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the cough reflex. • Paper and pencil, and the patient call light are kept within reach of patient to ensure a means of communication. • Psychosocial care Pediatric Nursing and child health care 39 Tracheostomy tube and skin care: • Inspect tracheostomy dressing for moisture or drainage • Wash hands • Explain procedure to pt. • Wear clean gloves, remove soiled dressing and discard. • Prepare sterile supplies (hydrogen peroxide, normal saline, or sterile water, cotton tipped applicators, dressing materials). • Put on sterile gloves. • Cleanse wound and tracheostomy tube with sterile applicators moistened with hydrogen peroxide and rinse with sterile saline. • If old tapes of outer cannula are soiled change it with care and secure with a knot. • Remove old tapes and discard. • Use sterile tracheostomy dressing and fit securely to cover the incision. Pediatric Nursing and child health care 40 Study Questions 1. What are the indications for Oxygen administration? 2. What are similarities and difference in giving IM medication to children and adults? 3. Discuss about the indications for NG tube feeding. 4. Discuss about the possible causes of fever in children and its management. 5. Discuss about the care of a child admitted to hospital in state of coma. 6. List the possible causes of convulsion in children. Pediatric Nursing and child health care 41 CHAPTER FOUR CARE OF THE NEW BORN Learning Objectives: After studying the material in this unit, the students will be able to: - Provide basic delivery room care for the new born - Identify high risk new born as early as possible and able to undertake basic neonatal resuscitation - Provide proper nursing care for the normal neonate immediately after birth - Perform assessment of the newborn before discharge - Detect and manage the common neonatal problems - Refer neonates with serious problems as soon as possible to higher facilities 4.1 Care of Normal Newborn: A) Care at birth: • Clear air way ( suction mouth and pharynx) • Temperature control ( dry and wrap with dry cloth) • clamping the cord immediately after the birth of baby app. 2.5 cm from abdomen Pediatric Nursing and child health care 42 • provide appropriate eye care to prevent Ophthalmia Neonatorum( TTC eye ointment) • Identification of newborn with mothers name • Vitamin K injection to prevent hemorrhagic disease of the newborn • Measurement (Weight, Height, Head circumference) • Encourage rooming-in immediately after delivery Assessment of APGAR score: • 7-10 well adjusted • 5-7 mild asphyxia • 3-4 moderate asphyxia • < 3 severe asphyxia B) Care in the Postnatal Ward: • Handle the baby gentle • Avoid infection (hand washing) • Keep the baby warm • Encourage and initiate exclusive breast feeding -4 months of age • Encourage care of umbilical stump • Give immunization ( BCG & OPV0) C) Assessment of the newborn before discharge: • Take vital sign • Check for sign infections (eye , cord ,skin) Pediatric Nursing and child health care 43 • Check for birth trauma (cephalohematoma, fracture..) • Check for anomalies ( spina-bifda, imporforate anus, club foot…) • Carryout systematic examinations ( head to foot) D) Classification of the newborn: Newborns are classified based on their gestational age and birth weight. Gestational age defined as: Preterm defined as gestational age below 37 complete weeks Term defined as gestational age above 37-42 weeks post term defined as gestational age above 42 weeks Classification of Newborn by birth weight: Low birth weight (LBW- is defined as birth weight < 2.5 kg , they may be Preterm or small for gestational age (SGA) Very LBW - birth weight < 1500gm Large for gestational age (LGA)- birth weight above 90th percentile. Pediatric Nursing and child health care 44 Appropriate for gestational age (AGA)- birth weight between and 10th and 90th percentile Small for gestational age-(SGA) – birth weight below 10th percentile 4.2 Causes of Low Birth Weight (LBW): Fetal: 1. Fetal distress 2. Multiple pregnancies 3. Erythroblastosis fetalis Placental: i. Premature separation ii. Placenta previa Uterine: Incompetent cervix Maternal: 1. Pre-eclampsia 2. Chronic illness 3. Infection 4. PROM (prematurerapture ofmembrane) 5. Poly hydrominous
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