MMEDATE CARE OF THE NEWBORNMrs. Aurisita M. Delos Reyes, RN, MANEstablish and maintain patency of the airway8uctioning= duration- 5-10 sec or < 5 secs in preterm= mouth before noseW !ositioningW = 8light trendelenburgW = 8ide lyingW !urposesW promotes drainage of secretionsW prevents increase C!W R side lying- increase pressure L side of the heart which favor the closure of Ductus Arteriosus and Foramen OvaleW !romotes gastric emptying thereby prevent reflux of gastric contents and aspirationW = 8upine {recommended for infants above 3 mos. _W = !rone- { maybe a cause in 8D8 _.W Maintain appropriate temperatureW = Temp of the NB at birth-36.4- 37.2 o CW = usually unstable and takes 6-8 hours to stabilizeFactors affecting temperature of the NBW 1. The thermoregulating center is immatureW 2. 8hivering mechanism of the NB is underdeveloped.W 3. nadequate adipose tissues {Brown fat_W 4. Neonates are prone to heat loss thru evaporation, radiation, convection, and conduction.NUR8NG MANAGEMENT:W 1. DRY THE 8KNW 2. WRA! THE NEWBORNW 3. EX!O8E TO DRO!LGHTW 4. CUDDLNG, HUGGNG, EMBRACNGcomplicationsW 1. HY!OGLYCEMA results from utilization of glucose in the form of glycogenW Normal blood sugar-W 35 - 60 mg%2. METABOLC ACDO88-breakdown of fats- accumulation of fatty acids3. RE8!RATORY D8TRE88.W !romote adequate circulationW Factors that influence circulatory changes after birthW Lung expansionW Cutting of the umbilical cordLUNG EX!AN8ON=W ncrease pressure in the LEFT side HeartW Closure of fetal structures {Foramen ovale and Ductus Arteriosus_Nursing care:W 1. stimulate to cryW =except if !reterm { Conserve energy_W 2. proper positionW 3. administer NDOMETHACN as orderedCutting of the umbilical cordW Decrease pressure in the RGHT side of the HeartW Closure of the DUCTU8 VENO8U8 and UMBLCAL BLOOD VE888EL8V.W Bonding- a special mutual relationship between mother and infant. deally started on the FR8T !EROD OF REACTVTY.METHOD8:W 1. BREA8TFEEDNGW = immediately after birthW 2. EYE TO EYE CONTACTW = Crede's !rophylaxis maybe delayed for 2 hours W 3. ROOMNG- NW 4. HUGGNG, CUDDLNG, and EMBRACNG!UR!O8E8 OF BREA8TFEEDNGW 1. BONDNGW 2. FACLTATE8 RELEA8E OF COLO8TRUM AND BREA8T MLKW 3.8TMULATE8 !RODUCTON OF !ROLACTN AND OXYTOCNW 4.8TMULATE8 GA8TROCOLC REFLEX FACLTATNG EARLY and MORE FREOUENT DEFECATON THU8 !REVENT JAUNDCEV.W A88E88MENT TOOL8W Apgar 8creening Test - authored by Dr. Virginia Apgar Done twice at 1 and 5 min. respectivelyW !urposes:W 1. To determine the degree of acidosis and the need for C!RW 2. To evaluate ability of the NB to ad]ust extrauterinely and theprognosisCRTERACRTERA:W 0W A!!EARANCE- BLUEW!R- AB8ENTW GRMACE- NO RE8!ON8EW MU8CLE TONE- LM!W RE8!RATON- AB8ENTW ONEW ACROCYANOTCW < 100W GRMACEW 8OME FLEXONW WEAK CRYW TWOW COM!LETELY !NKW100W 8TRONG CRY,8NEEZE, COUGHW ALL FLEXEDW 8TRONG CRYNTER!RETATONW 0-3= W !OOR,8EROU8,8EVERELY DE!RE88ED; C!RW 4-6W FAR,GUARDED, MODERATELY DE!RE88EDW NEED8 8UCTONNG & FURTHER OB8ERVATONW 7-10W GOOD, HEALTHY8LVERMANN AND ANDER8ONW!UR!O8E:W TO DETERMNE THE DEGREE OF RE8!RATORY D8TRE88W HGH R8K BABE8W A8 NECE88ARYW CRTERA:W NA8AL FLARNGW U!!ER AND LOWER CHE8TW X!HOD RETRACTON8W EX!RATORY GRUNTW NTER!RETATON:W 0-3W Good or healthy; no respiratory distressW 4-6W Fair, Guarded with mild respiratory distressW 7-10W !oor, serious with severe respiratory distressDubowitz/Ballard Exam for Gestational Age W NeuromuscularNeuromuscuIar!HY8CAL MATURTYW !REMATUREW 8KN W GELATNOU8, TRAN8!ARENT, V8BLE BLOOD VE88EL8W EAR CARTLAGEW AB8ENT/ !LABLEW BREA8T NODULEW 1-2 mmW GENTAL8W MALE- TE8TE8- UNDE8CENDEDW 8CROTUM- LE88 8WOLLEN, FEW RUGAEW FEMALE- CLTOR8 AND MNORA-!ROMNENTW 8OLE CREA8E8- ANETROR TRAN8VER8EW LANUGOW ABUNDANTTERMW 8MOOTH, !NK,8U!ERFCAL CRACKNG, LE88 V8BLE VEN8W FORMED AND FRM WTH N8TANT RECOLW 3-5 mmW !ARTALLY DE8CENDEDW MORE 8WOLLEN AND RUGAEW !ARTALLY COVERED BY MAJORAW 2/3 OF THE 8OLE WTH CREA8E8W LE88 LANUGO!O8T TERMW !ARCHMENT,DEE! CRACKNG, DE8OUAMATE8, NO V8BLE BVWTHCK CARTLAGE AND 8TFFW6 TO 10 mmWFULLY DE8CENDED; !ENDULOU8WMARKED 8WOLLEN; EXTEN8VE RUGAEWMAJORA COM!LETELY COVER8 MNORA and CLTOR8WENTRE 8OLE with CREA8E8WNO LANUGOMATURTY RATNG 8CALEW TOTAL 8CORE AOG {weeks_W -10 20 weeks Below 35= !RETERMW - 5 22W 0 24 35-45 = TERMW 5 26W 10 28 ABOVE 45= !O8TERMW 15 30W 20 32W 25 34W 30 36W 35 38W 40 40W 45 42W 50 44V.W DENTFCATON- preferably in the presence of the parentsW = include: Double bandingW Finger and footprintsW Birthmarks-HEMANGOMA8TRAWBERRY MARK88TRAWBERRY MARK8-{Nevus vasculosus_W Elevated areas formed by immature capillaries and endothelial tissuesW!ORTWNE 8TAN8-{Nevus Flammeus _W a macular purple or dark red lesion or patches W Can be seen face, buttocks, thigh and genitalsTELANGECTA88 NEVW =flat , red areas of capillary dilatation commonly seen at the glabella, upper eyelid, and upper lip!ORTWNE 8TAN8{Nevus Flammeus_COMMON MARK8{not to be use in D_W MONGOLAN 8!OT8Mongolian spotW Bluish, greenish black, gray patchesW = caused by accumulation of melanocytesW = seen at shoulder, upper arm, back and buttocksW = disappears at in a year { white skinned _W = pre-school { dark skinned _MLAMLAW = white spots caused by clogged sebaceous glandsW = disappears in 2 weeksLANUGOW = fine downy hairW = seen upper arm, shoulder and backW = common characteristic of premature babiesVERNX CA8EO8AVERNX CA8EO8AW = white cheesy substance seen in areas like back, armpit, inguinal, and buttocksW = serves as protection from infection and acts as insulatorNEWBORN RA8H/FLEABTE RA8H {Erythema Toxicum_ERYTHEMA TOXCUMW =pink papules with superimposed vesicles W =common at the face, back and buttocksW = self limitingDE8OUAMATONV. Care of the NB in the nurseryW A. Recheck identificationW B. Check for anal patencyW nsert thermometer { 1 in._ per anusW C. 8pecial CareW 1. nitial BathW A. H20 with non-alkaline based soap-to prevent destruction of acid mantle of the skinW B. Oil- spread vernix caseosaW C. Antimicrobial solution2. Cord DressingW !ractice strict aseptic technique { surgical asepsis_W Apply sterile clamp- to prevent OM!HALANGAW Maybe remove after 24- 36 hoursW Apply antiseptic solutionsW Betadine- prevent Tetanus NeonatorumW Alcohol { 70 % _- keep dry and prevent OM!HALT8W EX!O8E { keep uncovered_CREDE'8 !RO!HYLAX8WApplication of ophthalmic medication to prevent O!HTHALMA NEONATORUMWMedications:W1. 8ilver Nitrate-WOne percentW1 drop/eyeWLower con]unctival sacW2.Ointments:WTerramycinWGentamycinWErythromycinW !enicillin VTAMN K NJECTONW TO !REVENT BLEEDNGW DO8E =1 mg TermW .5 mg !re termW Route: MW 8ite: Thigh musclesW Vastus lateralisW Rectus FemorisANTHRO!OMETRC MEA8UREMENT8W BRTHWEGHT- 2.5- 3.4 kg or 5.5-7.8 lbsW BRTHLENGTH- 48-54 cm or 18-22 imW HEAD CRCUMFERENCE- 33-35 cm or 13-14 inW CHE8T CRCUMFERENCE- 31-33 cm or 12-13 inW ABDOMNAL CRCUMFERENCE- 29-31 cm or 11-12 inX. VTAL 8GN8W RR- 80 breaths/min at birth; stabilize bet. 30-60 breaths/ minW = rapid, irregular, with normal physiologic apnea of