2. Stroking, cuddling.
3. Crooning, calling baby by name, talking to infant.

3. Mother demonstrates comfort and skill in basic newborn care.
4. Mother verbalizes understanding of subjects discussed:
   1. Safety precautions.
   2. Health maintenance actions.
   3. Signs of normal infant behavior and health.

Complications During the Neonatal Period:

The High-Risk Newborn

1. General overview - successful newborn adaptation to the demands of independent extrauterine life may be complicated by environmental insults during the prenatal period or those arising in the period immediately surrounding birth. The nursing role focuses on minimizing the effect of present and emerging health problems and on facilitating and supporting a successful transition to extrauterine life.
2. General aspects - common neonatal risk factors:
   1. Gestational age profile:
      1. Prematurity.
      2. Dysmaturity.
      3. Postmaturity.
   2. Congenital disorders.
   3. Birth trauma.
   4. Infections.

3. Disorders affecting protective functions: neonatal infections
   1. Assess for intrauterine infections.
   2. Oral thrush (mycotic stomatitis).
      1. Pathophysiology - local inflammation of oral mucosa due to fungal infection.
      2. Etiology:
         1. Organism - Candida albicans.
         2. More common in vulnerable newborn, i.e., sick, debilitated; those receiving antibiotic therapy.
      3. Mode of transmission - direct contact with:
         1. Maternal birth canal, hands, and linens.
         2. Contaminated feeding equipment, staff’s hands.
      4. Assessment
         1. White patches on oral mucosa, gums, and tongue that bleed when touched.
         2. Occasional difficulty swallowing.
      5. Analysis/nursing diagnosis:
         1. Pain related to irritation of oral mucous membrane secondary to oral moniliasis.
         2. Altered nutrition, less than body requirements related to irritability and poor feeding.
      6. Nursing care plan/implementation:
         Goal: prevent cross-contamination.
         1. Aseptic technique; good handwashing.
         2. Givemedications as ordered:
            1. Aqueous gentian violet, 1-2%: apply to infected area with swab.
            2. Nystatin (Mycostatin) - instill into mouth with medicine dropper, or apply to lesions with swab, after feedings. Note: Before medicating, feed sterile water to rinse out milk.
      7. Evaluation/outcome criteria:
         1. Oral mucosa intact, lesions healed, no evidence of infection.
         2. Feeds well; maintains weight or regains weight lost, if any.
   3. Neonatal sepsis
      1. Pathophysiology - generalized infection; may overwhelm infant’s immature immune system.
      2. Etiology:
         1. Prolonged rupture of membranes.
         2. Long, difficult labor.
         3. Resuscitation procedures.
         4. Maternal infection (e.g., beta-hemolytic streptococcus vaginosis).
         5. Aspiration - amniotic fluid, formula, mucus.
         6. Iatrogenic (nosocomial) - caused by infected health personnel or equipment.
      3. Assessment:
         1. Respirations - irregular, periods of apnea.
         2. Irritability or lethargy.
      4. Analysis/nursing diagnosis:
         1. Fatigue related to increased oxygen needs.
         2. High risk for infection related to septic condition.
      5. Nursing care plan/implementation:
         1. Cultures (spinal, urine, blood).
         2. Check vitals.
         3. Monitor respirations.
         4. Give medications, as ordered.
      6. Evaluation/outcome criteria:
         1. Responds to medical/nursing regimen (all assessment findings within normal limits).
         2. Parent(s) verbalize understanding of diagnosis, treatment; demonstrate appropriate techniques in participating in care (as possible).
         3. Parent(s) demonstrate effective coping with situation; express satisfaction with care.