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Baby Care
How Can a Skilled Home Care Nurse Assist You With Your Baby?
Our Home Healthcare Nurses will make a physical assessment of your baby and implement her professional nursing skills and knowledge to train you and help you in the following:
She will obtain a data base to establish the plan of care
Nurse will identify patient or family problems or needs on the patient care plan
Nurse will establish baseline physiologic and developmental data for a child newborn to age 1 year
HHC Nurse is promoting self-care in the home
Nurse knows how to establish normal daily baby routines
Nurse will establish feeding patterns
Nurse will establish sleeping patterns
HHC nurse will pay particular attention to any specific pathology
She is paying attention to any abnormal findings noted on the physical examination
She is monitoring the mother-infant interaction during feeding
She will review and document health history
Nurse will conduct baby assessment including the following:
Nurse reviews baby body systems growth and developmental parameters
Nurse is alert and will report problems or any abnormal physical finding
Nurse will explain techniques of examination to the caregiver or mother
General
Was it a planned pregnancy?
Did the mother have prenatal care? How many visits did she have? At what point in the pregnancy did the mother initiate prenatal care?
Was the baby born at term, or was the infant born prematurely?
What is the baby’s date of birth?
What was the baby’s length and weight at birth?
Has the infant had any health problems since birth?
Is the baby taking any medications?
Is there any family history of serious illness?
How many hours does the baby sleep in a 24-hour period?
Does the baby appear healthy?
Is the baby alert and responsive?
Does the caregiver talk to and maintain eye contact with the baby?
Vital Signs
While the child is sleeping or resting nurse is assessing the apical heart rate for 1 full minute. The heart beat should be strong and regular.
Nurse will assess the respiratory rate for 1 full minute. Young infants may have an irregular respiratory pattern.
She will regularly check Axillary temperature.
Height and Weight
Nurse measures the infant’s height in the following manner by laying the baby on flat surface. Extend the baby’s knee, and flex his or her heel. Using the head and foot as a guide, make a mark on the surface, being careful to mark the level of the heel first. Measure the distance between the two marks while the mother is holding the baby.
Nurse will weigh the baby while he or she is wearing only a diaper. It is preferable to weigh the baby on the same scale and at the same time of the day.
Nurse will compare the baby’s height and weight with the standard growth grid.
If the baby was born prematurely, subtract the number of weeks the baby was early from the expected normal ranges.
Integument/ skin assessment
The baby’s skin should be warm and show no signs of bruising.
Mucosal membranes should be pink.
Note any birthmarks.
Skin turgor should be supple.
Poor skin turgor may indicate dehydration.
Skin rashes may warrant further treatment.
Diaper rash may be treated by eliminating diaper wipes and using a mild soap and water for cleansing, followed by an application of a thin layer of a zinc-based Ointment. Children with persistent diaper rash should be referred to their primary care provider.
Head
Nurse palpates the anterior fontanel which should be soft and flat.
Educate the mother that the anterior fontanel normally closes when the child is
12 to 18 months old.
Observes the fontanel if sunken may indicate dehydration.
A bulging fontanel may indicate increased intracranial pressure.
Measure the head circumference. The head should be measured with the tape measure placed just above the ears and over the occiput.
Compare the measurement with the standard growth grid.
Eyes
Nurse observes are babies are able to fix and gaze.
The eyes should be symmetrical.
There should be no drainage.
To observe whether the baby cries tears from both eyes.
Strabismus may be considered a normal finding in young infants up to 6 months.
To monitor strabismus and advice the mother to visit the doctor since it’s considered abnormal after 6 months.
Ears
Observe the baby’s response to sound. Check for ear symmetry. The tops of the ears should be even with the eyes.
A young infant’s ears should be pulled down and back for proper otoscope insertion.
A red, bulging tympanic membrane or any ear drainage may indicate otitis media.
Mouth
Observe the inside of the mouth for white patches, which could indicate thrush. Using your finger, check the palate for any cleft. At this time the gums may be felt for any emerging dentition.
Informs the mother to expect first teeth to appear usually at 5 to 6 months.
Nose
Air movement should be felt through the nares. Babies are normally nose breathers. If the baby is congested, the nurse will clean the nose with a bulb syringe, especially before feedings.
Respiratory
Nurse will assess lung sounds both anteriorly and posteriorly. An infant’s lungs are more easily assessed in the left lower lobe.
Nurse will immediately note any abnormalities.
Nurse is educated to observe the Infants knowing that they are at increased risk for respiratory infections because the airways are smaller and the alveoli are continuing to develop.
Nasal flaring and retractions indicate respiratory distress.
Cardiovascular
Infants have a thin chest wall, and their hearts are proportionally larger and easily heard.
Nurse is aware that heart murmur maybe heard in young infants. Some heart murmurs are innocent; however, all heart murmurs should be evaluated by the child’s primary care provider.
Nurse observes if the infant’s chest is normally round.
Nurse will check the babies heart rate/pulse.
Abdominal / Gastrointestinal
Nurse will observe the abdomen for contour, abdominal masses, or umbilical hernia.
Will check the umbilical cord stump in newborns and note any signs of infection.
Nurse will clean umbilical cord stump with alcohol each time the diaper is changed until it falls off and heals.
Nurse will educate the mother that the esophageal sphincter is immature in young infants, allowing them to spit up small amounts of formula when burping; but she will recognize this regurgitation and differentiated it from vomiting.
Bowel sounds should be heard in all four quadrants. Breast-fed infants will have mushy, seedy, yellow stools. Formula-fed infants will have soft, pasty, dark green to brown stools.
Stooling patterns are individually set, however, they may vary from one stool every other day to several stools every day.
It is not abnormal for babies to strain and grunt as they are passing a stool—a circumstance caused by immature musculature.
Genitourinary
Nurse will assess genitalia for any abnormalities.
She is monitoring if the baby is producing 1 to 2 ml/kg/hr of urine over a 24-hour period.
She will implement frequent diaper changes to help prevent diaper rash.
For uncircumcised infants, she will know how to retract the foreskin and cleanse the baby’s penis properly.
Neurological
Nurse assess normal new-born’s reflexes:
Cornea—
The baby should blink and the pupils should constrict when a bright light appears.
Rooting
—When the cheek is stroked, the baby should turn his or her head toward that side and begin to suck; this reflex disappears between 4 and 12 months.
Sucking—
The baby should begin sucking with stimulation of the circumoral area.
Startle (Moro)
—The baby should startle with loud noises or sudden change of position; this reflex disappears after 4 months.
Grasp
—When the insides of the palms are stroked, the baby should grasp the examiner’s fingers.
Babies should move all of their extremities equally.
They should be able to hold their heads up by 2 to 4months, roll from back to front by 4 to 6 months, sit unsupported by 6 to 8 months, crawl by 6 to 8 months, walk by 9 to 15 months
Babies should be able to hold objects by 3 to 4 months and should be able to transfer objects from hand-to-hand by 4 to 6 months.
Babies develop the pincer grasp by 7-9 months.
Feeding Patterns
Upon first assessment nurse will check if there are signs of dehydration such as weight loss, sunken anterior fontanel, decreased urination, poor skin turgor, and absence of tears when crying.
Babies should be held in a semi-upright position and face the nurse/mother during feedings. Do not prop the bottle.
Babies should be fed on demand.
Breast-fed babies generally eat every 2 to 3 hours, and formula-fed babies generally eat every 3 to 4 hours.
The amount the baby eats at each feeding is based on the baby’s weight. Most formulas contain 20 calories for each ounce.
Babies should be burped after they ingest 1 or 2 ounces.
Train the mother to prepare the formula according to the directions.
If the baby is not gaining weight, nurse is observant for a mother/caregiver who may be diluting the formula too much.
Observe the infants and mothers interactions during feeding.
Does the caregiver assess and appropriately respond to the infant’s cues for hunger, dissatisfaction, or need?
Sleep Patterns
Sleep patterns vary with each child. Newborns generally sleep 16 to 17 hours in each 24-hour period.
Healthy infants should be positioned on their back for sleeping. Infants generally begin to sleep through the night when they are 2 – 6 months old.
Nurse will establish a normal sleeping pattern for the baby.