Unit 3 nsg.care of neonate

normal neonate

1. NURSING CARE OF A NEONATE MS. PRIYANKA J SOLANKI ASSISTANT PROFESSOR

2. PEDIA MEAN A CHILD CHILD IS A PERFECT GIFT

3. PAEDIATRICS Pedia Means Child Iatrike means treatment Ics means branch of science

4. “ Pediatric can be defined as the branch of medical science that deals with the care of childhood from conception to adolescent in health and illness. It concern with prevention, promotion, curative and rehabilitative care of children.” 

5. Neonate:  A newborn baby, specifically a baby in the first 4 weeks after birth. After a month, a baby is no longer considered a neonate.

6. The  neonatal period  (birth to 1 month) is a time of extensive and ongoing system transition from uterine environment to external world, this includes the initial  period  after birth which is referred to as the perinatal   period . It would seem obvious to say that development does not stop at birth.

7. A healthy newborn infant born at term, between 38 to 42 weeks, cries, immediately after birth, establishes independent rhythmic respiration, quickly adapts with extra-uterine environment, having an average birth weight and no congenital anomalies.

8. The period from birth to 28 days of life is called neonatal period and the infant in this period is termed as neonate or newborn baby .

9. PHYSICAL CHARACTERISTICS OF HEALTHY NEONATES

10. Anthropometric Measurements Height – 48- 53 cm Weight – 2.5 – 3.5 kg Head circumference – 33- 35 cm Chest circumference - 31- 33 cm Posture : The newborn assumes the attitude of its intrauterine life , i.e. extremities flexed and fists clenched.

11. Head circumference  is a measurement of a child's  head  around its largest area. It measures the distance from above the eyebrows and ears and around the back of the  head .

12. Chest circumference  was measured by means of a steel tape at the level of the nipples, and the measurement taken with the  chest  at rest between maximum inspiration and expiration.

13. vital signs: Temperature : 97.7 degree Celsius i.e. 100 degree Fahrenheit. Pulses: normal- 120-160 beats per min. Respiration: normal- 40- 60breats /min. Blood pressure :normal range 60-70/31- 45mmHg . BP is directly related to gestational age and birth weight of the infant.

14. Posture : The newborn assumes the attitude of its intrauterine life , i.e. extremities flexed and fists clenched.

15. Other characteristics U/L  ratio  ( upper  body  segment  :  lower  body  segment ) at birth is about 1.7; at age 3 years it is 1.3; at greater than 7 years, it is 1.0 with the  upper  body  segment  an lower  body  segment  being about equal.

16. The neonate lies in a posture of partial flexion attitude as in utero.

17. The skin is pinkish but bluish hands and feet ( acrocyanosis ) may present for short time after birth, even in normal infant (1 month to 1 year baby).

18. Skin may be covered with vernix caseosa and lanugo hair es pecially at back.

19. Vernix caseosa , also known as  vernix , is the waxy or cheese-like white substance found coating the skin of newborn human babies. It is produced by dedicated cells and is thought to have some protective roles during fetal development and for a few hours after birth.

20. Lanugo  is the  hair  that covers the body of some newborns. This downy, unpigmented   hair  is the first type of  hair  that grows from  hair  follicles. It can be found everywhere on a baby's body, except on the palms, lips, and soles of the feet. Most fetuses develop  lanugo  around the fourth or fifth month of pregnancy.

21. The head may so moulding and caput succedaneum.

22. When a  baby  is born in a head-first position, pressure on the head in the birth canal may mold the head into an oblong shape. These spaces between the bones allow the  baby's  head to change shape. 

23. “ Caput succedaneum ” refers to swelling, or edema, of an infant's scalp that appears as a lump or bump on their head shortly after delivery . This condition is harmless and is due to pressure put on the infant's head during delivery. It doesn't indicate damage to the brain or the bones of the cranium.

24. The ear cartilage is firm and fully curved , showing good elastic recoil.

25. The eyes are largely covered with eyelids.

26. The breast nodule is palpable, measuring over 5 mm in diameter.

27. The scrotum shows adequate ragae with deep pigmentation and palpable testes(at least one). The labia majora covers labia minora . The sole of foot shows prominent deep creases.

28. The external auditory canal is relatively short and straight.

29. The eardrum is thick. The eustachian tube is short and broad.

30. The healthy neonates cries immediately after birth. Respiration: normal- 40- 60breats /min. The neonate can breath both through nose and mouth. Respiration is usually thoraco -abdominal without any retractions and grunting.

31. Pulses (heart rate): normal- 120-160 beats per min. It irregular and increased during crying and may be slow about 80 to 100 beats/min during sleep.

32. Blood pressure : normal range 60-70 (Systolic)/31-45 (diastolic)mmHg.

33. Temperature : 97.7 degree Celsius i.e. 100 degree Fahrenheit which falls after birth but become normal within 4 to 8 hours.

34. The cry of the newborn baby is vigorous, rooting, sucking and swallowing reflexes are well-developed. The newborn baby is able to take breastfeeding within one hour of birth and than fall a sleep.

35. A reflex that is seen in normal  newborn   babies , who automatically turn the face toward the stimulus and make sucking (rooting) motions with the mouth when the cheek or lip is touched. The rooting reflex helps to ensure successful  breastfeeding.

36. These  reflexes  are involuntary movements that happen either spontaneously or as responses to different actions. The  sucking reflex , for example, happens when the roof of a baby's mouth is touched. The baby will begin to  suck  when this area is stimulated, which helps with nursing or bottle feeding.

37. A neonate s pends about 80 percent of the time in sleeping (about 20 hours p er day). Demand of the feeding usually establishes every 3-4 hours after one week, initially feeding at irregular interval is seen.

38. Energy requirements – 55 cal/kg/day and it increase about 120 cal/kg/day at the end of the first week of age. Protein and carbohydrates are efficiently digested by newborn but the fat is not.

39. Neonate loses about 7-8 Percent of the body weight (may up to 10 Percent) during first week of life . The baby regains birth weight by 10 th day and then continues to gain weight about 20-30 gram/day for the next 3 months of age.

40. The baby passes urine shortly after the birth or within 24 hours or some in 48 hours. Limitations of renal functions lead to dehydration, acidosis, and hyperkalemia . The first stool that known as MECONIUM that passes within 24 hours after birth. It is greenish black colored thick and viscid. It is passed for 3-4 days and 3-4 times a day.

41. The neonate has blood volume about 80 ml/kg of the body weight. RBC - 6-8 million/ cmm Hb : 18 gm percent WBC : 10000-17000/ cmm Platelets : 350000/ cmm ESR is markely eleveted and poor clooting power are seen due to deficient vitamin-k .

42. An  erythrocyte sedimentation rate  ( ESR ) is a type of blood test that measures how quickly erythrocytes (red blood cells) settle at the bottom of a test tube that contains a blood sample. Normally, red blood cells settle relatively slowly. A faster-than-normal rate may indicate inflammation in the body.

43. IgG level high but IgM , IgA , IgE levels are negliable .

44. Neurological mechanisms are immature and not developed anatomically or physiologically. Temperature regulation is not fully developed, heat production is low and infant responds readily to environmental heat and cold.