nursing care of neonate ppt for nursing students

nursing care of newborn.nursing management of newborn

1. Nursing Care Of Neonates UNIT:3 By: Sakshi Srivastava Associate professor KINPMS

2. OBJECTIVES Basic care of newborn Hygiene measures Breast feeding immunization

3. Definition:-  Essential new born care is comprehensive stagey designed to improve the health of newborns through interventions before conception ,during pregnancy at and soon after birth ,and in the postnatal period .Treatment of key problems such as sepsis and birth asphyxia.

4. IMMEDIATE BASIC CARE OF NEONATES: 1)Deliver the baby on a warm and clean towel. 2)Establish and maintain a patent airway. 3)Ensure warmth 4)Assessment and documentation of baby ’ s condition. 5)care of eyes 6)clamp and cut the cord

5. 7)care of skin 8)Administration of vitamin K 9)Identification of baby. 10)Transfer of baby according to level of care required.

6. 1)Deliver the baby on a warm and clean towel.

7. 2)Establish and maintain a patent airway

8. 3)Ensure warmth

9. 4)Assessment and documentation of baby ’ s condition

10. 5)care of eyes

11. 6)clamp and cut the cord

12.  The umbilical cord is clamped when the cord pulsation stops as this provides the infant extra blood from the placenta.  Delay in clamping for 2– 3 minutes or till cessation of the cord pulsation facilitates transfer of 80-100 mL blood from the compressed placenta to a baby when placed below the level of uterus. This is beneficial to amature baby but may be deleterious to a pre-term or a low birth weight baby due to hypervolemia.  But early clamping should be done in cases of Rh- incompatibility (to prevent antibody transfer from the mother to the baby or babies born asphyxiated or one of a diabetic mother.

13. 7)care of skin

14. 8)Administration of vitamin K

15. 9)Identification of baby.

16. 10)Transfer of baby according to level of care required.  Level II Nursery:- Preterm babies with i) Gestational age between 32-36 weeks ii)Low birth weight (1500- 2000gm) iii)Major congenital malformation or iv)Suspected of having aspirated meconium ,should be transferred to special care nursery.  Level III Nursery :-The following categories of neonates should be admitted to intensive Care Nursery i)Birth weight less than 1.5kg ii)Gestational period less than 32 weeks iii)Neonates with respiratory distress iv)Infants with convulsions,central cyanosis(Congintal heart disease),severe Neonate jaundice (erythroblastosis fetails) and those requiring major surgery

17. HYGIENE MEASURES 1)Rooming in 2)Initiating breast feeding 3)Observation of early signs of disease 4)Prevention of infection 5)Care of bladder and bowel 6)Maintenance of personal hygiene 7)Parental teaching and follow up

18. 1)Rooming in ❑ Promotes early initiation of breast feeding ❑ Provides opportunity for mother baby interaction and bonding. ❑ Relieves mother ‘ s anxiety related to where about of the baby .

19. 3)Observation of early signs of disease Failure to pass meconium within 24 hours of birth Failure to pass urine within 48 hours of birth Failure to take feed. Excessive crying or undue lethargy. Jaundice within 24 hours of birth(Pathological Jaundice) Hypothermia or Hyperthermia Seizures Persistent vomiting or diarrhea Evidence of superficial infection like oral thrush,conjunctivitis,umbilical cord pustules on skin etc.

20. 4)Prevention of infection:  All personnel coming in contact with the baby should be free from infection  Hand washing should be practiced strictely  Strict aseptic precautions should be taken while handling the baby.  The personal hygiene of mother and baby should be maintained  Restrict the number of visitors attending the baby.

21. 5)Care of bladder and Bowel: ❖ If the neonate fails to pass urine and stool within 24 hours of birth ,it should be notified to the physician. ❖ The urine output is about 200- 300ml by the end of first week of life so neonate voids about 15-20 times in a day

22. 6)Maintenance of personal hygiene

23. 7)Parental Teaching and follow up: The period when mother is in post natal ward can be utilized for teaching the mother about all aspects of baby care. Parents are taught to observe the child ’ s daily behaviorrelated to feeding,sleep,activity,cry,elimination etc. Parents need to be told about- holding the baby,baby bath,eye and cord care ,feeding and nutritional supplements,immunization,prevention from infection and follow up. The parents should be educated about the danger signs in the baby, which if present require immediate hospitalization.

24. NEW BORN NUTRITION NUTRITIONAL REQUIREMENTS IN THE NEONATE The infant should get sufficient fluid. Fluid intake should be 150 – 175 mL/kg body weight per day The infant should get adequate calorie. A term healthy infant needs 100 – 110 KCal/kg of body weight per day. Low birth weight infant needs about 105 – 130 KCal/kg/ day. Each 30 mL (1 oz) of breast milk gives 20 calories. Calorie needs are primarily dependent on oxygen consumption

25. The food should have a balanced composition of protein (2 –4 g/kg/day), fat (4 –6 g/kg/day), carbohydrate (10 – 15 g/kg/day), minerals and vitamins and it should be easily digestible.

26. If the baby does not responding after birth then what we should do????

27. Newborn Resuscitation  20% death occur due to the birth asphaxia developmental delay,vision loss,cerebral palsy.  For most babies, the immediate care give at the birth is enough to stimulate the baby to start breathing.

28.   Approximately 10% of newborns require some assistance to begin breathing at birth.Less than 1% require extensive resuscitation measures. ◦ Term Gestation? ◦ Crying or breathing? ◦ Good muscles tone?  If answer to all these questions is “ YES ’’ , the baby does not need resuscitation.The baby should be dried and placed in skin – to-skin contact with the mother.Apgar scoring should be done simultaneously.If answer to above three questions is “ NO ’’,the infant requires resuscitation.

29.  TABC of Resuscitation   T-Maintenance of Temperature ◦ Dry the baby quickly ◦ Remove wet linen ◦ Place the baby under radiant warmer A-Establish an open airway ◦ Position the infant ◦ Suction mouth and nose {in few cases also trachea} ◦ ET intubation ,if needed to ensure open airway.

30. Position of Baby     Place the baby on his back on a flat surface. Position the head so that the neck is slightly extended. We may put a rolled cloth under the shoulders to maintain the position. The resuscitation surface should be well lit and warm. Keep the baby ’ s head and lower body covered to keep him warm.

31.  B-Initiate Breathing ◦ Tactile stimulation to initiate respiration ◦ PPV when necessary ,using either Bag and mask or mask or Bag and ET tube.  C-circulation  Chest compression  Medication [if needed ]

32.  Step 3: Ventilate     Ventilate about 40 times in 1 minute. After 1 minute, stop to see if the baby starts to breathe independently. Continue ventilation until the baby spontaneously cries or breaths If there is no breathing or gasping after 20 minutes, stop ventilation.

33.  Step 4: Monitor  Closely monitor a baby who had resuscitation or who has poor color, even if he appears to be breathing well.  If the baby ’ s breathing and color are good, give him to his mother       REFERRAL AFTER RESUSCITATION Not sustaining adequate breathing (less than 30 breaths in 1 minute) or gasping: continue resuscitation efforts during transport More than 60 breaths in 1 minute Indrawing of the chest Grunting (sound made when breathing out) The baby ’ s tongue and lips are blue or the whole body is pale or bluish.