Nursing 1902
The Newborn and the Family Part II
Gordon College
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Topics to Be Covered
Initial Nursing interventions and considerations during the newborn period
Newborn Nursing Care
Parent Teaching & D/C Planning
Breast Feeding
Nursing Care – Admission &
1st 4 Hours of Life
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Initial Physical Exam
Nursing Diagnosis
– Ineffective Airway Clearance r/t presence of mucus and retained lung fluid
– Risk for altered body temperature r/t evaporative, radiant, conductive, and
convective heat loss
– Acute pain r/t heel sticks for glucose or hematocrit tests or Vitamin K injection
Nursing Plan & Implementation
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Evaluate
– Maternal & Birth Hx
– Airway Clearance
– Vital Signs
– Body Temp
– Neurological status
– Ability to Feed
– Evidence of Complications
Admission Procedures
Documentation (Infant’s chart)
– Condition of Newborn
– Labor & Birth Record
• Note significant birth Hx
Admission Procedures
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Documentation (cont)
– Antepartal History
• Note significant maternal Hx
– Parent/Newborn Interaction
Weight & Length
Head, Chest, & Abdominal Circumference
Vital Signs
HCT and Hgb
Admission Procedures
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Clear Airway & Stable VS
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Neutral Thermal Environment
Optimal range 36.4C to 37.2C (97.5F to 99F)
Hypothermia
Unclothed under Radiant Warmer
Cover Head
Bath after temp & VS stable (2-4hrs)
Temp rechecked after bath, if stable → OC
If temp falls <36.4C(97.5F) → radiant warmer
Vitamin K - Aquamephyton
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Prophylaxis
Prevents hemorrhage d/t low prothrombin levels
R/T absence of gut bacterial flora which influences production of Vit K
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Erythromycin
Prohpylaxis for Neisseria gonorrhea
0.5% erythromycin
1% tetracycline
Opthalmic solution of povidone iodine 2.5%
Also effective against chlamydia
Neonatal Distress
• Signs
First Feeding
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Breast fed infants
Formula fed infants
Parent/Newborn Attachment
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Eye contact
Interactive bath
Newborn Care
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Maintain Cardiopulmonary status
Maintain NTE
Promote Hydration/Nutrition
Promote Skin Integrity
Prevent Complications
Promote Safety
Circumcision
Maintain Cardiopulmonary Status
VS every 6-8 hrs
Back to Sleep
Bulb syringe for secretions
Cardiorespiratory monitors prn
Indicators of risk:
Maintain NTE
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Dressed
Double blankets
Hat
Hypothermia
Promote Hydration/Nutrition
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Document I&O
Early & Frequent Feedings
Weigh @ Same time each day
Assess Breastfeeding techniques
Assess Bottle feeding techniques
Promote Skin Integrity
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Initial Bath
Clean between diaper changes
Remove cord clamp within 24 hours
Cord care
Prevent Complications
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NB @ continued risk for:
Hemorrhage
Cardiac symptoms
Infection
Pallor
Cyanosis not relieved by oxygen
Prevent infection
HAND WASHING
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Promote Safety
Compare identification numbers on ID bands
Sensors
Only allowing staff with proper identification to transport baby
Having baby accompany parent when leaving room
Report suspicious people
Circumcision
• 1999 AAP recommendation
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Contraindications
Circumcision – Nurse’s Role
Provide parents with information
Risks & Outcomes of Circumcision
Hygenic practices of uncircumcised males
Foreskin and glans connected @ birth and separate gradually until complete
between 3-5 yrs
NEVER force skin to retract
Gently test for retraction during daily bath
After retraction occurs – gentle washing of glans with soap and water
• Prior to Circumcision
• During Circumcision
• Post-circumcision
• Parent Teaching
Apply petroleum at diaper changes
If bleeds – apply pressure (if cont – call MD)
Glans normally has granulation tissue during healing
Report S&S of infection
Plastibells fall off within 8 days
No ointments while bell in place
Parent Teaching
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Picking up the newborn
Back to Sleep
Bathing
Cord Care
Temperature Assessment
Bulb Syringe
Swaddling the Newborn
Car Seat Safety
• Newborn Screening
• Immunization (Hep B)
Newborn Nutrition
Nutritional Needs
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105 to 108 kcal/kg/d
Fluid requirements = 140 to 160 mL/kg/d
Fe stores dependent upon Maternal intake
Formula fed infants ↑weight faster than breast fed babies
Breast Milk Feeding
• Colostrum
• Transitional Milk
• Mature milk
• Foremilk
• Hindmilk
Breastfeeding Advantages
Immunologic Advantages
• Protection a/g common infections until
• Secretory IgA
• Breast milk is non-allergenic
Nutritional Advantages
• Improved digestion and absorption when compared to formula
• Some proponents believe that it is the best milk for brain development
• High cholesterol in breast milk = production of enzymes to metabolize cholesterol
lending to a decrease in harmful long-term effects
• Provides infant with more minerals than formulas
• Breast milk is lower in Fe than formula, however, it is more readily absorbed from
breast milk than formula
• Vitamins NOT lost through processing and heating
Psychosocial Advantages
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Maternal-infant attachment
Increased feelings of maternal well-being
Contraindications & Disadvantages of Breastfeeding
Types of Formula
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Cows milk protein
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Soy protein – based
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Specialized formulas
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Potential Problems – Formula feeding
Formula Prepared Improperly
Allergic Reactions
Always use Fe fortified formulas
Constipation r/t Fe
NO Cow’s milk until 12mths of age
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Cultural Considerations
Many cultures DO NOT offer colostrum
Asians give boiled water until “milk flows”
Hmong women believe in supplementation but not in expressing their own breast milk
Most muslims breastfeed because the Koran encourages it until 2 yrs
African Americans emphasize “plentiful feeding” – solid foods early
Mexicans – fat baby = healthy baby and “spoiling is encouraged
NURSES SHOULD EVALUATE THE CULTURAL PRACTICE AND ONLY
INTERVENE IF IT IS HARMFUL TO THE BABY!
Client Education for Breast feeding
Basics of Milk Production
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Milk production = demand
Milk stored in sinuses under areola
Adequate maternal fluid intake required
Milk supply established by frequent feedings (Q 1 ½ to 3hrs)
Letdown reflex
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Positioning baby at breast
Baby’s entire body towards mother
Mother in comfortable position w/arms supported
Direct nipple straight into baby’s mouth
Brush infant’s mouth w/breast to stimulate rooting reflex
Procedure for feeding
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Avoid time limits
Allow nursing at first breast until breast is empty
Insert finger into baby’s mouth to break suction
Burp baby between breasts
Burp baby again at end of feeding
Wash nipple with warm water and dry
Helpful Hints
Assure baby is awake
Alternate beginning breast
Rotate baby’s position
Avoid supplemental formula feedings until supply established
Check w/ healthcare provider before taking medications
Storage of Breast Milk
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Refrigerated milk
Store in clean plastic containers NOT glass
Freezer compartment
Self – contained freezer
Separate deep freeze
Thaw in warm water
Never microwave or use boiling water to defrost
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Drugs and Breastfeeding
Most drugs pass into breast milk
Almost all appear in small amounts in breast milk
Very few drugs contraindicated
Avoid long acting drugs
Consider absorption rates and peak blood levels when administering drugs
Observe infant for drug reactions
Use single-symptom drugs vs. multi-symptom drugs
ALWAYS discuss with healthcare provider!
Client Education for
Formula Feeding
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Hold for all feedings
Point bottle nipple directly into mouth on top of the tongue
Nipple should be full of liquid at all times
Burp at intervals
Newborns frequently spit small amounts
DO NOT overfeed
Teach formula preparation
Teach bottle cleaning, storage, etc…
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Nutritional Assessment of Infant
Nutritional Hx from parent
Weight gain
Wet & Soiled Diapers
Growth chart %
Physical Exam
No more than 32oz per day
At least 108 kcal/kg/d (20 cal/30 mL of formula)