What Is the Normal Length of a Newborn Baby
Identification
Identification Bands
While the babe is withal in the commitment or birth room, it is the nurse's responsibility to prepare and initiate some form of identification. Each hospital differs in what is required; well-nigh use flexible plastic bands that come up in sets of three or iv with identical numbers on them. The nurse writes the mother's name and access number; the birth attendant's proper noun; the date and fourth dimension of birth; and the baby's sex on each band. One band is placed around the mother's wrist, 2 on the infant (wrist and ankle), and the fourth on the male parent or pregnant other. The printed number on the band should be recorded in the babe's and female parent'due south records.
Properly identifying each newborn post-obit birth is extremely important. Protective measures include identification bands, electronic bracelets, footprinting, and the completion of necessary records.
Electronic Bracelets
Another mechanism of ensuring infant safe is an electronic bracelet that creates an warning if the baby is taken off the obstetrical unit without the bracelet having been deactivated by hospital personnel.
Footprinting
Some hospitals also use newborn footprints and maternal fingerprints equally means of identification. These prints are taken before either the mother or the newborn leaves the delivery room, and they become role of the permanent health record.
Completing Birth Data in the Wellness Record
The patient record must include data about the newborn'southward sexual practice, hour of nascence, condition, and blazon of delivery. Document whatever identifying marks, care of the eyes, vitamin One thousand administration, and the mother's Rh status. Yous must consummate the chart before the newborn leaves the delivery room. Be peculiarly careful if someone in the family has a mutual name. In all cases, the mother'south total proper noun and the engagement and fourth dimension of the newborn's birth are of disquisitional importance and should be advisedly documented.
The birth attendant who delivered the newborn should consummate and sign a certificate of birth every bit before long equally possible. The nascence document is filed with the State Department of Vital Statistics. To best prevent later defoliation, advise parents to choose a name for the newborn before the birth certificate is filed.
Protection Against Disease
Standard Precautions
Infection command is not just very of import for the mother and the new infant, but is also important for members of the healthcare team. Many trunk fluids and substances are involved in the birth procedure, including amniotic fluid, blood, and sometimes stool. It is essential that all members of the healthcare team practice Standard Precautions, including thorough handwashing and gloving, before handling the baby or providing intendance to the female parent.
Eye Prophylaxis
If the mother has gonorrhea or chlamydia infecting her reproductive organs, the birth process could upshot in the infant being exposed to those organisms. Even babies born by cesarean section may have been exposed. Each of these organisms can cause blindness, or ophthalmia neonatorum, if left untreated. Therefore, specific protection against them is required in near states.
Erythromycin ointment, which is effective confronting both gonorrhea and chlamydia, is the drug of option (meet In
IN PRACTICE :Important MEDICATIONS 67-1
ERYTHROMYCIN 0.5% OPHTHALMIC OINTMENT
Dosage
Apply a thin line, i-2 cm long, of ointment forth the conjunctival sac.
Move from the inner to the outer canthus (see In Practice: Nursing Procedure 67-2).
Expected Effects: Prevention of gonorrheal or chlamydial ophthalmia neonatorum.
Adverse Side Effects: May cause blurred vision in the neonate.
Nursing Considerations
• Be conscientious not to touch the newborn's eyelid or eyeball with the tip of the tube.
• Filibuster assistants until after the initial bonding period with the mother and/or father
Practice: Important Medications 67-1). Treatment may safely exist delayed for 2-three hours while the baby and parents are getting to know each other (see In Practice: Nursing Process 67-two).
Vitamin M Assistants
Newborns are at adventure for bleeding problems during the first week of life considering their gastrointestinal tract is sterile. The lack of abdominal bacterial flora means that the newborn is unable to produce an adequate amount of vitamin K, which is important for production of certain clotting factors past the liver. Therefore, an intramuscular injection of 0.v to i.0 mg of vitamin Thou is usually administered during the offset hour after nascence (see In Practice: Important Medications 67-two). The nurse should document and report this injection.
Vaccinations
All newborns receive a first vaccination confronting hepatitis B soon after birth (In Practise: Important Medications 67-iii). It is important to educate parents about the need for the remaining doses to be given according to the guidelines of the Centers for Disease Command and Prevention. It is prophylactic for the mother to breastfeed, even if the mother is a hepatitis carrier, if the baby has been immunized.
IN Do :IMPORTANT MEDICATIONS 67-2
VITAMIN G (PHYTONADIONE, AQUAMEPHYTON)
Dosage
Apply 0.5-i.0 mg IM 1 fourth dimension within the first hr of life Expected Effects
Vitamin K is used to prevent and treat blood clotting problems in the newborn. It is a necessary component for the product of certain clotting factors by the body. The baby cannot produce vitamin G until the gastrointestinal tract is populated with microorganisms after several days of feedings.
Agin Side Furnishings
Local irritation, such equally pain and swelling where injected
Nursing Considerations
• Administer the injection into a large muscle, such as the anterolateral muscle of the newborn's thigh.
IN PRACTICE Important MEDICATIONS 67-3
VACCINATION FOR HEPATITIS B
If the mother is negative for hepatitis B surface antigen (HbsAg), the infant should receive:
Dosage: Either Recombivax HB 2.5 μg or Engerix-B ten μg If the female parent is positive for HbsAg, the infant should receive: Dosage: Hepatitis B allowed globulin (HBIG) 0.five mL AND
Either Recombivax HB v.0 mcg (at a separate injection site)
or Engerix-B ten mcg (at a separate injection site)
If mother's status for HbsAg is unknown, the infant should receive: Dosage: Either Recombivax HB 5.0 mcg or Engerix-B 10 mcg
Iii Doses Required
♦ First dose within 12 hours after birth
♦ Second dose at age 1-2 months
♦ Third dose at vi months of age
Expected Furnishings: The infant will develop antibodies to hepatitis B, which will protect the child from infection with the virus. Adverse Side Effects: Pain with injection
Promoting Parental-Babe Bonding
The best relationship between a parent and infant occurs when they are able to have early and extended contact. The nurse assists in the zipper, or bonding, process by encouraging parents to see, bear upon, and hold their newborn baby. With a good for you babe, practices to promote attachment rarely interfere with its transition to extrauterine life.
Special Considerations: Culture & ETHNICITY
In Chinese-American families, the new baby is the centre of focus and attention. Likewise, Ethiopians and Eritreans consider the female parent and baby delicate; every endeavour is made to protect them from affliction and harm. Childbearing is a joyful outcome; family and neighbors gloat with food and gift-giving. Korean and Mexican-American family members are expected to assist the new mother, then that she can focus on the baby.
Immediately after birth, one of the near important events that occurs is the formation of family relationships. The healthy, nonmedicated infant is in a state of "taking in" his or her environment. The mother is in a menstruum called the "maternal sensitive menstruation," which fosters the process of bonding.
Forming a bond with the babe begins during pregnancy. During the first hour after birth, the baby and parents take the next step in bonding, setting the stage for a loving human relationship. It may seem obvious, but for bonding to happen,the parents and the baby must be together. Behaviors that indicate this beginning attachment include:
• The mother moves from touching with her fingertips only, to stroking and massaging her baby.
• The mother and baby presume the en face up position, in which their heads align as they look at each other.
• The parents speak to the infant in high-pitched voices.
The nurse can facilitate bonding past keeping the baby and female parent together; placing the naked baby betwixt the female parent'southward breasts (skin-to-pare contact); delaying eye prophylaxis until afterwards this critical time period; and joining in the parents' happy exploration of the miracle of their newborn.
CHARACTERISTICS OF THE NORMAL NEWBORN
Each newborn is different, simply some characteristics are mutual to all newborns.
Weight and Length
At birth, the weight of a healthy newborn ranges from 5.5 to 9.v pounds (ii,500 to 4,250 1000). The boilerplate total-term infant weighs 7.5 pounds (3,500 k). Girls unremarkably weigh less than boys (see Fig. 67-2A and In Practice: Nursing Process 67-3).
Nursing Alert Be sure to gather all needed supplies and equipment before starting to weigh the baby Never leave the infant unattended for even a moment.
Key Concept Counterbalance the baby each solar day to note the babys condition and progress. Expect a weight loss of 5% to 10% from the birthweight before the baby begins to gain weight from feedings.
Normal newborn length ranges from eighteen to 22 inches (46 to 56 cm), with boys usually existence approximately one-half inch longer than girls. The easiest way to measure an infant's length is to make a mark on the crib canvass at the acme of the baby's head, then stretch the legs downward to their full length. Make some other mark on the sheet, and measure out between the two marks (Fig. 67-2B).
Head and Body
The newborn has a large head, averaging 13 to 14 inches (33 to 35.five cm) in circumference. A short neck supports it. The chest is somewhat smaller than the head, ten to 12 inches (25.five to 30.5 cm) in circumference. The head commonly measures one to 2 inches (2.5 to 5 cm) more than than the chest (see Fig. 67-2C and In Do: Nursing Procedure 67-4).
Head
The newborn'south caput may accept an irregular shape due to the events of labor and nascence. If the newborn was born past cesarean delivery without the mother laboring, the head is ordinarily round. If the newborn was delivered vaginally, the head may testify temporary molding (elongation) considering of the overlap of skull basic during the birth process.
FIGURE 67-2 · (A) Weighing a newborn. Observe the protective paw held over the babe. (B)Length should be measured shortly after birth, to serve every bit a baseline from which to estimate future growth. (C) The circumference of the head is measured by placing a not-stretchable record measure out merely above the eyebrows and over the nearly prominent office of the occiput.
Caput succedaneum results from an accumulation of fluid within the newborn's scalp (Fig. 67-3A). This swelling is caused by pressure to the head during delivery. The fluid causes the scalp to be puffy and edematous, and the edema crosses the midline of the babe'southward scalp. The condition disappears inside a few days. Cephalohematoma is an accumulation of claret between the bones of the skull and the periosteum, the membrane that covers the skull (Fig. 67-3B). This swelling stops at the midline. The newborn's advent may upset the parents. It is important to reassure them that the fluids will eventually be absorbed.
Fontanels. The fontanels are the "soft spots" in the newborn's skull, formed at the junction of the individual skull bones. These bones do not fuse completely before nascency, so that the caput can mold to fit through the mother's birth canal. Ii major fontanels can be felt. The anterior fontanel is found just in a higher place the forehead; it is diamond shaped. The anterior fontanel closes between the ages of 12 and xviii months. The posterior fontanel, located on the crown of the caput (near the back of the caput or occiput), is smaller and more triangular. It closes by the tertiary month of life.
Face. Newborns typically have pocket-size faces, flattened noses and ears, and receding chins. The newborn's eyes appear bluish or gray at nascence. He or she may await cross-eyed because the optics are unable to focus. The newborn usually has eyelashes and eyebrows at nativity. He or she keeps the optics closed nearly of the time because they are even so sensitive to vivid lights. During the first several weeks, the newborn is unable to produce tears because the lacrimal (tear) glands are not yet functioning.
The top of the ear should be at or above an imaginary line drawn from the inner canthus of the eye to the outer can-thus. The ears are functional at birth, only hearing improves over the kickoff 2 or 3 days, as the fluid in the eustachian tube is replaced with air.
FIGURE 67-three · (A) Caput succeda-neum: From the pressure of the birth canal, an edematous surface area is present beneath the scalp. Notation how it crosses the midline of the skull. (B) Cephalhematoma: A pocket-size capillary beneath the periosteum of the skull bone has ruptured, and blood has collected under the periosteum of the bone. Annotation how the swelling now stops at the midline. Because the claret is contained under the periosteum, it is necessarily stopped by a suture line.
Body
The normal newborn has a round chest and a slightly protruding abdomen. Engorgement of the breasts is common for the get-go 2 or 3 weeks of life in both boys and girls. This is one effect of no longer being nether the influence of the hormones of pregnancy from the mother's body. Another effect is that the baby's breasts may produce a small corporeality of fluid, known by the unusual term "witch's milk." The nurse should assure the parents that this is common and that trying to express the milk may effect in the complexity of infection.
The genitals may exist swollen, particularly in girls, as well as in whatsoever baby who was born in a breech position. The genitals of the female babe may be enlarged and take a mucoid, white, or blood-stained belch. This is called pseudomenstruation. The swelling and discharge will disappear spontaneously within about a week.
In male newborns, the scrotum usually appears relatively large and may have darker pigmentation than the parents look. This is because of the mother's hormones and will fade within a few weeks.
At term, the boy's testes normally can be either felt within the scrotum or easily stroked down from the inguinal canal. The foreskin, or prepuce, covers the glans of the penis and is ofttimes adherent at birth. If the opening of the foreskin is so small that it cannot exist pulled back at all, the status is chosen phimosis. The penis should be inspected to make up one's mind the location of the urinary meatus, which should be at the very tip of the penis. If information technology is located on the underside of the penis (almost the scrotum), it is termed hypospadias. A less common location is on the upper side of the penis; this is called epispadias.
Skin
Skin Color and Texture
A white newborn'south peel is pink or red in the starting time few days after birth. The skin of nonwhite babies may announced pink or tan, with some pigment changes occurring within hours or days of delivery. The newborn'southward skin should become smooth and of a color typical of its race within 2 weeks.
Considering of slowed peripheral circulation, the newborn's arms and legs may appear cyanotic; this condition is called acrocyanosis. It is common in the starting time 24 hours of life and is more prominent when the newborn is exposed to common cold. It is not a serious status.
Nursing Alert Report generalized cyanosis or pallor (paleness), which may signal a eye defect or respiratory disorder Report at once any jaundice that appears, especially within the first 24 hours.
The newborn's skin may be dry and peeling for a few days, and the skin may even show dry cracks in the folds of the wrists and ankles. The skin too may desquamate (peel) in large or pocket-size flakes.
Bumps, Rashes, and Other Marks
The nose and cheeks may have pinhead-sized white spots, caused by unopened oil and sweat glands. These spots are called milia. Sometimes white or greyness bumps known as Epstein'southward pearls are plant on the oral fissure's hard and soft palate.
You may see diverse types of marks on the skin. Some disappear early on in life; others are permanent birthmarks. If forceps or a vacuum extractor has been used for delivery, minor bruises or swollen areas may announced on the face or caput.
A marking that often appears on the newborn'south eyelid or forehead is called a stork bite. This type of mark generally fades during infancy, although it sometimes persists into adulthood. A port-vino stain is a flat, majestic-scarlet area with sharp borders; this is a permanent birthmark. The peel of some newborns is sensitive; many newborns develop a scarlet, raised rash known equally erythema toxicum.
Petechiae, small-scale purplish dots on the skin, are due to pressure level caused by labor and will fade. Veins may exist visible over the entire body. Dark blue areas of discoloration called Mongolian spots ofttimes announced on the buttocks, lower dorsum, or upper legs of nonwhite babies. These spots ordinarily disappear past early babyhood. It is important to know that they take no relationship to "Mongolism" or Down syndrome.
Hair and Vernix
Fine, downy hair, called lanugo, may exist seen on the face up, shoulders, and back. A white, thick, cheesy fabric may as well cover the pare. Chosen the vernix caseosa, information technology is composed of epithelial cells and the secretions of glands. Information technology protects the skin from the drying effects of amniotic fluid in utero and is especially noticeable in the hair and skin creases. Both the quantity of lanugo and the amount of vernix decrease with gestational historic period; a term baby volition usually accept less than a preterm babe.
NCLEX Warning Be alert to questions discussing * the physical appearance and typical behaviors of a newborn. The clinical scenario may reflect the demand for pedagogy any of the multiple aspects of care of the infant. Condom issues might be the focus of an NCLEX question.
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