Normal Newborn: Nursing Care Flashcards
Early Care
Prophylactic Medications
Vitamin K intramuscular injection = 0.5-1mg
* Infants cannot synthesize Vitamin K in the intestines without food & normal bacterial flora
* Given to the neonate to prevent Vitamin-K deficiency bleeding
* One dose is administered, typically within the first hour after birth
___ - 0.5%
Prevents ophthalmia neonatorum (happens from gonorrhea)
May temporarily blur the infant’s vision, so give after first hour of life to allow for parental bonding
If mother is infected w/gonorrhea, infant may need antibiotics as well
Erythromycin Ointment
Cardiorespiratory Status
___ - time that is the first 2 hours after birth
Assessing rate & character of the heart & lungs
Use a bulb syringe as needed to suction secretions
Episodes of regurgitation, gagging, & brief episodes of cyanosis may occur during this period
Watch for respiratory distress
Suction mouth 1st & then nares
Transition period
Thermoregulation
* Identify early & intervene
* Radiant warmer
* Immediate actions at delivery
> Place on the maternal abdomen
> Dry the newborn to prevent evaporative heat loss
> Remove wet linens & replace w/dry as soon as possible
> Warm any items that are to touch the newborn’s body
> Position the crib in the mother’s room near head of bed
* Preferred route for assessment: ___ ?
axillary
Hepatic Function
Blood Glucose Levels / Conjugated Bilirubin
Blood Glucose Levels
* Assess for risk factors
* Hypoglycemia is a blood glucose LESS THAN ___ - ___ mg/dL
* If hypoglycemic follow agency policy & repeat glucose levels per agency policy
* Watch for ___ & ___
40-45 mg/dL
hypothermia; respiratory distress
Conjugated Bilirubin
* Hyperbilirubinemia
* Assess for jaundice by blanching the skin on nose or sternum
> Assess how far down the body the jaundice extends
* Transcutaneous or total serum bilirubin levels are required for any jaundice in newborns
* Prevent w/adequate infant feedings to promote passage of stool
Eat to excrete
?
Involves the abnormal type of jaundice
Unconjugated bilirubin
?
Is the nonphysiologic, “normal” type of jaundice
Conjugated [Bilirubin]
Ongoing Assessments and Care
* Complete assessments every 8 hours minimum
* Weigh once/day
Newborn Bath
* Removes blood & amniotic fluid
* If mother has bloodborne pathogens, bathe early
* Immersion tub bathing vs sponge bathing
* Perform w/parents present, if able
12-24 hours after birth; 100.4°
! Wash head last
Diaper Care
* Check & change diapers frequently
___ is a thick, sticky, tar-like stool & may be difficult to remove from the skin
> Wash the area w/plain water or a mild soap solution
* Commercial wipes should be free of detergent & alcohol
Meconium
Umbilical Cord Care
* Monitor for bleeding or oozing immediately after birth
* Cord clamp is applied at birth & remains in place for ___
* Falls off completely within approximately ___ ?
* Monitor for signs of infection
* Cleanse w/water if necessary, but keep the site clean & dry for best care
* Fold diaper below the cord to avoid contamination w/urine or stool
* Appearance of cord as gelatinous to dry; yellowish-white to brown-black
24 hours
10-14 days
SIDS Prevention
Place babies on their backs to sleep
Encourage “Tummy Time”
Protecting the Newborn
* Make sure newborn always returns to the correct parents
* Take precautions to prevent infant abductions
* Prevent or recognize the early signs of infection
Circumcision - Reasons for Choosing
* Higher risk of UTI’s, STD’s/STI’s, HIV, inflammation of the glans, & penile cancer (uncommon)
* Religious, cultural, or social influence
* Fear of ___
> a tightening of the prepuce that prevents retraction & requires circumcision
phimosis
Circumcision - Reasons for Declining
* Risk of conditions in uncircumcised male are low
* Do not want to cause their children pain
* Less frequent amongst Asian, Hispanic, Native American
* Not covered by insurance
* Risk of complications
* An unwell newborn
Pain Relief with Circumcision
Past belief that newborns “don’t feel pain”
* Dorsal penile nerve block
* Ring block - placed around base of penis
* Eutectic Mixture of Local Anesthetic (EMLA) Cream - takes longer to take effect
* Premedicate & treat pain w/acetaminophen
Nursing Care for Circumcision
Assist
Evaluate
Assess
Monitor
Educate
* Assess & observe site at every diaper change
* Watch for any amounts of blood
* Loosely fasten diapers
* A yellow crust around the site indicates healing - don’t remove!
Caring for the Uncircumcised Penis
* Wash the penis daily
* Cleanse when soiled diapers are changed
DO NOT RETRACT THE FORESKIN (starts at 3-6 years of age)
Hepatitis B
The first dose of the Hepatitis B vaccine is administered in the birth facility, usually within 12 hours of birth
If mother is Hepatitis B positive, newborn will also receive hepatitis B immunoglobulin (HBIG) immediately after birth
> Provides passive immunity until the infant can develop their own antibodies
Refer to pediatrician for subsequent 2 doses of HepB after discharge
Hearing Screening
___ are the most common congenital abnormality in newborns
Early identification is key in preventing or reducing developmental delays
Hearing screen performed in the hospital
> If unsatisfactory results, rescreen
> If newborn does not pass hearing screen, refer for comprehensive audiologic evaluation no later than 3 months
Hearing disorders
Additional Newborn Screenings
Requirements can vary by state, but common conditions often included are:
> Phenylketonuria (PKU) [inherited]
> Hypothyroidism
> Galactosemia
> Hemoglobinopathies
- Sickle cell disease / thalassemia (lower hgb than normal)
Requirements for Discharge
* Appropriate gestational age
* Normal physical examination
* Making transition from fetal to neonatal life w/o difficulty
* Normal vital signs
* At least two successful feeds
* Passed urine & stool
* No excessive bleeding from the circumcision for @ least 2 hours
* Newborn screening tests are complete
* Parents demonstrate knowledge & ability of basic infant care
* Appropriate infant car seat ready for discharge
* Provide education on necessary follow-up care
