Neonatal Nursing Care: Part 3 Nursing Care of Normal Newborn

Developed by D. Ann Currie, RN MSN

Assessment Data: Condition of the Infant

Apgar scores at 1 and 5 minutesResuscitative measures Physical examinationVital signsVoidingsPassing of meconium

Apgar Score

Care of the Newborn immediately after birth

Maintain respirationsProvide and maintain warmthApgar scorePhysical assessmentNewborn identificationFacilitate attachment

Signs of Newborn Transition

Neonatal Distress

Newborn CarePositioningFeedingEliminationSafety Issues- Newborn identification Newborn abductionBondingCord CareCircumcision Care/Uncircumcision Care

When to Call for Help

Assessment Data: Infant Complications

Excessive mucusDelayed spontaneous respirations or

responsivenessAbnormal number of cord vesselsObvious physical abnormalities

Assessment Data: Labor and Birth

Duration and courseStatus of mother and fetus Analgesia or anesthesiaProlonged rupture of membranesMeconium-stained amniotic fluidNuchal cord Precipitous birthUse of forceps or vacuum extraction assisted

deviceFetal distress

Assessment Data: Maternal Complications

PreeclampsiaSpottingIllnessRecent infectionsRubella statusSerology resultsHepatitis B screen resultsExposure to group B streptococciHistory of maternal substance Human immunodeficiency virus (HIV) test result

Assessment Data: Family Parents’ interactions with their newborn Their desires regarding infant careInformation about other children in the homeAvailable support systemsPatterns of interaction within each family

unit

Physiologic Alterations Respiratory distressPallorHypothermiaAlterations in feeding and elimination

Nursing Care: Assessment Airway clearanceVital signsBody temperatureNeurologic statusAbility to feedEvidence of complications

Nursing Care: AssessmentReview of prenatal and birth information Gestational age Newborn’s adaptation to extrauterine lifeWeight and measurementVital signs every 30 minutes Assessment of Hct or blood glucose if

warranted

Daily Assessments Vital signsWeightOverall colorIntake and outputUmbilical cordCircumcisionNewborn feedingAttachment

Daily Newborn Care Assist with feedingsThermoregulationSkin careCord carePrevention of infectionSecurity

Cord Care

Common Concerns How to pick up a newborn Holding and feeding the infantChanging the diaperInterpreting newborn cuesBathing the newbornCord and circumcision careNormal voiding and stooling pattern

Parent Education Periods of reactivity and expected newborn

responsesNormal physical characteristics of the newbornThe bonding processThe infant’s capabilities for interaction The role of touch in facilitating parent-infant

interactionComforting techniquesProgression of infant behaviors Information about available educational

materials and support

Discharge Education Safety measuresVoiding and stool characteristicsCircumcision careCord careWaking and quieting the newborn Car safety ImmunizationsSigns of illness

Wrapping Newborn

Infant car restraint for use from birth to about 12 months of age

Signs of Illness Temperature above 38oC or below 36.6oC axillaryContinual rise in temperatureForceful or frequent vomiting Refusal of two feedings in a rowDifficulty in awakening babyCyanosis with or without a feedingAbsence of breathing longer than 20 seconds Inconsolable infant or continuous high-pitched cryDischarge or bleeding from umbilical cord, circumcision, or

any opening Two consecutive green watery or black stools, or increased

frequency of stoolsNo wet diapers for 18 to 24 hoursFewer than 6 to 8 wet diapers per day after 4 days of ageDevelopment of eye drainage

Documentation of DischargeTeachingHowChecking of ID BandsWith whomCondition at dischargeWhere

The End of Part III