Nursing Care Baby Newborn

7/27/2019 Nursing Care Baby Newborn

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NURSING CARE

ON PHYSIOLOGIC BABY NEWBORN

BYWIKA RISPUDYANI R., S.Kep., Ners


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DEFINITON

A newborn is an infant who is only hours,

days, or up to a few weeks old

In medical contexts, newborn or neonate

(from Latin, neonatus, newborn) refers to an

infant in the first 28 days after birth

The term applies to premature infants,

postmature infants, and full term infants.

Before birth, the term fetus is used.


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Neonatal Period:

Birth --> 28 days of life

Term Infant:

38 - 42 weeks of gestation

Transition Period: Phases of instability duringthe first 6-8 hours after birth


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PHYSICAL CHARACTERISTICS

A newborn's shoulders and hips are wide

The abdomen protrudes slightly

The arms and legs are relatively long with respect

to the rest of their body The average total body length of newborns are

35.650.8 cm (1420 inches), althoughpremature newborns may be much smaller

The Apgar score is a measure of a newborn'stransition from the uterus during the firstminutes after birth.


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WEIGHT

The average birth weight of a full-term newborn isapproximately 3.4 kg.(7 lbs), and is typically in the

range of 2.74.6 kg (5.510 pounds).

Over the first 57 days following birth, the body

weight of a term neonate decreases by 3%-7%, and is

largely a result of the resorption and urination of the

fluid that initially fills the lungs

In addition to a delay of often a few days beforebreastfeeding becomes effective.

After the first week, healthy term neonates should

gain 10-20 gram/kg/day.


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HEAD

A newborn's head is very large in proportion tothe body, and the cranium is enormous relative tohis or her face.

While the adult human skull is about of thetotal body length, the newborn's is about .

Normal head circumference for a full-term infantis 33 36 cm at birth.

At birth, many regions of the newborn's skullhave not yet been converted to bone, leaving"soft spots" known as fontanels.


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The two largest are the diamond-shapedanterior fontanel, located at the top front

portion of the head, and the smaller

triangular-shaped posterior fontanel, which

lies at the back of the head.

Later in the child's life, these bones will fuse

together in a natural process.

A protein called noggin is responsible for the

delay in an infant's skull fusion.


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HAIR

Some newborns have a fine, downy body haircalled lanugo.

It may be particularly noticeable on the back,shoulders, forehead, ears and face of prematureinfants.

Lanugo disappears within a few weeks.

Infants may be born with full heads of hair;others, particularly white infants, may have veryfine hair or may even be bald.

Amongst fair-skinned parents, this fine hair maybe blonde, even if the parents are not.


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SKIN

Immediately after birth, a newborn's skin is often

grayish to dusky blue in color.

As soon as the newborn begins to breathe,

usually within a minute or two, the skin's color

reaches its normal tone.

Newborns are wet, covered in streaks of blood,

and coated with a white substance known asvernix caseosa, which is hypothesised to act as an

antibacterial barrier.


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The newborn may also have Mongolian spots,

various other birthmarks, or peeling skin,

particularly on the wrists, hands, ankles, and feet.

A Mongolian spot, also known as "Mongolian

blue spot", "congenital dermal melanocytosisand "dermal melanocytosit is a benign, flat,

congenital birthmark with wavy borders and

irregular shape, discovered on


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It normally disappears three to five years after

birth and almost always by puberty

The most common color is blue, although they

can be blue-gray, blue-black or even deep

brown.


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GENITALS

A newborn's genitals are enlarged and

reddened, with male infants having an

unusually large scrotum.

The breasts may also be enlarged, even in

male infants.

This is caused by naturally occurring maternal

hormones and is a temporary condition.


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Females (and even males) may actually

discharge milk from their nipples (sometimes

called witch's milk), and/or a bloody or milky-

like substance from the vagina.

In either case, this is considered normal and

will disappear with time.


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UMBILICAL CORD

The umbilical cord of a newborn is bluish-white incolor.

After birth, the umbilical cord is normally cut,

leaving a 12 inch stub. The umbilical stub will dry out, shrivel, darken,

and spontaneously fall off within about 3 weeks.

Occasionally, hospitals may apply triple dye to theumbilical stub to prevent infection, which maytemporarily color the stub and surrounding skinpurple.


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INTERNAL PHYSIOLOGICAL CHANGES AT BIRTH

A newborn infant, seconds after delivery.Amniotic fluid glistens on the child's skin.

Upon entry into the air-breathing world, withoutthe nutrition and oxygenation via the umbilicalcord, the newborn must begin to adjust to lifeoutside the uterus.

Newborns can feel all different sensations, butrespond most enthusiastically to soft stroking,

cuddling and caressing. Gentle rocking back and forth often calms a

crying infant, as do massages and warm baths.


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Newborns can be comforted by nursing, or may

need to comfort themselves by sucking their

thumb, or a pacifier.

The need to suckle is instinctive and allowsnewborns to feed.


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CIRCULATORY

Transitional Circulation = acrocyanosis

Peripheral circulation = sluggish

High: RBC 4.8-7.1; Hgb 14-24; Hct 44-64

WBC 18,000 @ birth; 23-24,000 @ 1 day

Coagulation: Vit K dependent clotting factors are

decreased.

Platelet counts ok (150,000-350,000)


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RESPIRATORY

Before birth O2 needs met by placenta

After delivery need mature lungs that are

vascularized, have surfactant and sacules -usually adequate by 32-35 weeks-at term the

lungs hold approx. 20 ml of fluid/kg


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EYE

Newborn infants have unremarkable vision, being

able to focus on objects only about 18 inches (45

cm) directly in front of their face.

While this may not be much, it is all that isneeded for the infant to look at the mothers eyes

or areola when breastfeeding.

Depth perception does not develop until theinfant is mobile.

Generally, a newborn cries when wanting to feed.


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When a newborn is not sleeping, or feeding,

or crying, he or she may spend a lot of time

staring at various objects. Usually anything that is shiny, has sharp

contrasting colors, or has complex patterns

will catch an infant's eye. However, the newborn has a preference for

looking at other human faces above all else.


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AUDITORY

In utero, the infant can hear many internal noises,such as the mother's heartbeat, in addition to

external noises including the human voice, music and

most other sounds.

Therefore, though a newborn's ears may have somecatarrh and fluid, he or she can hear sound from

before birth.

Newborns usually respond more readily to a female

voice over a male voice.

The sound of other human voices, especially the

mother's, can have a calming or soothing effect on

the newborn.


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Conversely, loud or sudden noises will startle andscare them.

Newborns have been shown to prefer soundsthat were a regular feature of their prenatalenvironment, for example, the theme tune of atelevision programme their mother watchedregularly.

Naturally, the rhythm of the mother's breathing

and heartbeat are even more familiar to thenewborn, therefore they will prefer or expect tohear it regularly for prolonged periods.


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GASTROINTESTINAL SYSTEM

Newborns can respond to differing tastes,including sweet, sour, bitter, and saltysubstances, with a preference toward

sweetness. It has been shown that neonates show a

preference for the smell of foods that theirmother ate regularly, since the amniotic fluidchanges taste with different foods eaten bythe mother - as does breastmilk.


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Newborns' digestive tracts, which of course have

never been used prior to birth, are filled with a

greenish-black, sticky material called meconium. This has the function of standing in for fecal

material and allows the intestines to develop to

the point where they can process milk

immediately on birth.

This material is passed by the child in the first few

days.


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Immature at birth, reaches maturity at 2-3

years of age

Place food at back of tongue

Sucking becomes coordinated @32 wks

Little saliva until 3 months of age

Bowel sounds after 1 hour of birth

No normal flora at birth in GI system to

synthesize Vit. K


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IMMUNE SYSTEM

Limited specific and Non-specific immunity at

birth

Passive immunity(from mom- IgG) for the first

3 months of life ~ this will be reduced if baby

is born premature

Breastfeeding passive immunity (IgA)


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TEMPERATURE REGULATION

Brown fat is the primary source of heat production.Brown fat is broken down into glycerol & fatty acids

producing heat.

Brown fat is found at the nape of the neck, axillae,

around the kidneys and in the mediastinum.

An increase in the metabolic rate associated with

non-shivering thermogenesis --> increased O2

demands and caloric consumption Its important to provide a neutral thermal

environment to prevent metabolic acidosis and

prevent depleted brown fat.


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KIDNEYS AND URINATION

92% of all healthy infants void in the first 24

hrs of birth

Initial urine:cloudy, scant amounts, uric acidcrystals-> reddish stain on diaper

Kidneys not fully functional until child is 2

years of age.


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HEPATIC FUNCTION

Liver produces substances essential for clotting of

blood.

Stores needed iron for the first few months. Preterm

& small infants have lower iron stores than full termand heavier infants. (full term infants stores last 4-6

mo)

NB at risk for Physiologic Jaundice after 24 hours of

age, d/t increased breakdown of RBCs and

immature liver functioning.


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Jaundice in the 1st day is NOT normal

Bilirubin level greater than 12 at any time

needs further attention

Maternal causes of increased bilirubin levels in

the newborn: epidural use, oxytocin induced

labor, infection, hepatitis

Ethnic Influences: Asian infants levels may be

double other ethnic groups.


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NEUROLOGIC

All neurons are present, but many are

immature

Uncoordinated movements

Poor muscle control

Startle easily

Tremors in extremities


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CARE AND FEEDING

Infants cry as a form of basic instinctive

communication.

A crying infant may be trying to express a

variety of feelings including hunger,

discomfort, overstimulation, boredom,

wanting something, or loneliness.


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BREASTFEEDING

Breastfeeding is the recommended method offeeding by all major infant health organizations.

If breastfeeding is not possible or desired, bottle

feeding is done with expressed breast-milk orwith infant formula.

Infants are born with a sucking reflex allowingthem to extract the milk from the nipples of the

breasts or the nipple of the baby bottle, as well asan instinctive behavior known as rooting withwhich they seek out the nipple.


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Adequate food consumption at an early age is

vital for an infants development.

Children need more sleep than adultsup to

18 hours for newborn babies, with a declining

rate as the child ages.

Until babies learn to walk, they are carried in

the arms, held in slings or baby carriers, or

transported in baby carriages or strollers.


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Prevent infection:

Handwashing, stay away from large groups or

ill individuals, prophlactic agents (EES, cord

care, bathing)

Vernix

Breastfeeding


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Warmth

Bath after temperature is stable

Warmer/isolette/bundle

Hat

Keep out of drafts

Skin to skin


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Genital Care

Male Infant: if penis is uncircumcised DO NOT

RETRACT THE FORESKIN--- leave it alone

Female Infant: wipe front to back. If

smegma has accumulated in the labial folds

it can be carefully removed


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NURSING DIAGNOSIS

Ineffective Airway Clearance R/T excessiveoropharyngeal mucus

Ineffective Thermoregulation R/T newborn

transition to extrauterine life High Risk for infection R/T maturational factors,

immature immune system

PC: Hypoxemia

PC: Hyperbilirubinemia

(W) Beginning Integration of newborn into FamilyUnit


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Effective Breastfeeding

Risk for Altered Nutrition (more or less than

body requirements) R/T (insufficient caloric

intake or excessive caloric intake)


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THANK YOU

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Nursing Care Baby Newborn