56-1

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-12 inches to 13 inches in circumference
-Nipples may secrete whitish fluid (witches' milk)
-Heart murmurs may be normal
-Diaphragmatic breathing pattern
-Respirations are irregular with brief periods of apnea

Chest

-Lub-dub
-Slurring on one sound (usually lub) may indicate murmur
-Considered normal and disappears in few mo.

heart sounds

-Noisy for first few hours after birth
-Periodic breathing irregular with 5-15 sec pauses

lung sounds

-Soft, rounded without palpable masses
-Umbilical cord should have 3 vessels
-Bowel sounds present in all 4 quadrants
-Meconium stools for 2 - 3 days
-Voids: 5-8 times a day
Bladder holds 30-50 mL of urine

Abdomen

-Clitoris large, similar to penis, hormone influenced
-Pseudomenstruation-hormones
-Smegma- secretion in labial folds, don't remove
-Anus- check for patency

Genitalia

-Symmetrical bilaterally
-Each extremity ends with 5 digits
-Strong muscle tone
-Full range of motion
-No hip displacement

Extremities

presence of more than 5 fingers per hand/toes per foot

polydactyly

the fusion of 2/more digits

syndactyly

skin between 2/more digits

webbing

stroke cheek

rooting reflex

lips touched

sucking reflex

hold tight-4 months

palmar grasp reflex

feet grab-8 months; must disappear before walking occurs

plantar grasp reflex

big toe dorsiflex & toes flare

Babinski reflex

newborn walk

stepping reflex

head turned to 1 side and newborn will extend the arm & leg on that side & the opposite arm & leg will flex

tonic neck reflex

occurs when newborns have a sence of falling "C"

moro reflex/startle reflex

Behavioral state

Sleep state-20-22 hours a day
Quiet alert state-looking around
Crying state-strong, lusty, medium pitch

Hygiene: Bathing

-No tub bath until cord falls off
-Skin becomes dry and peels, little lotion
-Slippery little things
-Change diaper q2hrs
-Don't pull back foreskin, takes 3-5 years

Hygiene: Eye care

-Ophthalmia neonatorum-inflammation of the eyes
-Antibiotic ointment applied-contact with gonorrhea/chlamydia -MANDATORY

Hygiene: Umbilical cord care

-Assess for redness and drainage
-Cord care- triple blue dye, antimicrobial ointment
-Falls off in 7-14 days
-Skin should be pink
-Fold diaper below cord

Common Neonate Medications

-AquaMEPHYTON IM (to prevent hemorrhagic disorders).: Unable to produce Vit. K &
Given within 1 hour of birth
-Hepatitis B immunization may be administered in the newborn nursery with parental consent.

Neonate Nutrition

-A full-term infant needs 50 to 55 kcal/lb (110 to 120 kcal/kg) that equals 20 oz (600 mL) of breast milk or formula per day.
-At birth, the newborn's stomach will hold 20 mL, or slightly less than an ounce:
Weight loss 5%-7%
End of first week-can hold 60-90 mL
Feed q2-4 hours

Nutrition:

infant need to be fed q2-4hrs
breast mild recommended for the 1st year
give parents info. about the benefits of breastfeeding & bottle-feeding

-Colostrum contains protein, calories, immune globulins & Acts like a laxative
-Breastfeeding:
10 to 30 minutes a side per feeding
8 to 12 times a day

Breastfeeding

-Feed 15 mL first few days, then increase gradually
-Position head higher than stomach
-Burp when half of feeding consumed

Bottlefeeding

-Breastfeeding mothers receive a greater quantity and variety of foods than mothers who fully formula feed their infants, with mothers fully breastfeeding their infants receiving the most substantial food package.
-Breastfeeding mothers are eligible to participate in WIC longer than nonbreast feeding mothers.
-Breastfeeding mothers may receive follow-up support through peer counselors.
-Breastfeeding mothers may receive breast pumps and other aides to help support the initiation and continuation of breastfeeding.

WIC

Neonatal Screening Tests:

**Accomplished through heel sticks for blood draw to test for:
Hypoglycemia( SGA/LGA assessed)
Phenylketonuria (PKU)
Bilirubin

-Required in all 50 states
-Unable to break down phenylalanine
-Results devastating mental function and health
-Best results after milk received 48-72 hours

Phyenylketonuria (PKU)

check for liver function

Bilirubin

-is the surgical removal of the foreskin (prepuce) of the penis.
-Before the procedure begins, an informed consent must be signed by the parents.
-The penis should be washed with warm water with each diaper change.
-NPO for several hours
-EMLA cream -Tylenol drops

Circumcision

Discharge Teaching

Topics that require client teaching prior to discharge include the following:
Nutrition
Elimination
Diapering
Hygiene
Placing infant on back to sleep
Perineal care
Circumcision care
Umbilical cord care
Safety

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