N U R S I N G C A R E O F A N EWB O R N A N D F AMI LY

• Newborn or neonate
• – a baby in the neonatal period (the first 28 days of life)
• Nursing Diagnoses
• Ineffective airway clearance related to mucus in airway
• Ineffective thermoregulation related to heat loss from exposure in birthing room
• Imbalanced nutrition, less than body requirements, related to poor sucking reflex
• Readiness for enhanced family coping related to birth of planned infant
• Health-seeking behaviors related to newborn needs

The Average Newborn

Profile of a Newborn
• X “All newborns look alike.”
• “ Every child is unique.”

NEWBORN PRIORITIES IN THE FIRST

DAYS OF LIFE
1. Initiation & maintenance of respirations
2. Establishment of extrauterine circulation
3. Control of body temperature
4. Adequate nourishment
5. Waste elimination
6. Prevention of infection
7. Infant-parent relationship
8. Developmental care

IMMEDIATE CARE OF THE

NEWBORN
I. CARE OF THE NEWBORN AT THE D.R.
A. Establish and Maintain Respiration
1. Suctioning
- Turn head to one side
- Suction gently and quickly
- Suction the MOUTH first before the nose
- Test patency of the airway
- Proper position
a. Ensure an open airway.
b. Do not hyperextend head
- place neonate supine
- head slightly extended
B. Maintain Appropriate Body Temperature
• *Blot dry/ Rub dry the infant.
• 1. Wrap the newborn immediately
• 2. Wrap him warmly
• 3. Put him under a droplight
• Warmth
• At birth, the newborn must begin thermoregulation (maintenance of body temperature).
• 3 Factors :
• Heat production
• Heat retention
• Heat loss

HEAT PRODUCTION
• Thermogenesis – through
• general metabolism
• muscular activity
• nonshivering thermogenesis (unique to the newborn)
• Newborns rarely shiver as adults do to increase heat production.
• Shivering in newborns indicates that the metabolic rate has already doubled.
• Infant in a cool environment
• requires more heat
• metabolic rate increases
• producing more heat
• Newborn may cry and have muscular activity when cold, but there is no voluntary control of muscular activity.
• - If the newborn’s temperature is not adequately raised through increased metabolism, nonshivering
thermogenesis : the metabolism of brown fat begins.

Non Shivering Thermogenesis - the metabolism of brown fat

1. BROWN FAT
• special tissue/ fat found only in newborns
• highly vascularized giving it a brown color
• oxidized to produce or conserve heat
• increasing metabolism
• located at the back of the neck, intrascapular region, thorax, around the kidneys and adrenals,
in the axilla, around the heart and abdominal aorta and perineal area
• Once the brown fat has been metabolized, the infant no longer has this method of heat
production available.

• 2. HEAT RETENTION
• Newborns retain heat by staying in a flexed position.
• - reduces the area of skin exposed to the environmental temperature, thus decreasing heat loss
• - peripheral vasoconstriction retains heat
• Conservation of Heat
• 1. Brown fat
• 2. Kangaroo care – placing the newborn against the mother’s skin and then covering the newborn
• helps to transfer heat from the mother to the newborn, thus, conserving heat loss
• 3. HEAT LOSS
Newborn
- thin skin with blood vessels close to the surface and little subcutaneous fat to prevent heat loss
• Cold Stress - excessive heat loss
increased metabolism
significant increase in need for oxygen
newborn may experience hypoxia
** There may not be enough oxygen for the metabolic rate to increase, and the newborn will not be able to maintain
body temperature.

Effects of Cold Stress (temp<36.5)

• 1. Metabolic Acidosis
- increased BMR, anaerobic glycolysis, increased acid production, metabolic acidosis
• 2. Hypoglycemia
- increased energy requirement to produce heat
- glucose necessary for increased metabolism is made available when glycogen stores are
• converted to glucose
- if the glycogen is depleted, hypoglycemia results

4 MECHANISMS OF HEAT LOSS

• 1. Convection - flow of heat from the newborn’s body surface to cooler

surrounding air
• 2. Radiation - transfer of body heat to cooler solid object not in contact
with the baby
• 3. Conduction - transfer of body heat to cooler solid object in contact
with the baby
• 4. Evaporation -loss of heat through conversion of liquid to a vapor

• OTHER CAUSES OF HEAT LOSS:

• 1. insulation in newborn is not effective (little subcutaneous fat)
• 2. shivering is not present
IMME D I AT E A S S E S SME N T O F T H E N EWB O R N

A. ASSESSMENT FOR WELL-BEING

A = APPEARANCE least important

0 Points = Bluish-gray or pale all over
1 Point = Normal color (but hands and feet are
bluish)
2 Points = Normal color all over (hands and
feet are pink)
P = PULSE most important
0 Points = Absent (no pulse)
1 Point = Pulse below 100 beats per minute
(bpm)
2 Points = Pulse over 100 beats per minute
(bpm)
G = GRIMACE (reflex activity);
0 Points = Absent, no response to stimulation
1 Point = Facial movement only, grimacing
with stimulation
2 Points = Pulls away, sneezes, coughs, or
cries with stimulation
A = ACTIVITY (muscle tone)
0 Points = No movement, or “floppy” tone
1 Point = Flexed arms and legs with little
movement
2 Points = Active, spontaneous movement
R = RESPIRATION
0 Points = Absent, no breathing
1 Point = Slow or irregular breathing, weak crying
2 Points = Normal rate of breathing and effort, good crying

WHAT DOES AN APGAR SCORE MEAN?

 A score between 7 and 10 is considered normal.
 A score between 4 and 6 indicates that breathing assistance may be required.
 A score under 4 means that prompt, life-saving measures may be called for.
 To get the overall score for an infant, a score of 0 to 2 will be assigned for each of the 5 aspects medical staff will
check.

Heart rate: 0 means there is no heart rate, 1 means there are fewer than 100 beats per minute (not very responsive), 2
means there are more than 100 beats per minute (baby is vigorous)
Respiration: 0 means there is no breathing, 1 means there is a weak cry, 2 means there is a strong cry
Muscle tone: 0 means the baby is limp, 1 means the baby has some flexion, 2 means the baby has active motion
Reflex Response: 0 means no response to their airways being stimulated, 1 means there is a grimace during stimulation,
and 2 means there is a grimace and cough/sneeze during stimulation
Color: 0 means the baby’s entire body is blue/pale, 1 means the baby has good color except on their hands/feet, 2 means
the baby is completely pink and has good color
It’s important to keep in mind that an infant rarely has a perfect score. Medical staff will communicate with you if both
APGAR tests come back with a low score or if they have a reason for concern.

1st minute: general condition (NEURO/RESPI/CIRCULATORY CHECK)

5th minute: adjustment to extrauterine life
Apgar Scoring System : Interpretation of Results
• Score: 9 – highest score; 10 – perfect score
• 0-3 ------ poor, serious, severely depressed, needs CPR
4-6: ----- fair, guarded, moderately depressed, needs suction
7-10: ---- good, healthy
SILVERMANN ANDERSON SCORING
(RESPIRATORY DISTRESS)
• 0 ------ - No respiratory distress
• 1 -3 ----- slight distress
• 4-6----- moderate distress
• 7-10---- seriously distressed !

ANTHROPOMETRIC MEASUREMENTS

6. Take Anthropometric Measurements (Vital

Statistics)
• BW: 2.5 – 3.4 kgs
(5.5 – 7.5 lbs)
• * 1 K = 2.2 lbs
• BL: 47.5 – 53.75 cm
(19 – 21 ½ in)
• Average: 50.8 cm/20 in
• * 1 inch = 2.54 cm

• Length : mature female neonate-53 cm(20.9 in);

mature male- 54cm(21.3in)
• Head circumference: mature newborn-34-35 cm
(13.5 to 14 in)
• - measure with the tape measure drawn across the
center of the forehead and around the most
prominent portion of the posterior head)
• Chest circumference: term newborn – 2 cm less
than head circumference, measured at the level of
the nipple

NEWBORN CARE

HOW TO PROVIDE INFORMATION AND SUPPORT FOR THE CARE OF THE NEWBORN AFTER BIRTH.

In addition to physically assessing the newborn, you will need to be able to communicate effectively with mother, father
and family to assess how the newborn is doing. You need to provide practical guidance and support for breastfeeding as
well as information on cord care in the home for the baby.

As you ask the mother questions, remember to use simple, appropriate language. Treat any concerns she raises about
her baby or her role as a mother with respect, even if her worries might appear unnecessary to you. You should maintain
her trust at this time so that she will come to you when she has other concerns, which you may consider more serious. All
mothers (but especially first-time mothers) need lots of support and reassurance that they are caring for their babies
appropriately. You can communicate some of this information by active demonstration, for example, showing the new
mother how to hold or lift a baby, so that they can see what to do, and giving them opportunities to ask questions and
clarify any problems.

REMINDER
It is important to provide mothers, fathers and families with practical advice on
how to care for the baby during the first few days.

 Keep the baby warm- a baby should wear 1-2 layers more than an adult. If cold, put a hat on the baby’s head.
 Care for the umbilical cord. Do not put anything on the stump.
 Keep the baby clean. It is not necessary to wash the baby every day, but wash baby’s face and bottom when needed.
Make sure is warm when undressing baby.
 Provide nothing but breast milk day and night.
 You should see a health worker on day 3 and between 7 and 14 days and 4- 6 weeks after birth. At the 6 week visit the
baby will be immunized.
 Let the baby sleep on his/her back or side.
 Keep the baby away from smoke.
 It is not recommended to expose the baby to direct sunlight.

DANGER SIGNS FOR THE NEWBORN

Advice the mother and family to seek care immediately, day or night. They
should not wait if the baby has any of these signs.
 Difficulty in breathing
 Fever
 Feels cold
 Bleeding
 Not feeding
 Yellow palms and soles of feet
 Diarrhea

The mother and family should go to the health center as soon as possible if a baby has any of the following signs:
 Difficulty feeding ( poor attachment, not sucking well)
 Is taking less than8 feeds in 24 hours
 Pus coming from the eyes or skin pustules
 Irritated cord with pus or blood
 Yellow eyes or skin
 Ulcers or thrush (white patches) in the mouth- explain that this is different from normal breast milk in the mouth.

TO CHANGE A DIAPER

RELATED INFORMATION
 The baby’s diaper is changed, as necessary, but usually before or after feeding. When you change the diaper
watch the skin for reddened or sore areas, and tell the nurse if you find this condition. While changing the diaper,
note if the baby has voided, the kind of stool, the color, size, solid or soft. The nurse will tell you about recording
this.
 If the baby has frequent stools (4 or more in 24 hours) or they are watery or bloody, tell the nurse, and save the
stool for her to examine.
 The baby’s skin is soft and easily irritated, so wife gently when cleansing the skin.

PROCEDURES
Assemble equipment:
Cotton oil or water container for soiled diaper
A diaper a bed pad
1. Get ready in this way:
Wash and dry your hands
Collect the supplies at the baby’s unit.
2. Unpin the diaper, close the pins and place them in a safe place outside
of the bassinet or crib.
3. Cleanse the buttocks with cotton.
Use oil or water. Dry the skin with cotton, or remove excess oil. Place
the soiled cotton in the proper containers.
4. Place the soiled diaper and bed pad in the proper containers.
5. Put on the clean diaper.
Diapers are folded several ways. The nurse will tell you the method used
in your hospital. Usually, the diaper is folded in an oblong shape, by
folding one side over the same width. Fold one end up about one-third
of the length.
The extra part is placed in front for boy babies, and in the back for girl
babies. This gives an extra thickness for absorption of urine.
Place the diaper under the buttocks, bringing the folds up between the
legs. Lap the back fold to direct the pin and keep from pricking the baby.
Place the safety pin crosswise, directed toward the front.
6. Put a clean bed pad under the baby.
7. Wash and dry your hands.
8. Record the stool and urine.
9. Report to the nurse at once any rashes or reddened areas on the skin.
DAILY CARE OF THE BABY

RELATED INFORMATIONS

A baby’s daily care is not usually a complete bath, but certain parts of the body are cleansed. His skin is delicate and
easily irritated, so wipe it gently. Watch the skin for signs of any rash or reddened areas and for discharge from the eyes.
If he is a newborn baby notice whether there is any oozing from the cord?

Report whatever you see to the nurse promptly. Have the room warm and free from drafts before undressing
the baby and keep him covered with the blanket to prevent chilling. If the baby is not cleansed in the bassinet, you must
always pick him up, or keep your hand over him, when turning or moving from him, so
that he will not fall.

Assemble equipment:

Cotton a shirt or dress and diaper

Oil or water container for soiled cotton

1. Wash and dry your hands.

2. Collect the supplies.
Place the clean shirt and diaper within reach from the bassinet
3. Undress the baby in the bassinet. Keep him covered with the blanket to prevent chilling. When possible, ask the nurse
to look at him.
4. Put the soiled linen in proper container.
5. Cleanse the eyes first. Use a separate piece of cotton for each eye, wiping from the inner corner to the outer side of the
face. If there is any discharge, tell the nurse and she will give any special care needed.
6. Cleanse the face, head and outside part of the ear. The nose is not cleansed unless there appears to be some
discharge. Small twist of cotton moistened with water may then be used.
7. Wipe the folds of the skin. Do this in the folds about the neck, under the arms, at bend of the elbow, wrist, hands, under
the knee, about the ankles and feet. Remove excess water or oil with cotton. The nurse will tell you about the care of the
cord.
8. Put on the shirt.
9. Cleanse the buttocks and genitalia. For baby girl, separate the folds of the vulva and cleanse from the
front downward, using a separate piece of cotton for each stroke.
10. Put on the diaper.
11. Wash and dry your hands.
12. Report your observations to the nurse at once.

Note especially if there is:

a. Marked crying, irritability or quietness
b. Signs of pain or discomfort
c. Inability to move arms, legs, and head.
d. Twitching of muscles.
e. Chocking.
f. Presence of much secretion in the mouth or nose.
g. Trouble in swallowing or breathing.
h. Marked blueness of nails or skin.

BATHING A BABY

OBJECTIVES:

 To keep the skin clean and dry.

 To make the baby feel safe and comfortable.
 To stimulate circulation.
 To give the baby “mothering” care.

RELATED INFORMATION

 In some hospitals infants are given complete baths every day. In some, every other day. If the infant is not
bathed entirely, a partial bath is given. The nurse will tell you which plan is followed in your hospital.
 During the bath observe and report to the nurse. Rashes, sores, or reddened
 areas on the skin.
 Discharges from any part of the body. Unusual actions of the
baby.
 Handle the baby gently; always support his head and body firmly. Never turn away from him without pulling up
the bedside. Let him kick and move as much as he wishes and as is safe for him. Make the bath pleasant for the
baby.
 Avoid rush and interruptions as much as you can. “Mothering” is good for him. Talk to him and play with him as
you work.

PROCEDURES
Assemble equipment:
Mild soap oil, if used in your hospital
Clean cotton two washcloths of soft material
A soft towel bed linen as needed (small rubber sheet; crib sheet,
spread if use in hospital)
Basin or small tub Cotton bath blanket
Two toothpicks clothing for the baby (shirt; dia per; baby gown if use
in your hospital)
Laundry bag waste container
1. Get ready in this way: Wash and dry your
hands.
Collect the things you need. Put them in a clean place in the baby’s unit. Fill the basin 2/3 full of comfortably
warm water to the inside of the wrist.
2. Put on the isolation gown (if gowns are worn in caring for babies in your hospital).
3. Arrange the linen and clothing on the chair in the order you will use it.
4. Twist into wicks four or five small pieces of cotton slightly dampened with water
5. Speak to the baby
Lower the crib-side gently.
6. Wrap the baby loosely in a cotton blanket with his arms at his sides.
7. Cleanse the nostrils and ears with individual cotton wicks.
Discard cotton wicks in the waste container.
8. Moisten a washcloth with warm water and wash the face
Cleanse the eyes by wiping them gently from the inner corner outward. Pat the baby’s face dry with towel.
9. Pick up the baby.
Support his head and shoulder securely.
10.Make a good lather with one hand and shampoo his head.
Do not get soap in his eyes.
11.Hold him over the basin.
Rinse his head well with clear warm water. Pat dry, report scaling of the scalp to the nurse.
12.Undress the baby.
Put soiled linen in the laundry bag or place them where you have been taught to.
13.Place the baby on the bed pad.
Spread the cotton bath blanket at one end of the bed.
14.Make a lather with your hands or with a warm soapy washcloth.
Wash the baby’s body in this order: neck, arms, chest, abdomen, legs, back, between his legs and buttocks.
Discard the soiled washcloth.
15.Place the cotton blanket over him lightly.
Quickly rinse and dry your hands.
 16.Lift the baby from the bed.
Support his head and back, holding him securely in one arm.
17.Slip him, feet first into the basin (or tub)
Use your other hand to support and guide his legs and buttocks. Continue to support him with
your one arm and hand.
With your free hand rinse his body using the second washcloth.
If the baby cannot be placed in the tub of water, rinse him in bed using the second washcloth saturated with
clear, warm water.
18.Lift him from the basin (or tub).
Place him on the dry cotton blanket. Cover him lightly
Pat his skin thoroughly dry
Be sure you dry creases and skin folds. 19.Place the baby on a
dry part of the bed.
Discard the blanket with soiled linen, put on the shirt
Cleanse the genitalia of the baby girl with a cotton swab moistened in warm water or oil.
Very gently push back the foreskin of the infant boy unless it seems tight. Report this to the nurse
Avoid forcing a tight foreskin.
20. Put on the diaper
21. Cleans the baby’s nails with a toothpick.
Trim them straight across if they need it, the nurse will teach you how this is done

HOW TO MAKE THE BABYS BED AFTER HIS BATH:

Procedures:
1. Place the baby at the foot of the bed.
2. Loosen the bottom sheet at the head of the bed Fold it toward the foot of
the bed.
3. Place the crib sheet across the top of the mattress. Tuck the sheet under the
top of the mattress.
4. Move the baby to the head of the bed.
Remove the soiled sheet and put it with the soiled linen
5. Tuck the crib sheet under the foot of the mattress.
6. Make a square corners of the sheet at the top and bottom.
7. Tuck the sheet under the mattress on the side nearest to you.
8. Place the baby in the center of the mattress on a bed pad and small rubber sheet.
9. Or on Raise the crib side and make the opposite side in the same way. 10.Cover the baby as
necessary with a cotton blanket loosely placed. 11.Make up top covers, if these are used in your hospital
Ask the nurse 12.Raise the crib side
13.Remove the isolation gown as you have been taught. 14.Put any soiled linen or waste
materials in the proper places. 15.Wash your hands.
16.Report your observations to the nurse.

TAKING THE BABY TO HIS MOTHER FOR BREAST FEEDING RELATED INFORMATION

The time the baby is to go to his mother for breast feeding will depend upon the baby’s feeding schedule in the
hospital or on whether the mother has the baby with her at the bedsides most of the time (room-in) .The nurse will tell
you about the feeding schedule and the length of time the baby is to nurse. For the first breast feeding, the midwife will
take the baby to the mother and help her in getting him to a nurse.

PROCEDURE
1. Wash your hands.
 2. Wrap the baby in his blanket.
3. Carry the baby to his mother
Hold him with his head supported at the bend of your elbow and with your forearm and hand supporting his
back and buttocks.
4. Identify the baby’s name with that of the mother.
5. See that the mother has washed her hands before taking the baby. She should be in a comfortable
position in bed or sitting in a chair.
6. Remind the mother to cleanse the nipple before placing the baby to breast (if this procedure is carried out
in your hospital).
7. Observe the breast and nipple for any redness, cracks or soreness.
I any of these are present, tell the nurse before placing the baby for breast feeding.
8. Return to see that the baby is nursing all right. If the baby seems to be drowsy and not nursing, tell the
nurse so that she may help the mother. Remind the mother to bubble the baby at the end of the nursing
period.
9. Return the baby to the nursery.
Remove the wrapping blanket. Place him on his side or abdomen as the nurse instructs you.
10.Wash your hands.
BOTTLE FEEDING
RELATED INFORMATIONS
This lesson tells about bottle and nipple feeding. Babies are usually fed every 3 or 4 hours, or they may be fed
on an irregular schedule. Some babies become unhappy and fretful before the 3 or 4 hour interval; others appear not to
be ready for the feeding at the end of that time. This is called “self-demand” or self regulatory feeding. It means that the
baby is fed when he gives some sign that he is hungry. The nurse will tell you about the feeding schedule in the
hospital.
In some hospitals, babies are taken from the bassinet and held during the feeding period. They seem to enjoy
this feeling of close contact with you while taking the feeding.
PROCEDURES
In order to feed a baby you will need sterile formula in a bottle with nipple and nipple cover. Each formula will
be labelled in some way for the baby. The nurse will tell you how formulas are labelled in the hospital. You will also
need a bottle warmer (or basin of warm water), and a separate container for empty bottles and nipples.
1. Get ready in this way: Wash your hands.
i. Select the formula for the baby you will be feeding and Place it in the
bottle warmer.
2. After the formula has warmed for a few minutes, take it to the bassinet. Check the label on the formula with
the baby’s name on the bassinet and his identification bracelet, or tag.
3. Remove the nipple cover, and place it in the proper container.
i. Allowing the milk to drop on your wrist, test the nipple for flow and temperature of the formula.
The formula should be lukewarm, not hot, and should drop from the nipple, not spurt or run out
of it.
4. Change the baby’s diaper if necessary.
5. Wash your hands again.
6. Place a soft cloth or bib under the baby’s chin.
7. Pick up the baby in your arms, wrapped in his blanket. Hold him comfortably.
i. Touch the nipple to his lips. When he starts to root and suck, insert the nipple on top of the
baby’s tongue.
ii. Tilt the bottle so that the nipple is always filled with milk. If the flow of milk is too rapid or too
slow or the baby appears to have difficulty in breathing, sucking, or swallowing, report this to the
nurse.
iii. Do not force or urge the baby to take milk, if he does not want it. Report this to the nurse.
8. Bubble the baby at the end of the feeding.
i. Support his head and shoulders, raise him to a semi-up-right position, and gently pat his back,
 or place him against your shoulder and gently pat his back. Put him in bed on his side or on his
abdomen the way the nurse tells you.
ii. Rinse the bottle and nipple in cold water. Put them in
the proper container.
9. Wash your hands.
10.Record the amount of formula taken, and the way the baby took it
Prepared by: QUEENNE KIMVERLEE C. CLARO, MAN