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Care of the Newborn Handouts

  1. 1. Maternal and Child Health NursingCare of the Newborn PRINCIPLES IN IMMEDIATE NEW BORN CARE 1st day of life 1. Initiation and maintenance of respiration (used bulb syringe) 2. Establishment of extra uterine circulation 3. Control of body temp 4. Intake of adequate nourishment 5. Establishment of waste elimination MATERNAL and CHILD HEALTH NURSING 6. Prevention of infection 7. Establishment of an infant parent relationship CARE OF THE NEWBORN 8. Care that balances rest and stimulation or mental Development Lecturer: Mark Fredderick R. Abejo RN, MAN______________________________________ Immediate care of the newborn.Objectives: A-airway (most neonatal deaths with in 24 h caused by inability to initiate airway, lung function begins after Describe the normal characteristics of a term birth only) newborn. B-body temperature Assess a newborn for normal growth and C-check/asses the newborn development. D-determined identification Formulate nursing diagnoses related to a newborn or the family of a newborn. Identify expected outcomes for a newborn and family I. Establish and maintain a patent airway during the first 4 weeks of life. Plan nursing care to augment normal development of A. Never stimulate a baby to cry unless secretions a newborn, such as ways to aid parent-child bonding have been drained out. Implement nursing care of a normal newborn, such as “A crying infant is a breathing infant. Effective administering a first bath or instructing parents on cry means effective breathing” how to care for their newborn.  Do not slap the buttocks but rub the Evaluate expected outcomes to determine soles of the feet effectiveness of nursing care and outcomes  The normal infant cry is loud & lusty. achievement. Observe for the ff. abnormal cry: Use critical thinking to analyze ways that the care of a term newborn can be more family centered. High-pitched cry : hypoglycemia, increased ICP Integrate knowledge of newborn growth & Weak cry: prematurity development and immediate care needs with the Hoarse cry: laryngeal stridor nursing process to achieve quality maternal and child health nursing care. B. The position should be one that promotes drainage of secretions (head lower than the restGoals of the body) EXCEPT when there are signs of To establish, maintain and support respirations. increased intracranial pressure To provide warmth and prevent hypothermia.  Vomiting To ensure safety, prevent injury and infection.  Bulging To identify actual or potential problems that may  Tense fontanelles require immediate attention.  abnormally large head  Increased B  Decreased PR and RR  Widening pulse pressure  Shrill, high-pitched cry Oral mucus may cause the NB to choke, cough or gag during the first 12 to 18 hours of life. Place the neonate in a position that would promote drainage of secretions  Trendelenburg (contraindicated to Increased ICP)  Side lying position – If trendelenburgTHE NEONATE position is contraindicated, place infant  From birth through the first 28 days of life in side lying position to permit drainage  Also called “the newborn period” of mucus from the mouth. Place a small  2/3 of all deaths that occur during the 1st year of pillow or rolled towel at the back to life occur during this period; more than half prevent newborn from rolling back to occur in the 1st 24 hours after birth---an supine position. indication of how hazardous this time is for an infant  How well a NB makes major adjustments depends on his or her: C. Suction the newborn properly:  Genetic composition 1. Turn the baby’s head to one side  The competency of the recent intrauterine 2. Compress the suction bulb and insert in environment one corner.  The care received during the neonatal periodCare of the Newborn Abejo
  2. 2. Maternal and Child Health Nursing Care of the Newborn 3. Suction gently and quickly – prolonged Effects of cold stress and deep suctioning of the nasopharynx Cold stress metabolic acidosis CNS during the first 5-10 minutes of life will depression Coma Death stimulate the vagus nerve (located in the  Metabolic Acidosis – one of the airways by esophagus) and cause bradycardia. which heat is produced in the newborn is by increasing metabolism. When this occurs, fatty acids accumulate because of the breakdown of brown fat (seen only in newborns)  High risk for kernicterus- bilirubin in brain leading to cerebral palsy  Additional fatigue to allergy stressful heart  Hypoglycemia – due to the use of glucose stored as glycogen o Every NB is born slightly acidotic. Any new build-up of acid may lead to life-threatening metabolic acidosis, which can be lethal even to normal newborn infants. o The average NB temp.@ birth is around 4. Suction the mouth first before the nose 37.2°C. – when suctioning the nose, the o NB lose heat easily because: stimulation of the nasal mucosa will  They have immature temp.-regulating cause reflex inhalation of pharyngeal system material into the trachea and bronchi,  Of very little amount of subcutaneous causing aspiration. fat to provide heat 5. To test for patency of the airway,  They have a larger body surface area occlude one nostril at a time that results in more heat loss (REMEMBER: Newborns are nasal  They have little ability to conserve heat breathers). If the newborn struggles by changing posture and no ability to when a nostril has been occluded, adjust its own clothing additional suctioning is indicated Methods of Heat Loss in Newborn D. Keep the nares patent. Remove mucus and other • Convection – the flow of heat from the NB’s particles w/c can cause obstruction as newborns body surface to cooler surrounding air; ex: are “obligatory nasal breathers” until they are windows, air conditioners about 2-3 weeks old. • Conduction- the transfer of a body heat to a cooler solid object in contact with a baby; ex: E. Give O2 as needed. Oxygen should be given for baby placed on a cold counter 20-30 minutes when the neonate remains • Radiation – the transfer of body heat to a cooler cyanotic or tachycardic after initial suctioning solid obj. not in contact with a baby; ex: cold and stimulation. window or air con * asphyxiation → hypoxia → hypercapnia • Evaporation – loss of heat through conversion (↑ CO2) → acidosis → coma → death of a liquid to a vapor; ex: after delivery, • Observe precaution in giving oxygen newborns are wet, with amniotic fluid on their • Do not give more than 40% O2 as skin, tsb this may lead to retrolental fibroplasia (blood vessels of the eyes become spastic leading to blindness) • Use pulse oximeter and monitor O2 concentration every hour F. If the heart rate falls below 60 bpm, cardiac massage may need to be carried out.II. Maintain appropriate body temperature. Chilling will increase the body’s need for oxygen. 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 tissues and does not know how to shiver. Temp Regulation  Goal in temp regulation is to maintain it not less than 97.7% F (36.5 C)  Maintenance of temp is crucial on preterm and SGA (small for gestational age) - babies prone to hypothermia or cold stress o Neonates have “physiologic resilience” wherein they tend to adopt or take temperature of their own environment. (poikilothermic) “cold stress (hypothermia) is more dangerous than hyperthermia” Care of the Newborn Abejo
  3. 3. Maternal and Child Health Nursing Care of the Newborn To Prevent Hypothermia 1. Dry and wrap baby 2. Mechanical pressure – radiant warmer pre-heated first isolette (or square acrylic sided incubator) 3. Prevent is necessary exposure – cover baby 4. Cover baby with tin foil or plastic 5. Embrace the baby- kangaroo care 6. Delay initial bath until temp. has stabilized for at least 2 hours. 7. Maintain ambient temp. of nursery at 24°C or 75°F. 8. Perform any extensive examination or procedure under radiant heat to prevent heat loss and The Silverman & Anderson Scoring System expose only the part of the body to be examined. o Devised in 1956 and is a test used to 9. Note the presence of any cyanosis: evaluate or estimate the degrees of 2 types of cyanosis: respiratory distress in newborns or the a.) central cyanosis respiratory status of premature infants. b.) peripheral cyanosis hands & feet o A NB is observed and then scored on are cyanotic, due to cold each of five criteria ---0,1 or 2. The environment and poor circulation scores are then added. (the scores of this system are interpreted as opposite of the Apgar) The Silverman & Anderson Scoring System 0 1 2 Chest Synchronized Lag on Seesaw Movement respirations inspiration respirations Axillary temperature measurement. The thermometer Intercostal none Just visible Marked should remain in place for 3 minutes. The nurse presses Retraction the newborn’s arm tightly but gently against the Xiphoid none Just visible Marked thermometer and the newborn’s side, as illustrated Retraction Nares none minimal Marked DilatationIII. Perform Initial Assessment Expiratory none Audible by Audible by Grunt stethoscope unaided ear APGAR Scoring System o Developed by Dr. Virginia Apgar in 1958 Silvermann and Anderson Scoring Interpretation o It is a standardized method for evaluation of  0 : no respiratory distress the newborn and serves as a baseline for  4-6 : moderate respiratory distress future evaluations.  7-10 : severe respiratory distress o It is taken twice: initially @ 1 minute, and then @ 5 minutes after birth IV. Proper Identification of the Newborn  Proper Id is made in the delivery room before Special Considerations: mother and baby are seperated. 1st 1 min – determine general condition of baby o Identification Band Next 5 min- determine baby’s capabilities to adjust extra o Footprints uterine o Others – fingerprints, crib card, bead Next 15 min – dependent on the 5 min bracelet  Birth certificate APGAR Scoring System  A final identification check of the mother and infant must be performed before the infant can 0 1 2 be allowed to leave the hospital upon discharge to ensure that the hospital is discharging the right Appearance Pale or Body pink, Pink all over infant. (Color) blue all extremities blue over Pulse/♥ rate absent Below 100 Above 100 V. Preventing Infection Principles of cleanliness at birth: Grimace/ No grimace Sneezes,gags,  Clean hands Reflex response coughs,vigorous  Clean perineum Irritability cry and foot  Nothing unclean to be introduced into the vagina withdrawal  Clean delivery surface A ctivity / Limp, Some flexion of Active motion/  Cleanliness in cutting the umbilical cord Muscle Tone flaccid the extremities well-flexed  Cleanliness for cord care of the newborn baby Respiratory absent Slow,irregular, Good, Effort weak cry strong,lusty cry Handwashing  Before entering the nursery or caring for a baby APGAR result  In between newborn handling or after the care of 0 – 3 = severely depressed, need CPR, admission NICU each baby 4 – 6 = moderately depressed, needs add’l suctioning &  Before treating the cord oxygen  After changing soiled diaper 7 - 10 = good/ healthy  Before preparing milk formula. Care of the Newborn Abejo
  4. 4. Maternal and Child Health Nursing Care of the Newborn Credes Prophylaxis – Dr. Crede  Aspirate, then slowly inject the solution to  -prevent opthalmia neonatorum or gonorrheal distribute the medication evenly and minimize conjunctivitis the baby’s discomfort. - how transmitted – mom with gonorrhea  Remove the needle and gently massage the site drug: erythromycin ophthalmic ointment with an alcohol swab. (inner to outer) *It is part of the routine care of the NB to give prophylactic eye treatment against gonorrheal conjunctivitis or ophthalmia neonatorum within the first hour after delivery. * Neisseria gonorrhea, the causative agent,maybe passed on to the fetus when infected vaginal and cervical secretions enter the eyes as the baby passes the vaginal canal during delivery. This practice was introduced by Crede, German gynecologist in 1884. Silver Nitrate, VII. Care of Cord erythromycin and tetracycline ophthalmic ointments are the drugs used for this purpose. Ophthalmia neonatorum  Any conjunctivitis with discharge occuring during the first two weeks of life. It typically appears 2-5 days after birth, although it may appear as early as the first day or as late as the 13th. Administering Erythromycin or Tetracycline Ophthalmic Ointment  The cord is clamped and cut approximately  These ointments are the ones commonly used within 30 seconds after birth. nowadays for eye prophylaxis because they do not  In the delivery room, the cord is clamped twice cause eye irritation and are more effective against about 8 inches from the abdomen and cut in Chlamydial conjunctivitis. between.  Apply over lower lids of both eyes, then,  When the newborn is brought to the nursery, manipulate eyelids to spread medication over the another clamp is applied ½ to 1 inch from the eyes. abdomen and the cord is cut at second time.  Wipe excess ointment after one minute Č sterile  The cord and the area around it are cleansed with cotton ball moistened Č sterile water. antiseptic solution.  The manner of cord care depends on hospital protocol. What is important is that the principles are followed. Cord clamp maybe removed after 48 hours when the cord has dried.  The cord stump usually dries and fall within 7 to 10 days leaving a granulating area that heals on the next 7 to 10 days. Instruction to the mother on cord care: 1. No tub bathing until cord falls off. Do notVI. Preventing Hemorrhage sponge bath to clean the baby. See to it that cord  As a preventive measure, 0.5mg (preterm) to 1 does not get wet by water or urine. mg (full term) Vit. K or Aquamephyton is 2. Do not apply anything on the cord such as baby injected IM in the NB’s vastus lateralis (lateral powder or antibiotic, except the prescribed anterior thigh)muscle antiseptic solution which is 70% alcohol.  Vit-K – to prevent hemorrhage R/T 3. Avoid wetting the cord. Fold diaper below so physiologic hypoprothrombinemia that it does not cover the cord and does not get  Aquamephyton, wet when the diaper soaks with urine. phytomenadione or konakion 4. Leave cord exposed to air. Do not apply dressing  .1 ml term IM, vastus lateral or or abdominal binder over it. The cord dries and lateral ant thigh separates more rapidly if it is exposed to air.  .05 ml preterm baby 5. If you notice the cord to be bleeding, apply firm  Vit K – synthesized by normal flora of pressure and check cord clamp if loose and intestine fasten.  Vit K – meds is synthetic due intestine is 6. Report any unusual signs and symptoms which sterile indicates infection. Foul odor in the cord Procedure for Vitamin K injection. Presence of discharge  Cleanse area thoroughly with alcohol swab and Redness around the cord allow skin to dry. The cord remains wet and does not fall  Bunch the tissue of the upper outer thigh (vastus off within 7 to 10 days lateralis muscle) and quickly insert a 25-gauge Newborn fever 5/8-inch needle at a 90-degree angle to the thigh. Care of the Newborn Abejo
  5. 5. Maternal and Child Health Nursing Care of the Newborn NOTE: If 2 vessel cord- suspect kidney malformation - leave about 1” of cord - if BT or IV infusion – leave 8” of cord best access - no nerve - check cord every 15 min for 1st 6 hrs – bleeding .> 30 cc of blood bleeding of cord – Omphalagia – suspect hemophilia NOTE: Cord turns black on 3rd day & fall 7 – 10 days Faiture to fall after 2 weeks- Umbilical granulation Mgt: silver nitrate or catheterization - clean with normal saline solution not alcohol - don’t use bigkis – air - persistent moisture-urine, suspect patent uracus – fistula bet bladder and normal umbilicus dx: nitrazine paper test – yellow – urine mgt: surgeryVIII. Initial feeding IX. Immunization • May breastfeed immediately after birth • Formula feeding- 2 to 4 hours of age  BCG should be given as soon as possible after • Demand schedule birth in all population at high risk of tuberculosis infection Mothers milk is the best food a baby can have in the  OPV a single dose of OPV at birth or in the two first 6 months of life… weeks after birth is recommended to increase early protection. ADVANTAGES OF BREAST FEEDING  Hepatitis B vaccine it is important to administer  Enhances the infant’s immune system (IgA the first dose as soon as possible or within 24 Lactoferrin, lysozyme, interferon, bifidus Factor) hours after birth  It reduces the cost of feeding and preparation time  An excellent opportunity to enhance symbiotic NOTE: Instruct the mother to be aware of the bond following EARLY SIGNS OF SERIOUS DISEASE  It is easy to digest. and refer the baby immediately to a doctor  It is clean and has the right temperature.  Not gaining weight  It contains the ideal electrolyte and mineral  Excessive cry or not crying composition for infant growth  Convulsion, Twitching, Eye blinking  Stiff neck, body and limbs  Breastfeeding should start within 30 minutes after  Pus discharge or swelling of cord birth  Eye drainage  COLOSTRUM (first 2-3 days): good for babies and  Feverish or cold baby helps protect them against infection  Fast respiration, groaning and chest  When the baby is 6 months old, start giving other retraction food in addition to breastmilk  Not accepting feed  Continue to breastfeed sick babies  Irritable or lethargic  Breastfeeding mothers should eat nutritious food to  Pale or Jaundice become stronger  Cyanotic  Vomiting and Abdominal distension  Not passed urine within 2 days and stool within 1 day Care of the Newborn Abejo