Community Health Nursing 1 - Lecture

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR

Session # 19

LESSON TITLE: Early Essential Intrapartum and Newborn Materials:

Care, Newborn Screening, Basic Emergency Obstetric and
Newborn Care and Comprehensive Emergency Obstetric Pen, paper, index card, book, and class List
and Newborn Care
LEARNING OUTCOMES: Reference:
Upon completion of this lesson, the nursing student can:
1. Develop skills health care delivery in essential newborn care Famorca, Z. U., Nies, M. A., & McEwen, M. (2013).
Nursing Care of the Community. Elsevier
in low-resource areas;
Gezondheidszorg.
2. Identify the 5 metabolic disorders of newborn;
3. Describe the clinical manifestations and the complications that
may arise if the disorders are not promptly detected and treated;
and,
4. Outline the signal functions for emergency newborn care
(EmNC),

LESSON PREVIEW/REVIEW (5 minutes)

Instruction: What are the aims of IMCI? Explain.
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MAIN LESSON (30 minutes)

Early Essential Intrapartum and Newborn Care practices are evidenced-based standards for safe and quality care of birthing
mothers and their newborns, within the 48 hours of Intrapartum period (labor and delivery) and a week of life for the newborn.
 A series of time bound, chronologically- ordered, standard procedures that a baby receives at birth.
 Can prevent at least half of newborn death without additional cost to both families and hospitals.

At the heart of the protocol are four time- bound interventions:

1. Immediate and thorough drying of the newborn
 Immediate and thorough drying for 30 sec to one-minute warms the newborn and stimulate breathing.
 Use a clean, dry cloth to thoroughly dry the baby by wiping the eyes, face, head, front and back, arms and legs.
2. Early skin to skin contacts between mother and the newborn
 Place the newborn prone on the mother’s abdomen or chest skin-to-skin.
 Cover newborn’s back with a blanket and head with a bonnet. Place identification. This
prevents:
 Hypothermia Infection
 Hypoglycemia
3. Properly timed cord clamping and cutting
 Clamp and cut the cord after cord pulsations have stopped (typically at 1 to 3 minutes)
 Put ties tightly around the cord at 2 cm using cord clamp and 5 cm from the newborn’s abdomen.
 Cut between ties with sterile instrument.
This prevents:
 Anemia
 Protects against brain hemorrhage in premature newborn
4. Non-separation of baby from mother
 Time bound: Within 90 minutes of age

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  Continuous non-separation for early breastfeeding which protects the infants from infection.

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Early Essential Newborn Care within 90 minutes to 6 hours of life
Nursing Intervention:
 Give a single dose of Vitamin K 1mg (IM route)
 Inject hepatitis B and BCG vaccinations at birth
 Record.
 Thoroughly examine the baby. Weigh the baby and record.
 Check for birth injuries, malformations or defects.

After the 90 minutes of age Nursing Intervention:

 Support unrestricted, per demand exclusive breastfeeding, day and night
 Keep the newborn in the room with his/her mother, in her bed or within easy reach.
 Do not separate them (rooming-in).

Care Prior to Discharge:

 Ensure warmth of the baby
 Ensure the room is warm (> 25o C and draft - free).
 Explain to the mother that keeping baby warm is important for the baby to remain healthy
 Keep the baby in skin-to-skin contact with the mother as much as possible.
 Dress the baby or wrap in soft dry clean cloth.
 Cover the head with a cap for the first few days, especially if baby is small.

Newborn Screening is a public health program designed to screen infants shortly after birth for a list of conditions that are
treatable but not clinically evident in newborn period.

Goal:
 Early Detection of children at increased risk for selected metabolic or genetic diseases so that medical treatment can be
promptly initiated to avert metabolic crises and prevent irreversible neurological and developmental sequelae.

Components of NBS:
a. Education: Professionals, parents and policy makers
b. Screening: Collection activities, Specimen delivery, Laboratory testing and Result reporting
c. Early Follow-up:
d. Diagnosis:
e. Management: Medical management, Long term follow-up, Specimen mgt
f. Evaluation:

Cardinal Principles of Screening:

 The disorder has a relatively high incidence so that the cost per diagnosed individual is reasonable
 An effective and not overly expensive treatment is available.
 A relatively inexpensive screening test that is suitable for high volume testing (preferably automatable)
 The screening test has a very high sensitivity (very low false negatives) and high specificity (low false positives which require
expensive follow-up)

Criteria:
 Disorder produces irreversible damage before onset of symptoms
 Treatment is effective if begun early
 Natural history of disorder is known

Specimen Collection:
 Blood specimen is obtained from heel of infant should be obtained from medial or lateral side of the heel

Timing of Collection:
 Normal Term Newborn: Before nursery discharge or 3rd day of life whichever is earlier.
 Preterm or LBW: 2 weeks of age or at discharge whichever is earlier.

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 Newborn who is to receive blood transfusion. One specimen collected before transfusion & second specimen 2 days after
transfusion.

Results available:
 Seven (7) working days from the time the newborn screening samples are received.
 Laboratory result indicating an increased risk or of a heritable disorder (i.e. positive screen) shall be immediately released,
within twenty-four (24) hours followed by confirmatory testing can be immediately done.

Secondary Test:
 An abnormal finding on newborn screening test is not diagnostic of a disorder.
 Additional tests should be performed to substantiate the original finding.
 Also, the original specimen is retested for the analysis that is abnormal.

Basic Emergency Obstetric and Newborn Care and Comprehensive Emergency Obstetric and Newborn Care

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Basic Emergency Obstetric and Newborn Care
 It refers to lifesaving services for emergency maternal and newborn conditions/complications being provided by a health
facility or professional
 consist of the core district hospital. For geographically isolated/disadvantaged areas/ densely populated areas, the designated
BeMONC facilities are the following:
 Rural Health Unit,
 Barangay Health Station,
 Lying-in Clinics and Birthing Homes.
 Accessibility within 1 hour from residence or referring facility within the ILHZ (Inter-local Health Zones)
 Shall operate within 24 hours with 6 signal obstetric function.
 Shall have access to communication and transportation facilities to mobilize referrals.
 Staff composition:
 (1) Medical Doctor
 (1) Registered Nurse,
 (1) Registered Midwife.

Comprehensive Emergency Obstetrics and Newborn Care facility

 Refers to lifesaving services for emergency maternal and newborn conditions/complications as in Basic Emergency Obstetric
and Newborn Care plus the provision of surgical delivery and blood bank services and other specialized obstetric
interventions.

Signal Functions
1: Administer Parenteral Antibiotics
 Puerperal sepsis accounts for 8% of global maternal deaths and 33% of maternal death
 Effectively managed with injectable antibiotics
 IV Penicillin G 2MU every 6 hours
 Plus, Gentamicin 5 mg/kg body weight IV every 24 hours
 Plus, Metronidazole 500mg IV every 8 hours

2: Administer Uterotonic Drugs

 Postpartum hemorrhage accounts for 15% of global maternal deaths Up to 33% of maternal deaths
 Effectively managed through active management of third stage of labor (AMTSL)
 IM oxytocin within 1 minute of delivery

3. Administer Parenteral Anticonvulsants

 Severe pre-eclampsia and eclampsia account for 10% of global annual maternal deaths.

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  Hypertensive disorders account for 35% of maternal deaths in Kenya. *
 Effectively managed through use of parenteral anticonvulsants

4: Manually Remove Placenta

 Retained placenta: A major cause of postpartum hemorrhage and puerperal sepsis – both leading causes of maternal
mortality
 Managed through manual removal of the placenta; requires elbow-length sterile gloves

5: Remove Retained Products of Conception

 Complications from abortion account for 15% of global annual maternal deaths.
 Managed effectively through manual vacuum aspiration or medical evacuation using misoprostol
 Postabortion care provides an opportunity to prevent further unplanned pregnancy by promoting contraceptive use.

6: Perform Assisted Vaginal Delivery

 Obstructed labor accounts for 6% of maternal deaths.
 Assisted vaginal delivery, using forceps or vacuum extraction, when done appropriately, can avert unnecessary hospital
referral and caesarian delivery.

7: Perform Basic Neonatal Resuscitation

 Perinatal asphyxia is a leading cause of child mortality, accounting for 11% of global under-five deaths annually.*
 Severe forms are associated with serious long-term complications.
 Effective newborn resuscitation can reduce morbidity and mortality associated with perinatal asphyxia.

8: Perform Caesarean Delivery

 Caesarean section is a life-saving procedure required when vaginal delivery places the life or health of the mother or baby at
risk.
 It is the first of two additional signal functions required in facilities designated to provide CEmONC.

9: Provide Blood Transfusion

 Blood transfusion is a life-saving procedure for women suffering from postpartum hemorrhage – the leading single cause of
maternal mortality.
 Facilities providing CEmONC are required to provide blood transfusion.

CHECK FOR UNDERSTANDING (20 minutes)

You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct answer and
another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You are given 20 minutes
for this activity:

Multiple Choice

1. BEmoNC facility that had each of following functions at the time of survey was considered as provider of the basic EmNC
which of the following. select that all apply;
a. Incubator available
A. Warmth (drying and skin-to-skin contact)
B. Pediatrics nursery available
C. Eye prophylaxis (tetracycline eye ointment).
D. Clean cord care.
E. Early and exclusive breast feeding
F. Basic newborn resuscitation.
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2. To qualify as a CEmONC facility, all of the above services must be offered in # 1, but in addition the following functions which
of the following.
A. Neonatal resuscitation with bag and mask
B. Hypothermia Management (rewarming)

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C. Antibiotics for neonatal sepsis
D. Essential newborn care
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3. A nurse in a delivery room is assisting with the delivery of a newborn infant. After the delivery, the nurse prepares to prevent
heat loss in the newborn resulting from evaporation by:
A. Warming the crib pad
B. Turning on the overhead radiant warmer
C. Closing the doors to the room
D. Drying the infant in a warm blanket
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4. Soon after delivery a neonate is admitted to the central nursery. The nursery nurse begins the initial as sessment by
A. Auscultate bowel sounds.
B. Determining chest circumference.
C. Inspecting the posture, color, and respiratory effort.
D. Checking for identifying birthmarks.
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5. The head nurse is presenting education to COC nursing student to promote consistency in the interventions used with lactating
mothers. She emphasizes that the optimum time to initiate lactation is.
A. as soon as possible after the infant’s birth.
B. after the mother has rested for 4-6 hours.
C. during the infant’s second period of reactivity.
D. after the infant has taken sterile water without complications.
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6. As a CEmONC facility nurse, assessing a newborn infant following circumcision and notes that the circumcised area is red with a
small amount of bloody drainage. Which of the following nursing actions would be most appropriate?
A. Document the findings
B. Contact the physician
C. Circle the amount of bloody drainage on the dressing and reassess in 30 minutes
D. Reinforce the dressing
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7. Vitamin K is prescribed for a neonate. A nurse prepares to administer the medication in which muscle site?
A. Deltoid
B. Triceps
C. Vastus lateralis
D. Biceps
ANSWER: _ _

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8. If mother with PKU is not actively treated during pregnancy (nutrition monitoring/restriction, etc) what might be seen in the
offspring? Select that all apply.
A. Microcephaly,
B. Congenital heart disease,
C. Seizures
D. Facial dysmorphia (resembles FAS)
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9. Newborn screening is mandated (100% compliance expected) and is an example of population screening. The purposes
are: Select that all apply
A. To prevent at least half of newborn death without additional cost
B. Undetected disorders (could affect life, medical, and/or mental fxn)
C. To quickly separate apparently well babies who probably have the disorder from those who probably do not
D. To further evaluate presumed positive cases
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10. What specific enzyme deficiency accounts for 95% of all cases of congenital adrenal hyperplasia?
A. 21-hydroxylase deficiency
B. Estrogen synthetase deficiency
C. Beta-glucuronidase deficiency
D. 7-alpha-hydroxylase deficiency
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RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE-TO-FACE INTERACTION)

The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves. Write the
correct answer and correct/additional ratio in the space provided.

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LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you track
how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

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AL Activity: Turn and Talk

Instruction: The instructor will pose and prompt a question and you will have to discuss it with for 2 minutes.

Question: In your opinion, is essential integrated newborn care necessary? Explain.

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