Normal Newborn PP Final

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    Normal Newborn

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    Introduction:

    1. Definition of neonatal period: A period from

    birth 4 weeks postnatal.

    After the initial observation for neonatal

    condition requiring immediate intervention,

    the baby is sent to the normal newbornnursery or maternity floor for the purpose of

    follow up and stabilization.

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    The role of the neonatal nurse

    & physician inside the normal

    newborn nursery or maternity

    floor:

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    Admission Care:

    The role of the nurse is: - To carry out good interpersonal communication.- To take complete history about the mother andneonate.- To be sure that the neonate has identification band.- To perform complete physical assessment (Generalappearance, V.S, G.M, Gestational age assessment).- Prevention of hemorrhage (administer vit K if notgiven in the delivery room).

    - Documentation.

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    Assessment:

    The initial assessment:

    APGAR scoring systemPurpose:

    is to assess the newborn S immediate adjustment to

    extrauterine life

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    Transitional assessment (Periods of

    reactivity) :I) First period of reactivity:

    Stage 1: during the first 30 min. through whichthe baby is characterized as Physiologically

    unstable ( ), very alert, cries vigorously, may

    suck a fist greedily, & appears very interested

    in the environment.

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    Stage 2: it lasts for about 2-4 hours, through

    this period; all V.S & mucus production are

    decreased. The newborn is in state of sleep

    and relative calm.

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    II) Second period of reactivity: it lasts for

    about 2-5 hours, through which the newborn isalert and responsive, heart & respiratory rate,gastric & respiratory secretions are increased &

    passage of meconium commonly occurs.

    Following this stage is a period of stabilization

    through which the baby becomesphysiologically stable & a vacillating pattern ofsleep and activity .

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    passage of meconium

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    Assessment of Gestational age:(High-risk neonate)

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    Systematic Physical examination:

    - Growth measurements- Vital Signs- General appearance:

    . Posture: Flexion of head & extremities,

    taking them toward chest & abdomen

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    Head Circumference

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    Posture

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    . Skin:

    General description: At birth ; color :

    bright red, texture : soft and has good

    elasticity.

    Edema is seen around eye, face, and

    scrotum or labia.

    Cyanosis of hands & feet (acrocyanosis)

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    General description of the skin

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    Acrocyanosis

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    1. Vernix Caseosa: Soft yellowish cream layer

    that may thickly cover the skin of the

    newborn, or it may be found only in the

    body creases and between the labia.

    The debate of wash it off or to keep

    it.

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    Vernix Caseosa

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    2. Lanugo hair:

    - Distribution

    - The more premature baby is, the heavier

    the presence of lanugo is.

    - It disappears during the first weeks of life

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    Lanugo hair

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    3. Mongolian spots:

    Black coloration on the lower back, buttocks,

    anterior trunk, & around the wrist or ankle.

    They are not bruise marks or a sign of mental

    retardation, they usually disappear during

    preschool years without any treatment.

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    Mongolian spots

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    Mongolian spots

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    Mongolian spots

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    4. Desquamation:

    - Peeling of the skin over the areas of bony

    prominence that occurs within 2-4 weeks of

    life because of pressure and erosion of

    sheets.

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    Desquamation

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    Physiological Jaundice

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    Physiological Jaundice

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    Milia

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    Fontanels should be flat, soft, & firm. It

    bulge when the baby cries or if there is

    increased in ICP.

    Two conditions may appear in the head:

    Caput succedaneum & cephlhemtoma

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    Caput succedaneum

    An edematous swelling on the presenting portionof the scalp of an infant during birth, caused bythe pressure of the presenting part against the

    dilating cervix. The effusion overlies theperiosteum with poorly defined margins. Caput succedaneum extends across the midline

    and over suture lines. Caput succedaneum doesnot usually cause complications and usuallyresolves over the first few days. Managementconsists of observation only.

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    Caput succedaneum

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    Caput succedaneum

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    Caput succedaneum

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    Cephalhematoma:

    Cephalhematoma is a subperiosteal collection of blood secondary to rupture of blood vessels

    between the skull and the periosteum, in which

    bleeding is limited by suture lines ( never cross

    the suture lines ).

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    Cephalhematoma

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    8. Eyes:

    - Usually edematous eye lids- Gray in color. True color is not determined

    until the age of 3-6 months.

    - Pupil: React to light

    - Absence of tears

    - Blinking reflex is present in response to touch

    - Can not follow an object (Rudimentary

    fixation on objects).

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    Normal Eye

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    Eyelid Edema

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    Dysconjugate Eye Movements

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    Subconjunctival Hemorrhage

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    Congenital Glaucoma

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    9. Ears:

    Position:

    Startle Reflex:

    Pinna flexible, cartilage present.

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    Normal Ears

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    10. Nose:

    Nasal Patency (stethoscope).

    Nasal discharge thin white mucous

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    Normal Nose

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    Dislocated Nasal Septum

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    11. Mouth & Throat:- Intact, high arched palate.

    - Sucking reflex strong and coordinated

    - Rooting reflex

    - Gag reflex

    - Minimal salivation

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    12. Neck :

    Short, thick, usually surrounded by skin

    folds.

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    Neck

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    System assessment of the neonates:

    1. Gastrointestinal System:Mouth should be examined for abnormalities

    such as cleft lip and/or cleft