Judy A. Gretz, RNC, MSN, DNP Emory University & Emoryhealthcare.
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Transcript of Judy A. Gretz, RNC, MSN, DNP Emory University & Emoryhealthcare.
Judy A. Gretz, RNC, MSN, DNPEmory University & Emoryhealthcare
During our time today we will: Review the physiologic function and anatomy
of the skin Explore the fragility and characteristics of
neonatal skin Assess the newborn’s skin utilizing
AWHONN’s EBP Guidelines Compare sponge bathing to immersion
bathing Discuss recommended skin care practices for
prevention and treatment of skin issues
Barrier against infection Protection of internal organs Regulates insensible water loss Secretes electrolytes and water Provides tactile sensory input for sensations
of touch, pressure, temperature, pain, and itch
The Epidermis is subdivided into 5 layers (from deepest to most superficial layer:◦ Stratum basale (cellular generation layer)◦ Stratum spinosum◦ Stratum granulosum◦ Stratum lucidum◦ Stratum corneum (outermost layer & vital barrier
of skin)
Toxicity from topical agents◦ Percutaneous absorption of neomycin has been
reported to cause neural deafness Increased fluid, heat loss
◦ 10-20 layers of S.C. in the adult and term newborn◦ Preterm infants have fewer layers of S.C.
Traumatic injury Portal of entry for infection
◦ Diminished cohesion of dermis and epidermis make infant vulnerable to blistering and trauma, i.e
adhesive removal
Edema Blood flow reduced to epidermis Risk for injury
Appearance
Skin pH
Nutritional stores
Vulnerability to infection
Reduce traumatic injury Prevent dryness Avoid exposure to toxins Minimize exposure to unnecessary
substances Promote normal skin development
Assess skin surfaces head-to-toe daily
Note risk factors in environmentUse an objective scale to assess skin condition
Dryness◦ 1 = normal, no dryness◦ 2 = dry skin, visible scaling◦ 3 = very dry skin, cracking/fissures
Erythema◦ 1 = no evidence of erythema◦ 2 = visible erythema < 50% body surface◦ 3 = visible erythema > 50% body surface
Breakdown◦ 1 = none◦ 2 = small localized areas◦ 3 = extensive
Cotton surfaces, sheepskin Water or air mattress, gel pads Petrolatum-based emollient over groin, thigh
Transparent dressings on knees, elbows
Primary cause of skin breakdown Minimize amount of adhesive contact Bonding agents increase risk of trauma
Mineral oil, emollients facilitate removal
Avoid toxic solvents
Hydrogel electrodes, strips Pectin barriers, hydrocolloid tapes Soft gauze wraps Transparent dressings Alcohol-free skin protectants
Culture, gram stain to identify colonization Use antifungal ointment if fungus cultured Monitor for systemic fungal infection Consider systemic antifungal treatment
Culture, gram stain to identify colonization Use antifungal ointment if fungus cultured Monitor for systemic fungal infection Consider systemic antifungal treatment
Flush with sterile water or ½ normal saline Cover with petrolatum ointment Use transparent dressings, hydrogel,
hydrocolloid dressings in selected cases Disinfectant solutions injure healing tissue
Increased in premature infants <30 weeks
Select one of the following strategies:◦High humidity (>70% RH for 7 days)◦Transparent adhesive dressings◦Petrolatum-based emollient every 6 hrs
Zinc intake 400mcg/kg/day in premature infants
Full-term infants need 100-200mcg/kg/day, more if surgery
IV lipids 0.5g/kg/day prevents EFAD Adequate calories, protein intake needed
The goals of this project were to:1. Determine whether tub bathing lowers a
newborn’s axillary temperature significantly more or less than sponge bathing.
2. Determine whether or not there is a significant difference in umbilical cord healing between newborns who are tub bathed and those who are sponge bathed from 2-24 hours of birth.
3. Determine whether newborns that are tub bathed are more content during the bath than those who are sponge bathed.
4. Explore whether mothers of newborns who were tub bathed express more pleasure with the bath and are more confident regarding bathing on discharge than are mothers of newborns who are sponge bathed.
Goal 1: Significant?
YES
Goal 3: Significant?
YES
Goal 2: Significant?
NO
Goal 4: Significant?
NO
Vital signs, temp stable 2 – 4 hours Antiseptic soaps not required Universal precautions Not necessary to remove all vernix
No clinically significant heat loss when appropriate steps to preserve heat loss are taken.
Infants and mothers more content with tub bathing.
Flexible bathing time is acceptable and family choice is important.
Babies may be safely bathed at the bedside.
No difference in cord healing found.
Cleanse cord during bathing Initial application of anti-microbial agents is debatable
Routine isopropyl alcohol delays cord separation
Educate about normal cord appearance
Disinfect prior to procedureCleanse thoroughly with waterApply petrolatum-gauze dressings to site
No proven benefit from antimicrobial ointments
Urine makes skin moist, susceptible to injury
Alkaline pH activates enzymes, bile salts in stools which cause breakdown
Identify and treat underlying cause
•Use zinc oxide ointments•Apply thick layer to prevent re-injury•Use antifungal ointments for candida
Improves skin condition for premature and full-term infants
Protects skin during normal development
Reduces exposure to toxic or sensitizing agents
May have long-term benefits for skin
I would like to thank Juanita Davis, NNP-BC for sharing slides and information for this presentation today.
I also would like to thank all of the unsung heroes at the bedside, no matter their title or discipline, who each and every day support the lives of the smallest humans on earth.
Thank you
Anderson, G. C., Lane, A. E., & Chang, H. (1995). Axillary Temperature in Transitional Newborn Infants Before and After Tub Bath. Applied Nursing Research, 8(3), 123-128.
Bryanton, J., Walsh, D., Barrett, M., & Gaudet, D. (2004). Tub Bathing Versus Traditional Sponge Bathing for the Newborn. JOGNN, 33(6), 704-712.
Cole, J. G., Brissette, N. J., & Lunardi, B. (1999). Tub Baths or Sponge Baths for Newborn Infants? Mother Baby Journal, 4(3), 39-43.
Hardman, M.J., Moore, L., Ferguson, M. & Byrne, C. (1999) Barrier Formation in the Human Fetus is Patterned. Journal of Investigative Dermatology, p1106-1113.
Hardman, M.J. & Byrne, C. (2003). Neonatal Skin Structure & Function, Marcel Dekker Inc., USA.
Lund, C. H., Osborne, J. W., Kuller, J., Lane, A. T., Lott, J. W., & Raines, D. A. (2001). Neonatal Skin Care: Clinical Outcomes of the AWHONN/NANN Evidence-Based Clinical Practice Guideline. JOGNN, 30(1), 41-51.