Wear disposable gloves until admission bath!!! •MD clears mouth and nose with bulb syringe after head delivers •Nuchal cord removed if present •Delivery of shoulders and body
Immediate care with delivery
Infant placed on mother’s stomach and dried by nurse
•Cord may be clamped immediately or after pulsating stops
•Cord blood obtained for pH, type, Rh (If mother O or Rh-)
•Infant moved to warmer or mom holds. VS, assessment,
breastfeeding done
immediate care to follow
•Assesses condition of newborn and his/her adaptation to extrauterine life •Assess at 1 and 5 minutes •0-2 points assigned for each category then totaled. Score of 8-10 is desirable. Intervene medically when less than 8.
Apgar scoring
Categories •Heartrate •Respiratory effort •Muscle tone •Reflex irritability •Color
Apgar scoring
•ID bracelets placed on infant’s wrist and ankle, mother’s wrist
•Instillation of erythromycin, silver nitrate, or tetracycline ointment
into eyes to prevent ophthalmia neonatorum
•Vitamin K injection to promote blood clotting/prevent hemorrhage
until intestinal flora develop
immediate care following delivery
•Blood glucose checked
–protocols vary
•diabetic mothers
•large for gestational age (LGA)
•IUGR
•>40mg/dl
•Weight, length, head and chest circumferences
•Breastfeeding needs to be attempted within 30 min.
of delivery
•Bottle-fed infant–offer sterile water then formula
•Gestational age assessment – w/in 24 hrs
•evaluates physical and neuromuscular development
•score may not correspond with age by dates
immediate care following delivery
•Head •Caput succadaneum \:swelling of soft tissue •Cephalohematoma: collection of blood beneath cranial bone that doesn’t cross the suture lines •Anterior fontanel --diamond •Posterior fontanel -- triangle •level and soft •report bulging or extremely sunken
new born assessment - head
NORMAL •eyes-- sclera gray •ears --level with eye •nose -- patent nares •mouth -- intact palate MAY SEE •hemorrhages •low, skin tag, sinus •blocked nares •Epstein’s pearl, teeth, tongue tie, thrush
face newborn assessment
•Tonic-clonic neck --ROM exercises •Crepitus of collarbone --shoulder dystocia
neck new born assessment
- Apical pulse = 110-160 bpm
- Respirations = 30-60 breaths/min
- Distress
- nasal flaring
- retractions of intercostals, sternum
- grunting
- Axillary or Rectal temperature = 97.5-99.5 F or 36.5-37.5 C
- Assess patency of anus
- Assess bowel sounds
- Breast engorgement normal due to effect of maternal hormones
- Cord-dryness, bleeding, S/S infection.
- Examine back for alignment, pilonidal dimple, lanugo
trunk new born assessment
•Male
•circumcision–assess bleeding, infection, stable voiding
•uncircumcised– no need to retract foreskin
•testes into scrotum, rugae
•monitor voids
•1-3 first 24
hrs.and at least 6 by 4
theday
•Monitor BM’s
•1-5 first 24 hrs. Note color, consistency
Female •labia and clitoris •mucus •hymenal tag •Voids •1-3 first 24 hrs. and at least 6 by 4thday •Monitor BM’s •1-5 first 24 hrs. Note color, consistency
genitalia newborn assessment
- Acrocyanosis
- Symmetrical movement and length
- Check hip folds for symmetry -congenital hip dysplasia
- Barlow/Ortolani test–flex knees and abduct both hips to feel and listen for clicks
extremities newborn assessment
Color--pink, ruddy, jaundiced, pale •Temperature •Vernix caseosa--amount and location •Birthmarks •telangiectatic nevi “stork bites” •mongolian spots •Milia •Tissue turgor •Peeling skin, abrasions, scalp electrode site •Erythema toxicum--newborn rash”
skin newborn assessment
- Optimum nutrition for infant
- good latch-on prevents sore nipples
- coordinated suck/swallow with rest periods
- audible swallowing–”eh eh eh”
- sustains feeding at least 5-7 minutes initially and increases to 15-30min/breast
- disengages when satisfied, burps and retains feeding
- adequate voiding and stooling
- feeds q 2-4 hours
- In 30 minutes of breastfeeding
- ½ of feeding consumed in first 2 minutes
- ¾ of feeding in first 4 minutes
breast feeding
- coordinated suck/swallow
- able to eat 1/2-1 oz. Initially, 2-3 oz. at 48-72 hours
- feeds q 3-4 hours
- burps and retains without refluxing
bottle feeding
•Eye contact with parents, especially during feedings •Turns to mother’s voice •Able to be calmed by parents •Parents stroke and talk to infant •Parents ask questions about infant •Parents participate in cares
bonding
•Performed prior to discharge •Detect conditions that may cause mental retardation, physical handicaps, or death •Infant needs to have protein feedings for 24 hours prior to test •Heel pricked and blood applied to form
newborn screen
- PKU–phenylketonuria
- Galactosemia
- Sickle cell disease
- Maple syrup urine disease
- Homocystinuria
- Hypothyroidism
newborn screen conditions tested
•Immature–little control of body movements and reflexes
•Checking reflexes give info about health of
system
newborn NS
- See in focus 8-12 inches
- Prefer human faces
- Can follow moving objects
- High contrast colors–red, black, white
- Sensory overload–too much light, movement
newborn vision
- Acute hearing at birth
- Able to distinguish between mother’s voice and others ~ 2 days
- May perform routine hearing tests before discharge
newborn hearing
- Usually sleep 2-4 hours at a time
- Total of 15-20 hours/day
- Sleep states
- deep sleep
- REM sleep-stimulate nervous system growth
- drowsy
- alert–best time to feed and play
- active
- crying
- Usually won’t “sleep thru the night” until 8 weeks or after r/t caloric needs
- PAIN-now believed that newborns do feel pain
sleep
•As fetus, lungs not inflated but do make breathing movements
•During birth lung function is stimulated
by squeezing thru birth canal
•When cord clamped infant takes first breath to expand lungs
•Bulb syringe always kept with baby
•Respiratory distress
•cyanosis
•rate 60 or greater
•sternal and intercostal retractions
•nasal flaring
•grunting
respiratory system
•Fetal life, circulatory system also functions as respiratory system
•After cord cut systems separate
•foramen ovale (between R & L atrium)
•ductus arteriosus(pulmonary art & thoracic
aorta)
•If openings fail to close
•cyanosis
•murmurs-caused by blood leaking
•functional–sound of blood passing through normal valves
•organic–due to blood passing through
abnormal openings that failed to close
•Unstable after birth–cold stress
•Infant takes on temperature of environment
too warm–
face flushed, head sweaty
•too cool–face pale, bluish, mottled skin
•acrocyanosis
•Axillary temp is done primarily, but physician may
order a rectal temp if concerned about accuracy
•Keep head covered
circulatory system
-
Exam 171
-
Antepartum37
-
Intrapartum98
-
Postpartum44
-
Normal newborn30
-
abortion exam 213
-
Ectopic Pregnacy exam 25
-
PTL and PROM29
-
Placenta previa, Abruptio placentae21
-
diabetes in pregnacy16
-
SGA, LGA, infant of diabetic mother, post dates19
-
the preterm infant14
-
Exam 3 - DIC8
-
Hypertension and preeclampsia46
-
Common gynecologic problem50
-
infertility35
