Essentials of Maternity, Newborn, and Women’s Health Nursing Chapter 18 Nursing Management of the Newborn

Initial Newborn Assessments Signs indicating a problem Nasal flaring, chest retractions Grunting on exhalation, labored breathing Generalized cyanosis, flaccid body posture Abnormal breath sounds, abnormal respiratory rates Abnormal heart rates, abnormal newborn size

Initial Newborn Assessments (cont’d.) Apgar scoring (see Table 18.1) Length and weight, vital signs (see Table 18.2) Gestational age assessment (see Figure 18.3) Physical maturity (skin texture, lanugo, plantar creases, breast tissue, eyes & ears, genitals) Neuromuscular maturity (posture, square window, arm recoil, popliteal angle, scarf sign, heel-to-ear)

Apgar Scoring P = pulse (heart rate) G = grimace (reflex irritability) A = appearance (color) P = pulse (heart rate) G = grimace (reflex irritability) A = activity (muscle tone) R = respiratory (respiratory effort)

Gestational Age Preterm or premature: prior to 37 weeks’ gestation Term: 38 to 42 weeks’ gestation Postterm or postdates: after week 42 gestation Postmature: after week 42 gestation/placental aging Small for gestational age (SGA) Appropriate for gestational age (AGA) Large for gestational age (LGA)

Physical Maturity Assessment (Ballard) Skin texture Lanugo Plantar creases Breast tissue Eyes and ears Genitals

Neuromuscular Maturity Posture Square window Arm recoil Popliteal angle Scarf sign Heel to ear

Question Is the following statement True or False? Arm recoil is one measure of assessing a newborn’s physical maturity. a. True b. False

Answer b. False Arm recoil is a measure of a newborn’s neuromuscular maturity. An example of an assessment of physical maturity is skin texture.

Nursing Interventions: Immediate Newborn Period Maintaining airway patency Ensuring proper identification Administering prescribed medications (see Drug Guide 18.1) Vitamin K Eye prophylaxis Maintaining thermoregulation

Newborn Physical Examination Prenatal history Newborn physical examination Anthropometric measurements: length, weight, head circumference, chest circumference Vital signs Skin: condition and color; common skin variations (see Figure 18.12) Head: size, fontanels; variations in head size and appearance (see Figures 18.13 and 18.14); abnormalities in head or fontanel size

Newborn Physical Examination (cont’d.) Face: nose, mouth, eyes, ears Neck, chest Abdomen Genitalia (see Figure 18.16) Extremities and back Neurologic status Alertness, posture, and muscle tone Reflexes (see Table 18.4 and Figures 18.17 and 18.18)

Common Skin Variations in Newborns Vernix caseosa Stork bites or salmon patches Milia Mongolian spots Erythema toxicum Harlequin sign Nevus flammeus Nevus vasculosus

Variations in Head Size and Shape in the Newborn Molding Caput succedaneum Cephalhematoma Abnormalities Microcephaly Macrocephaly Large, small, or closed fontanels

Common Concerns During Newborn Transition Transient tachypnea of the newborn Physiologic jaundice Hypoglycemia

Nursing Interventions for Transient Tachypnea Providing oxygen Ensuring warmth Observing respiratory status frequently Allowing time for pulmonary capillaries and the lymphatics to remove the remaining fluid

Selected Screening for Newborns PKU Congenital hypothyroidism Galactosemia Sicke cell anemia

Nursing Management: Early Newborn Period: Nursing Interventions General newborn care Bathing and hygiene (see Teaching Guidelines 18.1 and Nursing Procedure 18.2) Gloves Plain water on face and eyes; mild soap for rest of body Elimination and diaper area care Urine characteristics Stool pattern Diaper area care

Nursing Management: Early Newborn Period: Nursing Interventions (cont’d.) Cord care (see Teaching Guidelines 18.2) Circumcision care Safety (see Teaching Guidelines 18.3) Prevention of abduction Car safety Infection prevention Sleep promotion Bonding

Nursing Management: Early Newborn Period: Nutrition Physiologic changes Nutritional needs Calories Fluid requirements Feeding method choice Feeding the newborn Frequency Measures to decrease air swallowing

Nursing Management: Early Newborn Period: Breast-Feeding Composition Assistance Positioning Education Storage and expression Concerns Sore nipples Engorgement Mastitis

LATCH Method for Assessing Breast-Feeding Sessions L: How well infant latches onto the breast A: Amount of audible swallowing T: Nipple type C: Level of comfort H: Amount of help mother needs

Question An infant typically requires how many calories per kilogram per day during the first 3 months? a. 80 b. 95 c. 110 d. 150

Answer c. 110 During the first 3 months, an infant needs 110 to 120 calories/kg/day.

Nursing Management: Early Newborn Period: Bottle Feeding Types of formula Assistance Positioning Education Weaning and introduction of solid foods

Nursing Management: Early Newborn Period: Discharge Preparation Preparing for discharge Education Cultural considerations Follow-up care Return visit Warning signs and symptoms Immunization information