transition and normal newborn care
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Transition and Normal Newborn Care. Monica L. Scrudder, RNC-NIC, BSN, MSN Franciscan Health System Regional Nurse Educator, Nursery Services. Objectives. Identify primary features of fetal circulation. - PowerPoint PPT PresentationTRANSCRIPT
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Transition and Normal Newborn Care
Monica L. Scrudder, RNC-NIC, BSN, MSNFranciscan Health System
Regional Nurse Educator, Nursery Services
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Objectives
• Identify primary features of fetal circulation.• Identify physiological changes that occur at
birth in the newborn’s transition to extrauterine homeostasis.
• Identify routine care for the newborn in the transition period.
• Identify signs and symptoms of common problems in the transition period.
• Identify nursing intervention that promote parental bonding.
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What Is Transition???
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The Transition Period
• Birth to 6 hours of age• Physiological change from placental
support to self-maintenance• Fetus prepares for transition over the
course of gestation• Transition depends on gestational age
and quality of placental support
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The Cardiac Puzzle
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Anatomy and Physiology
• Placental Fetal Circulation• Blood follows the path of least
resistance• Low pulmonary blood flow (only 8-10%
of right ventricular output secondary to high pulmonary vascular resistance
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The Fetal Circulation
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Ductus Venosus
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Foramen Ovale
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Ductus Arteriosis
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Fetal Lungs
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Fetal Metabolism and Hematology
• Glucose– Fetal concentrations 70-80% of maternal
glucose concentrations
• Glycogen– Large glycogen stores provide large energy
reserves to sustain newborn through transition period
• Brown Fat– Unique to newborn– Metabolized for heat
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Cardiopulmonary Adaptation at Birth
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Cardiovascular Adaptations At Birth
• Umbilical cord is clamped.• Three major shunts functionally close
during transition– Ductus Arteriosis– Foramen Ovale– Ductus Venosus
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Pulmonary Adaptation At Birth
• Stimuli for initiating respiration– Mild hypercapnia, hypoxia and acidosis– Light, noise, touch– Thoracic squeeze during vaginal delivery
• Empties approximately 1/3 of fetal lung fluid
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First Breath
• Air enters lungs at 2x normal pressure– 40-80 cm H2O
• Pulmonary vessels vasodilate in response to increased oxygen– Pulmonary vascular resistance decreases– Pulmonary blood flow increases
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Continued Pulmonary Adaptations
• Pulmonary vascular resistance (PVR) decreases to reach adult levels at 2-3 weeks of age
• Lung compliance improves
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Measurements
• Apgar score– Done at 1 minute and 5 minutes of age– If apgar less than 7 at 5 minutes of age,
continue every 5 minutes until greater than 7 for maximum of 20 minutes
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The Apgar Score
Sign 0 1 2Heart rate Absent Slow (<100
bpm)> 100 bpm
Respirations Absent Weak cry,Hypo-ventilation
Good, strong cry
Muscle Tone Limp Some flexion Active motion
ReflexIrritability
No response Grimace Cough or sneeze
Color Blue or pale Body pink,Extremities blue
Completely pink
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Assessment Findings During Transition
• Head circumference, length, weight• Gestational age assessment• Skin• Head• Respiratory assessment• Cardiac assessment• Gastrointestinal assessment• Extremities
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Medications in Transition
• Erythromycin Ointment • Vitamin K (AquaMEPHYTON)• Hepatitis B vaccine/Hepatitis B
Immunoglobulin
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Glucose Needs
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Contraindications to Feeding
• Cyanosis• Shock or asphyxia• Increased work of breathing • Ongoing oxygen requirement
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AAP/ACOG/AWHONN Guidelines
• Proper identification of newborn• Initial assessment within 2 hours of birth• Develop a plan of care• Document observations at least every 30 minutes until stable
for 2 hours• Prophylactic eye care within 1 hour of birth• Primary health care provider
– Perform initial physical exam no later than 24 hours of birth– Perform physical exam within 24 hours before discharge
• Document daily weight• Perform metabolic screening• Instruct parent in care of infant
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Guidelines (Cont)
• Implement emergency measures, including resuscitation, when necessary using such programs as the Neonatal Resuscitation Program
• Observe parent-infant interactions• Identify with parent(s) the appropriate facility for follow-up• Inform parent(s) of importance of immunizations• Identify high-risk mothers• Evaluate home environment
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Nursing Considerations
• Observations must be documented every 2 hours according to the State of Washington.– Follow hospital policy regarding this
guideline.• Vital sign routine• Daily weight• Physician notification• Timing of metabolic screening• Specific teaching issues for population
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Nursing Observations
• Cardiac and Respiratory Status• Feeding• Temperature• Color• Tone • Activity• Output• Parent-infant bonding
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Parent-Infant Bonding
• Bonding• Attachment• “En face”• “Parentese”• Red Flags
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Assess Parenting Styles and Abilities
• Parents’ level of knowledge• Family’s communication• Parental expectations• Infant’s responses to parenting activities• Parental feelings about self and infant• Parental support• Cultural beliefs• Potential need for referral
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Routine Care and Documentation
• Documentation of birth• Measurements• Medications• Physical assessment• Abduction prevention• Bathing/Hygiene• Cord Care• Feeding assessment• Metabolic screening• Elimination
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Discharge Criteria
• Feedings• Discharge weight• Metabolic screening• Birth certificate worksheet/paternity
papers• Teaching documented• Hearing screening
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Discharge Teaching
• Begins on admission• Assess Mother’s readiness to learn• Assess Father’s involvement• Involve Grandparents, siblings, and
other significant people
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Teaching Documentation
• Thermoregulation• Holding and Positioning• Hygiene• Feeding• Bulb syringe• Choking• Elimination• Circumcision Care• Safety• When to Call the Physician
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References
• Askin, DF. (2002) Complications in the Transition from Fetal to Neonatal Life. JOGNN 31(3): 318-27
• Buschbach, D., Schaub-Bordeaux, M. (2002) Newborn Physiological and Developmental Transitions: Integrating Key Components of Perinatal and Neonatal Assessment. Association of Women’s Health, Obstetric and Neonatal Nurses.
• Kenner, C., Wright-Lott, J. (2003) Comprehensive Neonatal Nursing: A Physiological Perspective. Philadelphia:Saunders
• Sansoucie DA, Cavaliere, TA. (1997) Transition from Fetal to Extrauterine Circulation. Neonatal Network, 16(2):5-12
• Verklan,TM, Walden, M., editors (2004) Core Curriculum for Neonatal Intensive Care Nursing (3rd ed.) St. Louis:Elsevier
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References (2)
• http://www.cayuga-cc.edu/people/web_pages/greer/biol204/heart4/heart4.html
• http://dic.academic.ru/pictures/enwiki/80/Patent_ductus_arteriosus.jpg
• http://www.007b.com/breastfeeding_pictures.php
• http://pregnancy.about.com/od/newbornbabies/ig/Newborn-Photo-Gallery/index.01.htm