Maternal & Birth History Apgar score at: 1 & 5 minutes Resuscitation measures needed Status of mother &

mp; fetus throughout L&D Analgesic or anesthesia given to mother Airway clearance- excessive mucous &/or delayed spontaneous respirations V/S, body temperature Voiding, passage of meconium Physical exam Neurologic status- delayed responsiveness Ability to feed Evidence of complications: o Abnormal number of cord vessels o Obvious physical abnormalities o Maternal problems that may have compromised fetus in utero Nursing Diagnoses Ineffective airway clearance related to presence of mucous & retained lung fluid Risk for altered body temperature related to evaporative, radiant, conductive, & convective heat loss Acute pain related to heel sticks for glucose or hematocrit tests or vitamin K injection Maintenance of Clear Airway & Stable Vital Signs Free flow oxygen should be available Position newborn on back or side Bulb syringe or DeLee wall suction Monitor V/S Maintenance of Neutral Thermal Environment Minimize need for increased oxygen consumption & use of calories Optimal range of 36.4-37.2C (97.5-99F) Perform assessment & interventions with: newborn unclothed & under radiant warmer Double-wrap & put stocking cap on head Maintenance of Neutral Thermal Environment Bathe under radiant warmer after temperature is stable: recheck temperature after bath; if stable, dress newborn in shirt, diaper & cap; wrap baby; place in open crib at room temperature; axillary temperature is below 36.4C (97.5F), return to radiant warmer Keep clothing & bedding dry

Normal Newborn Chapter 26

Reduce exposure to drafts Warm objects that will be in contact with newborn Encourage mothers to snuggle with newborn

Prevention of Complications of Hemorrhagic Disease: Newborn Prophylactic injection of vitamin K to prevent hemorrhage Absence of gut bacterial flora- influences the production of vitamin K in the newborn Phytonadione dose- 0.5 to 1mg within 1 hour of birth (IM- in the middle 1/3 of vastus lateralis muscle; 25gauge, 5/8in needle) Prevention of Eye Infection Prophylactic eye treatment for Neisseria gonorrheae Infected during birth process Installation may be delayed: up to 1 hr. after birth to allow eye contact during parent-infant bonding Ophthalmic ointments used- 0.5% erythromycin; 1% tetracycline; povidoneiodine solution(2.5%) Early Assessment of Neonatal Distress Maintain newborns temperature Teach parents signs to observe Respond immediately to signs of respiratory problems: o Positioning & vigorous fingertip stroking of spine o Nasal & oral suctioning with bulb syringe Recognize newborn distress: o Changes in color or activity o Grunting or sighing sounds with breathing o Rapid breathing o Chest retractions o Facial grimacing Initiation of First Feeding Breastfed newborns during first period of reactivity Formula-fed newborns during second period of reactivity Signs indicating newborn readiness: active bowel sounds, absence of abdominal distention, lusty cry that quiets with rooting & sucking behaviors when a stimulus is placed near lips Facilitation of Parent-Newborn Attachment Eye-to-eye contact in first period of reactivity Eye contact establishes attachment in human relationships Interactive bath

Admission Procedure Evaluation of newborns status & risk factors- no later than 2 hours after birth Review of prenatal & birth information for possible risk factors Gestational age assessment Assessment to ensure newborn is adapting to extrauterine life Confirm newborns ID with mothers Essential Data to be Recorded on Newborns Chart Condition of newborn Labor & birth record Antepartal history Parent-newborn interaction information Weighing, Measuring, Assessing Newborn Weigh newborn in both grams & pounds Measure newborn, recording measurements in both centimeters & inches: length; circumference of head & chest; abdominal girth (optional) Assess babys color, muscle tone, alertness & general state Free flow O2 should be readily available Hematocrit & blood glucose evaluation: at-risk newborns, SGA infants, LGA infants, if infant is jittery Position newborn on back or side if infant has copious secretions Bulb syringe or DeLee wall suction Umbilical cord assessment for signs of bleeding or infection/cord care- triple dye, bacitracin, alcohol Nursing Goals for Ongoing Newborn Care Maintenance of cardiopulmonary function Maintenance of neutral thermal environment Promotion of hydration & nutrition Prevention of complications Promotion of safety Enhancing attachment & family knowledge of childcare Assess for Essential Daily Care V/S Weight Overall color I&O Umbilical cord Circumcision Newborn nutrition Parent education

Attachment

Nursing Diagnoses During Daily Care of Newborn Risk for ineffective breathing pattern related to periodic breathing Altered nutrition: Less than body requirements related to limited nutritional & fluid intake & increased caloric expenditure Altered urinary elimination related to meatal edema secondary to circumcision Health-seeking behaviors related to lack of information about baby care, male circumcision, & breastfeeding or formula feeding Altered family processes related to integration of newborn into family or demands of newborn care & feeding Risk for infection related to umbilical cord healing, circumcision site, immature immune system or potential birth trauma (if forceps or vacuum extraction birth) Parents Common Concerns Use of bulb syringe Signs of choking Positioning When to call for assistance Temperature maintenance Infant positioning to facilitate breathing & digestion Holding & feeding skills Soothing & calming techniques Diapering Normal void & stool pattern Bathing Nail care Cord care Parents Common Concerns Rashes Jaundice Sleep-wake cycles Soothing activities Signs & symptoms of illness Infant safety: car seats Immunizations Metabolic screening (PKU) Circumcision/ uncircumcised penis/ genital care Immediate Safety Measures for Newborn Watch for excessive mucous Use bulb syringe to remove mucous

Have baby sleep on her back in crib or in someones arms

Elimination Characteristics & Patterns Urine: straw to amber without foul smell; 6-10 wet diapers a day Meconium: thick, tarry, dark green Transitional stool: thin, brown to green Breastfed: yellow gold; 6-10 small Formula-fed: pale yellow; 1-2 formed Cord Care Wash hands with soap & water before & after care Keep cord dry & exposed to air or loosely covered with clean clothes Clean cord & skin around base with an alcohol cotton ball or cotton swab at each diaper change Fold diaper below umbilical cord to air-dry Do not give tub baths until cord falls off in 7-14 days Check cord each day: o Odor o Oozing of greenish yellow material o Reddened areas o Report to MD any signs of infection Circumcision Care Squeeze soapy water over circumcision site 1x day Rinse area off with warm water & pat dry Apply petroleum jelly with each diaper change (unless a Plastibell) Fasten diaper loosely over penis Let Plastibell fall off by itself- about 8 days Avoid placing baby on his stomach Check for any foul-smelling drainage or bleeding at least 1x day Light, sticky, yellow drainage (part of healing process) Uncircumcised Infant Care Clean penis with water during diaper changes & with bath Do not force foreskin back over the penis Techniques for Waking Baby Loosen clothing, change diaper Hand-express milk onto babys lips Talk with baby while making eye contact Hold baby in upright position (sitting or standing) Stimulate rooting reflex (brush one cheek with hand or nipple)

Techniques for Quieting Baby Check for soiled diaper & change Swaddle or bundle baby Use slow, calming movements with baby Softly talk, sing, or hum to baby Signs of Illness in the Newborn Axillary temp>38C (100.4F)or<36.6C (97.8F) Continual rise in temperature More than 1 episode of forceful or frequent vomiting over 6 hours Refusal of 2 feedings in a row Lethargy, difficulty in awakening baby Cyanosis with or without a feeding Absence of breathing longer than 20 seconds Inconsolable infant Continuous high-pitched cry Discharge/bleeding from umbilical cord, circumcision, or any opening 2 consecutive green, watery stools Development of eye drainage No wet diapers for 18-24 hours, fewer than 6 to 8 wet diapers per day Parental Measures to Prevent Abduction Checking that ID bands are in place Only people with proper birthing unit ID to remove the baby from the parents room Reporting presence of any suspicious people on the birthing unit