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MATERNAL AND CHILD NURSING (RLE) > Module 03: Essential Intrapartum Newborn Care > Flashcards

Module 03: Essential Intrapartum Newborn Care Flashcards

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1
Q

This is known as the updated, evidence based national guideline on intrapartum and immediate postpartum care.

A

Practice Guidelines on Intrapartum and Immediate Postpartum Care

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2
Q

What is the Practice Guidelines on Intrapartum and Immediate Postpartum Care intended for?

A

Intended for the use by health professionals (Ob specialists and practitioners, nurses, and midwives) in all government and private health facilities,

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3
Q

What do the colors of the algorithm on preparing for birth represent?

A

(1) Green: Mother is stable.
(2) Yellow: Mother’s vital signs are fluctuating.
(3) Pink or red: Mother might suffer from cardiac arrest, prepare for resuscitation.

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4
Q

How should a nurse prepare for a birth?

A

(1) Introduce yourself to the woman.
(2) Obtain pregnancy history and birth plan.
(3) Check laboratory results including RPR and HIV.
(4) Identify the companion of choice and perform handwashing.
(5) Examine the woman and take her BP, HR, RR and temperature.
(6) Assess fetal heart rate and the presence of labor and stage.
(7) Fill out WHO partograph if cervix >4cm.

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5
Q

What are the recommended practices during labor?

A

(1) Admission to labor when the patient is already in the active phase.
(2) Allow a companion of choice to provide continuous support during labor (One to one intrapartum support)
(3) Continuous Maternal Support
(4) Position of choice during the first stage of labor (Upright Position and Mobility)
(5) Routine use of WHO partograph to monitor the progress of labor.
(6) Limit total number of IE to 5 or less.

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6
Q

What happens when the woman was admitted during her active phase?

A

(1) Less need for cesarean.
(2) No difference in need for labor augmentation.

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7
Q

Which people can be considered as the mother’s companion of choice?

A

(1) Husband
(2) Partner
(3) Friend
(4) Relative
(5) Healthcare worker

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8
Q

What should the nurse do when he or she is opted as the mother’s companion of choice?

A

(1) Good communication
(2) Respect for privacy
(3) No supine position or position of choice and mobility

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9
Q

Why is the Position of choice during the first stage of labor (Upright Position and Mobility) considered as a recommended practice during labor?

A

No difference between upright and recumbent position during labor in rates of SVD, CS and Apgar score <7 at 5 minutes.

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10
Q

Why is the freedom of movement important among mothers?

A

(1) Distract mothers from the discomfort of labor.
(2) Release muscle tension.
(3) Give a mother a sense of control,

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11
Q

What is utilized to monitor the progress of labor?

A

Partograph

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12
Q

What are some practices not recommended during labor?

A

(1) Routine NPO (Nothing By Mouth)
(2) Routine amniotomy to shorten spontaneous labor.
(3) Routine oxytocin augmentation
(4) Routine perineal saving on admission for labor and delivery.
(5) Routine enema during the first stage of labor.
(6) Routine IV fluids

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13
Q

Why is the routine NPO not a recommended practice during labor?

A

(1) No evidence of improved outcomes for mother nor newborn if on NPO
(2) Very small probable risk of maternal aspiration – 7/10 M Births

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14
Q

When is the routine NPO not needed or entailed prior to delivery?

A

For normal, low risk birth, no need for NPO except when intervention is anticipated.

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15
Q

What are the risks of routine amniotomy to shorten spontaneous labor?

A

Significant risk of cord prolapse, abruptio placenta and infrauterine infection.

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16
Q

When should oxytocin be utilized among doctors during labor?

A

Should be used by doctors only when indicated and in facilities where there is immediate access to CS.

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17
Q

When should healthcare practitioners avoid from using oxytocin?

A

Never use IM oxytocin before birth of the infant because its dosage cannot be adapted to the level of uterine activity.

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18
Q

What should be executed more than the routine preparation of IV fluids during labor?

A

Advantage is to have ready access for emergency meds.

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19
Q

What are the disadvantages of preparing IV fluids during labor?

A

(1) Interferes with the natural birthing process.
(2) Restricts woman’s freedom to move.
(3) Not as effective as food and fluids in labor to treat or prevent dehydration, ketosis, or electrolyte imbalance.

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20
Q

The nurse should encourage the woman to:

A

(A) Encourage the birth companion
(B) Encourage woman to:

(1) Move around and assume
(2) Position she is comfortable in
(3) Take in light snacks and oral fluids
(4) Empty her bladder

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21
Q

When should you plot the heart rate, contractions and Fetal Heart Bradycardia (FHB)?

A

Every 30 minutes

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22
Q

When should you plot the temperature?

A

Every two hours

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23
Q

When should you plot the blood pressure?

A

Every four hours

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24
Q

How should the nurse prepare for the birth?

A

(1) Ensure that the delivery room temperature is between 25 to 28 degrees Celsius
(2) Ensure that there are no air drafts.
(3) Introduce self to mother and her companion.
(4) Discuss maternal and newborn care in the immediate postpartum period.
(5) Perform proper handwashing.
(6) Arrange instruments and other needs plus 0.5% chlorine solution in a kidney basin for decontamination.
(7) Place dry cloth on mother’s abdomen.
(8) Prepare the equipment and newborn resuscitation.

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25
Q

What should the nurse do prior to delivery?

A

(1) Perform proper handwashing
(2) Don sterile double gloves if the lone birth attendant
(3) Allow other to push as she wish with contractions.
(4) Do not perform routine episiotomy.

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26
Q

What are the four core steps in immediate newborn care that is guaranteed to save lives?

A

(1) Immediate and thorough drying
(2) Early skin to skin contact
(3) Properly timed cord clamping
(4) Non-separation of newborn from mother for early breastfeeding

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27
Q

The National Policy on Essential Newborn Care is known as:

A

(1) Guideline development
(2) Dissemination
(3) Implementation and monitoring

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28
Q

The Essential Newborn Care Protocol (focuses on the first week of life) is characterized to be what?

A

Doable even by a single health worker caring for both the mother and the newborn

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28
Q

This is a series of time bound chronologically ordered, standard procedures that a baby receives from birth. It is simple, to the point, user friendly, and globally accepted evidence based protocol to essential newborn care.

A

Essential Newborn Care Protocol (focuses on the first week of life)

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29
Q

How is the Newborn Care Protocol organized?

A

(1) By time bands
(2) With cross references to sections of the WHO pregnancy, Childbirth, Postpartum, and Newborn Care Manual (2006)
(3) With algorithms that represent clinical pathways.

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30
Q

What are the Newborn’s immediate needs?

A

(1) To breathe normally
(2) To be warm
(3) To be protected
(4) To be fed

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31
Q

When should the nurse prepare for delivery?

A

Time band: During the second stage of labor. At the perineal bulging, with presenting part visible.

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32
Q

How should the nurse prepare for delivery when the mother is at the second stage of labor?

A

(1) Ensure that delivery area is draft free and room temperature is between 25 to 28 degrees Celsius
(2) Wash hands with clean water and soap.
(3) Double glove just before delivery.

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33
Q

How should the nurse prepare to meet the baby’s needs?

A

(1)Ensure all delivery equipment and supplies, including newborn resuscitation equipment, are available.
(2) Line up materials for delivery according to the sequence of use.

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34
Q

What are the materials needed to prepare for the mother’s delivery?

A

(1) 3 sets of sterile gloves (2 sets for OB; 1 set for the Pediatrician)
(2) Two clean and warm towels or blanket
(3) Self inflating bag or mask (normal and small newborn)
(4) Suction device
(5) Sterile cord clamp or ties
(6) Sterile forceps and scissors
(7) Rolled up piece of cloth
(8) Bonnet
(9) Clean dry warm surface

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35
Q

How should healthcare workers operate the equipment prior to and during delivery?

A

(1) Equipment must be checked daily and well before a delivery takes place.
(2) Resuscitation equipment should always be close to the delivery area.
(3) Health workers must know how to use the equipment.

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36
Q

Why is it important to remember the importance of observing standard precautions?

A

To help protect the mother and the baby and ourselves from infections with bacteria and viruses, including HIV

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37
Q

How should the baby be delivered?

A

In prone position on the mother’s abdomen, face turned to the side. And after that call the time of birth and sex.

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38
Q

What is the time band when the baby is delivered and placed in a prone position on the mother’s abdomen along with the time of birth and the gender being called?

A

Within the 1st 30 seconds

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39
Q

What should be done after delivering the baby?

A

Drying and providing warmth (Within the first 30 seconds)

40
Q

How should the nurse dry and provide warmth for the newly delivered baby?

A

(1) Use clean, dry cloth to thoroughly dry the baby, by wiping from the face, eyes, head, front and back of the trunk, arms and legs.
(2) Do a quick check of newborn’s breathing while drying.
(3) Remove the wet cloth.

40
Q

Why is drying and providing warmth important?

A

(1) Stimulates the newborn to breathe normally
(2) Minimizes heat loss
(3) Prevents hypothermia.

41
Q

What shouldn’t be done when drying and providing warmth for the baby?

A

(1) Do not suction unless mouth or nose are obstructed with secretions or other material.
(2) Do not ventilate unless the baby is apneic or floppy.

42
Q

When should the nurse ventilate?

A

When the baby is apneic or floppy

43
Q

How can newborns breathe on their own?

A

They can breathe adequately on their own if they are dried and stimulated properly.

44
Q

How many percent of newborns might require some help or assistance to begin breathing?

A

7% to 10%

45
Q

How many percent of newborns might require some advanced resuscitation?

A

1%

46
Q

What shouldn’t be done after delivering the baby?

A

(1) No slapping
(2) No hanging upside down
(3) No squeezing of the chest
(4) Do not wipe off the vernix
(5) Do not do foot printing

47
Q

This is known as the waxy coating on babies’ skin that has many benefits, such as hydrating, protecting and regulating their organs

A

Vernix caseosa

48
Q

What should you do when the baby is not breathing?

A

(1) Transfer to a firm or warm surface.
(2) Inform the mother that newborn is having difficulty breathing and that you will help the baby to breathe and start newborn resuscitation.

49
Q

What should be done after drying the newborn thoroughly and checking the baby’s breathing while drying?

A

Place the newborn on the mother’s abdomen in skin to skin contact. Cover the back with a dry blanket.

50
Q

This is a test given to newborns soon after birth. This test checks the baby’s heart rate, muscle tone and other signs to see if extra medical care or emergency care is needed.

A

APGAR score

51
Q

When is the APGAR test performed?

A

1 and 5 minutes after birth

52
Q

This is a newborn physical examination that allows clinicians to estimate the newborn’s gestational age.

A

Ballard Scoring System

53
Q

The Ballard Scoring System depends on what?

A

Neonate’s physical and neuromuscular maturity and can be used up to 4 days after birth.

54
Q

At usual practice, when is the Ballard Scoring System usually conducted?

A

After birth, it is usually used in the first 24 hours.

55
Q

When the newborn is crying and breathing after 30 seconds of drying, what should be the nurse’s intervention?

A

Skin to Skin (STS) Contact

56
Q

What should be done and avoided during Skin to Skin (STS) Contact?

A

(1) Avoid any manipulation, such as routine suctioning.
(2) Place the newborn prone on the mother’s abdomen or chest skin to skin.
(3) Cover newborn’s back with a blanket and head with a bonnet.
(4) Place identification band on the ankle.
(5) Do not remove the vernix.

57
Q

This is generally perceived to be an intervention for the provision of warmth and bonding.

A

Skin to Skin Contact

58
Q

What are the benefits of Skin to Skin (STS) Contact?

A

(1) Protection from hypoglycemia
(2) Colonization with maternal skin flora
(3) Doable even for caesarian section newborns
(4) Provides warmth
(5) Increases overall duration of exclusive breastfeeding

59
Q

Skin to Skin (STS) Contact can contribute to what?

A

(1) Overall success of breastfeeding or colostrum feeding
(2) Stimulation of the mucosa-associated lymphoid tissue system

60
Q

When should the cord be clamped after birth?

A

(1) When the cord pulsations stop.
(2) Between 1 and 3 minutes.
(3) Between 30 seconds to 1 minute in preterms.

60
Q

Hypothermia can lead to what?

A

(1) Infection
(2) Coagulation defects
(3) Acidosis
(4) Delayed fetal to newborn circulatory adjustment
(5) Hyaline membrane disease
(6) Brain hemorrhage

61
Q

After 30 seconds of drying and the newborn is not breathing or is gasping, what should be the intervention?

A

Reposition, suction and ventilate

62
Q

How should the nurse perform the intervention reposition, suction and ventilate?

A

(1) Clamp and cut the cord immediately
(2) Call for help
(3) Transfer to a warm firm surface
(4) Inform the mother
(5) Start resuscitation protocol

63
Q

What is the properly timed cord clamping?

A

1 to 3 minutes
(Intervention: Delayed or non immediate cord clamping)

64
Q

How should the nurse perform cord clamping?

A

(1) Remove the first set of gloved immediately prior to cord clamping.
(2) Clamp and cut the cord after cord pulsations have stopped at 1 to 3 minutes.

(A) Clamp cord using a sterile plastic clamp or tie at 2cm from the umbilical base
(B) Clamp again at 5cm from the base
(C) Cut the cord close to the plastic clamp.

65
Q

How should the nurse perform the initial cord care?

A

(1) Put ties tightly around the cord at 2 cm and 5 cm from the abdomen.
(2) Cut between ties with sterile instrument.
(3) Observe oozing blood.

66
Q

What should be avoided during cord care after non immediate clamping?

A

(1) Do not apply any substances to stump
(2) Do not bind or bandage stump
(3) Leave stump uncovered

67
Q

What is the benefit of properly timed clamping of the umbilical cord?

A

Reduced the risk of anemia in both term and preterm babies.

68
Q

How should the nurse assess the baby after cord clamping?

A

(1) Assess the cord is cut, examine the baby assess the baby for any signs of illness (eg. chest in drawing)
(2) If the baby is doing well, continue skin to skin contact and provision of warmth.

69
Q

Washing the newborn should be delayed until after what?

A

6 hours

70
Q

What are the disadvantages of washing the newborn immediately?

A

(1) Washing exposes to hypothermia
(2) Washing removes the crawling reflex

71
Q

This is known as the protective barrier to bacteria such as E coli and Group B Strep.

A

Vernix

72
Q

What is the time band when the intervention of providing breastfeeding support for initiation of breastfeeding?

A

90 minutes of age

73
Q

How should the nurse conduct the intervention of providing breastfeeding support for initiation of breastfeeding?

A

(1) Leave the baby on the mother’s chest for skin to skin contact
(2) Observe the newborn.
(3) Place identification tag or bracelet on the baby’s ankle.

74
Q

What should be executed after maintaining skin to skin contact?

A

Monitor the mother and baby during the first hour after the complete delivery of the placenta.

74
Q

How should the nurse monitor the mother and baby during the first hour after the complete delivery of the placenta?

A

(1) Never leave the newborn and the woman alone.
(2) Keep the mother and the baby in the delivery room.
(3) Record the findings, treatments and procedures. Monitor every 15 minutes.

74
Q

How long should skin to skin contact be maintained?

A

Uninterrupted for at least 90 minutes after birth and until the first thorough breastfeeding is complete.

75
Q

What should be monitored every 15 minutes when carrying out the observation of the mother and baby during the first hour after the complete delivery of the placenta?

A

15 minutes

76
Q

What will occur during the resting period when the baby and the mother is in the skin to skin contact?

A

(1) To begin with the baby will want to rest.
(2) Rest period may take a few minutes to 30 to 40 minutes before the baby shows feeding cues.

77
Q

What are the signs of readiness to breastfeed?

A

Only once the newborn shows feeding cues (e.g opening of the mouth, tonguing, licking, rooting), make verbal suggestions to the mother to encourage her newborn to move towards the breast (e.g nudging).

78
Q

How should the nurse aid during the first breast feed?

A

(1) Check attachment and positioning when the baby is feeding.
(2) Let the baby feed for as long as he wants on both breasts.
(3) Keep the mother and the baby together as long as possible after delivery.
(4) Delay tasks such as weighing, immunization, until after the first feed.

(Help both the mother and the child in a comfortable position)

79
Q

This is known as anti-body rich which protects the newborn from an infection or allergy.

A

Colostrum

80
Q

The colostrum is characterized as what?

A

Purgative, which clears meconium and prevents jaundice.

81
Q

What are the benefits of the colostrum?

A

(1) Growth factors (Help intestine to mature, prevents allergy, and intolerance)
(2) Rich in vitamin A and reduces the severity of infection.

82
Q

The capacity of a newborn’s stomach is similar to what fruit?

A

Calamansi

83
Q

What should the nurse avoid doing during the newborn’s first breast feeding?

A

(1) Health workers should note touch the newborn unless there is a medical indication.
(2) Do not give sugar, water, formula or other prelacteals.
(3) Do not give bottles or pacifiers (instigates nipple confusion)
(4) Do not throw away the colostrum.
(5) If the mother is HIV-positive, she needs special counseling.

84
Q

If the mother has HIV or AIDS what should be the universal precautions that must be followed as with any other delivery and after care?

A

(1) Her baby can have immediate skin to skin contact.
(2) Breastfeeding can begin when the baby is ready after delivery.
(3) Do not give the baby any other food or drink.
(4) Good attachment and positioning are vital.
(5) If replacement feeding is needed, prepare formula for the mother for the first five few needs.

85
Q

What are the eye antimicrobial that needs to be administered to the baby?

A

(1) 1% silver nitrate drops or
(2) 2.5% of povidone iodine drops or
(3) 1% of tetracycline ointment or erythromycin eye drops

Do not wash away the eye antimicrobial (apply from inner to outer canthus)

85
Q

When should eye care be conducted to the newborn?

A

Apply an eye antimicrobial within one hour of birth after wiping the eyes.

86
Q

When should the vitamin k prophylaxis, hepatitis B and the BCG vaccinations at birth?

A

From 90 minutes to 60 hours timespan

87
Q

What vaccinations should be administered and how should they be administered?

A

(1) Vitamin K Prophylaxis
(2) Hepatitis B
(3) BCG vaccinations

(A) Wash hands
(2) Inject a single dose of Vitamin K mg (IM Vastus Lateralis, Right Upper Outer)
(3) Inject Hepatitis B vaccine IM and BCG intradermally
(4) Record.

87
Q

How should the nurse carry out the interventions of examining the baby and checking for birth injuries, malformations and defects?

A

(1) Thoroughly examine the baby
(2) Weight the baby and record.
(3) Look for possible birth injury and or malformation.

Within 90 minutes of age.

88
Q

How should the nurse carry out cord care?

A

(1) Wash hands before and after cord care.
(2) Put nothing on the stump.
(3) Fold diaper below the stump. Keep cord stump loosely covered with clean clothes.
(4) If stump is soiled. Wash it with clean water and soap. Dry it thoroughly with clean cloth.

89
Q

How should the nurse provide an additional care for a small baby or twin?

A

If the newborn is delivered 2 months earlier and weights <1500 grams, refer to a hospital.

90
Q

What should the nurse do when the newborn is delivered 1 month early of is visibly small (1501 to 2499 grams)?

A

(1) Administer KMC
(2) Special support for breastfeeding
(3) Discharge planning

91
Q

What are the unnecessary procedures not recommended for all neonates?

A

(1) Routine suctioning
(2) Early bathing or washing
(3) Foot printing
(4) Giving sugar water, formula, or other prelacteals and use of bottles or pacifiers
(5) Application of alcohol, medicine and other substances on the cord stump and bandaging the cord stump or abdomen.

MATERNAL AND CHILD NURSING (RLE) (3 decks)

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