Included In This Lesson
Study Tools
Outline
Pathophysiology
Relating to the period immediately succeeding birth and continuing through the first 28 days of extrauterine life.
Etiology
Newborns come from within the mother’s womb. Usually from a vaginal birth or by C-section
Desired Outcome
Newborn will feed properly and have normal VS, assessments. Have proper elimination patterns and be free from infection. Caregivers will be properly educated on newborn care and signs and symptoms of when to call the physician.
Subjective Data
- Crying
Objective Data
- Normal vital signs
- Weight gain
- Reflexes intact
- Newborn resting comfortably
- Skin intact
Nursing Interventions and Rationales
| Nursing Intervention (ADPIE) | Rationale |
| Immediate needs of Newborn from birth-
Aspiration of mucus apgar score (based on HR, respiratory effort, muscle tone, reflex irritability, and skin color) maintenance of body temp (drying, wearing hat, warm blankets) eye care/injections (Erythromycin oint, Vit K, & Hep B) constant obs of condition ID bands (one on wrist, one on ankle) |
clear baby’s airway of mucus
Apgar score is the cardiorespiratory adaption at birth Body temperature-prevent from acidosis Erythromycin-eye oint to prevent ophthalmia neonatorum VIT K- prevent bleeding probs until infant can produce its own clotting factors Hep B- prevent newborn from acquiring Hep B (need consent for this) Constant Obs for any changes in condition Baby and parents tagged for having access to baby |
| Full Head to Toe Assessment-
VS, General appearance, reflexes) Ex: jaundice, umbilical cord, Mongolian spots, head shape, cleft lip/palate, sacral dimple Reflexes (rooting, sucking, grasp, startle/Moro, Babinski, step/dance, tonic neck) |
complete assessment shows if there are any abnormalities with the infant that need to be addressed immediately
Reflexes- these are the first building blocks of future development of a newborn. What starts out as reflexes will soon turn to purposeful, cognitive and physical activity |
| Assisting with breastfeeding
Lactation consult if needed |
making sure baby latches on properly and is feeding well by the mom, if having issues, can get a lactation consult to help assist so baby is getting proper nutrition |
| Assess newborn weight daily | after mother’s milk comes in, the newborn should start to gain weight. Normal to lose about 5-10% weight within the first few days. If newborn is not gaining weight at all, there could be a feeding issue/other problem to look into |
| Educate on:
-newborns elimination patterns -circumcision for males -bathing First 24 hours-1 wet diaper/1 stool Day 3- (3-4 wet diapers/1-2 stools) and change from Meconium to yellowish color Day 4-(after milk has come in)- >6-8 wet diapers/3 stools per 24 hours Circumcision-Main complication (hemorrhage & infection), glucose water on pacifier, use petroleum jelly on site) |
want to be sure that the newborn is in taking in enough nutrients and having normal elimination patterns/stool with no complications prior to discharge home
-note: after male circumcision, must void prior to discharge Circumcision- glucose water or gel on pacifier is very soothing Use of petroleum jelly on site after procedure helps keep the diaper from sticking to incision Note: yellow exudate that forms on 2nd day should not be removed. It is a sign of healing, not an infection Bath- main things to make sure baby’s axillary temp is warm enough and check water temp with the inner forearm |
| Newborn Discharge Teaching- when to call the physician | once the family is home with the newborn, it is important to educate them on when it is appropriate to call the doctor or to be seen right away for any complications that may arise |
| Newborn genetic testing-hearing screening/pulse ox screening
PKU, hypothyroidism, Galactosemia, maple syrup urine disease, sickle cell anemia, Tay Sachs Disease) |
blood test that screens for multiple genetic/metabolic disorders. Done at discharge and repeated at 7-10 days of age
Hearing screening to see if the infant may be deaf or hard of hearing Pulse ox screening (24-48 hours)- to detect if the baby might have CCHD (Critical congenital heart disease) |
A Nursing Care Plan (NCP) for Newborns starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.
References
https://my.clevelandclinic.org/health/articles/9705-newborn-care-in-the-hospital
https://newbornscreening.hrsa.gov/newborn-screening-process
Transcript
Hey everyone. Today, we’re going to be creating a nursing care plan for newborns. So let’s get started. First, we’re going to go over the pathophysiology. So relating to the period immediately succeeding birth is continued to the 28 days of extra uterine life is considered to be newborn. Nursing considerations: immediate postpartum assessment, assisting with breastfeeding, assessing daily weight, educating mother and family on newborn care, and discharge teaching. Desired outcome: the newborn will feed properly and have normal vital signs, proper elimination patterns, and be free from infection. Caregivers will be properly educated on newborn care and signs and symptoms of when to call the physician.
So we’re going to go ahead and get started on a care plan. We’re going to be listing out some subjective data and some objective data. Some newborn subjective data: you tend to see them crying, especially early on. Some objective data: going to make sure that these babies have normal vital signs, their reflexes are intact, and their skin is intact. We want to make sure that they are gaining weight properly as well.
Interventions are what we’re going to do for newborns. This is going to be for the immediate needs of a newborn from the moment that they are born. So we’re going to talk about some of the immediate needs, right when they’re born. So one of the first things is aspiration. The mucus. You’re going to be doing an APGAR score, and that is based on the heart rate, respiratory effort, muscle tone, reflex ability and the skin color. We’re going to also maintain body temperature. So the drying, making sure that the newborns are wearing a hat, and having a warm blanket. We’re going to be doing eye care and doing injections. So we’re going to be applying that erythromycin ointment, a vitamin K injection and a Hep B injection. We’re going to make sure we’re doing constant observation of the newborn. We’re going to be applying ID bands. So we’re going to be putting one on the wrist, one on the ankle. We’re also going to make sure we’re clearing the baby’s airway of mucus. The APGAR score is the cardiorespiratory adaptation at birth. The body temperature; we want to make sure we’re preventing acidosis, hence the warm blankets and the warm hat. Hep B injection. We want to make sure that we are giving this and the vitamin K injection. We both are giving in the muscle. The baby and the parents will be tagged for having access. Another intervention we’re going to be doing. We’re going to be doing a full head to toe assessment. So after the baby’s born, we’re going to do this full assessment. So we’re going to do a general appearance. We’re going to be checking the reflexes and doing vital signs. So we’re going to be looking at the umbilical cord. If they have anything like a Mongolian spot, and the shape of the head, if they have a cleft lip or a pallet, we’re going to be looking for those things. Reflexes; we’re going to be looking for rooting, sucking, grasping, startle, moro, babinski, and the tonic neck reflex all to which we want to make sure we’re assessing as all of these are the first building blocks. So the first development of a newborn. So what starts out as reflexes are going to soon turn into per purposeful cognitive and physical activity. Another intervention that we’re going to be doing, we’re going to assist with breastfeeding. So we’re going to be helping the mom with breastfeeding. We’re going to get a lactation consultation. If we’re needing help with the mom and able to get the baby latched. If they’re not latching properly, we want to make sure we’re getting that lactation consultation to help assist with the baby to make sure that the baby gets the proper nutrition. Another intervention, we want to make sure that we’re assessing that newborn weight daily. So daily weights. After the mother’s milk comes in, the newborn should be starting to gain some weight. It’s normal for them to lose about 5%, five to 10% of their weight. Within the first few days, if the newborn isn’t gaining weight at all, there could be a feeding issue or any other problem that we need to look into. Another intervention that we want to be doing is a lot of education. So education, we want to make sure that we are educating on elimination patterns, circumcision for males and bathing. So within the first 24 hours there should be a wet diaper and one stool. By day three, there should be three to four wet diapers and one to two stools. And the change from the meconium to that yellowish color on day four, after the milk has come in, there should be greater than 6 to 8 wet diapers and three stools per 24 hours. For circumcision, the main complication is hemorrhage and infection, glucose water on a pacifier and use of petroleum jelly on the site for circumcision. We want to make sure the newborn is taking in enough nutrients and having normal elimination patterns with no complication prior to discharge home. Note, after the male circumcision is complete, we want to make sure that they have voided prior to discharge for bathing. We want to main things with bathing. You want to make sure that the baby’s axillary temperature is warm enough and to check the water temperature with your inner full or arm. Another intervention that we want to be doing is newborn discharge teaching. So we’re going to be doing some discharge teaching. And when to call the physician, once the family’s home with the newborn; it’s important to educate them on when it’s appropriate to call the doctor or to be seen right away for any sort of complications that may arise. The newborn genetic testing we’re going to want to be doing prior to discharge, as well as a hearing and pulse screening. So for genetic testing, that includes PKU, hypothyroidism, urine disease, sickle cell anemia, and Tay Sachs disease. Some blood tests that screens from multiple genetic and metabolic disorders are done at discharge and repeated at seven to 10 days of age. Hearing screening. We, you want to see if the infant has any sort of deficits like heart of hearing, or if they’re deaf and with the pulse screenings, which is typically 24 to 48 hours, we want to detect if the baby might have CCHD or critical congenital heart disease.
All right, so now we’re going to head on to the key points. So newborns are relating to the period immediately succeeding birth and continuing through the first 28 weeks of extra uterine life. Newborns come from within the mother’s womb via vaginal birth, or C-section. Some subjective and objective: babies or newborns do cry, normal vital signs, weight gain, reflexes that are intact, newborn resting comfortably, and their skin that’s intact. You want to make sure we’re doing an immediate assessment post birth, head to toe assessment, assisting with breastfeeding and assessing newborn weight daily, educating on the newborn elimination patterns, feedings, circumcision for males, baths, genetic testing at discharge, hearing screen and pulse screening. Important to have all this education, especially at discharge. And that is the end of that care plan.
You guys did amazing. We love you. Go out, be your best self today, and as always happy nursing.
Miriam Wahrman, MSN/Ed, RNC-MNN 
Nichole Weaver, MSN/Ed, RN, CCRN 
