Week 8: Neonatal Vital Signs & Care PDF

Vital signs of the Neonate 1. Cardiac Rate- use apical pulse. (located lateral to the nipple line @ 4th intercostals space.) -160-180bpm @ birth but stabilizes @ 120-160 bpm. *radial pulse- not prominent. If prominent, may indicate congenital anomaly (Patent Ductus...

Vital signs of the Neonate 1. Cardiac Rate- use apical pulse. (located lateral to the nipple line @ 4th intercostals space.) -160-180bpm @ birth but stabilizes @ 120-160 bpm. *radial pulse- not prominent. If prominent, may indicate congenital anomaly (Patent Ductus Arteriosus) 2. Respiratory rate- rapid, irregular, shallow, and abdominal diaphragmatic. (Medulla Oblongata) -50-80 cpm @ birth but stabilizes @ 30-60 cpm. -w/ physiologic apnea of less than 15 seconds. (observed during Rapid Eye Movement) 3. Blood Pressure -75/42. @birth: systolic:60-80. Diastolic: 40-50 WOF: difference between upper & lower extremity pressure: (Coarctation of the aorta.)  Care of a newborn at Birth *** Provision of Warmth and Heat/ Regulation of temperature/ maintaining a neutral environment. Methods of heat loss: a. convection (cold air) b. conduction (cold hands) c. evaporation (TSB, loss thru skin surface) d. radiation (indirect. Bassinet near aircon) Hypothermia- subnormal temperature common in NBs. Cause hypothermia in NBs are as follows: 1. Hypothalamus is still underdeveloped *flexed position- helps guard against heat loss. (less skin surface is exposed.) 2. NBs have less subcutaneous/adipose tissues. (prevents heat loss) 3. have less stored brown fats- necessary for heat production.  Methods of Thermoregulation: 1. Immediate Thorough Drying Essential Intrapartal Newborn Care Guidelines *Dry the newborn thoroughly for at least 30 seconds using a clean, dry linen. *Do a quick check of breathing while drying *>95% of newborns breathe normally after birth *Follow an organized sequence (Mouth, nose,Rub the back, Cepahlocaudal, Genital) *Wipe gently, do not wipe off the vernix caseosa because it has antibacterial properties. (insulator, anti-bacterial properties) *Remove the wet cloth, replace with a dry one *If baby not breathing, STIMULATE by DRYING! *Do not slap, shake or rub the baby *Do not ventilate unless the baby is floppy/limp and not breathing *Do not suction unless the mouth/nose are blocked by secretions Methods of Thermoregulation: 2. Delayed Bathing- done at least after the 6th hour to wash away extra Vernix Caseosa and blood.(infection) *wear gloves in the initial bathing of the baby. (prevent contact to bodily secretions, HIV, etc.) *temperature: room: 24*C, water: 36.5-37.3*C *use elbow when testing the temperature of the water. *do bathing before feeding. (prevent spitting up, vomiting and possible aspiration.) *equipments like basin, washcloth, soap (hypoallergenic), towel, clean diapers, clothes should be assembled beforehand. (prevent hypothermia.) -  BATHING (continued) *manner: cleanest to dirtiest areas of the body. (face, trunk, extremities, diaper area.) *washing eyes: inner to outer canthus using washcloth. (prevent contamination of the other eye.) don’t use soap on the face. (irritant) *football hold- hold infant in one arm, feet is clipped on the armpits. *concentrate on creases/skinfolds where milk may be accumulated. (prevent rashes) *don’t wet the cord. (promote drying, and prevent infection.) air dry!! *wipe female vulva from front to back. (to prevent contamination of vagina.) *do not use powders and strong soaps. (allergenic)  THERMOREGULATION: 3. Skin-to-skin cotact- after the delivery of the mother, the baby is placed on the exposed chest of the mother. -baby is given a bonnet and wrapped with a blanket along with the mother. 1. dry the NB at once using a towel. 2. wrap and cover the baby. 3. expose the baby in either floor lamps or radiant warmers. 4. place NB on parents’ arms as long as breathing is already stable. (conserve heat & promote bonding.)  THERMOREGULATION: 4. Kangaroo Care- Done to insulate the baby using the bodily heat of another individual. May be done by any relative. -Aside from heat conservation, it also allows for bonding with the neonate. *Neonate/ Newborn’s chest are exposed. *Mother sits in a comfortable position, preferably reclined. *Chest of the mother is exposed. *The neonate’s chest is placed directly in contact with the exposed chest of the mother. *Both mother are neonate are given a blanket to cover them. *an expandable bandeau brassier may also be used in Kangaroo care. *the mouth and nose of the baby should still be visible to the mother to ensure that the child is breathing. Establishing/ Maintaining respiration or patent airway *DO NOT SUCTION THE BABY if the baby is able to cry or is pink, or with normal breathing. (Baby can expel mucus or other secretions by himself through the extrusion reflex). EINC RECOMMENDATION *Suction of the mouth and nose should not be done for babies born through clear amniotic fluid who start breathing on their own after birth. ***IF BABY IS NOT BREATHING, OR IS GASPING, OR RR IS >60/