Presentation 1
Presentation 1
Presentation 1
OBJECTIVES
if any laceration.
• Help the mother in cleaning of her perineum after each voiding and evacuation.
• Clean the perineal area from the front to back to avoid infection. Clean with
• Instruct mother to wear perineal pads loosely and to lie in Sim’s position
(sideline position).
• Clean the episiotomy suture with antiseptic solution.
• Observe for any edema, redness, varicosites etc. if so, apply ice or cold to
decrease edema and reduction in pain due to anaesthetic effect.
• Apply dry or moist heat to the episiotomy for comfort and healing.
c) Breast Care and Breast Feeding
• Assess the breast for softness or hardness, condition of breast
nipples (e.g. flat, inverted, big/small, cracked etc.).
• Assess mother’s knowledge on breast feeding.
• Help the mother to breast feed within ½ an hour of delivery
ASAP. Put the newborn in monkey position on the mothers’
chest.
• Tell the mother to breast feed whenever newborn cries (demand
feed). Instruct her to feed 6 to 10 times a day from both the
breasts at each feed.
• Help the mother to position the new born properly while breast
feeding for adequacy. Tell the mother to adopt to timely feeding
(2/3 hourly)—Advice her for wearing well fitting brassieres.
• Instruct regarding care of newborn during and after breast feeding.
• Instruct the mother to identify for rooting reflexes (i.e. tell mother
to bring her breast nipples near the cheeks of the newborn and
newborn automatically turns to fix the mouth to the breast
nipples).
• Instruct her to hold the feeding breast with her fingers in a scissors
grasp hold.
• Relax and feed the baby from each breast at least for 5-10 minutes.
• Advice her to burp the baby after feeding from the first breast.
After feeding, repeat for the next breast (To burp the baby, hold
the baby in upright position).
• Advice her to put the baby in right sideline positions after feeding.
• Advice her to express the extra milk from the breast after each
feed.
• Clean the mouth of the newborn.
• — Cracked nipple
• — Sore nipple
Identification
• · Tie identification band for the baby and mother with the same information of date and
time of delivery, sex, name of father and mother.
• Essentials of Newborn Assessment
• · During transition period
• · Check APGAR SCORE at 1 minute and 5 minutes.
• · Clear the airway if there is excessive secretion.
• · Wrap the baby in a thick towel.
• · Put the baby under the warmer if it is necessary.
• · Assess the general status (size , weight, length, head and chest
circumference), gestational status, normality of body system, vital
signs.
• · Measure body temperature every 30 minutes until stable and 4 hours
thereafter
Physical Assessment of Newborn
• Physical assessment includes vital signs and head to toe examination.
Vital Signs
• · Respiratory rate (normal: 30-60 per minute)
• · Heart Rate: Apical rate (Normal : 120-160 per minute)
• · Temperature: Either axillary or anal
• · Weight: Weigh newborn at the same time each time before feeding.
• · Place newborn on flat surface and extend legs fully before measuring to check
the length of the baby.
• · Measure around the fullest part of the occiput to check head circumference.
• · Measure the chest circumference over the nipples and across the lower border
of the scapula
Detailed Physical Assessment
Head and Face
• · Head size in proportion to body
• · Presence of moulding.
• · Symmetry features,
Fontannels
• · Anterior fontannels: Diamond shaped 3-4 cms long, 2-3 cms wide at 18
months.
• · Posterior fontannels: Triangle shaped, closed by 8-12 weeks.
• · Tense bulging fontannels indicate increase of intra-cranial pressure
• · Sunken fontannel indicates dehydration
Eyes
• · Colour
• · Precocious teeth
• · Hearing
• · Neck size
Chest
• · Contour and symmetry (normally round and symmetrical)
• · Breast engorgement may be evident 2-3 days after birth due to maternal hormone withdrawal
• · Respiration: (normally shallow, symmetrical, synchronous with abdominal movement).
• · Breath sounds (crackles may be present during transitional period representing fetal lung fluid
and areas of atelectasis.
• · Rhonchi indicate fluid, mucus or meconium in the larger bronchi.
• · Heart sound: (murmurs can be heard in case of improper closure of foramen ovale or ductus
arterioles.
Abdomen
• · Contour of abdomen (normally round)
• · Umbilical cord (normally check for two arteries and one vein)
• · Scaffold (deflated) sunken abdomen indicates diaphragmatic hernia.
• · Bowel sounds (normally audible when newborn is relaxed).
Genitalia
• Female
• · Labia minora may have vernix
• · Labia majora (normally covers minora and clitoris)
Upper Extremities
• · Flexion and movement (normally well flexed with symmetrical movement)
• · Grasp reflex (normally present)
• · Muscle tone and strength
• · Brachial pulses (normally present)
Lower Extremities
• · Length and flexion (normally short, bowed and flexed)
• · Dry the hair and skin with warm soft dry towels.
• · Drape the neonate in blankets or put the neonate in heated environment.
• · Do not give bath until body temperature is normal and stable.