OBSERVATION & CARE OF NEWBORN, parenting process.pptx

observation and care of new born & parenting process

1. OBSERVATION AND CARE OF NEWBORN & PARENTING PROCESS . PRESENTED BY: ARCHITA SHARMA MSc(N) 1 st Year SNGNC, IGMC SHIMLA

2. INTRODUCTION Newborns are one of the most curious and interesting humans one can ever encounter. They continue to become everyone’s joy wherever they go. As their healthcare provider, we are one of them who handle them primarily at the moment they were delivered, so it is up to us to give the best primary care to these little angels before we handover them to their parents.

3. DEFINITION The period from birth to 28 days of life is called neonatal period. The first week of life is known as early neonatal period and the late neonatal period extends from 7 th to 28 th days of age. Care given to new born during neonatal period is known as the new born care.

4. TYPES OF NEWBORN CARE Immediate care of newborn: Care of the baby that needs to be given at birth in the labor room. Later care of newborn: Care of the baby that needs to be given in the postnatal ward and after discharge at home.

5. ELEMENTS OF NEW BORN CARE There are three basic elements of new born care as discussed below: Basic preventive care including clean delivery practices and exclusive breast feeding. Early detection of danger signs. C. Treatment of problems such as sepsis and birth asphyxia.

6. APGAR SCORE Apgar scoring is described by Dr. Virginia Apgar. It is useful for quantitative assessment of newborn’s condition at birth especially for the respiratory, circulatory and neurological changes. Five objective criteria are evaluated at 1 minute and 5 minutes, after the newborn body is completely born.

7. 7-10 is normal; 4-6 is moderately depressed; 0-3 needs immediate resuscitation.

8. CONT…. Each parameter can have the highest score of two and the lowest is 0. The scores of the five parameters are added to determine the status of the infant. 0-3 points: the baby is serious and in danger and need immediate resuscitation. 4-6 points: the baby’s condition is guarded and may need more extensive clearing of the airway and supplementary oxygen. 7-10 points: are considered good and in the best possible health.

9. IMMEDIATE CARE OF NEWBORN Objectives: To establish and maintain respiration. To ensure warmth. To prevent infection. To provide care to the eyes. To provide care to the umbilical cord. To provide care to the skin. To make observation and documentation. To make identification and transfer.

10. CARE AT BIRTH Wipe mouth and nose for secretions after delivery of head with clean sterilize gauze pad. Deliver the baby onto a warm, clean and dry towel or cloth and keep on mother’s abdomen or chest (between the breasts). Position: Trendelenburg- Head lower than body. Side lying position – to permit drainage of mucus from the mouth. Place a small pillow or rolled towel at the back to prevent newborn from rolling back to supine position. Gently suction with the bulb syringe and short catheter from mouth first then nose to prevent aspiration of fluid into the lungs. Wipe both the eyes separately with sterile swab.

11. CONT…. Clamp and cut the umbilical cord after 1 minute, if baby breathing well. Immediately dry the baby with a warm clean towel or piece of clean cloth. Assess the baby’s breathing while drying. Leave the baby between the mother’s breast to start skin-to-skin contact for at least an hour.

12. CONT…. Cover the baby’s head with a cap. Cover the mother and baby with a warm cloth. Place an identity label/band on the baby. Encourage mother to initiate breastfeeding (within half an hour of birth in normal delivery and after 2 hours in LSCS).

13. LATER CARE OF NEWBORN Objectives: To receive the baby in postnatal ward. To initiate feeding. To prevent infection. To maintain personal hygiene . To observe for early signs of disease or congenital anomalies. To provide parental teaching.

14. WARMTH Warmth is provided by keeping the baby dry with adequate clothing. Baby should be kept to the side of the mother, so that the mother’s body temperature can keep the baby warm. Baby can be placed in skin to skin contact with mother (kangarooing) to maintain temperature of infant and facilitate breast feeding. Bathing at first day is avoided to prevent hypothermia.

15. ESTABLISH NORMAL BREATHING

16. BREAST FEEDING The baby should be put to mother’s breast within half an hour of birth as soon as possible, The mother has recovered from exertion of labour . Colostrum feeding must be offered. Mother should be informed about the importance and techniques of breast feeding.

17. CONT…. Demand feeding should be encouraged. Exclusive breastfeeding procedure should be explained to mother and family members.

18. SKIN CARE AND BABY BATH The baby must be cleaned off blood, mucus and meconium. No vigorous attempts should be met remove vernix caseosa, as it provides protection to the delicate skin. Baby bath can be given in the hospital by using warm water in a warm room gently and quickly. Bathing should be avoided in open place.

19. CONT…. During winter months the baby should have sponge bath rather than deep bath to avoid hypothermia. Use of olive oil or coconut oil can be allowed 3-4 weeks of age. Oil massage improves circulation and muscle tone. Oil massage should be given before birth. Exposure to morning sunrays is an important source of Vitamin D and warmth. The talcum powder should be applied over the axillae, groin and buttocks.

20. CARE OF UMBILICAL CORD The umbilical cord is cut about 2-3 inches from the navel with aseptic precaution during delivery and tied with cotton thread or disposable plastic drip. The cotton must be inspected for bleeding afterwards which commonly occurs due to shrinkage of cord and loosening of ligature. No dressing should apply and the cord should be kept open and dry. Normally it falls off after 5-10 days. Application of triple dye or junction violet is not advocated as routine any more.

21. CARE OF EYES Eye should be cleaned at the birth and once every day using sterile cotton swabs soaked in sterile water. Each eye should be cleaned using a separate swab. Application of Kajal in the eyes must be avoided to prevent infection or lead poisoning. The eye should be observed for redness, discharge or the excessive tearing for early detection of problems and prompt management.

22. CLOTHING OF BABY The baby should be dressed with loose, soft and cotton cloths. Large buttons, synthetic frock and plastic or nylon napkins should be avoided. A triangular shaped, soft, absorbent cloth should be used as napkin. The cloths should not be tight especially around the neck or abdomen. In winters, woolen clothing should be used.

23. GENERAL CARE The newborn should be kept with the mother for continuous rooming in a well-ventilated room.

24. CONT…. Baby should be handled with gentle approach after hand washing. No infected person should take care or touch the baby. Baby should be allowed to sleep in supine position which can prevent sudden infant death syndrome. General cleanliness is to be maintained and surrounding to be kept clean. Wet nappies should be changed immediately.

25. OBSERVATION The baby should be thoroughly observed twice daily for early detection of any abnormalities. Temperature, pulse, respiration, feeding behavior, stool, urine and sleep pattern should be assessed. Mouth, eyes, cord, and skin should be looked for any infections.

26. WEIGHT RECORDING Assess daily weight gain in healthy term babies which is about 30gm/day. Most infants double their weight by 4-5 months but in first week of life there is physiological loss of body weight because of removal of vernix caseosa, mucus, blood, passage of meconium and reduction of extracellular blood volume and also due to adaptation to new environment. With adequate breastfeeding majority of babies regain the weight within 7-10 days of birth.

27. IMMUNIZATION The mother should be informed about national immunization schedule and explanation should be given about importance of complete immunization and all possible reactions of following vaccines. In institutional deliveries all neonates should be immunized with BCG vaccine and zero polio. In outside or home deliveries the BCG and OPV should be given.

28. FOLLOW UP AND ADVISES Each infant should be followed up, at least once every month for first 3 months and subsequently 3 months interval till one year of age. Follow up is necessary for assessment of growth and development, early detection and management of health problems. Health education should be given regarding exclusive breast feeding, warmth, hygiene, rooming in, clothing, immunization and follow up. Harm full cultural practices should be discouraged. Care at home should be discussed and demonstrate to the mother and family.

29. PARENTING PROCESS Parents are usually the first people a child learns to trust. Parents and families are the most important people in children’s lives. The many different relationships people form over the course of the life span, the relationship between parent and child is among the most important.

30. DEFINITION The parent child relationship consists of a combination of behaviors, feelings and expectations that are unique to a particular parent and a particular child. The relationship involves the full extent of a child’s development.

31. TYPES OF PARENT CHILD RELATIONSHIP There are mainly four categories of parent child relationship:

32. SECURE RELATIONSHIPS This is the strongest type of attachment. A child in this category feels he can depend on his parent or provider. He knows that person will be there when he needs support.

33. AVOIDANT RELATIONSHIPS This is one category of attachment that is not secure. Avoidant children have learned that depending on parents won’t get them that secure feeling they want, so child learn to take care of themselves. Avoidant children may seem to independent and usually do not build strong relationships.

34. AMBIVALENT RELATIONSHIPS Ambivalence is another way a child may be insecurely attached to his parents. Child notice what behavior got their parents’ attention in the past and use it over and over. children are always looking for that feeling of security.

35. DISORGANIZED RELATIONSHIPS Disorganized children don’t know what to expect from their parents. Children with relationships learn to predict how his parent will react, whether it is positive or negative. Child also learns that doing certain things will make their parents do certain things.

36. PARENTING It is the process of promoting and supporting the physical, emotional, social, and intellectual development of a child from infancy to adulthood.

37. PARENTING STYLES It means a psychological construct representing standards and strategies that parents use in their child rearing. There are four main styles of parenting: Authoritarian. Authoritative. Permissive/ Indulgent. Detached.

38. Authoritarian Parents The parent is demanding but not responsive. These parents are rigid in their rules; they expect absolute obedience from the child without any questioning . Authoritarian parents are strict disciplinarians.

39. Authoritative Parents Authoritative parents show respect for the opinions of their children. Authoritative parents are both responsive and demanding ; they are firm, but they discipline with love and affection , rather than power.

40. Permissive/ Indulgent Parents Permissive parents have little or no control over the behavior of their children. Indulgent parents are responsive but not especially demanding. They have a few expectations of their children and impose little or inconsistent discipline. There are empty threats of punishment without setting limits.

41. Detached Parents Detached parents are neither responsive nor demanding. They may be careless or unaware of the child’s needs for affection and discipline.

42. CHARACTERISTICS OF A PARENT-CHILD RELATIONSHIP Flexible/Adaptable : Good parents must be flexible and adaptable. They have ability to recognize and accommodate the child’s need. Help the child by giving clear directions, offering opportunities to choose and negotiate. Connected : Parents should have ability to differentiate the child’s worth from his/her behavior , and create a reward-oriented environment in which consequences are positive outcome. Respond to a child’s problem or feelings with acceptance, support and validation .

43. CONT….. Open Communicator : The way the parent and child communicate sets the tone for the relationship. The healthy parent-child relationships use positive communication that separates the child’s worth from behavior. Appropriate Boundaries : The parent-child relationship includes various boundaries. Healthy boundaries consider that what the parent and the child want in a positive way to find a mutually agreeable solution or limit. Discipline : For healthy parent child relationship discipline also very important aspect. To finding the solution of conflicts and behavioral problem helps to encourage the strong relation rather than punishing children in an attempt to teach.

44. FACTORS INFLUENCING PARENT-CHILD RELATIONSHIP Family structure. Social and community support. Relationship history. Emotional system. Temperament. Parenting experiences. Intellectual capacity. Education (formal and informal). Cultural context and experiences.

45. METHODS TO IMPROVE PARENT CHILD RELATIONSHIPS Play games with child. Casual conversation. Bring the child new places. Rewarding.

46. A-Z of Parenting Accept your child for the wonderful person he or she is. Be a good role model in all you say and do. Communicate respectfully and listen attentively to your child. Discipline fairly, firmly and with love. Encourage good eating habits. Find ways to get and stay fit together. Give chores that built responsibility. Hug your child to build self -worth.

47. CONT…. Instill respect for other people. Join PTMs and other school activities to assess child’s progress. Keep your promise or do not make them. Laugh together and enjoy each other’s company. Make family rules and enforce them consistently. Never use physical force on your child. Offer your help whenever needed. Praise your child for achievements as well as for efforts. Quickly stop your child from harmful activities.

48. CONT…. Read together often and make reading fun. Show patience and remember nobody is perfect. Teach health and safety rules. Use every opportunity to show your love. Value your child’s thoughts and opinions. Wait until you cool down before disciplining your child. Xerox and save records of your child’s achievements. You can make a difference in your child’s life…so parent with pride. Zoom over this ABC again and again.

49. CONCLUSION ­­The health of a neonate is very important following delivery and in the rest of the neonatal period as it may determine the subsequent status of the baby throughout life. Therefore, after delivery a careful examination, assessment and care of the baby should be carried out to determine science or complications which need further assessment or management either primarily from the pediatrician or from other specialities to ensure proper growth and development of the baby. The parent child relationship consists of a combination of behaviours, feelings and expectations that are unique to a particular parent or a particular child. Whereas, parenting is the process of promoting and supporting the physical, emotional, social and intellectual development of a child which is having different styles of child rearing.

50. SUMMARY In this presentation on Observation and care of Newborn and Parenting process, we discussed about; Introduction. Definition of Neonate, Neonatal period, New born care. Types of newborn care. Elements of newborn care. APGAR scoring. Objectives of immediate newborn care. Care at birth.

51. CONT…. Objectives of later care of newborn. Later care of newborn. Follow up advises. Parenting process. Types of parent child relationship. Parenting styles. Characteristics of a healthy parent child relationship. Factors influencing parent child relationship. Methods to improve parent child relationship. A-Z of parenting.

52. RECAPITUALIZATION Define newborn care. What are elements of new born care? What is the maximum and minimum scoring of newborn care? What are the factors influencing parent child relationship? What are the methods of parent child relationship?

53. BIBLIOGRAPHY Book reference: Pal Panchali, Textbook of Pediatric Nursing for Nursing Students, 2 nd Edition. New Delhi; CBS Publishers and Distributors Pvt. Ltd.; 2021. P. 131-158. Dutta DC, Textbook of Obstetrics including Perinatology and Contraception, 8 th Edition. New Delhi; Jaypee Brother’s Medical Publishers (P) Ltd. 2015. P. 517-519. Net References: https://www.slideshare.net/SachinGadade4/newborn-care-83615506 https://www.scribd.com/presentation/519331548/CASE-STUDY-ON-OBSERVATION-AND-NEWBORN-CARE https://slideshare.net/reenelee_bonilla/parenting-ppt https://www.scribd.com/document/500226153/PARENTING-PROCESS