MIDTERM 2020 National Health Reproductive and Sexual Health - PDF

 Unitive type of physical union, the sexual union of a man and a woman in natural intercourse Procreative found only in natural intercourse. inherently ordered toward the creation of new human life Checkpoint Question 2020 National Health Goan...

 Unitive type of physical union, the sexual union of a man and a woman in natural intercourse Procreative found only in natural intercourse. inherently ordered toward the creation of new human life Checkpoint Question 2020 National Health Goan solated to Suzanne Matthews tells you she used to Reproductive and Sexual Health #2 worry because her breasts developed at Increase the proportion of puberty later than those of most of her adolescents who, by age 15 years, friends. Breast development is termed: have never engaged in sexual a. Adrenarche intercourseto 80.2% of girls and b. Menopause 79.2% of boys from baselines c. Thelarche 72.9% and 72.0%. d. Menarche Increase to at least 91.3% the Andrology: study of male reproductive system proportion of sexually active 15-to Gynecology: study of the female reproductive system 19-year-olds at risk for unintended pregnancy who used contraception at last sexual intercourse from a baseline of 83.0%. Reduce deaths from cancer of the uterine cervix to no more than 2.2 per 100,000 women, from a baseline rate of 2.4 per 100,000. Reduce breast cancer deaths to no more than 20.6 per 100,000 women, from a baseline rate of 22.9 per 100,000. Positional deviations of the Uterus Anteversion: The entire uterus tips far forward. Anteflexion: The body of the uterus is bent sharply forward at the junction with the cervix. Retroversion: The entire uterus tips far back. Retroflexion: The body of the uterus is bent sharply back just above the cervix.  Sexual Cycle response Excitement - stimulation, arterial dilation and venous constriction. increased blood supply leads to vasocongestion, increasing muscular tension Plateau - reached before orgasm, nipple elevation, distention of the penis. HR:100 to 175 Orgasm - discharges accumulated sexual tension (M:3-7:F;8-15 contractions) Resolution - 30-minute period in which genital organs return to an unaroused state. Types of Sexual Orientation Heterosexuality - a person who finds sexual fulfillment with a member of the opposite gender. Homosexuality - a person who a. Adrenarche - development of pubic and finds sexual fulfillment with a axillary hair member of his or her own sex. b. Menopause - cessation of menstruation Bisexuality - achieve sexual c. Thelarche - breast development satisfaction from both homosexual d. Menarche - first occurrence of and heterosexual relationships menstruation Transsexuality - A transsexual or transgender person is an individual Menstrual Cycle who, although of one biologic 1. Proliferative Phase - (Estrogenic, gender, feels as if he or she is of the Follicular) opposite gender 2. Secretory (progestational, luteal, Types of Sexual Expression premenstrual) Sexual Abstinence (celibacy) - is 3. Ischemic (ovary regress p 8-10 days, separation from sexual activity (Ott, endometrium of the uterus begins to Labbett, & Gold, 2007) degenerate, sloughs off) Masturbation - self-stimulation for 4. Menses erotic pleasure Erotic Stimulation - use of visual Menopause: Changes in Female materials such as magazines or Reproductive Cycle photographs for sexual arousal. Signals the end of menstruation Fetishism - sexual arousal resulting Ends the fertile period in females from the use of certain objects or Stops the production of ova situations.  Transvestism - transvestite is an (8) Treatment of breast and reproductive individual who dresses in the tract cancers and other gynecologic clothes of the opposite seX. conditions and disorders; Voyeurism - obtaining sexual (9) Male responsibility and involvement and arousal by looking at another men's RH; person's body. (10) Prevention, treatment and Sadomasochism - management of infertility and sexual Sadomasochism involves inflicting dysfunction; pain (sadism) or receiving pain 11) RH education for the adolescents, and (masochism) to achieve sexual (12) Mental health aspect of reproductive satisfaction. health care. Exhibitionism - revealing one's genitals in public. Bestiality - sexual relations with animals Pedophiles - individuals who are interested in sexual encounters with children. Responsible Parenthood The Responsible Parenthood and Reproductive - Health Act of 2012 - (Republic Act No. 10354), informally - known as the Reproductive Health Law or RH Law, is a law in the Philippines Elements of the RH Law (1) Family planning information and services; (2) Maternal, infant and child health and nutrition, including breastfeeding; (3) Prevention of abortion and management of post-abortion complications; (4) Adolescent and youth reproductive health guidance and counseling; (5) Prevention and management of reproductive tract infections (6) Elimination of violence against women and children and other forms of sexual and gender-based violence; (7) Education and counseling on sexuality and reproductive health; Care of the Mother and the Fetus during the Perinatal Period Human Embryos at Different stages of Life Terms used to Denote Fetal Growth Name Time Period OVUM From ovulation to fertilization ZYGOTE From fertilization to implantation EMBRYO From implantation to 5-8 weeks FETUS From 5-8 weeks until term CONCEPTUS Developing embryo or fetus and placental structures throughout pregnancy AGE OF VIABILITY The earliest age at which fetuses could survive if they were born at that time, generally accepted as 24 weeks, or fetuses weighing more than 400 g. Checkpoint Question Liz Calhorn asks how much longer her doctor will refer to the baby inside her as an embryo. The conceptus is an embryo: a. Until the time of fertilization. b. Until the placenta forms. c. From implantation until 20 weeks. d. From implantation until 5 to 8 weeks. Fetal Growth and Development End of Fourth Gestational Week The length of the embryo is about 0.75 cm; weight is about 400 mg. The spinal cord is formed and fused at the midpoint. The head is large in proportion and represents about one third of the entire structure. The rudimentary heart appears as a prominent bulge on the anterior surface Arms and legs are bud-like structures; rudimentary eyes, ears, and nose are discernible. End of Eighth Gestational Week The length of the fetus is about 2.5 cm (1 in.); weight is about 20 g. Organogenesis is complete.  The heart, with a septum and valves, beats Lung alveoli are almost mature; surfactant rhythmically. can be demonstrated in amniotic fluid. Facial features are definitely discernible; Testes begin to descend into the scrotal sac arms and legs have developed from the lower abdominal cavity. External genitalia are forming, but sex is not The blood vessels of the retina are formed yet distinguishable by simple observation. but thin and extremely susceptible to The abdomen bulges forward because the damage from high oxygen concentrations fetal intestine is growing so rapidly (an important consideration when caring for End of 12th Gestational Week (First Trimester) preterm infants who need oxygen). The length of the fetus is 7 to 8 cm; weight is End of 32nd Gestational Week about 45 g. The length of the fetus is 38 to 43 cm: weight Nail beds are forming on fingers and toes. is 1.600 g. Spontaneous movements are possible, Subcutaneous fat begins to be deposited in although they are usually too faint to felt by the former stringy. "little old man" the mother. appearance is lost). Some reflexes, such as the Babinski reflex, Fetus responds by morement to sounds are present. outside the mother's body. Bone ossification centers begin to form. An active Moro reflex is present. Tooth buds are present. Iron stores. which provide iron for the time Sex is distinguishable on outward during which the neonate will ingest only appearance. breast milk after birth, are beginning to be Urine secretion begins but may not yet be built. evident in amniotic fluid. Fingernails reach the end of fingertips. The heartbeat is audible through Doppler End of 36th Gestational Week technology. The length of the fetus is 42 to 48 cm; weight End of 16th Gestational Week is 1,800 to 2,700 g (5 to 6 1b). The length of the fetus is 10 to 17 cm; weight Body stores of glycogen, iron, carbohydrate, is 55 to 120 g. and calcium are deposited Fetal heart sounds are audible by an Additional amounts of subcutaneous fat are ordinary stethoscope. deposited Lanugo is well formed. Sole of the foot has only one or two Both the liver and pancreas are functioning. crisscross creases compared with a full The fetus actively swallows amniotic fluid, crisscross pattern evident at term. demonstrating an intact but uncoordinated Amount of lanugo begins to diminish. swallowing reflex; urine is present in Most fetuses turn into a vertex (head down) amniotic fluid. presentation during this month Sex can be determined by ultrasonography. End of 40th Gestational Week (Third Trimester) End of 20th Gestational Week The length of the fetus is 48 to 52 cm (crown The length of the fetus is 25 cm; weight is to rump, 35 to 37 cm); weight is 3,000 g (7 to 223 g. 7.5 16). Spontaneous fetal movements can be Fetus kicks actively, sometimes hard enough sensed by the mother to cause the mother considerable discomfort. Antibody production is possible. Fetal hemoglobin begins its conversion to Hair, including eyebrows, forms on the head; adult hemoglobin. vernix caseosa begins to cover the skin. Vernix caseosa starts to decrease after the Meconium is present in the upper intestine. infant reaches 37 weeks gestation and may Brown fat, a special fat that aids in be more apparent in the creases than the temperature regulation, begins to form covering of the body as the infant behind the kidneys, sternum, and posterior approaches 40 weeks or more gestational neck. age. Passive antibody transfer from mother to Fingernails extend over the fingertips. fetus begins. Creases on the soles of the feet cover at Definite sleeping and activity patterns are least two thirds of the surface. distinguishable as the fetus develops In primiparas (ie, women having their first biorhythms that will guide sleep/wake baby), the fetus often sinks into the birth patterns throughout life. canal during the last 2 End of 24th Gestational Week (Second Trimester) weeks of pregnancy. giving the mother a The length of the fetus is 28 to 36 cm; weight feeling the load she is carrying is less. This is 550 g. event, termed lightening, is a fetal Meconium is present as far as the rectum. announcement that the fetus is in a ready Active production of lung surfactant begins. position and birth is nearing. Eyelids, previously fused since the 12th McDonald's rule (symphysis-fundal height week, now open; pupils react to light. measurement) Hearing can be demonstrated by response to sudden sound. Measuring fetal heart rate with a Doppler When fetuses reach 24 weeks, or 500 to 600 transducer, which detects and broadcasts g, they have achieved a practical low-end the fetal heart rate to the parent-to-be as well age of viability if they are cared for after birth as to the nurse. in a modern intensive care nursery. End of 28th Gestational Week The length of the fetus is 35 to 38 cm; weight is 1,200 g. Rhythm strip and nonstress testing of fetal heart. The woman sits in a comfortable chair to avoid supine hypotension. Both a uterine contraction monitor and fetal heart rate monitor are in place on her abdomen Signs of pregnancy Presumptive signs - least indicative, could easily indicate other Estimate EDC (Estimated Date of Confinement) conditions Date of Quickening (Q) Probable signs Primigravida: obiective so it can be documented by an Date of Q + 4 months +20 days examiner. Ex..Q-April 5, 2020= August 25, 2020 Positive signs Multigravida; Demonstration of a fetal heart separate from Date of Q + 5 months + 4 days the mother's Ex..June 20, 2020=Nov. 24, 2020 Fetal movements felt by an examiner To estimate AOG (Assessment of Gestational Age) Visualization of the fetus by ultrasound Mcdonald's Rule (Fundic Height) Ultrasonography - And ultrasound is an imaging test - Formula: Ht in cm x 2/7= duration in months that uses sound waves to make pictures of organs, - Formula: Ht. in cm x 8/7=duration in weeks tissues, and other structures inside your body Bartholomew's Rule of four Presumptive Signs and Probable Signs This method estimates the age of gestation relative to the height of the fundus of the uterus above the symphysis pubis. - Level of xiphoid process= 9 months - Level of umbilicus-5 months - Level of symphysis pubis- 1 month Estimated Fetal Weight Rump to crown length in utero in cm CRL in uterus in cm x 100 = weight in gm Terms Related to Pregnancy Status Para Number of pregnancies that have reached viability regardless of whether the infants were born alive Gravida Woman who is or has been pregnant Primigravida Woman who is pregnant for the first time Primipara Woman who has given birth to one child past age of viability Multigravida Woman who has been pregnant previously Multipara Woman who has carried two or more pregnancies to viability Nulligravida Woman who has never been and is not currently pregnant Example A woman who has had two previous pregnancies, has given birth to two term children, and is again pregnant is gravida 3, para 2. A woman who has had two miscarriages at 12 weeks (under the age of viability) and is again pregnant is a gravida 3, para 0. Classifying pregnancy status(GTPAL or GTPALM) T: (Term)Number of full-term infants born (infants born at 37 weeks or after) P: (Preterm) Number of preterm infants born (infants born before 37 weeks) A: (Abortion)Number of spontaneous miscarriages or therapeutic abortions L: Number of living children M: Multiple pregnancies A woman who had term twins, then one preterm infant, and is now pregnant again would be? A pregnant woman who had the following pas history-a boy born at 39 weeks' gestation, now alive and well; a girl born at 40 weeks' gestation, now alive and well; a girl born at 33 weeks' gestation, now alive and well A woman who has had three previous pregnancies, has given birth to three term children, alive and well, and is again pregnant A 30 year old female is 25 weeks pregnant with twins She has 5 living children. Four of the 5 children were born at 39 weeks gestation and one child was born at 27 weeks gestation. Two years ago she had a miscarriage at 10 weeks gestation. A 27 year old female is currently 16 weeks pregnant. She has 2 year-old twins that were born at 39 weeks gestation and a 5 year-old who was born at 40 weeks gestation. She had no history of miscarriage or abortion. A 20 year old female is currently 8 weeks pregnant. She had a miscarriage at 12 weeks gestation two years ago. She has no living children. Topic 4: Intrapartal Care Common Preparation for Childbirth: Prenatal Yoga Perineal and abdominal exercises Tailor sitting ○ Stretches perineal muscles to make them more supple. ○ Legs are parallel so one does not compress the other. Squatting ○ Helps stretch the muscle of the pelvic floor Pelvic floor (kegels) ○ Helpful for relieving backache during pregnancy and labor Position and Presentation of the Fetus to identify location of the fetal back To determine position Findings : ○ The lateral sides of the fundus are palpated to determine the position of the fetal back and small parts. ○ The fetal spine will palpate as firm, flat and linear. ○ The fetal extremities are palpable by their varying contour and movements ○ The purpose of this maneuver is to determine whether the fetak back is left or right Third Maneuver (Pawlicks Grip) To determine engagement of presenting part and to estimate fetal station To determine presentation Abdominal Palpation: Leopolds Maneuver Fourth Maneuver (Pelvic Grip) First Maneuver ( Fundal Grip) To determine fetal part lying in the fundus To determine fetal presentation Stand at the side of the bed facing the client Warm hands and feels abdomen (fundus) with tips of both hands Decide which pole of the fetus is being help by three points To determine the degree of flexion of felt head ○ Relative consistency: head is harder and firmer To determine attitude or habitus ○ Shape: head will be round hard/smooth with Theories of Labor Onset transverse groove of the neck ○ Mobility: head will move independently on the Uterine muscle stretching results in release of prostaglandins trunk Pressure on the cervix stimulates the release of oxytocin Determine the fetal parts palpated Oxytocin stimulation works together with prostaglandin to Second Maneuver initiate contractions Change in the ration of estrogen to progesterone (increasing estrogen in relation go progesterone is interpreted as progesterone withdrawal) Placental age triggers contractions at a set point Rising Fetal cortisol levels reduces progesterone formation and increases prostaglandin formation Fetal membrane production of prostaglandin stimulate contractions Preliminary Signs of Labor  Lightening (descent if the fetal presenting part into the pelvis) ○ 10 - 14 days before labor begins ○ Changes a persons abdominal contour because it positions the uterus lower and anterior the abdomen. Increase in Level of Energy (increase in epinephrine release initiated by a decrease in progesterone) Slight loss of Weight ( increase urine production) ○ As progesterone levels falls, body fluid is more easily excreted from the body. Braxton Hicks Contractions Ripening of the Cervix ○ Seen only on pelvic examination. ○ Cervix feels softer than usual to palpation, similar to the consistency of an earlobe (Goodell sign) ○ Butter soft: cervix becomes still softer and it tips forward, Difference between True and False Labor Contractions (page 332 onwards) False Labor Contractions: Attitude describes the degree of flexion a fetus assumes Begin and remain irregular during labor Felt first abdominally and remain confined to the abdomen Optimal Position (Letter A): and groin ○ In complete flexion Often disappear with ambulation or sleep ○ The spinal column is bowed forward, the head is Do not increase in duration, frequency, or intensity flexed forward that the chin touches the sternum, Do not achieve cervical dilation the arms are flexed and folded on the chest, the True Labor Contractions: thighs are flexed onto the abdomen, and the Begin irregularly but become regular and predictable claves are pressed against posterior of the thighs. Felt first in lower back and sweep around to the abdomen in ○ This position is advantageous for birth because it a wave helps a fetus present the smallest anteroposterior Continue no matter what the patients level of activity diameter of the skull to the pelvis. Increase in duration, frequency, and intensity ○ It also puts the whole body into an ovoid shape, Achieve cervical dilation occupying the smallest space possible Components of Labor Moderate Flexion (Letter B): ○ Fetus is not as well flexed, chin is not touching the 1. Passage (pelvis) - Is of adequate size and contour chest but is in an alert or military position/attitude. 2. Passenger (the fetus) - Is of appropriate size and in an ○ Causes the next widest anteroposterior diameter, advantageous position and presentation the occipitofrontal diameter, to present to the birth 3. Powers of labor (uterine factors) - Are adequate canal 4. Psyche (A woman’s psychological outlook) - Which may Partial Extension (Letter C): either encourage or inhibit labor. This can be based on the ○ Presents the “brow” of the head to the birth canal person’s past experiences as well as present psychological Complete Extension (Letter D): state ○ Face presentation The Passage ○ Fetus is in complete extension, the back is arched and the neck is extended The passage refers to the route a fetus must travel from the ○ This unusual position usually presents too wide a uterus through the cervix and vagina to the external skull diameter to the birth canal for vaginal birth perineum. ○ May be an indication there is less than the usual The Passenger: Fetus amount of amniotic fluid present, which is not allowing the fetus adequate movement space. The body part of the fetus that has the widest diameter is the ○ It may also reflect a neurologic abnormality in the head, so this is the part that is least likely to be able to pass fetus, causing spasticity. through the pelvic ring. Fetal Lie: Molding: refers to the relationship between the long axis of the fetus with respect to the long axis of the mother Molding is a change in the shape of the fetal Skull produced Fetal Presentation: by the force of uterine contractions pressing the vertex of the Cephalic Presentation head against the not-yet-dilated cervix is the most frequent type of presentation, occurring often as Fetal Presentation and Position (Attitude): 96% of the time. Fetal Attitude:  O: occiput (chosen point) ○ M: mentum ○ Sa: sacrum ○ A: acromion Last letter defines whether the landmark points: ○ A: anteriorly ○ P: posteriorly ○ T: transverselg Engagement: Breech Presentation: Engagement refers to the settling of the presenting part of a means either the buttocks of the feet are the first parts that fetus far enough into the pelvis will contact the cervix. Station: refers to the relationship of the presenting part of the fetus to the level of the ischial spines. Frank breech: ○ Attitude is moderate because the hips are flexed, but the knees are extended to rest on the chest. ○ The buttocks alone present to the cervix Footling breech: ○ Neither the thighs nor lower legs are flexed. Mechanisms (Cardinal Movements) of Labor: ○ If one foot presents, it is a single-footling breech It is the effective passage of a fetus through birth canal ○ If both feet present, it is a double-footling breech involves not only position and presentation but also a Complete breech: number of different position changes. ○ The fetus has the thighs tightly flexed onto the ○ Descent: abdomen Is the downward movement of the ○ Both the buttocks and the tightly flexed feet biparietal diameter of the fetal head present to the cervix. within the pelvic inlet. Shoulder Presentation: ○ Flexion: As descent is completed the fetal head touches the pelvic floor, the head bends forward onto the chest, causing the smallest anteroposterior diameter to present to the birth canal Flexion is also aided by abdominal muscle contraction during pushing. ○ Internal Rotation: As the head flexes at the end of descent, then occiput rotates so the head is the best relationship to the outlet of the pelvis. This movement brings the shoulders, coming next, into the optimal position to enter the inlet ○ Extension: As the occiput of the fetal head is born, the back of the neck stops beneath the pubic arch and acts as a pivot for the rest of the head. The head extends, and the foremost parts of the head, the face, the chin, are born. ○ External Rotation: in a transverse lie, fetus is horizontally in the pelvis so the Almost immediately after the head of the longest fetal axis is perpendicular to that of the pregnant infant is born, the head rotates a final person. time (from the anteroposterior position it Fetal Position: assumed to enter the outlet) back to the diagonal or transverse position ○ Expulsion: Once the shoulders are born, the rest of the baby is born easily and smoothly. The Powers of Labor this is the force supplied by the fundus of the uterus and implemented by uterine contractions, which causes cervical dilation and expulsion. After full dilation of the cervix, the primary power is supplemented by the use of secondary power source, the abdominal muscles. Uterine Contractions: during pregnancy the uterus begins to contract and relax periodically (usually can be mistaken for true labor, braxton hicks contraction) Three Phases: ○ Increment: L: left Intensity of the contraction increases R: right  ○ Acme: The contraction at its strongest ○ Decrement: Intensity decreases Contour Changes: Changes from round to ovoid to an elongated one The lengthening straightens the body of the fetus, bringing it to better alignment with the cervix and pelvis Elongation of the uterus can cause pressure on the diaphragm Upper Portion: ○ Thickens Lower Segment: ○ Becomes thin-walled, supple, and passive Cervical Changes: Effacement: ○ Is the shortening and thinning of the cervical canal Dilatation: ○ Refers to the enlargement of widening of the cervical canal The Psyche Psychological outlook or state of feelings someone brings into labor. The Stages of Labor First Stage: The Latent Stage: ○ begins at the onset of regularly uterine contractions ○ Contractions are mild and short (lasting 20 to 40 seconds) The Active Stage: ○ Cervical dilation occurs increasing from 4 to 7 cm ○ Contractions grow stronger (lasting 40 to 60 seconds and occurs every 3 to 5 minutes in a row) The Transition Stage: ○ cause maximum cervical dilatation of 8 to 10 cm. ○ Contractions reach their peak of intensity (occurring every 2 to 3 minutes with a duration of 60 to 70 seconds Second Stage: from full dilatation and cervical effacement to birth of the infant; with uncomplicated birth, this stage takes about 1 hour Third Stage: Placental stage, begins with the birth of the infant and ends with the delivery of the placenta Placental Separation (signs): ○ Lengthening of the umbilical cord ○ Sudden gush of vaginal blood ○ Change in the shape (globular) of the uterus ○ Firm contraction of the uterus ○ Appearance of the placenta at the vaginal opening Schultze presentation: Shiny and glistening from fetal membrane Duncan presentation: Raw, red, irregular and dirty from maternal surface. Placental Expulsion: ○ Once separation has occurred, the placenta delivers either by the natural bearing-down effort of the birthing parent or by gentle pressure of the contracted uterine fundus by the primary healthcare provider. Fourth Stage: stage includes the first few hours after birth. It signals the beginning of dramatic changes because it marks the beginning of a new family. NCM 107 This keeps the baby warm stimulates breathing Early Essential Newborn Care & Postpartal Care and prevents hypothermia Early Essential Newborn Care 2. Early and sustained skin-to-skin contact the simplest solution to reduce newborn between mother and baby until the completion deaths. of the first breastfeed. focus on eliminating harmful and outdated Helps transfer warmth and protective bacteria childbirth, newborn and postpartum practices that keeps babies pink, warm, calm and healthy in the first 24 hours of life, replacing them with 3. Appropriately timed clamping and cutting of evidence-based practices. the cord Reduces anemia for all babies and prevents brain hemorrhage for smaller babies 4. Initiation of exclusive breastfeeding Gives all the necessary nutrients the baby needs, reducing the risk of death 1. Preparing for a birth Upon Arrival FIRST EMBRACE: A HEALTHY START FOR 1. Obtain the pregnancy history and birth plan. EVERY NEWBORN INFANT 2. Perform proper handwashing Central to EENC is the First Embrace-a 3. Examine the woman. Check for pallor.Check protected and prolonged skin-to-skin cuddle VS between mother and baby, which allows proper 4. Assess fetal heart rate. warming, feeding and cord care. 5. Assess the progress and stage of labor. First Embrace is composed of four key steps: 6. Fill out WHO partograph 1. Drying of baby immediately and thoroughly after birth hours in active labor heart rate or pulse rate urine voided vaginal bleeding hours since ruptured membrane blood pressure temperature amniotic fluid rapid assessment cervical dilatation uterine contractions any problems fetal heart rate normal (120-160 2. During labor - take in light snacks and oral fluids Encourage birth companion(s) to be present. - empty her bladder Encourage the woman to: Every 30 minutes: plot heart or pulse rate, - move around if she wants and assume a contractions and fetal heart rate position she is comfortable - 2 hours: plot temperature - 4 hours: plot blood pressure and cervical Call out time of birth. dilatation Immediately dry the baby Preparing for the Birth Place the baby in skin-to-skin contact with the Prepare the following: mother. - clean linen or towel(s), Cover the baby and mother with a clean warm - bonnet, cloth. - syringe, Cover the baby's head with a bonnet. - 10 IU ampule of oxytocin, Do not do routine suctioning. - basin with 0.5% chlorine solution for During the first 30 seconds decontamination THE APGAR SCORING SYSTEM Open the delivery kit containing sterile Evaluates five signs of cardiopulmonary and umbilical clamp or tie, instrument clamp, and neuromuscular function: heart rate, respiratory scissors. effort, muscle tone, reflex irritability, and color Prepare newborn resuscitation area by: - clearing a flat, firm surface; and - checking that resuscitation equipment including bag, masks and a suction device are within reach, clean and functional Immediate Newborn Care (The First 90 Minutes) 2. Immediate newborn care: the first 90 from 30 seconds TO 3 MINUTES minutes If baby is breathing normally or crying, avoid If the baby must be separated from his/her manipulation mother, clamp and cut the cord and put the Continue skin-to-skin contact with the baby baby on a warm surface in a safe place close prone on the mother's abdomen or chest. to the mother. Turn the baby's head to one side. Inject oxytocin into the mother's arm or thigh Keep the baby's back covered with a blanket Clamp and cut the cord after cord pulsations and head with a bonnet have stopped (between 1-3 minutes) Do not separate baby from the mother - apply a sterile plastic clamp or tie around the Do not wipe off the vernix, if present. cord at 2 cm from the umbilical base; Do not bathe the baby during the first 24 - apply the second clamp at 5 cm from the hours of life. umbilical base - cut close to the first clamp or tie using sterile scissors Within 90 minutes Provide breastfeeding support to ensure good Leave the baby on mother's chest in skin- positioning and attachment to-skin contact Kangaroo mother care - method of care of preterm infants - involves infants being carried, usually by the mother, with skin-to-skin contact  Do eye care Initiating exclusive breastfeeding once feeding administer erythromycin or tetracycline cues are present reduces risk of death by 22%, ointment, or 2.5% povidone-iodine drops, to but both eyes according to national guidelines Cup feeding with breast-milk saves lives, From 90 minutes to 6 hours prevents illness and malnutrition, but.... Examine the baby Common practices - malformations, especially those that need... too often, unnecessary suctioning, additional care or early referral immediate cord cutting and delayed drying Give vitamin K prophylaxis expose newborns to infection, breathing and Inject hepatitis B and BCG vaccinations at circulatory problems, hypothermia, anemia and birth brain hemorrhage. Inject hepatitis B Too often, newborn infants are distressed, BCG vaccinations at birth hypothermic and exposed to dangerous Dry cord care bacteria because of separation from mother. After Discharge.. too often, the first breastfeed is delayed Schedule postnatal contacts: because of incorrect sequencing of actions - within 24 hours immediately after birth. - 48-72 hours KMC - 7-14 days KMC keeps babies warm, protected from - 6 weeks infection, and reduces nsk death by up to half, but... Common practices... babies are often exposed to the dangers of separation, over-medicalization and exposure to infection.... small babies are often given infant formula which increases the risk of necrotizing enterocolitis, pneumonia, diarrhea, malnutrition and death. Nsg. Care Comparison between The First Embrace and Provide Pain Relief for Afterpains (Ibuprofen) common, harmful practices Relieve Muscular Aches The First Embrace Administer Cold and Hot Therapy. Drying thoroughly stimulates breathing and Promote Perineal Exercises. prevents hypothermia, damping the cord after Give Episiotomy Care. pulsations stop prevents anemia, but... Administer Sitz Baths. Skin-to-skin contact with the mother keeps Prevent Constipation. babies pink, warm, calm and healthy but... Prevent/Alleviate Breast Engorge