THE NEWBORN
From birth to 4 wks
Physiological Assessment:
-Newborn undergoes more profound physiological changes @ this time than at any other time during the life cycle.
-These changes assist the newborn to adapt to life out of the uterus.
Respiratory System: most important to sustaining life; prior to birth,
O2 needs are met by the placenta-the baby has to estab respiration once the cord is cut
3 things that need to happen in the respiratory system:
1) Initiation of respiration
3 factors involved:
a.
physical factor-the change in pressure from intra to extra-uterine life
b.
sensory factor-cold (most imp), pain, touch, light, sound
c.
chemical factor-all babies go thru this ~ transitory asphyxia- the period of time where O2 levels are decreased-a brief moment-where
NO
O2 is getting to baby-until lungs inflate & take over
(CO2 increases, O2 decreases, pH decreases)
Babies
with respiratory problems (premies) may need help with this.
2) Expansion of Alveola- resistance of lung tissue, thorax, diaphragm & resp muscles because they’ve
never used them before
-
lipoprotein which helps this = surfactant - a lipoprotein which when secreted
facilitates expansion of lungs by decreasing surface tension & prevents collapse of the alveolar walls
-
enables walls to contract & expand in the func of respiration
-
detected in utero after 28th week
-
babies born early require artifical surfactant after they are born
3) Removal of Lung Fluid
-
by pressure during vaginal delivery when their chest is squeezed in the vaginal canal, they swallow it, it is drained
by positioning
-
done by suction in c-section birth
-
**first breath is the most difficult for baby
Circulatory System: see fetal circulation notes
-
Total blood volume (TBV) of a newborn = about 300 ml, depends on how the cord is clamped
-
Cord is clamped when it stops pulsating (2-3 min)
-
Babies get 50-100 ml more blood from the cord & store it as iron for 3-5 mos-when their weight will start to
double
-
Cord is cut immediately if baby is in distress
-
TBV is also dependent on where the baby is placed - gravity, keep the newborn @ or below the level of the placenta
until cord is cut (usually placed on mom’s belly)
-
Some babies can’t handle the extra cord blood & develop jaundice; called Hyperbilirubemia-can’t
take the extra bilirubin
*Blood values are higher in this period than any other time in life cycle because they needed it in utero
for adequate oxygenation.
Normal levels: Hct 44-72%, Hgb 14.5-22.5g, RBC 5-7.5 mil, WBC
9000-30,000. Values start to normalize in about 10 days.
Temperature Regulation: babies have difficulty maintaining temp because
they have a large surface area (big head & long trunk) related to muscle mass leading to loss of heat from exposure. Babies only have a thin layer of subq fat & they have an inability to shiver.
Ways
we lose heat:
Conduction-
xfer of heat from warmer object to cooler by direct contact: touch w/cold hands, cold stethoscope, placing on a cold scale
Convection-
xfer from by to surrounding air: cold room, being outside in winter
Radiation-
only indirect contact: cold bassinet, being near a window
Evaporation-
excessive loss- 1st occurs at birth; happens during bathing (quickly dry babies off)
Newborns
conserve heat by:
1. peripheral
vasoconstriction (like adults)
2. assuming
the fetal position to decrease body surface area
Ways
babies product heat:
-non-shivering
thermogenesis = they have brown fat located between scapula, around neck, behind sternum & in deep layers of kidneys
-darker
in color due to rich blood supply
-2-6%
of total body wt.
-chemical
reaction occurs in the brown fat which brings down the triglycerides into glycerol & fatty acids thereby prod heat which
is distributed to other body parts by the blood
- first
appears in wks 26-30 gestation & continues to increase up to 5 wks after birth unless depleted by cold stress
Cold Stress- stress on the total body system when newborns consistantly
lose heat & have to produce & conserve heat. Causes increase in metabolic
rate & calorie consumption (leads to hypoglycemia), also increases O2 requirements (decreases surfactant production)
Hypoglycemia- can lead to brain damage/brain cell death & mental
retardation because glucose nourishes brain cells
Metabolic acidosis can occur-need to do nursing measures to maintain
neutral thermal environment
Neurological Assessment:
-newborns
are neither anatomically or physiologically well developed but function well enough to sustain life
-to know
if the baby is developing & functioning, you will test reflexes- reflexes are important indicators of normal development
Reflexes:
1. Moro-
2. Tonic neck-
3. Rooting- turning head toward
mom’s breast
4. Sucking- touch side of their
mouth or lips & they start
5. Babinski-
PHYSICAL ASSESSMENT head to toe
Head: - large & ¼ size of the total size of the baby
-asymmetrical due to molding of the skull bones during labor
-Cephalhematoma- accumulation of blood between the bone & periosteal
membrane
bleeding occurs due to pressure during birth or d/t long labor or use of forceps; not apparent at birth *does not cross suture lines *no bruising (echymosis) *firm
to touch
*resolves in weeks to months on its own w/no treatment
-Caput Succedaneum- swelling of soft tissue d/t prolonged & extended
pressure on the head
-can result from long labor or suction extraction
-does cross suture lines
-is apparent at birth
-does have bruising, there is no treatment, will resolve itself in days to a week or 2
Fontanels: (soft spots)
Anterior:
larger, closes in 12-18 mos
Posterior: closes in 2-3 mos
-fontanels overlap as head goes thru birth canal
-should feel soft & flat
-if depressed or indented, means dehydration
-if bulging, means intracranial pressure
-they allow for brain growth
Circumference: The increase in circumference of the head indicates brain growth. Normal range of newborn head circumference
is 33-37 cm (2 cm larger than chest)
Eyes: - babies can see, like to look at faces, can detect colors, mostly attracted to black &
white before 2 months of age; can see 7-8 inches away, like to look @ faces & eyes
-Strabismus- cross-eyed d/t poor muscle control
-Lacrimal (tear) ducts are not fully functional at birth. No Tears for
up to the 2nd month; post-term babies may cry tears
Ears: - can hear; pinna (top) of ear should be in direct alignment w/outer canthus of the eye
- ears & kidneys develop at the same time - low-set ears can sometimes indicate renal abnormalities, Down Syndrome…
Mouth: - is checked for intact hard/soft, cleft palate
Nose: - flat, tip of nose usually has bruise because of trauma during birth
-assess nasal patency by covering 1 nostril at a time (if they cry, they may not be getting enough air due to deviated
septum)
Thorax: - round chest, check circumference (2 cm less than head)
-breast tissue sometimes swollen as a result of maternal hormone influences, may discharge “witches milk”
may last a few weeks -tell parents not to massage or squeeze breast causing an infection called mastitis;
Abdomen: - round, protrudes-d/t weak abdominal muscles (stomach flattens at age 2-3 yrs)
-look at umbilical cord- it is clamped, clamp stays on 24 hrs to prevent bleeding, leaving a stump which starts to
dry in about 2 hours
-take care of cord with triple dye, then alcohol swab is used during every diaper change, also making sure to keep
diaper below the cord
-teach parents to assess the stump for s/s of infection-discharge, odor, swelling, redness
-no immersion in water until the cord falls off
Female Genitals: - normal to have swollen, enlarged labia d/t influence of maternal hormones, can
be hard to distinguish between labia majora & minora; will also have enlarged clitoris
-smegma sometimes present - white, cheeselike substance between labia, not
to be removed
-Pseudomenstruation- discharge sometimes blood tinged, or blood droplets
in diaper, no odor; disappears in 2-4 wks, d/t influence of maternal hormones
Male Genitals: - check loc of urinary meatus; should be on tip of the glans penis
-Hypospadias- meatus is loc on ventral (underside, below) surface of the
glans penis, not on tip
-Epispadias- meatus is on the dorsal surface of the glans penis
-Cryptochidism- failure of testes to descend into scrotal sac; wait 1 yr,
then if they haven’t descended, can be done surgically; palpate scrotum to assess this; testes usually descend in utero
between weeks 37-40
-Phimosis- where foreskin is small & can’t be pulled back to expose
the glans penis, circumcision will correct this problem
-Hydrocele- fluid collection surrounding the testes in the scrotum; you
can feel the fluid on palpation
- Circumcision- done for religious, cultural reasons; female partners of uncircumcised men have an increased risk of
cervical cancer; done the 2nd day -two types:
- Gomco: use Vaseline to keep diaper from sticking
- Plastibell: do not use Vaseline or plastic bell will fall off before fully healed.
