Chapter 18Caring for the Normal Newborn

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley

The Immediate Neonatal Assessment

Establish airwaySuction

Provide warmthDry the infantPlace on mother’s abdomen; heated blanketsPlace beneath radiant heaterCap

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley

The Immediate Neonatal Assessment

Observe respiratory effort, color, muscle tone

Stimulate neonate to breathe deeply and cry

Assess heart rate, temperatureNote obvious abnormalitiesCheck and record number of umbilical

cord vessels

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley

Apgar Score—1, 5 minutesAssesses immediate adaptationFive categories—each scored 0 to 2

Respiratory effortHeart rateMuscle toneReflex irritabilitySkin color

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley

Immediate Nursing CareMother–infant identification Infection/injury prevention

Eye prophylaxisVitamin K injectionHepatitis B vaccine (parental consent

required)Assess blood glucoseHematocrit and hemoglobin

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley

Question?The nurse administers vitamin K to the newborn for

what reason?

a. Most mothers have a diet deficient in vitamin K, which results in the infant being deficient.

b. Vitamin K prevents the synthesis of prothrombin in the liver and must be given by injection.

c. Bacteria that synthesize vitamin K are not present in the newborn’s intestinal tract.

d. The supply of vitamin K is inadequate for at least 3 to 4 months, and the newborn must be supplemented.

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyThe Later Neonatal

AssessmentBody positioningSkin color Body sizeLevel of reactivityMeasurements and determination of

gestational ageBallard Gestational Age by Maturity Rating

Tool

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley

Assessment of the Neonate: A Systems Approach

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley

Integumentary SystemInspect skin, scalp, nails, body hair

Color, texture, distribution, disruptions, eruptions, birthmarks

Well-lit roomBirth injuries

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley

Skin AssessmentSmooth and soft

Postterm infants—tough, leathery skinPustular melanosis Milia Erythema toxicumPigmentation—Mongolian spots, café-

au-lait marks

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley

BirthmarksBrown nevi—brown skin marks Nevus flammeus—“port wine stain” Telangiectatic nevus—“stork bite”Nevus vasculosus—“strawberry mark”

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyAssessment of the Infant’s

Head SymmetryEye shape, size, placement, and

coordinated lid movement, red reflex, gross vision

Ears: shape, size, placement, hearingMovement, color of the lipsChin—appropriate size

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley

Head—FontanelsEstimate sizeFullness without bulging—normalBulging and tense with large head

circumference—increased intracranial pressure

Sunken—dehydration

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyHead

Caput SuccedaneumDiffuse edema, crosses suture lines,

disappears in few daysCephalhematoma

Subperiosteal hemorrhageDoes not cross suture linesPersists for weeks

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley

AssessmentMouth

Epstein’s pearlsTeethAbility to suckHard and soft palate

NeckTorticollis

Facial features

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyRespiratory System

AssessmentSymmetry in chest movementBreast tissueNasal patencyRespiration rate, pattern, and use of

accessory musclesAuscultate lungs anterior and posterior

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley

Respiratory AssessmentSkin colorCapillary refillSigns of distress

RetractionsNasal flaringExpiratory grunting

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyCardiovascular System

Assessment Inspection and auscultationPoint of maximum impulseHeart rateCapillary refillPeripheral pulsesAuscultate all areas—murmurs

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyGastrointestinal 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 CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley

Conditions That Warrant Further Assessment

Abdominal distentionAbsence of bowel soundsDischarge from umbilical cord/siteAbdominal mass

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyGenitourinary System

AssessmentHips abductedPalpate and inspect scrotum, testes, and

penisMale—retract foreskinPalpate and inspect female genitaliaAnus and anal wink reflex

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyCommon Findings—Male

InfantsScrotal swellingSmegmaHypospadiusEpispadius

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyCommon Findings—

Female Infants

Hymenal tags

Vernix caseosa on labia

Pseudomenstruation

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyConditions That

Warrant Further Assessment

Undescended testiclesMicropenisAmbiguous genitaliaImperforate hymen Imperforate anus

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyMusculoskeletal

System AssessmentObserve infant’s movements in cribInspect for differences in extremity

length and sizeAssess muscle tone and symmetryGentle passive ROM to assess joint

rotationAssess head lagSkin folds on thighs

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley

Common FindingsTorticollis Developmental dysplasia of the hip

Asymmetry of hip foldsBarlow maneuverOrtolani maneuverCrepitusUnusual positions of foot

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley

Conditions That May Warrant Further Assessment

Fractured claviclePolydactyly Syndactyly Simian crease

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyNeurological System

AssessmentReflexes

Major—gag, Babinski, Moro, GalantMinor—palmar grasp, plantar grasp, rooting

and sucking, head righting, stepping, tonic neck

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley

Conditions That Warrant Further Assessment

Shoulder dystociaErb’s palsyCerebral palsySpina bifida

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton HisleyTeaching About Newborn

Care Temperature assessment BathingNail Care and umbilical cord careClothingDiaperingAttachment

Maternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & FamiliesMaternal-Child Nursing CareMaternal-Child Nursing CareOptimizing Outcomes for Mothers, Children, & FamiliesOptimizing Outcomes for Mothers, Children, & Families

Susan WardSusan WardShelton HisleyShelton HisleySusan WardSusan WardShelton HisleyShelton Hisley

Newborn CareCircumcision Ensuring optimal nutritionDischarge planning for the infant and

family Child care Newborn metabolic screening tests