Chapter 22 The Normal Newborn Nursing Care Elsevier

Early Care of the Normal Newborn Administering vitamin K Ø Providing eye treatment Ø Prevents bleeding problems Erythromycin ophthalmic ointment Cardiorespiratory status Positioning infant Ø Suctioning secretions Ø Close observation Ø Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 2

Question The nurse administers vitamin K to the newborn for what reason? Most mothers have a diet deficient in vitamin K, which results in the infant being deficient. B. Vitamin K prevents the synthesis of prothrombin in the liver and must be given by injection. C. Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract. D. The supply of vitamin K is inadequate for at least 3 -4 months, and the newborn must be supplemented. A. Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 3

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Continuing Care of the Normal Newborn Thermoregulation Preventing heat loss Ø Restoring thermoregulation Ø Performing expanded assessments Ø Interventions Keep infant dry and covered Ø Avoid contact with cold surfaces Ø Keep away from drafts Ø Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 5

Performing Expanded Assessments Blood glucose Assess all infants for risk factors and signs of hypoglycemia. Ø Perform screening test for blood glucose. Ø Maintain safe levels per institutional policies. Ø Bilirubin Assess risk for jaundice. Ø Ensure infant is feeding well. Ø Explain the condition to parents. Ø Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 7

Ongoing Newborn Assessment and Care Providing skin care Bathing Providing cord care Cleansing diaper area Assisting with feedings Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 8

Positioning the Infant Safe sleep (SIDS) The American Academy of pediatrics recommends all infants be placed supine to sleep. Ø Avoid overheating. Ø Pacifier use in infants over 1 month of age Ø Not to sleep in a bed or couch with adults Ø Plagiocephaly Ø Supervised periods of lying prone each day Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 10

Protecting the Infant Identification Ø Infant abduction Ø Identification bands were placed on the mother, the infant, and the father or other support person at birth. The nurse's role includes teaching parents how to safeguard their infants from abduction. Preventing infection Ø Scrupulous handwashing Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 11

Question The parents of a 3 -month-old infant report that their infant sleeps supine (face up) but is often prone (face down) while awake. The nurse's response should be based on knowledge that this is _____. unacceptable because of the risk of sudden infant death syndrome (SIDS) Ø unacceptable because it does not encourage achievement of developmental milestones Ø acceptable because it encourages fine motor development Ø acceptable because it encourages head control and turning over Ø Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 14

Circumcision Reasons parents choose circumcision include: To prevent certain conditions Ø Religious reasons Ø Parental preference Ø Lack of knowledge about care of the foreskin Ø Reasons parents reject circumcision: Ø A belief that uncommon conditions do not necessitate surgery and pain in the infant Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 15

Risks of Circumcision Hemorrhage Infection Unsatisfactory cosmetic effect Urinary retention Urethral stenosis or fistula Adhesions Necrosis Injury to the glans Pain during and after surgery Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 16

Signs of Complications After Circumcision Bleeding more than a few drops with first diaper changes Failure to urinate Signs of infection Fever or low temperature, Ø Purulent or foul-smelling drainage Ø Displacement of Plasti. Bell Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 20

Screening Tests Hearing loss Metabolic screening Phenylketonuria Ø Hypothyroidism Ø Galactosemia Ø Hemoglobinopathies Ø Other tests as determined by the State Department of Health Ø Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 21

Discharge and Newborn Follow-up Care Discharge 48 hours after vaginal birth, 96 hours after cesarean birth Ø Normal vital signs, feeding well, passed urine and stool, no bleeding from circumcision Ø Follow-up care American Academy of Pediatrics (AAP) recommends follow-up within 48 hours Ø Home visits, clinic visits, telephone counseling Ø Elsevier items and derived items © 2013, 2009, 2005 by Saunders, an imprint of Elsevier Inc. 22