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