copyright © 2013 wolters kluwer health | lippincott williams & wilkins essentials of maternity,...

Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins

Essentials of Maternity, Newborn, and Women’s Health

Nursing

Chapter 18Nursing Management of the

Newborn

Essentials of Maternity, Newborn, and Women’s Health

Nursing

Chapter 18Nursing Management of the

Newborn


Initial Newborn Assessments Initial Newborn Assessments

• Signs indicating a problem

– Nasal flaring, chest retractions

– Grunting on exhalation, labored breathing

– Generalized cyanosis, flaccid body posture

– Abnormal breath sounds, abnormal respiratory rates

– Abnormal heart rates, abnormal newborn size


Initial Newborn Assessments (cont’d.)Initial Newborn Assessments (cont’d.)

• Apgar scoring (see Table 18.1)

• Length and weight, vital signs (see Table 18.2)

• Gestational age assessment (see Figure 18.3)

• Physical maturity (skin texture, lanugo, plantar creases, breast tissue, eyes & ears, genitals)

• Neuromuscular maturity (posture, square window, arm recoil, popliteal angle, scarf sign, heel-to-ear)


Apgar ScoringApgar Scoring

A = appearance (color)

P = pulse (heart rate)

G = grimace (reflex irritability)

A = activity (muscle tone)

R = respiratory (respiratory effort)


Gestational AgeGestational Age

• Preterm or premature: prior to 37 weeks’ gestation

• Term: 38 to 42 weeks’ gestation

• Postterm or postdates: after week 42 gestation

• Postmature: after week 42 gestation/placental aging

• Small for gestational age (SGA)

• Appropriate for gestational age (AGA)

• Large for gestational age (LGA)


Physical Maturity Assessment (Ballard)Physical Maturity Assessment (Ballard)

• Skin texture

• Lanugo

• Plantar creases

• Breast tissue

• Eyes and ears

• Genitals


Neuromuscular MaturityNeuromuscular Maturity

• Posture

• Square window

• Arm recoil

• Popliteal angle

• Scarf sign

• Heel to ear


QuestionQuestion

Is the following statement True or False?

Arm recoil is one measure of assessing a newborn’s physical maturity.

a. True

b. False


AnswerAnswer

b. False

Arm recoil is a measure of a newborn’s neuromuscular maturity. An example of an assessment of physical maturity is skin texture.


Nursing Interventions: Immediate Newborn PeriodNursing Interventions: Immediate Newborn Period

• Maintaining airway patency

• Ensuring proper identification

• Administering prescribed medications (see Drug Guide 18.1)

– Vitamin K

– Eye prophylaxis

• Maintaining thermoregulation


Newborn Physical ExaminationNewborn Physical Examination• Prenatal history

• Newborn physical examination

– Anthropometric measurements: length, weight, head circumference, chest circumference

– Vital signs

– Skin: condition and color; common skin variations (see Figure 18.12)

– Head: size, fontanels; variations in head size and appearance (see Figures 18.13 and 18.14); abnormalities in head or fontanel size


Newborn Physical Examination (cont’d.)Newborn Physical Examination (cont’d.)

• Face: nose, mouth, eyes, ears

• Neck, chest

• Abdomen

• Genitalia (see Figure 18.16)

• Extremities and back

• Neurologic status

– Alertness, posture, and muscle tone

– Reflexes (see Table 18.4 and Figures 18.17 and 18.18)


Common Skin Variations in NewbornsCommon Skin Variations in Newborns

• Vernix caseosa

• Stork bites or salmon patches

• Milia

• Mongolian spots

• Erythema toxicum

• Harlequin sign

• Nevus flammeus

• Nevus vasculosus


Variations in Head Size and Shape in the NewbornVariations in Head Size and Shape in the Newborn

• Variations

– Molding

– Caput succedaneum

– Cephalhematoma

• Abnormalities

– Microcephaly

– Macrocephaly

– Large, small, or closed fontanels


Common Concerns During Newborn TransitionCommon Concerns During Newborn Transition

• Transient tachypnea of the newborn

• Physiologic jaundice

• Hypoglycemia


Nursing Interventions for Transient Tachypnea Nursing Interventions for Transient Tachypnea

• Providing oxygen

• Ensuring warmth

• Observing respiratory status frequently

• Allowing time for pulmonary capillaries and the lymphatics to remove the remaining fluid


Selected Screening for NewbornsSelected Screening for Newborns

• PKU

• Congenital hypothyroidism

• Galactosemia

• Sicke cell anemia


Nursing Management: Early Newborn Period: Nursing Interventions Nursing Management: Early Newborn Period: Nursing Interventions • General newborn care

• Bathing and hygiene (see Teaching Guidelines 18.1 and Nursing Procedure 18.2)

– Gloves

– Plain water on face and eyes; mild soap for rest of body

• Elimination and diaper area care

– Urine characteristics

– Stool pattern

– Diaper area care


Nursing Management: Early Newborn Period: Nursing Interventions (cont’d.)Nursing Management: Early Newborn Period: Nursing Interventions (cont’d.)• Cord care (see Teaching Guidelines 18.2)

• Circumcision care

• Safety (see Teaching Guidelines 18.3)

– Prevention of abduction

– Car safety

• Infection prevention

• Sleep promotion

• Bonding


Nursing Management: Early Newborn Period: NutritionNursing Management: Early Newborn Period: Nutrition

• Physiologic changes

• Nutritional needs

– Calories

• Fluid requirements

• Feeding method choice

– Feeding the newborn

– Frequency

– Measures to decrease air swallowing


Nursing Management: Early Newborn Period: Breast-FeedingNursing Management: Early Newborn Period: Breast-Feeding• Composition

• Assistance

• Positioning

• Education

• Storage and expression

• Concerns

• Sore nipples

• Engorgement

• Mastitis


LATCH Method for Assessing Breast-Feeding SessionsLATCH Method for Assessing Breast-Feeding Sessions

• L: How well infant latches onto the breast

• A: Amount of audible swallowing

• T: Nipple type

• C: Level of comfort

• H: Amount of help mother needs


QuestionQuestion

An infant typically requires how many calories per kilogram per day during the first 3 months?

a. 80

b. 95

c. 110

d. 150


AnswerAnswer

c. 110

During the first 3 months, an infant needs 110 to 120 calories/kg/day.


Nursing Management: Early Newborn Period: Bottle FeedingNursing Management: Early Newborn Period: Bottle Feeding

• Types of formula

• Assistance

• Positioning

• Education

• Weaning and introduction of solid foods


Nursing Management: Early Newborn Period: Discharge PreparationNursing Management: Early Newborn Period: Discharge Preparation

• Preparing for discharge

– Education

– Cultural considerations

• Follow-up care

– Return visit

– Warning signs and symptoms

– Immunization information

copyright © 2013 wolters kluwer health | lippincott williams & wilkins essentials of maternity,...

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