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FALL 2011Newborn Care
Health Promotion in the Pregnant Family
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Note to the student
As with every lecture faculty prepare, wedo our best to provide you with accurate,up-to-date information.
The newborn lecture is currently beingmodified.
In an attempt to provide YOU withinformation, I have made an abbreviated
version. How do you know if you are on the right
track? ANSWER THE OBJECTIVES.
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Note to the student
How do you know if you are on theright track? ANSWER THE
OBJECTIVES!
Ask yourself why or how does this
make a difference. What will I teach the patient? How do I know they understood me?
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Apgar Scores-Babys First Test
Done at 1 minute & 5 minutes old. Scores from 0-10.
- 7-10 = WNL- 4-7 = needs some
resuscitation or resp. support
- under 4 = needs immediate resuscitation
WHY do we do this? WHEN do we do it? WHATdo we do with the information?
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Apgar Criteria
Sign Score=0 Score=1 Score-2Heart
rate
Absent Below 100 Above 100
Respiratory
effort
Absent Weak,
irregular
Good,
crying
Muscle
tone
Flaccid Some ext.
flexion
Active ext.
movement
Reflex
irritability
No response Grimace or
week cry
Good cry
Color Blue all over
or pale
Acrocyanosis Pink all over
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Other first tests
Weight & length
State Mandated newborn screening(varies per state)
1. PKU (phenylkentonuria)2. Hypothyroidism3. Galactosemia (intolerance to milk r/t
deficient enzyme galactose)4. Hearing Screen5. Bilirubin Jaundice
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Normal PhysiologicalCharacteristics of
the Newborn
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Head
Fontanels: there are two soft spotson the babys skull
Openings at place where bones of theskull meet Anterior & posterior
Anterior: diamond-shaped, larger Posterior: smaller, triangular
(May pulsate when baby cries)
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Length, Head
Length: average is 20 inches
Head: at birth, your babys head is1/3 the size of an adults head
(Head should measure greater
than the chest measurement) Circumference is about 32-37 cm
(12.5-14.5 in.) 4
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Caput Succedaneum
Collection of serosanginous subqfluids.
Crosses suture lines.
Resolves within a few days of life.
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Cephalhematoma
Collection of blood between skull &periosteum.
Well defined & doesnt cross suture lines.
May occur 48 hrs post birth.
Reabsorbs by 3 months of age.
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Variations
If baby is born breech or c-section,head is very round (head did not
mold to the birth canal) fuzz on face and body, called lanugo
(may be fine black hair on shouldersand back of newborn)
Babies blink in response to brightlight
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Eyes
Blue, blue/gray or dark brown Eye color usually established at 3
months Common for eyes to appear crossed
strabismus Tearless
because the structure that makes tearsis immature at birth
Limited ability to focus 6
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Eye Medications at Birth
Erythromycin Tetracycline
Drugs used to prevent opthalmianeonatoriumin the newborn.
Targeted organisms are chlamydiaand gonorrhea.
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Nose
Nose: usually small, narrow Babies are nose-breathers
Sneezes are the means in whichbabies clear obstructions
Your baby can smell
Knows moms scent and can smell breastmilk
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Mouth
Mouth: lips pink; may see sucking
blister Sometimes see small teeth - called
Epsteins pearlsthey are actually
small, harmless cysts, may feel firmto touch
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Skin Variations
Skin may be mottled with reddish
patches May see Mongolian spot Hands and feet have peeling skin
Milia are white acne-like spots butthis is not acne, so leave baby alone
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Weight
Weight: 3405g (7# 8oz) African American or Asian may be
smaller Factors that influence
Age, size of parents, health of mother,interval between pregnancies
*What things can decrease birthweight? 3
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Weight
Weight increases at rate of 7 oz per
day Initially, newborns have a physiologic
wt loss of 5-10% due to fluid shifts
*Wt loss > than that indicates theneed for intervention?
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Umbilical Cord
Father participation cut the cord Cord looks white, similar to gelatin; soft How many vessels and what kind? Cord clamp-a plastic device put in place to
allow cord to close then purple dye used Cord will fall off in 7-10 days
Clean with alcohol after every diaper change(controversial)
Diaper fold below cord
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Chest
May see prominent chest bone(xyphoid)
May see enlarged breast tissue inboth sexes *What causes this?
May see extra nipples
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Respirations
Normal rate of breathing is 30-60
breaths per minute May see abdominal and diaphragm
movement in newborns
Transient tachypneatemporaryincreased breathing rate
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Genitalia
Females: may see enlarged labia, perhapseven a slight vaginal discharge. It may bewhite or even blood tinged
Males: scrotum is usually large, appears
swollen, covered with rugae Deeply pigmented in dark-skinned ethnic groups
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Elimination patterns
Meconium stool:
Transitional stool: Constipation:
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Elimination
Breast-fed stools:
Bottle-fed stools:
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Infant Stools
Meconium= 1st BMs. Average=2-10/day. Breastfed babies-looser stools.
If diarrhea, fear is dehydration (greencolor)
If constipation, glycerine suppository(prune or apple juice depends on age)
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Elimination
Urination
Most babies urinate immediately afterbirth Amount of urine is decreased until your
baby starts feeding. You may see voids
of 2-6 times in first two days of life;then 5-25 times as a newborn!
fl
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Reflexes Rooting: Sucking: Swallow: Gag: Grasp: Moro:.
So, there areseveral reflexes.Do you know the
normal/expected
response? Whatwill you teachthe parents?
How do you knowyour teaching iseffective?
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Reflexes
Tonic neck: Dance: Babinski:
Extrusion:
So, there areseveral reflexes.Do you know the
normal/expectedresponse? Whatwill you teach theparents? How do
you know yourteaching iseffective?
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Newborn care
Bathing Scalp: does not need to be washed every
day
cradle cap Eyes: wash first; use index finger and
separate part of washcloth for each eye Ears: clean behind ear and external lobe.
NO cotton swabs! Face: clean with washcloth, NO soap!
*Why do we not recommend soap?
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Bathing
Look at babys skin. Any rashes? Any
redness? Check diaper area for rash *What would you teach as far as diaper
rash goes?
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Heat Loss
Convection: loss of heat from thewarm body surface to cooler aircurrents
Example: Evaporation: loss of heat incurred
when water is converted to vapor
Example:
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Heat Loss
Conduction: loss of heat to a coolersurface by direct skin contact.
Example Radiation: loss occurs when heat
transfers from the heated body riseto cooler surfaces and objects not in
direct contact with the body. Example
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Circumcision
The surgical removal of the foreskin
of penis
60% of males are circumcised
females are also circumcised in somecultures
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What are your personal feelings
regarding circumcision? *Is it medically necessary?
Mutilation? Does the baby feel pain? Religious practices? Cultural considerations?
*What is the care for circumcised
penis? *What is care for uncircumcised
penis?
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Care of Genitalia
Female
Front to back Male
Circumcised: use of lubricant andgauze initially (retraction of foreskin)
Uncircumcised: retraction of foreskinduring bath
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Temperature: What is
Normal?
Rectal: Oral: Axillary:
Tympanic membrane: Patches:
What are the differences? When is eachused/done?TRADE in MERCURY Thermometershazardous material
B b T lk C i
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Baby Talk- Crying
How babies communicate their needs.-hot or cold? -tired or bored?
-hungry? -wet or uncomfortable?-overexcited? -in pain or distress?
Normal NB averages about 2.5-3 hrs crying/day.
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Colic
Colic Common in infants < 3 mo. of age Abdominal cramping expressed by crying and
drawing legs toward abdomen May be related to allergy to cows milk;
parental smoking
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Ways to manage colic:
Is there an allergy to cows milk? What types of foods is the
breastfeeding mom eating? Avoid soy formulas *What can you suggest to the new
mom?
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1. Feed baby
2. Burp baby.3. Wrap baby snuggly.
4. Talk soothingly.
5. Play music.
6. Change position
7. Change diapers.
8. Check to see if baby is too warm or cool.
9. Hold baby.
10. Put baby down.
11. Put baby to bed.12. Offer baby a toy (if over 3 mths old).
13. Take baby outside.
14. Take baby away from overstimulating environment.
F di B b
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Feeding Baby
Choices are breast or bottle feeding. Although Breastfeeding is best & encouraged,
decision is the familys (ultimately, mom). Deciding factors can be:
-money - job -culture/religion- ease -SE status -peer group-maternal/neonatal health status
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Breastfeeding
Most common now. Most infants are breastfed x 1 year & do well.
Encourage use of lactation specialist when problemsdevelop or a breastfeeding support group withintheir community
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Breastfeeding
Advantages
is
adva
ntages
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Breastfeeding
Positioning Ears, shoulders and hips in same line;
infant turned toward breast Musttake nipple andareola into mouth Cradle hold, side-lying, football hold
Breastfed babies eat q 2-4 hours. *Is it better to feed on demand or on
a schedule?
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Breastfeeding
The nurse will assess you for thefollowing:
L Latch A Audible swallowing T Type of nipple
inverted, flat; engorged breasts
C Comfort (breast & nipple) H Hold (positioning)
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Bottlefeeding
Advantages Disadvantages
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Bottle Feeding
Keep baby on same formula-dont switch. Easier on mom; allows dad time with
baby.
Can be expensive!-varies with type-ready-to-use-concentrate-powder
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Bottle Feeding
Variety of Formulas Cow milk base: Similiac, Enfamil, Gerber,
Carnation Good Start Soy protein base: Prosobee, Isomil,
Gerber Soy Special: Nutramagen, Alimentumused
if allergy or intolerance to cows milk
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Bottlefeeding
Hold baby for all feedings-never prop themup!!
Position to avoid ear infections To avoid ingestion of air, ensure nipple isfull of liquid at all times.
Burping
*Should a baby be fed every time he cries? Wash bottle items in dishwasher (Why no
more Boiling bottles?) Wash nipples by hand-will last longer
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Burping
-Results from air in esophagus esp. when lying down.
-Most needed under 2 months old.-Should be done at middle, or after 2oz. Of formula& at the end of each feeding.
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Burping cont.
Between switching breasts ifbreastfeeding
*What position should baby be placed inafter feeding? Use of bulb syringe
*What if baby spits up?
E E h
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Is Baby Eating Enough?
Will vary day-to-day.
How many wet/dirty diapers/day?
Any signs of hunger from baby?
Steady weight gain?
Dont start cereals until 4-6months/old.
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Nutrition
Expected weight gain/loss: 1.5#/month for 5 months; slows during
next 6 months of life Breast-fed infants typically gain less
than bottle-fed infants Weight loss of_________ for term
newborn is considered within normallimits.
f h G
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Infant Weight Gains
Should double birth weight by 6months.
Should triple BW by one yr. Compare to est. growth charts to
ensure WNL gains.
*Remember those G&D charts you havebeen seeing?
d i f lid F d
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Introduction of Solid Foods
Breast milkor formulais all that is
needed for the first six monthsoflife. Solid foods are recommended after 6
months.
I d i f S lid F dM
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Introduction of Solid Foods
Cereal High iron content Mix with breast milk or formula May use fruit juice after 6 months to
mix Vegetables
One at a time for a few days
ea
ts
O
nea
ta
t
Baby Baths
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Baby Baths
Sponge bath until umbilical cord gone& circumcision healed.
Dont need daily baths, 1-2x/wk.
Keep bath area warm & draft-free. Bathe head-to-toe; genitals last
(front-to-back).
B h S f
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Bath Safety
Never leave infant in bath alone!! Water should be under 120 degrees.
(test water on wrist)
No Q-tips. NO lotions, powders, or oils.
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Bonding
What is Bonding?When does Bonding Start?Benefits of Bonding?Who benefits?What about siblings?
D d & B b
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Dad & Baby
Couvade Have you heard of
this?
Its in Oldscheck it out!
Hold infant & makeeye contact soonafter birth.
Feed baby. Change diapers. Be there esp. in
times of illness.
Sibli Ri l
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Sibling Rivalry
Have sibling meet baby at hospital. Involve older child in infants care. Spend time alone with older child. Praise older child for routine good
behavior.
I f t S f t i th H
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Infant Safety in the Home
Install fire and Carbon monoxide detectors. Post emergency #s near the phone. If paint flaking, have it tested for lead.
Use non-slip pads under small rugs. Keep heavy & breakable objects out of
reach. Place furniture away from hazards.
(especially cords on blinds, etc.)
n ant Sa ety n t e ursery
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n ant Sa ety n t e ursery
Crib slats no more than 2 3/8 apart (usecare with old cribs). Position crib away from windows, heaters,
decorations, blind cords. No soft, fluffy crib pillows, comforters.
Mattress should fit snuggly (less than 2fingers-width between). No mobiles over crib. Strap on changing table. Fire resistant linens & sleepwear.
C S t
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Car Seats MVA leading cause of death in children.
All children under 40# need car seats All children under 12 should be in back seat. For babies under 1, middle of backseat.
should face rear of vehicle.
Be sure seat meets federal standards(especially if it has previously been used Ex:rummage sales)
P ti Abd ti
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Preventing Abduction
Never let baby out of your sight! Get references for nannies & babysitters. No announcement in papers. No stork on lawns. No Home Health people without ID.
W i Si
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Warning Signs
Teach parents to call the doctor when..
Less than 4 wet diapers/day
No BMs Jaundice after 7 days old. Diarrhea Temp over 100F (a)
Vomiting more than 2-3x/day Refuses to feed or nurses poorly
N si Di s s
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Nursing Diagnoses
Normal newborn
Effective breastfeeding Ineffective protection Ineffective thermoregulation Risk for infection Risk for injury
N sin Di n s s
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Nursing Diagnoses.
Parent Chronic sorrow Risk for impaired parent/infant
attachment Parenting, impaired Parenting, risk for impaired
Patient education