NURSING CARE OF FAMILY WITH A NEWBORN - greater than 37 cm (14.

8 in) or less than

33 cm (13.2 in), should be assessed
Neonatal Period
carefully for neurologic involvement
- undergo profound physiologic and - measured with a tape measure drawn
psychological changes at the moment of across the center of the forehead and
birth around the most prominent portion of
- Within minutes, newborn has to initiate the posterior head
respirations and adapt a circulatory
Chest Circumference
system to extrauterine oxygenation.
- Within 24 hours, neurologic, renal, - 2 cm (0.75 to 1 in) less than the head
endocrine, gastrointestinal, and circumference
metabolic functions - measured at the level of the nipples
- Neonatal period-first 28 days of life. - large amount of breast tissue or edema
- Neonate-baby in their first 28 days of of breasts, measurement will not be
life accurate

Physical Profile of a Newborn Temperature

Vital Statistics - 37.2° C (99° F) at birth

- falls almost immediately to below
Weight
normal because of heat loss and
- varies depending on the racial, immature temperature regulating
nutritional, intrauterine, and genetic mechanisms
factors that were present during  Convection –from the body
conception and pregnancy surface to cooler surrounding
- average birth weight of a Filipino air, away from windows and
newborn is 2.8 to 3 kg (6 to 6.6 lbs) cool surroundings(air
- newborn loses 5% to 10% of birth conditioners) reduces
weight (6 to 10 oz)  Conduction- body heat to a
 no longer under the influence cooler solid object in contact,
of salt and fluid-retaining covering surfaces with a
maternal hormones warmed blanket or towel helps
 Diuresis begins to remove high minimize
fluid load.  Radiation- body heat to a cooler
 voids and passes stool solid object not in contact,
Moving as far from the cold
Length surface
- mature female - 53 cm (20.9 in)  Evaporation- conversion of a
- mature males - 54 cm (21.3 in). liquid to a vapor. Newborns are
- limit - 46 cm (18 in) wet as the amniotic fluid on
- rare - great as 57.5 cm (24 in) their skin evaporates, dry
newborns asap (face, hair,
Head Circumference head) a large surface area,
- mature newborn - 34 to 35 cm (13.5 to Covering the hair with a cap,
14 in) remove any wet blankets and
 place the infant on a warm, dry - measurement is somewhat inaccurate,
blanket unless a cardiac anomaly is suspected
 Brown fat - a special tissue
found in mature newborns,
apparently helps to conserve or
produce body heat by
increasing metabolism
(intrascapular region, thorax,
and perirenal area)

Pulse

- fetus in utero - 120 to 160 beats per

minute (bpm)
- after birth, struggles to initiate
respirations, rapid as 180 bpm
- Within 1 hour after birth, average of
120 to 140 bpm
Physiologic Changes in Newborn
- slightly irregular, immaturity of the
cardiac regulatory center in the medulla Cardiovascular System
- Transient murmurs, incomplete closure
- necessary after birth because now the
of fetal circulation shunts
lungs must oxygenate the blood that
- listening for an apical heartbeat for a
was formerly oxygenated by the
full minute, rather than assessing a
placenta
pulse in an extremity
- peripheral circulation remains sluggish
- Always palpate for femoral pulse,
for at least the first 24 hours, common
absence suggests possible coarctation
to observe cyanosis in the infant’s feet
(narrowing) of the aorta
and hands (acrocyanosis), cold feet
Respirations (mittens)
- blood volume - 80 to 110 mL/kg body
- first few minutes - 80 breaths per
weight, 300 mL total
minute
- Hemoglobin level - 17 to 18 g/100 mL of
- at rest - average of 30 to 60 breaths per
blood
minute
- hematocrit - 45% to 50%
- Periodic respirations- irregular
- equally high white blood cell count at
breathing with short periods of apnea
birth - 15,000 to 30,000 cells/mm3
(without cyanosis), last less than 15
- most newborns are born with a lower
seconds, normal
than normal level of vitamin K, they
- observed by watching the movement of
have a prolonged coagulation or
the abdomen, use of the diaphragm and
prothrombin time
abdominal muscles
- intestine is sterile at birth, takes about
Blood pressure 24 hours for flora to accumulate and for
vitamin K to be synthesized, inject vit K
- at birth - approximately 80/46 mm Hg
- 10th day - rises to 100/50 mm Hg
Respiratory System - bile duct obstruction - clay-colored
(gray) stools, bile pigments are not
- first breath - a major undertaking,
entering the intestinal trac
requires a tremendous amount of
- Blood-flecked stools - anal fissure
pressure
- swallowed maternal blood and either
- pulmonary surfactant - fluid in the lungs
vomits fresh blood - black tarry stool
from intrauterine life, ease the surface
after 2 or more days.
tension on alveolar walls, allows alveoli
to inflate more easily than if the lung Urinary System
walls were dry.
- First breath – decreased pulmonary - voids within 24 hours after birth, does
artery pressure – increased PO2, not take in much fluid for the first 24
closure of ductus venosus and umbilical hours may void later than this, do not
arteries and veins due to decreased void within this time should be
flow, closure of foramen ovale examined for the possibility of urethral
- Increased O2 – closure of ductus stenosis or absent kidneys or ureters.
arteriosus - single voiding (15 mL), first 1or 2 days
(30 to 60 mL total), week 1 (300 mL),
Gastrointestinal System
Diapers weighed to determine the
- holds about 60 to 90 mL amount of output
food
- pancreatic enzymes, lipase and Immune System
amylase, remain deficient for the first
few months of life, limited ability to - difficulty forming antibodies until about
digest fat and starch 2 months, prone to infection.
- advisable to feed breastmilk for the first - some immunologic protection, passive
6 months of life antibodies immunoglobulin G (mother),
- first stool (meconium) - within 24 hours immunoglobulin A (colostrum)
after birth, does not pass by 24 to 48 - administered hepatitis B vaccine and vit
hours after birth, possibility meconium K during the first 12 hours after birth
ileus, imperforate anus, or volvulus
Neuromuscular System
- Meconium- a sticky, tar-like, blackish-
green, odorless material formed from Blink Reflex
mucus, vernix, lanugo, hormones, and
carbohydrates that accumulated during - protect the eye from any object coming
intrauterine life near it by rapid eyelid closure, shining a
- Transitional stool- changes in color and strong light and sudden movement
consistency, green and loose in the toward the eye
second or third day of life
- Breastfed (light yellow, sweet-smelling) Rooting Reflex
- Formula fed (bright yellow, slightly
more noticeable odor) - cheek is brushed or stroked near the
- phototherapy lights - bright green corner of the mouth, a newborn infant
stools, increased bilirubin excretion will turn the head in that direction
- serves to help a newborn find food
 - disappears at about the sixth week, Placing Reflex
newborn eyes focus steadily, so a food
source can be seen, and the reflex is no - similar to the step-in-place reflex,
longer needed except that it is elicited by touching the
anterior surface of the lower part of a
Sucking Reflex newborn’s leg against a hard surface
- few quick lifting motions
- newborn’s lips are touched, the baby
makes a sucking motion Plantar Grasp Reflex
- helps a newborn find food
- diminish at about 6 months of age - object touches the sole, the toes grasp
in the same manner as do the fingers
Swallowing Reflex - disappears at about 8 to 9 months in
preparation for walking
- Food that reaches the posterior portion - it may be present during sleep for a
of the tongue is automatically longer period
swallowed
- Gag, cough, and sneeze reflexes, Tonic Neck Reflex
maintain a clear airway
- also called a boxer or fencing reflex,
Extrusion Reflex position simulates that of someone
preparing to box or fence
- extrudes any substance that is placed - newborns lie on their backs , their
on the anterior portion of the tongue heads usually turn to one side or the
- prevents the swallowing of inedible other
substances - head turns where arm and leg extend
- disappears at about 4 months - the opposite arm and leg contract
- does not appear to have a function
Palmar Grasp Reflex - stimulate eye coordination
- disappears between the second and
- grasp an object placed in their palm by
third months
closing their fingers on it
- Mature newborns grasp so strongly Moro (startle) reflex
- disappears at about 6 weeks to 3
months, grasp meaningfully at about 3 - startling a newborn with a loud noise or
months by jarring the bassinet
- hold newborns in a supine position and
Step (Walk)-in-Place Reflex allow their heads to drop backward
about 1 inch, abduct and extend their
- held in a vertical position with their feet
arms and legs
touching a hard surface will take a few
- simulates the action of someone trying
quick, alternating steps
to ward off an attacker, then covering
- disappears by 3 months of age
up to protect himself
- By 4 months, babies can bear a good
portion of their weight unhindered by
this reflex
 - strong for the first 8 weeks, end of the - 3 months, may not be able to lift their
fourth or fifth month, at the same time head or arch their back, but neither
an infant can roll away from danger should they sag into an in verted “U”
position (poor muscle tone)
Babinski Reflex
Deep Tendon Reflexes
- sole of the foot is stroked in an inverted
“J” curve from the heel upward, a Patellar reflex
newborn fans the toes (positive
Babinski sign) - tapping the patellar tendon with the tip
- contrast to the adult, who flexes the of the finger
toes - lower leg moves perceptibly, has intact
- nervous system development is reflex
immature - test for spinal nerves L2–L4
- positive (toes fan) until at least 3
months of age Biceps reflex

Magnet Reflex - place the thumb of your left hand on

the tendon of the biceps muscle on the
- pressure is applied to the soles lying in a inner surface of the elbow, tendon
supine position, he or she pushes back contract than to observe movement
against the pressure - test for spinal nerves C5 and C6
- test of spinal cord integrity
Appearance of a Newborn
Crossed Extension Reflex
Skin
- one leg, lying supine is extended and
the sole of that foot is irritated by being Color
rubbed with a sharp object, the infant
- Ruddy complexion, increased
raises the other leg and extends it, as if
concentration of red blood cells in
trying to push away the hand irritating
blood vessels and a decrease in the
the first leg
amount of subcutaneous fat, fades
Trunk Incurvation Reflex slightly over the first month.
- Gray color – indicates infections
- When lie in a prone position and are - Twin transfusion phenomenon - one
touched along the paravertebral area twin is larger and has good color and
by a probing finger, they flex their trunk the smaller twin has pallor
and swing their pelvis toward the touch - Generalized mottling, common
- Acrocyanosis, blueness of hands and
Landau Reflex feet, normal, 24-48 hr
- Central cyanosis - indicates decreased
- held in a prone position with a hand oxygenation
underneath, supporting the trunk, - Physiologic jaundice - second or third
should demonstrate some muscle tone day of life, considered pathologic if it
 presents within the first 24 hours after - Erythema Toxicum - newborn rash, flea-
birth, Phototherapy is given bite rash, eosinophils reacting to the
- Pallor, anemia caused by excessive environment as the immune system
blood loss, inadequate flow of blood, matures
fetal–maternal transfusion, low iron - Forceps Marks - circular or linear
stores, blood incompatibility contusion matching the rim of the blade
- Harlequin Sign - asymmetric flushing of the forceps on the infant’s cheek
and sweatin g of the face
Head
Birthmarks
Molding
- Hemangiomas - vascular tumors of the
skin - abnormal head shape that results from
 Nevus Flammeus (port wine pressure on the baby's head during
stain) - deep color, macular childbirth
purple or dark-red, appear on - infant’s head that engaged the cervix
the face and thighs molds to fit the cervix contours during
 Strawberry Hemangioma - labor
elevated areas formed by
Caput Succedaneum
immature capillaries and
endothelial cells, high estrogen
- edema of the scalp at the presenting
levels of pregnancy, disappear
part of the head
in time (10 years old)
 Cavernous Hemangioma - Cephalhematoma
dilated vascular spaces, do not
disappear, removed surgically - collection of blood between the
- Mongolian Spots - collections of periosteum of a skull bone and the
pigment cells (melanocytes), slate-gray bone itself, is caused by rupture of a
patches across the sacrum or buttocks, periosteal capillary because of the
disappear by school age without pressure of birth
treatment
- Vernix Caseosa - white, cream cheese– Craniotabes
like substance that serves as a skin
lubricant, handle newborns with gloves - localized softening of the cranial bones,
to protect yourself from exposure infant takes in calcium in milk
- Lanugo - fine, downy hair that covers a
Mouth
newborn’s shoulders, back, and upper
arms, Epstein’s pearls
- Desquamation – dryness on the palms
of the hands and soles of the feet, - small, round, glistening, well
peeling similar to those caused by sun circumscribed cysts on the palate, a
burn result of extra calcium
- Milia - pinpoint white papule (a plugged
or unopened sebaceous gland)
Female Genetalia - score of 0 - indicates no respiratory
distress
Pseudomenstruation - Scores of 4 to 6 - indicate moderate
distress
- mucus vaginal secretion, which is - 7 to 10 - indicate severe distress
sometimes blood-tinged, action of
maternal hormones Brazelton Neonatal Behavioral Assessment
Scale
Assessment of Well Being
- evaluate a newborn’s behavioral
APGAR SCORING capacity or ability to respond to set
stimuli
- measure of the physical condition of a
 habituation
newborn infant
 orientation,
 motor maturity,
 variation,
 self-quieting ability, and
 social behaviour
- High score - a neurologically well
developed infant
- Low score - a sluggish infant who need
help in responding to social situations,
or possible brain damage

Developmental Milestones of Infants

One to Three Months

- less than 4, needs resuscitation.
- learning to live in the outside world.
- score of 4 to 6, may need clearing of the
airway and supple mentary oxygen Four to Six Months
- 7 to 10, adjusting well
- repeated every additional 5 minutes - learning to reach out and manipulate
the world around them
The Silverman and Andersen index - mastering the use of those amazing
tools, their hands, discovering their
- estimate degrees of respiratory distress
voices
in newborns
Seven to Nine Months

- figuring out how to move forward or

backward
Ten to Twelve Months - believed that personality developed
through a series of childhood stages in
- they might look and act more like a which the pleasure-seeking energies or
toddler libido become focused on certain
- “pincer grasp“ -- meaning they can hold erogenous areas
small objects - erogenous zone is characterized as an
area of the body that is particularly
Stages of Development sensitive to stimulation
 personality is mostly
- help you track whether your child is
established by the age of five
developing at the correct pace
1. The Oral Stage Age Range: Birth to 1
Newborn: During the first two months of life, Year Erogenous Zone: Mouth
react automatically to external stimuli. By the - develops a sense of trust and comfort
third month of life, start to smile at people 2. The Anal Stage Age Range: 1 to 3 years
Erogenous Zone: Bowel and Bladder
Infant: A lot of new abilities develop quickly by Control
the time a child turns one year old. - toilet training, sense of accomplishment
and independence
At three to six months of age, recognize familiar 3. The Phallic Stage Age Range: 3 to 6
faces, begin to babble, control their head Years Erogenous Zone: Genitals
movements and bring their hands together - discover the differences between males
and females
By six to nine months of age, start sitting - Oedipus complex- young boys wanting
without support, may bounce when held in a to possess the mother and the desire to
standing position and respond to people calling replace the father
their name, start communicating with gestures - Electra complex- young girls of wanting
to possess the father and the desire to
Between nine and 12 months old, can point at
replace the mother
things, pick up objects, crawl and even stand
- Penis envy- very young girls feel
with support, can imitate sound and gestures
deprived and envious that they do not
have a penis
Toddler: When children are between one and
4. The Latent Period Age Range: 6 to
three years of age
Puberty Erogenous Zone: Sexual
Preschool: Between three and five years of age, Feelings Are Inactive
children’s motor skills become refined - development of social and
communication skills and self-
School-age: School-age is the age between six confidence.
to 17 years old 5. The Genital Stage Age Range: Puberty
to Death Erogenous Zone: Maturing
Theories of Development Sexual Interests
- establish a balance between the various
Freud’s Psychoanalytic Theory life areas

- Sigmund Freud (1856–1939), Austrian

neurologist
Erikson’s Theory of Psychosocial Development

- Erik Erikson (1902–1996) Kohlberg’s Theory of Moral Development

- theory that stresses the importance of
culture and society in development of - Lawrence Kohlberg (1927–1987),
the personality American psychologist
- believed people experience a conflict - developed a theory on the way children
that serves as a turning point in gain knowledge of right an d wrong or
development moral reasoning
 Level 1. Preconventional
Morality, lasts until around the
age of 9
Stage 1 (Obedience and
Punishment). way to avoid
punishment
Stage 2 (Individualism and
Exchange) Reciprocity
 Level 2. Conventional Morality,
acceptance of authority and
conforming to the norms of the
group
Stage 3 (Developing Good
Interpersonal Relationships).
living up to social expectations
and roles
Piaget’s Theory of Cognitive Development
Stage 4 (Maintaining Social
Order). consider society as a
- Jean Piaget (1896–1980), Swiss
whole when making judgments,
psychologist
following the rules, doing one’s
- cognitive development or the way
duty, and respecting authority
children learn and think
- perform experiments, make obser  Level 3. Postconventional
vations, and learn about the world Morality, develop an
understanding of abstract
 The Sensorimotor Stage Ages:
principles of morality
Birth to 2 Years
Stage 5 (Social Contract and
 The Preoperational Stage Ages:
Individual Rights) Rules of law
2 to 7 Years
are important for maintaining a
 The Concrete Operational Stage
society
Ages: 7 to 11 Years
Stage 6 (Universal Principles)
 The Formal Operational Stage
universal ethical principles and
Ages: 12 and Up
abstract reasoning