Neonatal Stress Reactivity and Circumcision (Nursing)

00:01 I also want to talk to you about periods of reactivity.

00:04 And this is important because anytime you're going to do an assessment, you want to time it just right.

00:09 So just as we said, we want to time the vital signs for a time when the baby is quiet, we want to make sure that when the baby's resting, that we let the baby rest.

00:19 And that we choose to do our assessment at a time when the baby is active.

00:23 So the first period of reactivity happens immediately after delivery.

00:27 So this is going to last about 30 to 60 minutes after birth.

00:31 So this is going to be when the baby's awake and alert.

00:34 So we typically get our APGAR here, we're going to encourage bonding, we're going to make sure that we're doing skin to skin.

00:41 But we can also take vital signs during this time, we can look at the eyes, and we can do some very minor general survey activities.

00:50 Next, the baby's going to go into a sleep phase.

00:53 So in this period the baby is going to be resting, they may be slightly more difficult to rouse and this lasts for an hour to four hours after birth.

01:04 And then there's a second period of reactivity.

01:06 And this goes from our 4 to our 12.

01:09 And so in this particular instance, we may notice that the baby is particularly sensitive to sounds, both internal and external stimuli.

01:18 They may have their first viod, they may pass their first meconium.

01:22 if that has not already happened.

01:24 But we definitely want to make sure we are assessing for signs of mucus or any sort of respiratory distress, or any sort of apnea.

01:31 So apnea that lasts longer than 20 seconds would be something we would want to explore.

01:37 We also want to check for MSS because by this point, they've already had opportunities for feeding, whether it's breast, chest, or bottle, and we want to make sure that they're tolerating those foods very well.

01:47 So this is going to be something that we would do during the second period of reactivity.

01:55 Now let's talk about care of circumcision.

01:57 This would be for a baby with male genitalia for clients who have decided parents who want to have their baby circumcised.

02:05 Remember, this is an elective procedure.

02:07 It's not something that is required, and it is something that should be consented.

02:12 So for post procedure care, we want to focus on bleeding and for the baby's ability to void.

02:19 So we want to make sure bleeding is not heavy.

02:22 And we want to document that the baby is voiding without any sort of problem.

02:25 We want to focus on pain management and consoling.

02:29 So this might be something that the nurse does, but hopefully, we can take the baby to be with the parents and they can have more skin to skin time.

02:36 And that's really going to be the most effective way to offer that.

02:40 We may also want to encourage parents that are chest or breastfeeding that they may want to nurse the baby a little bit more post circumcision to provide that sense of comfort.

02:50 In terms of the skincare, we're only going to use water.

02:53 Don't want to use soap or anything that might be irritating to the penis.

02:58 We also want to use petroleum jelly and gauze around the penis so that the diaper doesn't stick to that open wound.

03:05 So remember, we're removing the foreskin and so all of that area is going to be open and it's going to be slightly weepy.

03:11 And so we don't want that weepiness of the tissue and exudate to stick to the diaper and the petroleum jelly will help that to occur.

03:21 As we move away from the immediacy of the circumcision, we're going to be looking for signs of infection.

03:27 So signs of infection would not be something you would see immediately after we'd be looking for bleeding and issues with voiding.

03:33 But hours later, days later, we're going to be looking for signs of infection.

03:37 So remember the timing in terms of establishing your priority of care.