Question

Newborn transition to extrauterine life essentially means the neonate is adapting to life outside of the uterine environment. This adaption begins immediately as the neonate takes in his/her first breath and continues over a period of time; during this time the neonate has periods of reactivity. The events that unfold with the neonate are predictable and involve all body systems.

Baby H is between 18 to 36-hours old

You walk into Baby H’s hospital room and find the temperature is cool, the curtains are open, and grandma has him on the bed with a diaper on and unswaddled. He has a relaxed posture with arms flat at his side, legs stretched out, and he appears to be asleep.

Identify whether or not this is a normal posture and tone for a newborn. What nursing action(s) would be most appropriate at this time? Describe the four different types of heat loss that can occur and provide us with nursing interventions to prevent each. What is important to know about thermogenesis in the neonate? Describe the nursing assessments.

The nurse completes his/her interventions with Baby H. Baby H had his first void immediately after birth, but at 18 hours old, he has yet to have his first stool; when do neonates pass their first stool? Describe stools that occur with the neonate and teach the parents about these stools. What discharge teaching would you provide to the parents about elimination, sleeping/positioning, and umbilical cord care?

Answer 1

The normal posture of a newborn in less than first 48 hours of birth is adduction or flexion.This posture of the neonate can be because of imbalance of body temperature regulations.

The nursing action which will be most appropriate here are

• Adjusting the room temperature to normal
• Swaddling the baby to regulate body temperature
• Closing the curtains to prevent entering of cool breeze or air into the room
• Teaching the grandmother about the techniques and importance of swaddling the baby

The 4 different types of heat loss

1.Radiation:the body itself evaporates some heat from the body

• The neonate has to be hydrated well with breastfeeding
• Avoiding any passive exercise or work on the neonate for a longer time

2.Evaporation:loss of body temperature by perspiration

• Maintain a normal temperature in the nenonates home
• Use cotton clothes to be worn and used for the child
• Avoid unnecessary exposure to extreme temperatures like sunlight

3.Convection :is a method of losing body temperature because of water

• Bathe the child in Luke warm water
• Avoid prolonged tone in bathing the neonate

4.Conduction:the body temperature is lost because of the air

• Do not expose the beinare to hot air
• Avoid using dryer techniques after bath or accidentally

The importance of thermogenesis in neonates are

• To prevent hypothermia
• To decrease the risk for morbidity and mortality

The nursing assessment are

• Monitor vital signs especially the body temperature
• Assess the baby skin tone ,subcutaneous fat
• Nature of skin for moistness or dryness

The bowel movement for neonate is expected within first 48 hours of birth or it can occur in less than 24 hours

The stools of the neonate are dark colored greenish black to black called as malena.As days pass on the stool turns on normal yellow in color. The frequency depends on the number of breastfed or intake .Some neonate may pass just one stool a day and others may pass more than 8 to 10 times a day.Both are normal.It is not a problem if neonate does not pass stop, for one or two days until any major events are notes like vomiting, abdominal distention ,cranky, etc.,

The umblical cord dries and falls down in about 5 to 7 days. Observe for any smelly discharge moozing ,pain to be reported.Normally it has to be kept dry.

Position the baby in supine with slight elevation of head end to avoid any regurgitation. Remove extra pillows clothes from the baby side.