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immediate new born care

nursing

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immediate new born care

  1. 1. MITTAL COLLEGE OF NURSING PRESENTATION ON IMMEDIATE AND ESSENTIAL CARE OF NEW BORN BABY SUBJECT :- OBSTETRIC $ GYNECOLOGY SUBMITTED TO, SUBMITTED BY MRS SNEHLATA PARASHAR Miss KHUSHBU RAWAT M.SC LECTURER B.Sc Nursing (OBG $ GYN) IVth Year SUBMITTETED DATE :- 27/03/2019
  2. 2. SPECIFIC OBJECTIVE:- At end at the class presentation, students will able to :- 1 To explain the introduction and definition of new born. 2 To discuss the characteristic and reflexes of new born. 3 To discuss the immediate care of new born. 4 To discussion the immunization. 5 Assessment of gestational age. 6 To discuss the essential and daily routine care. 7 Explain about the follow up care and general observation of new born. 8 To explain the grade of neonatal care.
  3. 3. NEW BORN BABY Introduction ;- The healthy new born infant born at term , between 38-42 weeks ,cries immediately after birth , establishes independent rhythmic respiration , quickly adapts with extra uterine environment.
  4. 4. Definition;- New born refers to an infant in the birth 28 days after birth , a new born is an infant with in hours , days or up to a few weeks from birth.
  5. 5. Characteristics of new born - 1.General measurement – weight= length= apgar score=
  6. 6. 2. Head measurement- Shape – round symmetrical , may have moulding and over riding suture. Head circumferance-33-35cm Fontanel in size ,shape- 1. Anterior- 2. Posterior-
  7. 7. 3.Eyes- Colour - blue white sclera Movement - random Reaction to light - pupils equal in size ,round and reaction to light. Tears - absent or occasionally Eyelids - Oedema present
  8. 8. 4.Ears- Reaction to noise – startle reflex to loud noise Position – symmetrical Patency – evidence of hearing
  9. 9. 5.NOSE= 1.Mucus-clear 2.patency-Infant are obligatory nose breathers. 6.MOUTH= Sucking and swallowing reflex present
  10. 10. 7.CHEST= 1.breast tissue – Nipple prominent 2.shape – almost circular and barrel shaped. 3. size – 30-35cm[12-13inches].
  11. 11. 8.Respiration - 1. Rate – 30-60 min 2. Rhythm – shallow ,irregular 3. muscular activity - diaphragmatic and abdominal 9.PULSE - 1. Rate - 120-160 min 2.Rhythm – irregular after crying
  12. 12. 10.ABDOMEN - Rounded ,protruded , bowel sound audible after 1-2 hours after birth. 11.UMBLICUS – 1.Apperance – clear ,gelatin,odorless 2.Number vessels at birth-
  13. 13. 12.ARMS - 1.movement –spontaneous. 2.Muscle tone –Flexed 3.fist – often clenched
  14. 14. 13.GENITO –URINARY - Female genitals – usually oedematous Male genitals – testes palpable each side Voiding – start by 24 hrs. after delivery ,3- 4 times/day. 14.RECTUM – Number of stool – meconium by 24 hrs.
  15. 15. 15.HIPS - Symmetrical , glateal folds even . 16 . SKIN –  Colour – generally pink  Birth mark – may be present  Lenguo – present over shoulder , pinnas ,forehead  Vernix caseosa – white , cheesy odorless , present in creases and folds .
  16. 16. CONT..... Hair – amount varies 17. TEMPRATURE – Normal – Heat loss – by conduction ,radiation and evaporation
  17. 17. 18.REFLEXES -  DOLL ‘S EYE – present  Rooting - present  Sucking /swallowing – present  Gag reflex – present  Grasp - present  Babinski – present  Moro – present  Tonic neck reflex – present
  18. 18. 19.CRY - 1.Frequancy – variable 2.pitch – moderate , pitch may be strong . 20. BEHAVIOUR – Responding to handling
  19. 19. .Reacts to environment . Eating ,sleeping pattern varies in interest 21.EXTERMITIES – 1.polydactyly 2.syndactyly 3.talipes equinovarus
  20. 20. 22.BACK -  Check abnormal spinal curvature  Spina bifida occulta ,meningocele ,meningomyelocele. 23.BUTTUCKS - Observed for any mass . Perianal area examined – anal opening ,anal fissures or any other abnormalities.
  21. 21. 24.PATTERN OF ELIMINATION - The neonate passes urine and meconium within 24 hrs. Afterwards for first few days baby voids 10-15 times and average six stool per day .
  22. 22. ASSESSMENT OF REFLEXES = 1. Reflexes' of EYE – 1.blinking – infant blink at sudden appearance of bright light or any object towards eye . At birth .
  23. 23. 2.Pupillary reaction - Pupil constrict when bright light falls on it
  24. 24. 3.DOLL’S EYE - At head is moved to right or left ,slowly . Disappearance – 3-4 month.
  25. 25. REFLEXES OF NOSE - 1.Sneeze – spontaneous response of nasal passage to any irritant .
  26. 26. 2.Globellar - Repetitive tapping on the forehead , cause eye to close tightly . At birth
  27. 27. REFLEXE’S OF MOUTH - 1. Rooting – Disappearance - 3-4 month
  28. 28. 2.SUCKING 3.GAG
  29. 29. 4.EXTRUSION 5.COUGH
  30. 30. REFLEX OF EXTERMITIES -  1.GRASP –  Disappearance – 3 month 2. BABINSKI – Disappearance - 1 yr.
  31. 31. BABINSKI -
  32. 32. MASS REFLEX’S -  1. MORO’S -  Disappearance – 3-4 month  2. TONIC NECK –  Disappearance - 3-4 month
  33. 33. MORO TONIC NECK
  34. 34. CONT...  3.CRAWL REFLEX  Disappearance – 4 weeks  4.DANCE / STEPPING –  Disappearance – 3-4 weeks .
  35. 35. CONT...
  36. 36. 5.GALANT [ TRUNK INCURVATION]
  37. 37. IMMEDIATE CARE OF NEW BORN INTRODUCTION –  Essential care of the normal healthy neonates can be provided by the mothers under supervision of nursing personnel or basic /primary health care providers . About 80percent of the newborn babies should be kept with their mothers rather than in separate nursery .
  38. 38. IMMEDIATE BASIC CARE  Maintenance of temperature .  Establishment of open airway and circulation .  Identification of new born .  Vitamin k injection .  Initiation of breast feeding .
  39. 39. MAINTENANCE OF TEMPERATURE -  Immediately dry the infant under a radiant warmer .  Skin to skin contact with mother .  Keep neonate head and extremities covered .  Rooming in [the baby should not be separated from mother ].  Bathing is avoided to prevent hypothermia and infection .  Temperature should be recorded and observation .  Avoided to unnecessary exposure and undressing baby.
  40. 40. ESTABLISHMENT OF OPEN AIRWAY-  [majority of babies cry at birth and take spontaneous respiration ]  When the head is delivered birth attendant immediately suction the secretions ,wipe mucus from face and mouth and nose .
  41. 41. CONT.... Suction the mouth and nose by using bulb syringe . Keep head slightly lower than the body . Position the baby on their backs or tilted to the side ,but not on their stomachs .
  42. 42. Importance of suctioning ;  As the foetal chest passes through the birth canal it is compressed ,squeezing excess fluid out of the baby taking its first breath.  After several seconds in this ‘’partly delivered ‘’ position ,fluid can be seen streaming out of the baby’s nose and mouth .
  43. 43. NEONATAL RESUSCITATION - Series of action ,used to assist newborn babies who have difficulty with making the physiological ‘transition ‘ from the intrauterine to extra uterine life . Neonatal resuscitation is a set of intervention used to assist the airway, breathing ,and circulation of a following birth.
  44. 44. CONT... It means a to support a maintain breathing ,circulation ,for an neonate .who has stop breathing or whose heart stop .
  45. 45. Initial steps of resuscitation -  Receiving the newborn baby in a prewarmed towel and placing the baby on the preheated radiant warmer .  AIRWAY-  Positioning the baby on the back with the neck slightly extended .[sniffing position]
  46. 46. SNIFFING POSITION
  47. 47. CONT...  Providing tactile stimulation – [rubbing the infant back , slapping the sole of the foot , flicking the heel ]. BREATHING – 1.Bag mask ventilation 2.Mouth to mouth 3.Mouth to mask
  48. 48. CHEST COMPRESSION -  Techniques –  1.two finger method.  2. two thumb encircling hand .  RATIO –  15;2 =2 RESCUE  30;2 = 1 RESCUE
  49. 49. APGAR SCORING - A –Activity /muscle tone P-Pulse / heart rate G-Grimace /reflex response A-Appearance /skin colour R-Respiration
  50. 50. A- ACTIVITY  0 points – flaccid /floppy limp  1 points – some flexion of extremities  2 point – active body movement P - Pulse rate 0 points –absent 1 points – below [100 beats /min.] 2 points –more than [100 beats /min.]
  51. 51. G-GRIMACE  0 points –no response  1 points –facial movement /grimace with stimulation  2 points – cry A-APPEARANCE 0 points –blue ,pale ,bluish -gray 1 points –body pink ,but extremities blue 2 points – complete pink
  52. 52. R-RESPIRATION  0 points –absent  1 points –irregular ,slow cry  2 points –good , strong cry TOTAL SCORE = 10 no depression – 7-10 Mild depression – 4-6 Severe depression – 0-3
  53. 53. CONT.....  Apgar score quick test performed on a baby at 1 -5 min. After birth .  The 1 min. Score determine how well the baby tolerate the birthing process .  The 5 min. Score tells the health care provider how well the baby is doing outside’s the mother womb .  In rare case ,the test will be done 10 min. After birth
  54. 54. NEW BORN IDENTIFICATION - New born identification before a baby leaves the delivery area , identification bracelets with identical numbers are placed on the baby and mother . Babies often have two ,on the wrist and ankle.
  55. 55. VITAMIN – K Vit.k prevent neonatal haemorrhage during first few days of life before infant is able to produce vit.k administration . Term infant [ 1mg ] –IM Preterm infant [ 0.5 mg ] – IM
  56. 56. ALTERNATIVE ROUTE - ORAL DOSE - 2 mg orally at birth REPEAT DOSE – [ 2 mg ] at 3-5 days and at 4-6 weeks of age .
  57. 57. INITIATION OF BREAST FEEDING -  Babies can be breast – feed as soon as the airway is cleared and they are breathing normally .  Breast feeding is the most effective way to provide baby with a caring environment and complete nutrition .  The first breast feeding should be with in 30 min. Of normal delivery and 4 hrs.in lscs .
  58. 58. CONT...  Breast milk and colostrums prevent neonate from anaemia and many nutritional deficiency disease .  Breast milk contains high lactose , low protein , enhance growth of lactobacillus which inhibit growth of E.Coli .  Breast milk reducing the risk of breast and uterine cancer in mother .
  59. 59. ASSESSMENT OF GESTATIONAL AGE AT BIRTH  INTRODUCTION –  Assessment of gestational age is mandatory for all neonates for further management . Last menstrual period is important clue for calculation of gestational age .  Using a new Ballard scale ,can be use with neonate born between 20-44 week gestational.
  60. 60. NEW BALLARD SCORE -  The Ballard scale is a commonly used technique of gestational age assessment .  These criteria are divided into two type physical and neuromuscular maturity .  The new Ballard score is a set of procedures developed by Dr. JEANNE L BALLARD .
  61. 61. COMPARISON - OLD NEW  Score ranged from 5 – 50 26 -44 wks.  Score starts with 0  Inaccurate in extremely preterm  -10 to 50 20 - 44 wks.  Starts with - 1  More accurate
  62. 62. cont...  Optimal age for maturational assessment ; between 30 and 42 hrs. Of age .  Eyes ; not included Birth to 96 hrs. Included
  63. 63. NEURO MUSCULAR MATURITY - 1.POSTURE ; As maturation progresses – increasing passive flexor tone. Increasing passive flexor tone – centripetal direction . Lower extremities slightly ahead of upper extremities .
  64. 64. POSTURE -

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