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A G E - S P E C I F I C C O M P E T E N C I E S F O R H E A L T H C A R E C A R E O F T H E N E O N A T E : B I R T H T O 2 8 D A Y S

P R O V I D E R S

1a

Stage

Care of the Neonate: Birth to 28 Days [Excerpts from the entire chapter...]

IMMEDIATE ASSESSMENT OF THE NEWBORN

T

he APGAR SCORE that has become the standard for newborn evaluation was developed by American physician, Virginia Apgar (1909-1974). The Apgar score is an index used to evaluate the condition of a newborn infant based on a rating of 0, 1, or 2 for each of the five characteristics of color, heart rate, response to stimulation of the sole of the foot, muscle tone, and respiration. A perfect score is 10.

The Apgar score is performed at one minute after birth and repeated at five minutes after birth. In cases in which the newborn is severely depressed, a 10-minute score is also performed. Scores should be 7 or higher at one minute and five minutes after birth.

SIGN

Heart Rate Respiratory Effort Reflex irritability (sneezing, coughing, grimacing) Muscle tone Color

0

No heartbeat No breathing for 60 seconds No response Completely limp Blue body, arms and legs

SCORE 1

Under 100 bpm Irregular, shallow breathing Weak reflexive response Weak movements of arms and legs Body pink with blue arms and legs

2

100-140 bpm Strong breathing and crying Strong reflexive response Strong movement of arms and legs Body, arms and legs completely pink

1 © 2010 Lee Abramo, MSN, RN ­ Age-Specific/Transcultural Competencies for Healthcare Providers

A G E - S P E C I F I C C O M P E T E N C I E S F O R H E A L T H C A R E C A R E O F T H E N E O N A T E ( B I R T H T O 2 8 D A Y S )

P R O V I D E R S :

NEONATAL VITAL SIGNS

Head Circumference: Temperature: Chest Circumference: Heart Rate: Respirations: Blood Pressure: Weight: Urination: Stool: 34 - 35 cm 97.6 - 98.6 axillary 32-33 cm 120 - 160 beats/min. (avg120) 40 - 90 breaths/min. average 80/46 (+/- 16 points) 2.5 - 3.4 Kg 6 - 8 times per day 2 - 3 stools per day

TEMPERATURE REGULATION (A Matter of Life and Death)

Newborns are at risk for heat loss. Heat loss can be rapid, and is due to the neonate's immature thermoregulation. Body heat is lost through convection, conduction, radiation, and evaporation.

Convection

· Convection is the loss of body heat to the cooler surrounding air....

Conduction

Conduction is the loss of body heat to cooler solid objects that are in contact with the body..... · Newborns can loose heat quickly...

Radiation

Radiation is the loss of body heat to a cooler solid object not in contact with the body......

Evaporation

Evaporation is the loss of body heat through conversion of a liquid to a vapor. · When the body is wet.... Loss of body heat can be deadly to the newborn.....

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A G E - S P E C I F I C C O M P E T E N C I E S F O R H E A L T H C A R E C A R E O F T H E N E O N A T E ( B I R T H T O 2 8 D A Y S )

P R O V I D E R S :

The newborn not only loses heat quickly, but also has difficulty conserving heat.... ....... Bacterial infections usually cause a baby's temperature to drop. Such a drop after stabilization should be reported to the neonatologist or pediatrician and investigated further.

HEAD-TO-TOE ASSESSMENT

SKIN

The skin is examined for: · Color (treat cyanosis immediately.) · Bruising · Petechiae (common over the presenting part) · Meconium staining · Jaundice (abnormal in the first 24 hours of life) · Birthmarks · Hemangiomas Sense of touch is intact. The newborn responds positively to soothing touch and will react to painful stimuli......

HEAD

Newborns are obligate nose breathers. The nasal passages should be cleared of nasal mucus by gentle use of a bulb syringe....

CHEST/THORAX

The thorax is examined for fractured clavicles as evidenced by bruising and crepitus......

ABDOMEN

The newborn's abdomen should be soft, non-distended, and .....

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A G E - S P E C I F I C C O M P E T E N C I E S F O R H E A L T H C A R E C A R E O F T H E N E O N A T E ( B I R T H T O 2 8 D A Y S )

P R O V I D E R S :

SKELETON PAIN ASSESSMENT

The skeletal system is examined for obvious abnormalities such as .........

Pain assessment is considered "the fifth vital sign" and it should always........ Infants are preverbal, so the healthcare provider must be alert to other signs that s/he is experiencing pain or discomfort. Such clues are.......... Newborns can become cyanotic and bradycardic from pain. Up until approximately the early 1970's, neonatal pain was widely underestimated. In fact, analgesics were rarely used even for surgery due to the belief that neonates did not feel pain...... Despite extensive studies indicating that neonates do suffer pain and distress from the pain, painful procedures are still being performed on newborns without the benefit of analgesia or anesthesia...... Compared with older children and adults, neonates are more sensitive to pain and vulnerable to its long-term effects..... A helpful tool for assessing pain in the newborn is the CRIES Pain Management Scale, which was developed at the University of Missouri-Columbia.

CRIES Pain Management Scale...[Example presented]

A number of other tools to evaluate children's pain have been developed and are currently in use throughout the United States and Europe. Another such tool is the Neonatal Infant Pain Scale (NIPS).... designed to document the neonate's pain responses to invasive procedures.

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A G E - S P E C I F I C C O M P E T E N C I E S F O R H E A L T H C A R E C A R E O F T H E N E O N A T E ( B I R T H T O 2 8 D A Y S )

P R O V I D E R S :

The NIPS uses the following indicators to assess neonatal pain.... · Spence, et al. (2005) studied the Pain Assessment Tool (PAT), and found it to be another valid tool for assessment of neonatal pain....[Example presented]

REFLEXES

An immature nervous system causes the newborn to make uncoordinated, flailing movements.....

Rooting reflex...[explanations presented for each reflex] Sucking reflex Swallowing reflex Moro (startle) reflex Babinski reflex Deep tendon reflexes PSYCHOSOCIAL DEVELOPMENT

Erik Erikson's eight stages of development begin in the neonatal period or stage.....[This section describes Erikson's Stage 1 ­ oral stage ­ as it relates to the neonate.]

COMMON FEARS AND STRESSORS

A major stressor in this age group is that of....

SAFETY CONCERNS

Heat loss....

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A G E - S P E C I F I C C O M P E T E N C I E S F O R H E A L T H C A R E C A R E O F T H E N E O N A T E ( B I R T H T O 2 8 D A Y S )

P R O V I D E R S :

Newborn abduction is a serious safety concern.... The Joint Commission's National Patient Safety Goals (NPSGs) require that two identifiers be used...

FAMILY EDUCATION

Assess the family's readiness to care for the newborn at home. Provide for interpreters and written educational material in the language or languages.... Stress the necessity of infant seats....

THE CIRCUMCISION CONTROVERSY

Despite the 1999 American Academy of Pediatrics (AAP) policy statement indicating that routine neonatal circumcision is not medically necessary, circumcision continues to be the most frequently performed surgical procedure in the newborn period in the United States (Kraft, 2003).... Full chapter contains 13 pages of reading material for the staff.

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