Professional Documents
Culture Documents
1.BIOLOGIC TASKS
a. establishing and
maintaining respiration
b. circulatory changes
c. regulation of body
temperature
d. ingesting, retaining and
digesting nutrients
e. elimination of waste
f. regulation of weight
2.BEHAVIORAL TASKS
a. establishing a regulated
behavioral tempo independent
of the mother
b. processing, storing, and
organizing multiple stimuli
c. establishing a relationship with
caregivers and the
environment
TRANSITION PERIOD
1. FIRST PERIOD OF REACTIVITY
Neurologic System
– Primitive reflexes
– Myelination follows the principles of
growth and development
Sensory Functions
Vision- Structurally incomplete; tear
glands do not begin to function until
2-4 weeks of age; visual acuity
between 20/100 and 20/400; RBW
Hearing- reacts to sound once the
amniotic fluid has been drained
from the middle ear
Smell-reacts to strong odors
Taste- prefers sweet taste
Touch-face, mouth, hands, soles
PRINCIPLES OF IMMEDIATE CARE
AIRWAY PATENCY
* most critical adjustment a
newborn must make at birth
TECHNIQUES to maintain patent
airway:
- wipe off mouth and nose with
sterile gauze
- suctioning with the use of rubber
bulb syringe or suction catheter
- positioning
PROVIDE OPTIMUM TEMPERATURE
1. NON-SHIVERING
THERMOGENESIS
3. GLUCONEOGENESIS
HOW TO PROVIDE WARMTH:
APGAR SCORING
- was developed by Dr. Virginia
Apgar in 1952
- done on the 1st minute, 5
and 10 minutes after
- based on 5 parameters, ranked
in order of importance
A. HEART RATE
- listening to heartbeat
with a stethoscope
between the left nipple
and sternum @ 3rd – 4th
LICS for 60 secs.
B. RESPIRATORY EFFORT
- “ a crying baby is a
breathing baby ”
C. MUSCLE TONE
D. REFLEX IRRITABILITY
- tested through a gentle
slap on foot; passing
catheter thru nose
E. COLOR
- acrocyanosis
PROPER IDENTIFICATION
CORD CARE
Normal = 1 vein and 2
arteries ( AVA )
Abnormal =
2 A & 2 V – Mongoloid;
1 A & 1 V-kidney agenesis
CARE:
a. asepsis should be observed
- present care needs no dressing
after cord has been clamped
or ligated and cut. If left
exposed, will dry because
water is lost and separates
more quickly than when
covered.
b. frequently inspect for
bleeding
c. cord is clamped – 2.5cm (1inch)
from the skin. Using a
disposable clamp, ligature or
cord tie
d. cleansed with betadine
antiseptic during the initial
care. 70% ethyl alcohol can
be used in the succeeding
cord care.
SKIN CARE- done to prevent
skin infection
Purposes:
a. Bonding
b. Involution
c. Breast feeding stimulation
- Bottle feeding is postponed
until sucking and swallowing are
well coordinated, to prevent
possible aspiration.
( BODY MEASUREMENTS )
WEIGHT AND LENGTH
Americans – 48-53 cm
(19-21 inches )
- 6-9 lbs
(2.7-4 kg)
Filipinos - 47.5 – 52 cm
(19 – 20 inches)
- 6.5 lbs (3 kg)
Newborn loses 5 – 10% of his body
weight during the first few days of life
due to:
a. withdrawal of hormones
b. voiding and passing out of stool
c. limited intake
will regain weight in 10 – 14 days of age
later on, he will be gaining
1lb/month for the 1st 6 months of
life thus:
2x @ 6 mos
3x @ 1 year
4x @ 2 years
HEAD CIRCUMFERENCE
- crown-to-rump circumference or
the sitting height
- 33 – 35 cm or 13 – 14 inches
- measured at the widest part,
which is the occipito-frontal
diameter, located across the
center of the forehead and
most prominent portion of the
posterior occiput.
- increases by 50% at one year
CHEST CIRCUMFERENCE
- 30.5 – 33 cm or 12 – 13
inches
- usually measures about
2-3 cm less than the HC
- tape measure placed at
the level of the nipple
ABDOMINAL CIRCUMFERENCE
- same as CC
- measured at level of umbilicus
- must be cylindrical in shape
and protrude slightly
VITAL SIGNS
-TPR are always obtained
-BP not routinely assessed
unless there is a potential
for cardiac, bleeding or
renal problems
A. TEMPERATURE
- 36.5 – 37 °C or 97.9 – 98 ° F
In the past, it is taken per
rectum to locate anal
opening; thus ruling out
imperforate anus.
- 30 – 60 breaths per
minute
- Varies with state of
alertness; are shallow,
irregular and abdominal
in nature
-With periods of apnea
lasting for 5 – 15
seconds. Thus, count RR
for 1 full minute
- If ↑ 60 – place temporarily
on NPO because of
danger of aspiration
C.HEART RATE
-65/41 mmHg – at 1 to 3
days of age
HEAD TO TOE
ASSESSMENT
GENERAL APPEARANCE
Gray
- indicative of infection
Pallor
Acrocyanosis
- bluish discoloration of the
hands and feet due to poor
peripheral circulation and
vasomotor instability.
Cyanosis
- may indicate disease state
- observed in crying / quiet state
HEMANGIOMAS
– vascular tumor of the
skin
HEAD
- proportionately large; ¼ of
total length
- cranium is large and face
relatively small
- has 6 bony plates, connected
by suture lines. Growth of
these bones along the sides
causes the head to ↑ in size
FONTANELS are opening at
points of union of skull
bones
1. MOLDING – asymmetric
adjustment in the shape of
the head to fit the cervix
during delivery
2. CAPUT SUCCEDANEUM
-subconjunctival hemorrhage –
due to pressure during
delivery causing rupture of
small capillaries; no treatment
Abnormal:
- Nuchal rigidity
- Congenital torticolis (wry
neck) – head held to one
side with chin pointing to
opposite side
CHEST
- anteroposterior and lateral
diameters equal
- clavicles should be
straight and symmetrical
- appears small since head
is large; but, @ 2 yrs,
CC is greater than HC
-breast engorgement both for
male and female, due to
mother’s hormone
- 30 – 60 breaths per
minute; chiefly abdominal
FEMALE
- vulva may be swollen due to
maternal hormones
- urinates within 24 hours
Variation:
PSEUDOMENSTRUATION –
blood tinged or mucoid
discharge
Abnormal:
Cryptorchidism
Inguinal hernia
BACK / RECTUM
BACK – spine intact; appears flat
in the lumbar / sacral
areas
- no openings, mass or
prominent curves
RECTUM – patent anal opening;
passage of meconium
within 24°
Abnormal:
Imperforate anus
No meconium within 36
hours
EXTREMITIES
Webbing ( Syndactyly )
tx:
1. oral glucose
2. keep warm
3. monitor the VS
4. administer ordered 10%-
25% IV glucose
HYPOPROTHROMBINEMIA
(neonatal bleeding disorder)
ANEMIA
WEIGHT LOSS
PHYSIOLOGIC JAUNDICE OR
HYPERBILIRUBINEMIA
Treatment:
1. early feeding- to speed
passage of feces thus
preventing reabsorption of
bilirubin in the bowels
2. phototherapy- exposure to
light to initiate maturation
of liver enzymes
DESQUAMATION
Hepatitis B (HBV) vaccine
administration
@ birth
@ 6 weeks
@ 14 weeks
Newborn Screening test for
diseases
NEWBORN
BATHING
ALLOWANCES
1. CALORIE
up to 2 mos of age=
120 calories/kg
body wt or 50-55
kcl/ lb every 24
hours for adequate
amount of food for
growth
beyond 2 months, decreases
=100 kcal/kg or 45
kcal/lb/day
2. CHON
LACTOSE, a disaccharide,
the most easily digested
carbohydrate
Improves calcium absorption
and aids in nitrogen
retention
It provides stools in which
gram positive microorganism
predominates
Adequate CHO levels in formula
allows CHON to be used in
building new cells
cow’s milk: 29%; human milk:
37%
4. FATS
a. breastfeeding
b. formula feeding
c. mixed feeding
Breastfeeding
a) physiologic readiness
b) absence of emotional stress
c) sucking – stimulates let
down reflex
d) rest, exercise, diet
Maternal Contraindication
1. narcotic addiction
2. active PTB
3. acute contagious disease
4. cardiac disease
5. cancer
6. extensive surgery
Infant Contraindication
1. cleft lip
2. cleft palate
Essentials of Breastfeeding
A. To start:
right on the delivery table
PRIMARILY to promote
bonding
within 30 minutes after
birth in normal spontaneous
delivery
within 4 hours after CS
B. Duration:
BREASTFEEDING
Mother
promotes bonding
promotes uterine involution
delays fertility (but not safe to
use as sole means of FP)
economically saves time,
money, effort
less incidence of breast
cancer
Baby
recommended only if
breastfeeding is not
possible
ADVANTAGES:
1. provides an alternative to
breastfeeding
2. more accurate assessment of
intake
3. may meet the needs of
working mothers
4. maybe indicated in cases of
congenital deformities,
inborn errors of metabolism,
allergies
FACTORS TO SUCCESS:
1. pasteurization of the milk
2. sanitation in milk handling
3. adequate sterilization,
refrigeration, storage
4. to be equal with mother’s milk
in nutrients: ADD sugar to
increase energy value,
DILUTE with water to reduce
minerals and CHON
concentration
SPECIAL CONSIDERATIONS
1.observe aspiration
precaution
2.hold bottle in upright
position so that the nipple
is always filled with milk
3.burp
4.demand feeding is preferred
than scheduled
B- EST FOR BABY
R- EDUCES ALLERGY
E- MOTIONAL BONDING
A- NTIBODY PRESENT
S- TOOL INOFFENSIVE
T- EMPERATURE ALWAYS IDEAL
F- RESH
E- CONOMICAL
E- ASY ONCE ESTABLISHED
D- IGESTED EASILY
I- MMEDIATELY AVAILABLE
N- UTRITIOUS
G-ASTROENTERITIS PREVENTED
COMMON SKIN DISORDERS
A. DIAPER DERMATITIS
1. diaper dermatitis-
perianal irritation due
to accumulation of
moisture, heat, and
chemical substances
2. ammonia dermatitis-
diffuse erythema in
the perianal and gluteal
areas caused by
breakdown of urea in
the urine to ammonia
by bacteria in the
feces
3. intertrigo – maceration
of any two skin surfaces
in close opposition /
chafing of the skin
B. MILIARIA/ HEAT RASH/
PRICKLY HEAT
- “bungang-araw”
- due to overdressing, warm
weather
C. SEBORRHEA DERMATITIS
- “cradle cap”
- due to accumulation of sweat
and dirt causing flat,
adherent and greasy scales
with pruritus and crusting;
usually indicates a secondary
infection
D. IMPETIGO