1. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins The Normal Newborn Chapter 12

2. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nurse’s Role in Caring for the Newborn Supporting the newborn as he or she adapts to life outside the womb Quickly recognizing the development of complications so that interventions can be initiated immediately Teaching the parents the skills needed to care for their newborn

3. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Immediate Assessments of the Newborn Success of cardiopulmonary adaptation –A vigorous or lusty cry –Heart rate greater than 100 beats per minute (bpm) –Pink color Apgar score

4. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins 5 Parameters Assessed by the Apgar Score Heart rate Respiratory effort Muscle tone Reflex irritability Color

5. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Indications of Apgar Score Scores of 7 to 10 –Indicate a healthy baby adapting well –Infant can be cared for in the regular newborn nursery or room-in with mother Scores between 4 and 6 –Indicate some difficulty in adjusting –Infant is cared for in a special nursery with oxygen and monitoring devices

6. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Indications of Apgar Score (cont.) Scores of 0 to 3 –Indicate severe difficulty in making the transition –Infants require observation and care in a neonatal intensive care unit (NICU)

7. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessments During the Transition Period Continue to observe newborn for signs of respiratory distress or cardiovascular compromise Observe the newborn closely for cold stress (body temperature of less than 97.6ºF [36.5ºC]) Assess for hypoglycemia in the newborn Perform a full physical assessment, including gestational age assessment, within the first few hours of life

8. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Signs of Hypoglycemia in the Newborn Jitteriness or tremors Exaggerated Moro reflex Irritability Lethargy Poor feeding Listlessness Apnea or respiratory distress High-pitched cry

9. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Goals for the Newborn Experience adequate cardiovascular, respiratory, thermoregulatory, and metabolic transitions to extrauterine life Remain free from signs and symptoms of infection Maintain hemostasis Be adequately identified before separation from the parents

10. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Interventions for the Newborn Supporting cardiovascular and respiratory transition Maintaining thermoregulation Preventing injury from hypoglycemia Preventing infection Preventing imbalanced fluid volume Preventing misidentification of a newborn

11. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Goals for the Newborn After Successful Transition Maintain a clear airway Remain free of infection Maintain clean intact skin Prevent abduction from the hospital Respond to the environment in an organized way Maintain an adequate body temperature

12. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders for Which Newborn Screening Is Performed Phenylketonuria (PKU) Congenital hypothyroidism Galactosemia Maple syrup urine disease Homocystinuria Biotinidase Sickle cell disease Congenital adrenal hypoplasia Cystic fibrosis

13. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Measures to Prevent Transmitting Infection to the Newborn Perform handwashing as per agency policy Keep all the newborn’s belongings together in the bassinet and do not share items between newborns Wipe down shared equipment (such as stethoscopes) with alcohol between uses Encourage rooming-in Use universal precautions

14. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessments of the Newborn Being Prepared for Discharge Continue to assess respiratory, cardiovascular, thermoregulatory, nutritional, and hydration status Monitor for signs of infection Check vigilantly for developing jaundice Watch for signs of pain, especially with circumcision Assess the adaptation of the mother and father to the parenting role

15. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Newborn Conditions Contraindicating Circumcision Still in the transition period Preterm or sick Family history of bleeding disorder until the disorder is ruled out in the newborn Diagnosis of a bleeding disorder Congenital genitourinary disorder, such as epispadias or hypospadias

16. Copyright © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins Focus of Discharge Teaching for New Parents Handling the newborn Clearing the airway Monitoring adequate temperature Monitoring stool and urine patterns Providing skin care Maintaining safety