Methodological instructions

On the I semester students

by discipline «Clinical nursing»

Specialty: 8.110.100 „Nursing”

((Magister degree nurses)

Lesson 15 (practical - 7:00.)

Topic: 15. A newborn baby. Physiological, quizzes and pathological conditions in the neonatal period. The concept of the maturity of the newborn. Features of the methods of examination of the newborn.
Premature baby. Signs of prematurity, premature classification.
Primary toilet and nursing of newborn. Caring for newborns. Sanitation treatment of newborns.

Objective: Learn to evaluate the condition of a newborn baby and be able to organize the care and feeding of term and preterm infants, given the anatomical and physiological characteristics of the child's life period.

Professional orientation of students: the neonatal period is the most difficult dlyaadaptatsiyi child to new conditions of life. During this period manifested congenital diseases and malformations of the child. The organization proper care and feeding zapezpechyty allow optimal conditions for rorzvytku child in the future.

List of practical work:

Work 1. Inspect the newborn baby. Look for features on the "subjective examination of the child.

Work 2. Identify signs of transient state (states), which takes place in the subject.

Work 3. Demonstrate manifestations of functional maturity (immature) child.

Work 4. Using an extract from maternity hospital, read pregnancy and childbirth and to assess the child's condition at birth (Apgar score).

Work 5. Inspect the premature baby. Identify signs of prematurity.

Job 6. Absorb the history of the mother of the child to identify the factors. What contributed to the premature birth.

Work 7. Organize care and feeding inspect premature baby.

Work 8. Sanitation work of newborns.

Work 9. Organize nursing infants after discharge from the hospital.

4. List of the main issues addressed in class:

I. Topic number 1 practical lesson

             1. Anatomical and functional properties of full-term newborn. The concept of functional maturity of the child.

             2. Criteria Apgar.

             3. Transient states of the neonatal period.

II. Topic number 2 practical classes

             1. The concept of the premature newborn baby.

             2. Anatomical and functional features of a premature baby.

             3. Peculiarities of transient states in premature infants.

             4. organization of nursing and feeding, depending on the degree of prematurity.

III. Topic number 3 practical classes

             1. Pervynyny toilet newborn baby.

             2. Terms of schodennnoho care for a newborn.

             3.Osoblyvosti hygienic mode of newborns.

             4. Organization patronage newborn after discharge from the hospital.

5. A summary of the material.

Neonatology - the doctrine of a newborn baby.

Mature called the newborn child, which in morphological and functional tin ready for extrauterine life in a rational organization of food and care.

Functional maturity of the child is determined by the presence of unconditioned reflexes life support (sucking, swallowing, search). The child is able to maintain adequate body temperature at ambient temperature, sufficiently active, shouting, according respond to stimulation with light, sound. Cardiovascular and respiratory systems operate rhythmically.

Immature newborn - full-term newborn, which are signs of morphological or functional immaturity manifested abnormalities in the adaptation to extrauterine life.

 Separately identify the concept of functional immaturity, resulting inability to maintain a constant body temperature when adequate ambient, reduced physical activity a child, weak cry, decreased reflexes, m "yazevoho tone, the appearance of seizures apnea and cyanosis.

The maturity of the child on morphological features determined by means of special tables that contain a list of external signs of the newborn, each of whom scored. In the past the amount determined by the degree of prematurity. In outward signs carried biochemical surfactant in amniotic fluid.

Too late baby born after 42 weeks of pregnancy.

The main features of overdue child has signs of trophic disorders: skin desquamation of the palms and feet, dry skin, perhamentovydna, scaly. Turgor pressure is lowered. Maybe no syrovidnoy lubrication. There ztonshennya or absence of subcutaneous fat. Skin, nails, navel can be painted in a greenish-yellow color. Weight of the child while in the normal range or slightly reduced.

Prematurity is a baby born at term gestation less than 37 weeks, weighing 2500 and body length of 45 cm or less.

       Determining the neonatal period, perinatal period.

Neonatal period - from birth and lasts up to 28 days.

Early neonatal period - starting from birth to 7 days of life

Late neonatal period - from 8 days to 28

Perinatal period - from 28 weeks of fetal development by the end of the first week of extrauterine life

Late antenatal period - from 28 to 40 weeks of fetal development

Intrapartum period - from the beginning of delivery before birth

         The main stages of observation fetus, newborn, their task.

1etap-prenatal or children's clinic (prenatal nursing: 1st-12-14tyzh. Pregnancy, 2nd - 32-34 weeks. 3rd before delivery)

Stage 2 - Maternity

Stage 3 - section, nursing newborn

1 st - in the first 3 days after discharge home 2 - and at 20 days of life - child 3 rd - 1 month

      Transient states of N / N (10), causes

Transient loss of initial body weight, simple eritema (physiological catarrh) Physiological peeling skin, Tribal tumor, Toxic erythema, transient hypothermia, Transient hyperthermia Trynzytorna hyperbilirubinemia, sexual crises, Transient features of renal function (early neonatal oliguria, albuminuria, uric acid infarct Glycosuria), transient dyzbakterioz.

     Causes - the transition to extrauterine life changing barometric pressure transient tamperatura, other tactile stimuli (manipulation of medical personnel and others.) Microbial environment

 Transient (transient, borderline, physiological) states are the result neblahopryyemnoho influence of environmental factors and stress that appear after birth.

Transient skin condition:

Simple erythema - redness of the skin, which appears on the second day of life. Congestion is kept to the end of the first week. The duration and intensity of erythema depends on the maturity of the newborn. In premature infants, it takes up to 2-3 weeks.

After erythema remains finely-velykovysivkove or peeling. Other more pronounced in post-children, and hardly noticeable in premature novlnarodzhenyh.

In 20-30% of children observed toxicity erythema. It appears spotty, vesicle-papular, pustular eruptions sometimes size from a few centimeters to large spots. Sometimes appear vesicles with serous fluid.

Localized rash on the face, extensor surfaces of the extremities, buttocks. Never happens on the palms or feet.

The general condition of children do not suffer. The rash 2-3 days disappear.

These skin changes are allergic manifestations to breast milk proteins.

Treatment is usually not needed. In extreme cases, you can apply antiallergic means.

Transient hyperthermia

In some children in 2-3 days of life against the backdrop of a satisfactory overall observed increase in body temperature to 39-40 C. This coincides with the maximum weight loss after birth.

Hyperthermia air "bind with high admission foods rich in protein, which is insufficient colostrum and the introduction of fluid. Contributing factors also immature thermoregulatory center.

Condition newborns usually do not suffer. Sometimes a child may become restless, refuses breast, appears dry mucous membranes and skin.

Therapeutic measures deemed adequate fluid administration and not overheating baby.

Physiological weight loss

Weight loss in the newborn air "is correlated with relative starvation, shortfalls liquid water loss during physiological shipments breathing. It is believed that heating and cooling increases the physiological loss of weight.

The maximum weight loss observed at 3-4 days after birth and is 6-9% greater weight loss observed in preterm (14%) and children with high birth weight.

To 6-7 day supply of most children recovered, the rest mass normalization observed up to 10 days.

Warning mass loss is an early attachment to the breast (in the first 8 hours after birth), sufficient introduction of liquid (bp "boiled water, 5% glucose).

In the first 5 days of liquid is introduced into the volume "bulk has been determined 5 ml / kg / d and 6-day - 6 ml / kg / d, but should not exceed 60-70 ml / d

Hormonal or "sexual" crises

The emergence of the crisis caused by the hormonal influence of estrogen hormones mothers since 7 months of gestation in utero pass from mother to fetus.

One pryaviv sexual crisis is symmetric breast engorgement, which appears at 2-4 days of life, reaching a maximum size up to 6-7 days.

This phenomenon is observed both in girls and in boys. Mammary glands are usually slightly enlarged, sometimes they swell to the size of walnuts. The skin over them strains may become hyperemic. Clicking secreted from the glands whitish liquid which reminds colostrum.

Treatment of this condition requires. It Memory "favorites that any press launch not because of the possibility of infection and suppuration of the breast.

Under the influence Folliculin girls recently seen deskvamatsiynyy vulvovaginitis - mucous in "yazki allocation grayish color, consisting of squamous vaginal epithelium and glandular tissue of the cervix. These manifestations are held during 1st 3 days.

For 3-7 days after the birth of girls in some cases appear minor blood "herbaceous, mucous discharge from the vagina.

Mili (Comedones, villia)

It's small (size 1-2 mm), whitish spots, which slightly increased over the skin. Situated largely on the tip of the nose or wings, at least on the cheeks, chin and forehead.

The appearance of spots, caused by hypersecretion of the sebaceous glands and the accumulation of secretions.

Mili frequently observed in full-term newborns, but may appear in preterm infants. The rash itself disappear within 1-2 weeks. Forecast favorable treatment is not performed.

Uric acid renal infarction

In the first weeks of life urine can be painted in a reddish color and become slightly turbid. Thus the remaining spots pelentsi tsehlovo red (urate).

Increased excretion of uric acid in the urine due to thickening of the blood, a small amount of concentrated urine. Latest caused by lack of ability to dissolve in a small eilkosti many urine urate. Significant role vidihaye increased basal metabolism as a result of the transition to extrauterine life. It is dominated kabolichni processes and collapse of a large number of cells. Metabolic products which ultimately is uric acid.

At autopsy in the renal tubules observed urate attacks.

Treatment consists of adequate fluid administration to increase urine output. If more than a week on pelentsi remain red spots, you should think about alkaptonuriyu.

Physiological albuminuria

The appearance of albuminuria due to increased permeability of capillaries, congestion of blood during childbirth and massive erythrocytolysis in the first days of extrauterine life.

Physiologic hyperbilirubinemia (physiological jaundice)

Transient jaundice appears, usually on a 2 -3 day life. In 60-70% of infants it is accompanied by jaundice skin. In very severe hiperbidirubinemiyi zhovtushnoho color comes not only the skin but also konyunktyvy, mucus, tears, spynnoyozhova liquid. Emptying normal color.

The appearance of yellow on one side due to increased erythrocytolysis on the other - reduced functional ability of the liver to capture indirect bilirubin. In addition, the latter can not enter into communication "Connection with glucuronic acid from the low enzymatic activity of the liver. The collapse in erythrocytes contributes shortened life span of red blood cells, ineffective erythropoiesis.

The general condition of children with physiological jaundice does not suffer. Sometimes in severe jaundice children become somewhat "yalymy in" yalo suck.

Zhotyanytsi length does not exceed 10-14 days. Premature she expressed stronger and held for 2-3 weeks.

Physiological jaundice is when the level of bilirubin in the blood serum does not exceed 205.2 mg / dL. Premature ditey_ bilirubin not more than 256.6 mg / dL.

Treatment is not required at physiological jaundice. When pronounced jaundice give children to drink 5% glucose between feedings.

Transient intestinal catarrh (physiological dyspepsia, dyzbakterioz)

For 5-10 days in the life of the child appears loose stools. Stool often up to 10 times a day, liquid, mixed with mucus. The general condition of the child is usually not affected.

The appearance of intestinal catarrh caused by hypersensitivity secretory-motor apparatus intestine, accompanied by increased permeability of the intestinal wall. In addition, a role played by intestinal microflora population.

Treatment of this condition requires.

Methods regime obyem feeding premature

Basic rules of nutrition premature baby:

- First feeding depends on the gestational age of the child (earlier introduction of milk promotes maturation of the gastrointestinal tract, reduces the incidence of infections, improve the metabolism of calcium and so on.), And the degree of prematurity is applied to the chest in the first 2-3 hours;

- Adherence to the precautionary principle and continuity in purpose-feeding;

- 7-8 times a day feeding after 2.5 - 3 hours. Methods - h / tube, dropper, spoon, with a horn (not a joke) - the appearance of sucking reflex and breast - in steady sucking reflex.

- Children of the gestation period to 33-34 weeks feeding is conducted through a tube (intermittent or continuous method)

- Optimal for a premature baby is breast-feeding

      There are oral and parenteral nutrition of preterm infants. Oral nutrition begin in 3-6 hours. after birth with the introduction of sterile water, which in the case of aspiration less podraznyuvatyme lung tissue than glucose or milk, about 1-2 ml deep and extreme hlybokonedonoshenym, 3 ml - premature IIst., 5 ml - premature babies (ND) and art. Later, you can replace a 5% glucose solution, gradually increasing the amount.

      Begin feeding depending on the degree of prematurity, initial feeding (hours after birth)

And after 6 - 9 h IIcherez 9 - 12 h, the third after 12 - 18 h, IV within 24 - 36 hours

      Methods of calculating the daily amount of food for premature

      In the first 10 days of life:

1.Razova amount of milk (ml) = 3 x nxm, where n - day of life, m - mass in kg

2.Dobova amount of milk (formula Romelya): V ext. = (N + 10) x for every 100g weight, where n - number of days of life.

For example, a child weighing 1800 g at 4-day living needs (4 +10) x18 = 252 ml of milk per day, while a 7-meals to 36 ml per feeding.

       After a 10-day life

1.Obyemnyy method - 1/5 of body weight per day.

 Premature babies who are born with birth weight of 1500 g (III-IVst.) calculations lead to months of age on the true (actual) weight, and then the one that should be.

Prematurity, birth weight 1500 to 2000 g (second century.) - To two-week old on actual, then the ideal;

When a body weight more than 2000 g (I c.) Rely on food ideal weight.

2.Kaloriynyy method - according to the energy needs of a premature baby

I-II century. prematurity - 120-115 kcal / kg (the second month of life) - January-June, 115-110 kcal / kg - second semester.

III-IV century. prematurity - 120-115 kcal / kg (from the fourth month of life) - the first half, 115-110 kcal / kg - second semester.

      Indications for parenteral nutrition are:

1.nedonosheni III-IV century. (Hlybokonedonosheni, very hlybokonedonosheni);

2.nedonosheni I-IIst. with severe pathology;

3.nedonosheni that the first hours of not receiving enteral nutrition

6. Tests

1. What is observed in the premature baby?

A. Physiological weight loss.

V. Physiological erythema.

C. Transient fever.

D. Physiological jaundice.

E. Transient features of kidney function.

2. What kept physiological jaundice in newborns?

A. 2 weeks or longer.

V. 10-14 days.

C. Up to 10 days.

D. 7-14 days.

E. to 7 days.

3. On what day reduced physiological weight loss in premature baby?

A. 10-14 days.

V. 7 days.

C. 2.3 week.

D. 3.4 week.

E. On day 10.

4. How long does a physiological erythema in a premature baby?

A. Less than 3 days.

B. 3-5 days.

C. Up to 1 week.

DK 2 weeks.

E. to 7 days.

5. Healthy newborns put to breast in the delivery room

A. In the first 5 minutes after birth

B. Within the first 30 minutes after birth

C. After 2 hours after birth

D. After 5 hours after birth

E. After 10 hours after birth

6. Umbilical wound treated:

A. It is not treated

B. 1% solution of iodine

C. 30% boric acid solution

D. 30% solution of sodium sulfatsil

E. 5% solution of chlorine bleach

7. Prevention honoblenoreyi newborn is:

A. solution of penicillin

V. Solution furatsilinom 1:5000

C. 30% boric acid solution

D. 30% solution of sodium sulfatsil

E. 3% hydrogen peroxide solution

8. Normal sizes large fontanelles in newborn:

A. 1x0, 5 cm

V. 1.5 x 2 cm

SA 2x2, 5 cm

D. 2.5 x 3 cm

E. 3,5 x4 cm

9. Evaluation of the newborn by Apgar spend on:

A. 1 and 3 minutes of life

B. 1 and 5 minutes of life

C. 3 and 5 minutes of life

D. 5 and 8 minutes of life

E. 5 and 10 minutes of life

10.Yaki parameters considered for evaluation of the child by the Apgar score?

A. Frequency of breathing.

B. Heart rate.

S. Ripple cord.

D. All answers are correct.

E. All the answers are not correct

11. What number on the scale Apharotsinyuyutsya bluish skin color?

A. 0 points

B. 1 point

C. 2 points

D. 3 points

E. 4 points

12. In novonvrodzhenoho heart rate is 85 per 1 min. Rate this figure according to Apgar.

A. 0 points

B. 1 point

C. 2 points

D. 3 points

E. 4 points

Answers to tests:

1. The correct answer is C.

2. The correct answer is A.

3. The correct answer is C.

4. Correct answer: D.

5. The correct answer is A.

6. The correct answer is A.

7. Correct answer: D.

8. The correct answer is B.

9. The correct answer is B.

10. The correct answer is B.

11. The correct answer is A.

12. The correct answer is B.

Recommended literature:

1. Nursing process. Fundamentals of nursing and clinical nursing / Gubenko I., Shevchenko O.T., Brazaliy LP, Apshay V.G. / K.: Health, 2001.

2. Nursing process: a handbook for nurses / V.V.Loyko. - Kyiv 2001, Red Cross Society of Ukraine, 526 p.

3. Ackley, B., & Ladwig, G. Nursing diagnosis handbook: A guide to planning care (6^th ed.). St. Louis, MO: Mosby, 2004.

4. Nursing / Apanasenko G.L, Bogun S.A., Trostsinska N.M. and others. - Ed. By M.G. Shevchuk. - K.: Health, 1994. - 496 p.

5. Nursing in therapy: Tutorial / M.I. Shved, N.V. Pasyechko. - Ternopil: Ukrmedknyha, 2004. - 546 p.

6. Netyazhenko V.Z., Semin A.G., Prysyazhnyuk M.S. General and special nursing. - K.: Health, 1993.

Additional:

1. Davidson’s Principles and practice of medicine (20^th ed.) / by Boon N., Colledge N., Walker B., and Hunter J., eds. – Churchill Livingstone, 2006. – 1392 p.

2. Vitenko I.S., Dudka L., L.Y. Zimenkovska Principles of general and medical psychology. - K.: High School, 1991.

3. Lisytsyn Yu.P. Word about health. - Moscow: Sov.Rossiya, 1986.

4. Matveev V.F. Fundamentals of medical psychology, ethics and deontology.-2nd ed., Rev. and add. - Moscow: Medicine, 1989.

The Instruction has been worked out by: __________As. Prof. Ostrovska L.O.

The Instruction was discussed at the Department of Clinical Immunology, Allergology and General Patients Care sitting June …, 2012. Minute № ….

The Head of the Department of

Clinical Immunology, Allergology

and General Patients Care Prof. I. Ya. Hospodarsky, MD, D.M.

The Instruction was adopted at the Nursing School Cycle Methodical Commission sitting. June …, 2012. Minute №….

The Head of the Cycle

Methodical Commission As. Prof. Yastremska S.O., Ph.D, BSN

Ternopil 2012