At 1 wk of age, the newborn continues to adapt to extrauterine life, both physiologically and behaviorally. Within this adaptation period are many normal variations. Review prior assessments for risk factors or deviations from expected norms.
NEONATAL ASSESSMENT DATA BASE
Activity/Rest
May be wakeful/fussy between feedings
May sleep more or less than the customary 17 hr/day
Circulation
Heart rate ranges from 110–160 bpm; is strong and regular.
Ego Integrity (Parents)
May verbalize unrealistic expectations of themselves and of neonate
May express feelings of ineptness or inadequate knowledge
Elimination
Urine pale and straw-colored, with output of 6–10 wet diapers per day.
Abdomen soft with bowel sounds in all four quadrants.
Defecation pattern varies; stool formed, yellow/brown, and passed 2–3 times per day in neonate fed cow’s-milk formula; mustard-colored, loose, and passed initially with each feeding, then possibly every few days, in breastfed neonate.
Food/Fluid
May have difficulty adjusting to breast or bottle feeding; oral intake may be inadequate or on occasion, excessive.
Weight gain averaging 1 oz/day.
Neurosensory
Facial expression symmetrical
Reflexes associated with feeding (sucking, swallowing, gag, and rooting) present and strong
Moro, grasp, and stepping reflexes present with strong, symmetrical response
Uncoordinated motor and reflex activity present (continued development of the neurological system)
Muscle tone good; head lag present
Pain/Discomfort
Irritability, crying associated with colic may occur.
Respiration
Respiratory rate 30–60/min with no signs of difficulty (e.g., grunting, retraction, or nasal flaring).
Normal alternation between rapid and slow rate occurs in response to stimuli.
Cry strong, lusty, demanding, and purposeful.
Lungs bilaterally clear; breath sounds equal.
Safety
Skin pink and warm to the touch, with good skin turgor; free of rashes; transitory color change or mottling may appear in response to cold.
Skin may appear slightly dry or peeling in folds.
Slight jaundice involving only upper body or upper extremities may be present, peaking at day 4 or 5, subsiding within 7 days of onset.
Temperature stable; axillary/pacifier, 97.6°F–98.6°F (36.5°C–37°C); rectal, 97.8°F–99°F (36.6°C–37.2°C).
Umbilical cord stump drying, with no evidence of inflammation; slight bleeding may be noted with detachment 7–14 days after birth.
Sexuality
Circumcised penis well-healed and free of exudate
DIAGNOSTIC STUDIES
Tests dependent on individual findings/concerns
Screening repeated at 7–14 days of age to detect inborn errors of metabolism
NURSING PRIORITIES
1. Facilitate newborn’s continued physiological and behavioral adaptation to extrauterine life.
2. Promote adequate fluid and nutritional intake.
3. Provide information to parent(s) about newborn’s safety, developmental needs, and interactional capabilities.
4. Encourage parental use of support systems.
NEONATAL ASSESSMENT DATA BASE
Activity/Rest
May be wakeful/fussy between feedings
May sleep more or less than the customary 17 hr/day
Circulation
Heart rate ranges from 110–160 bpm; is strong and regular.
Ego Integrity (Parents)
May verbalize unrealistic expectations of themselves and of neonate
May express feelings of ineptness or inadequate knowledge
Elimination
Urine pale and straw-colored, with output of 6–10 wet diapers per day.
Abdomen soft with bowel sounds in all four quadrants.
Defecation pattern varies; stool formed, yellow/brown, and passed 2–3 times per day in neonate fed cow’s-milk formula; mustard-colored, loose, and passed initially with each feeding, then possibly every few days, in breastfed neonate.
Food/Fluid
May have difficulty adjusting to breast or bottle feeding; oral intake may be inadequate or on occasion, excessive.
Weight gain averaging 1 oz/day.
Neurosensory
Facial expression symmetrical
Reflexes associated with feeding (sucking, swallowing, gag, and rooting) present and strong
Moro, grasp, and stepping reflexes present with strong, symmetrical response
Uncoordinated motor and reflex activity present (continued development of the neurological system)
Muscle tone good; head lag present
Pain/Discomfort
Irritability, crying associated with colic may occur.
Respiration
Respiratory rate 30–60/min with no signs of difficulty (e.g., grunting, retraction, or nasal flaring).
Normal alternation between rapid and slow rate occurs in response to stimuli.
Cry strong, lusty, demanding, and purposeful.
Lungs bilaterally clear; breath sounds equal.
Safety
Skin pink and warm to the touch, with good skin turgor; free of rashes; transitory color change or mottling may appear in response to cold.
Skin may appear slightly dry or peeling in folds.
Slight jaundice involving only upper body or upper extremities may be present, peaking at day 4 or 5, subsiding within 7 days of onset.
Temperature stable; axillary/pacifier, 97.6°F–98.6°F (36.5°C–37°C); rectal, 97.8°F–99°F (36.6°C–37.2°C).
Umbilical cord stump drying, with no evidence of inflammation; slight bleeding may be noted with detachment 7–14 days after birth.
Sexuality
Circumcised penis well-healed and free of exudate
DIAGNOSTIC STUDIES
Tests dependent on individual findings/concerns
Screening repeated at 7–14 days of age to detect inborn errors of metabolism
NURSING PRIORITIES
1. Facilitate newborn’s continued physiological and behavioral adaptation to extrauterine life.
2. Promote adequate fluid and nutritional intake.
3. Provide information to parent(s) about newborn’s safety, developmental needs, and interactional capabilities.
4. Encourage parental use of support systems.
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