Chapter 21: Care of the Normal Newborn Flashcards
1
Q
Early Care of the Normal Newborn
A
- administer vitamin K IM w/in 1 hour of birth
- administer ilotycin (erythromycin) ointment w/in 1 hour of birth
- protects against gonorrhea
- note the HR, RR, and breath sounds–>observe for any respiratory distress
- position the infant on their back or in the side lying position
- use bulb syringe to suction secretions–suction mouth 1st
- MUST keep bulb syringe in the crib
- prevent heat loss
2
Q
How to prevent heat loss in the newborn
A
- use a neutral thermal environment with a radiant warmer which allows infants to not use excess O2 and glucose to keep up their body temp
- use skin to skin contact
- dry the wet infant quickly with warm towels
- especially make sure the head is dry
- put a hat on the infant’s head
- warm all objects that will come into contact w/ the infant to prevent heat loss thru conduction
- to prevent heat loss by radiation, position infant’s crib away from outside walls
3
Q
how to restore thermoregulation if an infant drops its temperature
A
- look for obvious causes
- loose blankets, wet clothing, cool temp in room
- place infant skin to skin if only a slight drop in temp
- if skin to skin is not possible, add extra clothing, add a blanket
- if temp has not improved w/in the hour, place in radiant warmer
- inc infant’s temp slowly to prevent apnea
4
Q
blood glucose in the newborn
A
- for infant’s with glucose levels below 40-45, considered hypoglycemic
- feed the newborn if this occurs
- if glucose does not stabilize with feeding, may need IV feeding
5
Q
assessing bilirubin
A
- assess for jaundice by blanching the infant’s skin on the nose or sternum
- assess for jaundice Q8-12 hours w/ V/S
- obtain TC bili level on any jaundice looking infant
- discuss w/ parents the importance of adequate feedings to stimulate passage of stools and prevent high bili levels
- if breastfeeding, should nurse 8-12 times/day
- contact provider if infant not eating well, not voiding at least 6 times/day by day 4, or not producing stools adequately (1/day for formula fed, 4/day for breast fed)
6
Q
infant bathing
A
- may receive bath as soon after birth as temp is stable
- must by 98 deg F (36.7 deg C)
- early bathing dec exposure to maternal blood and bloodborne organisms
- better for infant to be bathed in a tub to help them maintain their temp
- keep water temp b/w 100-104 deg F
- infant should be placed under warmer until hair is dry and temp is returned to normal
- then wrap in 2 warm blankets w/ cap on
- check temp after 1 hour
7
Q
cord care
A
- check for bleeding and oozing
- cord clamp should be securely fastened with no skin caught in it
- remove after 24 hours
- purulent drainage or redness or edema indicates infection
- should become brownish black in 2-3 days, then fall off in 10-14 days
- should cleanse w/ water when necessary and keep it clean and dry
- keep diaper folded below the cord
8
Q
positioning for sleep
A
- sleep: should be taught to place infants on back to sleep
- use firm sleep surface, w/ no bumper pads or loose bedding
- put infant’s bed in parent’s room
- recommended to give a pacifier to sleep w/
- avoid overheating
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9
Q
how often to check baby V/S
A
Q8H unless mom is GBS +, then Q4H
10
Q
protecting the infant
A
- ensure infant always goes to correct parents
- ID bands, footprints, photographs
- take precautions to prevent infant abductions
- profile of abductor is woman of childbearing age, overweight, may be pretending to be pregnant or have had a pregnancy loss, may impersonate hospital staff
- everyone must wear ID badge, and parents should be taught never to give infant to anyone w/o proper ID
- prevent infections
- handwashing
- use separate supplies for each infant
- prevent infant falls
11
Q
circumcision: what is it? benefits? reasons to reject?
A
- removal of the prepuce (foreskin)
- may not be fully retractable until 3-6 yo
- must have vit K injection prior to this procedure
- benefits:
- reduces risk of penile CA, UTI during 1st yr of life, HIV, and transmission of other STDs
- prevents phimosis: tightening of the prepuce
- reasons for rejecting circumcision:
- may believe its cosmetic
- may be cultural
- risk of hemorrhage, infection
12
Q
potential complications of circumcision
A
- hemorrhage
- infection
- removal of too much or too little of prepuce
- urinary retention
- fistulas of urethra
- necrosis
- pain
13
Q
pain relief during circumcision
A
- must have pain control
- pain responses in infant:
- changes in V/S, O2 sats, intracranial pressure, catecholamine & cortisol levels
- irritable, altered sleep wake cycle, abnormal feeding
- commonly use dorsal penile nerve block
- most effective method
- may give acetaminophen after procedure
- nonpharmacologic: pacifier, oral sucrose, dec lights, talking softly to infant
14
Q
circumcision methods
A
- Comco (Yellen) clamp
- Plastibell
- in both above: first prepuce separated from glans w/ a probe and then incised to expose the glans
- Mogen clamp may also be used: most common in ritual circumcisions of Jewish infants
15
Q
circumcision nursing care
A
- pre-op
- consent, vit K given
- time out
- intra-op
- maintain sterile field
- administer oral sucrose
- be ready to suction if necessary
- post-op
- put petroleum jelly on the circumcision site to prevent diaper from sticking
- watch for excessive bleeding, failure to urinate, signs of infection, displacement of plastibell ring
- yellow crusting is normal
- administer tylenol
