4Nursing Care of Newborn and Family

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Nursing Care of Newborn andNursing Care of Newborn and

FamilyFamily

AssessmentAssessment


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Assessment of newbornAssessment of newborn

Physical assessment of newbornPhysical assessment of newbornfollowing delivery can be divided intofollowing delivery can be divided intofour phases:four phases:

1.1. The initial assessment using the ApgarThe initial assessment using the Apgarscoring system.scoring system.

2.2. Transitional assessment during theTransitional assessment during the

period of reactivity.period of reactivity.3.3. Assessment of gestational age.Assessment of gestational age.

4.4. Systematic physical assessment.Systematic physical assessment.


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1.Initial assessment: Apgar Scoring1.Initial assessment: Apgar Scoring

The most frequently used method to assessThe most frequently used method to assessthe newborn's immediate adjustment tothe newborn's immediate adjustment toextrauterine life.extrauterine life.

The score is based on observation of :The score is based on observation of :

1.1. Heart rate.Heart rate.2.2. Respiratory effort.Respiratory effort.

3.3. Muscle tone.Muscle tone.

4.4.

Reflex irritability.Reflex irritability.5.5. Color.Color. Each item is given a score of 0, 1,or 2.Each item is given a score of 0, 1,or 2.


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Initial assessment: Apgar ScoringInitial assessment: Apgar Scoring

Evaluation of all five categories are madeEvaluation of all five categories are madeat 1 and 5 minutes after birth andat 1 and 5 minutes after birth andrepeated until the infant's conditionrepeated until the infant's condition

stabilized.stabilized.Total scores of 0-3 represent severeTotal scores of 0-3 represent severe

distress.distress.

Scores of 4-6 signify moderate difficulty.Scores of 4-6 signify moderate difficulty.Scores of 7-10 indicate absence ofScores of 7-10 indicate absence of

difficulty in adjusting to extrauterine life.difficulty in adjusting to extrauterine life.


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Initial assessment: Apgar ScoringInitial assessment: Apgar Scoring

The Apgar score is affected by the degreeThe Apgar score is affected by the degree

of :of :

-

Physiologic immaturity.Physiologic immaturity.

- Infection.Infection.

- Congenital malformations.Congenital malformations.

- Maternal sedation or analgesia.Maternal sedation or analgesia.- Neuromuscular disorders.Neuromuscular disorders.


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2.Transitional assessment2.Transitional assessment

Periods for reactivityeriods for reactivity :: First period of reactivity: For 6-8 hours after birth.First period of reactivity: For 6-8 hours after birth.

1.1. Initial stage of alertness and activity:Initial stage of alertness and activity:

- During the first 30 minutes.During the first 30 minutes.

- The infant is very alert, cries vigorously, veryThe infant is very alert, cries vigorously, very

interest in the environment.interest in the environment.

- Neonate's eyes are usually open;Neonate's eyes are usually open;- The newborn has a vigorous suck; this is anThe newborn has a vigorous suck; this is an

opportune time to begin breast-feeding.opportune time to begin breast-feeding.


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Transitional assessmentTransitional assessment

- physiologically, the resp rate is high as 80 breath/min,physiologically, the resp rate is high as 80 breath/min,crackles may be heard, heart rate reach 180 beat/min,crackles may be heard, heart rate reach 180 beat/min,bowel sound are active , mucus secretions are increased,bowel sound are active , mucus secretions are increased,and temp may decrease.and temp may decrease.

2. Second stage:2. Second stage:- Lasts to 2-4 hours,Lasts to 2-4 hours,

- Heart and resp rate decrease, temp continues to fall,Heart and resp rate decrease, temp continues to fall,mucus production decreases ,and urine or stool is usuallymucus production decreases ,and urine or stool is usually

not passed.not passed.- The infant is in state of sleep and relative calm.The infant is in state of sleep and relative calm.

- Undressing or bathing is avoided during this timeUndressing or bathing is avoided during this time


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Transitional assessmentTransitional assessment

The second period of reactivity: begins when the infantThe second period of reactivity: begins when the infantawakes from this deep sleep.awakes from this deep sleep.

- It lasts about 2-5 hours andIt lasts about 2-5 hours and

- The infant is again alert and responsive,The infant is again alert and responsive,

- Heart and resp rates increase.Heart and resp rates increase.- The gag reflex is active gastric and respiratory secretions areThe gag reflex is active gastric and respiratory secretions are

increased,increased,

- Passage of meconium frequently occurs.Passage of meconium frequently occurs.

- This period is usually over when the amount of respiratoryThis period is usually over when the amount of respiratorymucus has decreased.mucus has decreased.

After this stage is a period of stabilization of physiologicAfter this stage is a period of stabilization of physiologicsystems and a vacillating pattern of sleep and activity.systems and a vacillating pattern of sleep and activity.


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3.Clinical assessment of gestational age3.Clinical assessment of gestational age

A frequently used method of dedetermining gestational age isA frequently used method of dedetermining gestational age isthe simplifies Assessment of Gestational Age by Ballard(1979):the simplifies Assessment of Gestational Age by Ballard(1979):

- It assess six external physical and six neuromuscular signs. (fig.It assess six external physical and six neuromuscular signs. (fig.8-1, A and box 8-2)8-1, A and box 8-2)

- Each sign has a number score, and the cumulative scoreEach sign has a number score, and the cumulative scorecorrelate with a maturity rating of from 20 to 44 weeks ofcorrelate with a maturity rating of from 20 to 44 weeks ofgestation.gestation.

1.Weight Related to Gestational Age:1.Weight Related to Gestational Age:

Birth weight alone is a poor indicator of gestational age andBirth weight alone is a poor indicator of gestational age andfetal maturity .fetal maturity .

Maturity: functional capacity: the degree to which the neonate'sMaturity: functional capacity: the degree to which the neonate'sorgan systems are able to adapt to the requirements oforgan systems are able to adapt to the requirements ofextrauterine lifeextrauterine life


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4. Physical assessment of the newborn4. Physical assessment of the newborn

Physical assessment of the newborn: table 8-4 pPhysical assessment of the newborn: table 8-4 p217-221217-221

General measurement.General measurement.

Vital signs.Vital signs. General appearance: Posture,General appearance: Posture, Head-to-toe assessment: Skin, Head, Eyes.Head-to-toe assessment: Skin, Head, Eyes.

Ears, Nose, mouth and throat, neck, chest,Ears, Nose, mouth and throat, neck, chest,

lunge, heart, abdomen, female male genitalia ,lunge, heart, abdomen, female male genitalia ,

back and rectum, extremities.back and rectum, extremities. Neuromuscular system.Neuromuscular system.


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Nursing care of the newbornNursing care of the newborn

Maintain a patent airway:Maintain a patent airway:- Initial :at delivery roomInitial :at delivery room- Subsequent: at normal nursery.Subsequent: at normal nursery. Maintain stable body temperature:Maintain stable body temperature:

The causes of heat loss at birth:The causes of heat loss at birth:1.1. evaporation: the lost of heat through moisture (a majorevaporation: the lost of heat through moisture (a major

cause).cause).

2.2. Radiation: the lost of heat to cooler solid objects in theRadiation: the lost of heat to cooler solid objects in theenvironment that are not in direct contact with theenvironment that are not in direct contact with the

infant.infant.3.3. Conduction: loss of heat from the body because ofConduction: loss of heat from the body because of

direct contact of skin with a cooler solid objectdirect contact of skin with a cooler solid object


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4. Convection is similar to conduction, except that heat loss4. Convection is similar to conduction, except that heat lossis aided by surrounding air currents; as direct flow of airis aided by surrounding air currents; as direct flow of airfrom air conditioner vent.from air conditioner vent.

Protect from infection and injuries:Protect from infection and injuries:

- Hand washing.- Hand washing.- A common practice in many newborn nurseries is the useA common practice in many newborn nurseries is the useof cover gowns to prevent infection.of cover gowns to prevent infection.

- Eye care, umbilical care, bathing, care of the circumcision.Eye care, umbilical care, bathing, care of the circumcision.- Vitamin K is administered to protect against hemorrhage.Vitamin K is administered to protect against hemorrhage.

- Proper identification.Proper identification.- Screening tests are used to detect various disorders.Screening tests are used to detect various disorders.


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Provide optimal nutrition:Provide optimal nutrition:

- Selection of a feeding method is one of the majorSelection of a feeding method is one of the majordecisions faced by parents their choices are: humandecisions faced by parents their choices are: human

milk and commercially prepared cow's milk-basedmilk and commercially prepared cow's milk-basedformula.formula. Promote parent-infant bonding (attachment):Promote parent-infant bonding (attachment):

- Infant behaviorInfant behavior

- Maternal attachment.Maternal attachment.- Paternal attachment.Paternal attachment.

- Siblings.Siblings.


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Prepare for discharge and home care:Prepare for discharge and home care:

- Early newborn discharge checklist: p :236Early newborn discharge checklist: p :236

Feeding, elimination, circumcision, color,Feeding, elimination, circumcision, color,cord, vital signs, activity, newborncord, vital signs, activity, newborn

screening.screening.

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4Nursing Care of Newborn and Family