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Chapter 7

NURS 3524 Chapter 7: PEDS Chapter 7 Week 1 Part 1


Department
Nursing
Course Code
NURS 3524
Professor
Mavoy Bertram
Chapter
7

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Nursing care of the newborn and family
Assessment
- Physical assessment after delivery is divided into 4 phases: the initial assessment, the
transitional assessment, assessment of gestational age and comprehensive, systematic physical
examination
- The nurse must be aware of behaviours that signal successful attachment between the parents
and infant.
Initial Assessment
- The Apgar scoring system is the most frequently used method
to assess the newborn’s immediate adjustment to extra-
uterine life.
- The score is based on observation of heart rate, respiratory
effect, muscle tone, reflex irritability and colour.
- Evaluations are made 1 and 5 minutes after birth and are
repeated q5 minutes until the infant’s condition stabilizes.
- The Apgar score is not a tool that stands on its own to
interpret past events, determine need for resuscitation or
predict future events linked to the infant’s neurologic or
physical status.
Transitional assessment
Periods of reactivity
- In the initial 24 hours, changes in HR, respiration, motor activity, colour, mucus production and
bowel activity occur in an orderly, predictable sequence which indicates lack of stress. Distress
child go through these stages at a slower rate.
- Last 6-8 hours after birth: first period of reactivity.
- The first 30 mins: alert, cries vigorously, suck on fingers/fist, interested in environment, eyes
open (parents to see one another), important time to start breastfeeding (full term infant
vigorous suck reflex)
- RR may be 80 breaths/min, HR 180 beats/min, bowel sounds present, ↑mucus production, ↓ in
temperature
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- Second stage of first period of reactivity (2-4 hours): ↓ in HR, RR, temperature (don’t undress or
bath the child at this point) and mucus production, urine and feces usually not passed. Asleep or
calm.
- The second period of reactivity (2-5 hours after the first period): when the infant wakes up from
deep sleep. Good for child and parents to interact. Child more active and alert, HR and RR ↑,
gastric and respiratory secretions ↑. Passage of meconium usually occurs. Period is over when
the amount of respiratory mucus has decreased.
Behavioural assessment
- The principal areas of behaviour for newborns are sleep, wakefulness, and activity such as
crying.
- The Brazelton Neonatal Behavioural Assessment Scale is used to assess the infant’s behaviour.
Patterns of sleep and activity
- First 2-3 days of life, constant sleep
- 6 distinct sleep and wake patterns: 1) quiet (deep) sleep, active (light) sleep, drowsy, awake
(quiet), active alert and crying.
- The ability to make smooth transition between states is called state modulation.
Cry
- Begin life with a strong, lusty cry
- Holding skin to skin or swaddling or wrapping the infant snugly in a blanket (hands should be
free to allow self-calming and avoid over heating) calms the child, promotes sleep and maintains
body temp.
- A weak, groaning cry or grunting during expiration = respiratory disturbance
- Absent, weak or constant crying = investigate.
Clinical assessment of gestational age
- Important because perinatal mortality and morbidity are rt gestational age and birth weight.
- New Ballard Scale is used, can be used with infants as young as 20 weeks.
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