EINC Presentation PDF

NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT ESSENTIAL INTRAPARTUM AND NEWBORN CARE (EINC) globally accepted evidence-based protocol to essential newborn care focusing on the first week of life  NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPART...

NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT ESSENTIAL INTRAPARTUM AND NEWBORN CARE (EINC) globally accepted evidence-based protocol to essential newborn care focusing on the first week of life  NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT INTENDED LEARNING OUTCOMES At the end of the lecture the students can: 2  NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT Determine the basic concept of newborn care based on World Health Organization Standards including practices that should no longer be continued. 3  NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT Discuss the purposes of the four (4) Time-Bounded Interventions in the care of the newborn immediately after birth 4  NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT Determine the nursing responsibilities related to the Essential Newborn Care in the first 90 minutes of life 5 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT WHAT IS EINC? 6 THE ESSENTIAL INTRAPARTUM AND NEWBORN CARE It is the firm resolve of the Department of Health to ensure that all deliveries are attended by skilled health professionals in well-equipped and accessible health facilities. Rationale Every year approximately 40,000 Filipino neonates die, mostly from preventable causes. Majority die within the first week High mortality and morbidity rates in newborns are directly related to inappropriate hospital and community practices currently employed throughout the Philippines. Newborn care has fallen in a gap between maternal and child care. 7 Essential Newborn Care (ENC) Protocol The ENC Protocol is a series of time bound, chronologically- ordered, standard procedures that a baby receives at birth. At the heart of the protocol are four time-bound interventions: Immediate and Thorough Drying Early skin to skin contact Properly timed cord clamping Non-separation of newborn from mother for breastfeeding initiation 8 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT WHAT IS THE PURPOSE OF EACH INTERVENTION? 9 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT Immediate and thorough drying of the newborn prevents hypothermia which is extremely important to newborn survival 10 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT Immediate and thorough drying of the newborn Use a clean, dry cloth to thoroughly dry the baby by wiping the eyes, face, head, front and back, arms and legs. 11 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT Early skin to skin contact prevents hypothermia, hypoglycemia and sepsis, increases colonization with protective bacterial flora and improved breastfeeding initiation and exclusivity 12 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT Early skin to skin contact Place the newborn prone on the mother’s abdomen or chest skin-to-skin. 13 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT Properly timed cord clamping & cutting decreases anemia in 1 out of every 3 premature babies and prevents brain hemorrhage in 1 out of 2. It prevents anemia in 1 out of every 7 term babies. 14 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT Properly timed cord clamping & cutting Clamp and cut the cord after cord pulsations have stopped (typically at 1 to 3 minutes) Put ties tightly around the cord at 2 cm and 5 cm from the newborn’s abdomen. Cut between ties with sterile instrument. 15 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT Properly timed cord clamping & cutting Observe for oozing blood. Note: Do not milk the cord towards the newborn. 16 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT Breastfeeding initiation within the 1st hour of life Prevents an estimated 19.1% of all neonatal deaths by means of protection from infection. First feed provides colostrum 17 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT Breastfeeding initiation within the 1st hour of life Observe the newborn. Only when the newborn shows feeding cues (e.g. opening of mouth, tonguing, licking, rooting), make verbal suggestions to the mother to encourage her newborn to move toward the breast e.g. nudging. 18 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT Crede’s Prophylaxis newborns receive prophylactic eye treatment to prevent opthalmia neonatorum, a severe eye infection contracted in the birth canal of a woman with 19 gonorrhea or chlamydia  NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT Crede’s Prophylaxis ophthalmic agents that have been approved for eye prophylaxis 1. 1% silver nitrate 2. 0.5% erythromycin 3. 1% tetracycline 4. 2.5% Povidone iodine drops 20  NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT The Essential Newborn Care Protocol also contributes to hospital efficiency, as it prohibits practices either without evidence to back it up or with evidence of harm. Harmful practices include washing before 6 hours of life, “routine” suctioning, “routine” separation and cohortingof babies. 21 What newborn care practices in the delivery room should no longer be continued? Routine suctioning of secretions Putting the newborn on a cold or wet surface. Removal of vernix caseosa 22  What newborn care practices in the delivery room should no longer be continued? Foot printing and bathing earlier than 6 hours of life Unnecessary separation of the newborn Transferring of the newborn to the nursery or NICU without indication 23 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT ESSENTIAL NEWBORN CARE FROM 90 MINUTESTO 6 HOURS 24 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT Vitamin K Prophylaxis A single dose of 0.5 to 1.0 mg of vitamin K is administered intramuscularly within the first to sixth hour of life to prevent bleeding problems Possible adverse reactions: Local irritation, such as pain and swelling at the site of injection. 25 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT NURSING RESPONSIBILITIES: 1. Administer IM injection into large muscle; vastus lateralis 2. Assess for signs of bleeding (black, tarry stools, hematuria, decreased hemoglobin and hematocrit levels, and bleeding from any open wounds or base of the cord) 26 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT 27 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT 28 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT 29 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT 30 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT 31 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT 32 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT Head Circumference (34-35 cm ) Slide the tape measure under the neonate’s head just above the baby’s eyebrows going around the occiput process. 33 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT 34 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT 35 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT 36 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT 37 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT 38 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT 39 NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT ASSESSMENTS FOR WELL BEING 40  NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT APGAR SCORING Proponent: Dr. Virginia Apgar Used to evaluate the prognosis of a newborn to determine if there is adjustment o extrauterine life Done twice at 1 and 5 minutes respectively 41 SCORES INTERPRETATION NOTRE DAME OF MARBEL UNIVERSITY 0-2 Severely depressed; Poor-severe difficulty in transition; needs immediate Resuscitation NURSING DEPARTMENT 3-6 Moderately depressed; Fair- have some difficulty adjusting; needs further observation & stimulation 7-10 Good condition; healthy, adapts well to extrauterine life 42  NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT BALLARD SCORING A. Physical Maturity 6 categories: Skin, Lanugo, Plantar creases, Breast buds, Ears, Genitals Each category is rated on a scale of 0 to 5, with 5 being the highest or most completed development. 43  NOTRE DAME OF MARBEL UNIVERSITY NURSING DEPARTMENT BALLARD SCORING B. Neuromuscular Maturity Posture Square window Arm Recoil Popliteal angle Scarf sign Heel-to-Ear 44 MATERNAL AND CHILD HEALTH NURSING: CARE OF THE NEWBORN 45 ThankYou Bianney Mae A. Ranes, RN +639126979359 [email protected]