Nursing Care of Newborn and Family Assessment

Assessment of newborn

1. 2. 3. 4.

Physical assessment of newborn following delivery can be divided into four phases: The initial assessment using the Apgar scoring system. Transitional assessment during the period of reactivity. Assessment of gestational age. Systematic physical assessment.

1.Initial assessment: Apgar Scoring

1. 2. 3. 4. 5.

The most frequently used method to assess the newborn's immediate adjustment to extrauterine life. The score is based on observation of : Heart rate. Respiratory effort. Muscle tone. Reflex irritability. Color. Each item is given a score of 0, 1,or 2.

Initial assessment: Apgar Scoring

Evaluation

of all five categories are made at 1 and 5 minutes after birth and repeated until the infant's condition stabilized. Total scores of 0-3 represent severe distress. Scores of 4-6 signify moderate difficulty. Scores of 7-10 indicate absence of difficulty in adjusting to extrauterine life.

Initial assessment: Apgar Scoring

The -

of : Physiologic immaturity. Infection. Congenital malformations. Maternal sedation or analgesia. Neuromuscular disorders.

Apgar score is affected by the degree

2.Transitional assessment
1. -

Periods for reactivity : First period of reactivity: For 6-8 hours after birth. Initial stage of alertness and activity: During the first 30 minutes. The infant is very alert, cries vigorously, very interest in the environment. Neonate's eyes are usually open; The newborn has a vigorous suck; this is an opportune time to begin breast-feeding.

Transitional assessment
physiologically, the resp rate is high as 80 breath/min, crackles may be heard, heart rate reach 180 beat/min, bowel sound are active , mucus secretions are increased, and temp may decrease. 2. Second stage: - Lasts to 2-4 hours, - Heart and resp rate decrease, temp continues to fall, mucus production decreases ,and urine or stool is usually not passed. - The infant is in state of sleep and relative calm. - Undressing or bathing is avoided during this time
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Transitional assessment

The second period of reactivity: begins when the infant awakes from this deep sleep. It lasts about 2-5 hours and The infant is again alert and responsive, Heart and resp rates increase. The gag reflex is active gastric and respiratory secretions are increased, Passage of meconium frequently occurs. This period is usually over when the amount of respiratory mucus has decreased. After this stage is a period of stabilization of physiologic systems and a vacillating pattern of sleep and activity.

3.Clinical assessment of gestational age

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A frequently used method of dedetermining gestational age is the simplifies Assessment of Gestational Age by Ballard(1979): It assess six external physical and six neuromuscular signs. (fig. 8-1, A and box 8-2) Each sign has a number score, and the cumulative score correlate with a maturity rating of from 20 to 44 weeks of gestation. 1.Weight Related to Gestational Age: Birth weight alone is a poor indicator of gestational age and fetal maturity . Maturity: functional capacity: the degree to which the neonate's organ systems are able to adapt to the requirements of extrauterine life

Clinical assessment of gestational age

Classification of infants at birth by both birthweight and gestational age provides amore satisfactory method for predicting mortality risks and providing guidelines for management of the neonate than estimating gestational age or birth weight alone. (Fig: 8-1, B) Appropriate for gestational age (AGA) :the infant whose weight is between 10th and 90th percentiles. Can be presumed to have grown at a normal rate regardless of the time of birth_ preterm, term, or post term. Large for gestational age (LGA): above 90th percentile can be presumed to have grown at an accelerated rate during fetal life . Small-for-gestational-age (SGA) infant below 10th percentile can be assumed to have intrauterine growth retardation or delay.

4. Physical assessment of the newborn

Physical

217-221 General measurement. Vital signs. General appearance: Posture, Head-to-toe assessment: Skin, Head, Eyes. Ears, Nose, mouth and throat, neck, chest,

assessment of the newborn: table 8-4 p

lunge, heart, abdomen, female male genitalia ,

back and rectum, extremities. Neuromuscular system.

Nursing care of the newborn

Maintain a patent airway: Initial :at delivery room Subsequent: at normal nursery. Maintain stable body temperature: The causes of heat loss at birth: 1. evaporation: the lost of heat through moisture (a major cause). 2. Radiation: the lost of heat to cooler solid objects in the environment that are not in direct contact with the infant. 3. Conduction: loss of heat from the body because of direct contact of skin with a cooler solid object

Nursing care of the newborn

4. Convection is similar to conduction, except that heat loss is aided by surrounding air currents; as direct flow of air from air conditioner vent. Protect from infection and injuries: - Hand washing. - A common practice in many newborn nurseries is the use of cover gowns to prevent infection. - Eye care, umbilical care, bathing, care of the circumcision. - Vitamin K is administered to protect against hemorrhage. - Proper identification. - Screening tests are used to detect various disorders.

Nursing care of the newborn

Provide

optimal nutrition: - Selection of a feeding method is one of the major decisions faced by parents their choices are: human milk and commercially prepared cow's milk-based formula. Promote parent-infant bonding (attachment): - Infant behavior - Maternal attachment. - Paternal attachment. - Siblings.

Nursing care of the newborn

Prepare

for discharge and home care: - Early newborn discharge checklist: p :236 Feeding, elimination, circumcision, color, cord, vital signs, activity, newborn screening.