[18] MIDTERMS | NEWBORN CARE Flashcards
(43 cards)
Two Broad Goals of Nursing Care during this Period:
- To promote the physical well-being of the newborn
- To enhance the establishment of a well-functioning family unit
Initiation of Admission Procedures: (4)
- Condition of the newborn
- Labor and birth record
- Antepartal history
- Parent-newborn interaction information
NEWBORN CARE
Essential Intrapartum and Newborn Care/EINC (4)
- Early skin-to-skin contact
- Immediate thorough dry
- Non-separation of mother from baby via breastfeeding
- Cord clamping properly tied
NEWBORN CARE
Classifications:
* ____ - the first 90 minutes
* ____ - from 90 minutes to 6 hours
* Care Prior to Discharge
- Immediate Newborn Care - the first 90 minutes
- Essential Newborn Care - from 90 minutes to 6 hours
- Care Prior to Discharge
NEWBORN CARE
FIRST 90 MINUTES
Time Band: At ____, with presenting part visible
Intervention: ____
Action:
* Ensure that delivery area is draft- free and between ____ using a room thermometer.
* Wash hands with clean water and soap.
* ____ just before delivery.
FIRST 90 MINUTES
Time Band: At perineal bulging, with presenting part visible
Intervention: Prepare for the delivery
Action:
* Ensure that delivery area is draft- free and between 25-28 degree Celsius using a room thermometer.
* Wash hands with clean water and soap.
* Double glove just before delivery.
NEWBORN CARE
FIRST 90 MINUTES
Time Band: Within the first 30 seconds (____)
Intervention: ____
Action:
* Use a clean, dry cloth to thoroughly dry the baby by wiping the eyes, face, head, front and back, arms and legs.
* Remove the wet cloth.
* Do ____ while drying.
FIRST 90 MINUTES
Time Band: Within the first 30 seconds (call out the time of birth)
Intervention: Dry and provide warmth
Action:
* Use a clean, dry cloth to thoroughly dry the baby by wiping the eyes, face, head, front and back, arms and legs.
* Remove the wet cloth.
* Do quick check of newborn’s breathing while drying.
NEWBORN CARE
FIRST 90 MINUTES
Time Band: If ____, newborn is not breathing or is gasping
Intervention: ____
Action:
* ____
* Transfer to a ____
* Inform the ____ that the newborn has difficulty breathing and that you will help the baby to breathe.
* Start ____
Time Band: If after 30 seconds of thorough drying, newborn is not breathing or is gasping
Intervention: Re-position, suction and ventilate
Action:
* Call for help
* Transfer to a warm, firm surface.
* Inform the mother that the newborn has difficulty breathing and that you will help the baby to breathe.
* Start resuscitation protocol.
NEWBORN CARE
FIRST 90 MINUTES
Time Band: If after 30 secs of thorough drying, newborn is breathing or crying
Intervention: ____
Action:
* If baby is crying and breathing normally, avoid ____, that may cause trauma or introduce infection.
* Place the newborn ____ or ____.
* Turn the newborn’s head ____
* Cover newborn’s back with a blanket and head with a bonnet (rationale: keeping temperature at optimal range of ____ to avoid ____)
* Place identification band on ankle
Intervention for Mother:
* Palpate the ____
* Exclude a second baby
* If no second baby, inject ____ into the ____
* If there is a second baby, get help and deliver
Time Band: If after 30 secs of thorough drying, newborn is breathing or crying
Intervention: Do skin-to-skin contact
Action:
* If baby is crying and breathing normally, avoid any manipulation, such as routine suctioning, that may cause trauma or introduce infection.
* Place the newborn prone on the mother’s abdomen or chest skin-to-skin.
* Turn the newborn’s head to one side
* Cover newborn’s back with a blanket and head with a bonnet (rationale: keeping temperature at optimal range of 36.4 to 37.2 C to avoid metabolic acidosis, hypoxia, and shock)
* Place identification band on ankle
Intervention for Mother:
* Palpate the mother’s abdomen
* Exclude a second baby
* If no second baby, inject oxytocin 10 IU IM into the mother’s arm or thigh
* If there is a second baby, get help and deliver
NEWBORN CARE
FIRST 90 MINUTES
Time Band: ____
Intervention: ____
Action:
* Remove the ____ immediately prior to touching or handling the cord.
* ____ after cord pulsations have stopped (typically at ____)
* Apply sterile plastic clamp or tie at ____ and the second
clamp at ____ from the ____
* Cut close to the first clamp with sterile scissors.
* Observe for oozing blood. It should have ____ and ____
Time Band: 1-3 minutes
Intervention: Do non-immediate or appropriately timed cord clamping
Action:
* Remove the first set of gloves immediately prior to touching or handling the cord.
* Clamp and cut the cord after cord pulsations have stopped (typically at 1 to 3 minutes)
* Apply sterile plastic clamp or tie at 2 cm and the second
clamp at 5 cm from the umbilical base
* Cut close to the first clamp with sterile scissors.
* Observe for oozing blood. It should have 2 arteries and 1 vein
NEWBORN CARE
FIRST 90 MINUTES
Time Band: Within 90 minutes of age
Intervention: ____
Action:
* Leave the newborn on ____
* Observe newborn for feeding cues
* Counsel on ____. Look for signs of good attachment and suckling.
For Small Baby or Twin
Intervention: for a visibly small newborn or a newborn born > 1 month early
Action:
* ____ with her as much as possible.
* Provide extra blankets to keep the baby warm
* If mother cannot provide skin-to-skin contact, use ____
* Do not bathe the small baby; ensure hygiene by wiping with a damp cloth but only ____
* Prepare a very small baby (____) or a baby born ____ for referral
Time Band: Within 90 minutes of age
Intervention: Initiation of breastfeeding
Action:
* Leave the newborn on mother’s chest in skin-to-skin contact.
* Observe newborn for feeding cues
* Counsel on positioning and attachment. Look for signs of good attachment and suckling.
For Small Baby or Twin
Intervention: for a visibly small newborn or a newborn born > 1 month early
Action:
* Skin-to-skin contact with her as much as possible.
* Provide extra blankets to keep the baby warm
* If mother cannot provide skin-to-skin contact, use warm blanket or radiant warmer
* Do not bathe the small baby; ensure hygiene by wiping with a damp cloth but only after 6 hours
* Prepare a very small baby (1.5 kg) or a baby born > 2 months early for referral
NEWBORN CARE
FIRST 90 MINUTES
Time Band: within 90 minutes of age
Intervention: ____
Action:
* Administer ____ or ____ ointment or ____ drops to both eyes after newborn has located breast (rationale: for treatment of ____)
* Do not wash away the eye antimicrobial.
Time Band: within 90 minutes of age
Intervention: Do eye care
Action:
* Administer erythromycin or tetracycline ointment or 2.5% providone-iodine drops to both eyes after newborn has located breast (rationale: for treatment of gonorrheal conjunctivitis)
* Do not wash away the eye antimicrobial.
NEWBORN CARE
ESSENTIAL NEWBORN CARE
Time Band: 90 minutes to 6 hours
Intervention: ____ (keep newborn in the room with the mother)
Action:
* Check for ____
* Weigh the newborn.
* Get the head, chest, abdominal circumference and length.
* Give ____, middle third ____ or ____ to prevent hemorrhagic disease; ____ single dose.
* Inject ____ and ____ vaccine
* Get the vital signs
* Perform the cord care
* Dress the newborn
Time Band: 90 minutes to 6 hours
Intervention: Rooming-In (keep newborn in the room with the mother)
Action:
* Check for birth injuries, malformations or defects.
* Weigh the newborn.
* Get the head, chest, abdominal circumference and length.
* Give Vit K prophylaxis (AquaMEPHYTON), middle third vastus lateralis or rectus femoris to prevent hemorrhagic disease; 0.5 – 1 mg single dose.
* Inject hepa B and BCG vaccine
* Get the vital signs
* Perform the cord care
* Dress the newborn
NEWBORN CARE
CARE PRIOR TO DISCHARGE
Time Band: After the ____ but prior to discharge
Intervention:
* Support ____, day and night
* Ensure the warmth of the baby
* Washing and bathing (hygiene)
* Sleeping
* Look for signs of serious illness, ____, and local infection
* Discharge instructions
Time Band: After the 90 minute of age but prior to discharge
Intervention:
* Support unrestricted per demand breastfeeding, day and night
* Ensure the warmth of the baby
* Washing and bathing (hygiene)
* Sleeping
* Look for signs of serious illness, jaundice, and local infection
* Discharge instructions
HEALTH TEACHINGS
Signs of Neonatal Distress: (4)
- Changes in color or activity
- Grunting or “sighing sounds”
- Rapid breathing with chest retractions
- Facial grimacing
MONITORING VITAL SIGNS
Should be monitored ____ for ____ until stable
Temperature
* Axillary method, skin sensor for continuous reading
* ____
Respirations
* Irregular yet normal (periodic apnea)
* ____
Pulse
* ____
* Apical pulse for a full minute
Should be monitored q30 minutes for 2 hours until stable
Temperature
* Axillary method, skin sensor for continuous reading
* 36.4 to 37.2 C
Respirations
* Irregular yet normal (periodic apnea)
* 30-60 cpm
Pulse
* 120-160 bpm
* Apical pulse for a full minute
PROMOTION OF ADEQUATE NUTRITION AND HYDRATION
Monitoring of Output
* Within 24 hours - ____
* Within 48 hours - ____
* Assess for abdominal distention, bowel sounds, hydration, fluid intake, and temperature stability
Weighing
* ____
* ____ of weight loss is normal during ____ due to limited intake, loss of excessive extracellular fluid, and passage of meconium (regained by ____)
Monitoring of Output
* Within 24 hours - voiding
* Within 48 hours - passage of stools
* Assess for abdominal distention, bowel sounds, hydration, fluid intake, and temperature stability
Weighing
* Same time of the day
* **10% **of weight loss is normal during first week due to limited intake, loss of excessive extracellular fluid, and passage of meconium (regained by 2 weeks)
Milk produced by the mother provides primary source of nutrition for the baby before they are able to eat and digest
Breast Mlik
BREASTFEEDING
STAGES OF MILK (3)
- Colostrum
- Transitional Milk
- Mature Milk
BREASTFEEDING
STAGES OF MILK - Colostrum
* ____ fluid
* ____ than mature milk
* Contains more protein, fat-soluble vitamins & minerals
* High level of ____
* Replaced by transitional milk within ____ after birth
- Yellowish or creamy fluid
- Thicker than mature milk
- Contains more protein, fat-soluble vitamins & minerals
- High level of IgA
- Replaced by transitional milk within 2-4 days after birth
BREASTFEEDING
STAGES OF MILK - Transitional Milk
* Produced from ____ until approximately ____
* Contains lactose, water-soluble vitamins, elevated levels of fats, and more calories than ____.
- Produced from the end of colostrums and production until approximately 2 weeks postpartum.
- Contains lactose, water-soluble vitamins, elevated levels of fats, and more calories than colostrum.
BREASTFEEDING
STAGES OF MILK - Mature Milk
* 10% solids (____) for energy and growth; rest is water, which is vital in maintaining hydration
- 10% solids (carbohydrates, proteins, fats) for energy and growth; rest is water, which is vital in maintaining hydration
BREASTFEEDING
PHYSIOLOGY OF BREAST MILK PRODUCTION
1. Decreased ____ levels after placental delivery
2. Stimulates ____ to produce ____
3. Acts on ____ to produce milk
4. Stored in collecting tubules
5. ____
6. When infant sucks - stimulates ____ to produce ____
7. Causes contraction of smooth muscles of collecting tubules
8. Breast milk is released
9. ____
- Decreased estrogen and progesterone levels after placental delivery
- Stimulates adenohypophysis to produce prolactin
- Acts on acinar cells to produce milk
- Stored in collecting tubules
- Milk-Secretion Reflex
- When infant sucks - stimulates posterior pituitary gland to produce oxytocin
- Causes contraction of smooth muscles of collecting tubules
- Breast milk is released
- Milk Ejection Reflex
BREASTFEEDING
ADVANTAGES OF BREASTFEEDING (B.R.E.A.S.T.F.E.E.D.I.N.G.)
* Best for baby
* Reduces ____
* ____, no cost and waste
* ____, greater immunity to infections
* Satisfies infant’s ____
* ____ always correct and constant
* Fresh milk never ____
* ____
* Easy once established/convenient
* ____
* Inhibits ____
* ____ greatly reduced
* No mixing required
- Best for baby
- Reduces incidence of allergies
- Economical, no cost and waste
- Antibodies, greater immunity to infections
- Satisfies infant’s nutritional needs
- Temperature always correct and constant
- Fresh milk never spoils
- Emotional bonding
- Easy once established/convenient
- Digested easily
- Inhibits ovulation
- Gastroenteritis greatly reduced
- No mixing required
BREASTFEEDING
ARTICLE REVIEW: 7 Surprising Superpowers of Breastmilk
- Breastmilk can potentially cure cancer.
- Breastmilk can ‘sense’ when your baby is sick.
- On hot days, your breastmilk automatically becomes more ‘watery’.
- Breastmilk can fight bacteria.
- Breastmilk cures acne.
- It’s a natural pain-relief medication.
- It’s the perfect pre-term baby milk.
