Personality Development of the Young Adult

o Eriksons psychosocial Developmental Stages

Care of the Newborn and Family

TRANSITION TO EXTRAUTERINE LIFE: A, B, Cs

Chemical and Thermal and Mechanical
Respiratory
o Pulmonary ventilation
o Pulmonary perfusion
Circulation: Changes occurring after birth
o Fetal shunts divert blood away from lungs in fetus
o After delivery shunts close in order for blood to travel to lungs in
newborn
o Foramen Ovale opening between RA and LA
Closes in response to change in pressure
Functionally closes in 1-2 hours
Permanent closure by 6 months
Murmur may be heard immediately after delivery, but may
disappear in about an hour
Need to monitor and document the murmur and any
changes in it
o Ductus Arteriosus connection between aorta and pulmonary artery
dont really need to know this
o Ductus Venosus shunt through liver dont really need to know this
Assessment of Newborn
o Pages 712-726 (new book = 556)
o Prenatal hx of the mother
Did she even have any prenatal care?
Due date (EDD = estimated date of delivery or EDB = estimated
date of birth; EDC = estimated date of confinement)
Nageles Rule Last Menstrual Period (LMP) + 7 days =
EDC; EDD; EDC
Age, weight, height
Maternal complications
Gestational diabetes
Infections during pregnancy
PIH (pregnancy induced HTN)
Labor and delivery options
How long was she in labor
Did baby show signs of distress during labor
Did they need to use forceps?
Vaginal or C-section
o Delivery Room Care
ABCs of resuscitation
Apgar Scores (page 709 or 554 of new book)

usus
Sign

Score
0

Acrocyanosis babies typically have blue hands and feet after

birth should return to normal, pink color within about an hour
or less
Prevent heat loss hat, blanket, immediate bonding with mother
(put on chest)
Promote bonding and feeding
Medications
Vitamin K injections (page 729)
Helps to prevent bleeding after birth
Usually give about 0.5 mg to 1 mg
IM injection sites
o Vastus lateralis
Injection was can be delayed until after first breastfeeding
The introduction of bacteria begins with the first feedings
and by 7 days of age healthy newborns are able to
produce their own vit K
Erythromycin Ophthalmic Ointment (antibiotic) (page 729)
Helps to prevent opthalmia neonatorum (inflammation of
the eyes as a result of gonorrheal or chlamydial infection
contracted by the newborn during passage through the
mothers birth canal)
Help to deter passage of chlamydia, syphilis, or gonorrhea
causing blindness in the baby
Can be delayed up to an hour after birth
Measurements
Weight
Weigh without close on (obviously)
Average weight: 2500-4000 grams (5lb 8oz 8lb 13oz)
o Right now 7lb 5oz is the average
Much bigger now then a while ago because the mothers
used to smoke and the babies had lower birth weights
Height

Assigned at one and five minutes (and q5 minutes PRN)

5 physiological parameters (0-2 pts)
Significance:
o 7-10 Good condition
o 4-6 fair condition O2, stimulation
o 0-3 poor condition resuscitation

Average height: 50 cm (20 inches)

Top of the head to the heel
Head circumference
Respiratory system
o RR = 30-60/min
o Their breathing pattern is irregular and thats normal
o S/S of respiratory distress
Grunting, flaring, retractions
Tachypnea > 60 resp/min
Apnea lasting longer than > 20 seconds
Cyanosis around mouth and in face
Retractions (indents between the ribs when just lying there [not
crying]
o Auscultate lungs (with smaller stethoscope)
o Assess nares obligate nose breathers
o Newborns should sleep on their back (think it reduces risk of SIDS
Need belly time cause we dont want flat heads need to be
present during belly time
Cardiovascular System
o Rate and rhythm 120-160/min
100-120 when quiet
160-180 when crying
o Pulses
Most common is the femoral
Weak or absent of one side
Hip dysplasia
Blood clot
o Acrocyanosis
o Murmur
Murmur means turbulence which may be normal (the shunt
hasnt closed yet)
But may mean a heart defect (maybe the shunt has not closed
and it should have my now)
o Perfusion
Capillary refill (normal is still < 2 seconds)
o Blood pressure
60-80/40-50
On thigh
Dont typically always get it more than once unless there is a
problem
o Umbilical cord
2 arteries, 1 vein
Whartons Jelly
Connective tissue that covers the arteries and vein so that
they dont collapse
Color of cord
Bluish white

care
Clamped at birth anf for the 1st 24 hours
Triple dye drying and antibacterial properties
Alcohol b.i.d.
Purpose of these is to dry it out
Do it with every diaper change
IT DEPENDS OF THE INSITUTION!!!!!!!! what is uses
where. Some places, they use nothing
If not using these drying agents
o Dont get it wet
o Roll down the diaper or have a hole cut out of the
diaper
o OPEN TO AIR
Thermoregulation
o T = 36.5 37.5 (axillary) (BUT IT DIFFERS BY INSTITUTION)
o Balance between heat loss to environment and heat produced by body
Heat loss:
Convection cool drafts
Radiation cool surfaces, not in direct contact
Heat production:
Non-shivering thermogenesis
Brown fat metabolism Cold Stress
o Location: Located in neck, axilla, mid-scapular,
kidneys
o Characteristics: Dense, rich nerve and blood supply
o Metabolism: Brown fat metabolism produces heat
(so dont want them to lose this brown fat)
Preterm babies dont have this brown fat so
even more imperative for them
o Requires oxygen and glucose
Increased heat production uses up oxygen and glucose
Behavioral Characteristics
o Periods of reactivity
1st period 30 mins after birth
Good time for initiating breastfeeding
Sleep phase 60-100 mins
Want the mom to rest during this period too but it is hard
nd
2 period
o Reflexes
Table 26-3 (page 698-705)
Moro startle if they hear a loud noise or are going over a
bump
Should be symmetrical, if not there may by dislocation
issues
Should be present for 6 months

Cord

Rooting (rub cheek gently and they should seek out), sucking,
gag
Babinski should disappear around 1 year of age
Stepping
Grasp palmar/plantar
Tonic neck fencing position
o Behavioral positions
Deep Sleep no response
REM sleep highest amount of time ** this is important
Drowsy delayed reaction
Quiet alert best interaction for feeding
Active alert sensitive to stimuli
Crying response to unpleasant stimuli
o Neuro Assessments
Self-comforting behaviors hand-to-mouth, sucking, clasping
hands (look worried)
Some people worry about giving pacifier in relation to
nipple confusion, but it may be a comforting thing
Habituation ability to shut out repeated stimuli
Senses:
Vision contrast, 19 cm away vision, en face
o Probably the least mature of senses at birth
Taste can distinguish sweet vs bitter
Smell turns head or startles when presented with
noxious smells
o Breast milk
Hearing turns head or starles with loud noises
Touch
Musculoskeletal System
o Symmetry of extremities
o Fontanels of Skull (soft spots) *** know this for test
Anterior diamond shaped, between frontal and parietal bones
Usually open for about 1 year
Posterior: triangular shaped, between parietal and occipital
bones
Usually closes within the first couple of days and may be
present still for 6-8 weeks
Bulging might indicate encephalitis
Sagging might indicate dehydration
o Molding
Temporary misshaping of the head when delivered vaginally
Movement of bones to fit through pelvis
o Skull Assessment ** test
Caput succedaneum
Edema of scalp
Crosses suture line

Seen when they had a hard time getting the baby out
even with an episiotomy and needed to use suction
Lasts about 2-4 days
Seen pretty ,much right away
Cephalohematoma
Collection of blood
Bleeding under periosteum
Usually one-sided
Lasts longer 3-6 weeks
Not seen right away
o Birth injuries
Lacerations, forceps marks
Facial palsy due to forceps
o Developmental Dysplasia of the hip
Dislocation of hip click
Ortolanis sign
If there is a click = positive Ortolani
Folds in the skin should look symmetrical if not, might have hip
dysplasia
GI System
o Meconium: 1st stools, black, and tarry, may be passed in utero
Want the 1st BM in about 24 hours after birth
o Transitional:
o Breast-fed:
o Bottle-fed:
GU System
o Assess genitals
o Urine production begins in utero
o 1st void within 24 hours
Will swallow the sterile urine when in utero
6-8 wet diapers per day
o Genitalia usually swollen
o Wipe little girls front to back
o Girls can have a little drop of blood
Pseudomestration think it may be withdrawal from the mother
Vaginal discharge is also normal just wipe gently and dont dig
around
Spread the labia and one nice swipe from front to back
Nutrition and Hydration
o Dont worry so much about the specific numbers except to know that
eventually 6-8 wet diapers a day is what you want
o Nutrition
Blood glucose
Brain function, thermoregulation
Minimally should be 40-60 mg/dL
Observe for s/s hypoglycemia

Weight loss
Up to 10% wt loss is normal
Due to fluid losses and increase in caloric use
Regain birth weight by 10-14 days

Breast Feeding

American Pediatrics Association in USA recommends breastfeeding for 1 year

Contraindications:
o HIV/AIDS
o Illicit drugs
o Cancer
Advantages
o Immune factors
o Inexpensive
o Natural
o Prevents allergies/asthma
Disadvantages
o Stressful
o Painful and integumentary issues
o Embarrassment in society
o Mastitis
o Pumping
Nurse on both breasts
o Every 2-3 hours for at least 15 minutes on each breast
The first milk that comes out is skim milk and the milk after that
contains fat
Supply and demand the more you nurse the more you make
*******
o Colostrum acts as a laxative
o Prolactin and _____ dont really worry about these
Frequency and duration
o Begin as soon as possible
o 8-12 feedings per 24 hours
o Do not limit times (average 10-20 mins)
No alcohol
Watch what you eat in moderation and see how the baby reacts

Water rarely breaks on its own

1-2 quarts
Can be a trickle or a gush

Nitrozine
Shows if the fluid that is coming out is amniotic fluid or
not
Can also look under microscope
If it is amniotic fluid, they say it is positive for ferning
Amnisure
Get fluid, shake it tells you if it is positing for amniotic
fluid or not
More expensive
AmnioHook
When they want to break the bag of water manually
Looks like a knitting needle
May want to progress labor a little further
Dont want to break it too early
o The babys head is up too high and the cord might
prolapse
Color of the amniotic fluid
Should be clearish pink or a little bloody
Miconium the baby has had a bowel movement
o Means the baby was under stress in utero
Fetal Scalp Electrobe
When you need to get a more accurate reading of the
babys HR
So need to break the water to access the babys head to
screw the electrobe into
May rule out the need for a C-section (if the HR was
actually good) or may indicate the need for a C-section (if
the HR was really bad)