Nursing Care Plan (NCP) for Newborns
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Outline
Lesson Objective for Nursing Care Plan (NCP) for Newborns
Upon completion of this care plan, nursing students will be able to:
- Demonstrate proficiency in newborn assessment, including physical examination, vital sign monitoring, and assessment of developmental milestones.
- Implement evidence-based nursing interventions for routine newborn care, emphasizing safety, comfort, and bonding between the newborn and the family.
- Differentiate between normal newborn variations and potential signs of complications, recognizing the importance of early identification and intervention.
- Provide comprehensive education to parents and caregivers on newborn care practices, feeding, sleep patterns, and signs of well-being or concern.
- Apply ethical and culturally sensitive care practices when providing care to newborns and their families.
- Demonstrate empathy and emotional support in interactions with parents, recognizing the significance of the postpartum period and the transition to parenthood.
Pathophysiology for Nursing Care Plan (NCP) for Newborns
The pathophysiology of newborns refers to the understanding of the physiological processes and deviations from normal that can occur in the first few weeks of life. While many newborns are born healthy, some may experience transitional changes or conditions that require special attention. Here’s an overview of key aspects of newborn pathophysiology:
- Fetal-to-Neonatal Transition:
- Normal Process: The transition from intrauterine life to extrauterine life involves changes in the cardiovascular, respiratory, and metabolic systems.
- Deviation: Premature infants or those born with respiratory distress may struggle with the transition, leading to respiratory distress syndrome (RDS) or transient tachypnea of the newborn (TTN).
- Respiratory System:
- Normal Process: Initiation of breathing is triggered by the mechanical compression of the chest during birth, leading to increased oxygen levels and decreased carbon dioxide levels.
- Deviation: Conditions such as meconium aspiration, respiratory distress syndrome, or congenital anomalies can impact respiratory function.
- Cardiovascular System:
- Normal Process: Closure of fetal shunts (ductus arteriosus, foramen ovale) and establishment of pulmonary circulation occur in the first hours to days after birth.
- Deviation: Conditions like persistent pulmonary hypertension of the newborn (PPHN) or congenital heart defects may affect circulatory adaptation.
- Thermoregulation:
- Normal Process: Newborns adjust to extrauterine temperatures through mechanisms like brown fat metabolism and non-shivering thermogenesis.
- Deviation: Preterm infants, in particular, may struggle with maintaining body temperature, leading to hypothermia.
- Metabolism and Nutrition:
- Normal Process: The transition from fetal to neonatal nutrition involves a switch from reliance on glucose to utilizing stored energy, especially if breastfeeding.
- Deviation: Conditions like hypoglycemia or metabolic disorders can affect energy metabolism.
- Hematopoietic System:
- Normal Process: Physiologic anemia occurs in the first few months of life as fetal hemoglobin is replaced by adult hemoglobin.
- Deviation: Conditions such as hemolytic disease of the newborn (HDN) or polycythemia may affect the blood.
- Infection and Immunity:
- Normal Process: Newborns have some degree of passive immunity from maternal antibodies, but their immune system is still developing.
- Deviation: Newborns are vulnerable to infections, especially if maternal antibodies are insufficient or if there are breaches in infection control practices.
- Renal System:
- Normal Process: Adaptation of renal function to excrete waste and regulate fluid and electrolyte balance.
- Deviation: Renal anomalies or conditions like transient tachypnea can impact fluid balance and renal function.
- Neurological Development:
- Normal Process: Rapid neurological development, including the establishment of basic reflexes and sensory functions.
- Deviation: Conditions like hypoxic-ischemic encephalopathy (HIE) or congenital neurological abnormalities can affect neurodevelopment.
Etiology for Nursing Care Plan (NCP) for Newborns
The term “etiology” typically refers to the cause or causes of a disease or condition. In the context of newborn care, it’s important to consider various factors that can influence the health and well-being of a newborn. Here are key etiological factors to consider:
- Perinatal Factors:
- Contributing Factors: Conditions or events occurring during the perinatal period, including maternal health, prenatal care, and labor and delivery complications.
- Examples: Maternal infections, gestational diabetes, preterm birth, birth trauma, or complications during delivery.
- Genetic Factors:
- Contributing Factors: Inherited factors that may influence the newborn’s health and susceptibility to certain conditions.
- Examples: Genetic disorders, congenital anomalies, or family history of specific health conditions.
- Environmental Factors:
- Contributing Factors: External elements that can impact the newborn’s health, including the physical environment, exposure to toxins, and socioeconomic factors.
- Examples: Air quality, parental smoking, socioeconomic status, and access to healthcare resources.
- Infectious Factors:
- Contributing Factors: The presence of infections that can affect the newborn either during the prenatal period, at birth or in the postnatal period.
- Examples: Maternal infections (e.g., rubella, cytomegalovirus), neonatal infections (e.g., sepsis), or exposure to environmental pathogens.
Desired Outcome for Nursing Care Plan (NCP) for Newborns
The desired outcomes for a nursing care plan focused on newborns aim to ensure the well-being of the infant, promote family bonding, and provide a foundation for a healthy start in life. Here are the key desired outcomes:
- Newborn Stability:
- Short-Term Goal: Achieve and maintain stable vital signs within normal ranges.
- Interventions: Monitor heart rate, respiratory rate, temperature, and blood pressure regularly. Implement interventions to address any deviations from normal.
- Successful Fetal-to-Neonatal Transition:
- Short-Term Goal: Facilitate a smooth transition from intrauterine to extrauterine life.
- Interventions: Provide warmth, initiate and support breastfeeding, and monitor for signs of respiratory distress. Intervene promptly if needed.
- Optimal Respiratory Function:
- Short-Term Goal: Ensure effective respiratory function with no signs of distress.
- Interventions: Monitor respiratory rate and effort, assess lung sounds, and provide support as needed, such as oxygen therapy or respiratory interventions for conditions like transient tachypnea of the newborn.
- Cardiovascular Adaptation:
- Short-Term Goal: Facilitate closure of fetal shunts and establishment of pulmonary circulation.
- Interventions: Monitor heart sounds, assess for signs of congenital heart defects, and provide support as needed.
- Thermoregulation:
- Short-Term Goal: Maintain normal body temperature.
- Interventions: Ensure a warm environment, promote skin-to-skin contact, and use appropriate thermal protection, especially for preterm infants.
- Stable Metabolism and Nutrition:
- Short-Term Goal: Achieve stable blood glucose levels and establish feeding patterns.
- Interventions: Monitor blood glucose levels, support breastfeeding or formula feeding, and provide education to parents on newborn feeding cues.
- Infection Prevention:
- Short-Term Goal: Minimize the risk of infections.
- Interventions: Implement infection control practices, promote hand hygiene, and educate parents on measures to prevent infections.
Subjective Data
- Crying
Objective Data
- Normal vital signs
- Weight gain
- Reflexes intact
- Newborn resting comfortably
- Skin intact
Nursing Assessment for Nursing Care Plan (NCP) for Newborns
- Initial Assessment:
- Time of Birth: Document the time of birth and initial assessments performed by the delivery team.
- Apgar Score: Record the Apgar score at 1 and 5 minutes after birth, assessing the newborn’s appearance, pulse, grimace response, activity, and respiration.
- Physical Examination:
- General Appearance: Assess overall appearance, noting skin color, posture, and presence of any anomalies.
- Vital Signs: Measure and record vital signs, including heart rate, respiratory rate, temperature, and blood pressure.
- Head and Fontanelles: Examine the head for symmetry, fontanelle tension, and any abnormalities.
- Eyes: Check for symmetry, red reflex, and any discharge.
- Ears: Inspect for position, size, and anomalies.
- Nose: Assess for patency and signs of nasal flaring.
- Mouth: Examine the palate, tongue, and oral mucosa.
- Neck: Inspect for range of motion and presence of neck webbing.
- Chest and Lungs: Auscultate lung sounds, assess chest movement, and note any signs of respiratory distress.
- Heart: Auscultate heart sounds and assess for murmurs or irregularities.
- Abdomen: Palpate for organ position, distension, and assess umbilical cord.
- Genitalia: Inspect for normal anatomy and identify gender.
- Extremities: Check for symmetry, range of motion, and presence of extra digits.
- Skin: Assess for color, temperature, and any abnormalities.
- Reflexes: Perform reflex assessments, including the Moro reflex, rooting reflex, and grasp reflex.
- Neonatal Behavioral Assessment Scale (NBAS):
- Sleep-Wake States: Observe the newborn’s sleep patterns and responsiveness to stimuli.
- Motor System: Assess muscle tone, movements, and reflexes.
- Social Interaction: Observe the infant’s response to visual and auditory stimuli.
- Physiological Responses: Monitor for signs of stress or discomfort.
- Feeding and Elimination:
- Breastfeeding/Formula Feeding: Assess the infant’s ability to latch onto the breast or bottle-feed.
- Urination and Stooling: Document the frequency and characteristics of urination and bowel movements.
- Laboratory and Diagnostic Tests:
- Newborn Screening: Ensure that appropriate screening tests, such as the newborn metabolic screening, are conducted.
- Blood Glucose Monitoring: Monitor blood glucose levels, especially in at-risk infants.
- Parental Interaction:
- Observation: Observe the interaction between the newborn and parents, assessing bonding and responsiveness to parental stimuli.
- Documentation:
- Accurate Recording: Document all assessment findings accurately and comprehensively.
- Growth Parameters: Record birth weight, length, and head circumference.
- Patient Education:
- Feeding Education: Guide breastfeeding techniques, formula feeding, and signs of hunger or satiety.
- Hygiene and Cord Care: Instruct parents on newborn hygiene, including cord care.
- Follow-Up Assessments:
- Routine Assessments: Plan for routine assessments in the postnatal period, including hearing tests and additional screenings.
- Documentation of Developmental Milestones: Monitor and document the achievement of developmental milestones.
Nursing Interventions and Rationales
| Nursing Intervention (ADPIE) | Rationale |
| Immediate needs of Newborn from birth-
Aspiration of mucus apgar score (based on HR, respiratory effort, muscle tone, reflex irritability, and skin color) maintenance of body temp (drying, wearing a hat, warm blankets) eye care/injections (Erythromycin oint, Vit K, & Hep B) constant obs of condition ID bands (one on the wrist, one on the ankle) |
clear baby’s airway of mucus
Apgar score is the cardiorespiratory adaption at birth Body temperature-prevent from acidosis Erythromycin-eye oint to prevent ophthalmia neonatorum VIT K- prevent bleeding probs until the infant can produce its clotting factors Hep B- prevent newborn from acquiring Hep B (need consent for this) Constant Obs for any changes in condition Baby and parents are tagged for having access to the baby |
| Full Head-to-Toe Assessment-
VS, General appearance, reflexes) Ex: jaundice, umbilical cord, Mongolian spots, head shape, cleft lip/palate, sacral dimple Reflexes (rooting, sucking, grasp, startle/Moro, Babinski, step/dance, tonic neck) |
complete assessment shows if there are any abnormalities with the infant that need to be addressed immediately
Reflexes- these are the first building blocks of the future development of a newborn. What starts as reflexes will soon turn into purposeful, cognitive, and physical activity |
| Assisting with breastfeeding
Lactation consult if needed |
making sure baby latches on properly and is feeding well by the mom, if having issues, can get a lactation consult to help assist so baby is getting proper nutrition |
| Assess newborn weight daily | after the mother’s milk comes in, the newborn should start to gain weight. Normal to lose about 5-10% weight within the first few days. If the newborn is not gaining weight at all, there could be a feeding issue/other problem to look into |
| Educate on:
-newborns elimination patterns -circumcision for males -bathing First 24 hours-1 wet diaper/1 stool Day 3- (3-4 wet diapers/1-2 stools) and change from Meconium to yellowish color Day 4-(after milk has come in)- >6-8 wet diapers/3 stools per 24 hours Circumcision-Main complication (hemorrhage & infection), glucose water on pacifier, use petroleum jelly on site) |
want to be sure that the newborn is taking in enough nutrients and having normal elimination patterns/stool with no complications before discharge home
-note: after male circumcision, must void before discharge Circumcision- glucose water or gel on a pacifier is very soothing The use of petroleum jelly on site after the procedure helps keep the diaper from sticking to the incision Note: yellow exudate that forms on the 2nd day should not be removed. It is a sign of healing, not an infection Bath- main things to make sure baby’s axillary temp is warm enough and check water temp with the inner forearm |
| Newborn Discharge Teaching- when to call the physician | once the family is home with the newborn, it is important to educate them on when it is appropriate to call the doctor or to be seen right away for any complications that may arise |
| Newborn genetic testing-hearing screening/pulse ox screening
PKU, hypothyroidism, Galactosemia, maple syrup urine disease, sickle cell anemia, Tay Sachs Disease) |
a blood test that screens for multiple genetic/metabolic disorders. Done at discharge and repeated at 7-10 days of age
Hearing screening to see if the infant may be deaf or hard of hearing Pulse ox screening (24-48 hours)- to detect if the baby might have CCHD (Critical congenital heart disease) |
Evaluation for Nursing Care Plan (NCP) for Newborns
- Vital Sign Stability:
- Criteria: Consistent maintenance of normal vital signs, including heart rate, respiratory rate, temperature, and blood pressure within age-appropriate ranges.
- Successful Transition:
- Criteria: Evidence of a successful transition from intrauterine to extrauterine life, as indicated by stable Apgar scores, effective respiratory efforts, and appropriate physiological adaptations.
- Feeding and Elimination Competence:
- Criteria: Demonstration of adequate feeding ability, whether through breastfeeding or formula feeding, along with appropriate urine and stool output. Monitoring for weight gain and signs of hydration.
- Parental Engagement and Education:
- Criteria: Observation of positive parental interaction, engagement, and confidence in caring for the newborn. Assess the understanding and application of feeding practices, hygiene, and any provided education.
References
https://my.clevelandclinic.org/health/articles/9705-newborn-care-in-the-hospital
https://newbornscreening.hrsa.gov/newborn-screening-process
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Transcript
Hey everyone. Today, we’re going to be creating a nursing care plan for newborns. So let’s get started. First, we’re going to go over the pathophysiology. So relating to the period immediately succeeding birth is continued to the 28 days of extra uterine life is considered to be newborn. Nursing considerations: immediate postpartum assessment, assisting with breastfeeding, assessing daily weight, educating mother and family on newborn care, and discharge teaching. Desired outcome: the newborn will feed properly and have normal vital signs, proper elimination patterns, and be free from infection. Caregivers will be properly educated on newborn care and signs and symptoms of when to call the physician.
So we’re going to go ahead and get started on a care plan. We’re going to be listing out some subjective data and some objective data. Some newborn subjective data: you tend to see them crying, especially early on. Some objective data: going to make sure that these babies have normal vital signs, their reflexes are intact, and their skin is intact. We want to make sure that they are gaining weight properly as well.
Interventions are what we’re going to do for newborns. This is going to be for the immediate needs of a newborn from the moment that they are born. So we’re going to talk about some of the immediate needs, right when they’re born. So one of the first things is aspiration. The mucus. You’re going to be doing an APGAR score, and that is based on the heart rate, respiratory effort, muscle tone, reflex ability and the skin color. We’re going to also maintain body temperature. So the drying, making sure that the newborns are wearing a hat, and having a warm blanket. We’re going to be doing eye care and doing injections. So we’re going to be applying that erythromycin ointment, a vitamin K injection and a Hep B injection. We’re going to make sure we’re doing constant observation of the newborn. We’re going to be applying ID bands. So we’re going to be putting one on the wrist, one on the ankle. We’re also going to make sure we’re clearing the baby’s airway of mucus. The APGAR score is the cardiorespiratory adaptation at birth. The body temperature; we want to make sure we’re preventing acidosis, hence the warm blankets and the warm hat. Hep B injection. We want to make sure that we are giving this and the vitamin K injection. We both are giving in the muscle. The baby and the parents will be tagged for having access. Another intervention we’re going to be doing. We’re going to be doing a full head to toe assessment. So after the baby’s born, we’re going to do this full assessment. So we’re going to do a general appearance. We’re going to be checking the reflexes and doing vital signs. So we’re going to be looking at the umbilical cord. If they have anything like a Mongolian spot, and the shape of the head, if they have a cleft lip or a pallet, we’re going to be looking for those things. Reflexes; we’re going to be looking for rooting, sucking, grasping, startle, moro, babinski, and the tonic neck reflex all to which we want to make sure we’re assessing as all of these are the first building blocks. So the first development of a newborn. So what starts out as reflexes are going to soon turn into per purposeful cognitive and physical activity. Another intervention that we’re going to be doing, we’re going to assist with breastfeeding. So we’re going to be helping the mom with breastfeeding. We’re going to get a lactation consultation. If we’re needing help with the mom and able to get the baby latched. If they’re not latching properly, we want to make sure we’re getting that lactation consultation to help assist with the baby to make sure that the baby gets the proper nutrition. Another intervention, we want to make sure that we’re assessing that newborn weight daily. So daily weights. After the mother’s milk comes in, the newborn should be starting to gain some weight. It’s normal for them to lose about 5%, five to 10% of their weight. Within the first few days, if the newborn isn’t gaining weight at all, there could be a feeding issue or any other problem that we need to look into. Another intervention that we want to be doing is a lot of education. So education, we want to make sure that we are educating on elimination patterns, circumcision for males and bathing. So within the first 24 hours there should be a wet diaper and one stool. By day three, there should be three to four wet diapers and one to two stools. And the change from the meconium to that yellowish color on day four, after the milk has come in, there should be greater than 6 to 8 wet diapers and three stools per 24 hours. For circumcision, the main complication is hemorrhage and infection, glucose water on a pacifier and use of petroleum jelly on the site for circumcision. We want to make sure the newborn is taking in enough nutrients and having normal elimination patterns with no complication prior to discharge home. Note, after the male circumcision is complete, we want to make sure that they have voided prior to discharge for bathing. We want to main things with bathing. You want to make sure that the baby’s axillary temperature is warm enough and to check the water temperature with your inner full or arm. Another intervention that we want to be doing is newborn discharge teaching. So we’re going to be doing some discharge teaching. And when to call the physician, once the family’s home with the newborn; it’s important to educate them on when it’s appropriate to call the doctor or to be seen right away for any sort of complications that may arise. The newborn genetic testing we’re going to want to be doing prior to discharge, as well as a hearing and pulse screening. So for genetic testing, that includes PKU, hypothyroidism, urine disease, sickle cell anemia, and Tay Sachs disease. Some blood tests that screens from multiple genetic and metabolic disorders are done at discharge and repeated at seven to 10 days of age. Hearing screening. We, you want to see if the infant has any sort of deficits like heart of hearing, or if they’re deaf and with the pulse screenings, which is typically 24 to 48 hours, we want to detect if the baby might have CCHD or critical congenital heart disease.
All right, so now we’re going to head on to the key points. So newborns are relating to the period immediately succeeding birth and continuing through the first 28 weeks of extra uterine life. Newborns come from within the mother’s womb via vaginal birth, or C-section. Some subjective and objective: babies or newborns do cry, normal vital signs, weight gain, reflexes that are intact, newborn resting comfortably, and their skin that’s intact. You want to make sure we’re doing an immediate assessment post birth, head to toe assessment, assisting with breastfeeding and assessing newborn weight daily, educating on the newborn elimination patterns, feedings, circumcision for males, baths, genetic testing at discharge, hearing screen and pulse screening. Important to have all this education, especially at discharge. And that is the end of that care plan.
You guys did amazing. We love you. Go out, be your best self today, and as always happy nursing.
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