Module 14 Part 2.pdf

Mechanisms of Heat Loss Module 14:  Conduction- cooler solid object in contact Providing care and support to infants and...

Mechanisms of Heat Loss Module 14:  Conduction- cooler solid object in contact Providing care and support to infants and with body toddlers  Convection- body surface to cool surrounding air A. Care of Newborn in the Delivery Room  Evaporation- conversion of liquid to vapor I. Maintain Patient Airway  Radiation- cooler solid object to object not  Drain secretions contact with the body a) Trendelenburg position (except if w/ III. APGAR SCORE signs of increased ICP) - supine with the head declined below the feet at an angle roughly 16 degrees. b) Suctioning Purpose: To remove mucus or saliva from your baby’s nose, mouth, or throat. When to suction?  Congestion heard in nose or throat  Visible mucus or saliva  Gurgling Interpretation:  Restlessness 0-3 - may indicate severe respiratory or CNS  Increased RR depression  Bluish discoloration - in serious danger and need resuscitation  Increased HR 4-6 - condition is guarded and may need more  PRN suctioning and oxygenation  Bulb syringe not helpful 7-10 - fetal well-being. Routine care only, no special How to suction? care needed  Mouth to nose (to prevent aspiration) *Done (1) one minute after birth to know the  Gently (to prevent condition of the newborn laryngospasm) *Repeat after (5) five minutes to determine how well  10 seconds or less to prevent the newborn is adjusting to extra uterine life. HYPOXIA (low oxygen in IV. Clean the BABY blood) and BRADYCARDIA  with oil to remove blood, mucus and vernix (slow heart rate) caseosa II. Keep the newborn warm V. Proper Identification  body temp upon birth at 37.2 C  Done before being remove from delivery  falls due to immature temp regulating room mechanism and loss.  ID tag/bracelet (wrist or ankle)  due to cold temperature in the  Take newborn’s footprints and record in Delivery Room the newborn’s medical record  newborns have difficulty conserving  NEWBORN SCREENING body heat due to little subcutaneous  Procedure to find out if baby has a fats (brown fat) congenital metabolic disorder that may  Shivering- present at birth that makes lead to mental disorder or death if left them prone to cold stress untreated. HOW?  Blood test (the baby's heel is pricked  Dry new born immediately to collect a sample of blood)  Wrap on a blanket  Hearing Screen  Place under a radiant warmer  Pulse Oximetry Testing or isolette with a temp of 33- IMPORTANCE: 34’C - early detection of disorders or  Place under drop-light at 12-18” abnormalities far from the newborn - to treat early to be able to grow up healthy with normal development.   Once a baby's temperature has stabilized, the first bath can be given. Taking NB’s Temperature  Take the temperature when your baby is quiet  Body temperature varies depending on the amount of activity, emotional stress, and type of clothing worn and temperature of the environment.  Reporting- exact thermometer reading and Heel prick test route  RECTAL – younger than 3 months old.  TEMPORAL / AXILLARY - babies to 6 months old.  RECTAL / TEMPORAL / EAR / AXILLARY – 6 months to 3 years old.  Check to make sure bulb of thermometer is not broken of cracked. NOTIFY THE DOCTOR WHEN:  Baby has fever over 37.7 C (axillary) or 38.3 (rectal) Hearing screen  Has/have the following condition/s:  Irritability (crying) How it is done?  Temp is less than 36.1 1) Within 48 hours or at least 24 hours from birth  Poor feeding but not later than 3 days after complete delivery.  Feels hot when touched 2) A newborn placed in intensive care may be  Breathing is difficult exempted from 3-day requirement but must be  + fever for 3 days tested by 7 days of age.  Coughing 3) A few drops of blood is drawn from pricking the  Fever with abnormal movements baby’s heel.  Does not look good 4) It is then blotches on a special absorbent card Administering Eye Care and dried for at least 4 hours. Credé's prophylaxis 5) If a screening suggests a problem, the doctor - to protect newborn against neonatal will follow up further testing and referral to a conjunctivitis acquired from the mother as specialist for treatment. the infant passes through the birth canal caused by Neisseria gonorrheae. B. Care of Newborn in Nursery How? I. Identification  Dry newborn’s face - check ID/wristband  Open one eye at a time by putting II. Take Anthropometric Measurement pressure in the upper and lower lids A. Weight  Instill drops of 2% AGNO4 (Silver - average birth weight- 6.5-7.5 lbs Nitrate) into the lower conjunctival sac - first few days of life- loses 5-10% of Cord Care body weight due to: Newborn is no  Inspect for the presence of AVA (2 arteries and 1 longer in the influence of maternal vein) hormones  Absence of one artery may indicate kidney B. Length- 19-21.5” or 35-50cm problem C. Head circumference- 33-35cm  Absence of one umbilical vessel may D. Chest Circumference- 31-33 cm indicate heart and kidney problem E. Abdominal Circumference- 31-33cm  The baby's umbilical cord stump will have a clamp. It needs to be kept clean and dry.  Newborn voids and passes stools  Assess for possible bleeding  If breastfed, they have low caloric intake  Clean the area with cotton swab soaked in because colostrum has low caloric intake. warm water.  If bottle fed, sucking is not yet effective  Birth weight is doubled by 6 months, tripled by one year, and quadrupled by 2 ½ years. Administer Vitamin K  Intramuscular shot given within 6 hours after birth.  Babies are born with very small amounts of stored Vitamin K in their bodies Purpose:  To prevent bleeding  To prevent low amount of vitamin K  To prevent Vitamin K Deficiency Bleeding Skin to Skin Contact  After birth, the newborn will be put on the mother’s chest for skin to skin contact. Purpose:  Reduces newborn crying  Helps start and sustain breastfeeding  Helps maintain baby’s body temperature Initial Feeding Breast feed  50 mins to 1 hour after normal delivery, 4 hours after C/S  Facilitate skin-to-skin contact until they are both ready to breastfeed. Signs of a good latch: Physical Assessment  The latch is comfortable and pain free.  SKIN  The baby's chest and stomach rest COLOR against your body, so that baby's head  Most newborns have a ruddy is straight, not turned to the side. complexion due to increased  The baby's chin touches your breast. concentration of RBC on blood vessels  The baby's mouth opens wide around and decreased subcutaneous fats your breast, not just the nipple. Ruddy complexion- refers to red,  The baby's lips turn out. blotchy patches that appears to be  The baby's tongue cups under your irritated. breast.  You hear or see swallowing.  Your baby's ears move slightly.  This fades slightly over the first month a) Acrocyanosis - is a persistent blue or cyanotic discoloration of the Circumcision extremities, most commonly occurring  Surgical removal of the penis’ foreskin in the hands, although it also occurs in  Usually done during the first 10 days (often the feet and distal parts of face. within the first 48 hours) after the baby has synthesized enough Vit. K Contraindications:  Hypospadias- opening of the urethra is on the underside of the penis instead of at the tip.  Epispadias- urethra ends in an opening on the upper aspect of the penis. b) Pallor- pale color of the skin c) Cyanosis- blue, grayish, or purple skin, lips, or nail beds. Lanugo  fine hair all over the body. d) Jaundice- yellowish discoloration of skin, white of the eyes Desquamation  drying of newborn’s skin within 24 hrs of life which results in areas of peeling e) Harlequin sign- cutaneous condition seen in newborn babies characterized by momentary red color changes of half the child, sharply demarcated at the body's midline (usually occurs during 2nd to 5th day of life, can be seen up to 21 days) Milia  pinpoint white papule on cheek or across the bridge of the nose BIRTHMARK  Mongolian spots- slate gray patches found across the sacrum or buttocks, usually disappears by school age (due to MELANOCYTES- the cell that cause pigmentation of the skin.) Erythema Toxicum  Newborn’s rash that usually appears in the 1st- 4th days of life, no treatment needed Vernix caseosa  White, cream-cheese like substance on newborn’s skin at birth.  HEAD  Protects the newborn skin  25% of total length  Facilitates extra-uterine adaptation of  Large and prominent forehead skin in the  Fontanelles should not be sunken  first postnatal week if not washed away (dehydrated) or bulging (brain swelling or  after birth. fluid build up)  Anterior fontanelle- diamond shaped, c) Cephalhematoma usually closes at 12-18 mos  Collection of blood between periosteum of Posterior fontanelle- triangular in shape, skull bone and the bone itself (due to closes at the end of second month bleeding; hemmorhage)  6th month of age, head and chest  Soft bulge or bump, usually at the back of circumference are equal the head, that resembles a bruise. As time  The head may be slightly indented, due to passes, the soft mass may begin to harden the fluid filled inside the cavity or calcify.  Fontanelles : Should fell soft and flat. : may feel a slight pulsation If fontanelle closes soon:  baby may have hyperthyroidism (increase thyroid hormones) condition called CRANIOSYNOSTOSIS- fibrous joints (sutures) between the bone plates in a baby’s skull fuse too early before the brain has finished growing. The brain is unable to expand due to the closed area.  Overriding of suture lines are normal due to extreme pressure exerted by passage thru the birth canal.  Sutures should never be separated, it may indicate increased ICP  EYES  Newborns cry tearlessly due to immature lacrimal ducts  Edema usually present around the orbit of the eyelids which will remain for 2-3 days  Cornea should be round and adult size  Pupils are round, dark and regular in shape  There is a physiologic strabismus  Head shape may appear prominent and (misaligned eyes) asymmetric due to molding so that it can  until 4 months due to immature eye fit the cervix contour. muscles a) Craniotabes- localized softening of the cranial  EARS bones due to the pressure of the fetal skull  Pinna tends to bend easily against the mother’s pelvic bone  Level on top of the ear should be level with the  upper canthus of the eye.  Ears set lower may indicate chromosomal abnormalities b) Caput Succedaneum - Edema on the scalp at the presenting part of the head, will slowly be absorbed about the third day of life (due to pressure; edema)  NOSE  May appear large for the face Positional Nasal Deformity  Asymmetric appearance of the nose due to a positional deformity.  Results from an unfortunate position in utero.   Nares in this case are asymmetric and  ABDOMEN slightly  Contour is slightly protuberant and  flattened towards the infant's right, globular  even though the septum is still  Scaphoid or sunken abdomen may indicate  centrally located. missing abdominal contents  Bowel sounds should be heard within an hour after birth  For the first hour of birth, umbilical cord is white, gelatinous marked with red and blue streaks of umbilical vein and arteries 1st hour- cord begins to shrink, dry, and be dislodged 2nd-3rd day- turns black  MOUTH 6th-10th day- breaks free  Should open evenly when newborn cries, otherwise, it may indicate cranial nerve injury  Tongue may appear large and prominent  Palate should be intact  ANOGENITAL AREA  Check for patency of the anus (through  Epstein’s pearls (gingival cyst) are present; insertion of the tip of thermometer >1 cm) harmless  Note time that the infant passes meconium  Unusual to have teeth, if present, assess for  If no meconium for the first 24 hours, stability suspect imperforated anus  MALE GENITAL  Scrotum is edematous due to maternal hormones  Testes should be present in the scrotum Cryptorchidism - undescended testes  NECK - most common genitourinary (GU)  Short and chubby, creased with skinfolds congenital abnormality. Testes  Strong enough to support the weight of the makes sperm cell and produce head hormones called Testosterone  Trachea ma be prominent in from the neck  Penis appears small  CHEST  Inspect for urethral opening if in the tip of  Breast may be engorged due to influence of the glans maternal hormones  Prepuce (foreskin) of the penis should be  May secrete thin watery fluid (witch’s milk) examined for Phimosis (tight foreskin); due to maternal hormones Paraphimosis (foreskin is trapped behind  Should be symmetric the corona of glans penis, may cause  Retractions should not be present strangulation, edema and necrosis)  (sign of respiratory distress)  c) Oligodactyly  Is the presence of fewer than five fingers or toes on the hand or foot.  FEMALE GENITAL  Vulva may be swollen due to influence of maternal hormones d) Congenital Talipes Equinovarus(Clubfoot)  May have mucous secretions which is  A deformity (birth defect) in which your sometimes blood tinged baby's foot or feet turn inward. (Pseudomenstruation) due to exposure to high levels of maternal hormones in utero.  Inspect for size and location of the labia, clitoris, meatus and vaginal opening.  TRUNK/SPINE  Spine appears flat in the lumbar and sacral area  Curves starts to form when child is able to e) Metatarsus adductus (Metatarsus varus) sit and walk  Is a common foot deformity that causes the  Abnormal pigmentation/hairy patches over front half of the foot, or forefoot, to turn the lower back may indicate underlying inward. vertebral abnormality  EXTREMITIES  Arms and legs appear short  Hands are clumped and clenched into fists  Fingernails are soft and smooth and are long enough to extent over the fingertips  Arms and legs should move symmetrically  Check for pulses a) Syndactyly  Is a condition in which children are born with fused or webbed fingers. b) Polydactyly (Hyperdactyly)  is the most common congenital anomaly of hand and foot. It is characterized by an extra finger or toe that may results from defective development during anterior- posterior patterning of developing limb.