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What is Full‑term Neonate and Its Assessment:Nursing Case Study

Wednesday, 12 March 2014

Full‑term neonate - A neonate born between 38 and 42 weeks' gestation is considered full‑term. At birth, the fetus must leave the life‑sustaining environment of the uterus and adapt to one that requires profound physiologic changes. Any interference with the neonate's transition to extrauterine life affects his well-being. Some physiologic factors that can affect the transition include initiation of extrauterine cardiopulmonary function, thermoregulation, defenses against infection, neurologic impairment, fluid and nutritional deficits, congenital defects, and skin impairment.

In the first 24 hours, two periods of reactivity occur. The first period, lasting up to 30 minutes after birth, reveals an alert, open‑eyed, vigorously crying, fist‑sucking neonate whose vital signs and bowel sounds increase while body temperature decreases. This is followed by a decrease in responses and vital signs and a sleep period lasting 2 to 8 hours.

The second period of reactivity starts when the neonate awakens (4 to 8 hours after birth). He's alert, with an increase in vital signs, secretions, and gagging. This period lasts 2 to 5 hours, concluding when secretions decrease and hunger, sucking, and a sleep and activity pattern become established.

Assessment
Health perception and management
■ Normal pregnancy and delivery

Physical examination
General appearance and nutrition
■ Gestational age 38 to 42 weeks
■ Apgar score 7 to 10 at 1 minute and at 5 minutes
■ Weight: 2,500 to 4,000 g (5 lb, 8 oz to 8 lb, 13 oz)
■ Length: 19" to 21" (48 to 53 cm)
■ Head circumference: 13" to 14" (33 to 35.5 cm), 0.75" to 1.25" (2 to 3 cm) larger than chest

Mental status and behavior
■ Alternates between sleeping and waking states
■ Habituates to environmental stimuli
■ Responds to visual and auditory stimuli
■ Self‑quiets effectively

Integumentary
■ Red (not beefy red) and smooth skin, changing to pink, dry, and flaky
■ Edema and puffiness around eyes, face, arms, legs, and presenting parts
■ Acrocyanosis
■ Possibly petechiae, nevi, spots, ecchymoses, rash, milia, and mongolian spots
■ Fingernails and toenails; lanugo and vernix caseosa
■ Intact skin and mucous membranes

Respiratory
■ Nasal patency and nasal breathing, thin white mucus, and sneezing
■ Respiratory rate ranging from 40 to 60 breaths/minute; chiefly abdominal breathing with slight sternal retractions during inspiration
■ Bronchial breath sounds bilaterally, with possible transient tachypnea and slight nasal flaring
■ Possibly crackles for short period after birth
■ Possibly irregular respirations or periodic breathing

Cardiovascular
■ Heart rate ranging from 110 to 160 beats/minute at apical site with regular rhythm; decreases during sleep and increases during crying
■ Blood pressure ranging from 60 to 80 mm Hg systolic and 30 to 45 mm Hg diastolic
■ Apical pulse at third to fourth intercostal space at sternal edge
■ S2 of higher pitch and sharper than S1
■ Possibly murmur because of functional vibrations within the heart or major arteries
■ Pink nail beds with transient cyanosis

Gastrointestinal
■ Intact mouth, lips, and palate; normal sucking, swallowing, gag, and rooting reflexes
■ Stomach capacity of about 90 ml
■ Soft, cylindrically shaped abdomen
■ Liver palpable; spleen not palpable
■ With clamp in place, cord at umbilicus has two arteries and one vein
■ Anus patent with meconium stool passing within 12 hours or history of meconium passage in utero

Neurologic
■ Bilateral and equal Moro, plantar, palmar grasp, and Babinski's reflexes; loud and lusty cry
■ Eyes usually closed, with vision the least developed sensory function and touch the most developed; infant can taste, smell, and hear
■ Startle, blinking, pupillary, crawling, yawn, and cough reflexes apparent
■ Daily sleep and activity patterns: 1 to 4 hours of alertness, activity, and crying; 4 to 5 hours of regular sleep; 12 to 15 hours of irregular sleep
■ Skin temperature of 97° to 98.6° F (36.1° to 37° C); rectal temperature 1° F (0.6° C) degree higher
■ Shows motor maturity within normal limits

Musculoskeletal
■ Normal range of motion in arms and legs with good muscle tone
■ Flexion of head, arms, and legs
■ Ear cartilage flexible
■ Equal muscle tone with symmetry; resists flexion
■ Creases on soles
■ Possibly skeletal deformities resulting from fetal positioning
■ Soft skull and rib bones with fontanels and separations at suture lines present in head (fontanels soft, flat, and firm)
■ More cartilage than ossified bone

Renal and urinary
■ Pale yellow urine, with voiding occurring within 24 hours after delivery
■ Volume of 200 to 300 ml voided every 24 hours, with bladder capacity of about 15 ml causing involuntary emptying
■ Kidneys palpable

Reproductive (includes breasts)
■ Female: larger labia minora than labia majora; edema of labia and clitoris
■ Male: palpable testes in scrotal sac; scrotum edematous, large and hanging, rugae present; urethral meatus at tip of penis

Diagnostic studies
■ Tests are determined by the physical examination findings or observable changes in the infant's status.
■ Possible blood tests include serum bilirubin levels, complete blood count, electrolyte analysis, blood type and Rh factor, and Coombs' test.
■ Chemstrip or Dextrostix urine test determines glucose levels (followed by serum glucose study if glucose levels are low).
■ Guthrie blood test identifies possible phenylketonuria (part of multiple screenings for metabolic defects).
■ Human immunodeficiency virus (HIV) deoxyribonucleic acid (DNA) polymerase chain reaction tests blood for the presence of HIV DNA or ribonucleic acid if the mother may be HIV-positive.

Teaching checklist
■ The neonate's status and assessment findings
■ Appearance and care of the umbilical cord, especially signs of infection
■ Changes in the neonate's status to report to the practitioner
■ Results of neonatal screening tests that were performed
■ Measures to promote healthy parent-neonate interaction
■ Method for contacting the practitioner after routine hours
■ Total care of the healthy neonate
■ Breast-feeding techniques
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