NURSING CARE OF A

FAMILY WITH A
NEWBORN
NEWBORN CARE
 THE APGAR SCORING SYSTEM

• Taken 1 minute and 5 minutes after birth

• For distressed infants: every 5 minutes until
stable
• 1 minute score: necessity for resuscitation
• 5 minute score: predicting mortality and
neurologic deficits
• Check APGAR Score TWICE..
THE APGAR SCORING SYSTEM

• Most important: heart rate

• HR below 100 bpm:
Asphyxiated
• HR above 160 bpm: Distress
THE APGAR SCORING SYSTEM

• Decreasing order of importance:

• Heart rate
• Respiratory rate
• Muscle tone
• Reflex irritability
• Color
 THE APGAR SCORING SYSTEM

• HR should be measured with

stethoscope over apical area
• Respiration assessed through counting
rise and fall of abdomen and
observing cry.
• Muscle tone assessed through observing
resistance in extension of extremities.
 THE APGAR SCORING SYSTEM

• Reflex irritability assessed through

slapping soles.
• Color is often cyanotic but turns pink
upon first breath.
• Indicates oxygenation and respiratory
status
 ASSESS 0 1 2 ACRONYM

blue at extremities no cyanosis

Skin color
blue or pale all over body pink body and Appearance
(Appearance)
(acrocyanosis) extremities pink

Pulse rate
Absent <100 ≥100 Pulse
(Puse)
Reflex
no response to grimace/feeble cry cry or pull away
Irritability Grimace
stimulation when stimulated when stimulated
(Grimace)

flexed arms and

Muscle tone
none some flexion legs that resist Activity
(Activity)
extension

Breathing weak, irregular,

absent strong, lusty cry Respiration
(Respiratory) gasping
 THE APGAR SCORING SYSTEM

• Normal
• 7-10: good adjustment, vigorous
• No intervention required
• Intermediate
• 4-6: moderately depressed infant
• Condition is guarded and may need airway
clearance and supplementary oxygen
 THE APGAR SCORING SYSTEM

• Low
• 0-3: severely depressed infant
• In serious danger; needs
resuscitation
 Ensure Airway and Breathing

• Stimulate baby to cry of baby does

not cry spontaneously or cry is weak
• Complete drying with a towel is
enough stimulation to breathe
• Rub soles of feet; do not slap the
buttocks.
 Ensure Airway and Breathing

• Stimulate cry only after secretions

are removed
• Normal cry is loud and lusty
 Ensure Airway and Breathing

• Observe for the following:

• High-pitched cry:
hypoglycemia, increased ICP
• Weak cry: prematurity
• Hoarse cry: laryngeal stridor
 Ensure Airway and Breathing

• Cardinal signs of respiratory distress

syndrome: tachypnea, nasal flaring,
grunting, intercostal retractions,
cyanosis
• Unable to initiate or maintain
respiration
 Prevent Infection

• To prevent infection:
• Handwashing of HC personnel
should be done
• Use single tube package of eye
ointment
• Each newborn should have own
bassinet and supplies.
 Prevent Infection
• To prevent infection:
• Newborns should be handled with
gloves.
• Avoid contact of newborn with
infectious persons.
• Suction bulb should be replaced after
24 hours and boiled for 10 minutes
before reuse.
 Prevent Hemorrhage

• Vitamin K (aquamephyton, aquamenadione)

• It administered 0.5 (preterm) to 1 mg (term) IM
via the vastus lateralis
• More is given if still with signs of bleeding
• Never injected in buttocks
• If oral, repeated doses necessary to be
effective
 CORD CARE

• CORD CARE:
• AVA (Artery – Vein – Artery).
• Cord care done per institution’s standards.
• Cord clamp removed after 48 hours when
cord has dried
• Stump usually falls off within 7-10 days
leaving a granulating area that heals after 4 days
 Initial Feeding

• Breastfeeding
• Done immediately after drying and when
infant shows hunger cues such as rooting and
sucking.
• Use colostrum; don’t give sugar water
(dextrose)
• Subsequent feedings per demand or every 2-
4 hours.
 ADVANTAGES OF EARLY BF:

• Maternal-child bonding
• Immunity (IgA)
• Successful BF for new mothers
• Speeds up 3rd stage of labor
• Oxytocin-induced contraction
prevents bleeding.
 Immunization
• Bacillus Calmette Guerin
• ID on deltoid region
• Expected to be inflamed and
form pus, eventually scarring

• Hepatitis B vaccine
• Ideally given at birth
• IM via vastus lateralis
 Warning Signs
• Not gaining weight • Fast RR over 60 cpm
• Excessive crying or not • Signs of RDS
crying • Not accepting feeding
• Convulsions • Irritable or lethargic which
• Stiff neck, body, and does not improve with
limbs comfort measures
• Unusual inflammation • Jaundice within 24 hours
of cord stump with pus • Cyanosis
• Eye discharge • Vomiting
• Boils on body • Has not passed stool within
• Fever over 38 C 24 hours
Care of the Infant
 CORD CARE
• Home care instructions:
• No tub bathing until cord falls off;
do sponge bath instead. Water and
urine should not touch the cord
• Use 70% isopropyl alcohol when
cleaning – not allowed anymore.
• Fold diaper below level of umbilicus
 CORD CARE
• Expose to air for rapid drying; do not
cover with abdominal binder
• If cord is bleeding, apply pressure and
check cord clamp
• report if with: foul odor, discharges,
redness around cord, fever, and if cord
remains wet and does not fall off within
7-10 days
 Rooming-In
• Keeping the mother and newborn in the
same room instead of leaving the
newborn in the nursery or NICU.

• Objectives:
• Promote breastfeeding
• Promote maternal-child bonding
 Rooming-In
• Kangaroo Mother Care
• Prolonged skin-skin contact of mother and
child as soon as child is stable
• Increased BF rates
• Improved growth and thermal control
• Transfer of normal skin flora
• Encourage bonding
 Sensory Stimulation
TOUCH - skin-to-skin contact, gentle caress, cuddling
- handle infants with gentleness
- clothes with soft fabric
- right-sided preference (more sensitive to touch)
SIGHT - black and white patterns
- encourage eye-contact
HEARING - Responds to voices
- More speech infant hears, the earlier they learn to talk and reach their
mental skills
- High pitched: stimulating; low-pitched: comforting and quieting
TASTE - Prefer sweet-tasting substances
- Milk temperature not too hot or too cold
SMELL - Can recognize smell of caregiver
- Recognizes breast milk
 Care of Diaper Area

• Diaper Rash
• Redness and soreness of diaper
area
• Causes: ammonia dermatitis,
diarrhea, allergy to new product,
infection, mechanical irritation
 Care of Diaper Area

• Diaper Rash Management:

• Keep skin clean and dry
• Apply baby oil, petroleum jelly or
protective ointments
• Expose to air and light several times a day
• Prevent diaper that’s too tight
• Wash well, iron, and dry cloth diapers
• Change diapers within 2-4 hours
 Clothing
• Should be cool and comfortable
• Laundry/ Wash frequently
• Easy to put on
• Large enough to allow free movement and
growth
• Cloth diapers or disposable diapers are based on
the caregivers discretion based on convenience
and economy
 Assessment (Head)

• Fontanels
• Anterior fontanel (Bregma)
• Diamond-shaped
• Junction of 2 parietal bones and frontal
bone
• Closes at 12-18 months
 Assessment (Head)

• Fontanels
• Posterior fontanel (lambda)
• Triangular in shape
• Junction of 2 parietal bones and occipital
bone
• Closes at 2 months
 Assessment (Head)

• Fontanels
• Normal
• Flat, soft, firm, pulsates
• Bulges when straining during
defecation or crying
 Assessment (Head)

• Caput Succedaneum
• Cone-head
• symmetrical
• Accumulation of fluid in scalp
• Disappears within 3-4 days
 Assessment (Head)

• Cephalhematoma
• Accumulation of blood between skull
bone and periosteum
• Asymmetrical
• Disappears 3-6 weeks
 Assessment (Breast)

• Newborns nodule is approximately 5-10 mm

• Nipple prominent, symmetrical form and
position
• Maternal hormones causes witch’s milk
and breast engorgement in males and
females
 Assessment (Breast)

• Abnormal findings:
• Supernumerary nipples
• Breast tissue less than 5 mm:
prematurity.
 Assessment (Abdomen)

• Proper order of assessment:

➢ Inspection, Auscultation, Percussion,
Palpation
• Abdomen is round, protuberant, dome-shaped
• Peristaltic sounds heard within 15-20 minutes
after birth
• Palpable femoral pulses
 Assessment (Umbilical Cord)

• 2 ARTERIES AND 1 VEIN (AVA)

• Umbilical stump should be:
• Clean and dry
• Not bleeding
• With tight clamp
 Assessment (Umbilical Cord)

• Umbilical stump healing:

• 1st hour: dries and shrinks
• 2nd to 3rd day: blackens
• 6th to 14th day: falls off leaving granulating
area
• 1 month: completely healed
Assessment (Umbilical Cord)

• ABNORMAL FINDINGS
• Unusually large base: hematoma or
omphalocele
• Bleeding in cord: loose clamp
• Foul odor and purulent discharge:
infection
 Assessment (Female Genitalia)

• Enlarged labia majora, clitoris, urinary meatus

and vaginal openings due to maternal
hormones
• Vaginal secretions (ex.
Pseudomenstruation) due to maternal
hormones
• Vernix caseosa found between labia
 Assessment (Male Genitalia)

• Foreskin or prepuce is retractable

• Urinary meatus located at end of penis
• Scrotum usually larger on left side
• Smegma found under foreskin around glans
• Erection is common