Chapter 18 Nursing Care
of a Family with a
Newborn
Learning objectives:
At the end of the lesson, the student will be able to
1. Explain the principles in the assessment of the
newborn.
2. Identify and differentiate the newborn reflexes.
3. Identify the different skin marks of the newborn.
4. Compute and interpret the APGAR Score
Newborn Assessment
Head to Toe Assessment
Anthropometric Measurements
WEIGHT: 2500-4300 g (5.5 to 9.5 lbs)
-weight loss 5-10%BW during 1st few days
-Breastfed NB regains BW in 10 days; formula-fed w/in 7 days
-ave wt gain 2 lbs/mo
LENGTH: 50 cm (19-21 inches)
HC: 33-35 cm/ 13-14 inches-forehead and occiput
CC: 31-33 cm/ 12-13 inches
AC: 31-33 cm/12-13 inches
Vital Signs
VS : checked when newborn is asleep / quiet
*T:36.5-37.5(97.7-98.6’F)
*RR: 30-60/min
*PR (apical): 120-160/min; average 140
-bw 4th or 5th ICS L midclavicular line
*BP: 80/60mmHg @ birth
-1 to 3 days: 65/41 mm HG; 10th day 100/50 mm Hg
- BP cuff no more than 2/3 length of upper arm or thigh
4 mechanisms of heat loss:
1. EVAPORATION- when amniotic fluid evaporates from the skin
2. CONDUCTION- naked baby is placed on a cool surface such as the floor,
table, weighing scales, cold bed
3. CONVECTION- baby is exposed to cool surrounding air or to a draught
from open doors & windows or a fan
4. RADIATION- baby is near cool objects, walls, tables, cabinets without
actually being in contact with them
NB’s are Poikilothermic
Immature temperature-regulating mechanisms
Lack subcutaneous fat
Cannot shiver
Measures to conserve heat:
Brown fat- increase metabolism (intrascapular region, thorax, perirenal
area)
Constricting BV
Kangaroo care
* Subnormal temp- bacterial infection
Pulse
At birth, 180 bpm
Immature cardiac regulatory systems
Transient murmurs
Radial & temporal pulses difficult to palpate
Absence of femoral pulse: Coarctation of
the Aorta
Respirations
1st few minutes- about 80 cpm
PERIODIC RESPIRATIONS-Irregular with short
periods of apnea (not > 20 sec)
Diaphragmatic and abdominal breathing
NB’S are OBLIGATE NOSE BREATHERS
PHYSIOLOGIC FUNCTION
Cardiovascular System
Clamping of UC →initial breath → ↓PAP promoting closure of DA
↑pressure on L side of ♥ closes FO
U. Vein & U. Arteries atrophy within next few weeks
Acrocyanosis- sluggish peripheral circ 1st 24 hours
Blood volume: 80-110 ml/kg or 300 ml
RBC Count= 6 M/cumm
Hct= 45% to 50%
Hgb= 17-18 g/100 ml
Cardiovascular System
Indirect Bilirubin= 1 to 4 mg/100 ml
WBC= 15,000 to 30,000/mm3
Prolonged PT due to low Vitamin K
Vitamin K administered
(AquaMEP)HYTON
Respiratory System
Initial breath due to:
=cold receptors
=lowered partial pressure of
O2(pO2)
=increased pCO2
Gastrointestinal System
Sterile at birth, colonized in 24h
Stomach capacity- 60-90 ml
Pancreatic enzymes(lipase & amylase) deficient
for 1st few months
Lowered glucose & protein levels dt immature
liver
GI SYSTEM
MECONIUM- 1st stool in 24h- tarlike, blackish
green, sterile
TRANSITIONAL STOOL- 2nd to 3rd day, green &
loose
BREAST-FED- 4th day, 3 to 4 light yellow,
soursmelling
FORMULA-FED- 2 to 3 more odorous, formed
GI system
CLAY-colored (GRAY)-bile duct
obstruction
Blood flecked- anal fissure
MILK ALLERGY/LACTOSE
INTOLERANCE- mucus, watery &
loose
URINARY SYSTEM
Voids w/in 24h-if not, urinary
stenosis, renal agenesis
15 ml/voiding with specific gravity
1.008-1.010
Daily Output 1st 2 days 30-60 ml
1st voiding pink or dusky due to uric
acid crystals
Immune System
Born with PASSIVE Abs (IgG) from
mother
Produce own Abs at 2 months
NEUROMUSCULAR SYSTEM
NBs exhibit NM function by:
moving extremities,
attempting head control,
strong cry &
NB reflexes until nervous system
matures
Physiologic Adjustment to
Extrauterine Life
Periods of reactivity
Periods of irregular adjustment in the 1st 6 hrs of life
1st PERIOD OF REACTIVITY- lasts for 30 mins; alert, exploring, searching,
making sounds, rapid HR, RR
Quiet, resting period- HR/RR slow, asleep for 90 mins
2nd PERIOD OF REACTIVITY- when baby wakes, often gagging or
choking on mucus; alert & responsive
QUIZ
Identify the following:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Compute the APGAR Score
11. A newly delivered infant has a pink trunk and blue hands and feet,
pulse rate of 60 and does not respond to your attempts to stimulate
her. She also appears to be limp and taking slow, gasping breaths.
What is her APGAR score?
12. You are assessing the one minute APGAR score for a newborn. She
is pink all over and has a pulse of 130. As you dry her off she begins
to cry vigorously and kick her legs. Her APGAR score is ?
13. After assisting in the delivery of a newborn the infant is pale and limp,
has a slow heartbeat but shows some respiratory effort. What APGAR
score would you give this infant?
14. You just delivered a baby boy. His body is pink, but his hands and feet
are blue. Vital signs are P110, R rapid and irregular. He has a weak cry
when stimulated and resists attempts to straighten his legs. His APGAR
score is
15. One minute after birth, your newborn patient is actively crying in
response to your bulb syringe. His body is pink, and he is moving his
extremities which are blue. His heart rate is 110. What is the newborns
APGAR score
ANSWERS
1. SYNDACTYLY
2. POLYDACTYLY
3. HARLEQUIN SIGN
4. PORT-WINE STAIN OR NEVUS FLAMMEUS
5. SUPERNUMERARY NIPPLES
6. STRAWBERRY HEMANGIOMA
7. MILIA
8. CONGENITAL TORTICOLLIS
9. SPINA BIFIDA
10. LOW-SET EARS
11. 3
12. 10
13. 2
14. 7
15. 9
APGAR Practice questions
You are assessing the one minute APGAR score for a newborn. She is
pink all over and has a pulse of 130. As you dry her off she begins to
cry vigorously and kick her legs. Her APGAR score is 10
A neonatal patient has a pink color, a pulse rate of 102, and a
respiration rate of 27. She grimaces in response to stimuli, has limited
muscle movement. This patient has an APGAR score of 7
A newborn has a strong cry and is actively moving his blue
extremities when stimulated. Vital signs are P140, R48. What is his
APGAR score? 9
What is a typical one minute APGAR score for a newborn? 8-10
It has been 5 minutes since your patient delivered her baby. The
infant is crying weakly and is curling his arms and legs. He is pink all
over with a pulse of 90 and weak respirations. What is his APGAR
score ? 6
After assisting in the delivery of a newborn the infant is pale and limp,
has a slow heartbeat but shows some respiratory effort. What APGAR
score would you give this infant? 2
You just delivered a baby boy. His body is pink, but his hands and
feet are blue. Vital signs are P110, R rapid and irregular. He has a
weak cry when stimulated and resists attempts to straighten his legs.
His APGAR score is 7
