1. Chapter 15 Physiological and Behavioral Components of the Neonate

2. Objectives Define key terms
The learner will be able to
Define key terms
Identify the changes that occur during the transition from intrauterine to extrauterine life and the related nursing actions
List the critical elements in neonatal assessment
List the critical elements of neonatal gestational age assessment
Discuss methods used in neonatal pain management

3. Objectives
Describe the nursing care for neonates during the first week of life
List the common laboratory and diagnostic tests for the neonate
Discuss nursing actions that support parents in the care of their neonate
Describe therapeutic and surgical procedures commonly encountered by neonates and the related nursing care

4. Neonatal Period Maintaining body heat Maintaining respiratory function
Definition
Focus of nursing care
Maintaining body heat
Maintaining respiratory function
Decreasing risk of infection
Assisting parents in providing appropriate nutrition and hydration
Assisting parents in learning to care for their newborn

5. Transition to Extrauterine Life: Respiratory System
Physiological changes
Mechanical, chemical, and sensory stimuli
Surfactant
Initiation of first breath
Signs of respiratory distress

7. Transition to Extrauterine Life: Circulatory System
Physiological changes
Initiation of changes
↓ Pulmonary resistance  ↑ ulmonary blood flow  ↑ systemic vascular resistance
Ductus venosus
Foramen ovale
Ductus arteriosus

9. Transition to Extrauterine Life: Thermoregulatory System
Physiological changes
Neutral thermal environment (NTE)
Brown fat
Factors that negatively affect thermoregulation
Decreased subcutaneous fat
Decreased brown fat in preterm infants
Large body surface
Loss of heat from convection, radiation, conduction, and/or evaporation

10. Thermoregulation: Cold Stress
Cold stress occurs when
↓ environmental temperature  ↓ body temperature 
↑ heart and respiratory rate  ↑ O2 consumption, depletion of glucose, and ↓ surfactant  respiratory distress
Risk factors
Signs and symptoms

11. Actions to decrease risk
Nursing actions
Actions to decrease risk
Actions when neonate displays signs of cold stress

12. Transition to Extrauterine Life: Metabolic System
Physiological changes
Hypoglycemia
Risk factors
Signs and symptoms
Nursing actions

13. Transition to Extrauterine Life: Hepatic System
Physiological changes
Bilirubin conjugation
Indirect bilirubin
Direct bilirubin
Hyperbilirubinemia
Blood coagulation
Vitamin K

14. Transition to Extrauterine Life: Gastrointestinal System
Physiological changes
Characteristics of stools
Meconium
Transitional
Breastfeed
Formula feed
Diarrhea

15. Transition to Extrauterine Life: Immune System
Physiological changes
Active humoral immunity
Passive immunity
Lymphocytes
Immunoglobulins
Risk factors for infection

16. Neonatal Assessment Preparation for assessment General survey
Review prenatal and labor record for risk factors
Observe respiratory pattern
Observe posture
Assess skin for color, birthmarks, and birth trauma
Assess level of alertness/activity
Assess muscle tone

17. Neonatal Assessment Posture Pulse Head circumference Blood pressure
Microcephaly
Macrocephaly
Chest circumference
Length
Weight
Temperature
Respirations
Pulse
Blood pressure
Integumentary
Acrocyanosis
Pilonidal dimple
Head
Molding
Fontanels
Caput succedaneum
Cephalohematoma

18. Neonatal Assessment Neck Eyes Abdomen Ears Rectum Nose Genitourinary
Mouth
Chest/lungs
Cardiac
PMI
Murmurs
Abdomen
Rectum
Genitourinary
Pseudomenstruation
Hypospadias
Epispadias
Hydrocele
Undescended testes

19. Neonatal Assessment Musculoskeletal Reflexes Neurological Polydactyly
Syndactyly
Ortolant maneuver
Neurological
Hypertonia
Hypotonia
Reflexes
Moro
Startle
Tonic neck
Rooting
Sucking
Palmer grasp
Planter grasp
Babinski
Stepping/dancing

20. Gestational Age Assessment
Dubowitz neurological examination
Ballard Maturational Score
Physical and neuromuscular maturity
SGA
AGA
LGA

21. Pain Assessment Sources of pain Premature Infant Pain Profile (PIPP)
Neonatal Infant Pain Scale (NIPS)

22. Behavioral Characteristics
Periods of reactivity
Initial period of reactivity
Period of relative inactivity
Second period of reactivity
Brazelton’s Neonatal Behavioral Assessment Scale (BNBAS)

23. Nursing Care of the Neonate: First 4 Hours
Universal precautions
Maintain body heat
Dry immediately
Support respirations
Apgar score
Vital signs
Identifying bands
Neonatal assessment
Gestational age assessment
Administer erthromycin ophthalmic
Administer phytonadione (vitamin K)
Bath with neutral pH soap
Promote parent – nfant attachment

24. Nursing Care of the Neonate: 4 Hours to Discharge
Vital signs
Temperature regulation
Neonatal assessment
Promote parent – infant attachment
Promote sibling attachment
Prevent infant abduction
Instruct parents to place neonate on back
Assist with feedings
Provide information on newborn care
Provide information on normal newborn characteristics

25. Skin Care Potential threats to skin integrity
Decreasing risk for skin breakdown
AWHONN’s Quick Guide for Neonatal Skin Care

26. Laboratory and Diagnostic Tests
Newborn screening
State and national requirements
Obtaining blood sample
Newborn hearing screening
Otoacoustic emissions (OAEs)
Auditory brainstem response (ABR)

27. Therapeutic and Surgical Procedures
Immunizations
Hepatitis B
Intramuscular injections
Circumcision
Contraindications
Risks
Benefits
Procedure

28. Review Questions Milia is
Fine, downy hair that develops after 16 weeks gestation
A rash with red macules and papules
A benign transient pattern of pink and white blotches on the skin
White papules on the face more frequently seen on the nose and chin

29. Answer 4

30. Chapter 16 Discharge Planning and Teaching

31. Objectives The learner will be able to Define key terms
List principles of teaching and learning when providing newborn care information to parents.
Discuss nutritional needs of newborns and infants
Discuss the incorporation of cultural values in the care of newborns

32. Objectives Describe the stages of human milk
Describe the process of human milk production
Develop a teaching plan for breastfeeding instructions
Develop a teaching plan for formula feeding instructions
Develop a teaching plan for general newborn care

33. Principles of Teaching and Learning
Environment
Assessment of learning needs
Delivery of content
Evaluation
Five rights of teaching

34. Breastfeeding Factors influencing woman’s decision to breastfeed
Partner’s support
Advantages of breastfeeding
Contraindications for breastfeeding
Composition of human milk

35. Breastfeeding Stages of human milk Milk production Let-down reflex
Stage 1: Colostrum
Stage 2: Transitional milk
Stage 3: Mature milk
Foremilk
Hind milk
Milk production
Let-down reflex

36. Review Question
Foremilk has higher water content; whereas, hind milk has higher fat content.
True
False

37. Answer 1

38. Breastfeeding Process of breastfeeding
Infant’s signs of hunger and readiness to feed
Proper positioning
Woman’s comfort
Lying down, sitting
Cradle, football, and cross cradle positions
Positioning of newborn
Bring baby to breast, not breast to baby

39. Breastfeeding Latching-on Signs of successful breastfeeding
Removing newborn from breast
Teaching topics
Positions
Determining effectiveness of feeding
Decreasing risk of nipple tissue breakdown
Comfort and relaxation
Nutrition and fluids
Expressing and storing milk
Medications

40. Bottle Feeding Advantages Disadvantages
Composition of manufactured formulas
Teaching topics
Formula preparation
Frequency and amount of feedings
Feeding positions
Burping

41. Infant Nutritional Needs
Birth to 4 months
4 months to 6 months
Introduction of solid foods

42. Newborn Care Bathing Bulb syringe Clothing Circumcision Colic
Cord care
Diapering
Elimination

43. Newborn Care Feeding Follow-up care Nonnutritive sucking
Potential signs of illness
Prevention of dental decay
Safety
Car seats
Accidents

44. Newborn Care Shaken baby syndrome Sibling rivalry
Sudden infant death syndrome (SIDS)
Skin care
Soothing baby
Swaddling
Temperature taking
Uncircumcised males

45. Class Activity
Select one teaching topic and develop a teaching plan that incorporates principles of teaching and learning.
Role play with another student teaching a new mother your selected topic.