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New Born Care: Catheter Suctioning
New Born Care: Catheter Suctioning
The Neonate
From birth through the first 28 days of life
Also called “the newborn period”
Adaptation to extrauterine life requires rapid and profound physiologic changes
This includes aeration of the lungs, rerouting of the circulation and activation of the GI tract
Behavioral states: quiet sleep, active sleep, drowsy, alert, fussy, and crying
2/3 of all deaths that occur during the 1st year of life occur during this period; more than half occur in
the 1st 24 hours after birth---an indication of how hazardous this time is for an infant
How well a NB makes major adjustments depends on his or her:
o Genetic composition
o The competency of the recent intrauterine environment
o The care received during the neonatal period
o
PRINCIPLES IN IMMEDIATE NEW BORN CARE
1st day of life
1. initiation and maintenance of respiration (used bulb syringe initiate a/w)
2. establishment of extra uterine circulation
3. control of body temp
4. intake of adequate nourishment
5. establishment of waste elimination
6. prevention of infection
7. establishment of an infant parent relationship
8. dev’t care that balances rest and stimulation or mental dev’t
9.
Immediate care of the newborn.
A-airway (most neonatal deaths with in 24 h caused by inability to initiate a/w, lung function begins after
birth only)
B-body temperature
C-check/asses the newborn
D-determined identification
Nsg alert:
No smoking
Always humidify to prevent drying of mucosa
Over dosage of oxygen can lead to scarring of retina leading to blindness ( retro lentalfibrolasia or retinopathy of
prematurity)
When mecomium stained (greenish) never administer oxygen with pressure ( O2 pressure will push mecomium inside)
3. Stimulate the baby to cry if baby does not cry spontaneously or if baby’s cry is weak.
“A crying infant is a breathing infant. Effective cry means effective breathing”
Do not slap the buttocks but rub the soles of the feet
Do not stimulate the NB to cry unless the secretions have been suctioned to prevent
aspiration
The normal infant cry is loud & lusty. Observe for the ff. abnormal cry:
High-pitched cry : hypoglycemia, increased ICP
Weak cry: prematurity
Hoarse cry: laryngeal stridor
4. Oral mucus may cause the NB to choke, cough or gag during the first 12 to 18 hours of life. Place the
neonate in a position that would promote drainage of secretions
Trendelenburg (contraindicated to Increased ICP)
Side-Lying
5. Keep the nares patent. Remove mucus and other particles w/c can cause obstruction as newborns are
“obligatory nasal breathers” until they are about 2-3 weeks old.
6. Give O2 as needed. Oxygen should be given for 20-30 minutes when the neonate remains cyanotic or
tachycardic after initial suctioning and stimulation.
* asphyxiation → hypoxia → hypercapnia(↑ CO2) → acidosis → coma → death
• Observe precaution in giving oxygen
• Do not give more than 40% O2 as this may lead to retrolental fibroplasia (blood vessels of the eyes become
spastic leading to blindness)
• Use pulse oximeter and monitor O2 concentration every hour
7. If the heart rate falls below 60 bpm, cardiac massage may need to be carried out.
Effects of Hypothermia
( Cold stress)
To Prevent Hypothermia
1. Dry and wrap baby
2. Mechanical pressure – radiant warmer
pre-heated first isolette (or square acrylic sided incubator)
3. Prevent an necessary exposure – cover baby
4. Cover baby with tin foil or plastic
5. Embrace the baby- kangaroo care
6. Delay initial bath until temp. has stabilized for at least 2 hours.
7. Maintain ambient temp. of nursery at 24°C or 75°F.
8. Perform any extensive examination or procedure under radiant heat to prevent heat loss and expose only the part of the body to
be examined.
9. Note the presence of any cyanosis:
2 types of cyanosis: a.) central cyanosis
b.) peripheral cyanosis hands & feet are cyanotic, due to cold environment and poor circulation
Characteristic of Newborn
The end of your journey has come after 40 weeks. The fruit of your labour (literally) will soon be in your hands.
There are a few things you might want to know about your new arrival. Typically, a newborn baby has the following
characteristic appearance:
• Weight: Average 2.8 kg for Indian babies (range 2.5 – 3.2 kg). Babies below 2.5 kg at birth are considered to
be low birth weight and need special evaluation.
• Length: Approximately 50 cm. Remember, small women have small babies and many genetic factors also play a role in
determining the length of the baby.
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• Head: Your baby’s head appears large for the body and may have an elongated shape or appear to have
some ‘bumps’. This is due to changes called molding, which occurs in labour and delivery. Small bumps called
‘caput’ usually disappear in 1 – 2 days. Soon the head gets rounder. The head circumference is 33 – 35 cm.
• Soft spots or Fontanelles: There are 2 areas on the head where bone formation is incomplete at birth. The larger
one, in front of the head closes by 6 – 18 months. The smaller one at the back usually closes by 6 weeks.
• Hair: As all people vary, so does their hair. Your baby may have lots of hair or none at all! It depends on
familial and racial factors.
• Heart beats: Usually the heart rate is 120 – 140 beats per minute.
• Respiratory rate (breathing): It is faster than adults, usually 30 – 40 breaths / minute. Breathing may be noisy or stop
for many seconds. This is not uncommon.
• Colour: Depending on the parents, the skin colour of newborn varies. In general, newborn babies look flushed
and pink all over. However, the palms and soles of the feet may look dusky or little bluish soon after birth.
Axillary temperature measurement. The thermometer should remain in place for 3 minutes. The nurse presses the newborn’s arm
tightly but gently against the thermometer and the newborn’s side, as illustrated
Handwashing
Before entering the nursery or caring for a baby
In between newborn handling or after the care of each baby
Before treating the cord
After changing soiled diaper
Before preparing milk formula.
3 cleans in community
o clean hand
o clean cord
o clean surface
betadine or povidone iodine – to clean cord Bathing
check AVA, then draw 3 vessel cord - oil bath – initial
- to cleanse baby & spread vernix caseosa
If 2 vessel cord- suspect kidney malformation Fx of vernix caseosa
- leave about 1” of cord 1. insulator
- if BT or IV infusion – leave 8” of cord best access - no nerve 2. bacterio- static
- check cord every 15 min for 1st 6 hrs – bleeding .> 30 cc of blood Babies of HIV + mom – immediately give full
bleeding of cord – Omphalagia – suspect hemophilia bath to lessen transmission of HIV
- 13 – 39% possibly of transmission of
Cord turns black on 3rd day & fall 7 – 10 days HIV
Faiture to fall after 2 weeks- Umbilical granulation
Mgt: silver nitrate or catheterization
- clean with normal saline solution not alcohol
- don’t use bigkis – air
- persistent moisture-urine, suspect patent uracus – fistula bet bladder and normal umbilicus
dx: nitrazine paper test – yellow – urine
mgt: surgery
Immediate Care of the Newborn
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A irway
B ody temperature
C heck/ assess the newborn
D etermine identification
Stimulate & dry infant
Assess ABCs
Encourage skin-to-skin contact
Assign APGAR scores
Give eye prophylaxis & Vit. K
Keep newborn, mother, & partner together whenever
Physical Assessment
Temperature - range 36.5 to 37 axillary
Common variations
o Crying may elevate temperature
Stabilizes in 8 to 10 hours after delivery
o Temperature is not reliable indicator of infection
A temperature less than 36.5
Temp: rectal- newborn – to rule out imperforate anus
- take it once only, 1 inch insertion
Imperforate anus
1. atretic – no anal opening
2. agenetialism – no genital
3. stenos – has opening
4. membranous – has opening
Earliest sign:
1. no mecomium
2. abd destention
3. foul odor breath
4. vomitous of fecal matter
5. can aspirate – resp problem
Mgt: Surgery with temporary colostomy
Heart Rate
range 120 to 160 beats per minute
Common variations
Heart rate range to 100 when sleeping to 180 when crying
Color pink with acrocyanosis
Heart rate may be irregular with crying
Although murmurs may be due to transitional circulation-all murmurs should be followed-up
and referred for medical evaluation
Deviation from range
Faint sound
Cardiac rate: 120 – 160 bpm newborn
Apical pulse – left lower nipple
Radial pulse – normally absent. If present PDA
Femoral pulse – normal present. If absent- COA - coartation of aorta
Respiration
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- range 30 to 60 breaths per minute
Common variations
Bilateral bronchial breath sounds
Moist breath sounds may be present shortly after birth
Signs of potential distress or deviations from expected findings
Asymmetrical chest movements
Apnea >15 seconds
Diminished breath sounds
Seesaw respirations
Grunting
Nasal flaring
Retractions
Deep sighing
Tachypnea - respirations > 60
Persistent irregular breathing
Excessive mucus
Persistant fine crackles
Stridor
Skin
o Skin reddish in color, smooth and puffy at birth
o At 24 - 36 hours of age, skin flaky, dry and pink in color
o Edema around eyes, feet, and genitals
o Venix Caseosa -whitish, cheese-like substance, covers the fetus while in utero and lubricates
the skin of the NB. The skin of the term or postterm nb has less vernix and is frequently dry;
peeling is common, esp. on the hands & feet
o Lanugo -moderate in full term; more in preterm; absent in postterm; shed after 2 weeks in
time of desquammation Skin color
o Turgor good with quick recoil blue – cyanosis or hypoxia
o Hair silky and soft with individual strands White – edema
Grey – inf
o Nipples present and in expected locations Yellow – jaundice , carotene
o Cord with one vein and two arteries
o Cord clamp tight and cord drying
o Nails to end of fingers and often extend slightly beyond
Acrocyanosis
o Bluish discoloration of the hands and feet maybe present in the first 2 to 6 hours after birth
o This condition is caused by poor peripheral circulation, w/c results in vasomotor instability & capillary
stasis, esp. when the baby is exposed to cold.
Mongolian Spots
Patch of purple-black or blue-black
color distributed over coccygeal and
sacral regions of infants of African-
American or Asian descent. Not
malignant. Resolves in time. They
gradually fade during the first or
second year of life. They maybe
mistaken for bruises and should be
documented in the NB’s chart.
Mottling
Physiologic Jaundice
o Hyperbilirubinemia not associated with hemolytic disease or other pathology in the newborn.
Jaundice that appears in full term newborns 24 hours after birth and peaks at 72 hours. Bilirubin may
reach 6 to 10 mg/dl and resolve in 5 to 7 days.
o If jaundice occurs within 2 days – pathologic jaundice
o If jaundice occurs at 3rd-7th days of life – physiologic jaundice
o Jaundice is first detectable on the face (where skin overlies cartilage) and the mucus membranes of
the mouth and has a head-to-toe progression.
o *Evaluate it by blanching the tip of the nose, the forehead, the sternum, or the gum line. This
procedure must be done with appropriate lighting. Another are to assess is the sclera.
o Jaundice maybe related to breastfeeding, hematomas, immature liver function, bruises from forceps,
blood incompatibility, oxytocin induction or severe hemolysis process
Nsg Resp:
1. cover eyes – prevent retinal damage
2. cover genitals – prevent priapism –
painful continuous erection
3. change position regularly – even
exposed to light
4. increase fld intake – due prone to
dehydration
5. monitor I&O – weigh baby
6. monitor V/S – avoid use of oil or lotion
due- heat at phototherapy
= bronze baby syndrome-
transient S/E of phototherapy
Exchange Transfusion
o Is the withdrawal and replacement of newborn’s blood with donor blood.
Milia
Milia which are exposed to sebaceous
glands, appear as raised white spots on
the face, esp. across the nose.
No treatment is necessary, bec they will
clear within first month.
Infants of African heritage have a similar
condition called transient neonatal
pustular melanosis.
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Erythema toxicum
Is an eruption of lesions in the area
surrounding a hair follicle that are firm, vary
in size from 1-3 mm, and consist of a white
or pale yellow papule or pustule w/ an
erythematous base.
It is often called “newborn rash” or “flea-
bite” dermatitis
The rash may appear suddenly, usually over
the trunk and diaper area and is frequently
widespread.
The lesions do not appear on the palms of the
hands or soles of the feet.
The peak incidence is 24-48 hours of life.
Cause is unknown and no treatment
Harlequin Sign
o The color of the newborn's body appears to be half red and half pale. This condition is transitory and
usually occurs with lusty crying. Harlequin Coloring may be associated with to an immature
vasomotor reflex system.
BIRTH MARKS
Telangiectatic nevi (stork bites)
3 types Hemangiomas
a.) Nevus Flammeus – port wine stain – macular purple or dark red lesions seen on face or thigh.
NEVER disappear. Can be removed surgically
b.) Strawberry hemangiomas – nevus vasculosus – dilated capillaries in the entire dermal or subdermal
area. Enlarges, disappears at 10 yo.
c.) Cavernous hemangiomas – communication network of venules in SQ tissue that never disappear
with age.
Nevus Flammeus (port-wine stain)
HEAD
o Head circumference should be 2 cm greater than chest circumference
o Assess fontanelles and sutures - observe for signs of hydrocephalus and evaluate neurologic
status
o Craniosynostosis
o Microcephaly
o macrocephaly
Clubfoot
Nursing Role
Be knowledgeable about normal newborn variations and responses that indicate further investigation
o Respiratory distress
o Central cyanosis
o Thermoregulation problems
o Dehydration
Teaching TALIPES – “clubfoot”
During physical and behavioral assessment, identify family's need for teaching a.) Equinos – plantar
flexion –
o Involve family early in care of infant
horsefoot
o Process establishes uniqueness and allays concern b.) Calcaneous –
Teaching dorsiflexion –
o Feeding cues heal lower that
o Alert state foot anterior
posterior of foot
o Cord care
flexed towards
o Sleeping anterior leg
Neurological Status c.) Varus- foot turns
Assessment begins with period of observation in
Observe behaviors - note: d.) Valgus- foot turns
o State of alertness out
Equino varus- most
o Resting posture common
o Cry
o Quality of muscle tone
o Motor activity
o Jitteriness – feeling of extreme nervousness
o Differentiate causative factors
Examine for symmetry and strength of movements
Note head lag of less than 45 degrees
Assess ability to hold head erect briefly
Reflexes
Immature central nervous system (CNS) of newborn is characterized by variety of reflexes
o Some reflexes are protective, some aid in feeding, others stimulate interaction
o Assess for CNS integration
Protective reflexes are blinking, yawning, coughing, sneezing, drawing back from pain
Rooting and sucking reflexes assist with feeding
“?What reflexes should be present in a newborn? Reflexes are involuntary movements or actions. Some movements are spontaneous, occurring as part of the
baby's usual activity. Others are responses to certain actions. Reflexes help identify normal brain and nerve activity. Some reflexes occur only in specific periods
of development. The following are some of the normal reflexes seen in newborn babies””
BABINSKI reflex
• Grasp reflex
Grasp reflex - Stroking the palm of a baby's
hand causes the baby to close his/her fingers in
a grasp. The grasp reflex lasts only a couple of
months and is stronger in premature babies.
Palmar & Plantar
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Moro reflex
Step reflex -
Rooting Reflex
Suck reflex -
Rooting helps the baby become ready to
suck. When the roof of the baby's mouth is
touched, the baby will begin to suck. This
reflex does not begin until about the 32nd
week of pregnancy and is not fully developed
until about 36 weeks. Premature babies may
have a weak or immature sucking ability
because of this. Babies also have a hand-to-
mouth reflex that goes with rooting and
sucking and may suck on fingers or hands.
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ASSESSMENT OF PHYSICAL MATURITY CHARACTERISTICS OF NEWBORN
Observable characteristics of newborn should be evaluated while not disturbing baby
Gestational assessment tools examine the following physical characteristics
o Resting posture
o Skin
o Lanugo
o Sole (planar) creases
o Breast tissue
o Ear form and cartilage distribution
o Evaluation of genitals
Male genitals
l Age
-Ballards & Dobowitz
Findings Less 36 weeks (Preterm) 37 - 38 39 and up
Sole creases Anterior transverse crease Occasional creases 2/3 Covered with creases
only in
Breast nodules 2mm 4mm or 3.5 mm > 5 or 7mm
Scalp hair Fine & fuzzy Fine & fuzzy Coarse & silky
Ear lobe Pliable Some cartilage Thick cartilage
Testes and Scrotum testes in lower canal Some intermediate Testes pendulus
Scrotum – small few rugae Scrotum full extensive rugae
BIRTHMARKS:
1. Mongolian spots – stale gray or bluish discoloration patches commonly seen across the sacrum or buttocks due to
accumulation of melanocytes. Disappear by 1 yr old
2. MIlla – plugged or unopened sebaceous gland . white pin point patches on nose, chin or cheek.
3. Lanugo – fine, downy hair – common preterm
4. Desquamation – peeling of newborn, extreme dryness that begin sole and palm.
5. Stork bites (Talengeictasi nevi) – pink patches nape of neck
hair will grow as child grows old
6. Erythema Toxicum – (flea bite rash)- 1st self limiting rash appear sporadically & unpredictably as to time & place.
7. Harlequin sign – dependent part is pink, independent part is blue
(side lying – bottom part is dependent pink)
8. Cutis Marmorato – transitory mottling of neonates skin when exposed to cold.
9. Hemangiomas – vascular tumors of the skin
3 types Hemangiomas
a.) Nevus Flammeus – port wine stain – macular purple or dark red lesions seen on face or thigh. NEVER disappear. Can be
removed surgically
b.) Strawberry hemangiomas – nevus vasculosus – dilated capillaries in the entire dermal or subdermal area. Enlarges, disappears
at 10 yo.
c.) Cavernous hemangiomas – communication network of venules in SQ tissue that never disappear with age. - MOST
DANGERIOUS – intestinal hemorrhage
Skin color blue – cyanosis or hypoxia
White – edema
Grey – inf
Yellow – jaundice , carotene
Vernix Caseosa – white cheese like for lubrication, insulator
Some babies may need some extra attention from you and the doctor after birth. These include: