Chapter 12 The Term Newborn

The term newborn

Chapter 12

Adjustment to Life Outside the Uterus

Adjustment depends on

• Genetic background
• Health of the recent uterine environment
• A safe delivery
• Care during the first month of life

When observing the newborn, the nurse identifies expected normal findings as well as variations and deviations from normal, which must be reported to the health care provider.

Observation

Measures inherent neurologic capacities & response to selected stimuli Areas tested include:

• Alertness
• Response to visual & auditory stimuli
• Motor coordination
• Level of excitement
• Organizational process in response to stress

Phase 3

Care of the Newborn

Neonatal Behavioral Assessment Scale

Tonic Neck

Moro

Rooting/Sucking

Infant's head turns in the direction of anything that touches the cheek, in anticipation of food.Disappears 3-4 mo Infant will suck on a finger or nipple place in the mouth Disappears 7-12 m

A loud noise, bumping the crib, or suddenly lowering infant's head will cause them tosymmetrically extend and abduct the arms and then adduct in an embrace-like motion.Disappears 3-6 mo

Turn the infant's head to one side, and the arm on that side, with flexion of the opposite arm and leg. This is a postrual position assumed by sleeping infants.Disappears 5-7 mo

Nervous System: Reflexes

Babinski

Palmer

Dancing/Stepping

Place an object in the hand of the newborn, and he or she will grasp it tightly. Same is true of the toes when pressure is applied to the sole (called Plantar grasp).Disappears 3 mo

Stroke the sole of the foot; the big toe will dorsiflex, and the toes will flare out.Disappears Variable but by the time they begin walking

Hold the infant upright above a table; he or she will lift the foot up on contact wih the firm surface of the table.Disappears 4-5 mo.

Newborn Initial Assessment

Head Lag-When lifted from the bed, the infant's head will fall backMolding-Head may be misshappen from sitting in the birth canal Caput succedaneum-Swelling of the soft tissues of the scalp, self resolves Cepahlohematoma-Head, blood, tumor, self resolves Fontanelles-Unossified spaces or soft spots of the skull Ears-Should be in line with outer canthus of the eye to upper tip of the ear Sleep First Phase-The first 30 minutes of life the newborn is alert. Best time for bonding. Sleep Phase-During the next few hours, infant becomes sleepier & less responsive. Second Reactive Phase-After deep sleep, the infant becomes responsive and alert again. Stability Phase-After 24 hours, the sleep-wake pattern becomes more stabilized.

Physical Assessment

04

01

Reflexes

Heart rate

05

02

Color

Respiration

06

03

Timing/Scoring

Muscle tone

Score is obtained at 1 and 5 minutes after birth. Sternal retractions must be reported immediately to the health care provider.

APGAR Scoring

Providing Warmth

• Unstable heat-regulating system
• Acrocyanosis is evident because of sluggish peripheral circulation
• Cannot adapt to change in temperatures easily
• Sweat glands do not function during neonatal period, so infant is at risk for developing elevated temperature if overdressed or placed in overheated environment

Integumentary System

Assess turgor and overall skin condition.

• Usually covered with fine hair called lanugo (disappears within a week of birth)
• Covered in vernix caseosa—made of cells and glandular secretions; thought to protect skin from irritation and effects of a watery environment
• Physiological jaundice (icterus neonatorum) seen as a yellow tinge to the skin; caused by the rapid destruction of excess red blood cells

Preventing Infections

• Newborn’s response to inflammation and infection is slow because of the immaturity of the immune system
• Umbilical cord stump is a primary site of infection if not kept clean
• Hand hygiene is the primary means of preventing infection and its spread

Discharge Planning and Parent Teaching

Areas may include

• Basic infant care
• Safety measures
• Immunizations
• Return appointments
• Proper use of a car seat
• Signs and symptoms of problems and who to contact
• Feeding
• Furnishings
• Clothing
• Skin care

Begins upon admission of the laboring mother