Transcript Nursing Care of the Normal Newborn Chapter 14

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1. Explain how to support immediate cardiovascular and respiratory
transitions in the newborn
2. Identify two methods to promote thermoregulation for the newborn.
3. Discuss appropriate interventions for the newborn with hypoglycemia.
4. Describe immediate care of the newborn regarding eye prophylaxis and
administration of vitamin K.
5. Explain the nurse’s role in protecting the infant from misidentification in
the hospital.
6. Identify effective infection control procedures in the nursery.
7. Describe when and how the newborn receives his or her first bath.
8. Describe strategies hospitals can take to protect the newborn from
abduction.
9. Identify signs of pain in the newborn, and list nursing measures to help
decrease or avoid pain in the newborn.
10. Compare the care of the uncircumcised newborn male with that of the
circumcised newborn.
11. List immunizations and newborn screening tests that should be done
before the newborn is discharged home.
12. Develop a teaching plan for the parents regarding normal newborn care.
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Your role
◦ To support the newborn
◦ To quickly recognize the development of
complications
◦ To report changes in condition to the RN to
facilitate rapid intervention
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Neonatal Resuscitation Program (NRP)
◦ Current standard of care for resuscitation of the
newborn immediately after birth
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Licensed practical nurse (LPN)
◦ Normally is not responsible for a complete
resuscitation
◦ Must be able to initiate resuscitation and assist
throughout the process
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First 6–12 hours after birth are a critical
transition period for the newborn
Must be alert to early signs of distress
Must be ready to intervene quickly to prevent
complications and poor outcomes
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Assessment
◦ Concerned with the success of cardiopulmonary
adaptation
◦ Transition period: first 6–12 hours of life
◦ Heart and respiratory rates at least every 30 minutes
during the first 2 hours of transition
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Assessment (cont.)
◦ Monitor the axillary temperature every 30 minutes
until it stabilizes
 Expected range (between 97.7oF [36.5oC] and 99.5oF
[37.5oC])
◦ Be alert for signs of hypoglycemia.
◦ Full physical assessment, including gestational age,
completed within first few hours of life
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Selected nursing diagnoses
◦ Impaired spontaneous ventilation related to ineffective
transition to newborn life
◦ Risk for injury: hypoglycemia related to immature
metabolism and/or presence of risk factors
◦ Ineffective thermoregulation related to immature
heat-regulating mechanisms
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Selected nursing diagnoses (cont.)
◦ Risk of infection related to immature immune system,
possible exposure to pathogens in the birth canal or in
the nursery, and umbilical cord wound
◦ Risk of imbalanced fluid volume related to immature
blood clotting mechanisms
◦ Risk of injury: misidentification related to failure of
delivery room personnel to adequately identify the
newborn before separation from the parents
Which of the following is within your role as an
LVN/LPN?
a. To resuscitate newborn
b. To complete initial newborn assessment
c. To support the newborn
d. To support the family of the newborn
c. To support the newborn
Rationale: The role of the LVN/LPN is to support the
newborn, quickly recognize the development of
complications, and report changes in condition to
the RN to facilitate rapid intervention.
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Outcome identification and planning
◦ Primary goal of nursing care immediately after delivery
and in the first 6–12 hours of life
 Maintaining the safety of the newborn during transition
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Outcome identification and planning (cont.)
◦ Appropriate patient goals
 Newborn will experience adequate cardiovascular,
respiratory, thermoregulatory, and metabolic transitions
into extrauterine life
◦ Additional goals
 Newborn will remain free from signs and symptoms of
infection, maintain hemostasis, and be adequately
identified before separation from the parents
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Implementation
◦ Supporting cardiovascular and respiratory
transition
 Nursing interventions to support newborn vital
functions begin before the birth occurs
 Ensure that adequate supplies are present
 Ensure that all equipment is functioning
properly
◦ Supporting cardiovascular and respiratory
transition (cont.)
 Observe the newborn carefully at birth
‒If the newborn cries vigorously:
•Palpate the base of the umbilical cord
and count the pulse for 6 seconds
•Pulse above 100 bpm and a vigorous cry
are reassuring signs
◦ Supporting cardiovascular and respiratory
transition (cont.)
 If the newborn does not cry immediately:
‒Transport him or her to a preheated
radiant warmer for prompt resuscitation
‒Dry him or her quickly to prevent heat
loss
‒Bag and mask connected to 100% oxygen
are used to provide respiratory support
◦ Supporting cardiovascular and respiratory
transition (cont.)
 Most newborns do not require resuscitation
‒However, a very small number of infants
require chest compressions, intubation,
and medications
 Give constant attention to the airway
‒A bulb syringe is used to suction the
mouth first and then the nose
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It is important to suction the mouth of a
newborn before the nose
◦ If the nose is suctioned first, the newborn
may gasp or cry and aspirate secretions in
the mouth
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Maintaining thermoregulation
◦ Critical to protect the newborn from chilling
 Cold stress increases the amount of
oxygen and glucose needed by the
newborn
 Can quickly deplete glucose stores and
develop hypoglycemia
 Can also develop respiratory distress and
metabolic acidosis if exposed to prolonged
chilling
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Maintaining thermoregulation (cont.)
◦ If the newborn cries vigorously and has an
adequate heart rate:
 Quickly dry the newborn on the mother’s
abdomen
 Swaddle him snugly, and apply a cap to
prevent heat loss
 Kangaroo care
 Thermoneutral environment
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Preventing injury from hypoglycemia
◦ Best way to prevent injury from
hypoglycemia is to prevent the condition
altogether
◦ When a newborn displays signs of
hypoglycemia
 Perform a heel stick
 Glucose level of less than 50 mg/dL
 Immediately initiate treatment
Why is it important to suction the mouth of the
newborn before suctioning the nose?
a. The parents would not like it if you put
something in their babies nose and
then their mouth
b. If the nose is suctioned first, the newborn may
gasp or cry and aspirate secretions in
the mouth
c. You would spread any infection the newborn
might have
d. The newborn is a natural born mouth breather
b. If the nose is suctioned first, the newborn may
gasp or cry and aspirate secretions in the mouth
Rationale: When you suction a newborn’s nose you
irritate the baby and he or she cries. If they gasp
and cry they can aspirate whatever is in their
mouth.
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Preventing infection
◦ Prevent opthalmia neonatorum
◦ Administered within the first hour of birth
◦ Three ophthalmic agents approved for eye
prophylaxis
 1% silver nitrate – used infrequently
 0.5% erythromycin
 1% tetracycline
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Preventing infection (cont.)
◦ Umbilical cord stump
 Use strict aseptic technique when caring
for the cord
 Triple dye, bacitracin ointment, or
povidone-iodine
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Preventing imbalanced fluid volume
◦ Immature clotting mechanism
 Vitamin K
 Within the first hour after birth, 0.5 to 1
mg of vitamin K (AquaMEPHYTON) is given
intramuscularly
 Potential source of hemorrhage is the
clamped umbilical cord
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Preventing misidentification of a newborn
◦ Delivery room nurse must take the utmost
care to positively identify the newborn
before he or she is separated from the
parents
◦ Most hospitals use some form of bracelet
system
◦ Instruct the parents to always check the
bands when the newborn is brought to them
Evaluation: goals and expected outcomes
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Nursing process in providing care to the
normal newborn
◦ Assessment
 Important to be familiar with signs that
indicate the newborn needs special care
‒Potential for aspiration
 Signs of respiratory distress or central
cyanosis should not be present
◦ Assessment (cont.)
 Potential for infection
‒Infected umbilical cord
 Signs of redness and edema at the base
 May have purulent discharge
‒Early signs of sepsis in the newborn
 Poor feeding, irritability, lethargy,
apnea, and temperature instability
◦ Assessment (cont.)
 Late signs of sepsis in the newborn
‒Enlarged spleen and liver, jaundice, and
petechiae
 Perform a thorough skin assessment
‒Turgor should be present and the skin
should be intact
◦ Selected nursing diagnoses
 Ineffective airway clearance related to mucus and
secretions
 Risk of infection related to cross-contamination of
equipment, poor hand washing, poor hygienic
practices, transmission from mother to baby
 Risk of impaired skin integrity
 Risk of injury: newborn abduction
 Risk of disorganized infant behavior related to
pain, invasive procedures, or environmental
overstimulation
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Outcome identification and planning
◦ Monitoring for and preventing complications is
the aim of most newborn care interventions
◦ After the transition period
 Appropriate goals include the newborn’s
maintenance of a clear airway; freedom from
infection; clean intact skin; freedom from
abduction from the hospital; and responsive to
the environment in an organized way
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Implementation
◦ Keeping the airway clear
◦ Preventing transmission of infection
◦ Providing skin care
◦ Providing safety
◦ Enhancing organized infant behavioral
responses
Evaluation: goals and expected outcomes
It is important to prevent the misidentification of
a newborn. Most hospital use identification
bands. What is it important for you to do?
a. Instruct the parents to always check the
bands when the newborn is brought to them
b. Always check the mothers identification
band with
the fathers identification band
c. Always check the fathers identification
band with
the newborn’s
d. Instruct the parents to never take the
newborns’
identification band off
a. Instruct the parents to always check the
bands when the newborn is brought to
them
Rationale: Instruct the parents to always check the
bands when the newborn is brought to them.
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Assessment
◦ Continue to assess
 Respiratory, cardiovascular,
thermoregulatory
 Nutritional and hydration status
 Monitor for signs of infection
 Check vigilantly for developing jaundice
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Assessment (cont.)
◦ Watch for signs of pain
 Injections and heel sticks
 Circumcision
◦ Pay attention to behavior, such as crying,
sleeplessness, facial expression, and body
movements
◦ Heart and respiratory rates, blood pressure, and
oxygen saturation
◦ Assess the adaptation of the mother and father to
the parenting role
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Pain related to painful procedures such as
injections, heel sticks, and circumcision
Risk of infection related to inadequate
immunity in the neonatal period
Risk of injury from undetected metabolic and
hearing disorders
Deficient knowledge (parental) related to
normal newborn care
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Outcome identification and planning
◦ Prevention of, and relief from, pain are
applicable goals throughout the
newborn’s stay in the hospital
◦ Protection from infection and injury from
preventable diseases
◦ Evaluate parental knowledge and ability to
care for the newborn throughout the
hospital stay
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Implementation
◦ Preventing and treating pain
◦ Assisting with circumcision
◦ Preventing infection through neonatal
immunization
◦ Preventing injury through neonatal
screening
◦ Supporting the parent’s role through
discharge teaching
 Handling the newborn
 Clearing the airway
 Maintaining adequate temperature
 Monitoring stool and urine patterns
 Providing skin care
 Maintaining safety
◦ Evaluation: goals and expected outcomes
Tell whether the following statement is true or
false.
The way to tell if a newborn is in pain is that he
or she sleeps all the time.
False
Rationale: Pay attention to behavior, such as crying,
sleeplessness, facial expression, and body
movements. Heart and respiratory rates, blood
pressure, and oxygen saturation should also be
monitored.