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Immediate care lamiaa slide share


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Immediate care lamiaa slide share

  1. 1. Prepared By /lamiaa Elsayed Pediatric Nursing Immediate care of newborn 1
  2. 2. The 1st 24 hours of LifeThe first 24 hours of life is a very significanttime due to critical transition fromintrauterine to extra uterine life .
  3. 3. Immediate care of newborn 3
  4. 4. Purposes of immediate care of newborn• Establish and maintain respiratory function.• Provide warmth and prevent hypothermia.• Ensure safety from injury and infection.• Identify actual and potential problems that might require immediate action. Immediate care of newborn 4
  5. 5. ImmediateCare of the Newborn• Airway• Breathing• Temperature• APGAR• IDENTIFICATION
  6. 6. Implementation:• Oro-pharengeal Suctioning:• 1.Wipe the neonate’s mouth with a piece of gauze around your index finger once his head has been delivered.• Wrap and dry the neonate in a warmed towel.• Suction the neonate’s mouth with a disposable Suctioning. Immediate care of newborn 6
  7. 7. Implementation:• Place the neonate in a radiant warmer.• Replace the wet towel and wrap the neonate in another dry towel.• Place newborn in trendlenburng position.• Do suction of oropharyngeal canal.• Oxygen may be given.• Continue suction as fluid is aspirated. Immediate care of newborn 7
  8. 8. Dry the Baby • Hypothermia is common • Wet newborns rapidly lose heat • Use a warm, dry, soft towel • Any absorbent material:
  9. 9. Replace the Wet Towels • Then let the mother hold the baby • Her body heat will help keep the baby warm • Cover the head to prevent heat loss
  10. 10. POSITIONING OF THE NEWBORN • Positioning Right side lying 1. promote drainage secretion 2. fasten gastric emptying time • good airway.
  11. 11. Airway & Breathing• Suction gently & quickly using bulb syringe or suction catheter• Starts in the mouth then, the nose to prevent aspiration Immediate care of newborn 11
  12. 12. Suction first from Mouth and then fromNose Use a by use of bulb syringe
  13. 13. Airway & Breathing• Stimulate crying by rubbing• Position properly- side lying / Provide oxygen when necessary Immediate care of newborn 13
  14. 14. Assess the newborn’s conditionA- One minute APGAR Score&- reassess at5 minutes.B-Neurological examination by checkingcommon reflexes of the newborn.C-Vital signs pulse, respiration &temperature.D-Growth measurement include length,weight, head & chest circumferences. Immediate care of newborn 14
  15. 15. Assess the newborn’s conditionE-Assess for any gross abnormality, congenitaldefects in head,F- eyes, ears, chest, spine,. face, nose,abdomen, anus, external genitalia &extremities.G-Assess for any signs of eye infection. Immediate care of newborn 15
  16. 16. Apgar score• The Apgar score is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two and summing up the five values.The resulting Apgar score ranges from zero to 10. Immediate care of newborn 16
  17. 17. APGAR Scoring SystemA ctivity/ Muscle ToneP ulse/ Heart RateG rimace/ Reflex Irritability/ ResponsivenessA ppearance/ Skin ColorR espiration/ Breathing1 2 3 4 5 Immediate care of newborn 17
  18. 18. APGAR
  19. 19. Apgar score Sign 0 1 2Heart rate(pulse Absent Below 100 Above 100Respiratory Absent Weak cry Good , strong cry effortMuscle tone none Some flexion of Active motion , extremities extremities well flexed . Reflex No Grimace Cry irritability response Color Blue or Body pink , Pink pale extremities blue Immediate care of newborn 19
  20. 20. Significance of Apgar score• Healthy newborn: 7-10 at both 1 and 5 minutes .• Moderately depressed newborn : 3-6 ( Need resuscitation )• Severely depressed newborn : 1-2 ( Intensive resuscitation ) Immediate care of newborn 20
  21. 21. Cord CareImmediate care of newborn 21
  22. 22. Cord Care• Use sterile plastic clamp or ligature, the first ligature is placed about 2.5-3 cm from the abdomen & second ligature is placed about 1cm from the first ligature.• Press between the two ligatures.• Cut the cord by blunt sterile scissor after the second clamp.• Examine umbilical cord structure (two arteries and one vein) Immediate care of newborn 22
  23. 23. Cord Care Continue• Paint the end of the stump with alcohol.• Clean the cord at the base of cord firstly, then the stump from down to up with one direction and cleaning the cord clamp.• Let the cord exposed not covered by the diaper.• Assess the signs of cord healing and signs of infection (erythema edema tenderness). Immediate care of newborn 23
  24. 24. Cord CareImmediate care of newborn 24
  25. 25. Eye care:• Clean the eye lids é sterile warm sterile water and cotton.• Wipe from inner to outward.• Install one drop of solution of isophenicol.• Wipe the excess of solution by clean cotton. Immediate care of newborn 25
  26. 26. Vitamin K Injection• Administer 1mg. Vitamin K by I.M injection.• Route: IM into the lateral anterior thigh (Vastus lateralis). Immediate care of newborn 26
  27. 27. Vitamin K Administration Immediate care of newborn 27
  28. 28. Identification of the newborn• Identification of the newborn which place on wrist & ankle (mother name, hospital no, sex, weight of newborn).• Before transferring to nursery, ID tag should be applied. Immediate care of newborn 28
  29. 29. Dressing/ Wrapping • “Mummy” • Wrap in warm blanket • Cover head with stockinette cap Immediate care of newborn 29
  30. 30. Assessment of vital signs•temperature : the axillary method is the safest .Normal axillary temperature is 36 – 36.5 °C •Heart Rate ( HR ) : HR is counted for 60 seconds at the apex of the heart (Rangefrom 100- 160 b/m immediately after birth ) .•Respiratory Rate ( RR ) :RR varies from 30- 60 b/m when the infant is not crying .•Blood Pressure ( BP ) :Not routinely assessed in healthy term infants .The range of normal blood pressure in term infants is 60- 90 mmhg for systolic pressure and 40 – 50 mmhg for diastolic pressure . Immediate care of newborn 30
  31. 31. ANTHROPOMETRIC MEASUREMENT• HEAD CIRCUMFERENCE : 33-35cm• CHEST and ABDOMEN : 31-33cm• LENGTH : 47-54cm• WEIGHT : 2500-4000 grams Immediate care of newborn 31
  32. 32. Assessment of Growth Immediate care of newborn 32
  33. 33. Immediate care of newborn 33
  34. 34. Neurologic System
  35. 35. Neonatal Primitive Reflexes Immediate care of newborn 35
  36. 36. ReflexesInclude the Moro , startle , palmer and planter grasps, sucking and rooting and swallowing reflexes, tonic neck reflex ,stepping , and babinski sign . Immediate care of newborn 36
  37. 37. Moro Reflex or startle reflex• quick change in the infants position will cause the infant to throw the arms outward, open the hands, and throw back the head . Immediate care of newborn 37
  38. 38. Palmer grasp• Palmar and plantar grasp - the infants fingers or toes will curl around a finger placed in the area Immediate care of newborn 38
  39. 39. planter grasp• Palmar and plantar grasp - the infants fingers or toes will curl around a finger placed in the area Immediate care of newborn 39
  40. 40. Babniski reflex• the infants foot is stroked, the toes will extend upward . Immediate care of newborn 40
  41. 41. Rooting reflex• This reflex begins when the corner of the babys mouth is stroked or touched . Immediate care of newborn 41
  42. 42. Sucking reflex• When the roof of the babys mouth is touched, the baby will begin to suck. Immediate care of newborn 42
  43. 43. Asymmetric tonic neck reflexTonic neck reflex - When a babys head is turned to one side, the arm on that side stretches out and the opposite arm bends up at the elbow. Immediate care of newborn 43
  44. 44. Dance or step reflex• This reflex is also called the walking or dance reflex because a baby appears to take steps or dance when held upright with his/her feet touching a solid surface. Immediate care of newborn 44
  45. 45. Immediate care of newborn 45