Immediate Newborn Care PDF

IMMEDIATE NEWBORN CARE ---------------------- *Purpose:* ---------- - Establish and maintain respiratory function. -------------------------------------------- - Provide warmth and prevent hypothermia. --------------------------------------- - Ensure safety from injury and infectio...

IMMEDIATE NEWBORN CARE ---------------------- *Purpose:* ---------- - Establish and maintain respiratory function. -------------------------------------------- - Provide warmth and prevent hypothermia. --------------------------------------- - Ensure safety from injury and infection. ---------------------------------------- - Identify actual and potential problems that might require immediate action. --------------------------------------------------------------------------- Suction - Airway - Breathing - Dry - Temperature - APGAR - Assesment - Cord Care - VS-Anthropometric -Eye Care - Vitamin K/HEP B - Wrap - Identification - REFLEXES A. **[SUCTIONING - Oro-Pharyngeal / AIRWAY-BREATHING]** 1. Wipe the neonate's mouth - gauze - index finger once his head has been delivered. 2. Wrap and dry the neonate in a warmed towel. 3. Suction the neonate's mouth with a disposable suctioning. 4. Suction gently & quickly using bulb syringe or suction catheter 5. Starts in the mouth then, the nose to prevent aspiration 6. Suction first from mouth and then from nose 7. Stimulate crying by rubbing B. **[DRY THE BABY]** 1. Use a warm, dry, soft towel 2. Hypothermia is common C. **[REPLACE WET TOWEL]** 1. Wet newborns rapidly lose heat 2. Any absorbent material: D. **[Place the neonate in a RADIANT WARMER.]** 1. Replace the wet towel and wrap the neonate in another dry towel. 2. Place newborn in trendlenburng position. 3. Do suction of oropharyngeal canal. 4. Oxygen may be given. 5. Continue suction as fluid is aspirated. E. **[POSITIONING OF THE NEWBORN]** Positioning - Right side lying 1. promote drainage secretion 2. fasten gastric emptying time 3. good airway 4. Position properly- side lying / Provide oxygen when necessary F. **[ASSESS the newborn's condition]** 1. One minute APGAR Score and reassess - 5 minutes. 2. Neurological examination - check reflexes of the newborn. 3. V/S TPR, BP 4. Measure weight, length head & chest circumferences. 5. Assess for any gross abnormality, congenital defects in head, eyes, ears, chest, spine,. face, nose, abdomen, anus, external genitalia &extremities. 6. Assess for any signs of eye infection. G. **[APGAR Score- 10/10 = 2-0-1]** A ctivity/ Muscle Tone P ulse/ Heart Rate G rimace/ Reflex Irritability/ Responsiveness A ppearance/ Skin Color R espiration/ Breathing *[Significance of Apgar score ]* Healthy newborn: 7-10 at both 1 and 5 minutes. Moderately depressed newborn : 4-6 ( Need resuscitation ) Severely depressed newborn : 0-3 ( Intensive resuscitation ) H. **[CORD CARE]** - Use sterile plastic clamp or ligature, the first ligature is placed about 2.5-3 cm from the abdomen & second ligature is placed about 1cm from the first ligature. - Press between the two ligatures. - Cut the cord by blunt sterile scissor after the second clamp. - Examine umbilical cord structure (two arteries and one vein) - Paint the end of the stump with alcohol. - Clean the cord at the base of cord firstly, then the stump from down to up with one direction and cleaning the cord clamp. - Let the cord exposed not covered by the diaper. - Assess the signs of cord healing and signs of infection (erythema edema tenderness). I. **[ASSESSMENT of VITAL SIGNS]** - Temperature : rectal route - Heart Rate ( HR ) - 60 seconds at the apex of the heart (100- 160 bpm immediately after birth ). - Respiratory Rate ( RR ) : - RR varies from 30- 60 b/m when the infant is not crying. - Blood Pressure ( BP ) : 60- 90 mmhg *Not routinely assessed in healthy **term** infants.* J. **[ANTHROPOMETRIC MEASUREMENT]** - Head Circumference : 33-35cm - Chest and Abdomen : 31-33cm - Length : 47-54cm - Weight : 2500-4000 grams K. **[EYE CARE:]** 1. Clean the eye lids é sterile warm sterile water and cotton. 2. Wipe from inner to outward. 3. Apply ophthalmic ointment (Erythromycin). L. **[VITAMIN K Injection / HEP B]** - Administer 1mg. Vitamin K by I.M injection. - Route: IM into the lateral anterior thigh (Vastus lateralis). M. **[DRESSING / WRAPPING]** 1. "Mummy" wrap 2. Wrap in warm blanket 3. Cover head with stockinette cap N. **[IDENTIFICATION of the newborn]** - Identification of the newborn which place on wrist & ankle (mother name, hospital no, sex, weight of newborn). - Before transferring to nursery, ID tag should be applied. O. **[REFLEXES]** 1. Moro Reflex or Startle Reflex 2. Palmar and Plantar grasp 3. Babinski reflex 4. Rooting reflex 5. Sucking reflex 6. Tonic neck reflex 7. Dance or step reflex Growth and Development Review ----------------------------- **Theories of Growth and Development** **Erikson's Theory of Psychosocial Development** - - **Erik Erikson's 8 Stages of Psychosocial Development** 1. **Trust vs Mistrust: Infancy (0 to 18 months)** Task: attachment to the mother/caregiver Successful: feeling of trust Unsuccessful: mistrust, suspicion, uncertainty of the future  2. **Autonomy vs Shame and Doubt: Early childhood (18 months to 3 years) ** Task: develop a sense of personal control over physical skills and sense of independence  Successful: feeling of self-control, self sufficiency Unsuccessful: lack of independence, feelings of self-doubt 3. **Initiative vs Guilt: Late childhood (3 to 6 years) ** Task: become purposeful and directive Successful: sense of purpose Unsuccessful: sense of guilt, self-doubt, and lack of initiative 4. **Industry vs Inferiority School age (6 to 12 years) ** Task: develop physical, social, and learning skills Successful: self-confidence, competence Unsuccessful: feelings of inferiority, poor self concept 5. **Identity vs Role Confusion: Adolescence (12-20 years) ** Task: develop sense of self and personal identity Successful: sense of strong identity Unsuccessful: self-confusion 6. **Intimacy vs Isolation: Early adulthood (20-35 years)** Task: form intimate, loving relationship with other people Successful: strong relationship Unsuccessful: loneliness, isolation 7. **Generativity vs Stagnation: Middle adulthood (35 to 65 years) ** Task: achieve life goals and creating positive change for the benefit of others Successful: feelings of accomplishment Unsuccessful: inability to grow as a person 8. **Integrity vs Despair: Late adulthood (65 years to death) ** Task: reflection on life Successful: sense of fulfillment and integrity Unsuccessful: regret, bitterness,dissatisfaction with life **Jean Piaget's Theory of Cognitive Development** - - **4 Stages of Cognitive Development** 1. - - 2. - - - 3. - - 4. - - **Sigmund Freud's Psychosexual Development** - - **5 Stages of Psychosexual Development** 1. - - 2. - - - - 3. - - 4. - - 5. - - **Lawrence Kohlberg's Theory of Moral Development** - **Stages of Moral Development** Here are three levels of moral development, with each level consisting of different stages:  **Level 1: Preconventional Morality ** - Stage 0 (birth to 2 years). *Egocentric Judgement:* no concept of right or wrong - Stage 1 (2 to 3 years). *Obedience and Punishment:* behavior driven by avoiding punishment. - Stage 2 (4 to 7 years). *Individualism and Exchange:* behavior is driven by rewards or have favors returned. **Level 2: Conventional Morality ** - Stage 3 (7 to 10 years). *Good Boy- Nice Girl Orientation:* behavior is determined by social approval. - Stage 4 (10-12 years). *Law and Order Orientation:* social rules and laws determine behavior. **Level 3: Postconventional Morality** - Stage 5 (12-40): *Social Contract and Legalistic Orientation:* rules and laws exist for the greater good of all. - Stage 6(40-up): *Universal Ethical Principles Orientation:* development of own moral principles even if they conflict with the law of the society. **PHYSIOLOGIC GROWTH AND DEVELOPMENT** - - - - - - - - - **MILESTONE DEVELOPMENT** Here are the important milestones that an infant goes through:  **2 to 3 months** - - - - - **4 to 5 months** - - - - - **6 to 7 months** - - - - - - **8 to 9 months** - - - - - - **10 to 11 months** - - - **12 months** - - - **15 to 18 months** - - - - - - Stages of Play by Age --------------------- **1. Unoccupied play** (0--3 months) \- Newborns from 1 to 3 months old will participate in unoccupied play. \- Think of it as their first attempt to learn about the world. They'll observe their surroundings and make random body movements out of curiosity. Unoccupied play might not look like playing, but it sets the stage for [[future development]](https://www.parents.com/baby/development/growth/baby-development-week-by-week/). *You can encourage unoccupied play by:* - - - - Interaction with caregivers helps babies gain awareness about their new life. **2. Solitary play** (0--2 years) \- From birth to around 2 years old, children don't pay much attention to playmates in social settings. - They'd rather keep themselves entertained through independent play. By [[engaging in solo play]](https://www.parents.com/toddlers-preschoolers/development/social/going-solo-independent-play-in-toddlers/), kids learn about their surroundings, build confidence and independence, practice creativity, experience cause and effect, and fine-tune their motor skills.^4^**\ ***You can encourage independent play by:* - - - - **3. Onlooker play** (2 years) \- Around 2 years old, toddlers engage in onlooker play. \- This involves watching others playing but not participating themselves. \- Parents might be quick to discount the benefits of onlooker play, but experts say it helps kids gain the confidence needed to join the fun. They'll learn how to play and [[interact with others]](https://www.parents.com/toddlers-preschoolers/development/social/social-development-milestones-ages-1-to-4/). *You can encourage onlooker play by:* - - **4. Parallel play** (2+ years) \- Kids might use the same toys and mimic each other but won't directly interact with their peers. -Parallel play is common in kids from ages 2 to 3. It indicates a child is almost ready for social interaction. *You can encourage parallel play by:* - - - **5. Associative play** (3--4 years) \- more interested in the actions of others. \- They'll begin engaging with their peers while playing, but they'll still do things mainly on their own. \- kids might draw on the same paper without commenting on each other's designs, or they might exchange clothes while playing dress-up. Because kids won't be working toward a shared goal, there's little organization involved with associative play. This type of play [[helps with social skills]](https://www.parents.com/toddlers-preschoolers/development/social/social-skills-activities-for-kids-to-do-at-home/), cooperation, language, problem-solving, and conflict resolution. *You can encourage associative play by:* - - **6. Cooperative play** (4+ years) \- children truly start playing with others. \- Kids first participate in cooperative play around 4 or 5 years old. \- practice skills they've gained through other stages of play, such as verbal communication, teamwork, and sharing. \- learn new skills like kindness, empathy, and compromise. \- work toward a common goal, whether it's building a block tower together or playing duck-duck-goose. It's essential for [[social and emotional development]](https://www.parents.com/toddlers-preschoolers/development/social/social-emotional-learning-is-essential-for-child-development-heres-how-to-teach-it-at-home/).^7^ *You can encourage cooperative play by:* - - *Other Types of Play* --------------------- ### **7. Symbolic play** Around 18 months, {#symbolic-play-around-18-months.ListParagraph} ### - toddlers may experiment with symbolic play, using one object to represent another. For instance, they may use a marker as a cell phone or pretend a ball is an apple. ### [They may also start to engage in one or two simple acts of [pretend play](https://www.parents.com/benefits-of-pretend-play-6828493), like stirring a pot on the stove in a play kitchen or pretending to drink from a teacup.] *You can encourage symbolic play by:* - - ### 8. Dramatic or fantasy play ### -focuses on your child's most impressive tool: their imagination. ### - Any type of fantastical activity falls into this category, such as dress-up, playing \"house,\" or pretending you work at a restaurant. \"They\'re trying out behaviors to mimic what they see in the real world,\" says Dr. Starnes. *You can encourage dramatic play by:* - - ### 9. Competitive play \- consists of organized activities with rules and winners. Some examples are [[family board games]](https://www.parents.com/best-family-board-games-8382737) and sports. \- Not only do children learn about teamwork through competitive play, but they also gain experience with taking turns, following rules, and coping with failure, which are all important lessons for navigating society. *You can encourage competitive play by:* - - - ### 10. Physical play \- involves body movement, but not necessarily in a competitive setting. \- Some examples are playing tag, throwing a frisbee, dancing to music, and riding scooters. Physical play can develop fine and gross motor skills in children. It also helps with balance, hand-eye coordination, muscle development, and more. *You can encourage physical play by:* - - ### 11. Constructive play \- children create something with materials in an organized way (think [[building with Legos]](https://www.parents.com/best-lego-sets-8402505) or making a sandcastle). They're relying on their ideas to navigate the world around them. \- itteaches about persistence, planning, creativity, and logical thinking. Kids also get real-world experience with scientific and mathematical concepts, which often fuels their natural curiosity.^9^  *You can encourage constructive play by:* - - **Fear and Anxiety** **Infant and toddler. **Characterized by separation anxiety, loss of control (shown in behaviors related to toileting, feeding, bedtime), and fears of bodily pain and injury **[3 phases of separation anxiety:]** - Protest-  hours and several days of screaming, crying, and is inconsolable. - Despair- child becomes withdrawn, hopeless, and apathetic. - Detachment- occurs after prolonged separation of parent; child appears to have adjusted to the loss; becomes more interested in the environment; appears to be happy and content with caregivers and other children. ***Interventions:*** - Encourage parents to stay with and participate in the care as often as possible. - Continue and maintain the same routine to what the infant/toddler is accustomed to. - Provide comfort measures such as their favorite toy, pacifier for oral and sucking stimulation, and blanket. - Provide a safe environment especially during temper tantrums such as side rails up, keeping equipment out of reach. - Allow toddler with opportunities to make choices to gain some control. - Provide age appropriate distraction and pain reducing techniques. **Preschooler. **separation anxiety decreases, fears loss of family routine and schedules, and fear of bodily injury from invasive procedures; believes that hospitalization is a punishment for bad actions. ***Interventions:*** - Encourage parents to stay with and participate in the care as often as possible. - Acknowledge and allow expression of fears and anger - Explain procedures in simple terms  - Encourage interaction and play with other children of the same age - Encourage the preschooler to be independent - Bring a familiar items with the child - Continue to set normal limits and provide structure **School age. **Fears of getting behind in school, fear of disability and death, loss of control and independence, separation from family and friends, child may ask many actions and relate his or her actions with the cause of condition. ***Interventions:*** - Explain illness, and treatment to child and patent (use body diagrams, models or videotapes) - Encourage independence and provide choices as much as possible - Allow participation in discussion and expression of feelings and fears - Continue doing school work/assignments if possible - Provide privacy - Set limits, and establish routines **Adolescence.** Experience fear of being different, concerns with appearance, fears of separation from friends, loss of privacy and independence, may exhibit withdrawal and noncompliance with the treatment regimen. **Interventions:** - Encourage questions and open discussion regarding the effect of illness or treatment in their appearance and relationship - Provide clear information about the condition and treatment (may use body diagrams) and involve them in decision making as much as possible - Maintain privacy such as wearing pajama instead of gown - Allow visitation from peers if possible - Encourage interaction with friends and others in the same age group