse monitor the frequency of urination?
  • What instructions should be given to the parents regarding care of the genitalia?
  • What causes jaundice?
  • Give an example of typical documentation for a newborn’s stools.
  • Discuss Figure 12-15 on page 298.
  • Discuss methods to manage constipation and hiccoughs. What is the gastrocolic reflex? What vitamins are necessary for the newborn?
  • What is considered proper umbilical cord care? Discuss the importance of hand hygiene.
  • What information should be provided to parents in each of the areas listed?
  • Chapter 012 lo

    1. 1. Chapter 12The Term Newborn
    2. 2. Objectives• Briefly describe three normal reflexes of the neonate, including the approximate age of their disappearance.• Demonstrate the steps in the physical assessment of the newborn.• State four methods of maintaining the body temperature of a newborn.• State the cause and appearance of physiological jaundice in the newborn.Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 2
    3. 3. Objectives (cont.)• Define the following skin manifestations in the newborn: lanugo, vernix caseosa, Mongolian spots, milia, acrocyanosis, desquamation.• State the methods of preventing infection in newborns.• Interpret discharge teaching for the mother and her newborn.Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 3
    4. 4. Adjustment to Life Outside the Uterus• Adjustment is dependent upon – Genetic background – Health of the recent uterine environment – A safe delivery – Care during the first month of lifeElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 4
    5. 5. Adjustment to Life Outside the Uterus (cont.)• Respirations stimulated due to chilling and chemical changes in the blood – Sensory and physical stimuli – First breath opens alveoli – Independent air exchange begins• Initiates cardiopulmonary interdependenceElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 5
    6. 6. Adjustment to Life Outside the Uterus (cont.)• Ability to metabolize food hampered by immaturity of digestive system (deficient in enzymes from pancreas and liver)• Kidney’s ability to concentrate urine and maintain fluid balance is limited due to decreased rate of glomerular flow and limited renal tubular reabsorption• Neurological functions are primitiveElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 6
    7. 7. Physical CharacteristicsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 7
    8. 8. Nervous System: Reflexes • Moves arms and legs vigorously but cannot control them • Full-term infants are born with the following reflexes (which help keep them alive) – Blinking – Sneezing – Gagging – Sucking – Grasping • They can also cry, swallow, and lift their head (slightly) when lying on their abdomenElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 8
    9. 9. Reflexes• Moro• Rooting• Tonic neck• DancingElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 9
    10. 10. Head• Molding from delivery process – May have swelling of the soft tissues of the scalp, called caput succedaneum – May see a cephalhematoma—a collection of blood beneath the periosteum of the cranial bone • Does not cross the suture line• Fontanels (soft spots) protect the head during delivery and allow further brain growthElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 10
    11. 11. Visual Stimuli and Sensory Overload• Can see and fixate on points of contrast – Toys with contrasting colors or those that make noise attract the newborn’s attention• Tears are absent until 1 to 3 months of age• Sensory overload can occur if there is too much detrimental stimulation• Important for the nurse to keep surrounding environment as calm and quiet as possible, no bright lighting or loud alarmsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 11
    12. 12. Hearing• Ears well-developed, but small• Hearing ability present at birth (sick or premature newborn may not respond to sounds)• Normal drainage and sneezing occurs after birth to rid ear canals of amniotic fluid• May react to sudden sounds by increased pulse or respiratory rate or startle reflex• Responds to voices by decreasing motor activity, sucking activity, and turning head toward the sound• Hearing screening performed before dischargeElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 12
    13. 13. Sleep • 15 to 20 hours per day • Specific pattern of • Phases of sleep-wake reactivity that can influence the response cycle to stimuli and bonding – First reactive – Quiet sleep – Sleep – Rapid eye movement – Second reactive (REM) sleep – Stability – Active alert – Quiet alert – Crying – TransitionalElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 13
    14. 14. Pain• Produces catecholamines and cortisol – Heart and respiratory rates change – Blood pressure increases as does blood glucose levels• Untreated pain can have long-term effects – Pain pathways and structures required for long-term memory are well developed by 24 weeks gestation• Unrelieved pain can cause exhaustion, irritability, and delay the healing processElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 14
    15. 15. Pain Assessment Tools• COMFORT• CRIES• FLACC• PIPP• NIPS• NPASSElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 15
    16. 16. Conditioned Responses• A response of reflex that is learned over time• Example is a hungry infant stops crying when it hears its mother’s voice, even though food is not available• Emotions particularly subject to this type of conditioningElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 16
    17. 17. Neonatal Behavioral Assessment Scale• Measures inherent neurological capacities and response to selected stimuli• Areas tested include – Alertness – Response to visual and auditory stimuli – Motor coordination – Level of excitement – Organizational process in response to stressElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 17
    18. 18. Respiratory System• Once umbilical cord is clamped and cut, the lungs take on the function of breathing oxygen and removing carbon dioxide – First breath helps to expand the collapsed lungs – Full expansion does not occur for several days• Most critical period is the first hour of life• Newborn should be position on the back or side to help maintain a patent airwayElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 18
    19. 19. Bulb Suctioning • Nurse ensures patent airway is maintained through correct positioning of neonate (on its back or side) and removing any mucus from the mouth and nose with a bulb syringeElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 19
    20. 20. Apgar Score• Standardized method of • Nurse monitors for evaluating newborn’s respiratory distress as condition immediately after evidenced by delivery – Rate and character of• Five objective signs respirations – Color (cyanosis) measured – General behavior – Heart rate – Respiration • Sternal retractions must – Muscle tone be reported immediately – Reflexes to the health care – Color provider• Score is obtained at 1 and 5 minutes after birth Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 20
    21. 21. Circulatory System • Has approximately 300 mL of • If the ducts fail to close circulating blood volume when they are • Neonatal circulation differs supposed to, the neonate may become from fetal circulation cyanotic because the • Dependent upon ducts within blood bypasses the the heart to close at certain lungs and does not points in time, such as pick up any oxygen – Foramen ovale – Ductus arteriosusElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 21
    22. 22. Providing Warmth• Unstable heat-regulating system• Acrocyanosis is evident because of sluggish peripheral circulation• Cannot adapt to change in temperatures easily• Sweat glands do not function during neonatal period, so infant is at risk for developing elevated temperature if overdressed or placed in overheated environmentElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 22
    23. 23. Obtaining Temperature, Pulse Rate, and Respirations• Temperature: can be • The nurse should report taken rectally or in – Temperature elevations the axilla >99.8° F or <97.1° F• Pulse and – Pulse rates >160 or <110 beats/min respiratory rates: – Respirations >60 or count before taking <30 breaths/min temperature as – Noisy respirations infant may cry when – Nasal flaring or chest disturbed retractionElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 23
    24. 24. Maintaining Body Temperature of the NewbornElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 24
    25. 25. Musculoskeletal System• Skeleton is flexible• Movements are random and uncoordinated• Development of muscle control proceeds from head to foot and from the center of the body to the periphery• Head and neck muscles are the first ones under controlElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 25
    26. 26. Length and Weight• Average length – 19 to 21.5 inches (46-56 cm)• Average weight – 6 to 9 pounds (2722 to 4082 g)• In the first 3 to 4 days after birth, the infant loses about 5% to 10% of its birth weight – May be a result of withdrawal from maternal hormones, fluid shifts, and the loss of feces and urineElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 26
    27. 27. Genitourinary System• Kidneys not fully developed at birth – Glomeruli are small – Renal blood flow is about a third of an adult – Ability to handle a water load is reduced – Renal tubules are short and have limited capacity for reabsorbing important substances – Decreased ability to concentrate urine and cope with fluid imbalances• Important for nurse to note first void• Newborn has about 6 wet diapers per dayElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 27
    28. 28. Male Genitalia• Testes descend into scrotum before birth• Location of the urethral opening should be on the tip of the penis• A white cheesy substance (smegma) is found under the foreskin• Some parents may choose to have their child circumcised while others may not – Whatever their decision, proper care of the male genitalia must be taught to the parentsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 28
    29. 29. Female Genitalia• May be slightly swollen• Thin white or blood-tinged mucus may be discharged from the vagina (pseudomenstruation) caused by hormonal withdrawal from the mother• Cleanse the vulva from the urethra to the anus to prevent fecal matter from entering the urinary meatus, leading to UTIElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 29
    30. 30. Integumentary System• Assess turgor and overall skin condition – Usually covered with fine hair called lanugo (disappears within a week of birth) – Covered in vernix caseosa—made of cells and glandular secretions; thought to protect skin from irritation and effects of a watery environment – Physiological jaundice (icterus neonatorum) seen as a yellow tinge to the skin; caused by the rapid destruction of excess red blood cellsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 30
    31. 31. Safety Alert• Jaundice that appears in the first day of life is not normal and should be recorded and reportedElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 31
    32. 32. Gastrointestinal System• Normal functions begin shortly after birth• Meconium, the first stool, is a mixture of amniotic fluid and intestinal gland secretions• Sticky, greenish black, thick, and passed 8 to 24 hours after birth• Stool color and consistency change over time• Color, amount, and consistency are somewhat dependent upon what the infant is fed (breast milk versus formula)Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 32
    33. 33. Normal Infant Stool CycleElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 33
    34. 34. Gastrointestinal System Upsets• Constipation• Hiccoughs• DigestionElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 34
    35. 35. Preventing Infections• Newborn’s response to inflammation and infection is slow because of the immaturity of the immune system• Umbilical cord stump primary site of infection if not kept clean• Hand hygiene is the primary means of preventing infection and/or its spreadElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 35
    36. 36. Immunoglobulin G (IgG)• Crosses the placenta and provides newborn with passive immunity• Rarely lasts longer than 3 monthsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 36
    37. 37. Immunoglobulin M (IgM)• Produced by the newborn• Elevated level suggests serious infectionElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 37
    38. 38. Immunoglobulin A (IgA)• Produced after neonatal period (about 1 month) ends• Contained in breast milk• Provides some resistance to respiratory and gastrointestinal infection – Before age 1 month, infants are at risk for such infectionsElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 38
    39. 39. Discharge Planning• Begins upon admission of the laboring mother• Areas may include – Basic infant care – Safety measures – Immunizations – Return appointments – Proper use of a car seat – Signs and symptoms of problems and who to contactElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 39
    40. 40. Home Care• Feeding• Furnishings• Clothing• Skin careElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 40
    41. 41. Question for Review• When is the Apgar score assessed and what does it mean?Elsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 41
    42. 42. Review• Objectives• Key Terms• Key Points• Online Resources• Critical Thinking Question• Review QuestionElsevier items and derived items © 2011, 2007, 2006 by Saunders, an imprint of Elsevier Inc. 42

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