Nursing Care for the Term Infant

A newborn, also called a neonate, is an infant that's less than 28 days old and is considered a term newborn once they reach 37 weeks of gestation.

As the nurse, you'll collaborate with the registered nurse or RN to support the newborns' adaptation to extrauterine life by monitoring their temperature, as well as the adaptations of their cardiovascular and respiratory systems.

Now one of the major adaptations a newborn infant must make is establishing thermal regulation, which is the ability to balance heat loss and heat production with the goal of maintaining a steady core temperature.

Keep in mind that newborns don't have a lot of subcutaneous fat to help keep them warm, so be sure to keep them wrapped in a warm blanket.

And because their heads provide a relatively large surface area for heat loss, put a cap on their head. Other steps you can take to prevent heat loss include keeping their diaper area dry to prevent heat loss by evaporation.

Avoid placing them on cold surfaces to prevent heat loss by conduction, ensuring they are not exposed to drafts to prevent heat loss by convection.

And ensuring they are not placed next to a window to prevent heat loss by radiation. Also, be sure to measure the newborn's temperature regularly, which should be between 97.1 °F or 36.2 °C and 99.8 °F or 37.7 °C, and notify the RN if the infant is not able to maintain their temperature within the expected range.

Next, auscultate the newborn's apical pulse and remember to listen for a full minute. It's a good idea to check this first when the infant is in a quiet state.

Note their heart rate and rhythm, and keep in mind that it's not uncommon for newborns to have a murmur during the 1st 48 hours of life as the ductus arteriosis shunt closes.

A term newborn's heart rate normally varies between 110 and 160 BPM, but it can rise to 180 BPM when they're crying or drop as low as 80 BPM during deep sleep.

A consistently high or low heart rate should be reported to the RN. Then monitor perfusion by palpating pulses, which should be equal bilaterally and test capillary refill.

To test capillary refill in newborns with lighter skin, gently press down on their forehead or chest until the area blanches, and then release it.

In newborns with darker skin, assess capillary refill on the palms of the hands or soles of the feet. Normally, color should return within 3 seconds.

Then observe the newborn's respirations. Be sure to count for a full minute, since they are usually irregular, and there may be occasional 5 to 22nd pauses.

You'll notice that their abdomen will rise and fall with each respiration. This is called diaphragmatic breathing, where the diaphragm is the predominant muscle used for breathing and pushes the abdomen out during inhalation.

This is a normal finding in a term newborn and typically disappears around 6 months of age. A normal respiratory rate is between 30 to 60 breaths per minute, which will vary depending on the infant's activity.

Upon auscultation, soft, low pitched vesicular lung sounds should be noted throughout the lung fields, though fine crackles might be noted immediately after birth, as fetal lung fluid is still being cleared.

If you observe a respiratory rate of more than 60 breaths per minute or less than 30 breaths per minute, as well as signs of distress like nasal flaring, apnea, grunting, or substernal or intercostal retractions, report this to the RN immediately.

All right, as a quick recap, a newborn, also called a neonate, is an infant that's less than 28 days old and is considered a term newborn when they reach 37 weeks of gestation.

As the nurse, you'll collaborate with the registered nurse or RN to support the term newborns adaptation to extrauterine life by monitoring their temperature as well as their cardiovascular and respiratory systems.