Case Study On Observation and Newborn Care

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CASE

STUDY ON
OBSERVATI
ON AND
NEWBORN
CARE
Submitted By
Ankita Manna
M.Sc Nursing 1st Year
EBMCON

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Introduction
Newborns are one of the most curious and interesting humans you could ever encountered.
They continue to become everyone’s joy wherever they go. As their healthcare provider, we
are one of them who handled 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.
Care provided during the prenatal and neonatal period is critical to ensure the health of
mother and baby and new born care is a comprehensive strategy designed to improve the
health of new born through intervention before conception, during pregnancy and soon after
birth. Components of essential new born care are ensuring warmth, immediate skin to skin
care, initiation of early breast feeding, umbilical cord care, eye care, vitamin K administration
and immunization.
DEFINITION
“The period from birth to 28 days of life is called neonatal period and infant in this is termed
as neonate or new born baby.” The first week of life is known as early neonatal period and
the late neonatal period extends from 7th day to 28 days of age. Care given to new born
during neonatal period is known as new born care.
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.

ELEMENTS OF NEW BORN CARE


A) Basic preventive care including clean delivery practices and exclusive breast feeding.
B) Early detection of danger signs.
C) Treatment of problems such as sepsis and birth asphyxia.
APGAR SCORE
 Apgar scoring is described by Dr.Virginia Apgar.
 It is useful to quantitative assessment of newborn’s condition at birth especially for
the respiratory, circulatory and neurological status.
 Five objective criteria are evaluated at 1 minute and 5 minute, after the newborn body
is completely born.

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APGAR SCORE
Respiration

Heart rate /minute

Muscle tone

Reflex irritability

Skin colour

 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 & 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.

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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.

CARE AT BIRTH
1. Wipe mouth and nose of secretion after delivery of the head with clean sterile gauze pad.
2. Position- Trendelenburg- Head lower than the 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.
3. Gently suctioning with bulb syringe and short catheter from mouth first then nose to
prevent aspiration of fluid into the lungs.
4. Deliver the baby onto a warm, clean and dry towel or cloth and keep on mother's abdomen
or chest (between the breasts).
5. Wipe both the eyes separately with sterile swab.
6.Clamp and cut the umbilical cord after 1 minute, if baby breathing well.
7. Immediately dry the baby with a warm clean towel or piece of cloth.
8. Assess the baby's breathing while drying.
9. Leave the baby between the mother's breasts to start skin-to-skin care for at least an hour.
10. Cover the baby's head with a cap. Cover the mother and baby with a warm cloth.
11. Place an identity label/band on the baby.
12. Encourage mother to initiate breastfeeding (within half an hour of birth in normal
delivery) & (after 2 hrs. in LSCS)

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

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
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 .
 Colostrums feeding must be offered.
 Mother should be informing about the importance and techniques of breast feeding.
 Demand feeding should be encouraged.
 Exclusive breast feeding procedure should be explained to the mother and family
members
SKIN CARE AND BABY BATH
 The baby must be cleaned off blood, mucus and meconium.
 No vigorous attempts should be met to remove the 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.
 During winter months the baby should have sponge bath rather than deep bath to
avoid hypothermia.

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 Use of olive oil or coconut oil can be allowed after 3-4 weeks of age. Oil massage
improves circulation and muscle tone.
 Oil massage should be given before the bathing.
 Exposure to morning sunrays is an important source of vitamin D and warmth.
 The talcum powder should be applied over the axillae , groins and buttocks.
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 clip.
 The cord 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 of after 5-10 days.
 Application of triple dye or junction violet is not advocated as a routine any more.
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.
CLOTHING OF BABY
 The baby should be dressed with loose, soft and cotton cloths.
 Large buttons synthetic frock and plastic or nylon napkin 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 winter woolen clothing should be used.
GENERAL CARE
 The new born should be kept with the mother for continues rooming in a well
ventilated room.
 Baby be should handled with gentle approach after hand washing.
 No infected person should take care or touch the baby.

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 Baby should allow to sleep in a 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 change immediately.
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.
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, mucus, blood,
passage of meconium and reduction of extracellular blood volume & also due to
adaptation to new environment.
 With adequate breast feeding majority of babies regain the weight within 7-10 days of
birth.
IMMUNISATION
 within first week of life.
 The mother should be informed about national immunization schedule and
explanation should given about important of complete immunization and all possible
reaction 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
FOLLOW UP AND ADVISES
 Each infant should be followed up, at least once every months 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.

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CONCLUTION
The newborn care is very essential to reduce infant morbidity and mortality rate.
BIBLIOGRAPHY

1. C.S.Dawn,Pictorial and practical under graduate and post graduate text book of
obstetrics ,neonatology and reproductive and child health education.16
ed.Kolkatta,India:2004.p.79-96.
2. Myles ,Diane M.Fraser,Margaret A. Cooper.Myles text book for midwives.5
ed.China:Elseiver;2009.p.167-182.
3. Sudha salhan ,text book of obstetrics, first ed. New Delhi, India: Jaypee
publications;2007.p.1.
4. Sabaratnam Arul kumaran, V. Siva nesaratnam, Alokendu chatterjee, Pratap kumar.
Essential of obstetrics. New Delhi, India: Jaypee publishers, 2004.p.102-107.
5. Samantha M .Pfeifer.National medical sciencesfor independent study obstetrics and
gynaecology .6 ed.New Delhi, India:Lippincott Williams and Wilkins;2008.p.42-52.
6. Susan L.Ward,Maternal –child nursing care.India:Jaypee publications;2010.p.256-
286.
7. TK.Indrani ,Text book of Midwifery.New Delhi,India:Jaypee publishers;2003.p.1.

(B).REFERENCES ON JOURNALS :

1. Asim kwyak , Frank A.Chervenak.Donald school journal of ultrasound in obstetrics


and gynaecology . New Delhi,India: January-march 2010. 4(1).p.13-16.
2. Lynn L.Simpson.Obstetrics and gynaecology clinics of North America . London
:Elseiver publishers;March2004.31(1).p.35.
3. Micheal O.Crardner,Manju Monga . Obstetrics and gynaecology clinics of North
America . London :june-2004.31(2)p.345.
4. Neal M. Lonky .Obstetrics and gynaecology clinics of North America. London: Dec-
2002.29(2).p.613-614.
5. Susan M.Ramin. Obstetrics and gynaecology clinics of North America. London: Sept-
2001.28(3).p.513.
6. Val Vogt ,Thomas D.Elmora,Frank Wiling. Obstetrics and gynaecology clinics of
North America. London: june 2001.28(2).p.189- 202.

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