Care of Mother, Child and 08 L E C

27
Adolescents (Well clients)
Prof’s name here
21 O1
TOPIC TITLE HERE

OUTLINE REFERENCES
I G. Physiologic Function
II Reflexes “PROF’S PPT ON QUIPPER AND LECTURE”
III Nursing Care of Newborn

1.Gastrointestinal System (continuation)

G. Physiologic
• Anemia is derived Function
from the Greek word anaimia,
1. Gastrointestinal System
- can hold about 60-90 mL
(very little; about half of a mug of coffee)
- regurgitates when the stomach is overfilled
(the cardiac sphincter of the newborn is not well-
developed)
- meconium – passed within 24 hrs after birth
- sticky, tar-like, blackish-green
- transitional stool – 2nd – 3rd day of life
- green and loose, almost like diarrhea
- by the 4th day from birth:
breastfed baby’s tool – golden yellow, mushy,
sweet-smelling stools 3-4 times a day
(sweet because of lactic acid)
Formula-fed baby’s stool – pale yellow,
slightly firmer, slightly more noticeable odor
2-3 times a day.
(not really loose or mushy)
*if by the 4th day still loose and watery, might indicate
lactose tolerant
Bright green – when placed undergoing phototherapy
(when bilirubin is excreted in stool, its pigment is
green)
Blood-flecked – with anal fissures
Black and tarry – might have swallowed some
maternal blood
(If after 2 or more day and still black and tarry, needs
to be further assessed)
*Melena – black and tarry stool because of bleeding
from the intestine
*Hematochezia - the passage of fresh blood per anus,
usually in or with stools.
2. Urinary System
- voids within the first 24 hours of life
*micturate is the other term for void
- 1st voiding may be pink and dusty due to uric acid
crystal formed in the bladder in utero
- 1st 2-3 days: about 15mL in a single voiding (30-60
mL per day)
- after 1st week of life: daily output increases to about
300 mL
*if did not void within 24 hours of life, should be
assessed and if it still has not void after 24 hours,
newborn might have a urethral stenosis or a
blockage/there’s no hole in the newborn’s urethra.

3. Immune System
- prone to infection
- born with natural passive immunity (IgG)
(from the mother; also called maternal passive
immunity bc the antibodies are from the mother)
Meconium – greenish and tarry - Receives antibodies from the mother
Breastfed baby poop – mushy, golden in color through the placenta
Formula fed baby poop – light in color - Some protection against polio, measles,
diphtheria, pertussis, chickenpox, rubella
and tetanus
 - Very little immunity against herpes
simplex

Additional info:
* Palmar grasp reflex - All the things that you would
put in the palm, the newborn will grasp it
(it disappears after 3 months because the baby can
4. Neuromuscular System now grasp meaningfully)
- mature newborns demonstrate neuromuscular *Plantar grasp reflex – the baby will bend his toes in
functions by moving their extremities, trying to the part where the penlight touches it
control head movement, exhibiting a strong cry and *Step-in-place reflex – hold the newborn vertically
having newborn reflexes then place him in a hard surface
- limpness (hypotonia – decreased muscle tone) or
total absence of neuromuscular response – may be
due to narcosis (mother has taken elicit drugs or has
low bloody supply), shock or cerebral injury
(other term for hypotonia is floppy baby syndrome)
- flailing or twitching movements of extremities
without stimuli – due to an immature nervous system
(sudden twitching of the newborn)

REFLEXES

Additional info: Additional info:

*Sucking reflex – the nipple of the mother/bottle
should be placed between the lips.
*They give pacifier to the newborn to stimulate the
reflex
*Swallowing reflex – dapat nasa likod or posterior to
stimulate the reflex because if you are going to place
it in the anterior part you would stimulate the
extrusion reflex.
*Extrusion reflex – if the newborn’s tongue is
nakalabas
*Moro reflex – support the newborn with both hands
at the back. It will elicit a startle reflex if you drop the
newborn’s head by an inch.
Manner of flexing is like protecting himself from the
thing that’s making him startle.
Other ways to elicit moro reflex is making a loud noise
or moving the crib by shaking it.
*Babinski reflex – if positive babinski sign – will fan
out – spreading of toes

Additional info:
*Landau reflex – when you hold the newborn in
prone, there should be some muscle tone; the baby
would try to resist.
NURSING CARE OF NEWBORN
A.Feeding
-term newborn (right AOG)
- breastfed - may be fed immediately
- colostrum – “first” milk (first 3-4 days of life);
thin, watery, yellow fluid that contains
protein, sugar, water, minerals, vitamins and
maternal antibodies.
(4-9 days transitional breast milk)
(10 days true breast milk)
- let-down reflex (milk ejection reflex)
(Prolactin – stimulates the production of
breast milk.)
(Oxytocin – stimulates the release of the
prolactin)
(to prevent uterine atony and hemorrhage)
- formula-fed - after 2-4 hours after birth
-feed per demand, but can be fed as often as
every 2 hours in the first few days
-should be burped at least 2x during feeding
(so there would be no accumulation of gases
in gthe newborn’s stomach)
*if the mother wants to breastfeed the newborn,
should establish breastfeed within 6 weeks
*the milk that is leaking from the breast of the mother
is called fore milk
*if the baby still suckles, it will expel hind milk
(stimulated by sucking)
B. Bathing
- delay initial complete bath until 6 hours after birth
- succeeding baths - once a day, best done by parent
under nurse’s supervision
- room should be warm and water temperature is
about 37-38oC
- should be done before feeding
(to prevent vomiting)
- proceed from the cleanest to the most soiled areas
- talcum powder is not advisable
(talcum contains a zinc stereate which is an irritant to
the respiratory system)
C. Sleeping
- should be positioned supine to decrease the
incidence of Sudden Infant Death Syndrome (SIDS)
(other term for SIDS is crib death)
- sleeps an average of 16 hours a day in the first week
of life
- by 4 months: sleeps an average of 15 hours a day
and through the night
(sleeping schedule is not erratic anymore)
D. Cord Care
- fold the diaper down so that cord does not get wet
during voiding
- do not use 70% alcohol
(alcohol is an irritant to the cord)
- let the stump fall off on its own
- usually comes off within 10-14 days

E. Diaper Area Care

- prevent diaper dermatitis
(cause of diaper dermatitis: from the ammonia in the
urine)
(diaper should be changed if it is already full or have
feces)
- with each diaper change, the area should be washed
with clean water and dried well
- wearing gloves for diaper care as part of standard
precautions

F. Clothing
- also cover the newborn’s head to prevent heat loss
- a rule to be comfortable:
▪ if the mother feels cold, keep the baby warm
▪ if the mother feels warm, keep the baby cool

G. Elimination
- to get the urine output of a newborn, subtract the
weight (g) of an unused diaper from the weight (g) of
a used diaper
- the difference will be converted to mL (1 g = 1 mL)

H. Cuddling
- teach parents to handle infants with assurance and
gentleness
(to establish trust)
- kangaroo care / kangaroo mother care
- advise parents to cuddle them against their bare
chest
(bare upper part of parent and also bare upper part of
the newborn)
- infants need to be kept warm while being held
- effective in promoting close physical contact
MEDICATIONS:
1. Terramycin – put on the conjunctiva
2. Vitamin K – for clotting
(e.g. Phytonadione, Aquamephyton)
3. BCG vaccine – 0.1 mL ID (intradermal) at deltoid site
4. Hepatitis B – 1 mL Intramuscular at the vastus
lateralis