18 Nursing Care of A Family With A Newborn

Chapter 18 Nursing Care

of a Family with a
Newborn
Learning objectives:

At the end of the lesson, the student will be able to

1. Explain the principles in the assessment of the
newborn.
2. Identify and differentiate the newborn reflexes.
3. Identify the different skin marks of the newborn.
4. Compute and interpret the APGAR Score
Newborn Assessment
Head to Toe Assessment
Anthropometric Measurements
 WEIGHT: 2500-4300 g (5.5 to 9.5 lbs)

-weight loss 5-10%BW during 1st few days
-Breastfed NB regains BW in 10 days; formula-fed w/in 7 days
-ave wt gain 2 lbs/mo
 LENGTH: 50 cm (19-21 inches)
 HC: 33-35 cm/ 13-14 inches-forehead and occiput
 CC: 31-33 cm/ 12-13 inches
 AC: 31-33 cm/12-13 inches
Vital Signs
VS : checked when newborn is asleep / quiet
*T:36.5-37.5(97.7-98.6’F)
*RR: 30-60/min
*PR (apical): 120-160/min; average 140

-bw 4th or 5th ICS L midclavicular line
*BP: 80/60mmHg @ birth
-1 to 3 days: 65/41 mm HG; 10th day 100/50 mm Hg
- BP cuff no more than 2/3 length of upper arm or thigh
4 mechanisms of heat loss:
1. EVAPORATION- when amniotic fluid evaporates from the skin
2. CONDUCTION- naked baby is placed on a cool surface such as the floor,
table, weighing scales, cold bed
3. CONVECTION- baby is exposed to cool surrounding air or to a draught
from open doors & windows or a fan
4. RADIATION- baby is near cool objects, walls, tables, cabinets without
actually being in contact with them
NB’s are Poikilothermic
 Immature temperature-regulating mechanisms
 Lack subcutaneous fat
 Cannot shiver
Measures to conserve heat:
 Brown fat- increase metabolism (intrascapular region, thorax, perirenal
area)
 Constricting BV
 Kangaroo care
* Subnormal temp- bacterial infection
Pulse
At birth, 180 bpm

Immature cardiac regulatory systems
Transient murmurs
Radial & temporal pulses difficult to palpate
Absence of femoral pulse: Coarctation of
the Aorta
Respirations
1st few minutes- about 80 cpm

PERIODIC RESPIRATIONS-Irregular with short
periods of apnea (not > 20 sec)
Diaphragmatic and abdominal breathing
NB’S are OBLIGATE NOSE BREATHERS
PHYSIOLOGIC FUNCTION
Cardiovascular System
 Clamping of UC →initial breath → ↓PAP promoting closure of DA
 ↑pressure on L side of ♥ closes FO
 U. Vein & U. Arteries atrophy within next few weeks
 Acrocyanosis- sluggish peripheral circ 1st 24 hours
 Blood volume: 80-110 ml/kg or 300 ml
 RBC Count= 6 M/cumm
 Hct= 45% to 50%
 Hgb= 17-18 g/100 ml
Cardiovascular System
Indirect Bilirubin= 1 to 4 mg/100 ml

WBC= 15,000 to 30,000/mm3
Prolonged PT due to low Vitamin K
Vitamin K administered
(AquaMEP)HYTON
Respiratory System
Initial breath due to:

=cold receptors
=lowered partial pressure of
O2(pO2)
=increased pCO2
Gastrointestinal System
 Sterile at birth, colonized in 24h

 Stomach capacity- 60-90 ml
 Pancreatic enzymes(lipase & amylase) deficient
for 1st few months
 Lowered glucose & protein levels dt immature
liver
GI SYSTEM
 MECONIUM- 1st stool in 24h- tarlike, blackish

green, sterile
 TRANSITIONAL STOOL- 2nd to 3rd day, green &
loose
 BREAST-FED- 4th day, 3 to 4 light yellow,
soursmelling
 FORMULA-FED- 2 to 3 more odorous, formed
GI system
CLAY-colored (GRAY)-bile duct

obstruction
Blood flecked- anal fissure
MILK ALLERGY/LACTOSE
INTOLERANCE- mucus, watery &
loose
URINARY SYSTEM
Voids w/in 24h-if not, urinary

stenosis, renal agenesis
15 ml/voiding with specific gravity
1.008-1.010
Daily Output 1st 2 days 30-60 ml
1st voiding pink or dusky due to uric
acid crystals
Immune System
Born with PASSIVE Abs (IgG) from

mother
Produce own Abs at 2 months
NEUROMUSCULAR SYSTEM
NBs exhibit NM function by:

moving extremities,
attempting head control,
strong cry &
NB reflexes until nervous system
matures
Physiologic Adjustment to
Extrauterine Life
Periods of reactivity
 Periods of irregular adjustment in the 1st 6 hrs of life
 1st PERIOD OF REACTIVITY- lasts for 30 mins; alert, exploring, searching,
making sounds, rapid HR, RR
 Quiet, resting period- HR/RR slow, asleep for 90 mins
 2nd PERIOD OF REACTIVITY- when baby wakes, often gagging or
choking on mucus; alert & responsive
QUIZ
Identify the following:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Compute the APGAR Score
11. A newly delivered infant has a pink trunk and blue hands and feet,
pulse rate of 60 and does not respond to your attempts to stimulate
her. She also appears to be limp and taking slow, gasping breaths.
What is her APGAR score?
12. You are assessing the one minute APGAR score for a newborn. She
is pink all over and has a pulse of 130. As you dry her off she begins
to cry vigorously and kick her legs. Her APGAR score is ?
13. After assisting in the delivery of a newborn the infant is pale and limp,
has a slow heartbeat but shows some respiratory effort. What APGAR
score would you give this infant?
14. You just delivered a baby boy. His body is pink, but his hands and feet
are blue. Vital signs are P110, R rapid and irregular. He has a weak cry
when stimulated and resists attempts to straighten his legs. His APGAR
score is
15. One minute after birth, your newborn patient is actively crying in
response to your bulb syringe. His body is pink, and he is moving his
extremities which are blue. His heart rate is 110. What is the newborns
APGAR score
ANSWERS
1. SYNDACTYLY
2. POLYDACTYLY
3. HARLEQUIN SIGN
4. PORT-WINE STAIN OR NEVUS FLAMMEUS
5. SUPERNUMERARY NIPPLES
6. STRAWBERRY HEMANGIOMA
7. MILIA
8. CONGENITAL TORTICOLLIS
9. SPINA BIFIDA
10. LOW-SET EARS
11. 3
12. 10
13. 2
14. 7
15. 9
APGAR Practice questions
 You are assessing the one minute APGAR score for a newborn. She is
pink all over and has a pulse of 130. As you dry her off she begins to
cry vigorously and kick her legs. Her APGAR score is 10
 A neonatal patient has a pink color, a pulse rate of 102, and a
respiration rate of 27. She grimaces in response to stimuli, has limited
muscle movement. This patient has an APGAR score of 7
 A newborn has a strong cry and is actively moving his blue
extremities when stimulated. Vital signs are P140, R48. What is his
APGAR score? 9
 What is a typical one minute APGAR score for a newborn? 8-10
 It has been 5 minutes since your patient delivered her baby. The
infant is crying weakly and is curling his arms and legs. He is pink all
over with a pulse of 90 and weak respirations. What is his APGAR
score ? 6
 After assisting in the delivery of a newborn the infant is pale and limp,
has a slow heartbeat but shows some respiratory effort. What APGAR
score would you give this infant? 2
 You just delivered a baby boy. His body is pink, but his hands and
feet are blue. Vital signs are P110, R rapid and irregular. He has a
weak cry when stimulated and resists attempts to straighten his legs.
His APGAR score is 7

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Chapter 18 Nursing Care

At the end of the lesson, the student will be able to

 WEIGHT: 2500-4300 g (5.5 to 9.5 lbs)

*PR (apical): 120-160/min; average 140

At birth, 180 bpm

1st few minutes- about 80 cpm

Indirect Bilirubin= 1 to 4 mg/100 ml

Initial breath due to:

 Sterile at birth, colonized in 24h

 MECONIUM- 1st stool in 24h- tarlike, blackish

CLAY-colored (GRAY)-bile duct

Voids w/in 24h-if not, urinary

Born with PASSIVE Abs (IgG) from

NBs exhibit NM function by:

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