Nursing Care of The Newborn and Family

Nursing Care of The Newborn and Family

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ObjectivesBy the end of this discussion, you will be able to:

• Discuss the immediate and subsequent care

• Explain the initial assessment of the newborn

• Identify the Classification of High- Risk Neonate

• Discuss the nursing care for a normal newborn and family

Initial Assessment of NewbornApgar scoring system

• Initial assessment

• Assess the immediate adjustment to extra uterine

life

• Performs at the 1 minute and repeated after 5

minutes and 10 minutes after birth until the

infant's condition stabilized

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Apgar Scoring System

4

Sign 0 1 2

Heart rate Absent <100 beats per minute

>100 beats per minute

Respiratory

effort

Absent Irregular; slow, weak cry

Good; strong cry

Muscle tone Limp Some flexion Well flexed

Reflex

irritability

No response Grimace Cry, sneeze

Color Blue, pale Body pink, extremities blue

Completely pink

Apgar Scoring System

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Total Score Health Status of Newborn Type of Needed Care Area for Providing Care

7-10 • Not Depressed• No Neonatal Asphyxia

• Routine newborn care

• Roaming in• Normal Nursery

4-6 • Mild Depressed• Mild Neonatal Asphyxia

• Health care for a high-risk neonate

• Neonatal Intensive Care Unit (NICU)

0-3 • Sever Asphyxiated

• Need Resuscitation

• Advanced health care

• Intubation

• Neonatal Intensive Care Unit (NICU)

Interpretation of Apgar score

• Identifies the high-risk neonate

• Assess the quality and quantity of neonatal care

• Determines the need for newborn resuscitation

• Predicts future events linked to the infant's neurologic and

physiologic status 6

Classification of High- Risk Neonate

Classified according to:

• Birth weight

• Gestational Age (term, pre and post term

• Apgar Score

• Mortality and morbidity Rate

Classification of High- Risk Neonate

Classified according to:Birth weight:

• Low-birth-weight (LBW): an infant whose birth weight is less than 2500 g,

regardless of gestational age.

• Very low-birth-weight (VLBW) infant :an infant whose birth weight is less than

1500g

• Extremely-low-birth-weight (ELBW) infant: an infant whose birth-weight is less

than1000g.

Nursing Care of Normal Newborn

Immediate Care:

• Performs at the second stage of labor

• Takes place in the delivery room

Subsequent Care:

• Performs after newborn discharge from delivery room

• Takes place either in the Normal Nursery/ Roaming in or Neonatal

Intensive Care Unit (NICU)


Goals of Nursing Care are to:

• Maintain a patent airway

• Maintain a stable body temperature

• Protect from infection and injuries

• Promote Parent- infant bonding

• Provide optimum nutrition


Maintain a patent airway:

• Maintain newborn in supine position with neutral neck position (avoiding neck flexion and hyperextension)

• Position the infant after feeding to facilitate drainage and secretions

• Suction mouth and nasopharynx with bulb syringe as needed



• Mechanical suction( Oropharyngeal)

-Use properly sized catheter

-Correct suctioning technique (Why)

• Close monitoring of vital signs

• Observe for respiratory distress. If occurs, report it immediately

• Nasal suctioning should be done after oral suctioning to minimize the

possibility of aspiration of oropharyngeal content



• Gentle Suctioning up to 5 seconds, with sufficient time between

attempts to allow reoxygenation and to prevent (Why)

- Laryngospasm

- Reflex bradycardia

- Cardiac arrhythmias from vagal stimulation


Maintain a stable Body temperature:

• Control methods

of heat loss

• Evaporation

• Radiation

• Conduction

• Convection

http://www.cmnrp.ca/uploads/documents/Newborn_Thermoregulation_SLM_2013_06.pdf



Evaporation: is the major source of heat loss through moisture especially when combined with the cool atmosphere at the delivery room

Nursing intervention:

• Rapidly and thoroughly drying of skin and hair with warm towels

• Place the infant in Skin-to skin with the mother covered by blanket



Radiation:

• The loss of heat to cooler solid object in the environment that are not in direct contact with the infant

• It occurs when the crib or incubator is placed close to cold air from window or air condition


• Place crib away from cold window or air condition



Conduction:

• loss of heat by direct contact with cooler object

• Nursing intervention:

• Place infant on padded, covered surface

• Skin to skin with mother (Kangaroo care)



Convection: heat loss by air currents

• Placing the infant in the direct of air from a fan or air condition

Nursing care:

• Place crib away from cold window or air condition

11/1/2020 Omayah Nassar, RN, PhD 18

Identification

• Proper identification of the newborn is essential

• The nurse must be sure that the identification bands are fitted properly

The identification bands included:

• Name, sex, mothers admission number, date, time of birth

• Footprints and cord blood sample are used for identification 19



• A written copy of safety instructions should be given to the

parents

• Instruct parents to look at identification badges of nurses and

any hospital personnel who come in contact with infant

• Instruct parent not to give their infant to any one without proper

identification20


• Mothers are advised not to leave infant alone while they shower or use

the bathroom

• Nurses should be aware of visitors with unusual behaviors

• Instruct parents to implement infant's safety measures after discharge

from hospital

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• Prophylactic eye treatment is needed to prevent ophthalmia neonatorum

and infectious conjunctivitis of the newborn (silver nitrate 1% solution, or

erythromycin or tetracycline 1% ointment prevent gonococcal

conjunctivitis

• Preferred in single- dose ampules

22

Eye care


Eye Care

• Studies of maternal attachment suggest that in the first hour of life, a

newborn has a greater ability to focus on coordinated movement than at any

other time during the next several days

• Because eye contact is important in the development of maternal-infant

bonding, routine administration of silver nitrate or antibiotics may be

postponed to 1 hour after birth.


Eye Care:

• Topical and systematic antiviral can be used to prevent herbal conjunctivitis

• EBP use of oral erythromycin for infants under 6 weeks may cause infantile

hypertrophic pyloric stenosis

24


Protect from infection and injuries:


• Encourage Exclusive breast feeding

• Hand washing of all individual provide care for the neonate

• Umbilical care

• Bathing

• Care of circumcision

• No artificial nails

• No long fingernails


Bathing

• Nurse should wear gloves when handling baby before bathing, Why???

• The initial newborn bath is best delayed for at least 2 hours, until thermal

and cardiorespiratory stabilization has been achieved and initial skin-to-

skin holding and breastfeeding is complete.

• EBP: early bathing increase incidence of hypothermia and

hypoglycemia, and hypoxia26


Bath time is an opportunity to:

• Observing newborn arousal state ,alertness, and muscle activity

• Involve parents in the care of their infant

• Teach correct hygiene procedures

• Learn about their newborn physical characteristics

• Communicate effectively with infant

27


• Bath should be performed 3-4 times per week

• Use plain and warm water only if cleansing needed, use soaps with mild

and neutral pH

• Baby Shampoo, alkaline soaps, oils, powder, and lotions SHOULD NOT

BE used, because they alter the acid mantle, thus providing a medium for

bacterial growth


Umbilical /Stump Care:

• The use of antiseptic agent causes prolong cord drying and separation

• Initial cleaning with sterile water then subsequently with water

• The diaper is placed below the cord to avoid irritation and wetness

• The average time of separation of umbilical cord is 5-15 days

• Nurses must teach the parents about the importance of observation and

monitoring the cord

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Provide Optimum Nutrition

• Exclusive Breast feeding (the first 4-6 months of life)

• Secretory IgA is found in high levels in colostrum, but levels gradually

decline over the first 14 days of life.

• Secretory IgA prevents bacteria and viruses from invading the intestinal

mucosa in breast-fed newborns, thus protecting from infection

30


Male Circumcision

• The surgical removal of the foreskin on the glans penis, is not a common

practice in most countries, depending on the region.

• Risks and Benefits of Neonatal Circumcision (Box 7.4)

• Attachment

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• Promote Parent-Infant Bonding (Attachment)

• The process of parenting is based on a mutual relationship between parent and infant.

• Infants enjoy human contact and response to visual and auditory stimuli

• Infant enjoy with human faces and interactions with others more than objects



• Attachment

• Parent-infant attachment describe attributes of parent-infant attachment as proximity, reciprocity, and commitment

• Enface position, in which the mother's and infant's eyes meet in visual contact in the same vertical plane, is significant in the formation of affectional tie


Attachment

Maternal Attachment

Infant Parent Bonding

Attachment

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.Nursing Care of Normal Newborn

Stages of maternal attachment:

• During pregnancy

• During labor

• Post partum period

37



• During pregnancy:

- Acceptance of pregnancy

- Pregnancy massage

38



• During labor:

- Put the newborn on the mother’s chest before cutting of the

umbilical cord

- En-face position

- Kangaroo Care39



• Post partum period:

- Breast feeding

- Holding the newborn frequently

- Provide direct caring to the infant

- Infant Massage

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• Paternal Engrossment

• Fathers show specific attachment behaviors to the newborn.

• This process of paternal engrossment, forming a sense of absorption, preoccupation, and interest in the infant

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• The process of engrossment has significant implications for

nurses.

• Fathers need to be encouraged to express their positive feelings,

especially if such emotions are contrary to any popular belief that

fathers should remain stoical

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References

Hockenberry, M. J.,Wilson, D. & Rodgers, C., (2017). Wong's Essentials of

Pediatric Nursing (10th ed.). St. Louis, MO: Elsevier Mosby


Documents

Nursing Care of The Newborn and Family