Normal Newborn S

8/8/2019 Normal Newborn S

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Apgar ScoringActivity (muscle tone)0 Limp; no movement; flaccid1 Some flexion of arms and legs2 Active motion

Pulse (heart rate)0 No heart rate1 Fewer than 100 beats per minute2 At least 100 beats per minute

Grimace (reflex response)0 No response to airways being suctioned1 Grimace2 Vigorous Cry; cough, or sneeze

Appearance (color)0 The baby's whole body is completely bluish-gray or pale1 Good color (pink) in body with bluish hands or feet2 Good color all over (completely pink)

Respiration (breathing)0 Not breathing

1 Weak cry; may sound like whimpering, slow or irregular breathing2 Good, strong cry; normal rate and effort of breathing


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Pulmonary System Transition

First baby must take that first breathe

Function of respiration switches

Management


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Cardiac System Transition

Closure of the foramen ovale- after cordis clamped

Closure of the ductus arteriosus

Closure of the ductus venosus

Common variations

Murmurs

Acrocyanosis


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Nursing Responsibilities

Dry and Stimulate- to makebaby cry

Suction (if needed)

Assess heart rate

Weight and identify


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Newborn Thermoregulation

Heat production

Brown adipose tissue

Heat loss

Convection

Radiation

Evaporation- most common Conduction

Response to heat


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Nursing Interventions to

Prevent Hypothermia

Dry infant, removewet blankets

Apply a hat andwarm blankets

Avoid placing infanton cold surfaces

Avoid placing infants

in drafts

Place under radiantwarmer iftemperature is

unstable- naked


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Normal Newborn Vital Signs

Temperature:

Axillary: 36.5-37c (97.7-98.6F)

Rectal:

36.6-37.2c (97.8-99F) Heart rate:

Apical: 120-160bpm. Varies withsleeping or crying

Respiration: 30-60 breaths/min Blood Pressure: 80/40.varies.

Arm/Thigh- not part of normalv/s for baby


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Newborn Sleep Cycle

Sleep states:

Deep or quiet sleep

Active (REM)

Alert states:

Drowsy

Wide awake Active awake

Crying


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NursingAssessment of the newborn


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Newborn Appearance

Head circumference

3237 cm (12.5-14.5)

Approx. 2-3 cmlarger than chestcircumference

Fontanels- Anterior and posterior

Molding

Caput succedaneum

Cephalhematoma


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Newborn Measurements

Weight

2,500 4,000 g

5 lb 8 oz 8 lb 13 ozAverage: 3405g

7 lb 8 oz

Length

4852 cm (18-22 in)

Average: 50cm(20in)


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Newborn Appearance

Caput succedaneum Cephalhematoma


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Eyes, Ears, Nose, and Mouth

AssessmentEyes

Symmetry in appearance, aligned with the ears. ifbelow indicates down syndrome.

normal placement

Ears Without lesions, cysts, nodules

Sinus tract

Nose

Patent nares bilaterally

Sneezing (common)- this is like a reflex to clearairway. Is normal. Doesn't mean infection or cold.

Mouth

Palpate soft and hard palate

Teeth

Tongue


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Abdominal and Back Assessment

Abdomen

Round, full, symmetrical, normal bowel sounds

Two arteries, one vein in cord

Brachia

land femora

lpu

lses- make sure ispresent & strong

Hernia- common in African Americans

Back

Spine intact- nice straight curve

Patent anus

No sacral dimples- can be sign of spinal bifida.Report to doctor.

Lanugo


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Genital and Anal Assessment

Normal finding

Patent anus

Stool and urine by 24 hours after birth

Male Findings:

Testes palpable in scrotum

Undescended testes

Epispadius -pee hole is on the top part of theshaft

Hypospadius- pee hole is on the bottom part ofthe shaft

Scrotum pendulous- when is swollen. You see iton breech babies.

Imperforate anus


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Genital and Anal Assessment

Female Finding:

Labia & clitoris edematous

Hymenal tag Vaginal discharge- normal

Pseudomenstruation- spot of

bleeding from the materna

lhormone passing through the

babies system causes this or breastto swell


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Skin Assessment

Acrocyanosis

Vernix caseosa- whitish coat whenborn. Lubricate and protect theirskin in utero.

Milia- white spots on the nose andface. It will disapear.

Erythema toxicum (newborn rash).Disappear by itself.

Mongolian spots

Birthmarks Telangiectacic nevi (stork bites)

Nevus flammeus (pork wine stain)

Nevus vasculosus (strawberry mark)

Mongolian spot

Birthmark


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Neurologic System

Normal reflexes Blink- reaction to light within 2 hours after birth. Open

and close the eyes.

Sucking Rooting- stroke the side of face. They should turn to

that side. To see if able to find breast.

Grasp (plantar and palmer)- finger in hand. Clamp.

Moro when you lift them of the crib a little or through

startle. Their hand come to a C. Up to 6 months. Babinski- finger through feet. Flare till 2 yr. opposite

after that.

Stepping- when u stand them up and move legs like ifthey are stepping

Tonic neck- head one side and hand goes other way


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General Nursing Care

Erythromycin ointment

Vitamin K prophylaxis (0.51.0 mg)

First bath


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Gestational Age Assessment-

not important

Dubowitz Tool

Neuromuscularmaturity

Posture

Square window

Arm recoil

Popliteal angle

Scarf sign

Heel-to-ear

Physical maturity

Skin

Lanugo

Plantar surface

Breasts

Eye and ear Genitalia


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Newborn Nutrition

Calorie requirements:

50 to 55kcal/lb/day or 105-108kcal/kg/day

Breast Milk

Colostrum- provides baby with passiveimmunity

Transitional

Mature milk

Fore milk Hind milk

Frequency

1 and a half to 3 hours

Determined by baby cues


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Newborn Stools

Meconium- 1rst poop. Passes first 8-24hours. Thick and tarry.

Transitional- switches to greenish loosestool.

Breast fed stools- liquid. Seed. Yellowcolor stool.

Formula fed stools- more formed and

pasty brown color


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Newborn Stools


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Questions

If newborn temp is 96.5F, what would youdo? You warm up the baby with radiantwarmer, naked. You want it to be at least

97.5F. Do double wrapping if is slightly loweror put on mother stomach and out blanketsover it. Sign of infection is low temp., babiescant maintain body temp and have to be puton the radiant several times.

The caput crosses the suture line. Caput isfull of fluids. Heals hours to days.

Vitamin k given in vastus lateralis and isgiven to prevent bleeding. Promotes clotting

factor.


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Baby looses heat to cold window,how is it loosing heat? Radiation.

Rectal temp done initially tonewborn to check for patency.

What is the bluish discoloration inthe hand and feet? Acrocyanosis.

Baby should be placed to sleep onthe back to prevent SID. And havethem turn the head to the side.

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Normal Newborn S