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MATERNAL AND CHILD

MATERNAL AND CHILD

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Published by josephine
from notes of MR. BADAJOS RN,RM,IVT
from notes of MR. BADAJOS RN,RM,IVT

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Published by: josephine on Jul 17, 2009
Copyright:Attribution Non-commercial

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10/22/2014

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PRINCIPLES OF IMMEDIATE CAREI. AIRWAY PATENCY
* Most critical adjustment a newborn must make at birthTECHNIQUES to maintain patent airway:
wipe off nose and mouth with sterile gauze
suctioning with the use of rubber bulb syringe or suction catheter 
positioningi.if NSD without problem = TRENDELENBURGii.traumatic delivery = FLAT
with head turned towards the side
stimulating the newborn to cryII
. PROVIDE OPTIMUM TEMPERATURE
POSSIBLE WAYS TO PRODUCE HEAT:1.SHIVERING2.METABOLISM OF BROWN FAT3.GLUCONEOGENESISHOW TO PROVIDE WARMTH:1.Dry, newborn’s skin2.Wrap, using soft blanket3.Use of pre heated bassinet or crib, radiant warmer, drop light or floor lamp
III. INITIAL ASSESSMENT OF CONDITION
 APGAR SCORING
was developed by Dr. Virginia Apgar in 1952
done on the 1st minute, 5 and 10 minutes after 
based on 5 parameters, ranked in order of importance A.HEART RATEB.RESPIRATORY EFFORTC.MUSCLE TONED.REFLEX IRRITABILITYE.COLOR
IV. PROPER IDENTIFICATIONV. PREVENTION OF INFECTION AND INJURY
 A. ASEPTIC TECHNIQUE1. CORD CARE- Check: Normal = 1 vein and 2 arteries (AVA) Abnormal = 2 A & 2 V – Mongoloid2. SKIN CAREoil bath – high risk prematuresoap/water bath – full term* use mineral oil to remove vernix caseosa on the body* use skin antiseptic or any mild soap for a regular bathB. PROPHYLAXIS1. EYE (Crede’s prophylaxis)> to prevent ophthalmia neonatorum or gonorrheal conjunctivitis> use of ophthalmic ointments like terramycin,tetracyclineTECHNIQUE:- inner to outer canthus while exposing the lower conjunctival sac2.HYPOPROTHROMBINEMIA prophylaxis> prescribed with single dose (1 mg /0.1ml) of Phytonadione solution(Aquamephyton) per IM, vastus lateralis
1
 
> Aquamephyton, a Vit. K water-soluble preparation – acts as preventivemeasure against neonatal hemorrhagic disease 
VI. MOTHER – CHILD BONDINGVII. NUTRITION
Purposes:a.Bondingb.Involutionc.Breast feeding stimulation
VII. BAPTISM OF INFANTNORMAL CHARACTERISTICS OF A NEONATE1.ANTHROPOMETRIC MEASUREMENTSA.WEIGHT AND LENGTH
 Americans - 53 cm (21 inches)7.7 lbs.Filipinos - average weight = 6.9 lbs (2500 – 4000gms.)average length = 48 – 53cm (19 – 21inches)Newborn loses 5 – 10% or 6 – 9% of his body weight during the first few days of life due to:a. withdrawal of hormonesb.voiding and passing out of stoolc.limited intake
will regain weight in 10 – 14 days of age
later on, he will be gaining 1 lb/month for the 1
st
6 mos. Of life thus:2x @ 6 mos.3x @ 1 year 4x @ 2 years
B.HEAD CIRCUMFERENCE
-
33 – 35 cm or 13 – 14 inches
C.CHEST CIRCUMFERENCE
-
31 – 33 cm or 12 – 13 inches
D.ABDOMINAL CIRCUMFERENCE
-
same as CC
2. VITAL SIGNSA.TEMPERATURE
-
36.5 – 37 °C or 97.7 – 98 ° F
B.RESPIRATION
-
30 – 60 breaths per minute
C.HEART RATE
-
Fluctuates between 120 – 180 beats/minute
E.BLOOD PRESSURE
-
High immediately after birth and falls to a minimum within 3 hours after birth.
-
67/41 mmHg – 80/40
2.HEAD TO TOE ASSESSMENTI.GENERAL APPEARANCE
2
 
II.SKIN
Pre term
– thin, translucent, ruddy skin; with easily seen veins and venules esp. over theabdomen.
Term
– thick, pinkish, mottled
Post term
– thick, parchment-like with peeling and cracking; few blood vessels over theabdomen.
III.COLOR
VARIATIONS:1.Gray - indicative of infection
Pallor- usually as a result of anemia2.Cutis Marmorata3.Acrocyanosis4.Cyanosis
cyanotic when quite and grows pink when cries → atelectasis
with normal color when quite then cyanotic when crying → congenitalheart disease, “ Blue Baby “
5.
Harlequin sign6.Physiologic jaundice or Neonatal hyperbilirubinemia
Full term = appears after 24°, becomes definite bet 2 – 7 days;disappears after 7
th
day
Pre term = appears after 18°, becomes definite bet 3 – 10 days;disappears after the 9
th
– 10
th
day
-
Serum unconjugated bilirubin does not exceed 12mg/100cc
-
 Above 20mg/100cc, will cross the blood brain barrier → interfere with chemical synthesisof brain → permanent cell damage and possible mental retardation, epilepsy, cerebralpalsy → KERNICTERUS7.OTHERS:
LANUGO
VERNIX CASEOSA
FORCEP MARKS
MILIA
NEVI (STORKBITES)
MONGOLIAN
ERYTHEMA TOXICUM NEONATORUM
DESQUAMATION
HEMANGIOMAS 
IV.HEADFONTANELS
are opening at points of union of skull bones
 Anterior – is diamond shaped, closes @ 12 – 18 mos.
Posterior – is triangular in shaped, closes @ 2 – 3 mosVARIATIONS IN THE HEAD:1.MOLDING2.CAPUT SUCCEDANEUM3.CEPHALHEMATOMA4.CRANIOTABES
EYES
-
Normal findings:
subconjunctival hemorrhage
edema of eyelids for 2 – 3 days till kidneys are able to excrete urine efficiently
pseudostrabismus or transient strabismus – cross-eyed
DOLL’S eyes – eyes do not follow movement of the head. Persists for 10 days,then disappear  
EARS
-
shld. be in line with the outer canthus of the eyes
-
ears set lower are found in those with chromosomal aberrations like trisomy18 and withmental retardation
3

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