[18] MIDTERMS | NEWBORN CARE Flashcards
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.
BREASTFEEDING
Preparation of Breast:
* Avoid use of ____ on nipples
* Use of creams, nipple rolling, pulling and rubbing to ____ nipples is not advisable.
* Women with flat or inverted nipples may find ____ useful.
- Avoid use of soap on nipples
- Use of creams, nipple rolling, pulling and rubbing to “toughen” nipples is not advisable.
- Women with flat or inverted nipples may find breast shells (breast cups) useful.
BREASTFEEDING
Assisting with First Feeding:
* Within the ____
* Baby and Mother are ____
* Position with mother and baby
* Assess infant’s response to feeding (WOF ____)
- Within the first hour of birth
- Baby and Mother are stable
- Position with mother and baby
- Assess infant’s response to feeding (WOF cyanosis and choking)
BREASTFEEDING
Mother-Baby Position:
* Infant’s head and body ____
* Infant’s nose ____
* Infant’s body ____
* Mother supporting ____
- Infant’s head and body ____
- Infant’s nose ____
- Infant’s body ____
- Mother supporting ____
BREASTFEEDING
Feeding Techniques: Positions (4)
- Craddle
- Football hold
- Cross-craddle hold
- Side-lying position
BREASTFEEDING
Latching-On Techniques: Signs of Good Attachment (4)
- Chin touching breast
- Mouth wide open
- Lower lip turned outward
- More areola visible above than below the mouth
BREASTFEEDING
Removal from the Breast
* By ____ - mother should ____
* Indent the breast tissue with ____ and remove infant when suction is released
- By inserting finger into the cordner of the infant’s mouth between the gums - mother should remove breast quickly before the infant begins to suck again
- Indent the breast tissue with a finger near the infant’s mouth and remove infant when suction is released
BREASTFEEDING
- Suckling Effectively - ____ and pausing sometimes
- Duration - ____ and then increase the time of feeding in each breast
- Volume of Breast Milk/Day - ____, but some women are producing more milk
- Next Breastfeeding - begin on the ____ for even stimulation and emptying of the breast
- Suckling Effectively - slow and deep sucks and pausing sometimes
- Duration - 10 minutes and then increase the time of feeding in each breast
- Volume of Breast Milk/Day - average of 1 quart, but some women are producing more milk
- Next Breastfeeding - begin on the last breast for even stimulation and emptying of the breast
BREASTFEEDING
COMMON BREAST PROBLEMS: (7)
- No milk
- Engorgement
- Nipple pain
- Nipple trauma
- Flat or inverted nipples
- Plugged ducts
- Mastitis
BREASTFEEDING
COMMON BREAST PROBLEMS: No Milk
* ____ - whole grains, dark green leafy vegetables, (spinach, broccoli, malunggay, camote tops), garlic, nuts/seeds (almonds, fennel), ginger, papaya, mussels, spices (cumin, anise, turmeric)
* Warm compress
* ____
* Good attachment
* ____
- “Galactogogues” - whole grains, dark green leafy vegetables, (spinach, broccoli, malunggay, camote tops), garlic, nuts/seeds (almonds, fennel), ginger, papaya, mussels, spices (cumin, anise, turmeric)
- Warm compress
- Lactation massage
- Good attachment
- Frequent BF
BREASTFEEDING
COMMON BREAST PROBLEMS: Engorgement
* Temporary swelling or fullness of the breast when milk begins to “come in” or change from ____ to ____.
* Usually occurs on the ____
* Result of ____
* May also be caused by milk retention if feedings are delayed, too short, or infrequent.
* Treatment may include: application of heat and cold, ____, and a ____ may be worn both day and night to help support breasts
- Temporary swelling or fullness of the breast when milk begins to “come in” or change from colostrums to transitional breast milk.
- Usually occurs on the 2nd or 3rd day after birth.
- Result of accumulation of milk, enlarged lymph glands & increased blood flow.
- May also be caused by milk retention if feedings are delayed, too short, or infrequent.
- Treatment may include: application of heat and cold, massage and proper breastfeeding techniques, and a well-fitting bra may be worn both day and night to help support breasts
BREASTFEEDING
COMMON BREAST PROBLEMS: Nipple Pain
* Pain for ____
* Usually peaks at the ____ and resolves soon afterward.
- Pain for a minute or less
- Usually peaks at the 3rd to 6th day and resolves soon afterward.
BREASTFEEDING
COMMON BREAST PROBLEMS: Nipple Trauma
* ____ pain
* Appear ____
* Treatment includes proper positioning, rotating used nipples, application of ____.
* Redness of breasts tissue, purulent discharge, fever, mastitis or breast abscess may require ____.
- Sustained pain
- Appear red, cracked, blistered, or bleeding
- Treatment includes proper positioning, rotating used nipples, application of small amount of BM in affected nipples.
- Redness of breasts tissue, purulent discharge, fever, mastitis or breast abscess may require antibiotic treatment.
COMMON BREAST PROBLEMS: Plugged Ducts
* ____ is present, and a hard area may be palpated
* ____ may be present on the nipple
* Massage and proper breastfeeding
* Plugged ducts may progress to ____ if not treated promptly
- Localized edema and tenderness is present, and a hard area may be palpated
- Tiny, white area may be present on the nipple
- Massage and proper breastfeeding
- Plugged ducts may progress to mastitis if not treated promptly
BREASTFEEDING
COMMON BREAST PROBLEMS: Mastitis
* Inflammation of ____
* Caused by ____ or ____
* Onset of flu-like symptoms: fever, chills, body aches and headache.
* Localized breast pain, tenderness, a hot reddened area on breast; usually on ____
* Treatment: antibiotics, analgesics, antipyretics, rest, warm compress, ____, and balanced diet
- Inflammation of breast tissue
- Caused by blocked milk ducts or milk excess
- Onset of flu-like symptoms: fever, chills, body aches and headache.
- Localized breast pain, tenderness, a hot reddened area on breast; usually on upper outer quadrant
- Treatment: antibiotics, analgesics, antipyretics, rest, warm compress, adequate fluid intake, and balanced diet
BREASTFEEDING
EXPRESSION OF MILK (3)
- Unable to nurse for medical or employment reasons
- Manual or breast pump
- Breasts need frequent stimulation
BREASTFEEDING
BREAST PUMPS (2)
- Hand-held
- Electric or battery-operated
BREASTFEEDING
TIPS ON STORING BREAST MILK
* Not refrigerated – ____
* Refrigerated – up to ____ stored in a ____
* Freezer compartment inside the refrigerator for up to ____
* Self contained freezer unit of a refrigerator for up to ____
* In a separate deep freeze unit at____
- Not refrigerated – 3-4 hours
- Refrigerated – up to 3 days stored in a clean plastic container
- Freezer compartment inside the refrigerator for up to 2 weeks
- Self contained freezer unit of a refrigerator for up to 3 to 4 months
- In a separate deep freeze unit at 0⁰ F or less up to 6 months.
BREASTFEEDING
POLICIES ON THE PROMOTION OF BREAST MILK
* ____ - Philippine Code of Marketing of Breast Milk Subtitutes
* ____ - The Rooming-in and Breastfeeding Act of 1992
- Executive Order no. 51 - Philippine Code of Marketing of Breast Milk Subtitutes
- R.A. no. 7600 - The Rooming-in and Breastfeeding Act of 1992
PROMOTION OF SKIN INTEGRITY
* Bathing
* Cleansing of ____
* Diaper change
* ____
* Cleansing of buttocks and perineal area
* ____
* Keep ____
- Bathing
- Cleansing of buttocks and perineal area
- Diaper change
- Cord care
- Cleansing of buttocks and perineal area
- Fresh water and cotton or mild soap and water with diaper changes.
- Keep clean and dry.
