Nurse Jackie Reviews Cord Care of the Newborn

Goals:

• To constitute, maintain and support respirations.
• To provide warmth and prevent hypothermia.
• To ensure condom, prevent injury and infection.
• To place actual or potential bug that may require immediate attention.

Establish respiration and maintain articulate airway

The most important need for the newborn immediately subsequently birth is a clear airway to enable the newborn to breathe effectively since the placenta has ceased to office equally an organ of gas exchange. It is in the maintenance of acceptable oxygen supply through constructive respiration that the survival of the newborn greatly depends.

Newborns are obligatory nose breathers. The reflex response to nasal obstacle, opening the mouth to maintain airway, is not nowadays in most newborns until 3 weeks after birth.

To institute and maintain respirations:

1. Wipe mouth and nose of secretions after delivery of the head.

ii. Suction secretions from oral fissure and olfactory organ.

• Compress bulb syringe before inserting
• Suction mouth outset, so, the olfactory organ
• Insert bulb syringe in one side of the mouth

3. A crying baby is a breathing infant. Stimulate the baby to weep if babe does non cry spontaneously, or if the weep is weak.

• Do not slap the buttocks rather rub the soles of the feet.
• Stimulate to weep after secretions are removed.
• The normal baby cry is loud and croaking. Detect for the following abnormal cry:
  • High, pitched cry – indicates hypoglycemia, increased intracranial pressure.
  • Weak cry – prematurity
  • Hoarse cry – laryngeal stridor

4. Oral mucous may crusade the newborn, to choke, cough or gag during the first 12 to 18 hours of life. Place the infant in a position that would promote drainage of secretions.

• Trendelenburg position – head lower than the torso
• Side lying position – If trendelenburg position is contraindicated, place babe in side lying position to permit drainage of mucus from the mouth. Place a pocket-sized pillow or rolled towel at the back to forestall newborn from rolling back to supine position.

5. Continue the nares patent. Remove mucus and other particles that may be cause obstruction. Newborns are obligatory olfactory organ breathers until they are about 3 weeks onetime.

Care of the Eyes

It is part of the routine care of the newborn to give prophylactic middle handling against gonorrhea conjunctivitis or opthalmia neonatorum. Neisseria gonorrhea, the causative agent, may be passed on the fetus from the vaginal canal during delivery. This practice was introduced by Crede, a High german gynecologist in1884. Silver nitrate, erythromycin and tetracycline ophthalmic ointments are the drugs used for this purpose.

Erythromycin or tetracycline Opthalmic Ointment:

1. These ointments are the ones commonly used now a days for heart prophylaxis because they do not crusade eye irritation and are more effective against Chlamydial conjunctivitis.
2. Apply over lower lids of both eyes, and then, manipulate eyelids to spread medication over the optics.

Vitamin K or Aquamephyton

The newborn has a sterile intestine at nascence, hence, the newborn does not possess the abdominal bacteria that manufactures vitamin 1000 which is necessary for the formation of clotting factors. This makes the newborn prone to bleeding. As a preventive measure, .five (preterm) and 1 mg (full term) Vitamin K or aquamephyton is injected IM in the newborn's vastus lateralis (lateral anterior thigh) muscle.

Care of the string

The cord is clamped and cutting approximately within 30 seconds subsequently birth. In the commitment room, the string is clamped twice virtually eight inches from the abdomen and cut in between. When the newborn is brought to the nursery, another clamp is applied ½ to 1 inch from the abdomen and the cord is cut at second time. The string and the area around it are apple-pie with clarified solution. The manner of cord care depends on hospital protocol. What is important is that the principles are followed. Cord clamp maybe removed afterwards 48 hours when the cord has dried. The cord stump normally dries and fall within seven to 10 days leaving a granulating area that heals on the next 7 to 10 days.

Instruction to the mother on cord care:

1. No tub bathing until string falls off. Do not sponge bath to clean the baby. Run into to it that string does not get wet by water or urine.
2. Do not employ annihilation on the cord such every bit baby powder or antibiotic, except the prescribed antiseptic solution which is 70% alcohol.
3. Avoid wetting the string. Fold diaper beneath so that it does non comprehend the cord and does not get wet when the diaper soaks with urine.
4. Exit cord exposed to air. Practise not employ dressing or abdominal binder over it. The string dries and separates more speedily if it is exposed to air.
5. If you lot notice the cord to be bleeding, apply firm pressure and check cord clamp if loose and fasten.
6. Report whatsoever unusual signs and symptoms which indicates infection.
   • Foul aroma in the cord
   • Presence of discharge
   • Redness effectually the cord
   • The cord remains wet and does non fall off within 7 to 10 days
   • Newborn fever

THE APGAR SCORING SYSTEM

The APGAR Scoring Organization was developed by Dr. Virginia Apgar as a method of assessing the newborn'southward adjustment to extrauterine life. Information technology is taken at one infinitesimal and 5 minutes after birth. With depressed infants, repeat the scoring every 5 minutes as needed. The one minute score indicates the necessity for resuscitation. The v minute score is more reliable in predicting bloodshed and neurologic deficits. The most of import is the heart rate, then the respiratory rate, the muscle tone, reflex irritability and colour follows in decreasing order. A heart charge per unit below 100 signifies an asphyxiated babe and a heart rate above 160 signifies distress.

Assess	0	1	2
Centre RATE	Absent	Below 100	Higher up 100
RESPIRATION	Absent-minded	Slow	Good crying
MUCLE TONE	Flaccid	Some flexion	Agile motion
REFLEX IRRITABILITY	No response	Grimace	Vigorous cry
Colour	Blueish all over	Body pinkish, Extremities blue	Pink all over

Score:

• vii – ten Skilful adjustment, vigorous
• Moderately depressed infant, needs airway clearance
• Severely depressed infant, in demand of resuscitation.

ASSESSING THE AVERAGE NEWBORN

Head Circumference	34 – 35 cm
Temperature	97.6 – 98.six F axillary
Chest Circumference	32 – 33 cm
Centre Rate	120 – 140 bpm
Respirations	30 – 60 bpm
Weight	2.v to 3.4 kg
Length	46 to 54 cm

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 exam reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Besides an IELTS passer.

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Source: https://nursingcrib.com/nursing-notes-reviewer/immediate-care-of-the-newborn/

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