Chapter 18
Caring for the Normal Newborn

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
The Immediate
Neonatal Assessment
 Establish airway
 Suction
 Provide warmth
 Dry the infant
 Place on mother ’ s abdomen; heated blankets
 Place beneath radiant heater
 Cap

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
The Immediate
Neonatal Assessment
 Observe respiratory effort, color, muscle tone
 Stimulate neonate to breathe deeply and cry
 Assess heart rate, temperature
 Note obvious abnormalities
 Check and record number of umbilical cord vessels

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Apgar Score —1, 5 minutes
 Assesses immediate adaptation
 Five categories —each scored 0 to 2
 Respiratory effort
 Heart rate
 Muscle tone
 Reflex irritability
 Skin color
Susan Ward
Shelton Hisley

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Immediate Nursing Care
 Mother –infant identification
 Infection/injury prevention
 Eye prophylaxis
 Vitamin K injection
 Hepatitis B vaccine (parental consent required)
 Assess blood glucose
 Hematocrit and hemoglobin

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
The Later Neonatal Assessment
 Body positioning
 Skin color
 Body size
 Level of reactivity
 Measurements and determination of gestational age
 Ballard Gestational Age by Maturity Rating Tool

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Assessment of the Neonate:
A Systems Approach

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Integumentary System
 Inspect skin, scalp, nails, body hair
 Color, texture, distribution, disruptions, eruptions, birthmarks
 Well-lit room
 Birth injuries

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Skin Assessment
 Smooth and soft
 Postterm infants —tough, leathery skin
 Pustular melanosis
 Milia
 Erythema toxicum
 Pigmentation —Mongolian spots, café-au-lait marks

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Birthmarks
 Brown nevi —brown skin marks
 Nevus flammeus — “ port wine stain ”
 Telangiectatic nevus — “ stork bite ”
 Nevus vasculosus — “ strawberry mark ”

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Assessment of the Infant ’ s Head
 Symmetry
 Eye shape, size, placement, and coordinated lid movement, red reflex, gross vision
 Ears: shape, size, placement, hearing
 Movement, color of the lips
 Chin —appropriate size

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Head —Fontanels
 Estimate size
 Fullness without bulging —normal
 Bulging and tense with large head circumference —increased intracranial pressure
 Sunken —dehydration

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Head
 Caput Succedaneum
 Diffuse edema, crosses suture lines, disappears in few days
 Cephalhematoma
 Subperiosteal hemorrhage
 Does not cross suture lines
 Persists for weeks
Susan Ward
Shelton Hisley

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Assessment
 Mouth
 Epstein ’ s pearls
 Teeth
 Ability to suck
 Hard and soft palate
 Neck
 Torticollis
 Facial features

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Respiratory System Assessment
 Symmetry in chest movement
 Breast tissue
 Nasal patency
 Respiration rate, pattern, and use of accessory muscles
 Auscultate lungs anterior and posterior

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Respiratory Assessment
 Skin color
 Capillary refill
 Signs of distress
 Retractions
 Nasal flaring
 Expiratory grunting

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Cardiovascular System
Assessment
 Inspection and auscultation
 Point of maximum impulse
 Heart rate
 Capillary refill
 Peripheral pulses
 Auscultate all areas —murmurs
Susan Ward
Shelton Hisley

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Gastrointestinal System
Assessment
 Abdominal inspection, including umbilical cord
 Auscultate bowel sounds, upper abdomen for gastric bubble, and heart sounds of the abdominal aorta
 Palpation

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Conditions That Warrant
Further Assessment
 Abdominal distention
 Absence of bowel sounds
 Discharge from umbilical cord/site
 Abdominal mass
Susan Ward
Shelton Hisley

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Genitourinary System
Assessment
 Hips abducted
 Palpate and inspect scrotum, testes, and penis
 Male —retract foreskin
 Palpate and inspect female genitalia
 Anus and anal wink reflex

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Common Findings —Male Infants
 Scrotal swelling
 Smegma
 Hypospadius
 Epispadius

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Common Findings —
Female Infants
 Hymenal tags
 Vernix caseosa on labia
 Pseudomenstruation
Susan Ward
Shelton Hisley

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Conditions That
Warrant Further Assessment
 Undescended testicles
 Micropenis
 Ambiguous genitalia
 Imperforate hymen
 Imperforate anus
Susan Ward
Shelton Hisley

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Musculoskeletal
System Assessment
 Observe infant ’ s movements in crib
 Inspect for differences in extremity length and size
 Assess muscle tone and symmetry
 Gentle passive ROM to assess joint rotation
 Assess head lag
 Skin folds on thighs

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Common Findings
 Torticollis
 Developmental dysplasia of the hip
 Asymmetry of hip folds
 Barlow maneuver
 Ortolani maneuver
 Crepitus
 Unusual positions of foot

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Conditions That May Warrant
Further Assessment
 Fractured clavicle
 Polydactyly
 Syndactyly
 Simian crease

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Neurological System
Assessment
 Reflexes
 Major —gag, Babinski, Moro, Galant
 Minor —palmar grasp, plantar grasp, rooting and sucking, head righting, stepping, tonic neck

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Conditions That Warrant
Further Assessment
 Shoulder dystocia
 Erb ’ s palsy
 Cerebral palsy
 Spina bifida

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Teaching About Newborn Care
 Temperature assessment
 Bathing
 Nail Care and umbilical cord care
 Clothing
 Diapering
 Attachment

Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Newborn Care
 Circumcision
 Ensuring optimal nutrition
 Discharge planning for the infant and family
 Child care
 Newborn metabolic screening tests