What Kind of Nurse Takes Care of Babies
Learning Objectives
1. Describe the respiratory and cardiovascular changes that occur in the newborn during the transition from the fetal to the newborn environment.
2. Identify the four causes of newborn heat loss. State at least ane example of each. Place nursing considerations related to the prevention of cold-stress of the neonate.
3. Land the four primary goals for immediate care of the newborn.
four. Identify the 5 components of the Apgar score. Identify nursing considerations related to each component.
5. Talk over the procedure for proper identification of a newborn. State nursing considerations related to safety precautions, prevention of nosocomial infections, and completion of nascency documentation.
6. Country nursing considerations related to Standard Precautions, center prophylaxis, vitamin K administration, and parental bonding.
vii. Talk over the normal ranges of weight and length of the neonate. State nursing considerations related to molding, caput succedaneum, cephalohematoma, anterior fontanel, and posterior fontanel.
viii. Define and discuss the nursing considerations related to the post-obit terms: pseudomenstruation, phimosis, acrocyanosis, milia, Epstein's pearls, erythema toxicum, petechiae, Mongolian spots, lanugo, and vernix caseosa.
9. Define the following reflexes of the newborn: rooting, palmar grasp, Moro's, tonic neck, Babinski'southward, stepping, and sucking.
10. Identify the important elements of data regarding the process of labor and nascence that must be reported to the newborn nursery nurse.
11. Place the components of the initial assessment of a newborn. Include nursing considerations related to each of the following: the umbilical cord, concrete measurements, vital signs, respiratory status, and elimination and meconium. Identify the components of a routine cess of a newborn. Include nursing considerations related to each of the following: vital signs, weight, urine, and stools.
12. State the important nursing considerations related to each of the post-obit: holding a newborn, dressing a newborn, cord intendance, circumcision, and sleep.
13. Land the primary benefits of breastfeeding. Define the following terms: colostrum, foremilk, hindmilk, and LATCH. Identify the nursing considerations for each term. State the nursing considerations related to the following common issues of breastfeeding: sore and cracked nipples, engorgement, plugged ducts, and mastitis.
14. Identify the teaching considerations regarding nutrition for the breastfeeding mother. Place the teaching considerations for the mother who is canteen feeding.
| Of import TERMINOLOGY | |||
| acrocyanosis | epispadias | lanugo | phimosis |
| alveoli | Epstein'southward pearls | mastitis | port-vino stain |
| Apgar | erythema toxicum | meconium | prepuce |
| bonding | fontanels | milia | pseudomenstruation |
| brown fat | foremilk | molding | smegma |
| cephalohematoma | galactosemia | Mongolian spots | stork seize with teeth |
| caput succedaneum | hindmilk | neonate | surfactant |
| circumcision | hypospadias | ophthalmia neonatorum | vernix caseosa |
| desquamate | hypothyroidism | outer canthus | |
| en face position | inner canthus | ||
Acronyms
G6PD
LATCH
LDR
LDRP
PKU
SIDS
The care babies receive and the bond they form with their parents during the first several weeks of life accept many effects. These factors influence the growth and development of healthy infants and the closeness of the entire family. Equally a nurse, you play a special role equally a teacher and advocate for family caregivers and their newborns.
A normal baby is built-in with the reflexes and body systems needed to live outside the woman's torso. By no means, however, is the baby ready to live on its own. The baby cannot see its ain basic needs without help. In this topic, y'all will learn to aid neonates (newborns during the first 28 days of life) and teach their new parents how to treat them. You volition acquire most immediate care for healthy newborns, their physical and behavioral characteristics, and the typical care of the babe from the time of birth until the fourth dimension of discharge.
Of import CONCEPTS IN NEWBORN Care
At the fourth dimension of nativity, the neonate must quickly make four dramatic changes to adapt to the earth outside the shelter of the womb. These changes are temperature regulation, circulation, respiration, and source of nourishment.
The neonate must likewise consummate these transitions quickly; the first 24 hours of life are critical for the newborn. In providing initial intendance, the focus is on monitoring and assessing the newborn's vital systems and keeping the baby warm. The infant's well-being depends on having a clear airway and constructive respiration. Assessing the respiratory and circulatory systems, checking vital signs, and administering cord care are important skills that you will demand to master.
Respiration
The changes in respiration are the greatest challenge for the newborn. The infant must begin breathing immediately after nativity. Before nativity, all of the fetus' oxygen had been provided through the placenta, where gases and nutrients from the maternal blood diffused into the fetal blood. As soon as the cord is clamped, however, the infant's lungs become the organs of gas exchange.
Excess secretions in the airway tin can block breathing and, if inhaled, tin crusade aspiration pneumonia. Immediately after delivery of the infant's head, the nascence attendant removes secretions first from the mouth, so the olfactory organ with either gloved fingers or with a small, soft-bulb syringe (In Practice: Nursing Procedure 67-1).
The modify from beingness enclosed by the muscular walls of the uterus and the bag of amniotic fluid to an air-filled room with calorie-free, noises, and stimulation must be quite a stupor. The healthy infant responds to the changes in pressure, temperature, gravity, and stimulation past taking the first breath. When the newborn takes the first breath, he or she unremarkably makes the first sounds.
Although the fetus had some breathing movements in utero, the lungs were filled with fluid, and no gas exchange occurred across the lung sacs (alveoli). The first breath expands the air passages and the alveoli. The good for you newborn has enough surfactant—a chemical that stabilizes the walls of the alveoli—to allow the sacs to remain open, rather than collapsing after each breath. This means that the next breath will not require as much effort.
The get-go few breaths gear up into process events that (1) assist with the conversion from fetal to adult blazon circulation, (2) empty the lungs of liquid, and (3) constitute neonatal lung book and function in the newborn. The baby's respirations may not stabilize for about 2 hours afterwards nascency. During that time, some breaths may sound noisy and moisture. Still, it is abnormal for the respiratory rate to be greater than 60 breaths per minute at two hours of life.
If the mother has been medicated, or has had a long-lasting anesthetic, the newborn may not exhale at in one case and must exist stimulated.
Nursing Alarm Past 2 hours of life, the baby's respiratory charge per unit should be less than 60 breaths per minute. Apgar numbers are pregnant and might besides exist related to NCLEX questions.
Circulation
The circulatory pathway changes abruptly when the umbilical cord is clamped and and then cutting. At birth, the fetal circulatory structures (the foramen ovale, ductus arteriosus, and ductus venosus) must shut to permit blood to menstruation to the centre, lungs, and liver. If these circulatory changes exercise not occur spontaneously, the newborn volition have inadequate oxygenation because of persistent fetal circulation. Surgical intervention is required to right this trouble.
Nursing Alert Information technology is important to remember that the changes in the circulatory system happen at the same time as the changes in respiration; the transitions to support life after birth by these two systems are completely interrelated.
Torso Temperature
When the fetus was inside the mother'southward uterus, the temperature was very stable. The fetus had no need to expend energy to maintain its ain temperature. After being built-in, yet, the baby must work to proceed warm. The baby loses estrus by 4 mechanisms: conduction, convection, evaporation, and radiations (Fig. 67-1).
To counteract the rut loss, the babe has three ways to maintain its temperature: shivering, which is not very efficient; muscle movements, which have simply a little benefit; and the production of heat caused past using a stored fat known as brown fat. Merely infants built-in at term have much brown fat, and after information technology is used, the baby cannot create more. This is one reason that it is so important for the nurse to take steps to continue the baby warm. If the baby needs to work difficult to keep his or her temperature elevated, the baby may get cold-stressed. A chain of events then occurs that can exist harmful to the baby's blood sugar, oxygenation, and acrid-base of operations rest.
Effigy 67-1 · Estrus loss in the newborn can be caused by any one, or a combination, of the following factors: (A) Conduction: heat loss due to direct contact with a colder surface. (B) Convection: oestrus loss due to air movement. (C) Evaporation: heat loss due to the cooling effect of water loss on the skin. (D) Radiations: heat loss via infrared oestrus rays due to body metabolism.
A newborn'southward skin has a blue or dusky tinge at kickoff. As soon as oxygen enters the circulating blood in quantity, the white newborn'due south skin turns lighter and assumes a pink tone. Newborns of other races remain slightly darker.
Intendance OF THE NEWBORN IMMEDIATELY AFTER Nascence
It is important to prepare goals for the immediate intendance of the newborn. Without goals, actions become merely routines; but if the goals are clear, then it is possible to make a plan to meet them. The importance of each goal and the way that it is addressed will vary from one place to some other. Four goals for immediate management of the newborn are to:
1. Found and maintain an airway and respirations
2. Provide warmth and prevent hypothermia
3. Provide a safety environment and routine preventive measures
four. Promote maternal-infant zipper
NCLEX Alarm Clinical situations may ask you to differentiate between the normal newborn and a newborn who needs nursing interventions. Respirations, body temperature, or reflexes may be described in the scenario. Be certain to know how to utilize the Apgar scores.
Initial Assessment: Apgar Score
The Apgar score was named for the physician who adult information technology, Dr. Virginia Apgar. A mnemonic for the 5 criteria of the Apgar score is appearance, pulse, grimace, activity, respiratory attempt. Information technology provides a quick and accurate ways to assess the newborn'southward physical condition at the time of nativity. The score is used to determine whether the baby needs immediate help or resuscitation. It should exist adamant at 1 minute and once more at five minutes after nascency. The i-minute score is most accurate in predicting immediate survival, whereas the v-infinitesimal score may be better in predicting long-term survival and whatever neurologic harm. If the Apgar score is less than 7 points at the five-infinitesimal measurement, a third Apgar reading may exist obtained at 10 minutes after birth.
Five criteria are assessed each time (Tabular array 67-1). To obtain an Apgar score, requite a number from 0 to 2 on each area of the Apgar scoring chart to the infant. So total all the numbers. Record both the 1- and five-infinitesimal Apgar scores on the newborn's nautical chart.
Tabular array 67-1. The Apgar Score
| SCORE | |||
| 0 | 1 | 2 | |
| Heart rate | Absent | <100 | >100 |
| Respiratory effort | Absent | Ho-hum, irregular | Good, crying |
| Musculus tone | Flaccid | Some flexion of extremities | Active motion |
| Reflexes, Irritability | No response | Weak cry or grimace | Vigorous cry |
| Color | Blue, pale | Trunk pink, extremities blue | Completely pinkish |
The following listing describes the meanings of the Apgar scores:
• If the total score is x, the newborn is in the best possible condition.
• If the score is 7 to 9, the newborn usually does not demand resuscitation.
• If the score is 4 to vi, the newborn is in danger.
• If the score is 0 to three, the newborn needs emergency resuscitation.
Nursing Alert If the Apgar score is 7 or less, a person who is skilled in neonatal resuscitation should evaluate the babe and provide immediate aid.
Neonatal Resuscitation
If animate does not brainstorm either spontaneously or following tactile stimulation, the newborn'south respiratory center is probably depressed. You must have emergency action. The newborn must exist resuscitated immediately; permanent brain harm can occur if the newborn is without oxygen for more than approximately 4 minutes.
The purpose of resuscitation is to establish an airway, provide oxygen to the lungs, and stimulate the newborn to exhale. When respiratory difficulties develop in the delivery room, the birth bellboy or anesthesiologist assists the newborn. When a infant develops complications in the newborn plant nursery, nonetheless, you may be the person to brainstorm the resuscitation efforts (see In Exercise: Nursing Process 67-1).
Maintaining Body Temperature
Fifty-fifty with the birthing room temperature set at 75°F (23.9°C), the air is a cold shock to the babe emerging from the warm mother'southward body, still wet with amniotic fluid. Lifting the newborn onto the mother'south bare tummy or chest, perhaps fifty-fifty before the string is clamped or cutting, lets the heat of the female parent'south trunk transfer to the newborn. The infant should also be quickly dried, and all wet towels and blankets should be promptly removed and replaced with dry ones. Warm towels or receiving blankets should be placed over female parent and newborn. The infant volition lose a great deal of heat from its head, and so many hospitals and birth centers place a cap on the infant'due south head to conserve warmth. When it is time for the infant assessment, using a radiant warmer, a prewarmed mattress, and warm instruments provides a rut-gaining, rather than a estrus-losing, surroundings (Box 67-1). The goal of thermoregulation is to remainder heat loss and heat product and create a neutral thermal environment.
Clamping and Cutting the Cord
The nativity attendant will make up one's mind when to place two Kelly clamps on the umbilical cord. Delaying this process allows the babe to receive additional claret from the placenta. Whether or not this is best for the baby depends on the gestational historic period of the baby, the health of the mother and baby, and other factors. After the cord is clamped, the infant must obtain oxygen through its own respiratory try. The cord is cut between the two clamps; usually a cord claret sample is obtained from the portion of the cord still attached to the placenta.
BOX 67-1.
Conserving Heat for a Newborn
In that location are several things you tin can do to help a newborn maintain its temperature.
In the Delivery or Birth Room
♦ Prewarm whatsoever blankets, towels, hats, or wearable before the nascency.
♦ Dry the babe immediately
♦ Supercede wet blankets or towels after drying the baby.
♦ Prewarm the infant resuscitation surface area.
♦ Prepare birth room temperature at 75°F (23.ix°C).
♦ Do non lay the baby on moisture sheets while being suc-tioned.
In the Nursery
♦ Send the newborn in an isolette with the portholes airtight.
♦ Place newborn intendance areas abroad from windows, outside walls, doorways, and drafts.
♦ Keep the newborn's head covered and the body well wrapped for the get-go 48 hours.
♦ Postpone the newborn bathroom until the babe's temperature has been stable for 2 hours at about 97.6°F-98.6°F (36.5°C-37°C).
♦ Breast-stroke the newborn under a radiant heater:
♦ Do not wash off all vernix (protective textile on skin) initially
♦ Embrace work table and scales so they are not cold.
♦ Organize work so that the newborn is uncovered but briefly.
♦ Heat any oxygen or humidified air given.
Afterwards the baby is dried, he or she is handed either to a nurse or to the mother for skin-to-skin contact. This can be done before the Kelly clamp is replaced with a plastic umbilical cord clench. When replacing the Kelly clamp with a plastic umbilical cord clamp, be careful to place the clamp 1-2 cm above the belly button, taking particular care not to clench any of the baby's skin along with the string. The Kelly clamp is removed simply afterward the plastic clench is applied.
Nursing Alert Leave the Kelly clench on the cord stump until after the plastic umbilical cord clamp has been applied. Otherwise, the infant volition lose blood through the string stump.
Source: https://what-when-how.com/nursing/care-of-the-normal-newborn-maternal-and-newborn-nursing-part-1/
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