[18] MIDTERMS | NEWBORN CARE

Question 1

Two Broad Goals of Nursing Care during this Period:
1. To promote the physical well-being of the newborn
2. To enhance the establishment of a well-functioning family unit

Question 2

Initiation of Admission Procedures:
1. Condition of the newborn
2. Labor and birth record
3. Antepartal history
4. Parent-newborn interaction information

Question 3

NEWBORN CARE

Essential Intrapartum and Newborn Care/EINC
* Early skin-to-skin contact
* Immediate thorough dry
* Non-separation of mother from baby via breastfeeding
* Cord clamping properly tied

Question 4

NEWBORN CARE

Classifications:
* Immediate Newborn Care - the first 90 minutes
* Essential Newborn Care - from 90 minutes to 6 hours
* Care Prior to Discharge

Question 5

NEWBORN CARE

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.

Question 6

NEWBORN CARE

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.

Question 7

NEWBORN CARE

FIRST 90 MINUTES
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.

Question 8

NEWBORN CARE

FIRST 90 MINUTES
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 identificationo 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

Question 9

NEWBORN CARE

FIRST 90 MINUTES
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 2cm and the second
clamp at 5cm from the umbilical base
* Cut close to the first clamp with sterile scissors.
* Observe for oozing blood. It should have 2 arteries & 1 vein

Question 10

NEWBORN CARE

FIRST 90 MINUTES
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

Question 11

NEWBORN CARE

FIRST 90 MINUTES
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.

Question 12

NEWBORN CARE

ESSENTIAL NEWBORN CARE
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 – 1mg single dose.
* Inject hepa B and BCG vaccine
* Get the vital signs
* Perform the cord care
* Dress the newborn

Question 13

NEWBORN CARE

CARE PRIOR TO DISCHARGE
Time Band: After the 90 minute of agem 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

Question 14

HEALTH TEACHINGS

Signs of Neonatal Distress:
* Changes in color or activity
* Grunting or “sighing sounds”
* Rapid breathing with chest retractions
* Facial grimacing

Question 15

MONITORING VITAL SIGNS
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

Question 16

PROMOTION OF ADEQUATE NUTRITION AND HYDRATION
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)

Question 17

Milk produced by the mother provides primary source of nutrition for the baby before they are able to eat and digest

Answer 17

Breast Mlik

Question 18

BREASTFEEDING

STAGES OF MILK
1. Colostrum
2. Transitional Milk
3. Mature Milk

Question 19

BREASTFEEDING

STAGES OF MILK - Colostrum
* 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

Question 20

BREASTFEEDING

STAGES OF MILK - Transitional Milk
* Produced from the end of colostrums and production until approximately 2 weeks postpartum.
* Contains lactose, water-soluble vitamins, elevated levels of fats, & more calories than colostrum.

Question 21

BREASTFEEDING

STAGES OF MILK - Mature Milk
* 10% solids (carbohydrates, proteins, fats) for energy & growth; rest is water, which is vital in maintaining hydration

Question 22

BREASTFEEDING

PHYSIOLOGY OF BREAST MILK PRODUCTION
1. Decreased estrogen and progesterone levels after placental delivery
2. Stimulates adenohypophysis to produce prolactin
3. Acts on acinar cells to produce milk
4. Stored in collecting tubules
5. Milk-secretion reflex
6. When infant sucks - stimulates posterior pituitary gland to produce oxytocin
7. Causes contraction of smooth muscles of collecting tubules
8. Breast milk is released
9. Milk Ejection Reflex

Question 23

BREASTFEEDING

ADVANTAGES OF BREASTFEEDING (B.R.E.A.S.T.F.E.E.D.I.N.G.)
* 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

Question 24

BREASTFEEDING

ARTICLE REVIEW: 7 Surprising Superpowers of Breastmilk
1. Breastmilk can potentially cure cancer.
2. Breastmilk can ‘sense’ when your baby is sick.
3. On hot days, your breastmilk automatically becomes more ‘watery’.
4. Breastmilk can fight bacteria.
5. Breastmilk cures acne.
6. It’s a natural pain-relief medication.
7. It’s the perfect pre-term baby milk.

Question 25

BREASTFEEDING

Preparation of Breast:
* Avoid use of soap on nipples
* use of creams, nipple rolling, pulling & rubbing to “toughen” nipples is not advisable.
* Women with flat or inverted nipples may find breast shells (breast cups) useful.

Question 26

BREASTFEEDING

Assisting with First Feeding:
* 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)

Question 27

BREASTFEEDING

Mother-Baby Position:
* Infant’s head and body straight, facing mother’s breast
* Infant’s nose opposite her nipple
* Infant’s body close to mother’s body
* Mother supporting infant’s whole body, not just neck and shoulders

Question 28

BREASTFEEDING

Feeding Techniques: Positions
* Craddle
* Football hold
* Cross-craddle hold
* Side-lying position

Question 29

BREASTFEEDING

Latching-On Techniques: Signs of Good Attachment
* Chin touching breast
* Mouth wide open
* Lower lip turned outward
* More areola visible above than below the mouth

Question 30

BREASTFEEDING

Removal from the Breast
* 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

Question 31

BREASTFEEDING

• 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

Question 32

BREASTFEEDING

COMMON BREAST PROBLEMS:
* No milk
* Engorgement
* Nipple pain
* Nipple trauma
* Flat or inverted nipples
* Plugged ducts
* Mastitis

Question 33

BREASTFEEDING

COMMON BREAST PROBLEMS: No Milk
* “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

Question 34

BREASTFEEDING

COMMON BREAST PROBLEMS: Engorgement
* 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

Question 35

BREASTFEEDING

COMMON BREAST PROBLEMS: Nipple Pain
* Pain for a minute or less
* Usually peaks at the 3rd to 6th day and resolves soon afterward.

Question 36

BREASTFEEDING

COMMON BREAST PROBLEMS: Nipple Trauma
* 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.

Question 37

COMMON BREAST PROBLEMS: Plugged Ducts
* 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

Question 38

BREASTFEEDING

COMMON BREAST PROBLEMS: Mastitis
* Inflammation of breast tissue
* caused by blocked milk ducts or milk excess
* Onset of flu-like symptoms: fever, chills, body aches & 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

Question 39

BREASTFEEDING

EXPRESSION OF MILK
* Unable to nurse for medical or
* employment reasons
* Manual or breast pump
* Breasts need frequent stimulation

Question 40

BREASTFEEDING

BREAST PUMPS
* Hand-held
* Electric or battery-operated

Question 41

BREASTFEEDING

TIPS ON STORING BREAST MILK
* 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.

Question 42

BREASTFEEDING

POLICIES ON THE PROMOTION OF BREAST MILK
* Executive Order no. 51 - Philippine Code of Marketing of Breast Milk Subtitutes
* R.A. no. 7600 - The Rooming-in and Breastfeeding Act of 1992

Question 43

PROMOTION OF SKIN INTEGRITY
* 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.