characteristics of newborn[1]
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CHARACTERISTICS OF
THE TYPICAL NEWBORN
INFANT
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GENERAL
The nurse is in a unique position to aid the
newborn infant in the stressful transition
from a warm, dark, fluid-filled environment
to an outside world filled with light, sound,and novel tactile stimuli. During this period
of the newborn adjusting from intrauterine
to extrauterine life, the nurse must be
knowledgeable about a newborn's normalbiopschosocial adaptations to recogni!e
an deviations .
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To begin life as an independent being, the
bab must immediatel establish pulmonar
ventilation in conjunction with markedcirculator changes. These radical and rapid
changes are crucial to the maintenance of
life. "ll other neonatal bod sstems changetheir functions or establish themselves over
a longer period of time. The nurse performs
an initial assessment to evaluate the
neonate, its immediate postbirth adaptations,
and the need for further support
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TERMS:
Neonatal Period:
#irth --$ %& das of life
Term Infant:
& - (% weeks of gestation
Transition Period: )hases of instabilit
during the first *-& hours after birth
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VITAL SIGNS OF THE NEWBORNINFANT
a. Temperature +egulation.
The infant's bod temperature drops
immediatel after birth in response to the
extrauterine environment. /is internal organs are
poorl insulated and his skin is ver thin and does
not contain much subcutaneous fat. The infant's
heat regulating mechanism has not full developed.
/is temperature rapidl reflects that of his
environment. The flexed position that the infantassumes is a safeguard against heat loss because
it substantiall diminishes the amount of bod
surface exposed.
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0ursing implications are centered on
regulating an environment to provide constant
bod temperature of a neutral thermalenvironment. The infant is placed in blankets,
s and a controlled temperature environment
after birth to counteract the drop in bodtemperature that occurs immediatel after
birth. "fter admission to the nurser, the infant
is placed in isolation isolette and a
temperature probe ma be used for
continuous monitoring. The infant's axillar
temperature is maintained at *.( to 1.%o 2.
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03T45 "n isolette is a self-contained unit
that controls the temperature, humidit,
and oxgen concentration for an infant.
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Pulse
The normal pulse range for an infant is
%6 to (6 beats per minute bpm.
The rate ma rise to *6 bpm when the
infant is cring or drop to 66 bpm whenthe infant is sleeping.
The apical pulse is considered the most
accurate .
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Blood Pressure
The average blood pressure#) of an
infant at birth is 1%7(%.
" drop in sstolic #) of about 8 mm
/g the first hour after birth is common. The newborn's #) ma be taken with a
Doppler blood pressure device. This
greatl improves accurac .
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Respiratios
The respirations of a newborn infant are
irregular in depth, rate, and rhthm and var
from 6 to *6 beats per minute.
+espirations are affected b the infant's activitthat is, cring. 0ormall, respirations are
gentle, quiet, rapid, and shallow.
The are most easil observed b watching
abdominal movement because the infant'srespirations are accomplished mainl b the
diaphragm and abdominal muscles. 0o sound
should be audible on inspiration or expiration
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Respiratios
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!HARA!TERISTI!S OF THENEWBORN INFANT"S HEA#
The newborn infant's head represents
one-fourth of his total bod length.
9ts circumference is equal to that of his
abdomen or chest. The average si!e is to -8 cm.
The head is shaped or molded as it is
forced through the birth canal in vertexpresentations .
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Moldi$
During deliver, for the large head to
pass through the small birth canal, the
skull bones ma actuall overlap in a
process referred to as molding. :uch molding reduces the diameter of
the skull temporaril.
This elongated look usuall disappearsa few hours after birth as the bones
assume their normal relationships
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Mouldi$
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Fotaels
The infant's skull is separated into six bones one
from another along the suture lines .;here more
than two bones come together, the space is
called a fontanel.
This is the unossified space or soft spot
between the cranial bones of the skull in an
infant.
The infant's pulse is sometimes visible there. The anterior fontanel is located at the
intersection of the sutures of the two parietal
bones and the frontal bones.
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Fotaels
9t is diamond-shaped and strongl pulsatile.
9t normall closes at < to & months of age.
The posterior fontanel is located at the
junction of the sutures of the % parietalbones and occipital bone.
9t is small, triangular shaped, and less
pulsatile. 9t normall closes at 7% to
months of age. The anterior fontanel is the larger of the two.
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%ep&al&e'ato'a
This is a collection of blood between a
cranial bone and its overling periosteum.
#leeding is limited to the surface of the
particular bone. 9t is caused b pressure of the fetal head
against the maternal pelvis during a
prolonged or difficult labor.
This pressure loosens the periosteum from
the underling bone, therefore rupturing
capillaries and causing bleeding.
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!ep&al&e'ato'a(
9t ma be apparent at birth but sometimes
are not seen until %( to (& hours of life
because subperiosteal bleeding is slow.
9t varies in si!e, rather firm to the touch andtends to increase in si!e from to das
and then become softer and more fluctuant.
=ost cephalhematomas are absorbed
within several weeks. 0o treatment is required in the absence of
unexplained neurologic abnormalities
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!aput Su%%edaeu'
This is an abnormal collection of fluid
under the scalp on top of the skull that
ma or ma not cross the suture lines,
depending on the si!e. )ressure on the presenting part of the
fetal head against the cervix during labor
ma cause edema of the scalp . This diffuse swelling is temporar and
will be absorbed within % or das
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!HARA!TERISTI!S OF THE NEWBORNINFANT"S E)ES AN# EARS
4es.
The infant's ees ma be folded and
creased and ma seem out of shape
because the contain little hardenedcartilage.
The infant's ees ma not track properl
and ma cross strabismus or twitchnstagmus. This will cause concern if it
extends beond six months.
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!olor
"t birth, the iris color is usuall graish-
blue in 2aucasians and graish brown
or brown in dark-complexioned races.
" gradual deposition of pigmentproduces the final ee color of the bab
at the age of three to six months and
sometimes it ma take a ear .
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Pupils
The pupils do react to light and the
infant can focus on objects about eight
inches awa. The infant's blinking is a
natural protection reflex.
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La%ri'al apparatus
The lacrimal apparatus is small and
nonfunctioning at birth and tears are not
usuall produced with cring until one to
three months of age.
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Ears
The infant's ears tend to be folded and
creased.
" line drawn through the inner and
outer canthi of the ee should come tothe top notch of the ear where it joins
the scalp.
The infant usuall responds to sound atbirth.
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Stru%ture o* i*at"s ear
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!HARA!TERISTI!S OF THENEWBORN INFANT"S S+IN
The infant has delicate skin at birth that
appears dark red because it is thin and
laers of subcutaneous fat have not et
covered the capillar beds. This redness can be seen through
heavil pigmented skin and becomes
even more flushed when the bab cries.
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Veri, !aseosa
This is a soft, white, chees, ellowish cream on
the infant's skin at birth .
9t is caused b the secretions of the sebaceous
glands of the skin.
9t offers protection from the water environment
of the uterus, is absorbed in the skin after birth,
and serves as a natural moisturi!er.
9f there is a large amount of vernix caseosa
present, it should be meticulousl removed as it is
thought to be a good culture medium for bacteria.
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Veri, !aseosa
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Lau$o
This is a long, soft growth of fine hair on
the infant's shoulders, back, and
forehead. 9t disappears earl in
postnatal life.
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Lau$o
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Mo$olia Spots
These are blue-black colorations on the
infant's lower back, buttocks, and
anterior trunk. The are often seen in
infants of #lack, 9ndian, =ongolian, or=editerranean ancestr. These spots
occur less frequentl in 2aucasian
babies. The spots are not bruises nor are
the associated with mental retardation.
The disappear in earl childhood
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Mo$olia Spots
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-audi%e
This is a ellow discoloration that ma
be seen in the infant's skin or in the
sclera of the ee. >aundice is caused b
excessive amounts of free bilirubin inthe blood and tissue
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Pete%&iae
These are small, blue-red dots on the
infant's bod caused b breakage of tin
capillaries. The ma be seen on the
face as a result of pressure exerted onthe head during birth. True petechiae
does not blanch on pressure.
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Pete%&iae
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Milia
These are tin sebaceous retention
csts. The appear as small white or
ellow dots and are common on the
nose, forehead, and cheeks of the infant.The are of pin head si!e and
opalescent. =ilia is due to blocked sweat
and oil glands that have not begun to
function properl. The disappear
spontaneousl within a few weeks
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Milia
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Birt&'ar.s
These are small, reddened areas
sometimes present on the infant's eelids,
mid-forehead, and nape of the neck. The
ma be the result of local dilatation of skincapillaries and abnormal thinness of the
skin. The are sometimes called stork bites
or telangiectasia. These marks usuall
fade and disappear altogether. The mabe noticeable when the infant blushes, is
extremel warm, or becomes excited
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Birt&'ar.s
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He'a$io'a
" /emangioma or strawberr mark is a
tpe of birthmark that is characteri!ed b
a dark or bright red raised, rough
surface. The do not develop for severaldas. The ma regress spontaneousl
or ma even increase in si!e. :urgical
removal is not recommended. There is a
wait-and-see attitude advocated before
surgical removal
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He'a$io'a
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GASTROINTESTINAL S)STEM
=outh.
The infant's lips should be pink and the tongue
smooth and smmetrical.
The tongue should not extend or protrude
between the lips.
The connective tissue attached to the underside
of the tongue should not restrict the mobilit of
the tip of the tongue.
The gums ma have tooth ridges along them,
and rarel a tooth or two ma have erupted
before birth .
GASTROINTESTINAL
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GASTROINTESTINALS)STEM The roof of the mouth should be closed,
and the uvula should be present.
:ometimes there are glistening spots
firm white or graish-white nodules,usuall multiple on the palate that are
referred to as 4pstein's pearls.
" common site for them is at thejunction of the hard and soft palates
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Sto'a%&
The capacit of the infant's stomach is
about one to two ounces 6 to *6 ml at
birth, but increases rapidl.
=ilk passes through the infant'sstomach almost immediatel.
The infant is capable of digesting
simple carbohdrates and proteins, buthas a limited abilit to digests fats.
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Itesties
9rregularit in peristaltic motilit slows
stomach empting.
)eristaltic increases in the lower ileum,
which results in one to six stools a da. The first stools after birth and for three
to four das afterwards are called
meconium. =econium is string,tenacious, and black and has a tarr
texture.
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Itesties
;ith the ingestion of colostrum or
formula, a gradual transition occurs.
There ma be few greenish stools and
the stools will graduall become moreellow. ?ormula stools are lemon ellow
and curd. #reast milk stools are ellow-
orange, soft, and more frequent.
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03T45 )eristalsis is referred to as
progressive wavelike movement that
occurs involuntaril in hollow tubes of
the bod, especiall the alimentarcanal.
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I*at/s Stool
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!IR!0LATOR) S)STEM
#lood ?low.
;hen the umbilical blood stops flowing at birth,
sudden pressure differences occur within the
circulator sstem.
These differences cause the blood flowing to thelungs and liver to increase and the blood flowing
through the bpass channels to decrease.
)eripheral circulation refers to residual canosis in
hands and feet. This ma be apparent for one to twohours after birth and is due to sluggish circulation.
#lood is shunted to vital organs immediatel after
birth
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Blood !oa$ulatio
During the first few das of life, the prothrombin
level decreases and clotting time in all infants is
prolonged.
This process is most acute between the second
and fifth postnatal das. 9t can be prevented to a
large extent b giving vitamin @ to the infant
after birth.
;ith the ingestion of food, establishment of
digestion, and maturation of the liver, vitamin @
is manufactured b the bab and clotting time
stabili!es within a week to ten das.
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RESPIRATOR) S)STEM
Antil the infant's first breath of air is taken, the
alveoli air sacs in the lungs are in an almost
complete state of collapsed.
The lungs should be in this state because the
lung must not fill with amniotic fluid or other
liquids. /owever, the fluid7liquid that flows in the
lungs during normal deliver is squee!ed or
drained from the infant lungs.
The major portion of the fluid is absorbed after
deliver b the alveolar membranes into the
blood capillaries
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RESPIRATOR) S)STEM
The most frequent cause of respirator
difficult in the first few hours of birth has
been due to the too liberal use of
sedatives, tranquili!ers, analgesics, andanesthetics that affect not onl the
mother, but pass over the placenta to
the infant.
These drugs make the bab sleep and
disinclined to take the first breath.
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EN#O!RINE S)STEM
The endocrine glands are considered
better organi!ed than other sstems
. Disturbances are most often related to
maternall provided hormonesestrogen, luteal, and prolactin that ma
cause the following conditions
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EN#O!RINE S)STEM
Baginal discharge and7or bleeding ma
occur in female infants.
This discharge is white mucoid in color.
#leeding ma occur as a result ofwithdrawal from maternal hormones at
the time of birth.
There are usuall onl a few blood spotsseen on the diapers. The entire process
terminates in one to two das
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EN#O!RINE S)STEM
4nlargement of the mammar glands ma
occur in both sexes.
This is particularl noticeable about the
third da of life. #reast secretion ma also occur. :welling
usuall subsides in two to three weeks.
The breast should not be squee!edC it
onl increases the chances of infection
and injuries to the tender tissue.
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NE0ROM0S!0LAR S)STEM
The newborn infant exhibits remarkable
sensor development and an ama!ing
abilit for self-organi!ation in social
interactions. The infant's muscles are firm and resilient.
/e has the abilit to contract when
stimulated, but lacks the abilit to control
them. /e wiggles and stretches, but movements
are uncoordinated.
NE0ROM0S!0LAR
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NE0ROM0S!0LARS)STEM
2ephalo-2audal /ead to Toe in
Development.
ross motor development occurs first,
followed b finer motor development. +eflex actions present at birth serve the
infant until neuromuscular development
is improved. "bsence of reflex activit often
indicates some form of brain damage
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!o''o I*at Re1e,es
.+ooting. The infant turns his head to the side
when the side of his face is touched.
% =oro reflex. The infant's total bod responds
to a startling event. /is arms extend out and up,
legs flex toward abdomen. This reflex is usuall
lost b three months of age.
Tonic neck reflex. The infant assumes a
fencer's position. /is arm and leg on one side is
extended, the opposite side is flexed. /is head
is turned toward extended side. This is not
evident after four months of age
!ARE OF THE NORMAL
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!ARE OF THE NORMALNEWBORN INFANT
The practical nurse has a unique opportunit of
closel observing and providing care for the
newborn infant after deliver.
#ecause of the newborn infant's helplessness, his
needs must be met initiall b nursing personnel. =an nursing assessments and evaluations are
conducted for the well-being of the infant.
0ursing care does not stop with the newborn
infant. 9nteraction with the parents is also important in
the development of a famil unit
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The 0ewborn 9nfant
!ARE OF THE NEWBORN IN THE
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!ARE OF THE NEWBORN IN THE#ELIVER) ROOM
There are several needs of a newborn
infant that require close attention.
4stablishing and maintaining
respirations are the two needs that mustbe met immediatel.
Esta2lis&i$ ad Maitaii$ t&e
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( Esta2lis&i$ ad Maitaii$ t&eNe32or"s Air3a4(
The phsician suctions the infant before it is
completel born with a bulb sringe or a
DeEee trap.
" DeEee trap is used if meconium waspresent in the amniotic fluid.
The infant's mouth is suctioned first and
then his nose.
3nce the infant is delivered, his head isheld slightl downward to promote drainage
of mucus and fluid.
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The infant's face is wiped thoroughl clean.
9f the infant doesn't breathe spontaneousl,
he should be stimulated to cr b slapping
his heels, lightl tapping the buttocks, and7orrubbing his back gentl.
The infant is then positioned with his head
slightl down when placed in the radiant
warmer. The bulb sringe is used to remove mucus
from his mouth and nose
Re'o i$ 'u%us *ro' i*at"s ose
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Re'o5i$ 'u%us *ro' i*at"s ose(
!o''o %&ara%teristi%s o*
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!o''o %&ara%teristi%s o*e32or respiratios
a 0ose breathers. :leeps with mouth closed,
does not have to interrupt feedings to breathe.
b 9rregular rate.
c Asuall abdominal or diaphragmatic incharacter.
d +anges from (6 to *6 breathers per
minute. e #reathing is quiet and shallow.
f 4asil altered b external stimuli. g )eriods of apnea less than 8 seconds is
normal.
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. "crocanosis ma occur during periods of cring."crocanosis refers to canotic look of the bab's
hands and feet when he is cring. ;hen the bab
stops cring, his hands and feet get pink again.
% :igns and smptoms of newborn respiratordistress.
a 9ncreased rate or difficult breathing-growing
and seesaw breathing. 9n normal respirations, the
infant's chest and abdomen rise. ;ith seesawrespirations, the infant's chest wall retracts and his
abdomen rises with inspirations.
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b :ternal or subcostal retractions.
c 0asal flaring.
d 4xcessive mucus, drooling.
e 2anosis.
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See6sa3 respiratios(
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Maitaii$ Bod4 Te'perature
Dr the infant thoroughl immediatel
after deliver.
The infant is extremel vulnerable to
heat loss because his bod surface areais great in relation to his weight and he
has relativel little subcutaneous weight.
/eat loss after deliver is increased bthe cool deliver room and the infant's
wet skin
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% )lace the infant in a radiant heat
warmer. )lace a stockinette cap on
the infant's head to prevent heat loss
through the head. ( ;rap the infant snugl in a warm
blanket. 8 )lace the infant closel to
the mother's skin. :kin-to-skin contact
with the mother will help prevent heat
loss .
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Ideti*4 t&e I*at A*ter #eli5er4
The infant must be properl identified
before leaving the deliver room.
"n identification 9D band is placed on
the infant's wrist and leg. "n identical band matching the infant's
band is placed on the mother's wrist
The infant's footprints or palm prints placed
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The infant s footprints or palm prints placed
next to the mother's thumb print is rarel
done in most facilities.4ach facilit has its own instant
identification method
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4stablish )arent-9nfant #onding
)rocess.
)arent-infant bonding is the initial step
in the process of attraction andresponse between the newborn and the
parents.
This paves the wa for development oflove and affiliation that forms a strong
famil unit.
FThis process should begin as soon after
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FThis process should begin as soon after
deliver as possible.
F9n the deliver room as soon as the infant isdr and identified, he should be given to the
parents.FThe infant is more alert during the first hours
approximatel four after birth than in the
immediate subsequent hours .
VIRGINIA APGAR S!ORING OF
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VIRGINIA APGAR S!ORING OFTHE NEWBORN
The initial ")"+ scoring is performedin the deliver room b the phsician.
")"+ scoring is a method of
evaluating the condition of the newbornat one minute and at five minutes after
deliver.
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P
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Purpose
The ")"+ scoring chart is used toevaluate the conditions of the bab at
birth, determine the need for
resuscitation, evaluate the effectivenessof resuscitative efforts, and to identif
neonates at risk for morbidit and
mortalit.
O27e%ti5e Si$s 0sed *or
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O27e%ti5e Si$s 0sed *orE5aluatio
/eart rate.
% +espirator effort.
=uscle tone.
( +eflex irritabilit.
8 2olor.
S i
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S%ori$
4valuations at each of the fivecategories are initiall done at one
minute after birth.
% 4ach item has a maximum score oftwo and a minimum score of !ero.
The final ")"+ score is the sum
total of the five items, with a maximumscore of ten. The higher the final ")"+
score, the better condition of the infant.
i
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s%ori$
( 4valuations at one minute quicklindicate the neonate's initial adaptation
to extrauterine life and whether or not
resuscitation is necessar. 8 The five-minute score gives a more
accurate picture of the neonate's overall
status, including obvious neurologic
impairment or impending death.
M i i * t
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Measuri$ i*at
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% +ecord measurements in inches andcentimeters.
Document the information in the appropriate
areas on 0ursing 0otes, the deliver room record,
and the instant data card. ( Take infant's vital signs and document on
0ursing 0otes and the deliver room record.
a Temperature-onl the first one is done rectall,
the remainder are axillar. b /eart rate and respirations-count a full minute
because of the irregularities in rhthm.
Ta.i$ i*at"s
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Ta.i$ i*at ste'perature
Nor'al eoatal 5ital
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o a eo a a asi$s
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f. "spirate fluids. "spirate the infant's mouth and nose gentl
with a bulb sringe.
% 9nsert a number 8 ?rench catheter into the
bab's nares to check for patenc.
9nsert a number & ?rench catheter in the
bab's mouth down into the stomach and gentl
aspirate stomach contents.
( +ecord the color and amount of aspirate on,
0ursing 0otes and on the deliver record sheet.
E5aluate t&e i*at"s p&4si%al
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E5aluate t&e i*at s p&4si%al%oditio assess'et
. "ssessment % Do a complete head-to-toe assessment,
looking for an gross abnormalities on his hands,
feet, palate, spine, and so forth.
Document if the infant voids or passesmeconium.
( Document presence of reflexes dealt with
more extensivel in the tpical newborn.
a =oro. b :ucking. c rasping. 8 2ount the number of vessels in the cord and
document
"ssess head for molding, caput
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"ssess head for molding, caput
succedaneum, or cephalhematoma and
document in appropriate records.1 3bserve and record an birthmarks.
h. )lace the infant on his side .
To promote drainage of mucus.
0ote that he is supported b a pillow to his
backside.
I*at pla%ed o &is
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pside(
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)rovide for infant's safet while in openwarmer.
)lace the infant in an isolette if his
temperature is below
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!o''o i*at re1e,es
A#MINISTRATION OF VITAMIN +
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A#MINISTRATION OF VITAMIN +
Bitamin @ is given as a prophlaxis forhemorrhagic disease.
9t is administered intramuscular 9= in
the vastus lateralis muscle
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E)E PROPH)LA8IS FOR THE
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NEWBORN
This procedure is required b law in allstates as prophlaxis against
gonorrhea .
Er4t&ro'4%i Op&t&al'i%
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4 4 pOit'et
a. 4rthromcin 3phthalmic 3intment.This has become the drug of choice and
is received in a sterile sringe from the
pharmac. 9t is injected into each ee from the
inner to outer canthus immediatel after
birth.
9t does not appear to cause much ee
irritation
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I :ilver 0itrate :olution. Two drops areapplied in each ee in the conjunctival sac,
not the cornea.
The infant ees ma or ma not beirrigated after instillation, depending on
local polic. The infant ma get profused
discharge and chemical conjunctivitis for a
few das with no residual damage. 3ne percent silver nitrate solution is no
longer recommended for use
Ad'iistratio o* er4t&ro'4%i
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4 4op&t&al'i% oit'et
INITIAL BATH
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INITIAL BATH
The amount of time required for theinitial bath is determined b local polic.
9f the infant's temperature is greater than
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INITIAL BATH
The procedure for actuall completingthe bath is also determined b local
polic.
"llow the parent to participate ifpossible.
+emove as much of the vernix as
possible.
:ome ma not come off during the first
bath because it is so stick.
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Thank ouJ.
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