Family with an Infant Summary by Loreyce Sanchez https://padlet.com/loreycekylesanchez/vbvcuy0gnow91dzk Loreyce Sanchez | BSN 2-B en-us 2020-10-20 09:22:43 UTC 2020-10-20 12:23:11 UTC hello@padlet.com https://padlet.net/icons/png/1f476.png Nursing Process loreycekylesanchez https://padlet.com/loreycekylesanchez/vbvcuy0gnow91dzk/wish/844163736 Assessment
  • Review of mother’s pregnancy history
  • Physical examination of the infant
  • Analysis of laboratory reports
    • Hematocrit
    • Bilirubin
    • Blood type
  • Assessment of parent-child interactions 
  • To be certain bonding is beginning 
  • Begins immediately after birth
  • Continued at every contact during:
    • newborn’s birthing center stay
    • early home visits
    • well-baby visits
    • sick baby visits
  • CRUCIAL: Teaching new mothers and their partners to make assessments concerning infant’s;
  • Temperature
  • Respiratory rate
  • Overall health 
Why is it crucial?
> so they can continue to MONITOR AT HOME

Diagnosis
  • Nursing diagnoses associated with newborns center on the difficulty of establishing:
    • Respirations
    • Beginning nutrition
    • Assisting with parent–newborn bonding.

Outcome Identification and Planning
  • Nursing care planning; taken to account of the newborn’s needs
    • During this transition period
    • Mother’s need of adequate rest during postpartum period
    • Parents’ need to be acquainted with their new child
  • Adapt teaching schedules to the schedules of
    • Mother
    • Her partner
    • The newborn
  • The woman must go home from the healthcare setting with enough energy to practice what she has learned
  • Important planning measures for newborns
    • Help regulate their temperature
    • Help them grow accustomed to feeding
  • Refer parents to helpful websites and other resources when appropriate

Implementation
  • Effective way to help: 
  • Role modeling by the nurse during the newborn period
    • New parents grow confident with their newborn
  • Parents will be observing you closely
  • Important consideration during all interventions
  • Conserving newborn warmth and energy
    • Help prevent hypoglycemia and respiratory distress

Outcome Evaluation
  • An evaluation of expected outcomes 
    • A baby’s primary caregiver is able to give beginning newborn care with confidence
  • To ensure infant’s long-term health needs
    • Be certain a woman and her partner make arrangements for continued health supervision for their newborn


]]> 2020-10-20 09:30:30 UTC https://padlet.com/loreycekylesanchez/vbvcuy0gnow91dzk/wish/844163736 FAMILY WITH AN INFANT SUMMARY loreycekylesanchez https://padlet.com/loreycekylesanchez/vbvcuy0gnow91dzk/wish/844174359 2020-10-20 09:35:54 UTC https://padlet.com/loreycekylesanchez/vbvcuy0gnow91dzk/wish/844174359 Profile of a Newborn loreycekylesanchez https://padlet.com/loreycekylesanchez/vbvcuy0gnow91dzk/wish/844188929 Vital Statistics
  • Measured for a newborn usually consist:
    • Weight
    • Length
    • Head 
    • Chest circumferences
  • All healthcare providers who care for newborns are aware of safety issues specific to newborn care when taking these measurements not leaving a newborn unattended on a bed or scale protecting against hypothermia.

Weight
  • Newborn breathing well:
    • Weighed nude and without a blanket soon after birth in the birthing room
  • Why the the vital statistics are obtained later
    • Performing these measurements while an infant is still damp exposes the newborn unnecessarily to chilling
  • Why taking the Newborn’s weight is important
    • Helps to determine maturity
    • Helps establish a baseline against which all other weights can be compared
  • What’s the reason why a newborn’s weight varies 
    • Racial
    • Nutritional
    • Intrauterine
    • Genetic factors that were present during conception
    • Pregnancy
  • Plotting weight in conjunction with height and head circumference
    • Highlights disproportionate measurements
  • Measurements:
    • Length
      • Relation to weight is a second important determinant used to confirm that a newborn is healthy
      • Average birth length (50th percentile) of a mature female newborn: 49 cm(19.2 in.)
      • For mature males: 50 cm (19.6 in.)
      • The lower limit of expected birth length: arbitrarily set at 46 cm (18 in.)
      • FUN FACT: rare, babies as 57.5 cm (24 in.) have been reported.
    • Head circumference
      • Measured with a tape measure drawn across the center of the forehead and then around the most prominent portion of the posterior head (the occiput)
      • Mature newborn:  34 to 35 cm (13.5 to 14 in.)
    • A mature newborn with a head circumference greater than 37 cm (14.8 in.) or less than 33 cm (13.2 in.) should be carefully assessed for neurologic involvement, although some well newborns have these measurements.
    • Chest circumference 
      • Measured at the level of the nipples
      • NOTE: If a large amount of breast tissue or edema of the breasts is present, this measurement will not be accurate until the edema has subsided.
      • chest circumference in a term newborn: 2 cm (0.75 to 1 in.) less than head circumference

Vital Signs
  • Measurements begin to change from those present in intrauterine life at the moment of birth.
> Temperature 
  • At birth: 99°F (37.2°C)
    • Reason: confined in their mother’s warm and supportive uterus.
    • Baby will have lower temperature when born because of heat loss
  • Birthing room temperature
    • approximately 68° to 72°F [21° to 22°C]
  • Heat loss mechanisms
1. Convection
  • Flow of heat from the newborn’s body surface to cooler surrounding air
2. Radiation
  • Transfer of body heat to a cooler solid object not in contact with the baby, such as a cold window or air conditioner
3. Conduction
  • Transfer of body heat to a cooler solid object in contact with the baby
4. Evaporation
  •  Loss of heat through conversion of liquid to vapor
> Pulse
  • In utero: 110 to 160 beats/min
  • Immediately after birth can be as rapid as 180 beats/min
  • Within 1 hour after birth (when sleeping): 120-140 beats/min
  • When crying: 180 beats/min
  • Can decrease during sleep: 90-110 beats/min
  • Should always palpate femoral pulses 
    • Should always document
    • Absence: suggests possible coarctation (narrowing) of the aorta, which is a cardiovascular abnormality (Lissauer, 2015)
  • Difficult to palpate accurately: radial and temporal
  • Best to palpate: apical  heartbeat for a full minute THAN on an extremity or over the carotid artery
> Respiration
  • Few minutes of life: high as 90 breaths/min
  • About the next hour: 30-60 breaths per minute
> Blood pressure 
  • At birth: 80/46 mmHg
  • By 10th day: 100/50 mmHg (remains for a year)
  • Reason: 
    • Newborns is somewhat inaccurate due to the small size of their arms
    • It is not routinely measured unless a cardiac anomaly is suspected.
    • For an accurate reading, the cuff width used must be no more than two thirds the length
  • Increase when crying (use Doppler method - may achieve better results)

Psychological Functions
  • Just as changes occur in vital signs after birth, so do changes in all major body systems.
> Cardiovascular System
  • Now: lungs are responsible for oxygenating blood that was formerly oxygenated by the placenta.
  • Blood values
    • 80-110 ml/kg of body weight or about 300 ml total
  • Blood Coagulation
    • a newborn’s intestine is sterile at birth unless membranes were ruptured more than 24 hours
    • it will take about 24 hours for flora to accumulate 
    • for ongoing vitamin K to be synthesized
> Respiratory System
  • First breath: about 40 to 70 cm H2O
    • able to inflate alveoli for the first time
  • Reflex to breathe, combination of cold receptors 
a. Lowered partial pressure of oxygen (PO2)
  • falls from 80 mmHg to as low as 15 mmHg before a first breath
b. An increased partial carbon dioxide pressure (PCO2)
  • rises as high as 70 mmHg before a first breath
> Gastrointestinal System
  • Usually sterile at birth
  • Bacteria may be cultured from the tract in most babies within 5 hours after birth and from all babies at 24 hours of life.
  • Stools
    • First stool: pass within first 24 hours
    • Consists of meconium (during intrauterine life)
    • If doesn’t pass first 24-48 hours could have:
      • Meconium ileus
      • Imperforate anus
      • Volvulus 
  • Transitional stool
    • Comes on 2nd-3rd day of life
    • Changes color and consistency
    • Appears both loose green, may resemble diarrhea to the untrained eye
> Urinary System
  • Voids within 24 hours after birth
  • Doesn’t void a lot within 24 hours may void more but 24 hour-point is a general rule.
  • Doesn’t void in 24 hours:
    • Suspect urethral stenosis or 
    • Absent kidneys or utereters
  • Kidneys of newborns do not concentrate urine well
    • usually light colored and odorless
  • The infant is about 6 weeks of age before much control over reabsorption of fluid in tubules and concentration of urine becomes evident.
  • Single voiding
    • Only about 15 ml
    • may be easily missed in an absorbent diaper
> Immune System
  • limited immunologic protection at birth
    • Not able to produce antibodies until about 2 months 
    • Reason: most immunizations are not administered until 2 months of age
  • Now: lungs are responsible for oxygenating blood that was formerly oxygenated by the placenta.
  • Born with passive antibodies
    • Got from when they were in their mother’s placenta
> Neuromuscular System
  • Functions:
    • moving their extremities
    • attempting to control head movement
    • exhibiting a strong cry
    • demonstrating newborn reflexes
  • Maneuvers:
  1. Blink Reflex; protect eye from any object coming near it by rapid eyelid closer
  2. Rooting Reflex; moves head to direction where touched
  3. Sucking Reflex; when lips are touched they start making a sucking motion
  4. Swallowing Reflex; food that touches the posterior of the tongue is automatically swallowed
  5. Extrusion Reflex; putting out inedible substances on the end of their tongue
  6. Palmar Grasp Reflex; grapes object that’s placed in their palms and quickly wrapping their fingers around it
  7. Step (Walk)-in-Place Reflex; held in a vertical position with their feet touching a hard surface will take a few quick, alternating steps
  8. Placing Reflex; touching the anterior lower leg against a surface such as the edge of a table.
  9. Plantar Grasp Reflex; if toes touches an object it will attempt to grasp the object like hands do
  10. Tonic Neck Reflex; when the arm and leg on the side toward which the head is turned extend, and the opposite arm and leg contract (“boxer” or “fencing reflex”)
  11. Moro Reflex; “startle reflex”
  12. Babinski Reflex; foot is stroked in an inverted “J” curve from the heel upward, a newborn fans the toes (positive Babinski sign)
  13. Magnet Reflex; If pressure is applied to the soles of the feet of a newborn lying in a supine position, he or she pushes back against the pressure.
  14. Crossed Extension Reflex; When a newborn is lying supine, if one leg is extended and the sole of that foot is irritated by being rubbed with a sharp object, such as a thumbnail, the infant raises the other leg and extends it as if trying to push away the hand irritating the first leg.
  15. Trunk Incurvation Reflex; lies in a prone position and is touched along the paravertebral area on the back by a probing finger, the newborn flexes the trunk and swings the pelvis toward the touch
  16. Landau Reflex; supported in a prone position by a hand, the newborn should demonstrate some muscle tone.
  17. Deep Tendon Reflexes; both a patellar and a biceps reflex are intact in a newborn
> The Senses
  • Hearing
  • Vision
  • Touch
  • Taste
  • Smell

]]> 2020-10-20 09:43:14 UTC https://padlet.com/loreycekylesanchez/vbvcuy0gnow91dzk/wish/844188929 Assessment for Well-being loreycekylesanchez https://padlet.com/loreycekylesanchez/vbvcuy0gnow91dzk/wish/844239902 AGPAR Scoring
  • Apgar scoring is done at one and five minutes after birth.
  • The newborn is considered to be “vigorous” if the initial scores are 7 and above. 
  • If the five-minute score is less than 7,scoring is done every five minutes thereafter until the score reaches 7.
    • Heart rate; use stethoscope  bserving and counting the pulsations of the umbilical cord at the abdomen if the cord is still uncut.
    • Respiratory effort; chest movements
    • Muscle tone
    • Reflex irritability
      • Response to a suction catheter in the nostrils 
      • Response to having the soles of the feet slapped
  • Color; may appear cyanotic at moment of birth
  • Respiratory evaluation

]]> 2020-10-20 10:12:43 UTC https://padlet.com/loreycekylesanchez/vbvcuy0gnow91dzk/wish/844239902 Appearance of a Newborn loreycekylesanchez https://padlet.com/loreycekylesanchez/vbvcuy0gnow91dzk/wish/844251237 Skin
Color (ruddier for their first month than any other)
  • Cyanosis
  • Hyperbilirubinemia; caused by the accumulation of excess bilirubin in blood serum.
  • Pallor; occurs as the result of anemia
  • Harlequin Sign; lying on his or her side appears red on the dependent side of the body and pale on the upper side, as if a line had been drawn down the center of the body.
Birthmarks 
  • Hemangiomas
  • Mongolian Spots
    • collections of pigment cells (melanocytes) that appear as slate-gray patches across the sacrum or buttocks and possibly on the arms and legs of newborns.
Vernix Caseosa 
  • White, cream cheese–like substance that serves as a skin lubricant in utero.
Lanugo
  • Fine, downy hair that covers a term newborn’s shoulders, back, upper arms, and possibly also the forehead and ears.
Desquamation
  • Within 24 hours after birth, the skin of most newborns begins to dry
  • The dryness is particularly evident on the palms of the hands and soles of the feet and results in areas of peeling similar to those caused by sunburn.
Milia
  • Sebaceous glands in a newborn are immature, so at least one pinpoint white papule (a plugged or unopened sebaceous gland) is usually found on a cheek or across the bridge of the nose of every newborn.
  • (looks like whiteheads)
Erythema Toxicum
  • The rash usually appears in the first to fourth day of life but may appear as late as 2weeks of age. 
  • It begins with small papules, increases in severity to become erythematous by the second day and then disappears by the third day. 
  • “Flea-bite rash”: lesions are so minuscule.
Forceps Marks
  • Mark occurs with normal forceps use
  • Does not denote unskilled or overly vigorous application of forceps
  • The mark disappears in 1 to 2 days (along with the edema that accompanies it)
Skin Turgor
  • Poor turgor
    • suffered malnutrition in utero
    • difficulty sucking at birth
    • have certain metabolic disorders such as adrenocortical insufficiency
    • always needs to be reported as it suggests poor hydration
Fontanelles
  • The fontanelle may bulge if the newborn strains to pass a stool or cries vigorously or is lying supine 
  • In some newborns, the posterior fontanelle is so small that it cannot be palpated readily
  • The posterior fontanelle closes by the end of the second month
Sutures
  • Suture lines should never appear widely separated in newborns 
  • Wide separation suggests increased intracranial pressure because of abnormal brain formation
Molding
  • The part of the infant’s head that engaged the cervix (usually the vertex) molds to fit the cervix contours during labor
  • After birth, this area appears prominent and asymmetric 
Caput Succedaneum
  • Edema of the scalp at the presenting part of the head. 
  • It may involve wide areas of the head, or it may resemble a large egg 
 Cephalhematoma 
  • A collection of blood between the periosteum of a skull bone and the bone itself
  • Caused by rupture of a periosteal capillary because of the pressure of birth 
Craniotabes
  • A localized softening of the cranial bones that is probably caused by pressure of the fetal skull 
  • More common in firstborn infants than in infants born later, because of the lower position of the fetal head in the pelvis
Eyes
  • Newborns usually cry tearlessly, because their lacrimal ducts do not fully mature until about 3 months of age
  • Pressure during birth sometimes ruptures a conjunctival capillary of the eye, resulting in a small subconjunctival hemorrhage 
Ears
  • A newborn’s external ear is not as completely formed as it will be eventually 
  • A good practice is to test a newborn’s hearing by ringing a bell held about 6 inches from each ear. A hearing infant who is crying will stop momentarily at the sound
Nose
  • A newborn’s nose tends to appear large for the face.
  • As the infant grows, the rest of the face grows more than the nose does, and this discrepancy disappears 
Mouth
  • A newborn’s mouth should open evenly when he or she cries 
  • All newborns have some mucus in their mouths. Newborns delivered by cesarean birth usually have an increased amount 
Neck
  • The neck of a newborn is short and often chubby, with creased skin folds 
  • The neck is not strong enough to support the total weight of the head but in a sitting position, a newborn should make a momentary effort at head control 
Chest
  • The chest in some newborns looks small because the head is large in proportion 
  • In both female and male infants, the breasts may be engorged. Occasionally, the breasts of newborn babies secrete a thin, watery fluid popularly termed witch’s milk 
Abdomen
  • The contour of a newborn abdomen looks slightly protuberant. 
  • A scaphoid or sunken appearance may indicate missing abdominal contents or a diaphragmatic hernia
Anogenital Area 
  • Male Genitalia
    • The scrotum in most male newborns is edematous and has rugae 
    • It may be deeply pigmented in African American or dark-skinned newborns 
  • Female Genitalia
    • The vulva in female newborns may be swollen because of the effect of maternal hormones 
    • The discharge disappears as soon as the infant’s system has cleared the hormones 
Back
  • The spine of a newborn typically appears flat in the lumbar and sacral areas. 
  • A newborn normally assumes the position maintained in utero 
Extremities
  • The arms and legs of a newborn appear short. The hands are plump and clenched into fists. 
  • A newborn’s arms and legs should move symmetrically (unless the infant is demonstrating a tonic neck reflex) 

]]> 2020-10-20 10:19:31 UTC https://padlet.com/loreycekylesanchez/vbvcuy0gnow91dzk/wish/844251237