MCN 273 FINAL EXAM: YOUR A+ GUIDE THROUGH
QUESTIONS AND ANSWERS.
Jaundice Clinical Therapy: Phototherapy
Overhead lights: ensure eye protection, watch for dehydration
Biliblanket: wraps around baby, eye goggles not required, watch I/Os, make sure baby stays warm
Possible exchange of newborn's blood if jaundice is bad
When Jaundice is Concerning
Jaundice <24hrs of life
Jaundice for >2wks
Evaluate Rh/ABO blood types with Coombs test
Newborn Care: Bathing
Ideally delay until 24hrs (except in Hep B and HIV positive mothers)
Sponge bath until cord falls off and circumcision is healed
Water should be warm to the inner aspect of adult forearm
Minimally expose infant
Work cleanest to dirtiest (head to toe)
Don't cut, peel, or bite nails
Newborn Care: Diapering and Dressing
One more layer than you would have on
Keep out of direct sun until 6m when sunscreen can be used
Launder clothes separately with double rinse
Newborn Care: Cord Care
Keep cord dry and exposed to air
Fold diapers around stump
Clean cord and skin around base
Detaches in 7-10 days
Check daily for odor, redness, S/S of infection
Newborn Care: Circumcision
Separation of prepuce from glans
Benefits outweigh risks but ultimately parents' choice
Use analgesia, comfort procedures, assess for signs of hemorrhage, infection
Observe for first void
Apply petroleum gauze/jelly
Gomco or Plastibell
Newborn Care: Circumcision Care
, With each diaper change, clean with warm water and apply petroleum jelly
Always observe for foul-smelling drainage or bleeding
Plastibell will fall off on own ~8 days after circumcision
Light sticky yellow film is normal
Newborn Care: Uncircumcised Care
Don't force foreskin back over penis
Foreskin will retract normally (possibly around 5yrs)
Maintain good hygiene
Newborn Care: Safety
Code pink
Verify identity of newborn
ID bands with sensors
Secure unit
Enforce visitation
Educate parents to ask for staff ID before removing baby
Never leave newborn alone in room
Never lift newborn if parent feels weak or instead y on feet
Protect newborn from infection by encouraging hand-washing
Newborn Care: Sleep and Activity
Place newborn on back to sleep with no other objects in crib
Crib slats should be <2"
Firm, fitted mattress with sheet
Reduce risk of SIDS by room sharing, not bed sharing
Newborn Care: Newborn Screening
Mandated newborn screening tests in all 50 states for phenylketonuria, hypothyroidism, sick cell, cystic
fibrosis, hearing test
Car seat screening (20-30minute test before baby goes home; watches for apnea spells)
Rear face until 2yrs
Newborn Discharge Teaching: When to Call
Axillary temp >37.4C (99.3F) or <36.5C (97.7F)
>1 episode of forceful vomiting or frequent vomiting
Refusal of 2 feedings in a row
Lethargy, difficulty awakening baby
Cyanosis
Absence of breathing >15sec
Inconsolable infant, continuous high-pitched cry
Discharge/bleeding form cord or circumcision site
2 consecutive green watery or black stools
QUESTIONS AND ANSWERS.
Jaundice Clinical Therapy: Phototherapy
Overhead lights: ensure eye protection, watch for dehydration
Biliblanket: wraps around baby, eye goggles not required, watch I/Os, make sure baby stays warm
Possible exchange of newborn's blood if jaundice is bad
When Jaundice is Concerning
Jaundice <24hrs of life
Jaundice for >2wks
Evaluate Rh/ABO blood types with Coombs test
Newborn Care: Bathing
Ideally delay until 24hrs (except in Hep B and HIV positive mothers)
Sponge bath until cord falls off and circumcision is healed
Water should be warm to the inner aspect of adult forearm
Minimally expose infant
Work cleanest to dirtiest (head to toe)
Don't cut, peel, or bite nails
Newborn Care: Diapering and Dressing
One more layer than you would have on
Keep out of direct sun until 6m when sunscreen can be used
Launder clothes separately with double rinse
Newborn Care: Cord Care
Keep cord dry and exposed to air
Fold diapers around stump
Clean cord and skin around base
Detaches in 7-10 days
Check daily for odor, redness, S/S of infection
Newborn Care: Circumcision
Separation of prepuce from glans
Benefits outweigh risks but ultimately parents' choice
Use analgesia, comfort procedures, assess for signs of hemorrhage, infection
Observe for first void
Apply petroleum gauze/jelly
Gomco or Plastibell
Newborn Care: Circumcision Care
, With each diaper change, clean with warm water and apply petroleum jelly
Always observe for foul-smelling drainage or bleeding
Plastibell will fall off on own ~8 days after circumcision
Light sticky yellow film is normal
Newborn Care: Uncircumcised Care
Don't force foreskin back over penis
Foreskin will retract normally (possibly around 5yrs)
Maintain good hygiene
Newborn Care: Safety
Code pink
Verify identity of newborn
ID bands with sensors
Secure unit
Enforce visitation
Educate parents to ask for staff ID before removing baby
Never leave newborn alone in room
Never lift newborn if parent feels weak or instead y on feet
Protect newborn from infection by encouraging hand-washing
Newborn Care: Sleep and Activity
Place newborn on back to sleep with no other objects in crib
Crib slats should be <2"
Firm, fitted mattress with sheet
Reduce risk of SIDS by room sharing, not bed sharing
Newborn Care: Newborn Screening
Mandated newborn screening tests in all 50 states for phenylketonuria, hypothyroidism, sick cell, cystic
fibrosis, hearing test
Car seat screening (20-30minute test before baby goes home; watches for apnea spells)
Rear face until 2yrs
Newborn Discharge Teaching: When to Call
Axillary temp >37.4C (99.3F) or <36.5C (97.7F)
>1 episode of forceful vomiting or frequent vomiting
Refusal of 2 feedings in a row
Lethargy, difficulty awakening baby
Cyanosis
Absence of breathing >15sec
Inconsolable infant, continuous high-pitched cry
Discharge/bleeding form cord or circumcision site
2 consecutive green watery or black stools
