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

2. 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

3. 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)

4. 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)

7. 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)

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

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

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

11. 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.

12. 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

13. 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 and 18.14); abnormalities in head or fontanel size

14. 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 and )

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

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

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

19. 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

20. Selected Screening for Newborns
PKU
Congenital hypothyroidism
Galactosemia
Sicke cell anemia

21. 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

22. 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

23. 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

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

25. 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

26. 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

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

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

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