maternity nursing overview 2 of 2
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How To Use A Bulb Syringe
Clear the Mouth first, then the Nose
(M before N)
! Compress the bulb prior to suctioning
! Gently insert the tip of the syringe into the dependent side of the
newborn’s mouth to collect drainage
! Release the compression of the bulb to allow for re-expansion andcollection of the secretions
! Remove the blub syringe from the mouth and squeeze the bulb torelease the collected drainage into the appropriate receptacle ortissue
THE HEALTHY NEWBORN (cont.)
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THE NEWBORN BATH
" Wash the head first (keep the infant wrapped to prevent heat loss)
" Wash the body in 1-2 minutes and dry completely. Remove wetlinen
IMPORTANT TO WORK EFFICENTLY TO PREVENTHEAT LOSS!!
THE HEALTHY NEWBORN (cont.)
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MEDICATIONS YOU WILL BE ADMINISTERINGVITAMIN K – Administer within 1 hour of birth. Vitamin K is not
required to make clotting factor but is required to convert precursor
proteins made in the liver into activated proteins with coagulantproperties.
Without Vitamin K at birth, bleeding can occur from the GI tract,
umbilicus, circumcision site, and any other puncture site.
Vitamin K is given intramuscularlyinto the thigh.
THE HEALTHY NEWBORN (cont.)
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MEDICATIONS YOU WILL BE ADMINISTERING (cont.)
EYE PROPHYLAXIS – To prevent from unknown Gonorrhea orChlamydia infection in the mother which can cause blindness in the
infant
Can use: Tetracycline Ointment 1%
Erythromycin Ointment 0.5%
Ophthalmic sol. of Povidine-Iodine 2.5%
# Needs to be given within 1 hour of birth
# Deposit a 1-2 cm ribbon of sterile ointment into the conjuctival sac
THE HEALTHY NEWBORN (cont.)
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MEDICATIONS YOU WILL BE ADMINISTERING (cont.)
ENGERIX, Hepatitis B vaccine
Mother must sign consent before
this can be given
Given intramuscularly in opposite
thigh of the Vitamin K injection
THE HEALTHY NEWBORN (cont.)
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6 ‘Rights’ of Medication Administration
!Right Person!Right Drug
!Right Dose
!Right Time!Right Route
!Right documentation
THE HEALTHY NEWBORN (cont.)
YOU MUSTALWAYS CHECKTHE DRUG WITHTHE PHYSICIAN’SORDER….
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REFLEXES
MORO (Startle) – Hold infant in semi-sitting position, allow head and
trunk to fall backward with support, or place the infant on a flatsurface, make a loud abrupt noise.
The infant will have symmetric abduction and extensionof arms, and legs will follow in a similar pattern; slight shaking ortremor may be included, infant may cry.
THE HEALTHY NEWBORN (cont.)
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REFLEXES (Cont.)
STEPPING or WALKING – Hold infant vertically under arms or on trunk,
allowing one foot to touch table surface. The infant will simulatewalking alternating flexion and extension of feet.
Term infants will walk on the soles of their feet while
preterm will walk on their toes. This reflex willdisappear at 3-4 months.
PALMAR GRASP – Press the palmar surface of the infant's hand with afinger. The infant will grasp the finger and hold tight when youattempt to withdraw. This reflex will disappear at 2 months
THE HEALTHY NEWBORN (cont.)
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REFLEXES (Cont.)
BABINSKI (Plantar) – On the sole of the foot, beginning at the heel,
stroke upward along lateral aspect of sole, then move finger across
ball of foot. All toes hyperextend, with dorsiflexion of big toe –recorded as ‘Positive’ sign. Absence of the Babinski requiresneurologic evaluation. This reflex will disappear after 1 year of age.
THE HEALTHY NEWBORN (cont.)
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REFLEXES (Cont.)
ROOTING – Stroke the infant’s cheek and corner of the mouth and theinfant’s head turns toward the stimulus and the mouth opens. This
will disappear at 3-4 months.
SUCKING – Touch or stroke the baby’s lips – the mouth opens and
sucking movement begin. This reflex will disappear at 12 months.
THE HEALTHY NEWBORN (cont.)
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REFLEXES (Cont.)
TONIC NECK – Place the infant supine and turn his or her head to
one side – the infant extends the arm on the side in which thehead is turned and flexes the upper extremity on the opposite
side (fencing position)
THE HEALTHY NEWBORN (cont.)
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REFLEXES
THE HEALTHY NEWBORN (cont.)
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GENERAL APPEARANCE
COLOR – Consistent with genetic background; pink ucous membranes;
mottled with cooling, bruises over presenting part.
Acrocyanosis – blue palms and soles
Circumoral cyanosis – blue around mouth – requires IMMEDIATEattention
Jaundice – yellow skin color; mild jaundice normal after day 1 of life
THE HEALTHY NEWBORN (cont.)
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GENERAL APPEARANCE (Cont.)
HARLEQUIN COLOR CHANGE – In side-lying position, red colordemarcated on dependent side, pale color on upper half; persists
1-13 minutes; color reverses if infant is rotated to other side.
THE HEALTHY NEWBORN (cont.)
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RESPIRATORY• Diaphragmatic and abdominal breathing
• Rate – 40-60 breaths/minute (may decrease in sleep and
increase after crying)
• Periodic Breathing – pauses in breathing up to 20 seconds
without bradycardia or color change (this is normal)
•
Respiratory Distress - expiratory grunting, nasal flaring,cyanosis
• Allow the newborn to cry – helps to clear retained fetal lung fluid
THE HEALTHY NEWBORN (cont.)
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TONE/NEUROMUSCULAR
• Term infant is flexed, fists clenched
•
Term infant with healthy tone can be pulled up to sitting positionusing the palmar grasp reflex
• Head moves side to side, moves all extremities, moves smoothly
between behavioral states
• Frank breech presentation mayhave extended legs for a brief time
THE HEALTHY NEWBORN (cont.)
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THE HEALTHY NEWBORN (cont.)
Skin
• Vernix caseosa – greasy yellow-white substance covering infant
• Lanugo – fine hair on cheeks, shoulders, forehead, pinna ofears
• Milia – tiny white papules on brow, cheek, and nose
• Erythema toxicum (newborn rash) – small white or yellowpapules on a red base which can last several hours to severaldays
•
Sucking blisters – vesicles on lips, hands from in utero
• Stork bite (nevus simplex) – pink macule on nape of neck, uppereyelids, bridge of nose or upper lip that usually fades
• Mongolian spots – bluish or gray-blue areas of pigmentation on
dorsum and buttocks, commonly found on dark skinned races
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HEADFontanels
# Anterior – palpated as 5cm diamond
# Posterior – palpated as smaller triangle
# Palpate sutures – should be enjoined (sutures aremembranous attachments that make the bones join insuch a way that the head can squeeze through the birthcanal)
THE HEALTHY NEWBORN (cont.)
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GI/GUABDOMEN
• Soft and rounded – not distended
• Bowel sounds present 1-2 hours after birth
•Abdominal distention caused by mucus, blood and amniotic fluidswallowed during birth
• Infant should void by 24 hours of age
• Meconium stools
(black tarry sticky substance)
may last for 3 days then becomethe seedy yellowish transitional stool
• Failure to pass meconium stool is sign of intestinal obstruction
and places the newborn at high risk for hyperbilirubinemia
THE HEALTHY NEWBORN (cont.)
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Glucose Monitoring
Normal Blood Glucose for the term infant during the first day of life:
40 – 60 mg/dL
And after the first day of life will range between 50 – 90 mg/dL
Heel puncture for blood glucose testingmust be done on the lateral aspect of the
foot to avoid damage to the nerves and
calcaneus bone
THE HEALTHY NEWBORN (cont.)
Murray & McKinney 2010
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Conjugation of Bilirubin
Contributing factors in increased bilirubin
# Excess production# Red blood cells break down more quickly
# Decreased albumin
# Immature liver
# Preterm and late term infants
# Lack of intestinal flora# Decreased intestinal motility
# Trauma such as bruising
# Fatty acid release
# Family background
THE HEALTHY NEWBORN (cont.)
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HYPERBIRUBINEMIA
Physiologic Jaundice – also called nonpathologic ordevelopmental jaundice. Jaundice is visible whenthe bilirubin level reaches 5-7 mg/dL
Bilirubinometer – non invasive devise to measure bilirubinlevel in the infant’s skin
Transcutaneous bilirubinometer(TcB)
THE HEALTHY NEWBORN (cont.)
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NEWBORN ASSESSMENT
THE HEALTHY NEWBORN (cont.)
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To Beautiful Mom
MEDICATIONS
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Prenatal vitamins
Iron
Folic acid
Rhogam
Procardia
MEDICATIONS TO KNOW
ANTEPARTUM
Terbutalin
Indocin
Magnesium Sulfate
Colace
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MEDICATIONS TO KNOW (cont.)
Pitocin
Terbutaline
Magnesium sulfate
Fentanyl
Marcaine
Nubain
Stadol
Numorphan
Misprostil
Phenergan
Ampicillin
Gentamycin
Clindamycin
Cefotan
Prostin F2 alpha (hemabate
Methergine
Penicillin-G
Narcan
Barbituates (Seconal)
Benzodiazepines (Valium,Versed)
INTRPARTUM
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Mylicon/Mylanta
Colace
Motrin
Tylenol
Tylenol #3
Percocet/Percodan
Charcoal
MEDICATIONS TO KNOW (cont.)
POSTPARTUM
Rubella Vaccination
Vicodin
Duramorph
Benadryl
Nubain
Gentamycin
Clindamycin
Methergine, Hemabate
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Erythromycin Ophthalmic
Vitamin K
Hepatitis vaccination
Narcan
MEDICATIONS TO KNOW (cont.)
NURSERY
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Murray, S. S., & McKinney, E. S. (2010). Foundations ofmaternal-newborn and women’s health nursing (5th ed.).Maryland Heights, MN: Saunders Elsevier.
Harnikka (October 4, 2007). Fundus. Retrieved May 1, 2011,from !""#$%%&&&'()*"*+,'-).%&/"-!01234+567589:;
Wibenson888 (March 14, 2007). Primitive Reflexes. RetrievedMay 1, 2011, from !""#$%%&&&'()*"*+,'-).%&/"-!0126?@A?BB
CypressCC (June 3, 2010). Newborn Assessment. RetrievedMay 1, 2011, from !""#$%%&&&'()*"*+,'-).%&/"-!0121"(#>;3C@#&
REFERENCES
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