SKIN- TO – SKIN CONTACT

> Sacred Hour

SKIN- TO – SKIN CONTACT
There is a growing body of evidence that skin-to-skin contact after the
birth helps newborns and their mothers in many ways.
• Calms and relaxes both mother and newborn
• Regulates the newborn’s heart rate and breathing, helping them to
better adapt to life outside the womb
• Stimulates digestion and an interest in feeding
• Regulates temperature
• Enables colonization of the newborn’s skin with the mother’s friendly
bacteria, thus providing protection against infection
• Stimulates the release of hormones to support breastfeeding and
mothering.
 EYE CARE
• — tetracycline hydrochloride 1% eye ointment
• — erythromycin 0.5% eye ointment
• — povidone iodine 2.5% solution (water-based)
• — silver nitrate 1% solution
• — chloramphenicol 1% eye ointment.
To perform eye care:
✓ Explain to the mother that you will be putting an ointment or drops into her baby’s eyes
to prevent infection. Reassure her that this is a routine procedure.

✓ After baby has located the breast, administer erythromycin or tetracycline ointment, or
2.5% povidone-iodine drops, to both eyes according to national guidelines. Apply from the
inner corner of each eye, outwards.

✓ Do not wash away the eye antimicrobial.

NEWBORN CARE
(FROM 90 MINUTES TO 6 HOURS)
Examine the Baby
After the baby has detached from the breast:
✓ wash hands;
✓ thoroughly examine the baby;
✓ put an identification tag around the ankle; and
✓ weigh the baby and record.
Explain to the mother that you will be examining her baby
and checking for birth injuries and/or malformations,
especially those that need additional care or early
referral.

Check for breathing difficulties including:

- grunting,
- chest in-drawing, or
- fast or slow respiratory rate.
Check the baby’s
✓ temperature – normal axillary temperature is of 36.5–
37.5 °C;
✓ eyes for redness, swelling or pus draining; or
✓ umbilical stump for oozing blood.
Check for abdominal distention.
Look at the head, trunk and all limbs of the baby.
Check for possible birth injuries, including:
- bumps on one or both sides of the head;
- bruises, swelling on the buttocks;
- abnormal position of legs (after breech extraction);
- asymmetrical arm movement; or
- arm that does not move.
If the above birth injuries are present:
- explain to parents that these are likely to disappear in a week or two, and do not
need special treatment;
- gently handle the limb that is not moving; and
- do not force the legs into a different position.
If the above birth injuries are present:
- explain to parents that these are likely to disappear in a week or two, and do not
need special treatment;
- gently handle the limb that is not moving; and
- do not force the legs into a different position.
ADMINISTRATION OF VITAMIN K PROPHYLAXIS
INJECT HEPATITIS B AND BCG VACCINATIONS

Explain to the mother that you will be injecting:

• vitamin K to prevent bleeding and hepatitis B vaccine to prevent
her baby from catching an infection of the liver that can cause
cancer later in life; and BCG vaccine to prevent serious infections
due to tuberculosis
Explain to the mother that you will be injecting:
• vitamin K to prevent bleeding and hepatitis B vaccine to prevent
her baby from catching an infection of the liver that can cause
cancer later in life; and BCG vaccine to prevent serious infections
due to tuberculosis
Explain to her that there may be soreness at the injection site or other minor side-effects, but that
these are uncommon and that the benefits of getting the injections outweigh the risks.
- Inject a single dose of vitamin K (phytomenadione) 1 mg IM.
- Inject hepatitis B vaccine IM and BCG intradermally, as per national
guidelines.
- Ensure that there is no excessive bleeding before leaving the baby and
mother.
- Wash hands.
- Record the injections.
If the baby has other problems, MANAGE accordingly.
Note: Babies requiring surgical procedures, those with birth trauma, preterm, and in utero to
maternal medication known to interfere with vitamin K are at high risk of bleeding and must be given
vitamin K 1 mg IM.
 VITAMIN K INJECTION
Vitamin K → Clotting Factor → Prevents Bleeding

Vit K- synthesized only in the presence of normal bacterial flora in the intestines

NB has relatively sterile intestines; they cannot synthize Vit K

Reason why Synthetic Vitamin K is given to prevent hemorrhage.

DRY CORD CARE
CORD CARE
Umbilical Stump → “Kept clean and dry”

Do not apply anything

Pediatricians used to recommend cleaning of the base of with rubbing alcohol.

However, it is now recommended to leave the stump completely alone because
alcohol is believed to irritate the skin and sometimes delays healing.
PHYSICAL ASSESSMENT
Vital Signs – RAT
◦ Respiratory Rate (30 to 60 breaths per minute)
◦ Pulse Rate (120 to 160 beats per minute)
◦ Temperate (37 degrees Celsius)
***Blood Pressure: 80/40mmHg
Respiratory Rate
Characteristic: rapid breaths and then pause for up to 10 seconds at a time;
breathe more through their nostrils than their mouth; breathing pathways are much
smaller and easier to obstruct.
“Periodic Respirations”

Pulse Rate
Characteristic: during sleep (PR can be as low as 80 bpm); if crying (PR up to
180 bpm)
Site: Apical
Temperature
Normal Range: 36.5 – 37.5 (97.7 – 99.4)
Axillary: 36.4 – 37.2 (97.5 – 99)
Rectal: 36.6 – 37.2 (97.8 – 99)

Site: Rectal (Ideal), Axillary, Forehead

ANTHROPOMETRIC MEASUREMENT
Weight of Newborn
BIRTH LENGTH
Range – 45 to 55 cm
Average – 50 cm
Direction: Crown to heel
measured from the top of their head to the bottom of one of their heels

Computation of Expected Height Gain:

Age in yr x 5 +80 = ht in cm
Age in yr x 2 +32 = ht in inches
Physiologic Weight Loss
NB loses 5% to 10% of BW (6-10 oz)

Breastfed NB regains weight in 10 days, bottle fed NB in 7 days

Weight gain, 2 lb per month for the first 6 month of life

**BW doubles by 6, triples by 12, quadruples by 24

HEAD CIRCUMFERENCE
measured with a tape measure drawn across the center of the forehead and then
around the most prominent portion of the posterior head (the occiput)
Normal Range: 34 to 35 cm (13.5 to 14 in.).
CHEST CIRCUMFERENCE
measured at the level of the nipples
The chest circumference in a term newborn is about 2 cm (0.75 to 1 in.) less than
head circumference.
Normal Range- 32 to 33 cm.
ABDOMINAL CIRCUMFERENCE
Approximately the same as the chest circumference
Measured just above the umbilicus
APGAR SCORING
Developed by: Virginia Apgar

Performed at 1st and 5th minute of life

→The 1-minute score determines how well the baby tolerated the birthing process
→The 5-minute score tells the health care provider how well the baby is doing outside
the mother's womb.

Results:
7-10 normal
**the higher the better
SILVERMAN ANDERSON SCORING
SYSTEM
GROWTH AND DEVELOPMENT
BASIC CONCEPTS

Growth
Quantitative
Increase in size
DEVELOPMENT
Qualitative
Increase in Skill
Gradual and Orderly unfolding of the characteristics of the individuals as they go
through the successive stages of growth.
Changes from simplicity to complexity and implies as increasingly progressive
maturity of behavior as well as organization of personality and character.
Is of the following types:
Physical
Cognitive
Socio-emotional
Moral
Sexual
Maturation
Optimal Development
Part of the development that is controlled from the within
the “internal ripening” aspects, indicating that growth has
reached its optimal level.
Heredity- process of transmitting biological traits from offspring through genes, the
basic unit of heredity; accounts why offspring look like their parents

Genetics- Study of Heredity

Eugenics- The scientific study and practice of principles that will improve the
hereditary qualities of future generations.
ENVIRONMENT
Totality of surrounding conditions that influence that growth, development, and
survival of the organism.
One of the risk factors for developmental problems
Includes these basic social units:
◦ Family, School, Peer group, Neighborhood
STAGES OF DEVELOPMENT
Number to as the number of periods in the life cycle, in which the functions and
relative emphasis of a given type of behavior differ from those at other periods
of life.

Life span is arbitrary divided into these stages or periods, with each period bring
a part of a whole

DEVELOPMENTAL TASK- refers to behaviors that are expected to be manifested

at or about a certain period in the life of an individual; the successful
achievement of these tasks leads in later tasks; success or failure in performing
these may be due to physical maturation, cultural pressure, and family
background/ rearing practice.
STAGES OF GROWTH AND
DEVELOPMENT
Prenatal
Neonatal/Newborn -First 28 days of life
Infancy- 1 month–1 year
Toddlerhood- 1–3 years
Preschooler- 3–5 years
School Age- 6–12 years
Adolescent- 13–17 years
Adolescent Late Adolescent 18–21 years
PRINCIPLES OF GROWTH AND
DEVELOPMENT
Growth and development are continuous processes from conception until death
Growth and development proceeds in an orderly sequence
Different children pass through the predictable stages of development
All body systems develop at different rates (do not develop at same rate)
Development is cephalo-caudal.
Development is proximodistal.
Development proceeds from gross to refined skills
There is an optimum time for initiation of experiences or learning
Neonatal reflexes must be lost first before development can proceed.
A great deal of skills and behavior is learned by practice.
PSYCHOANALYTIC THEORY
Sigmund Freud
Physical Growth and Change are governed by unconscious drives and instincts
Three Components of Personality:
ID- pleasure principle, person’s instinctual drives, first component of personality
to evolve.
EGO- reality principle; rational, controlling component of the personality, which
tries to satisfy needs through appropriate socially acceptable behaviors
SUPEREGO- personality component that is repository of the child’s
internalization of parental or societal values, morals, and roles “goodness”
THEORY OF PSYCHOSEXUAL
STAGES OF HUMAN GROWTH
Sigmund Freud, the father of Psychoanalysis, believed that all human beings
pass through a series of psychosexual stages
Each stage is dominated by the development of sensitivity in a particular
erogenous of pleasure-giving spot in the body
Each stage posses for individuals a unique conflict that they must resolve before
they go the next higher stage.
Fixation- tendency to stay at particular stage.
 STAGE PSYCHOSEXUAL NURSING IMPLICATIONS
STAGE
Infancy Oral Stage Provide oral stimulation by giving pacifiers; do not discourage
thumb sucking.

Toddler Anal Stage Toilet Training

Preschoole Phallic stage Accept children’s sexual interest, such as fondling his or her
r own genitals, as a normal area of exploration.
**Oedipus Complex, Electra Complex

School-age Latent Stage Help children have positive experiences with learning so their
child selfesteem continues to grow
Adolescent Genital Stage Provide appropriate opportunities for the child to relate with
opposite and own sex relationships.