What are some reasons why a newborn would cry?
Why shouldn't try to feed your baby each time that it cries?
?Inform the parents that newborns cry when they are hungry, overstimulated, wet, cold, hot, tired, bored, or need to be burped.
?Instruct the mother not to feed her newborn every time he cries. Overfeeding can lead to stomach aches and diarrhea.
?After ch
What are some quieting techniques?
? Swaddling
? Close skin contact
? Nonnutritive sucking with pacifier
? Rhythmic noises to simulate utero sounds
? Movement (a car ride, vibrating chair, infant swing, rocking newborn)
? Placing the newborn on his stomach across a holder's lap while gentl
How should the newborn be placed while sleeping to prevent SIDS?
Supine position
When are you allowed to bath the baby by immersion?
Bathing by immersion is not done until the newborn's umbilical cord has fallen off and the circumcision has healed, if applicable.
What is the proper way of cleansing a baby?
Move from the cleanest to dirtiest part of the newborn's body
beginning with his eyes, face, and head;
proceed to the chest, arms, and legs;
wash the groin area last.
When would you not want to bathe a baby?
Bathing shouldn't be done immediately after feeding to prevent spitting up and vomiting
.
How can you clean a baby's eyes?
The newborn's eyes should be cleaned using a clean portion of the wash cloth.
Clear water should be used to clean each eye, moving from the inner to the outer canthus.
How to cleanse & care for an
uncircumcised
penis?
In male newborns, to cleanse an uncircumcised penis, wash with soap and water and rinse the penis.
The foreskin should not be forced back or constriction can result.
How to cleanse a female newborn's perineum?
In female newborns, wash the vulva by wiping from
front to back
to prevent contamination of the vagina or urethra from rectal bacteria.
Review on feeding a baby!
? The newborn is
offered the breast immediately after birth
h* and frequently thereafter.
? Newborns need to be breastfed at least
8 to 12 times in a 24-hr period
d*.
? Newborns who are breastfed will average
15 to 20 min per breast
t* and 30 to 40 min fo
Review on # stools & voids for both breastfed/formula babies!
?
Breastfed
newborns should have
3 or more bowel movements
s* per day
?
Formula
(bottle) fed newborns are
less frequent
? Breastfed newborns should have
six or more wet diapers per day
? Formula-fed infants have a similar number of voids.
Cord care
? Before discharge, the cord clamp is removed.
?
Prevent cord infection by keeping the cord dry, and keep the top of the diaper folded underneath it
t*
?
Sponge baths are given until the cord falls off, which occurs around 10 to 14 days
s* after birth. Tu
When is it not appropriate to initiate circumcision?
Circumcision should not be done immediately
following birth because the newborn's level of vitamin K is at a low point, and the newborn would be at risk for hemorrhage
Contraindications for Circumcision
? Newborns born with hypospadias (abnormal positioning of urethra on ventral under-surface of the penis) and epispadias (urethral canal terminates on dorsum of penis) because the prepuce skin can be needed for surgical repair of the defect
? Familiar hist
What are examples of instruments used to perform a circumcision?
Gomco (Yellen) or Mogen clamp, or Plastibell device
Gomco (Yellen) or Mogen clamp
What can you cover the wound with to prevent infection & control bleeding?
? The provider applies the Gomco (Yellen) or Mogen clamp to the penis, loosens the foreskin, and inserts the cone under the foreskin to provide a cutting surface for removal of the foreskin and to protect the penis.
?
The wound is covered with sterile pet
Plastibell device
What should you avoid using w/ circumcision w/ a Plastibell?
? The provider slides the Plastibell device between the foreskin and the glans of the penis.
?The provider ties a suture tightly around the foreskin at the coronal edge of the glans.
?This applies pressure as the excess foreskin is removed from the penis.
What are some Nonpharmacologic methods that can be used to enhance pain management?
Swaddling and Nonnutritive sucking (sucrose pacifier)
What medication can be administered post-procedure?
Liquid acetaminophen
10 to 15 mg/kg can be administered orally after the procedure and repeated every 4 to 6 hr as prescribed for a maximum of 30 to 45 mg/kg/day.
What are the restrictions in terms of feeding the baby before the circumcision?
Newborn will not be able to be bottle feed for up to 2-3 hr prior to the procedure to prevent vomiting and aspiration based on the preferences of the provider.
Newborns who are breastfed can nurse up until the procedure.
What adverse effects should be reported to the doctor after the circumcision?
? Redness
?Discharge
?Swelling
?Strong odor
?Tenderness
?Decrease in urination
?Excessive crying from the newborn
?Frank bleeding
What can form over the glans by day two & what should the parents be told not to do?
Tell the parents that a film of
yellowish mucus (expected finding) can form over the glans by day two, and it is important not to wash it off.
What should parents avoid using to clean the penis?
Teach the parents to avoid using premoistened towelettes to clean the penis because they contain alcohol.
What instructions to provide on how to care and clean the penis after the circumcision?
?Teach the parents to keep the area clean.
?Change the newborn's diaper at least every 4 hr,
?Clean the penis with warm water with each diaper change.
?With clamp procedures, apply petroleum jelly with each diaper change for at least 24 hr after the circu
Nursing interventions: Hemorrhage
? Monitor the newborn for bleeding.
? Provide gentle pressure on the penis using a small gauze square.
?Gelfoam powder or sponge can be applied to stop bleeding.
?If bleeding persists, notify the provider that a blood vessel can need to be ligated.
?Have
Nursing interventions: Cold stress/hypoglycemia
? Monitor the newborn for excessive loss of heat resulting in increased respirations and lowered body temperature.
? Swaddle and feed the newborn as soon as the procedure is over.
Instruction to provide the parents on how to properly clothe their newborn?
? The best clothing is soft and made of cotton.
? Clothes should be washed separately with mild detergent and hot water.
? Dress lightly for indoors and on hot days. Too many layers of clothing or blankets can make the newborn too hot.
? On cold days, cov
How should a newborn be placed while sleeping & how can it be placed while awake?
? Never place the newborn on his stomach to sleep during the first few months of life.
?
The back-lying position is the position of choice.
?The newborn can be
placed on his abdomen when awake and being supervised
d*.
How should the newborn's be made up & what should not be placed inside the crib?
? NEVER provide a newborn with a soft surface to sleep on (pillows or water bed).
? The
newborn's mattress should be firm
m*.
?
NEVER put pillows, toys, bumper pads, or loose blankets in a crib
b*.
?
Crib linens should be tight-fitting
g*.
What should be considered to maintain the safety of a crib?
?The space between the mattress and sides of the crib should be less than 2 fingerbreadths.
?The slats on the crib should be no more than 5.7 cm (2.25 in) apart.
What should you not do to a newborn's neck?
Do not tie anything around the newborn's neck.
Where should and should not a crib be placed?
? The newborn's crib or playpen should be away from window blinds and drapery cords. Newborns can become strangled in them.
? The bassinet or crib should be placed on an inner wall, not next to a window, to prevent cold stress by radiation.
Car seat safety
?
Rear-facing car seat in the back seat
t*
?
Preferably in the middle (away from air bags and side impact)
? Put car seat at a
45 degree angle
? Keep infants in rear-facing car seats until age 2 or until the child reaches the maximum height and weight for
1. a nurse is reviewing care of the umbilical cord with the parent of a newborn. Which of the following instructions should the nurse include in the teaching?
a. Cover the cord with a small gauze square.
B. Trickle clean water over the cord with each diap
a. Covering the cord with a gauze square prevents the cord from drying and encourages infection.
B. Water should not be applied to the cord.
C. The cord should be kept clean and dry. hydrogen peroxide is not applied to the cord site.
d. CORRECT: Folding t
2. a nurse is reviewing contraindications for circumcision with a newly hired nurse. Which of the following conditions are contraindications? (select all that apply.)
a. hypospadias
B. hydrocele
C. Family history of hemophilia
d. hyperbilirubinemia
e. epi
a. CORRECT: hypospadias involves a defect in the location of the urethral opening and is a contraindication to circumcision.
B. hydrocele, a collection of fluid in the scrotal sac, is not a contraindication to circumcision.
C. CORRECT: a family history of
3. a nurse is providing discharge teaching to the parents of a newborn regarding circumcision care. Which of the following statements made by a parent indicates an understanding of the teaching?
a. "his circumcision will heal within a couple of days."
B.
a. The circumcision will heal within a couple of weeks.
B. The yellow mucus should remain in place as part of the healing process.
C. CORRECT: The penis should be cleaned with warm water with each diaper change.
d. a tub bath should not be given until the
4. a nurse is caring for a newborn immediately following a circumcision using a gomco procedure. Which of the following actions should the nurse implement?
a. apply gelfoam powder to the site.
B. Place the newborn in the prone position.
C. apply petroleum
a. gelfoam powder is used to control bleeding when there is a risk for hemorrhage.
B. Newborns should not be placed in the prone position.
C. CORRECT: Petroleum gauze is applied to the site for 24 hr to prevent the skin edges from sticking to the diaper.
5. a nurse is reviewing car seat safety with the parents of a newborn. Which of the following instructions should the nurse include in the teaching regarding car seat position?
a. Front seat, rear?facing
B. Front seat, forward?facing
C. Back seat, rear?fa
a. This is not an appropriate position for the car seat.
B. This is not an appropriate position for the car seat.
C. CORRECT: The newborn should be restrained in a car seat in a rear?facing position in the back seat until 2 years of age.
d. This is not an