UNIT 2 LESSON 6 (NOTES).pdf

Unit 2 (Lesson 6) Immediate Care of the Newborn Immediate Care of the Newborn Establishing Respiration: Transition at birth: The newborn must transition from relying on the placenta for oxygen to breathing independently....

Unit 2 (Lesson 6) Immediate Care of the Newborn Immediate Care of the Newborn Establishing Respiration: Transition at birth: The newborn must transition from relying on the placenta for oxygen to breathing independently. Stimulation to breathe: Drying and clearing the airways typically stimulate the baby to breathe on its own. APGAR Scoring: Evaluates 5 vital signs (appearance, pulse, grimace, activity, respiration) assessed at 1 minute and 5 minutes post-birth. Measures: Appearance (skin color) Pulse (heart rate) Grimace (response to stimuli) Activity (muscle tone) Respiration (breathing effort) Score: A score of 8-10 indicates a healthy newborn. Promoting Warmth, Bonding, and Early Breastfeeding: Skin-to-skin contact: Helps regulate the baby’s temperature, promotes bonding, and encourages breastfeeding. Breastfeeding initiation: Within 90 minutes of birth, providing colostrum, which is rich in antibodies. This also stimulates uterine contractions, reducing the risk of postpartum hemorrhage. Unit 2 (Lesson 6) Immediate Care of the Newborn 1  Vital Signs: Temperature: Initial: Around 37.2°C at birth but may fall due to exposure to the environment. Intervention: Drying and skin-to-skin contact help maintain warmth. Heart rate: Immediately after birth: Can be as high as 180 beats per minute, stabilizing to 120-160 bpm within the first hour. Respiration: Initially rapid, with rates between 30-60 breaths per minute. Breathing tends to be irregular and abdominal. Identification and Registration: Infant identification: A plastic bracelet is placed on the baby’s wrist or ankle with details including the hospital number, baby’s name, gender, mother’s name, birth date, time, and weight. This prevents misidentification and baby switching Measuring Vital Statistics and Normal Ranges: Recording the newborn’s measurements provides a baseline for tracking growth and development. Weight: Normal range: 2,800 – 3,000 grams (6 – 6.6 lbs) for Filipino newborns. Length (Crown-to-Heel): Normal range: 46 cm – 53 cm (18 – 21 inches). Head Circumference: Normal range: 34 cm – 35 cm. Unit 2 (Lesson 6) Immediate Care of the Newborn 2  Chest Circumference: Slightly smaller than the head, typically 32 cm – 33 cm. Abdominal Girth: Measured around the umbilicus, helps in assessing overall health Cord Care: The umbilical cord stump must be kept clean and dry. Sponge baths are recommended until the stump falls off, usually within 7-10 days. Signs of infection: Redness, swelling, or pus at the stump should be reported to a healthcare provider. Care instructions: Parents should not cover the stump with abdominal binders or apply creams and antiseptics, as this can slow healing Keep the umbilical cord clean and dry until it falls off (7-10 days). Give sponge baths; do not immerse in water. Educate parents on signs of infection: swelling, pus, redness. Discourage use of abdominal binders over the cord. Fold diapers below the cord to allow air circulation. Do not apply creams, alcohol, or antiseptics to the cord stump. After the cord falls off, a small, pink area may remain; keep it dry for another 24-48 hours to prevent infection. Newborn Reflexes: Several reflexes indicate normal neurological function in newborns: Rooting Reflex: When the cheek is stroked, the baby turns its head to nurse. Moro Reflex: When startled, the baby throws out its arms and pulls them back. Grasp Reflex: The baby will grasp objects placed in their palm Blink Reflex: The baby blinks in response to bright light or when something approaches the eyes. Unit 2 (Lesson 6) Immediate Care of the Newborn 3  Sucking Reflex: The baby automatically sucks when the roof of the mouth is touched, aiding in feeding. Swallowing Reflex: The baby swallows automatically after sucking, allowing them to ingest milk. Extrusion Reflex: The baby pushes out any object placed on the tongue, preventing unwanted substances from entering. Palmar Grasp Reflex: The baby grasps any object placed in their palm, showcasing their natural gripping ability. Step-in-Place Reflex: When held upright, the baby makes stepping movements as if walking. Placing Reflex: The baby lifts a foot when the top of the foot is touched, helping them adapt to standing. Plantar Reflex: Toes curl when the sole of the foot is stroked, indicating normal nerve function. Tonic Neck Reflex: When the head is turned to one side, the arm on that side extends while the opposite arm bends. Magnet Reflex: The baby pushes against pressure applied to the sole of their foot, showing resistance. Babinski Reflex: The toes fan out when the sole of the foot is stroked, demonstrating healthy neurological function. Cross Extension Reflex: When one leg is extended and the sole is touched, the other leg flexes in response. Trunk Incurvation Reflex: The body curves toward one side when the back is stroked, indicating normal reflex activity. Landau Reflex: When held in a prone position, the baby lifts their head and arches their back, reflecting muscle strength. Deep Tendon Reflex: Tapping a tendon causes a contraction in the corresponding muscle, indicating healthy reflexes. Conducting Thorough Physical Assessment Unit 2 (Lesson 6) Immediate Care of the Newborn 4  Skin Lanugo: Fine downy hair covering the newborn’s body, especially the shoulders and back. Disappears after a few weeks. Desquamation: Peeling skin, usually seen on the palms and soles within 24 hours. It is normal and doesn’t require treatment. Milia: Tiny white bumps on the face, especially the nose and cheeks. These are blocked sebaceous glands and disappear in a few weeks. Skin Turgor: Pinch the skin; if it quickly returns to normal, the baby is well- hydrated. Head Fontanelles: Anterior fontanelle: A soft spot at the top of the head; closes between 12- 18 months. Posterior fontanelle: Smaller soft spot at the back of the head; closes by 2 months. Molding (Cone Head): The baby’s head may appear cone-shaped due to compression during birth, but it will return to normal after a few days. Caput Succedaneum: Swelling of the scalp caused by pressure during birth; resolves within a few days. Eyes and Cry Tearless Cry: Newborns cry without tears because their tear ducts are underdeveloped. Tears typically start around 1-3 months. Eye Examination: Eyes should be clear without discharge. Some babies may have subconjunctival hemorrhages (small red spots) due to pressure during birth, which resolve on their own. Ears Unit 2 (Lesson 6) Immediate Care of the Newborn 5  The pinna of the ears tends to bend easily but is strong enough to recoil afterward. The ears should level with the inner to outer canthus of the eyes. Hearing Test: Assess by ringing a bell held about 6 inches from each ear. A crying infant will momentarily stop at the sound. A quiet infant will blink, appear to attend to the sound, and possibly startle. Nose The nose appears large relative to the face. Choanal Atresia Test: Close the newborn’s mouth and compress one naris at a time to check for blockage at the back of the nose. Note any discomfort or distress while breathing. Nasal flaring indicates respiratory distress. Mouth The mouth should open evenly when the baby cries. The newborn's tongue appears large and prominent, and all newborns have mucus in their mouths. Palate Inspection: Ensure the palate is intact. Normally, 1-2 small, round glistening cysts (Epstein pearls) are seen in the palate. Neck The neck is short and often chubby with creased skin folds. The head should rotate freely but is not strong enough to support its total weight. Newborns make momentary efforts at head control in a sitting position. The clavicles should be intact. When lying prone, newborns can slightly raise the head to lift the nose out of mucus or spit-up milk. The trachea may be prominent at the front of the neck. Chest The chest is approximately 2 inches smaller than the head and symmetrical. Unit 2 (Lesson 6) Immediate Care of the Newborn 6  Breast Engorgement: Both male and female newborns may experience engorged breasts that can secrete thin, watery fluid known as witch's milk. This engorgement typically disappears within a week as maternal hormones clear from the system. Lung Sounds: Rhonchi may be heard, which is a harsh, innocent sound of air passing over mucus. This occurs as the alveoli open slowly over the first 24- 48 hours, and babies may have mucus in the back of the throat. Abdomen The abdomen appears slightly protruberant, and bowel sounds should be present within 1 hour after birth. The edge of the liver is usually palpable 1-2 cm below the right costal margin, and the spleen is palpable 1-2 cm below the left costal margin. Ballard Score Used to assess the gestational age of the newborn by evaluating physical and neuromuscular maturity. Premature (Preterm): Born before 37 weeks gestation. Full Term: Born between 37 to 41 weeks gestation. Late Term: Born between 41 to 42 weeks gestation. Post Term: Born after 42 weeks gestation. Meconium and Stool Patterns: First stool (meconium): Passed within the first 24 hours, it is sticky, dark, and tar-like. Transitional stools: Greenish and loose after the second or third day. Breastfed stools: By the fourth day, stools are light yellow, soft, and passed 3- 4 times a day. Sweet smelling A newborn’s stomach holds about 60 to 90 mL of fluid and has limited ability to Unit 2 (Lesson 6) Immediate Care of the Newborn 7  digest fat and starch because the pancreatic enzymes, Sleeping Position: To reduce the risk of Sudden Infant Death Syndrome (SIDS), babies should always be placed on their backs to sleep. This position is the safest until the baby can roll over independently Clothing: Newborns need a minimal wardrobe; resist buying excessive items. Basics are essential for newborns. Recommended items: Side-tie or side-snap shirts (until umbilical cord falls off) Bodysuits, one-pieces, shirts, pants Sleep socks or booties, bonnets, sweaters (for cold weather) Average newborn clothing fits babies weighing 5 to 7 lbs. Many babies outgrow newborn sizes within weeks. Expect multiple outfit changes daily due to messes. Number of clothing pieces needed depends on laundry frequency. Diaper Area Care: Start preventing diaper dermatitis from day one. Wash the diaper area with clear water at each change. Dry the area thoroughly to avoid irritation. Prevent ammonia in urine from causing diaper rash. Newborns’ initial stool is sticky and tarry (meconium). Use cotton or cotton balls wet with clean water or baby oil for removal. Choose hypoallergenic products to avoid skin irritation. Unit 2 (Lesson 6) Immediate Care of the Newborn 8  Newborn Screening: Routine newborn screening tests for developmental, genetic, and metabolic disorders. Allows for early detection and management before symptoms develop. Prevents potential mental retardation or death from untreated disorders. Early diagnosis and treatment support normal growth and development. Screenings occur within 24-48 hours of life. Methods include: 1. Collecting drops of blood via heel-prick. 2. Using a tiny earpiece or microphone for hearing screening. Unit 2 (Lesson 6) Immediate Care of the Newborn 9