Newborn Care Reviewer Exam Study Guide, Exams of Nursing

Download Newborn Care Reviewer Exam Study Guide and more Exams Nursing in PDF only on Docsity! NUR 1221 NEWBORN CARE REVIEWER EXAM STUDY GUIDE 2024 PRINCIPLES OF NEWBORN CARE •Establishment of respiration •Prevention of hypothermia •Establishment of breastfeeding •Prevention of infection •Identification of at risk neonate CARE AT BIRTH - The umbilical cord should be clamped as soon as the neonate is completely delivered. - Put ties tightly around cord at 2cm and 5cm from baby's abdomen, cut between ties with a sterile blade. OR - Use commercially available Cord Clamp at 2 cm from baby's abdomen - Observe for oozing blood. If blood oozes, place a second tie between the skin and first tie. Care of Eyes - should be cleaned at birth and apply Erythromycin 1% eye ointment at each eye from inner to outer canthus at lower conjuctival sac to prevent Opthalmia Neonatorum. Skin Care - Clean the baby off blood, mucus and meconium before presenting to the mother. - Bathing of babies soon after birth is not recommended so it is done 6 hours after birth. NEONATAL RESUSCITATION - the set of interventions at the time of birth to support the establishment of breathing and circulation - About 8% to 10% of babies require some assistance at birth - Only about 1 to I .5% needs extensive resuscitative techniques including chest compression and medications Physiology of asphyxia - Although fetal lungs are expanded in-utero, but alveoli are fluid filled. At birth, the fluid in the alveoli is absorbed into lung tissue and is replaced by the air.The blood vessels in fetal lungs are markedly constricted. Exposure to oxygen after birth causes the pulmonary arterioles to relax, permitting a dramatic increase in pulmonaryblood flow. The blood absorbs oxygen from the air in the alveoli, and the oxygen-enriched blood is pumped into the tissues throughout the body. Risk Factors - Have more chances of needing assisted or advanced resuscitation and these babies also require post-natal care in a specialized center. High Risk Factors •Mother with high blood pressure, edema feet, diabetes and severe anemia. •Bleeding in second or third trimester •Previous fetal or neonatal death. •History of previous premature or low birth weight baby .•Maternal age less than 16 years or more than 35years. •Breech or other abnormal presentation. •Multiple pregnancies e%. Equipment •Before delivery one must check the following equipment’s, which should be in working condition: •Source of heat, either radiant warmer or 200-wattbulb •Minimum two clean dry sheets for each newborn •Oxygen supply •Self-inflating bag with face mask of three different sizes •Laryngoscope with endotracheal tubes of different sizes •Drugs -Epinephrine, Naloxone, Normal Saline Solution •Suction catheters size 12F & 14F •Tape, scissors •Appropriate size gloves Role of Apgar Score - the measure of the status of the new born immediately after delivery. •Perform and record Apgars core at 1min & at 5mins. •If the score is less than 7 at 5 mins. , the Apgar score should be perform at 10 mins. •A score of 7-10 indicates a healthy newborn. •A scoreof 3-6 is considered moderately depressed. •A score of 0-2 is severely depressed. ESSENTIAL POSTNATAL CARE •Prevention and optimal management of hypothermia •Prevention of neonatal infections •Promotion of breast feeding. •Early identification of dangers signs for systemic illness and its management. •Mother should be advised regarding the immunization schedule. Identification of At Risk Neonates and Anthropometric Measurements •Record weight, length and head circumference (Anthropometric Measurement) 1) Birth weight: < 2500 g are known as low birth weight > 1800g can be managed at home. < I800 g would need referral a. Length - Average 45.7-55.9 cm (18-22in) b. Chest Circumference - 30-33 cm (12-13inches) -should be equal to or 2-3 cm < head circumference. C. Head Circumference - 25% of the body length; circumference 33-37cm -Bones of the skull are not fused -Palpable sutures -Fontanels Molding , Caput Succedaneum, Cephalohematoma - Caput succedaneum - boggy swelling over the scalp because of pressure over the presenting part Heat Lost 1) Radiation: If the environment is lower than 30°C, the baby is likely to loose more heat from its body 2) Conduction contact with cold objects 3) Convection: surrounding air that is moving around the baby. 4) Evaporation: From the wet surface of the skin. Temperature Recording - Normal temperature in a newborn is 36.5 -37S°C Bathing of newborn •Warm a small area or corner of theroom •Use warm water checked with her elbow, and undresses the infant on her lap. •Bathe the infant quickly and gently •Immediately wrap the infant in a warm towel and dried thoroughly from head to toes. •Quickly dress and wrap the infant, remembering to place a cap on baby's head. •Place the infant close to mother and allow breast-feeding. Promotion of Breastfeeding - wash her hands before feeding - sitting upright in the bed or in a chair, or lying on herside. - hold the baby, cradle hold, baby's head and body supported against the mother's arm, with buttocks resting in her hand; - football hold, baby's legs are supported under the mother's arm, and the head is at the breast, resting in the mother's hand; and lying on the side with the baby lying on his/her side facing the mother. - bring the baby close to her, - cup the breast in her hand in a C position - woman place her nipple against the side of the baby's mouth - alternate the breast with which she begins feeding at each feeding to ensure emptying of both breasts - 10 minutes at each breast, (every 2 to 4 hours) - air dry her nipples for approximately 15 to 20 minutes - mother burp the infant at the end of the feeding - uterine cramping may occur, because of the release of oxytocin - provide for adequate rest and to avoid tension - dvise the woman to avoid taking medications and drugs Danger Signs in a Newborn •Lethargy with poor suck •Hypothermia (Cold abdomen and feet) •Breathing difficulty •Abdominal distention •Bleeding from any site •Jaundice: Yellow staining of palms/soles Give Immunization advice after birth - CG, OPV-0, and Hepatitis B vaccines are recommended Weight Changes after Birth - Full term - Lose weight during the first 2 to 3 days of life. *5 to 7 percent* by the end of I0 days. - Preterm - loose weight up to I0 per cent but regain birth weight by 14 days of age. HEPATITIS B - HBV - 0.5 ml IM in the upper thigh as soon after birth as possible (preferably within 12 hours of birth). - HIG - 200 units IM in the other thigh within 24 hours of birth, or within 48 hours of birth at the latest. TUBERCULOSIS – IF MOTHER Has active lung tuberculosis - Do not give the tuberculosis vaccine (BCG) atbirth;