Professional Documents
Culture Documents
Dr. Ursua
05/06-07/15
The 1st 24 hours of life is a very significant and a highly vulnerable time due to
critical transition from intrauterine to extrauterine life
TEMPERATURE
Dry immediately
o
Using a towel or the sheets
Place in infant warmer or use drop light
o
Bacinette(?) Or crib is prepared
Wrap warmly
APGAR SCORING
INVOLVES 5 INDICATOR S:
1.
2.
3.
4.
5.
Activity
Pulse
Grimace
Appearance
Respirations
Anthropometric measurements
Bathing: Oil bath/warm water bath
Cord Care
Dressing/ Wrapping: mummified
Eye prophylaxis: Credes
o
Before: silver nitrate is used
DACM MED2016
COMPONENTS
PROPER I DENTIFICATION
BATHING
CORD CARE
Umbilical stump
Rubbing alcohol
OTHERS
Mummy
Wrap in warm blanket
Cover head with stockinette cap
DAILY CARE
GENERAL APPEARANCE
1Immediately
after birth
o
Determine which baby needs CPR
2Within the 1st 24 hours after birth
3Prior to discharge
VITAL SIGNS
2
Active,
spontaneous
>100bpm
Pulls away, sneezes,
coughs
Completely pink
1
Some flexion of
extremities
<100bpm
Facial grimace only
Acrocyanosis
0
No movement
(flaccid or limp)
Absent
No response with
stimulation
Bluish gray or pale
all over
Absent
SCORE INTERPRETATION
SCORE
7 to 10
4 to 6
INTERPRETATION
Well baby
At risk
Infant needs intensive care
0 to 3
Sick baby
Prognosis for new born is
grave
NURSING INTERVENTIONS
Rarely needs resuscitation
Requires resuscitation
Suction
Dry immediately
Ventilate until stable
Careful observation
Intensive resuscitation
ET/ Ambu bag
Ventilate with 100% oxygen
CPR
Maintain body temperature
Parental support
GENERAL GUIDELINES
DACM MED2016
Full term:
Symmetric
Flexed extremities
Breech presentation
o
Knees and legs straightened or in FROG position
o
All breech presentation should be delivered via CS!
APGAR SCORE
POSTURE
TEMPERATURE
Convection
o
The flow of heat from the body surface to cooler surrounding air
o
Eliminating drafts such as windows or aircon, reduces convection
Conduction
o
The transfer of body heat to a cooler solid object in contact with the
baby
o
Covering surfaces with a warmed blanket or towel helps minimize
conduction heat loss
Radiation
o
The transfer of heat to a cooler object not in contact with the baby
o
Cold window surface or air con; moving as far from the cold surface,
reduces heat loss
Evaporation
o
Loss of heat through conversion of a liquid to a vapour
o
From amniotic fluid, new born should be dried immediately
NURSING CONSIDERATIONS:
PULSE
BODY MEASUREMENT
Awake: 120-160 bpm to 120-140 bpm
Asleep: 90-110bpm
Crying: 180 bpm
Rhythm: Irregular immaturity of cardiac regulatory center in the medulla
Duration: 1 full minute, not crying
Site: apical
SPECIAL CONCERNS
Keep warm
Characteristics:
o
Nasal breathers, gentle, quiet, rapid BUT shallow
o
May have short periods of apnea (<15 secs) and irregular without
cyanosis periodic respirations
Rate: 30- 60 cpm
Duration: Full 1 minute
NURSING CONSIDERATIONS
Position on side
Suction as needed
WEIGHT
LENGTH
Crown to rump
Head to heel
HEAD CIRCUMFERENCE
CHEST CIRCUMFERENCE
SILVERMAN-ANDERSON INDEX
NURSING CONSIDERATIONS
Assess for:
o
Color
o
Hair distribution
o
Turgor/ texture
o
Pigmentation/ birthmarks
o
Other skin marks
BLOOD PRESSURE
SKIN COLOR
Very smooth and puffy especially at the legs, dorsal aspects of the hands and
feet and in the scrotum and labia
Pinkish red (light skinned) to pinkish brown to yellow (dark skinned)
Ruddy or reddish due to increased RBC concentration and decreased
subcutaneous tissues
Examples: cyanosis/acrocyanosis, pallor, jaundice and meconium staining
3
DACM MED2016
ACROCYANOSIS
PALLOR/CYANOSIS
JAUNDICE
PHYSIOLOGIC JAUNDICE
Usually found over the face, upper body and conjunctiva of the eyes
PATHOLOGIC JAUNDICE
Within 24 hours
Duration:
o
Fullterm: 1 week
o
Preterm: 2 weeks
MANAGEMENT OF JAUNDICE
Maintain hydration
LANUGO
Found after 20 weeks of gestation on the entire body except the palms and
soles
Fine downy hair that covers the shoulders, back and upper arms
NURSING CONSIDERATIONS
DACM MED2016
VERNIX CASEOSA
NURSING CONSIDERATIONS
MILIA
MONGOLIAN SPOTS
SALMON PATCHES
STORK BITES
Telangiectatic Nevi
Flat red or purple lesions
Back of the neck, lower occiput, upper eyelid and bridge of the nose
Can be seen after 2 years of age
STRAWBERR Y MARKS
PWS involving the forehead (V1 area of the trigeminal nerve), eye
abnormalities (choroidal vascular abnormalities, glaucoma),and
leptomeningeal and brain abnormalities (vascular malformations, calcification
or cerebral atrophy).
MOTT LING
Cutis marmorata
Reticulated pattern of constricted capillaries and venules due to vasomotor
instability in immature infants
Bluish mottling or marbling of skin in response to chilling, stress or overstimulation
ERYTHEMA TOXICUM
Newborn rash
Small, white, yellow or pink to red papular rash
May be seen in trunk, face and extremities
Seen within 48 hours
PETECHIAE
ECCHYMOSIS
Bruises
As a result of rupture of blood vessels
May appear over the presenting part as a result of trauma during delivery
May also indicate infection or bleeding problems
HARLEQUIN SIGN
When on one side, dependent side turns red and upper side/half turns pale
Due to gravity and vasomotor irritability or immature circulation
Skin resembles a Clowns suit
CAF-AU-LAIT SPOTS
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MEASURE
Head circumference: if HC is CC
SUTURES
Overriding or separated
HEAD LAG
CAPUT SUCCEDANEUM
CEPHALHEMATOMA
MOLDING
FORCEP MARKS
CRANIOTABES
EARS
CRANIOSYNOSTOSIS
Color
o
White sclera
o
Slate gray, brown or dark blue
o
Final eye color: seen after 6-12 months
Symmetrical
Pupils equally round and reactive to light
(+) Blink reflex
(+) transient strabismus due to weak EOM
Able to move and fixate momentarily
(+) Red reflex
o
If (-): cataract
(+) Edema on eyelids related to pressure during delivery or effects of
medication
(-) Tear formation
o
Begins at 2-3 months
NURSING CONSIDERATIONS
DOC:
o
Erythromycin 0.5%
o
Tetracycline1%
o
Old: Silver Nitrate 1%
MOUTH
EYES
Accessory tragus
Remnant of the 1st branchial arch
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NECK
CC 2cm than HC
Cylindrical, equal AP:T diameters
Symmetrical
Abdominal breathers
(+) Bronchial sounds
(+) Breast engorgement: subsides after 2 weeks
(+)Prominent/edematous nipples
(+)Accessory nipples
(+) Witch Milk
ABDOMEN
UMBILICAL CORD
2 arteries, 1 vein
Apply 70% isopropyl alcohol to the cord with each diaper change and at least
2-3x a day
Note for any signs of bleeding or drainage from the cord and other
abnormalities
MALES
EXTREMITIES
ANUS
Check patency
First stool: Meconium: within 1st 24 hours
o
Sticky, tarlike, blackish-green, odorless material
Transitional stool
o
Within 2-10 days after birth
o
Breastfeed
Pale yellow, firm , less frequent 2-3x with more noticeable odor
NURSING CONSIDERATIONS
Bottle feeding may be started with sterile water to 4 hours after birth prior to
formula feeding
Labia: edematous
Clitoris: Enlarged
Pseudomenstruation possible
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REFLEXES
SUCKING/ROOTING
EXTRUSION
Anything placed on the anterior portion of the tongue will be spit out
To prevent swallowing of inedible substances
Disappears after 4 months
o
Disappearance indicates readiness for semi-solid to solid foods
SWALLOWING
While the baby is falling asleep or is sleeping, gently and quickly turn the head
to one side
As the baby faces the left side, the left arm and leg extend outward while the
right arm or leg flex and vice versa
Disappears within 3-4 months
BALLARDS SCORING
Place a finger in the palm of the babys hand, then place a finger at the base
of the toes
Fingers will curl or grasp the examiners finger and the toes will curl downward
Palmar: fades within 3-4 months
Plantar fades within 8 month
MORO
Hold baby in a semi sitting position then allow the head and trunk to fall
backward to at least a 30 degree angle
Symmetrically abducts and extends the arms, fans the fingers and forms a C
with the thumb and the forefinger, and adducts the arms to an embracing
position and returns to a relaxed state
Present at birth
Complete response at 8 weeks
Most significant reflex indicative of CNS problem ( >6 months)
Disappears after 4-5 months
STARTLE
BABINSKI
Gently stroke upward along the lateral aspect of the sole, starting at the heel
of the foot to the ball of the foot
Dorsiflexion of big toe and fanning of little toes
Disappear: starts at 3 months to 1 year
o
Disappearance indicates maturity of CNS
DACM MED2016
Identification band
Birth registration
Birth record and documentation
8
NEWBORN SCREENING
SHOULDER HOLD
?
CH
CAH
GAL
PKU
G6PD
?
Severe mental retardation
Death
Death or cataract
Severe mental retardation
Severe anemia, kernicterus
?
Normal
Alive and normal
Alive and normal
Normal
Normal
FOOTBALL HOLD
CRADLE HOLD
DACM MED2016