Running head: NEWBORN ASSESSMENT

Newborn Assessment Katie D. VanderVelde Ferris State University

NEWBORN ASSESSMENT

NEWBORN ASSESSMENT

NEWBORN ASSESSMENT

NEWBORN ASSESSMENT

NEWBORN ASSESSMENT Nursing Diagnosis and Interventions Table

Nursing Diagnosis Effective breastfeeding r/t normal oral structure and gestational age greater than 34 weeks.

Necessary Assessments/Interventions 1) Encourage and facilitate early skin-to-skin contact within 2 hours after birth. 2) Monitor the infants responses to breastfeeding. 3) Avoid supplemental bottle feeding and do not provide samples of formula upon unless otherwise noted. 4) Encourage rooming-in and breastfeeding on demand (Ladwig & Ackley, 2011).

Rationale Early skin-to-skin contact with the mother has a more successful outcome with breastfeeding. Mothers are more likely to breastfeed in the first one to four months, and usually breastfeed longer, if they had early skin-to-skin contact with their babies (Moore, 2013). During skin-toskin contact breastfeeding should be done on demand so connection between the mother and baby happens. Breastfeeding is the best choice for the mother to make in regards to how newborns should be feed. Infants who are breastfed are less likely to experience a variety of infections and to develop chronic conditions later in life (Perrine, Scanlon, Li, Odom, & GrummerStrawn, 2012).Monitoring the newborns responses to breastfeeding shows how much the baby can or cannot handle. Mothers should not be stressed or worried if the baby is not drinking exactly what the recommended amount is. The mother needs to know that the baby will only drink as much as it needs. Many studies have documented that the most common reason for discontinuing breastfeeding in the first 3 months is maternal concern about milk supply (Flaherman & Newman, 2011). Nurses need to watch the response of the baby during

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breastfeeding to make the baby is having a correct latch and sucking appropriately. The newborn has decreased ability to adapt to temperature extremes. Newborns use mechanisms in order to compensate for their lack of adapting to temperature extremes. The amount of brown adipose tissue in the newborn is a key energy source for heat production. However, the premature infant has decreased metabolic processes and nonshivering thermogenesis (Ringer, 2013). For this reason, infants need to receive sufficient fluids and be protected from the hot environment. In addition, the temperature should be kept at 72 degrees Fahrenheit, and the infant should be covered and kept warm. For routine measurements taking temperature in infants less than 4 weeks of age should be in the axilla. Evidence shows that taking temperature in the left axilla in a newborn is an alternative to using rectal temperatures, which minimizes discomfort and potential risk of perforation (Friedrichs, Staffileno, Fogg, Jegier, Hunter, Portugal, & Peashey, 2013). The skin of the newborn is susceptible and sensitive to trauma and infection that requires special care (Sarkar, Basu, Agrawal, & Gupta, 2010). This is why close monitoring of dryness and redness is important. Individualizing the plan of care for the treatment of the newborns skin makes sure the newborn is getting care specific to his needs. All soaps,

Ineffective thermoregulation r/t immaturity of neuroendocrine system.

1) Recognize that the infant is vulnerable to develop heat stroke in hot water; ensure the newborn receives sufficient fluids and is protected from the hot environment. 2) Keep room temperature at 72 degrees Fahrenheit. 3) Take the following actions to maintain body temperature in the infant/child: -Keep the head covered. -Use blanked to keep infant warm. -Keep client covered during procedures, transport, and diagnostic testing. 4) For routine measurement of temperature, use an electronic thermometer in the axilla in the newborn (Ladwig & Ackley, 2011).

Impaired skin integrity r/t dry and thin skin.

1) Individualize plan of care according to the newborns skin condition, needs, and procedures. 2) Monitor site of dryness at least once a day for redness/less dryness, and encourage mother to monitor sites upon discharge. 3) If skin gets dryer implement a treatment plan for topical treatment or coconut oil. 4) Avoid massaging or harsh

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rubbing sites of dryness on the newborn (Ladwig & Ackley, 2011).

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cleansers, and powders should be used with proper indications and cautious judgment. Coconut oil is easily available and economical, which can be applied to neonatal skin (Sarkar, Basu, Agrawal, & Gupta, 2010). The newborn should use treatment that is not harmful to the umbilicus but still helps the skin. In addition, since the newborns skin is sensitive to trauma rubbing and massaging harshly should be avoided, especially while applying treatment to the dry areas. Monitoring the site for less dryness will ensure that the treatment can be lessened.

NEWBORN ASSESSMENT References

Ringer, S. A. (2013). Core concepts: Thermoregulation in the newborn part I: Basic mechanisms. NeoReviews, 14(4), e161-e167. doi: 10.1542/neo.14-4-e161 Flaherman, V. J., & Newman, T. B. (2011). Regulatory monitoring of feeding during the birth hospitalization. Pediatrics, 127(6), 1177-1179. doi: 10.1542/peds.2011-0056 Friedrichs, J., Staffileno, B. A., Fogg, L., Jegier, B., Hunter, R., Portugal, D, & Peashey, J. M. (2013). Axillary temperatures in full-term newborn infants: using evidence to guide safe and effective practice. Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses, 13(5), 361-368. doi: 10.1097/ANC.0b013e3182a14f5a Ladwig, G.B., & Ackley, B.J. (2011). Mosbys guide to nursing diagnosis (3rd Ed.). Maryland Heights, MO: Mosby Elsevier Moore, E. R. (2013). Early skintoskin contact for mothers and their healthy newborn infants. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 42(s1), S86-S86. doi: 10.1111/1552-6909.12177 Perrine, C. G., Scanlon, K. S., Li, R., Odom, E., & Grummer-Strawn, L. M. (2012). Babyfriendly hospital practices and meeting exclusive breastfeeding intention. Pediatrics, 130(1), 54-60. doi: 10.1542/peds.2011-3633 Sarkar, R., Basu, S., Agrawal, R. K., & Gupta, P. (2010). Skin care for the newborn. Indian Pediatrics, 47(7), 593-598. http://link.springer.com/article/10.1007/s13312-010-0132-0