IMMEDIATE CARE OF THE NEWBORN•AIRWAY•TEMPERATURE•APGAR•IDENTIFICATION
AIRWAY• Suctioning Suction gently and quickly (5 to 10 seconds). Prolonged and deep suctioning of the nasopharynx during the first 5 to 10 minutes of life will stimulate the VAGUS NERVE (located in the esophagus) and cause bradycardia.
> Suction the MOUTH first before the nose. If the nose is suctioned first, the stimulation of the nasal mucosa will cause reflex inhalation of pharyngeal material into the trachea and bronchi, causing ASPIRATION.>To test the patency of the airway, occlude one nostril at a time. (REMEMBER: newborns are NOSE BREATHERS.) If a newborn struggles when a nostril has been occluded, additional suctioning is indicated.
POSITIONING OF THE NEWBORN Right side lying 1. promote drainage secretion 2. promote closure of foramen ovale 3. fasten gastric emptying time 4. prevent an increase in intracranial pressure
> The position when suctioning should be one that promotes drainage of secretions – HEAD LOWER THAN THE REST OF THE BODY BUT head should be higher than the rest of the body if there are signs of increased ICP:•Vomiting•Bulging, tense fontanels•Dilated scalp veins•Abnormally large head•Increased BP•Decreased PR and RR•Widening pulse pressure•Shrill, high-pitched cry
TEMPERATURE REGULATION (THERMOREGULATION)• Maintain appropriate Body Temperature. Chilling will increase the body’s need for O2. The newborn suffers large losses of heat (cold stress) because he is wet at birth, the delivery room is cold, he does not have enough adipose tissue and does not know how to shiver.• Wrap the newborn immediately• Wrap him warmly• Put him under a droplight
TEMPERATURE 36.5 – 37.4ºC Rectal thermometer check the patency of rectum passage of meconium after 24 hours (imperforate anus)
HEAT LOSS IN NEWBORN• CONVECTION – flow of heat from body surface to cooler surroundings• RADIATION – transfer of body heat to a cooler solid object not in contact with the body• CONDUCTION – transfer of body heat to a cooler solid object in contact with the body• EVAPORATION – loss of heat through conversion of a liquid to a vapor
convection radiationconduction evaporation
0 1 2APPEARANCE BLUE/ PALE BODY PINK, Completely EXTREMITIES BLUE, (ACROCYANOSIS S- PINK NORMAL) 1ST 480 DUE RUDDY SKIN TO IMMATURITY OF CIRCULATIONPULSE ABSENT < 100 BEATS / > 100 BEATS / MIN MINGRIMACE NONE > WEAK CRY > SNEEZE, / COUGH,LUSTY CRY (GOOD, STRONG, VIGOROUS)ACTIVITY FLACID / LIMP > SOME EXT. WITHDRAWAL FLEX OF FEET EXT. FLEX WELLRESPIRATION ABSENT < 30 > 60
APGAR : AREAS OF ASSESSMENT
TOTAL SCORE INTERPRETATION0-3• POOR,SERIOUS,SEVERELY DEPRESSED; CPR4-6• FAIR,GUARDED, MODERATELY DEPRESSED• NEEDS SUCTIONING & FURTHER OBSERVATION7-10• GOOD, HEALTHY, ADAPTS WELL IN THE EXTRAUTERINE LIFE
IDENTIFICATION• Boy (blue), Girl (pink)• Gender and Name of the mother ex. baby girl Ingrid Garcia• Bed number• Room number• Name of the Ob-Gyne/Pediatrician
ROUTINE NEW BORN CARE• BATHING• ANTHROPOMETRIC MEASUREMENT• CREDE’S PROPHYLAXIS• VITAMIN K INJECTION• UMBILICAL CORD CARE• PRINTS
BATHING• Oil Bath spread or remove vernix caseosa• Warm bathf. foot ball holdg. check temp using the elbow(37-38ºC)h. from the cleanest the most soiled areasnof the body. head eyes nose mouth ear neck chest axilla UE (arm, forearm & hands) abdomen back LE (thigh,leg & foot) genitalia anus
ANTHROPOMETRIC MEASUREMENT• HEAD CIRCUMFERENCE : 33-35cm• CHEST and ABDOMEN : 31-33cm• LENGTH: 47-54cm• WEIGHT : 2500-4000 grams
• Note: A reduction of NB weight of about 5-10% of BW (6-10oz) or less known as Physiologic weight loss during the 1st 3-10 days of life is normal.• Causes: • -Infant is no longer under the influence of maternal hormones. • -Voids and passes out stools. • -Has relatively low nutritional intake • -Has beginning difficulty establishing sucking
CREDE’SPROPHYLAXISTo prevent OphthalmiaNeonatorum or GonorrhealConjunctivitis (Neisseriagonorrhea) which causesblindness if not treated.Infection can be acquiredduring delivery from a motherwith untreated gonorrhea
Ophthalmic drops BEFORE: Silver Nitrate or AgNO3 1% 1-2 drops 1-2 gtts into the lower conjunctival sac PRESENT: Ointment – inner to outer canthus Erythromycin – drug of choice of Chlamydial Trachomatis
VITAMIN K INJECTIONVitamin K facilitates production of the clottingfactor; thus, prevents bleeding, should be givenwithin one hour after birth. Full term (0.1 ml) Preterm (0.05 ml)Aquamephyton (generic: phytonadione)Route: IM into the lateral anterior thigh(Vastus lateralis). In children below 12 monthsof age who have not yet learned how to walk,this is the preferred site of injection becausethe gluteal muscles are not yet fully developed.
UMBILICAL CORD CARE• Check two umbilical arteries, one umbilical vein & wharton’s jelly• Milking (depends on hospital policy)• Disinfect the cord – *Practice aseptic technique • Use povidoneiodine (Betadine); 70% Isoprophyl alcohol to prevent Tetanus Neonatorum and Omphalitis infection of the cord (streptococcal and staphylococcal)
• Place the cord clamp 1-2 inches from the base• cut (1 cm or ½ inch from the cord clamp) and disinfect – ** The cord will fall off after – 7-10 days • Application of sterile cord clamp to prevent bleeding within the 1st 24 hours• Signs of Omphalitis: • *Reddening of the area • *Fever • *Discharge and foul smell
PRINTS• Foot prints of the baby (most reliable)• Thumb mark of the mother• Identification bracelet
Nursing Intervention1. Meet physiologic needs2. Meet psychological needs3. Foster healthy family relationships4. Provide education