Immediate Care of the Newborn Baby PDF

Clinical Procedures Immediate Care of the Newborn Baby Outlines  Introduction  Immediate care of new born baby 1. clearing the air way 2. Assessment of baby's condition using Apgar score 3. Clamping and cutting the cord 4. Thermal adaptation 5. Identification 6...

Clinical Procedures Immediate Care of the Newborn Baby Outlines  Introduction  Immediate care of new born baby 1. clearing the air way 2. Assessment of baby's condition using Apgar score 3. Clamping and cutting the cord 4. Thermal adaptation 5. Identification 6. Care of the eyes 7. Vitamin K 36  Clinical Procedures Introduction Definition of neonatal period: The time from birth though the twenty eight day of life. During this time the neonate must make many adjustments to extra - uterine life. The following measures are designed to assist the infant in accomplishing the adaptations to extra uterine life. 1- Clearing the air way As soon as the head is born, and before the baby takes its first breath, the pharynx (mouth) and Nasopharynx (nose) must be suctioned to prevent aspiration of mucous, blood and meconium and debris into the trachea when breathing begins. This should be done using mechanical suction to minimize the risk of virus transmission. Once the baby is born it should be held down for a few moments to promote drainage of mucous and to facilitate the drainage of liquid material from pharynx by gravity. Then, the infant is transferred to a warmed bassinet. 37  Clinical Procedures 2-Assessment of baby's condition using Apgar score Apgar score is scoring system used to assess cardiopulmonary function of newborn baby Assessment by Apgar scoring is carried out at 1 minute and at 5 minute after birth for rapid evaluation of early cardiopulmonary adaptation. A score of 7 to10 is normal, 3 to 6 indicates mild to moderate distress, 0 to 2 sever distress and the infant needs resuscitation and I.C.U The infant is assigned a score of 0 to 2 in each of the five items and the scores are totaled. A Appearance (color) P Pulse (Heart rate) G Grimes (Reflexes) A Activity (muscle tone) R Respiration 38  Clinical Procedures Sign 0 1 2 Heart rate Absent < 100 b.p.m ≥ 100 b.p.m Weak cry, Respiratory effort Absent Good, crying hypoventilation Cry or active Reflex irritability No response Grimace withdrawal Some flexion of Muscle tone Limp Active motion extremities Body pink, Color Blue, pale Completely pink extremities blue NOTE:- Bradypnea: less than 15 breath /min Tachypnea: more than 60 breath /min 3-Clamping and cutting the cord The cord consists of 2 arteries and one vein, covered by substance called Wharton’s jell. The length of cord is about 50 cm. Separation of the infant from the placenta is achieved by dividing the umbilical cord between two clamps which should be applied approximately 8-10 cm from the umbilicus of the fetus. The cord is clamped and divided, as soon as pulsations have ceased. If ligation is done carelessly the baby may loss a great deal of blood very quickly. The cord ligation is applied 2-2.5 cm from the umbilicus. The cord is ligated with a special clamp or rubber bands or tapes. The blood volume of a term newborn infant is 80-100ml per kg body weight. 39  Clinical Procedures 4-Thermal adaptation Characteristics of newborns that predispose them to loss heat. The skin is thin. The blood vessels are close to the surface. Heat is readily transferred from the warmer internal areas of the surrounding air. To conserve heat, the healthy full- term infant remains in apposition of flexion. This reduces the amount of skin surface exposed to the surrounding temperatures and decreases heat loss. Methods of heat loss in the neonate:- A-Evaporation Occurs when wet surfaces are exposed to air At birth the infant loses heat when amniotic fluid on the skin evaporates. 40  Clinical Procedures Evaporation also occurs during bathing. Thus drying the infant as quickly as possible at birth and after bathing helps prevent excessive heat loss. B-Conduction Occurs when new born come in direct contact with objects that are cooler than their skin. Placing infants on cold surfaces such as (scales or touching them with cold hands or a cold stethoscope causes this type of heat loss). The reverse is also true, that is wrapping newborns in warm blankets or placing them against the mother's skin can protect them against heat loss. C-Conviction Occurs when heat is transferred to air surrounding the infant by currents of cool air passing over the surface of this body. Maintaining warm environmental temperatures help to prevent this type of heat loss. Oxygen should be warmed before administration. Newborns are often placed in incubators for a short time after birth so that the surrounding temperature can be controlled to prevent convective heat loss. D-Radiation Is the transfer of heat to cooler objects that are not in direct contact with the infant. For examples:- Infants placed near cold windows loss heat by radiation. 41  Clinical Procedures Infants should be kept away from windows and outside walls to minimize radiant heat loss. Small amounts of heat are lost through respiration and in urine and faces. It is important for the midwives to ensure that they employ measures to minimize heat loss at delivery by ensuring that the delivery room temperature is 21-24 C and encouraging skin to skin contact with the mother to promote heat gain. Covering the baby head is of particular importance 5-Identification When babies are in hospital, it is necessary that they are readily identifiable one from another. Various methods of indicating identity can be employed. e.g.:- Name bands are applied usually one on the infant's wrist and one on the ankle. Each contain the family name, sex of the infant, 42  Clinical Procedures and date and time of birth.name bands should remain on the baby until his discharge from hospital. 6-Care of the eyes Before the baby is transferred to the nursery the eyes must be receive prophylactic treatment to prevent ophthalmic neonatorum. The most common medication for eye prophylaxis is: tetracycline and erthromycin ointment. 7-Vitamin K Hemorrhagic disease of the new born is acumination which results from a deficiency of vit-K one dose of vit-K prevents bleeding problems until the infant is able to produce it on his her own. Vitamin K is given to the neonate within the first hour after birth intramuscularly injection of 0.5 mg to 1 mg of water soluble vit.K. This can be prevent hemorrhagic disease. Note: Post natal bleeding tendency occurs as a result of: In ability of synthesize vit. K Immaturity of liver in terms of production of prothrombin and other clotting factors 43  Clinical Procedures Breast self Examination Introduction:- Monthly breast self-exams should always include: visual inspection (with and without a mirror) to note any changes in contour or texture; and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses. The best reason for performing monthly breast self examinations is the fact that 90 percent for all lumps and Just under half of all breast cancers are actually discovered by women or by their partners. As with all tumors, early detection leading to early treatment is the single most important factor in successful tumor removal and preservation of the breast. As in all types of cancer, early detection and treatment saves lives. Definition:- Is a method of finding abnormalities of the breast, for early detection of breast cancer? The method involves the women herself looking at and feeling each breast for possible lumps, or swelling. Breast self examination is the only non invasive procedure that can be regularly performed between internal breast imaging and clinical breast examination (CBE). The purpose of a Breast Self-Exam  To learn the topography of the breasts.  Knowing how the breasts normally feel will allow you to notice changes in the future. 44  Clinical Procedures  There is a three-pronged attack one can make in order to detect breast cancer: o Breast Self-Examination: Feeling your breasts. o Mammography: An X-ray of your breast. o Clinical Breast Examination (CBE): When an experienced doctor examines the breasts. Time of performing Breast Self-Examination Women older than 20 years should perform it on a regular monthly basis about 1 week after the onset of each menstrual period, when the breasts are typically not tender or swollen. BSE is most effective when it uses a dual approach incorporating both inspection and palpation. After menopause, BSE should be performed on the same day each month (chosen by the woman for ease of remembrance). Time required: 15 minutes a month Equipments:-  A mirror which lets you see both breasts.  A pillow for your head and shoulders.  Privacy. The Seven Ps methods:- Similar method of self-examination is known as the seven' Ps of BSE:- 1. Position: Inspect breasts visually and palpate in the mirror with arms at with various positions. Then perform the examination lying 45  Clinical Procedures down, first pillow under one shoulder, then with a pillow under the other shoulder, and finally lying flat. 2. Perimeter: Examine the entire breast, including the nipple, the axillary's tail that extends into the armpit, and nearby lymph nodes. 3. Palpation: palpate with the pads of the fingers, without lifting the fingers as they move across the breast.. 4. Pressure: First palpate with light pressure, then palpate with moderate pressure, and finally palpate with firm pressure. 5. pattern: There are several examination patterns, and each woman should use the one which is most comfortable for her.the vertical strip pattern involves moving the fingers up and down over the 46  Clinical Procedures breast.the pie-wedge pattern starts at the nipple and moves outward.the circular pattern involves moving fingers in concentric circles from the nipple outward.don't forget to palpate into the axilla. 6. Practice: practice the breast self exam and become familiar with the feel of the breast tissue, so you can recognize changes. A health care practitioner can provide feedback on your method. 1. Plan: know what to do if you suspect change in your breast tissue.know your family history of breast cancer.have mammography done as often as health care provider recommends. Instructions before doing breast self- examination:- a. Start checking your breasts when you are at 20 years or older. b. Mark your calendar to help you remember to do BSE on a regular schedule. One easy way to remember to do BSE is to do the exam on the same day of each month. 47  Clinical Procedures c. Do your BSE one week after your monthly period. This is the time when your breasts may be the least swollen, lumpy, or tender. d. If you are pregnant or have gone through menopause (change of life), do a BSE on the same day of each month. e. Use your fingertip pads to do the exam. Fingertip pads are the top parts of your fingers. f. Use three types of pressure while you do your BSE. First, press lightly. Second, press with medium pressure to feel a little deeper into the breast. Last, use firm pressure to feel deep within your breast. g. Use small circles to feel your breast tissue. Use your fingertip pads to make overlapping circles on your breast and armpits. h. Examine your entire breast area using up and down lines. Talk to your caregiver and make your own personal decision about doing BSE. (Fig.1). BSE involves the following:-  General Visual Exam (looking) 48  Clinical Procedures 1. Look for changes in symmetry, contour, shape, and overall texture of the breasts. 2. Look for dimpling, scaling, redness, sores, and enlarged pores in the skin. 3. Look for discharge, scaling, sores, puckering, and inversion of the nipples. Change color, size or texture Skin dimpling Nipple discharge  General Touch Exam (Palpation and feelling) Feel for unusual lumps, bumps, thickenings, and tender or enlarged lymph nodes in the breasts, under the arms, along the collarbone, and in center of chest between the breasts. The Five Steps of a Breast Self-Exam Step 1: Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips. Breast Self-Exam – Step 1 49  Clinical Procedures Here's what you should look for:  Breasts that are their usual size, shape, and color  Breasts that are evenly shaped without visible distortion or swelling If you see any of the following changes, bring them to your doctor's attention:  Dimpling, puckering, or bulging of the skin  A nipple that has changed position or an inverted nipple (pushed inward instead of sticking out)  Redness, soreness, rash, or swelling Step 2: Now, raise your arms and look for the same changes. Breast Self-Exam - Steps 2 and 3 Step 3: While you're at the mirror, look for any signs of fluid coming out of one or both nipples (this could be a watery, milky, or yellow fluid or blood). Step 4: Next, feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast. Use a firm, smooth touch with the first few finger pads of your hand, keeping 50  Clinical Procedures the fingers flat and together. Use a circular motion, about the size of a quarter. Cover the entire breast from top to bottom, side to side — from your collarbone to the top of your abdomen, and from your armpit to your cleavage. Follow a pattern to be sure that you cover the whole breast. You can begin at the nipple, moving in larger and larger circles until you reach the outer edge of the breast. You can also move your fingers up and down vertically, in rows, as if you were mowing a lawn. This up-and-down approach seems to work best for most women. Be sure to feel all the tissue from the front to the back of your breasts: for the skin and tissue just beneath, use light pressure; use medium pressure for tissue in the middle of your breasts; use firm pressure for the deep tissue in the back. When you've reached the deep tissue, you should be able to feel down to your ribcage. Breast Self-Exam - Step 4 Step 5: Finally, feel your breasts while you are standing or sitting. Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower. Cover your 51  Clinical Procedures entire breast, using the same hand movements described in Step 4.and press on nipple between fingers Breast Self-Exam - Step 5 Tips for Doing Your BSE 1. Mark your calendar to remind yourself to do your BSE regularly. This is a good way to prevent worry if find a normal cyclic change. 2. Stay relaxed and breathe normally as you do your BSE. Becoming tense will produce some knots that you may mistake for something worrisome. 3. Report any changes or unusual pain to your doctor or nurse practitioner. Keep a log of changes, if that helps you remember. 4. Remember to have an annual clinical exam and a mammogram. 52  Clinical Procedures Procedure Checklist: Breast Exam No. STEPS 2 1 0 1. Welcome the woman and, introduce yourself. 2. Define the procedure: It is a technique by which a thorough inspection and palpation of the breast is made during antenatal and postnatal period in order to collect data about the breast condition of the mother. 3. Identify the Objectives:  To discover any abnormalities that causes harm or problem as early as possible.  To detect early any breast lesion.  To learn how to examine breast for self and for others.  To encourage BSE practice.  To reinforce the woman's confidence in BSE ability.  To assess the breast size, shape, contour, elasticity and symmetry. (in antenatal period)  To assess the nipple for type, size and secretions.  To examine the areola and nipple for evidence of blisters, cracks or fissures  To assess the breast for signs of engorgement, mastitis or abscess (in postpartum period)  To check the beast tissue for presence of lump or cyst that may require further medical evaluation.  To detect and treat early any abnormalities or complication. 4. Place the woman on the examination couch and Explain the procedure to her. 5. Drape the woman and keep the doors and curtain closed. 6. Wash your hands. 53  Clinical Procedures 7. Inspection: a) On sitting position: Ask the client to sit in comfortable position facing the examiner  With arm relaxed at sides.  With arms held over head.  With hands on hips ,pressing in to contract the chest muscles b) On the supine position: Ask the client to assume the supine position and put her right arm over her head and inspect the right breast (Reverse this step for the left breast). 8. Palpation :examine the right breast on the supine position:  Put right hand behind head. Use pads of fingers of left hand, held flat together, gently press on the breast tissue using small circular motion, imagine the breast as a face of a clock. Beginnings at the top (12 O' clock position) make a circle around the outer area of the breast.  Move in one finger width, continue in smaller and smaller circles until you have reached the nipple (cover all areas including the breast tissues leading to the axilla)  Reverse the procedure to the left breast. Underarm Examination: 9.  Examine the left under arm area with arm held loosely at side. Cup the finger of the opposite hand and insert them high into the underarm area. Draw finger down slowly, pressing in circular pattern, covering all areas.  Reverse the procedure for the right underarm 10. Nipple Examination Gently squeeze the nipple of each breast between the thumb and index finger to check for discharge. 54  Clinical Procedures 11. Assist the woman to get down from examination table and redress her clothes, then wash hands 12. Report abnormality. 13. Record findings and woman's reaction. Total mark 55