Exam 3
Nursing care of a family with a newborn
Vital statistics
A. Weight
1. Weigh each day, naked (nothing except umbilical clamp
and security tag). Use the same scale if possible
2. Newborn can loose about 5-10% of birth weight
Anything more than 10% should be reported.
3. Breastfed infants will recapture birth weight in about 10
days, bottle fed infants will recapture weight in about 7
days.
B. Length
1. Anywhere from 18-24 inches for term.
2. Sometimes has to be stretched out for most accurate
length
3. Include the cone head portion
4. How does this plot on a growth chart?
C. Head circumference
1. Measure across the center of the forehead and prominent
portion of the posterior head
2. Go around the crown of the head.
D. chest circumference
1. about 2 cm less than head circumference.
E. When doing vital statistics, make sure we never leave
newborn unattended and protect against hypothermia
Newborn at Birth
A. Newborn period
1. 28 days
2. Adjustments
Intrauterine to extrauterine life
B. Neonatal transition
1. First few hours of life.
2. Sometimes baby can go to the nursery during the first 4
hours for extra eyes.
Temperature regulation
A. Newborn
1. Thermoregulation
2. Neutral thermal environment (NTE)
The temperature range where head production is at
the minimum needed to maintain normal body
temperature.
Newborns have little subq fat to provide insulation
Shivering is also rarely seen in newborns
a. Means of increasing metabolism and thereby
heat in adults
, B. Factors affecting NTE
1. Decrease in subq fat and thin epidermis
2. Blood vessels close to the skin surface
Newborns can conserve heat by constricting blood
vessels and moving away from the skin.
3. Flexed full-term newborn position
4. Metabolize brown fat to keep warm
They are more susceptible to heat loss therefore they
have brown fat to help keep warm and are flexed.
5. Monitor for hypothermia with axillary temps
Axillary temps are standard now
Check BS as they may be hypoglycemic
Heat loss Types
A. Convection
1. Warm body surface loses to cooler air current
2. Removal from incubator
3. Air conditioning/drafts
B. Radiation
1. Warm body surface loses to cooler surfaces/objects not
in direct contact with the body
2. Cooler room, windows, or basinet or incubator walls
3. Ex: kangaroo warmers, they are directly touching the
baby
C. Evaporation
1. Warm body loses heat when moisture evaporates off
body
Get the water off sooner rather than later
2. Amniotic fluid after birth
3. Baths
D. Conduction
1. Warm body surface loses to cooler surface by direct skin
contact
2. Cold hands, scales, stethoscope
3. Cold exam tables, radiant warmers
Newborn vital signs
A. Temperature
1. 36.5-37.5 (97.7-99.5)
2. Will stabilize within 4 hours after birth to 98.6.
3. Can run lower temperatures when having an infection.
B. Pulse
1. After 1 hour after birth
120-140
2. Can remain slightly irregular because of immaturity of
the cardiac regulatory center in the medulla, and
transient murmurs may result from the incomplete
closure of fetal circulation shunts
, 3. When crying
May rise to 180 bpm
4. During sleep
Can decrease to 90-110 bpm
5. Check for brachial and femoral pulses as they should be
palpated for both strength and timing comparisons
6. Lack of a femoral pulse or having a brachial/femoral
delay is suggestive for a L sided heart lesion and
coarctation of the aorta
C. Respirations
1. Over the first hour of life, the RR will stabilize
30-60 breaths/min
a. Count for a full minute
2. For the first few minutes of life, the RR can be as high as
90 breaths/min
3. Depth, rate, and rhythm may be irregular with short
periods of apnea (without cyanosis)
Sometime they can stop breathing for about 5
seconds, and this is okay. If they are reaching the
normal RR, and are not cyanotic, they are okay.
4. Best visualized by watching the abdomen because
breathing involves the diaphragm and abdominal
muscles.
5. Coughing and sneezing reflexes are present at birth to
help clear the airway
6. They are obligate nose breathers and will show resp
distress if the nose becomes obstructed.
7. Short periods of crying may be beneficial to increase the
depth of respirations and aid in aerating deep portions of
the lungs, may be beneficial to a newborn.
8. Long periods of crying can exhaust the CV system,
cause the baby to become fatigued and serve no purpose.
D. BP
1. Newborn
SBP: 60-80
DBP: 40-50
2. 10 days it rises
Approx. 100/50
Remains at this level for the infant year.
3. Cuff size
The cuff width used must be no more than 2/3 the
length of the upper arm or thigh.
4. Crying
BP is increased, doppler method may achieve better
results
, Hemodynamic monitoring is used when continuous
assessment is required.
Newborn adaptation
A. CV
1. First breath cases decreased pressure in the pulmonary
artery
Three shunts
a. Ductus venosus
i. Will atrophy over the next few weeks as
the receiving blood from the placenta, the
blood within them clots and closes them.
b. Ductus arteriosus
i. the fetal shunt between the pulmonary
artery and the aorta
ii. This will close as the pressure decreases
c. Foramen ovale
i. The opening between the right and left atria
ii. Permanent closure does not happen for
weeks
2. Blood volume
80-110 mL/kg of body weight (~ 300 ml total)
H/H can average 17-18/45-50%
a. once proper lung oxygenationhas been
established, the need for the high RBC
diminishes so, within a matter of days, RBC
begin to be destroyed.
b. As this happens bilirubin will be released and
the serum level rises.
i. At birth bilirubin is 1-4
c. WBC
i. 15,000-30,000 cells at birth
ii. 40,000 cells if birth was stressful
iii. Sometimes this can be dismissed, but
should not if pallor, resp difficulty, or
cyanosis is present
3. Infants gut is sterile, vitamin K is synthesized through
intestinal flora around day 7.
Normal bacteria will be obtained through food
before vit K is synthesized naturally, therefore
this is why they receive the shot.
All babies are deficient. If they don’t get this shot,
they can have a brain bleed, petechia etc…
Umbilical cord assessment
A. 20% with a single umbilical artery have health problems
1. Heart, kidney, or digestion problems, and genetic
conditions.
Nursing care of a family with a newborn
Vital statistics
A. Weight
1. Weigh each day, naked (nothing except umbilical clamp
and security tag). Use the same scale if possible
2. Newborn can loose about 5-10% of birth weight
Anything more than 10% should be reported.
3. Breastfed infants will recapture birth weight in about 10
days, bottle fed infants will recapture weight in about 7
days.
B. Length
1. Anywhere from 18-24 inches for term.
2. Sometimes has to be stretched out for most accurate
length
3. Include the cone head portion
4. How does this plot on a growth chart?
C. Head circumference
1. Measure across the center of the forehead and prominent
portion of the posterior head
2. Go around the crown of the head.
D. chest circumference
1. about 2 cm less than head circumference.
E. When doing vital statistics, make sure we never leave
newborn unattended and protect against hypothermia
Newborn at Birth
A. Newborn period
1. 28 days
2. Adjustments
Intrauterine to extrauterine life
B. Neonatal transition
1. First few hours of life.
2. Sometimes baby can go to the nursery during the first 4
hours for extra eyes.
Temperature regulation
A. Newborn
1. Thermoregulation
2. Neutral thermal environment (NTE)
The temperature range where head production is at
the minimum needed to maintain normal body
temperature.
Newborns have little subq fat to provide insulation
Shivering is also rarely seen in newborns
a. Means of increasing metabolism and thereby
heat in adults
, B. Factors affecting NTE
1. Decrease in subq fat and thin epidermis
2. Blood vessels close to the skin surface
Newborns can conserve heat by constricting blood
vessels and moving away from the skin.
3. Flexed full-term newborn position
4. Metabolize brown fat to keep warm
They are more susceptible to heat loss therefore they
have brown fat to help keep warm and are flexed.
5. Monitor for hypothermia with axillary temps
Axillary temps are standard now
Check BS as they may be hypoglycemic
Heat loss Types
A. Convection
1. Warm body surface loses to cooler air current
2. Removal from incubator
3. Air conditioning/drafts
B. Radiation
1. Warm body surface loses to cooler surfaces/objects not
in direct contact with the body
2. Cooler room, windows, or basinet or incubator walls
3. Ex: kangaroo warmers, they are directly touching the
baby
C. Evaporation
1. Warm body loses heat when moisture evaporates off
body
Get the water off sooner rather than later
2. Amniotic fluid after birth
3. Baths
D. Conduction
1. Warm body surface loses to cooler surface by direct skin
contact
2. Cold hands, scales, stethoscope
3. Cold exam tables, radiant warmers
Newborn vital signs
A. Temperature
1. 36.5-37.5 (97.7-99.5)
2. Will stabilize within 4 hours after birth to 98.6.
3. Can run lower temperatures when having an infection.
B. Pulse
1. After 1 hour after birth
120-140
2. Can remain slightly irregular because of immaturity of
the cardiac regulatory center in the medulla, and
transient murmurs may result from the incomplete
closure of fetal circulation shunts
, 3. When crying
May rise to 180 bpm
4. During sleep
Can decrease to 90-110 bpm
5. Check for brachial and femoral pulses as they should be
palpated for both strength and timing comparisons
6. Lack of a femoral pulse or having a brachial/femoral
delay is suggestive for a L sided heart lesion and
coarctation of the aorta
C. Respirations
1. Over the first hour of life, the RR will stabilize
30-60 breaths/min
a. Count for a full minute
2. For the first few minutes of life, the RR can be as high as
90 breaths/min
3. Depth, rate, and rhythm may be irregular with short
periods of apnea (without cyanosis)
Sometime they can stop breathing for about 5
seconds, and this is okay. If they are reaching the
normal RR, and are not cyanotic, they are okay.
4. Best visualized by watching the abdomen because
breathing involves the diaphragm and abdominal
muscles.
5. Coughing and sneezing reflexes are present at birth to
help clear the airway
6. They are obligate nose breathers and will show resp
distress if the nose becomes obstructed.
7. Short periods of crying may be beneficial to increase the
depth of respirations and aid in aerating deep portions of
the lungs, may be beneficial to a newborn.
8. Long periods of crying can exhaust the CV system,
cause the baby to become fatigued and serve no purpose.
D. BP
1. Newborn
SBP: 60-80
DBP: 40-50
2. 10 days it rises
Approx. 100/50
Remains at this level for the infant year.
3. Cuff size
The cuff width used must be no more than 2/3 the
length of the upper arm or thigh.
4. Crying
BP is increased, doppler method may achieve better
results
, Hemodynamic monitoring is used when continuous
assessment is required.
Newborn adaptation
A. CV
1. First breath cases decreased pressure in the pulmonary
artery
Three shunts
a. Ductus venosus
i. Will atrophy over the next few weeks as
the receiving blood from the placenta, the
blood within them clots and closes them.
b. Ductus arteriosus
i. the fetal shunt between the pulmonary
artery and the aorta
ii. This will close as the pressure decreases
c. Foramen ovale
i. The opening between the right and left atria
ii. Permanent closure does not happen for
weeks
2. Blood volume
80-110 mL/kg of body weight (~ 300 ml total)
H/H can average 17-18/45-50%
a. once proper lung oxygenationhas been
established, the need for the high RBC
diminishes so, within a matter of days, RBC
begin to be destroyed.
b. As this happens bilirubin will be released and
the serum level rises.
i. At birth bilirubin is 1-4
c. WBC
i. 15,000-30,000 cells at birth
ii. 40,000 cells if birth was stressful
iii. Sometimes this can be dismissed, but
should not if pallor, resp difficulty, or
cyanosis is present
3. Infants gut is sterile, vitamin K is synthesized through
intestinal flora around day 7.
Normal bacteria will be obtained through food
before vit K is synthesized naturally, therefore
this is why they receive the shot.
All babies are deficient. If they don’t get this shot,
they can have a brain bleed, petechia etc…
Umbilical cord assessment
A. 20% with a single umbilical artery have health problems
1. Heart, kidney, or digestion problems, and genetic
conditions.
