Happy BIRTHday Tracey Whitley BSN RNCOB CEFM Graduate

Happy BIRTHday! Tracey Whitley, BSN, RNC-OB, C-EFM Graduate Student University of North Carolina at Charlotte

Objectives �Please refer back to your course schedule for the objectives for today What is the newborn period?

Transition from Intrauterine to Extrauterine life �Physiologic � Establish and maintain respirations � Adjust from fetal to adult circulation � Temperature regulation � Ingesting, retaining, and digesting nutrients � Waste elimination � Regulating weight �Behavioral � Establishing a routine � Processing, storing, and organizing stimuli � Establishing relationships

Establishing and Maintaining Respirations �Intrauterine oxygenation � Placenta provides gas exchange and is responsible for oxygenation of fetus � Fetal lungs are filled with amniotic fluid � Decreased blood flow to lungs �Extrauterine (at birth) � First few cries shift fluid out of lungs � Blood flow increases to lungs � Gas exchange now happens in the Refer to table 23. 1 in text lungs � Lungs are responsible for oxygenation of the body

Circulation: Fetal to Adult �Adult Circulation � Shunts close and blood is Change starts immediately after birth forced to go to lungs � Normal adult circulation begins �Fetal Circulation � Shunts blood �Foramen Ovale �Patent Ductus Arteriosus Refer to table 23. 2 in text

Temperature Regulation �Thermoregulation dependent on environment � What are some nursing interventions to keep babies warm and not lose heat from the following methods? � Convection � Radiation � Evaporation � Conduction �How can a baby generate heat? � Increase muscle activity � Metabolism of brown fat �Hyperthermia? �How do you take a newborn’s temp?

Ingesting, Retaining, & Digesting Nutrients �Suck Swallow Breath � Obligated nose breathers � If nose is occluded cannot breath �Breast or Formula? ? ? �Capacity of the stomach

Waste Elimination �Void � First void? � How old? � How often? �Stool � Meconium � Transitional Meconium Transitional � Milk stool � (Refer to Box 23. 1) Breastfeeding Formula Feeding

Regulating Weight �How much do you weigh? � Small for gestational age? � Large for gestational age? � Just right? �Weight loss in the newborn � What is right? � What is too much?

Behavioral Adaptation � Establish a regulated rhythm (independent of mom) � Sleep wake cycle � Influence of gestational age � Process, store, and organize all stimuli � Sensory (vision, hearing, smell, taste, touch) � Stimuli responds according to caregiver � Caregiver tense baby may demonstrate difficulty feeding � Establishing a relationship with the caregiver and environment � Temperament � Habituation � Ability to console self � Wanting to be cuddled � Irritability and crying

Immediate Assessment and APGAR �ABC (Airway, Breathing, Circulation) � Is the baby crying? � Does the baby have good tone? � What is the heart rate? �APGAR score 0 1 2 Heart rate Absent < 100 bpm >100 bpm Respirations Absent Weak cry Strong cry Muscle tone Limp Some flexion Active motion Reflex irritability No response Grimace Cry or pull away from stimuli Color Blue or pale Body pink/ extremities blue Completely pink

APGAR and Interventions �When does assessment start? �What is a strong respiratory effort? �Will the heart rate respond with respirations? �What does good tone look like?

APGAR and Interventions Continued �What is grimace? �What is normal color? �Good first steps? � Dry, warm, stimulate � Adequate ventilation

Nursing Care and Potential Complications at Birth �Nursing care is focused on transition � Stabilization � Collecting birth vital signs and stats � Identification � Giving first medications � Constant assessment for continued transition �Decreased respiratory drive � Is the baby sedated? � Is the baby sick or stressed? � What was pregnancy and intrapartum history? �Circulation �Temperature control

Admission to Mother Baby Unit � Assessment � Head to toe (review of all systems) � Reflexes and sleep wake cycles � Gestational age assessment � Pain in the newborn � Newborn nutrition � Breast feeding (human milk) � Formula feeding � Readiness and hunger cues � Normal Labs � Teaching plan and anticipatory guidance for newborn care

Assessment �Head to toe � Visual � Palpation � Auscultation of different systems � Refer to table 24 -2 in text �Assess each system

Respiratory �Respirations are stimulated by � Mechanical factors � Thermal factors � Sensory factors �Nose breathers �Abdominal breathers �Assessment � Rate � Rhythm � Sound � Respiratory distress https: //www. youtube. co m/watch? v=NBA 9 iigi. Dg k https: //www. youtube. com/wa tch? v=Hr. Tef. Io. Kypg

Cardiovascular �Heart � Changes to adult circulation �Assessment � Rate, rhythm, and sound � Cyanosis- circumoral vs acrocyanosis �Pulses � Brachial & femoral �Blood Pressure- why not? �Screenings � Congenital Heart Defect Screening

GU and GI system �Genital � Placement of the urethra- is it right? � Girls may have pseudomenses due to hormones � Circumcision �Renal � Concentrated or diluted? � Volume 15 -60 ml/kg/day (too low- 1 ml/kg/day) �GI � Feeding �Frequency and amount � Immature cardiac sphincter � Patency of the rectum � Stool pattern

Hepatic System �Palpation � Can be palpated 1 cm below the right costal margin � Occupies approximately 40% of the abdomen �Function � Iron stores � Carbohydrate metabolism � Conjugated bilirubin �Physiologic Jaundice �Pathologic Jaundice (table 23 -3) � Coagulation �Screening � Transcutaneuos Bilirubin � Serum Bilirubin

Integumentary and Immune Systems � Integumentary � Visual inspection � Vernix and Lanugo � Sweat glands/ milia � Desquamation (peeling) � Monglolian spots � Nevi � Erythema Toxicum � Cord care � Immune System � Antibodies transferred from mom � Unable to produce adult type immune response � Can produce protective immunity from vaccines � WBC response is delayed � At risk for infection? ? ?

Neuromuscular �Reflexes � Primitive and protective � Absence is cause for concern � Table 23 -4 �Periods of reactivity � First period (up to 30 minutes after birth) � Resting period- sleeps or has decreased motor activity � Second period of reactivity (2 -8 hours after birth)

Assessment �Additional areas to assess � Head and face �Molding, overriding sutures, caput? �Fontanels �Ears and eyes �Mouth � Skeletal �Barlow test and Ortlani maneuver �Fetal positioning in utero vs congenital condition

Gestational Age Assessment �Ballard Gestational Age Assessment Chart Figure 24 -1

Sleep-Wake Cycles �Six states � Deep sleep � Light sleep � Drowsy � Quiet alert � Active alert � Crying �What is the best state? �What clues should we watch for?

Neonatal Pain �Physiologic and psychologic � Changes can include: �Heart rate, blood pressure, vagal tone, respiratory rate and oxygen saturation, and release of many endocrine hormones � Crying and attempts to withdraw from painful stimuli �Pain response � Varies based on gestational age � Behavioral state �Assessment �Management � Nonpharmacologic � Pharmacologic

Circumcision Care �Culture �Surgery- Informed Consent � Gomco clamp � Plastibell �Post procedure assessment and care �Pain management �Parent teaching

Newborn Nutrition �Feeding cues �Breast feeding � Table 25. 1 and Box 25 -2 (benefits and effective signs) � Cultural beliefs � Position, latch, and duration � Pumping and storing human milk �Formula feeding � Timing and amount � Preparation � Guilt or shame

Normal Labs and Screenings �Blood glucose level �Newborn screening- table 24 -3 �CBC- box 24 -6 �Car seat testing �Congenital Heart Disease screening �Hearing screen

Teaching Plan and Anticipatory Guidance �Family centered care �Use every opportunity to teach �Demonstrate and have parents return demonstration � Bath � Bulb suction � Diapering � Swaddling � Taking temperature �Encourage bonding and skin to skin

Newborn Care and Teaching �Discharge teaching starts at admission and is with every interaction �Safety behaviors and how to handle baby �The final teaching should be a review with only a few new bits of information �Follow-up care �Special considerations � Teen mom � First time parents � Multiples � Culture

Danger Signs � When should parent notify their doctor? � Box 24 -14 � Hypothermia or Hypertermia � Refusal to eat for 2 consecutive feedings � Vomiting (more than once over a 6 hour period) � Diarrhea (green watery, two consecutive) � Decreased bowel movements (less than 3/day) � Decreased urination (less than 6/day) � Difficulty breathing � Cyanosis � Lethargy (difficulty waking, sleeping for more than 6 hours) � Bleeding � Inconsolable crying � Drainage from eyes

From Birth to Home!!!

References Alden, K. R. (2012). Physiologic and behavioral adaptations of the newborn. In D. L. Lowermilk, S. E. Perry, K. Cashion, and K. R. Alden (Eds). Maternity & Women’s Health Care (10 th ed. )(pp. 528 -552). St. Louis, MO: Elsevier Mosby Alden, K. R. (2012). Nursing care of the newborn and family. In D. L. Lowermilk, S. E. Perry, K. Cashion, and K. R. Alden (Eds). Maternity & Women’s Health Care (10 th ed. )(pp. 553 -605). St. Louis, MO: Elsevier Mosby Alden, K. R. (2012). Newborn nutrition and feeding. In D. L. Lowermilk, S. E. Perry, K. Cashion, and K. R. Alden (Eds). Maternity & Women’s Health Care (10 th ed. )(pp. 606 -636). St. Louis, MO: Elsevier Mosby Pictures from Google images