NCM 107 - CARE OF MOTHER, CHILD AND ADOLESCENT (WELL CLIENT)

St. Paul University Philippines

Tuguegarao City, Cagayan 3500

School of Nursing and Allied Health Sciences

Bachelor of Science in Nursing II

CARE OF THE NEWBORN

DIRECTION: Make a comprehensive outline utilizing the following guide.

1. Discuss why intrapulmonary fluid and fetal breathing movements are

important for normal pulmonary function.
 Intrapulmonary fluid maintains the lungs at an appropriate level of
expansion in order to stimulate their growth and development
 Fetal breathing movement helps to maintain the high level of lung
expansion that is essential for normal growth and structural maturation
of the fetal lungs
2. Explain why surfactant is important for respirations and identify two
prenatal conditions that may be associated with a decrease in surfactant
production.
 The surfactant mixture is an essential group of molecules to support air
breathing.
 Hyaline Membrane Disease occurs when there is not enough of a
surfactant in the lungs, the tiny alveoli collapse with each breath. As the
alveoli collapse, damaged cells collect in the airways, which makes it
even harder to breath.
 Neonatal respiratory distress syndrome (RDS) is a problem often seen in
premature babies and the condition makes it hard for the baby to
breathe.
3. Describe the four factors that are essential for the initiation of
respirations.
 Mechanical- After birth of the newborn's trunk the chest wall recoils
creating a negative intrathoracic pressure which is thought to produce a
small passive inspiration of air that replaces that fluid that is squeezed
out. Then the newborn exhales creating a positive entrathoracic
presssure distributing the inspired air throughout the aveoli beginning to
establish functional residual capacity (FRC), the air left in the lungs at
the end of a normal expiration.
 Reabsorptive-Higher intrathoracic pressure increases absorption of fluid
via the capillaries and lymphatic system. The negative intrathoracic
 pressure created when the diaphram moves down with inspiration
causes lung fluid to flow from the alveoli across the aveolar membranes
into the pulmonary interstitial tissue. Proteins in the capillaries create
oncotic pressure which draws the interstitial fluid into the capillaries and
lymphatic tissue to balance the concentration of protein.
 Sensory- After birth light, sounds, and the effects of gravity for the first
time.
 Thermal- There is a decrease in environmental temperature after birth
from 37 to 22.5 Celsius which chills the moist newborn.
4. Explain characteristics of periodic breathing in the neonate.
 Periodic breathing is found in premature and full term infants. It occurs
when the infant has pauses in breathing for less than 10 seconds at a
time followed by a series of rapid, shallow breaths and returns to normal
without any stimulation or intervention.
5. Identify when the ductus venosus functionally closes.
 The ductus venosus naturally closes during the first week in full-term
neonates; but longer to close in pre-term neonates. Functional closure
occurs within minutes of birth. 
6. Describe the physiological event that causes closure of the foramen ovale.
 At birth, when the lungs become functional, the pulmonary vascular
pressure decreases and the left atrial pressure exceeds that of the right.
This forces the septum primum against the septum secundum,
functionally closing the foramen ovale.
7. Define nonshivering thermogenesis and discuss its effect on
thermoregulation in the newborn.
 Nonshivering thermogenesis a processes that do not involve contraction
of skeletal muscles, which mainly involves burning of brown adipose
tissue, triggered by sympathetic activity.
 Premature and full-term neonates, as well as infants, are able to double
their metabolic heat production during cold exposure. Nonshivering
thermogenesis is possible within hours after birth and may persist up to
the age of 2 years 
8. Identify three nursing interventions to prevent heat loss by evaporation
and convection after birth.
 All wet infants must be dried immediately and then wrapped in another,
warm, dry towel. Do not leave an infant in a wet towel.
 Insulate the infant. Dress the infant and use a woollen cap.
 Provide a warm environment for all infants. The smaller the infant, the
warmer the required environment.
9. Explain how depletion of brown adipose tissue stores places the term
newborn at risk of respiratory distress.
 The newborn infant is vulnerable to a range of respiratory diseases,
many unique to this period of early life as the developing fluid-filled fetal
lungs adapt to the extrauterine environment.
10. Identify two factors that may place an infant at risk for physiological
jaundice.
 Peak total serum bilirubin : < 15 mg/dL (full-term, breastfed infant) 
 Daily rise in bilirubin levels < 5 mg/dL/day
11. Discuss why delayed cord clamping at birth can affect that development
of jaundice.
 It may increase the potential for excessive placental transfusion leading
to neonatal polycythemia, especially in pregnancies with risk factors
such as maternal diabetes, severe intrauterine growth restriction, and
living in high altitudes.
12. Describe the fetal to newborn transition process that takes place in the
gastrointestinal tract.
13. Identify the enzymes that aid in digestion and those that are deficient at
birth.
14. Identify when bowel sounds become present in the newborn.
 Bowel sounds become active 1-2 hours after birth.
15. Identify three physiological factors that enable the newborn’s kidneys to
produce and excrete urine.
16. Explain the origin and significance of “brick dust spots” in the neonate’s
urine.
 Urate crystals are most common in infants who are breastfed and are
made up of uric acid, an end product of normal metabolism.
17. Describe what is meant by “humoral immunity.”
 Humoral immunity is the formation of antibodies against foreign
antigens, which triggers specific destructive mechanisms against
invading pathogen, cancerous cell, or material recognized as non-self.
18. Discuss the psychosocial adaptation in the newborn.
 Healthy full-term newborns show a predictable pattern of behavioural
changes, behavioural states and cues, sensory abilities, and physiologic
adaptations during the first 6- 8 hours following delivery. This
transitional period is divided into an initial period of reactivity and
inactivity and a second period of reactivity.
19. Discuss the components of the neonate’s initial adaptation.
20. Describe how the infant should be positioned to prevent SIDS.
  Place your baby to sleep on his or her back, rather than on the stomach
or side, every time you put the baby to sleep for the first year of life.
21. Name three nursing actions that should be used to assess the infant’s
true skin color.
22. Describe how to obtain neonatal body measurements.
The average weight for full-term babies (born between 37 and 41 weeks
gestation) is about 7 lbs (3.2 kg). In general, small babies and very large
babies are more likely to have problems.
Head circumference the distance around the baby's head The average
newborn's head measures 13 3/4 in (35 cm)

23. Identify two maturity components that are assessed in the Ballard tool.
 The physical assessment includes an exam of Skin texture, Lanugo,
Plantar creases, Breast, Eyes and ears, Male genitals, Female genitals
 The neuromuscular assessment includes an exam of the Posture, Square
window, Arm recoil, Popliteal angle, Scarf sign, Heel to ear
24. Describe when and why the Ballard assessment tool should be
performed.
 This scoring allows for the estimation of age in the range of 26 weeks-44
weeks.
 Gestational age assessment is an important way to learn about your
baby's well-being at birth. By identifying any problems, your baby's
healthcare provider can plan the best possible care.
25. Discuss whether or not the Ballard maturity score should be identical to
the gestational age of the neonate.
 The New Ballard score can be used to diagnose superfoetation in
discordant twins, when detailed first trimester ultra-sound data is not
available.
26. Describe the location of the fontanels. Explain why it is important to
assess them.
 Posterior fontanel (triangle-shaped) lies at the junction between
the sagittal suture and lambdoid suture. At birth, the skull features a
small posterior fontanel with an open area covered by a tough membrane
 Anterior fontanel is a diamond-shaped membrane-filled space located
between the two frontal and two parietal bones of the developing fetal
skull.
 Two smaller fontanels are located on each side of the head, more
anteriorly the sphenoidal or anterolateral fontanel (between the
sphenoid, parietal, temporal, and frontal bones) and more posteriorly the
mastoid or posterolateral fontanel (between the temporal, occipital, and
parietal bones).
 The fontanels may pulsate, it is normal and seems to echo the heartbeat,
perhaps via the arterial pulse within the brain vasculature, or in
the meninges.
27. Differentiate between caput succedaneum and cephalhematoma and
discuss how each is treated.
 A caput succedaneum is an edema of the scalp at the neonate’s. It often
appears over the vertex of the newborn’s head as a result of pressure
against the mother’s cervix during labor. Needs no treatment. The edema
is gradually absorbed and disappears about the third day of life.
 Cephalhematoma is a collection of blood between the periosteum of a
skull bone and the bone itself within the first 24 to 48 hours after birth.
It occasionally forms over the occipital bone. Observation and support of
the affected part and transfusion and phototherapy may be necessary if
blood accumulation is significant.
28. Identify the major and minor reflexes
 Rooting reflex- This reflex starts when the corner of the baby's mouth is
stroked or touched.
 Suck reflex- When the roof of the baby's mouth is touched, the baby will
start to suck. This reflex doesn't start until about the 32nd week of
pregnancy and is not fully developed until about 36 weeks. Premature
babies may have a weak or immature sucking ability because of this.
Because babies also have a hand-to-mouth reflex that goes with rooting
and sucking, they may suck on their fingers or hands.
 Moro reflex- That’s because it usually occurs when a baby is startled by
a loud sound or movement. In response to the sound, the baby throws
back his or her head, extends out his or her arms and legs, cries, then
pulls the arms and legs back in.
 Tonic neck reflex- When a baby's head is turned to one side, the arm on
that side stretches out and the opposite arm bends up at the elbow.
 Grasp reflex- Stroking the palm of a baby's hand causes the baby to
close his or her fingers in a grasp.
 Stepping reflex- This reflex is also called the walking or dance reflex
because a baby appears to take steps.