Guided Lecture Notes, Chapter 18, Nursing Management of the Newborn

Guided Lecture Notes, Chapter 18, Nursing Management of the Newborn

Learning Objective1.Define the key terms. Perform the assessments performed during the immediate newborn period.

Review the key terms at the beginning of the chapter. In a class discussion, describe how the key terms relate to the chapter’s content.
Remind your students that careful examination of the newborn at birth can detect anomalies, birth injuries, and disorders that can compromise adaptation to extrauterine life. Review the transitions occurring during the immediate newborn period.

Identify the key assessments made during the immediate newborn period including:

Initial newborn assessment (refer to PowerPoint slides 2 and 3)
Apgar scoring (refer to Table 18.1 and PowerPoint slides 4 and 5)
Length and weight (refer to Figures 18.1 and 18.2)
Vital signs (refer to Table 18.2 and PowerPoint slide 6)
Gestational age (refer to PowerPoint slide 7)
Physical maturity and neuromuscular maturity (refer to Figure 18.3 and PowerPoint slides 8, 9, 10, and 11)

Learning Objective 2. Employ interventions that meet the immediate needs of the term newborn.

Teach your students that during the immediate newborn period, care focuses on helping the newborn to make the transition to extrauterine life. Point out that the nursing interventions include maintaining airway patency, ensuring proper identification, administering prescribed medications, and maintaining thermoregulation. (Refer to PowerPoint slide 12.)
Describe measures used to maintain airway patency. (Refer to Figure 18.4.)
Discuss the need for proper identification, relating various methods used by facilities. (Refer to Figure 18.5.)
Explain the prescribed medications that are administered to the newborn. (Refer to Drug Guide 18.1.)
Describe the rationales for administration of vitamin K and eye prophylaxis. (Refer to Figures 18.6 and 18.7.)
Discuss ways to maintain thermoregulation. (Refer to Figure 18.8.)

Learning Objective 3. Demonstrate the components of a typical physical examination of a newborn.

Review the importance of the prenatal history as a component of the newborn’s assessment.
Discuss the progression of the physical examination from the least invasive steps to areas most likely to irritate the newborn. (Refer to Table 18.3 and PowerPoint slides 13 and 14.)

General appearance
Anthropometric measurements: length, weight, head circumference, chest circumference (refer to Figures 18.1,18.2, and 18.9)
Vital signs (refer to Figure 18.10)
Skin: color, condition, variations (refer to Figures 18.11 and 18.12 and PowerPoint slide 15.)
Head: size and appearance, variations, and abnormalities (refer to Figures 18.13 and 18.14 and PowerPoint slide 16)
Face: nose, mouth, eyes, ears (refer to Figure 18.15)
Neck
Chest
Abdomen
Genitalia (refer to Figures 18.16 and 18.19)
Extremities and back (refer to Nursing Procedure 18.1 for steps for performing the Ortolani and Barlow maneuvers to identify congenital hip dislocation known as developmental dysplasia of the hip [DDH])
Neurologic status: alertness, posture, muscle tone, reflexes

Describe how to elicit the typical newborn reflexes. (Refer to Table 18.4, Figures 18.17 and 18.18, and PowerPoint slide 17.)

Learning Objective 4. Distinguish common variations that can be noted during a newborn’s physical examination.

Explain to your students that many variations are considered normal.
Identify typical variations of the skin: vernix caseosa, stork bites, milia, Mongolian spots, erythema toxicum, harlequin sign, nevus flammeus, and nevus vasculosus. (Refer to PowerPoint slide 15.)
Describe variations in head size and appearance: molding, caput succedaneum, and cephalhematoma. (Refer to PowerPoint slide 16.)
Discuss common abnormalities in head or fontanel size, such as microcephaly, macrocephaly, large fontanels, and small or closed fontanels. (Refer to PowerPoint slide 16.)

Learning Objective 5. Characterize common concerns in the newborn and appropriate interventions.

Teach your students that during the newborn period of transition, certain conditions can develop that require intervention and can be a source of anxiety for the parents. Point out that these common concerns include transient tachypnea of the newborn, physiologic jaundice, and hypoglycemia. (Refer to PowerPoint slide 18.)
Explain the underlying mechanism of transient tachypnea and factors associated with its development. Discuss nursing interventions for this condition. (Refer to PowerPoint slide 19.)
List interventions for a newborn with hypoglycemia. Note that this condition is defined as a blood glucose level of less than 30 mg/dL or plasma concentration of less than 40 mg/dL in the first 72 hours of life.
Describe how to assess for jaundice and measures used to reduce the risk of jaundice. Explain the use of phototherapy as a treatment measure for physiologic jaundice.

Learning Objective 6. Compare the importance of the newborn screening tests.

Explain the rationale for screening during the newborn period.
Identify the various screening tests performed. (Refer to Table 18.5 and PowerPoint slide 20.)
Discuss the procedure of using drops of blood taken from the newborn’s head for screening tests for genetic and inborn errors of metabolism. (Refer to Figure 18.22.)

Learning Objective 7. Plan for common interventions that are appropriate during the early newborn period.

Emphasize the role of the nurse as educator and role model during the early newborn period.
Discuss the general care measures for the newborn. (Refer to PowerPoint slides 21 and 22.)
Elaborate on nursing measures for the following:

Bathing and hygiene (refer to Nursing Procedure 18.2 and Teaching Guidelines 18.1)
Diaper area care
Cord care (refer to Teaching Guidelines 18.2)
Circumcision care (refer to Figure 18.19)
Clothing
Safety (refer to Teaching Guidelines 18.3 and Figure 18.20)
Infection prevention
Sleep promotion
Bonding enhancement

Describe the nurse’s role in assisting with screening tests. (Refer to Table 18.5, Box 18.1, Evidence-Based Practice 18.1, and Figure 18.22.)

Learning Objective8. Analyze the nurse’s role in meeting the newborn’s nutritional needs.

Identify the physiologic changes in the newborn that can affect nutrition.
Explain the typical nutritional needs of a newborn, including calorie and fluid requirements. (Refer to PowerPoint slide 23.)
Emphasize the need for the nurse to support the parents’ choice of feeding method.
Discuss measures for feeding the newborn, including positioning and burping.
Describe breast-feeding as the optimal choice for nutrition. (Refer to Box 18.2.)
Discuss measures the nurse can implement to assist with breast-feeding, including indicators of effective feeding, positioning, and education about feeding, breast-milk storage and expression, and problems or concerns that may develop. (Refer to Nursing Care Plan 18.1,Teaching Guidelines 18.4,Figures 18.23, 18.24, and 18.25, andPowerPoint slide 24.)
Discuss the LATCH assessment for breast-feeding sessions. (Refer to Table 18.7 and PowerPoint slide 25.)
Review the caloric requirements of the newborn. (Refer to Table 18.6 andPowerPoint slides 26 and 27.)
Discuss measures the nurse can implement to assist with bottle-feeding. (Refer to Teaching Guidelines 18.5, Figure 18.26, and PowerPoint slide 28.)
Review the weaning process and introduction of solid foods.

Learning Objective 9. Outline discharge planning and education needed for the family with a newborn.

Review the impact of limited facility stays on newborn care and teaching.
Identify the important principles to teach parents prior to discharge.
Discuss the areas to include in the discharge teaching plan (refer to PowerPoint slide 29):