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NURSING CARE OF A NEWBORN AND FAMILY

Prepared by: Doreen Payumo

FOR HEALTH PROMOTION OF THE TERM NEWBORN

Assessment Assessment begins immediately after birth Continued at every contact during a newborn's hospital stay, early home visits, and well-baby visits. Teaching parents to make assessments concerning their infant's vital signs and overall health.

PROFILE OF A NEWBORN
Vital Statistics Vital statistics for a newborn include weight, length, and head and chest circumference.

Weight

The birth weight of newborns varies depending on the nutritional, intrauterine, and genetic factors that were present during pregnancy. A newborn loses 5% to 10% of birth weight (6 to 10 oz) during the first few days after birth. This weight loss occurs because the newborn is no longer under the influence of salt- and fluid-retaining maternal hormones.

A newborn also voids and passes stool, all measures that reduce weight. because approximately 75% to 90% of a newborn's weight is fluid.

Length The average birth length (50th percentile) of a mature female neonate is 53 cm (20.9 in). For mature males, the average birth length is 54 cm (21.3 in). The lower limit of normal length is arbitrarily set at 46 cm (18 in). Rare babies with lengths as great as 57.5 cm (24 in) have been reported. Head Circumference The head circumference is usually 34 to 35 cm (13.5 to 14 in). Greater than 37 cm (14.8 in) or less than 33 cm (13.2 in) should be carefully investigated for neurologic involvement. Head circumference is measured with a tape measure. Drawn across the center of the forehead and around the most prominent portion of the posterior head.

Temperature The temperature of newborns is about 99F (37.2C) at birth because they have been confined in an internal body organ. The temperature of birthing rooms, approximately 68F to 72F (21C to 22C), can add to this loss of heat.

Pulse

The heart rate of a fetus in utero averages 120 to 160 bpm. Immediately after birth, as the newborn struggles to initiate respirations, the heart rate may be as rapid as 180 bpm.

Within 1 hour after birth, as the newborn settles down to sleep, the heart rate stabilizes to an average of 120 to 140 bpm. During crying, the rate may rise again to 180 bpm. In addition, heart rate can decrease during sleep, ranging from 90 to 110 bpm.

Respiration The respiratory rate of a newborn in the first few minutes of life may be as high as 80 breaths per minute. As respiratory activity is established and maintained, this rate settles to an average of 30 to 60 breaths per minute when the newborn is at rest.

Blood Pressure The blood pressure of a newborn is approximately 80/46 mm Hg at birth. For an accurate reading, the cuff width used must be no more than two thirds the length of the upper arm or thigh.

A Doppler method may be used to take blood pressure.

Assessing the Average Newborn

6.) Stools The first stool of a newborn is usually passed within 24 hours after birth. It consists of meconium, a sticky, tarlike, blackish-green, odorless material. If a newborn does not pass a meconium stool by 24 to 48 hours after birth, the possibility of imperforate anus or bowel obstruction should be suspected.

About the second or third day of life, newborn stool changes in color and consistency, becoming green and loose. By the fourth day of life, breast-fed babies pass three or four light yellow stools per day. They are sweet smelling, because breast milk is high in lactic acid, which reduces the amount of putrefactive organisms in the stool.

A newborn who receives formula usually passes two or three bright yellow stools a day. These have a slightly more noticeable odor, compared with the stools of breast-fed babies.

A.) Blink Reflex A blink reflex in a newborn serves the same purpose as it does in an adult to protect the eye from any object coming near it by rapid eyelid closure. It may be elicited by shining a strong light such as a flashlight or otoscope light on an eye. A sudden movement toward the eye sometimes can elicit the blink reflex. B.) Rooting Reflex If the cheek is brushed or stroked near the corner of the mouth, a newborn infant will turn the head in that direction. This reflex serves to help a newborn find food. When a mother holds the child and allows her breast to brush the newborn's cheek, the reflex makes the baby turn toward the breast. The reflex disappears at about the sixth week of life. At about this time, newborn eyes focus steadily, so a food source can be seen, and the reflex is no longer needed.

C.) Sucking Reflex When a newborn's lips are touched, the baby makes a sucking motion. The reflex helps a newborn find food. When the newborn's lips touch the mother's breast or a bottle, the baby sucks and so takes in food. The sucking reflex begins to diminish at about 6 months of age.

Vernix caseosa A white, cream cheeselike substance that serves as a skin lubricant. Usually, it is noticeable on a term newborn's skin, at least in the skin folds, at birth.

ASSESSMENT FOR WELL-BEING


Apgar Scoring

Vitamin K Administration Newborns are at risk for bleeding disorders during the first week of life because their gastrointestinal tract is sterile at birth and unable to produce vitamin K, which is necessary for blood coagulation. A single dose of 0.5 to 1.0 mg of vitamin K is administered intramuscularly within the first hour of life to prevent such problems.Infants born outside a hospital also should receive this important protection

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