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Newborn Assessment and Abnormalities

Newborn Assessment and Abnormalities

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Published by kimberson

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Categories:Types, Research
Published by: kimberson on Aug 15, 2010
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01/28/2013

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Immediate Care of the Newborn
Goals:
y
 
To establish, maintain and supportrespirations.
y
 
To provide warmth and preventhypothermia.
y
 
To ensure safety, prevent injury andinfection.
y
 
To identify actual or potential problemsthat may require immediate attention.
E
stablish respiration and maintain clear airway
 The most important need for the newbornimmediately after birth is a clear airway toenable the newborn to breathe effectively sincethe placenta has ceased to function as an organof gas exchange. It is in the maintenance of adequate oxygen supply through effectiverespiration that the survival of the newborngreatly depends.Newborns are obligatory nose breathers. Thereflex response to nasal obstruction, openingthe mouth to maintain airway, is not present inmost newborns until 3 weeks after birth.
To establish and maintain respirations:
 1. Wipemouthandnose of secretionsafterdelivery of thehead.2. Suction secretions from mouth and nose.
y
 
C
ompress bulb syringe before inserting
y
 
Suction mouth first, then, the nose
y
 
Insert bulb syringe in one side of themouth3. A crying infant is a breathing infant. Stimulatethe baby to cry if baby does not cryspontaneously, or if the cry is weak.
y
 
D
o not slap the buttocks rather rub thesoles of the feet.
y
 
Stimulate to cry after secretions areremoved.
y
 
The normal infant cry is loud and husky.Observe for the following abnormal cry:
o
 
H
igh, pitched cry  indicateshypoglycemia, increasedintracranial pressure.
o
 
Weak cry  prematurity
o
 
H
oarse cry  laryngeal stridor4. Oral mucous may cause the newborn, tochoke, cough or gag during the first 12 to 18hours of life. Place the infant in a position thatwould promote drainage of secretions.
y
 
Trendelenburg position  head lowerthan the body
y
 
Side lying position  If trendelenburgposition is contraindicated, place infantin side lying position to permit drainageof mucus from the mouth. Place a smallpillow or rolled towel at the back toprevent newborn from rolling back tosupine position.5. Keep the nares patent. Remove mucus andother particles that may be cause obstruction.Newborns are obligatory nose breathers untilthey are about 3 weeks old.
Care of the
E
yes
 It is part of the routine care of the newborn togive prophylactic eye treatment againstgonorrhea conjunctivitis or opthalmianeonatorum. Neisseria gonorrhea, the causativeagent, may be passed on the fetus from thevaginal canal during delivery. This practice was
 
introduced by
C
rede, a German gynecologistin1884. Silver nitrate, erythromycin andtetracycline ophthalmic ointments are the drugsused for this purpose.
E
rythromycin or tetracycline OpthalmicOintment
:
 1.
 
These ointments are the onescommonly used now a days for eyeprophylaxis because they do not causeeye irritation and are more effectiveagainst
C
hlamydial conjunctivitis.2.
 
Apply over lower lids of both eyes,then, manipulate eyelids to spreadmedication over the eyes.
V
itamin K or Aquamephyton
 The newborn has a sterile intestine at birth,hence, the newborn does not possess theintestinal bacteria that manufactures vitamin Kwhich is necessary for the formation of clottingfactors. This makes the newborn prone tobleeding. As a preventive measure, .5 (preterm)and 1 mg (full term) Vitamin K oraquamephyton is injected IM in the newbornsvastuslateralis(lateralanterior thigh)muscle.
Care of thecord
 The cord is clamped and cut approximatelywithin 30 seconds after birth. In the deliveryroom, the cord is clamped twice about 8 inchesfrom the abdomen and cut in between. Whenthe newborn is brought to the nursery, anotherclamp is applied ½ to 1 inch from the abdomenand the cord is cut at second time. The cord andthe area around it are cleansed with antisepticsolution. The manner of cord care depends onhospital protocol. What is important is that theprinciples are followed.
C
ord clamp mayberemoved after 48 hours when the cord hasdried. The cord stump usually dries and fallwithin 7 to 10 days leaving a granulating areathat heals on the next 7 to 10 days.
Instruction to the mother on cord care:
 1.
 
No tub bathing until cord falls off.
D
onot sponge bath to clean the baby. Seeto it that cord does not get wet bywater or urine.2.
 
D
o not apply anything on the cord suchas baby powder or antibiotic, exceptthe prescribed antiseptic solution whichis 70% alcohol.3.
 
Avoid wetting the cord. Fold diaperbelow so that it does not cover the cordand does not get wet when the diapersoaks with urine.4.
 
Leave cord exposed to air.
D
o not applydressing or abdominal binder over it.The cord dries and separates morerapidly if it is exposed to air.5.
 
If you notice the cord to be bleeding,apply firm pressure and check cordclamp if loose and fasten.6.
 
Report any unusual signs and symptomswhich indicates infection.
y
 
Foul odor in the cord
y
 
Presence of discharge
y
 
Redness around the cord
y
 
The cord remains wet and doesnot fall off within 7 to 10 days
y
 
Newborn fever
 
TH
E
APGAR SCORING SYST
EM
 The APGAR Scoring System was developed by
D
r. Virginia Apgaras a method of assessing the newborns adjustment toextrauterine life. It is taken at one minute and five minutesafter birth. With depressed infants, repeat the scoring everyfive minutes as needed. The one minute score indicates thenecessity for resuscitation. The five minute score is morereliable in predicting mortality and neurologic deficits. The mostimportant is the heart rate, then the respiratory rate, themuscle tone, reflex irritability and color follows in decreasingorder. A heart rate below 100 signifies an asphyxiated baby anda heart rate above 160 signifies distress.ASSESS 0 1 2
H
EART RATE Absent Below 100 Above 100RESPIRATION Absent Slow Good cryingMU
C
LE TONE Flaccid Some flexion Active motionREFLEX IRRITABILITY No response Grimace Vigorous cry
C
OLOR Blue all overBody pink,Extremities bluePink all overScore:
y
 
7  10 Good adjustment, vigorous
y
 
Moderately depressed infant, needs airway clearance
y
 
Severely depressed infant, in need of resuscitation.
ASS
E
SSING TH
E
A
VE
RAG
E
N
EWB
ORNHead Circumference 34 35 cm
Temperature 97.6 98.6 F axillary
C
hest
C
ircumference 32 33 cm
H
eart Rate 120 140 bpmRespirations 30 60 bpmWeight 2.5 to 3.4 kgLength 46 to 54 cm

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