CORD DRESSING RD NOTES

*performed inside NICU - infant radiant warmer

system?
*small table for eqpt
*closed cap + mask
IMMEDIATE NEWBORN CARE

7 cm dilated - Dr order trans of mom from

labor>delivery room = prepare crib: disinfectin prep
of the delivery

1. Disinfects and prepares crib before the delivery of

the newborn.
a) In & out, incl frame, new linen
2. Prepares two (2) droplights.
3. Assembles all equipments.
a) Equipment on right side, working area on
left side
b) Layette over infant warmer, dress, diaper,
bonnet, mittens, boots, 2nd layetter
c) Arrange in order of use (top to bottom:
dress, diaper, bonnet, boots and mittens,
second layette + binder (not necessary but
used to restrain NB knees when applying
medication))
d) Prep hypotray: inside portion is sterile. +
tuberculin syringe, medication needed later, 4. Performs medical handwashing then disinfects
another med for crede’s proph, tape hand using hand
measure, add thermometers, ample swab sanitizer.
e) Kidney basin for waste receptacle, comb to 5. Opens sterile kidney basin pack.
clean bb’s head 6. Gets 4 sterile cotton balls and places it on the
f) Steth - pediatric steth if available - use kidney basin. Pours alcohol on the cotton balls.
smaller diaphragm 7.Opens sterile clothing pack and places the contents
g) Working gloves, CBs, sharps container, on top of the sterile
alcohol field.
h) Prepare jotdown notebook 8. Prepares the hypotray.
9. Opens the sterile instrument pack and places the
2 sterile forceps under
the hypotowel correctly.
9. Prepares the Vitamin K injection correctly.
a) Prep medication: should not be done very
early to maintain the patency of the drug.
b) Vit K is amber colored ampoule to prev
exposure of sunlight - prep when bb is
about to be delivered

c)
d)
e)
f)
g)
h) Prep of vit K: tuberculin syringe
i. 1 ampoule = ten administrations
ii. Hospital: 1 bb=1ampoule
iii. Scored ampoule
iv. Disinfect neck before breaking - CB
WITH ALCOHOL, discard
v. Get another CB, wrap it around the
neck and make sure the dot (score) is
facing AWAY from you
vi. Make sure medication is at the bottom
of ampoule, then break
vii. Place on tray, then discard the sharps
viii. Aspirate content of vit K - prep
aspirating needle - lock, remove cover
using one hand, drop cover
ix. Withdraw 0.1 cc
x.
xi. Pull plunger down to remove excess air,
then push until u see single drop on top
of it.
xii. Put back cover using Fish hook, making
sure to not contaminate the tip, place it
on the tray - no need to prep medx
ticket because it is a UNIVERSAL ORDER
for babies to receive Vit K and Crede’s
prophylaxis - to prevent infection and
bleeding
11. Washes hands then dons a clean pair of gloves.
(medical handwashing + disinfect using alcohol) -
working gloves to protect nurse from the newborn
because newborn has come in contact with the
discharges of the mother
12. Upon receiving the newborn, checks the ID band;
weighs the baby, provides warmth; checks for
bruises and deformities. ( no injuries, complete
appendages, gender pair w id band, spinal
alignment)
- baby is already wrapped when endorsed to you
- before endorsing to you, the pediatrician will
Weigh the baby (remove the cover so layette
will not be included)
- take note of wt in jotdown notebook
- when the baby is endorsed to you - remove the
cover because we have the layetter - turn bb to
sides when removing
- IDENTIFY BB - id band at foot part and check
- do quick head to toe assessment
13. Takes Vital Signs for 1 full minute, (rectal temp;
CR; RR)
a) Beyond / less than range - RECHECK
b) Core TEMP: initially check rectally to check
for patency of anus - hole or none
c) Both feet w fingers, elevate and slightly fold
so anus is exposed, insert only the tip in
circular motion - slowly - ensuring not to
injure the mucosa lining - beep: read and
record - place it on waste receptacle
d) CR: disinfect stet, warm, count one full
minute, record
e) RR: place over the chest/abdomen & feel for
rise and fall- observe for retractions (ribs)
f) CHEST AND ABDOMEN SHOULD RISE AND
FALL SIMULTANEOUSLY, it should NOT be in
a seesaw manner
g) No wristwatch because we do not want to
injure baby in case they come in contact
with the watch
14. Restrain the upper mid lower extremities.
a) lock bb arm, tuck layette under buttocks
b) Binder not used bc cord should be left open
- used to restrain knees - place on top of
knees, crisscross @ the back, bring forward -
then square knot - not too tight/loose
15. Applies Crede’s Prophylaxis properly from inner
to outer canthus.
- double check again
- discard first drop - expose lower lid of bb - pull
cheeck downward - tip should not come in contact w
bb’s eye
- make sure bb is not crying
- check again
15. Gets 1 sterile cotton ball with alcohol and
disinfects the site for intramuscular injection.
 a) Locate site first: - between anterior and
lateral upper thigh
- divide into 3 parts: upper, mid, and lower
third - CHOOSE THE MIDDLE THIRD - vastus
lateralis
- IM : 90 degrees
b) Circular motion - inner to outer - then
discard
i. Get another CB(can be dry - heel of
palm over knee to lock knee of baby -
LIGHTLY - then do CUSHION FASHION to
grab most of the muscle
ii. W other hand, grab needle, remove
cover, drop
iii. Inject 90 degrees, hold the hub,
aspirate to check if you hit a blood
vessel, if none then slowly introduce VIT
K d) Cord on top
iv. Remove, then press until no blood
comes out - no need to rub - RUBBING
ENHANCES ABSORPTION
v. Lock cover of needle, then discard
needle
vi. Once done, remove CB and remov the
restraints - kneee and layette
17. Injects the Vit K correctly into the vastus lateralis.
18. With the use of the sterile forceps, gets 1 CB with
alcohol and
disinfects the stump of the cord with one stroke.
19. using 1 CB with alcohol, disinfects the cord going
from the edge of the stump of the cord with one
stroke.
20. Uses the last cotton ball to disinfect the base of
the cord.
21. Releases the restraints from the upper and lower
extremities.
22.Takes the anthropometric measurements
accurately and records it.
* TAKE MEASUREMENTS-tape measure cm
- head: lower border of tape measure - in line w bb
eyebrow and tip of the ears - support bb head -
position TM inches facing u, slowly lower head, make
sure lower border is in line with tip of the ear and
the eyebrows - MEASURE AND READ - IF IT FALLS SA
NUMBER THEN IT IS 0.5
-CHEST : on top in line w nipple - slowly turn bb to
sides then slowly lower the tape measure to lvl of
nipple - stretch so not folded -place in line - READ
-abdominal - slowly lower - position right next to
umbilical cord (above) - read
-remove TM
-length - tip in line with the heel - turn bb to side
- try to extend extremeties a little - back of leg -
stretch heel to vertex of the head - position thumb
sa measurement - then while mt hold on TM, slowly
return bb to supine - then read the measurement
without removing finger - place to waste receptacle
23.Takes the vital signs except the temperature.
24. Cleanses the newborn using a towel and comb.
- *WASHING DONE 6 HRS AFTER BIRTH - we only
remove excess blood - commonly found at the
vertex - since bb is vertex position
- use comb to remove excess blood - support neck
and remove blood poolling on the head - do it gently
esp with dried blood - do not force - when done
place to waste receptacle
25. Puts on the newborn’s diaper and clothing.
-use sterile baby’s dress - follow how it
is worn, in hospital we use baby’s gown - arms first-
make sure bb is in the fist position so finger will not
beinjured - turn to side then insert excess - get the
excess then do the same to other side - tie cord
(inside and outside)
a) - put on bonnet to prev hypothermia-
support head
b) Fold the dress for aesthetic reasons -for bb
to be presentable for the family
c) Sterile dress because cord comes in contact
with the dress
e) Male bb - diaper should no be placed on top
of bb’s cord
f) Lift buttocks supporting both feet - insert at
the back - diaper lower than cord so when
full w urine, it doesnt contaminate the cord
g) Put on mittens - put it from the back (?) -
but check the inside first for excess thread -
remove excess
h)
i) Placing it straight and not from back has the
tendency to let it flip backwards - insert
then lock - tie - not too tight or too loose -
apply to other hand
j) Put on booties - the id band is at the top
k) Change layette - carry bb and support well -
remove layette - spread new layette
l) Diamond shape - fold head portion -
spreadv - gently lower bb - layette is in line
with the neck - insert arms sa fold - then
bring across - tuck excess at the back - lower
portion bring to the top - stretch excess -
arms under fold - wrap bb - tuck exccess
m) Put bb to crib - head elevated - to prev inc in
intracranial pressure - buttocks first, then
lower bb head - prepare the labels and so
on
n) RECHECK VITAL SIGNS - temp @ axillary --
lift arm and position thermometer every 30
mins
26. Wraps tire newborn in a blanket and prepares for
footprint taking.
27. Does the aftercare. Soaks instruments for 30
minutes in a disinfectant solution then rinses and
dries the instruments.
- begin with the sharps - drop to sharps
container
- disinfect thermometer - stem to bulb
twisting motion - placed next to bb
- return equipment
- remove gloves then do handwashing
28. Document accurately.
 a)

b)

c)

d) Make sure heading is complete

e)

f) Follow shift color

29. Monitors the vital signs every 30 minutes for 2

hours then every hour
for 2 hours.

II. PERSONAL ATTRIBUTES

1. Performed procedure with ease and confidence.

2. Showed inter in his/her work.

3. Attentive while doing the procedure.

4. Analyzed the importance or personal hygiene and

good grooming.
5. Accepted constructive criticism and suggestions
with a positive attitude
6. Performed procedure with honesty.
7. Handled the newborn with tender loving care.