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How to do the proper procedure of newborn

Unang Yakap>Do the hand washing

>Double gloving

>Call out the time of birth

>Put the baby at the mothers abdomen between the breast immediately.

>Use blanket to dry the baby at least 30 seconds. : To stimulate the baby to breath.

>Do not wipe off the vernix caseosa : to provide natural protective cover of the baby.

>Do not wash the baby within 6 hours: to prevent hypothermia and infection.

>Do a rapid assessment while drying the baby.

>Remove the wet cloth.

>Initiate skin to skin contact: put the baby at the abdomen or between the breast.

>Cover the head of the baby by using bonnet.

>Use second linen to coversthe babys back: To keep the baby's warm.

>Remove the first gloves: to prevent infection.

>Do not cut the cord immediately: allow cord pulsations to stop without milking.

>Clamp the cord at 2cm from the umbilicus base.

>Apply 2nd clamp at 5cm from umbilicus.

Benefits of proper cord Clamping

A. Prevent anemiaB. Lower the rate of intraventricular hemorrhage

>Injects 10IU oxytocin to the mother arm: to prevent uterine atony.

>Apply skin to skin contact: check the mothers condition then deliver the placenta .

>Examine how heavy the bleeding is and examine the perineum.

Benefits of Skin-to-Skin Contact

A. Promotes bonding between mother and childB. Overall success of breast feeding/colostrums feedingC. Allows colonization with maternal skin floraD. Protects baby from hypoglycemia

>Encourage the crawling reflex

After the babys breastfeed complete

1. Administer the erythromycin and Vitamin KRationale: Eye care to prevent opthalmia neonaturum or prevent blindness.

>Keep the child in the mothers arm.

>Rooming in the mother and the newborn

>The baby is wash after 6 hrs.

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Goals of Department of Health (DOH)

Unang Yakap

1. Eradicate extreme poverty and hunger.2.

Achieve universal primary education.3. Promote gender equality and empower women.

4. Reduce child mortality.5. Improve maternal health6. Combat HIV/AIDS, Malaria and other diseases.7. Ensure environmental sustainability.8. Develop a Global partnership for development.

Benefits of Skin-to-skin contact

1. Promotes bonding between mother & child.2. Overall success of breast feeding/colostrums feeding.3. Allows colonization with maternal skin flora.4. Protect the baby from hypoglycemia.

Assessment of the patient prior and after delivery

Nursing Care in Labor/delivery

On Admission need to be calm and reassuring.

Mother may be stressed and tired.

Collecting data:Need to know EDC, previous OB history, pre-natal care.

Onset of laborcontractions, bloody show, condition of membranes.Vital signsmother and baby.

Nursing Care During Labor

During Latent phase:

Vital signs and interview on admission

Encourage activity and ambulation (if ROM intact).

Provide information regarding what to expect.

Diet may be only clear liquids or NPO.

Nursing Care During Labor

During Active phase:

Mother will be concentrating more on her labor.

Assess her ability to cope and effectiveness of her support system.

Never leave mother in active labor alone.

Offer opportunity to void every two hours.

Usually will be NPO with IV fluids to provide for hydration and medications as needed.

Nursing Care During Labor

Transitional phase:

This is the last bit of stretching that must be done before birth.

Most difficult part of the labor process.

Prepare for delivery

At complete dilatation for primigravida

At 7-8 cm for multipara

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Nursing Care During Labor

Continue to offer opportunity to void as needed.

Vital signs for mother and baby more often.

Signs you might observe are:

Nausea/vomiting

Involuntary shaking/tremors of the legsMood changeDesire to push

Nursing Care During Labor

With rupture of membranes:

Assess fetal condition by noting FHTs

Note amount and color of fluid:Meconium staining

With PROM these additional problems may occur.InfectionProlapsed cord

Preparation for Delivery

Provide for cleanliness throughout labor.

Perineal cleansing

Prepare sterile table and equipment.

Provide emotional supportive care to patient and family.

Notify physician .

Evaluating the Fetal Condition

The fetal heart tones are the best indicator of fetal condition.

Can be assessed with fetoscope, doppler, or monitor.

Best to listen during or immediately following a contraction to determine fetal distress.

The Fetal Heart Tones

The location they are best heard can be an indicator of fetal position.

Above the umbilicus may be a breech position.

Below the umbilicus probably indicates a vertex presentation.

The Fetal Heart Tones

The location can also indicate fetal descent.

May be heard in the side at the level of umbilicus at first.

As progress is made in descent will be closer to midline and lower.

Just prior to birth may be in midline just over the pubic bone.

The Fetal Heart Tones

Generally will need to establish a baseline for each baby.

Average range for normal FHTs is 120 to 160 beats per minute.

Should have beat-to-beat variability of 610 per minute.

Decelerations of Fetal Heart Tones

May indicate fetal distress.

Should be evaluated in relation to the contractions.

Early decels are early in the contraction as it is beginning.

Late decels occur late toward the end of the contraction.

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Variable decels do not show any typical pattern in relation to the contractions.

Nursing Care During Stage Two

Continue to assess vital signs of mother and baby more often as labor progresses.

Watch for signs of impending birth:Bulging perineum

CrowningDilated anusUncontrollable urge to push

Perineal cleansing prep.

Notify physician

Danger Signals to Note

Abnormal vaginal bleeding

Cessation of contractions after labor established

Elevated B/P, sever headaches, blurred vision

Elevated temperature, pulse, respirations

Rigid uterus after contraction

Exhaustion

Danger Signals

Irregular fetal heart rate:

Persistent tachycardia

Persistent bradycardia

Decelerations

Meconium-stained amniotic fluidHyperactivity of the fetus

Prolapsed of the cord

Assisted Deliveries

Forceps may assist mother in delivery to shorten the 2nd

stage of labor.

Mother may be exhausted and unable to push.

Baby may be showing of fetal distress.

Low outlet forceps may be used.

Vacuum extraction is another method.

Care of the Infant

Airway clearance and establishment of independent respirations are the first priority.

Warmth is of immediate concern as well.

Cord is clamped and cut.

Bondinggive baby to parents as soon as possible.

Assessment of Neonate

Apgar Assessment Results

Rating of 710 is a vigorous newborn.

Rating of 46 is a moderately depressed newborn who may require some intervention.

Rating of less than 3 is s severely depressed baby who will require intervention.

Prophylactic Care

Eye treatment

To prevent opthalmic neonatorumConjunctivitis from gonorrhea or clamydia

Ilotycin, Tetracycline, Silver Nitrate

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Aquamephyton

To prevent bleeding problems in newborn.

Vitamin K is given as one time dose of 0.5-1 mg.

Other Needs of the Newborn

Identification is very important.

Triple band bracelets are commonly used.

Babys footprints and mothers thumb prints are used, as well as a photo.

Security is also an important concern.

The OB area is a locked, secured

unit.

Nursing Care During Stage Three

Placenta is delivered following birth of the baby.

Pitocin hastens delivery of the placenta and is usually given at this point.

Signs of placental separation are:

Globular shape and firm uterusLengthening of the cord

Gush of blood or increase in bloody flow.

Stage Three

Mechanism of placental delivery are:

Schultze Mechanism--80% of the time the shiny fetal surface is seen first.Duncan Mechanism20% of the time the dull maternal surface escapes first.

The placenta will be carefully inspected after delivery

For abnormalities

For completness

Nursing Care During Stage Four

Early Post-partum recoverythe first 1-2 hours after delivery.

Careful observation and assessment is of utmost importance and may be done every 15 minutes

during the first hour.Check B/P, PulseFundal tone and location

Lochial flow

Perineal assessment

Hemorrhage is the number 1 priority of concern at this time.

Pitocin may be use to control P-P bleeding.

Warmth is also a need during this period.

May be hungry and thirsty.Allow for privacy with family for bonding.