NURSING TOOL BOX SERIES

  SMALL FOR GESTATIONAL AGE This term refers to a baby whose birth weight is below 10 th  percentile of his gestational age commonly referred to as low birth weight but this includes preterm babies. They are susceptible to various problems including: ü  Congenital abnormalities ü  Foetal hypoxia that may lead to intrapartal death ü  Birth asphyxia due to inadequate perfusion, meconium aspiration leading to airway obstruction. ü  Hypothermia due to little subcutaneous tissues ü  Apnoeic attacks hypoglycemia  SIGNS AND SYMPTOMS ü  Mostly they are born after 37 weeks. ü  Pale, dry loose skin with wrinkles and have little or no lanugo ü  Subcutaneous fat is minimal ü  Shows features of retarded growth ü   The abdomen appears sunken ü   Sutures and fontanel appear normal ü  Eyes are alert and has mature facial expression ü  Skull bones are hard and allow little mobility ü  Have strong cry ü  Umbilical cord is thin ü  Swallowing and sucking reflexes are present so they feed well ü  Normal mu

  physiology of the pre term baby   1. Immunity is low due to: ·  Low gamma globulins responsible for immunity. ·  Delicate skin that is vulnerable to injuries and infection ·  Lack of passive immunity which  usually develops around 38 weeks gestation 2. Blood system ·  Has poor peripheral circulation with high tendency to hemorrhage because of weak vascular walls. ·  Prone to hemorrhage due to lack of clotting factors(vitamin A is administered to promote clotting) ·  Unable to store iron hence at risk of iron deficiency anemia. ·  They have very few blood cells and may develop non pitting anemia 3. Weight ·  Initially they lose up to 10% of their birth weight and start gaining and reach birth weight 2-3 weeks post delivery. 4. Temperature regulation is poordue to: ·  Immature heat regulatory centre ·  Limited food intake and low metabolic rate ·  Inability to shiver and generate heat ·  Excessive heat loss due to little or nosubcutaneous fat. The brown fat is usually in baby’s body by

  PRE TERM BABY    This refers to a baby born before 37 complete weeks of pregnancy. Some of them may have growth retardation and therefore be small while others may be excessively large for gestational age (macrosomia) Low birth weight baby is one with less than 2500g  predisposing factors 1. Maternal factors – maternal ageeg. Primigravida below 17 years or above 35 years 2. Maternal disease in pregnancy such as anaemia, hypertension, pre-eclampsia. 3. Foetal factors –congenital abnormalities; multiple pregnancy and polyhydromnous due to over distension of the uterus; rhesus incompatibility interfering with foetal viability 4. Placental factors –APHdue to placenta praevia and placenta abruption 5. Social factors –strenuous exercises, excessive drinking of alcohol and smoking, previous history of miscarriage, physiological stress.    clinical features   ·  Small stature with low birth weighs less than 2500g ·  Thin and sparsely distributed hair on the head. ·  Skin is reddish with plen

  CHARACTERISTIC OF NORMAL NEONATE   Weight is 2.5 -3.5 kgs. Length from vertex to heel is 45-52 cm Head circumference is 35 cm and increases by 1-2 cm during the first month Fontannelles and sutures are patent. Anterior fontanel closes at 18 -24 months while the posterior closes at 6-8 weeks. Skin is covered by vernixcaseosa, a secretion of the sebaceous gland that helps in heat retention and acts as a lubricant during delivery. Umbilical cord shrivels by necrosis and falls off in 7 days. The remaining part forms abdominal ligaments. Hernia may develop but usually disappears spontaneously. Reflexes are fully developed. Senses are developing.

  NORMAL NEONATE This refers to a baby born at term or as near term as possible after 37 weeks of gestation and has no complications. Upon birth the infant has to undergo physiological changes in order to adapt to life outside the uterus to have independent existence. PHYSIOLOGICAL CHANGES AT BIRTH 1. Respiration occurs due to: ·  Low oxygen and high carbon- dioxide stimulates respiratory center and respiration begins ·  Compression of the chest wall during second stage creates a vaccum and aid respiration ·  External stimuli e.g handling the baby, cold extra uterine environment makes the baby gasp and respiration starts ·  Baby is encourage to cry initially by flicking the sole of the foot for it allows complete aeration of the lungs ·  Presence of surfactant factor aids expansion of the lungs (lecithin:sphingomyelin =2:1 and is an indicator of lung maturity detectable on amniocentesis) The normal respiration rate at birth is 40-50/ min Irregular breathing may be due to the following

  FIRST EXAMINATION OF THE BABY   This is a routine procedure done after third stage of labour in labour ward but is also done in the nursery as part of admission procedure. The aims are; ·  To rule out congenital abnormalities ·  To rule out birth injuries ·  To assess maturity of the baby Head     ü  measure the head circumference (average is 35 cm ü  Check for the moulding of the foetal skull ü  Width of the fontannelles and sutures, bilging of fontanel and wide sutures may indicate hydrocephalus ü  Depression on the skull may imply a fracture ü  Injuries e.g caput succadenium and cephalohaematoma Eyes    ü  absence of eyebrows ü  Conjuctivalhaemorrage / bleeding ü  Any discharge and squint Nose ü  Check for any deformities e.g.Well formed septum ü  Bleeding from the nose ü  Check for nasal flaring which is a sign of respiratory distress ü  Check for blocked nostrils   Mouth ü  Bleeding from the mouth ü  Check for tongue tie ü  Abnormalities e.g cleft palate or cleft lip ü  Frothing

  INFECTION CONTROL IN THE NEW BORN UNIT Due to low immunity of the babies in the NBU, infection control is critical to protect the babies from infection during their stay in the unit. This is necessitates high infection control measures within the unit. The following are some ways of ensuring infection control in the nursery. ·  Keep the unit clean, free from dust. The windows should remain closed at all times to prevent flowing in of dusty air. ·  Daily dump dusting and cleaning of the incubator and cots ·  Isolation of infected babies for barrier nursing. ·  Restriction of visitors to ensure adequate control of human traffic into the nursery. Visitors should see the babies through the window glass. ·  Washing hand before and after handling the baby for any procedure. ·  Strictly observing aseptic technique while performing procedures. ·  Feeding utensils should be rinsed, decontaminated, cleaned thoroughly in soapy water and kept in presept till the next feed. ·  Staff working in is