Prior to Newborn Video Week 1 Do not generally take blood pressure only if in NICU etc As we palpate brachial we want equal and femoral left and right AND we want brachial to be equal to femoral If femoral are less than brachial this could be cardiovascular issue or congenital heart anomaly get another nurse to assess then would probably do echocardiogram or Doppler study per doctors orders Need goggles to cut the cord assess the cord to see if 2 arteries and 1 vein the cord clamp would stay in place until the baby is ready for discharge Umbillical cord dries up and falls off will usually fall off 10 days 2 weeks discard it you teach how to clean and take care of it special scissors to cut the cord Sometimes need to check the blood glucose on a newborn look at risk factors as to whether the baby is at risk for hyperthermia hypoglycemia they lose body heat very quickly do lots of drying of the skin put under radiant warmer and want them skin skin with mom If baby is giving signs of hypoglycemia or protocols any baby less than 5 lbs or greater than 8 lbs routinely do bg on the capillary on the foot of the baby towards the center bc we have vessels and nerves that we can damange so do a heel stick on the periphery to increase the amount of blood we can use a heel warmer and it activates as you twist and press them the foot is in a dependent position gets more circulation to the area and wrap the foot in a blanket cleanse the area with alcohol Bulb syringe general syringe we use for adults sometimes if have a patient trying to get built up ear wax out creates negative pressure so when she pushes it into liquid it pulls the liquid up into it and then push liquid into ear and then turn head and warm soapy solution comes out not with newborn newborn depress the bulb syringe and try to clear secretions from oral pharynx in the mouth then sweep on sides of mouth the blow it out and get any other secretion after oral pharynx clean then clean the nares one of the bulb syringe will be in every babies bassinet if falls on floor get a new one parents are taught how to use this before discharge If bottle feeding baby soft nipple is for preemies born before 38 weeks gestation they don t have as much brown fat sucking pads so use softer nipples special pads for babies with cleft lip and palate too note how much the baby ingests and look to see how baby tolerates the feeding In special care nursery a newborn may need to have an orgastric tube put down smaller catheter measure from tip of nose to ear to xyphoid process and then the orgastric tube may stay down or may be an intermittent feed sometimes newborn baby hypoglycemia they need calories in so they don t burn brown fat so give formulas so they have calories in and wont have to work so hard to suck so put it orgastric tube place the baby after they ve been burped put the head higher than the rest of the body so it does not decompensate into respiratory distress Used to percuss secretions if baby aspirated secretions the cupping holds air so when we press in it makes the noise sounds like hitting them loosens secretions so then we can use a catheter to bring the stuff up or bulb syringe sometimes electric toothbrush to the chest to loosen secretion so they can suction out to prevent pneumonia and decrease risk for aspiration pneumonia in the newborn Amnihook long crochet needle and has a pointed tip on the end and if a practitioner not in scope of practice for rn or nurse midwife with sterile gloves pelvic exam assess cervix for thinning and if bag of water has not ruptured this is sterile they will slide amnihook with their fingers and nick it and pull it and the amniotic fluid will rupture either with a gush depending on where fluid on body or slow trickle amniotic fluid will leak from vagina until the baby is born the uterus doesn t know the membranes are ruptured so it keeps making fluid Once membrane ruptured we are at a risk for infection for organisms to ascend into the vagina and uterus increases bc wet warm environment so try to get mom in good labor pattern monitor fetal heart tone and monitor for infection mom can develop coreo amniotic 2 membranes that surround fluid can lead to endometritus postpartum in the mom or neonatal septus to the fetus so monitor very closely During fetal monitoring generally doing external fetal monitoring 2 belts on mothers belly one over the fundus bc most contractal part of the uterus than under to pick up fetal heart tones most likely where the babys back is feel the sides of mother abdomen back feels smooth and firm and arms and leg side would be more protruded if head down position the chest where the heart will be is the two lowere quadrants of the mother if head up then fetal heart sounds would be up in the top quadrants As longas good tracings from the fetus and getting accurate tracings from uterus we will continue with external monitoring don t want to add inside stuff if having difficult and try internal monitoring we can internally monitor the fetus by putting a scalp electrode practitioner and labor and delivery nurse can put it on scope of practice for l d nurse etc with a vaginal exam they would slide the scalp eletode to the head and the membranes have to be ruptured to do this and want the scalp electrode to go onto a bony prominence anterior fontanel is where 4 bones comes to gether we don t want the soft tissue so the practitioner pushes is out the electrode itself screws only ab 2 mm in length into the babies head and then we take these off outside the vagina so what is left is screwed into the scalp and the mom has a wire that attaches outside the vagina to velcrow on the inside leg which is attached to a monitor unscrew at end counterclockwise after baby is born DO NOT pull off If having difficulty monitoring uterine contractions not for a nurse catheter goes up vagina into uterus around baby through amniotic fluid if floating membranes have to be ruptured the end part of catheter out of the vagina attached to fetal monitoring and tells us the exact mm of pressure that the uterus is exerting when having contractions and that there is adequate resting time these increase infection though CALLED AN IUCP INTRAUTERINE PRESSURE CATHETER How to scrub tell you amt of time if NICU we do a 3 minute scrub newborn nursey 3 minute hand wash not with a brush take watches and rings off have an brush with impregnanted soap divide the time per hand something plastic that cleans under …