Fa 11 Nbn Student Ppt

7/31/2019 Fa 11 Nbn Student Ppt

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FALL 2011Newborn Care

Health Promotion in the Pregnant Family


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Note to the student

As with every lecture faculty prepare, wedo our best to provide you with accurate,up-to-date information.

The newborn lecture is currently beingmodified.

In an attempt to provide YOU withinformation, I have made an abbreviated

version. How do you know if you are on the right

track? ANSWER THE OBJECTIVES.


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Note to the student

How do you know if you are on theright track? ANSWER THE

OBJECTIVES!

Ask yourself why or how does this

make a difference. What will I teach the patient? How do I know they understood me?


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Apgar Scores-Babys First Test

Done at 1 minute & 5 minutes old. Scores from 0-10.

- 7-10 = WNL- 4-7 = needs some

resuscitation or resp. support

- under 4 = needs immediate resuscitation

WHY do we do this? WHEN do we do it? WHATdo we do with the information?


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Apgar Criteria

Sign Score=0 Score=1 Score-2Heart

rate

Absent Below 100 Above 100

Respiratory

effort

Absent Weak,

irregular

Good,

crying

Muscle

tone

Flaccid Some ext.

flexion

Active ext.

movement

Reflex

irritability

No response Grimace or

week cry

Good cry

Color Blue all over

or pale

Acrocyanosis Pink all over


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Other first tests

Weight & length

State Mandated newborn screening(varies per state)

1. PKU (phenylkentonuria)2. Hypothyroidism3. Galactosemia (intolerance to milk r/t

deficient enzyme galactose)4. Hearing Screen5. Bilirubin Jaundice


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Normal PhysiologicalCharacteristics of

the Newborn


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Head

Fontanels: there are two soft spotson the babys skull

Openings at place where bones of theskull meet Anterior & posterior

Anterior: diamond-shaped, larger Posterior: smaller, triangular

(May pulsate when baby cries)


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Length, Head

Length: average is 20 inches

Head: at birth, your babys head is1/3 the size of an adults head

(Head should measure greater

than the chest measurement) Circumference is about 32-37 cm

(12.5-14.5 in.) 4


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Caput Succedaneum

Collection of serosanginous subqfluids.

Crosses suture lines.

Resolves within a few days of life.


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Cephalhematoma

Collection of blood between skull &periosteum.

Well defined & doesnt cross suture lines.

May occur 48 hrs post birth.

Reabsorbs by 3 months of age.


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Variations

If baby is born breech or c-section,head is very round (head did not

mold to the birth canal) fuzz on face and body, called lanugo

(may be fine black hair on shouldersand back of newborn)

Babies blink in response to brightlight


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Eyes

Blue, blue/gray or dark brown Eye color usually established at 3

months Common for eyes to appear crossed

strabismus Tearless

because the structure that makes tearsis immature at birth

Limited ability to focus 6


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Eye Medications at Birth

Erythromycin Tetracycline

Drugs used to prevent opthalmianeonatoriumin the newborn.

Targeted organisms are chlamydiaand gonorrhea.


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Nose

Nose: usually small, narrow Babies are nose-breathers

Sneezes are the means in whichbabies clear obstructions

Your baby can smell

Knows moms scent and can smell breastmilk


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Mouth

Mouth: lips pink; may see sucking

blister Sometimes see small teeth - called

Epsteins pearlsthey are actually

small, harmless cysts, may feel firmto touch


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Skin Variations

Skin may be mottled with reddish

patches May see Mongolian spot Hands and feet have peeling skin

Milia are white acne-like spots butthis is not acne, so leave baby alone


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Weight

Weight: 3405g (7# 8oz) African American or Asian may be

smaller Factors that influence

Age, size of parents, health of mother,interval between pregnancies

*What things can decrease birthweight? 3


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Weight

Weight increases at rate of 7 oz per

day Initially, newborns have a physiologic

wt loss of 5-10% due to fluid shifts

*Wt loss > than that indicates theneed for intervention?


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Umbilical Cord

Father participation cut the cord Cord looks white, similar to gelatin; soft How many vessels and what kind? Cord clamp-a plastic device put in place to

allow cord to close then purple dye used Cord will fall off in 7-10 days

Clean with alcohol after every diaper change(controversial)

Diaper fold below cord


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Chest

May see prominent chest bone(xyphoid)

May see enlarged breast tissue inboth sexes *What causes this?

May see extra nipples


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Respirations

Normal rate of breathing is 30-60

breaths per minute May see abdominal and diaphragm

movement in newborns

Transient tachypneatemporaryincreased breathing rate


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Genitalia

Females: may see enlarged labia, perhapseven a slight vaginal discharge. It may bewhite or even blood tinged

Males: scrotum is usually large, appears

swollen, covered with rugae Deeply pigmented in dark-skinned ethnic groups


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Elimination patterns

Meconium stool:

Transitional stool: Constipation:


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Elimination

Breast-fed stools:

Bottle-fed stools:


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Infant Stools

Meconium= 1st BMs. Average=2-10/day. Breastfed babies-looser stools.

If diarrhea, fear is dehydration (greencolor)

If constipation, glycerine suppository(prune or apple juice depends on age)


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Elimination

Urination

Most babies urinate immediately afterbirth Amount of urine is decreased until your

baby starts feeding. You may see voids

of 2-6 times in first two days of life;then 5-25 times as a newborn!

fl


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Reflexes Rooting: Sucking: Swallow: Gag: Grasp: Moro:.

So, there areseveral reflexes.Do you know the

normal/expected

response? Whatwill you teachthe parents?

How do you knowyour teaching iseffective?


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Reflexes

Tonic neck: Dance: Babinski:

Extrusion:

So, there areseveral reflexes.Do you know the

normal/expectedresponse? Whatwill you teach theparents? How do

you know yourteaching iseffective?


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Newborn care

Bathing Scalp: does not need to be washed every

day

cradle cap Eyes: wash first; use index finger and

separate part of washcloth for each eye Ears: clean behind ear and external lobe.

NO cotton swabs! Face: clean with washcloth, NO soap!

*Why do we not recommend soap?


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Bathing

Look at babys skin. Any rashes? Any

redness? Check diaper area for rash *What would you teach as far as diaper

rash goes?


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Heat Loss

Convection: loss of heat from thewarm body surface to cooler aircurrents

Example: Evaporation: loss of heat incurred

when water is converted to vapor

Example:


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Heat Loss

Conduction: loss of heat to a coolersurface by direct skin contact.

Example Radiation: loss occurs when heat

transfers from the heated body riseto cooler surfaces and objects not in

direct contact with the body. Example


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Circumcision

The surgical removal of the foreskin

of penis

60% of males are circumcised

females are also circumcised in somecultures


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What are your personal feelings

regarding circumcision? *Is it medically necessary?

Mutilation? Does the baby feel pain? Religious practices? Cultural considerations?

*What is the care for circumcised

penis? *What is care for uncircumcised

penis?


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Care of Genitalia

Female

Front to back Male

Circumcised: use of lubricant andgauze initially (retraction of foreskin)

Uncircumcised: retraction of foreskinduring bath


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Temperature: What is

Normal?

Rectal: Oral: Axillary:

Tympanic membrane: Patches:

What are the differences? When is eachused/done?TRADE in MERCURY Thermometershazardous material

B b T lk C i


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Baby Talk- Crying

How babies communicate their needs.-hot or cold? -tired or bored?

-hungry? -wet or uncomfortable?-overexcited? -in pain or distress?

Normal NB averages about 2.5-3 hrs crying/day.


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Colic

Colic Common in infants < 3 mo. of age Abdominal cramping expressed by crying and

drawing legs toward abdomen May be related to allergy to cows milk;

parental smoking


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Ways to manage colic:

Is there an allergy to cows milk? What types of foods is the

breastfeeding mom eating? Avoid soy formulas *What can you suggest to the new

mom?


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1. Feed baby

2. Burp baby.3. Wrap baby snuggly.

4. Talk soothingly.

5. Play music.

6. Change position

7. Change diapers.

8. Check to see if baby is too warm or cool.

9. Hold baby.

10. Put baby down.

11. Put baby to bed.12. Offer baby a toy (if over 3 mths old).

13. Take baby outside.

14. Take baby away from overstimulating environment.

F di B b


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Feeding Baby

Choices are breast or bottle feeding. Although Breastfeeding is best & encouraged,

decision is the familys (ultimately, mom). Deciding factors can be:

-money - job -culture/religion- ease -SE status -peer group-maternal/neonatal health status


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Breastfeeding

Most common now. Most infants are breastfed x 1 year & do well.

Encourage use of lactation specialist when problemsdevelop or a breastfeeding support group withintheir community


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Breastfeeding

Advantages

is

adva

ntages


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Breastfeeding

Positioning Ears, shoulders and hips in same line;

infant turned toward breast Musttake nipple andareola into mouth Cradle hold, side-lying, football hold

Breastfed babies eat q 2-4 hours. *Is it better to feed on demand or on

a schedule?


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Breastfeeding

The nurse will assess you for thefollowing:

L Latch A Audible swallowing T Type of nipple

inverted, flat; engorged breasts

C Comfort (breast & nipple) H Hold (positioning)


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Bottlefeeding

Advantages Disadvantages


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Bottle Feeding

Keep baby on same formula-dont switch. Easier on mom; allows dad time with

baby.

Can be expensive!-varies with type-ready-to-use-concentrate-powder


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Bottle Feeding

Variety of Formulas Cow milk base: Similiac, Enfamil, Gerber,

Carnation Good Start Soy protein base: Prosobee, Isomil,

Gerber Soy Special: Nutramagen, Alimentumused

if allergy or intolerance to cows milk


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Bottlefeeding

Hold baby for all feedings-never prop themup!!

Position to avoid ear infections To avoid ingestion of air, ensure nipple isfull of liquid at all times.

Burping

*Should a baby be fed every time he cries? Wash bottle items in dishwasher (Why no

more Boiling bottles?) Wash nipples by hand-will last longer


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Burping

-Results from air in esophagus esp. when lying down.

-Most needed under 2 months old.-Should be done at middle, or after 2oz. Of formula& at the end of each feeding.


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Burping cont.

Between switching breasts ifbreastfeeding

*What position should baby be placed inafter feeding? Use of bulb syringe

*What if baby spits up?

E E h


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Is Baby Eating Enough?

Will vary day-to-day.

How many wet/dirty diapers/day?

Any signs of hunger from baby?

Steady weight gain?

Dont start cereals until 4-6months/old.


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Nutrition

Expected weight gain/loss: 1.5#/month for 5 months; slows during

next 6 months of life Breast-fed infants typically gain less

than bottle-fed infants Weight loss of_________ for term

newborn is considered within normallimits.

f h G


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Infant Weight Gains

Should double birth weight by 6months.

Should triple BW by one yr. Compare to est. growth charts to

ensure WNL gains.

*Remember those G&D charts you havebeen seeing?

d i f lid F d


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Introduction of Solid Foods

Breast milkor formulais all that is

needed for the first six monthsoflife. Solid foods are recommended after 6

months.

I d i f S lid F dM


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Introduction of Solid Foods

Cereal High iron content Mix with breast milk or formula May use fruit juice after 6 months to

mix Vegetables

One at a time for a few days

ea

ts

O

nea

ta

t

Baby Baths


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Baby Baths

Sponge bath until umbilical cord gone& circumcision healed.

Dont need daily baths, 1-2x/wk.

Keep bath area warm & draft-free. Bathe head-to-toe; genitals last

(front-to-back).

B h S f


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Bath Safety

Never leave infant in bath alone!! Water should be under 120 degrees.

(test water on wrist)

No Q-tips. NO lotions, powders, or oils.


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Bonding

What is Bonding?When does Bonding Start?Benefits of Bonding?Who benefits?What about siblings?

D d & B b


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Dad & Baby

Couvade Have you heard of

this?

Its in Oldscheck it out!

Hold infant & makeeye contact soonafter birth.

Feed baby. Change diapers. Be there esp. in

times of illness.

Sibli Ri l


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Sibling Rivalry

Have sibling meet baby at hospital. Involve older child in infants care. Spend time alone with older child. Praise older child for routine good

behavior.

I f t S f t i th H


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Infant Safety in the Home

Install fire and Carbon monoxide detectors. Post emergency #s near the phone. If paint flaking, have it tested for lead.

Use non-slip pads under small rugs. Keep heavy & breakable objects out of

reach. Place furniture away from hazards.

(especially cords on blinds, etc.)

n ant Sa ety n t e ursery


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n ant Sa ety n t e ursery

Crib slats no more than 2 3/8 apart (usecare with old cribs). Position crib away from windows, heaters,

decorations, blind cords. No soft, fluffy crib pillows, comforters.

Mattress should fit snuggly (less than 2fingers-width between). No mobiles over crib. Strap on changing table. Fire resistant linens & sleepwear.

C S t


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Car Seats MVA leading cause of death in children.

All children under 40# need car seats All children under 12 should be in back seat. For babies under 1, middle of backseat.

should face rear of vehicle.

Be sure seat meets federal standards(especially if it has previously been used Ex:rummage sales)

P ti Abd ti


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Preventing Abduction

Never let baby out of your sight! Get references for nannies & babysitters. No announcement in papers. No stork on lawns. No Home Health people without ID.

W i Si


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Warning Signs

Teach parents to call the doctor when..

Less than 4 wet diapers/day

No BMs Jaundice after 7 days old. Diarrhea Temp over 100F (a)

Vomiting more than 2-3x/day Refuses to feed or nurses poorly

N si Di s s


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Nursing Diagnoses

Normal newborn

Effective breastfeeding Ineffective protection Ineffective thermoregulation Risk for infection Risk for injury

N sin Di n s s


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Nursing Diagnoses.

Parent Chronic sorrow Risk for impaired parent/infant

attachment Parenting, impaired Parenting, risk for impaired

Patient education

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Fa 11 Nbn Student Ppt