BSc Nursing 3rd Year Child Health Nursing Chapter 3 Nursing Care Of Neonate Question And Answers

Nursing Care Of Neonate Short Answer Questions

Question 1. APGAR scoring
Answer:

Apgar is a quick test performed on a baby at 1 and 5 minutes after birth. The 1-minute score determines how well the baby tolerated the birthing process. The 5-minute score tells the healthcare provider how well the baby is doing outside the mother’s womb.

In rare cases, the test will be done 10 minutes after birth. The Apgar test is done by a doctor, midwife, or nurse.

Read And Learn More: Bsc Nursing 3rd Year Child Health Nursing Previous year Question And Answers

The provider examines the baby’s:

1. Breathing effort
2. Heart rate
3. Muscle tone
4. Reflexes
5. Skin color

Each category is scored with 0, 1, or 2, depending on the observed condition.

1. Breathing effort:

• If the infant is not breathing, the respiratory score is 0.
• If the respirations are slow or irregular, the infant scores 1 for respiratory effort.
• If the infant cries well, the respiratory score is 2.

2. Heart rate:

• Heart rate is evaluated by stethoscope.
• This is the most important assessment:
• If there is no heartbeat, the infant scores 0 for heart rate.
• If the heart rate is less than 100 beats per minute, the infant scores 1 for heart rate.
• If the heart rate is greater than 100 beats per minute, the infant scores 2 for heart rate.

3. Muscle tone:

• If muscles are loose and floppy, the infant scores 0 for muscle tone.
• If there is some muscle tone, the infant scores 1.
• If there is active motion, the infant scores 2 for muscle tone.

4. Reflex Or Grimace: Grimace response or reflex irritability is a term describing a response to stimulation, such as a mild pinch:

• If there is no reaction, the infant scores 0 for reflex irritability.
• If there is grimacing, the infant scores 1 for reflex irritability.
• If there is grimacing and a cough, sneeze, or vigorous cry, the infant scores 2 for reflex irritability.

5. Skin color:

• If the skin color is pale blue, the infant scores 0 for color.
• If the body is pink and the extremities are blue, the infant scores 1 for color.
• If the entire body is pink, the infant scores 2 for color.

Question 2. Kangaroo Mother Care (KMC).
Answer:

Kangaroo Mother Care Introduction:

• Caring for low birth weight babies is a great challenge for the neonatal care unit and the family.
• Number of low-birth-weight babies is still far beyond the expected target in our country.
• The cost of quality management of these babies is increasing day by day. Kangaroo mother care is a low-cost approach for the care of low birth weight baby

Kangaroo Mother Care Definition :

• Kangaroo mother care ( KMC ) is a special way of caring for low birth weight ( LBW ) infants by skin-to-skin contact.
• It promotes their health and well-being by effective thermal control, breastfeeding, and bonding KMC is initiated in the hospital and continued at home. Three important aspects of KMC are kangaroo position, nutrition, and follow-up

Kangaroo Mother CareComponents: In KMC, the infant is continuously kept in skin-to-skin contact by the mother and breastfed exclusively to the utmost extent.

The two components of Kare:

1. Skin-to-skin contact: Direct, continuous, and prolonged skin-to-skin contact is provided between the mother and her baby to promote thermal control
2. Exclusive breastfeeding: Skin-to-skin contact promotes lactation and feeding interaction with exclusive breastfeeding for adequate nutrition and to improve desired weight gain.

KMC Benefits :

• KMC helps in thermal control and metabolism. Prolonged, continuous, and direct skin-to-skin contact between the mother and neonate provides effective thermal control and reduces the risk of hypothermia.
• KMC results in increased duration and rate of breastfeeding.
• KMC satisfies all five senses of the infant. Baby feels the warmth of the mother through skin-to-skin contact ( touch ), listens to mother’s voice and heartbeat ( hearing ), sucks the breast to feed ( taste ), smells the mother’s odor ( olfaction ), and makes eye contact with the mother’s ( vision)
• During KMC, the baby has more regular breathing and less predisposition to apnea
• KMC protects against nosocomial infection and reduces the incidence of severe illness including pneumonia during infancy
• Daily weight gain is slightly better with KMC, and the duration of hospital stay may be reduced. LBW babies Receiving KMC could be discharged from the hospital earlier than conventional care.
• KMC facilitates better mother-infant bondage due to significantly less stress during kangarooing than the incubator care of the baby.
• KMC is one of the best methods of transporting small babies by keeping them in continuous skin-to-skin contact with their mother or family members
• The mother feels increased confidence, self-esteem, a sense of fulfillment, and deep satisfaction with KMC. Father feels more relaxed, comfortable, and better bonded
• KMC does not require additional staff compared to incubator care.

KMC Preparation:

• Counseling:
  • Explain the benefits of KMC to the mother and the family members.
  • Demonstrate the procedure to the mother gently and with patience. Answer the questions as asked by the mother and the family members to remove anxiety.
  • Allow the mother to interact with someone who has already practiced KMC for her baby.
  • Discuss the procedure with the mother-in-law, husband, or any other members of the family.
• Mother’s Clothing: The mother should wear a front-open, light dress, as per local culture. Mother can wear a sari blouse, gown, shawl, etc.
• Baby’s Clothing: Socks, Baby should be dressed with a front-open sleeveless shirt, cap, and hand gloves.

Question 3. Essential newborn care
Answer:

Newborn care: Assessment of newborn as soon as possible after birth.

The purpose of the initial assessment is mainly to assess the need for resuscitation, to ascertain the gestational age, and to detect the presence of any congenital anomalies or any disorders that may affect the well-being of the baby. It should be done at the time/ place of birth by the trained birth attendant immediately after delivery of the neonate.

Newborn Care Initial Assessment:

• The initial assessment of neonates is a very important activity immediately after birth. The most essential assessment is the ” first cry “. A good cry helps in the establishment of satisfactory breathing.
• The respiration, heart rate, and skin color are the basic criteria that should be evaluated immediately to determine the need for life-saving support, i.e. resuscitation.
• The physiological status including temperature, degree of consciousness, general level of activity, gross congenital anomalies, presence of birth injury, meconium staining, and evidence of shock also need to be ascertained immediately and promptly after birth
• Another significant assessment of the neonate is ‘ Apgar scoring’ as described by Dr. Virginia Apgar. Despite its limitations, it is a useful quantitative assessment of the neonate’s condition at birth, especially for the respiratory, circulatory, and neurological status.
• Five objective criteria are evaluated at one minute and 5 minutes after the neonate’s body is completely born. The criteria are, respiration, heart rate/minute, muscle tone, reflex irritability, and skin color

Immediate Basic Care of Neonates:

Immediate basic care of the newborn at birth includes maintenance of temperature, establishment of an open airway, initiation of breathing, and maintenance of circulation. As the majority of babies cry at birth and take spontaneous respiration, no resuscitation is required at birth in about 95 to 98 percent of neonates.

• These healthy normal neonates need only warmth, breastfeeding, close observation for early detection of problems, and protection from infections and injuries
• The baby should not be separated from the mother. After cutting the umbilical cord aseptically, the baby should be kept dry, wrapped with dry warm cloths, examined thoroughly and quickly to assess normal characteristics, to detect congenital malformations or any signs of illness, and then put to the mother’s breast
• Identification tag to be given to the mother and baby. The sex of the baby is shown to the mother. Recording to be done neatly and accurately about the event of the birth of the baby ( especially birth date, time, sex, examination findings or presence of any problems, etc. ), in the delivery record sheet.
• The mother and baby should be transferred to lying – in – ward usually after one hour of observation in the delivery room or when the condition is set. permits. Sick or at-risk neonates need special care in special settings.

Question 4. Immediate management of newborn baby.
Answer:

Immediate management of newborn baby:

The following care needs to be given to the newborn at birth, in the labor room

• Deliver the baby on a warm and clean towel
• Establish and maintain a patent airway
• Ensure warmth
• Assessment and documentation of the baby’s condition
• Care of eyes
• Clamp and cut the cord
• Care of skin
• Administration of vitamin K.
• Identification of baby
• Transfer of the baby according to the level of care required.

1. Receive the baby on a warm, clean, and dry towel.

2. Establish and maintain a patent airway:  The neonate cries spontaneously at birth.

• During crying the secretions of the mouth and nose are suctioned to clear the airway of mucous and amniotic fluid. If the baby is not crying, gentle tactile stimulation is provided. If the child does not cry even after stimulation, CPR should be given.
• The suction of the baby’s mouth and nose should be done using a bulb syringe or mucous trap. Gentle suction should be done to prevent bradycardia, laryngospasm, and cardiac arrhythmias from Vagal stimulation.

3. Ensure warmth:

In neonates, the heat-regulating mechanism is immature. The neonate loses heat due to evaporation, radiation, conduction, and convection. To prevent heat loss from the baby following steps should be taken The delivery room should be warm, with a temperature of 25-28 ° C.

• Dry the infant thoroughly soon after birth using a warm towel.
• Place the baby under a radiant warmer or over the mother’s chest in skin-to-skin contact with her

4. Assessment and documentation of the infant’s condition:

At 1 minute and 5 minutes of birth Apgar scoring is done and while drying the baby head – to – toe assessment is done to find out any abnormality in the newborn

5. Care of Eyes: 

• The eyes of the neonate are cleaned as soon as the head is delivered using sterile cotton swabs dipped in sterile water.
• The eyes are cleaned from the inner canthus to the outer canthus with separate swabs for each eye. Thereafter medicated eye drops should be instilled to protect the baby’s eyes from bacterial infections that may be contracted during delivery

6. Care of Cord:

• The umbilical cord is clamped when the cord pulsation stops as this provides the infant with extra blood from the placenta. The cord is clamped with two clamps and then cut between the clamps leaving about 1 ” or 5cm from the abdomen of the baby.
• The stump is left without any dressing and it is inspected repeatedly for any bleeding for up to 24 hours. It is observed routinely for any redness, inflammation, and discharge till it falls off

7. Care of Skin:

• The newborn’s skin is delicate so it should be gently wiped off blood, mucous, and secretions. No attempt should be made to rub off the protective vernix caseosa.
• The areas with folds such as the neck, axillae, groins, and creases at joints require special attention.
• The practice of giving a bath to the baby at the time of birth increases the risk of hypothermia so bathing should be postponed for 48-72 hours or more after birth depending on the baby’s condition

8. Administration of Vitamin K:

• For a few days after birth, the newborn is unable to synthesize Vitamin K that is needed for blood clotting so there is a potential problem of abnormal bleeding.
• Therefore 1mg of Vitamin K is administered to the baby intramuscularly

9. Identification of the Baby: 

• Before the baby is transferred from the labor room, an identification band is placed to the baby’s wrist, specifying the name of the mother, registration number, date and time of birth, and baby’s seAlso foot impression of a baby is taken for the baby’s identification.
• It is important to provide the mother an opportunity to see and touch the baby and note the sex before transferring the baby to the nursery

10. Transfer:

All the normal babies are transferred to the mother and nursed along with her in the postnatal area. This is called rooming-in. Breastfeeding should be started within half an hour of birth. However, sick or at-risk neonates should be transferred to a Neonate Intensive Care Unit ( NICU )

Question 5. Nursing Care for Infants Receiving Phototherapy
Answer:

Phototherapy (light therapy) is a way of treating jaundice. Special lights help break down the bilirubin in your baby’s skin so that it can be removed from his or her body. This lowers the
bilirubin level in your baby’s blood

Baby will need to be in an incubator whilst under photo therapy to keep warm:

• The phototherapy unit will be placed over the top of the incubator occasionally more than one unit may be used. This can be switched off when your baby needs to come out to be fed
• Proper covering and shielding of gonad
• Assess skin exposure
• Proper position
• Care for the infant under phototherapy
• Assess and adjust the thermoregulation device.
• Promoting elimination and skin integrity.
• Hydration
• Assure effectiveness of phototherapy provides eye protection Eyes are covered with eye patches to prevent damage to the retina by the Baby is placed naked 45 cm away from the tube lights in a crib or incubator If using closer, monitor the temperature of the baby.
• Baby is turned every two hours or after each feed During phototherapy, the bilirubin level in your baby’s blood will be checked at least once every day. Phototherapy is stopped when the bilirubin level decreases.
• Temperature is monitored every two to four hours.
• Weight is taken at least once a day.
• More frequent breastfeeding or 10-20% extra fluid is provided.
• Urine frequency is monitored daily.
• Serum bilirubin is monitored at least every 12 hours.
• Phototherapy is discontinued if two serum bilirubin values are < 10 mg/dl.
• Baby should spend as much time as possible under the phototherapy lights for it to be most effective, but your baby can come out for feeding or cuddling if he or she is upset.
• Baby will need to have regular (usually daily) blood tests whilst under photo therapy to assess the levels of bilirubin and ensure the phototherapy is effective.
• Promoting infant-parent interaction.
• Loss, greenish stool.
• Transient skin rashes.
• Hyperthermia.
• Increasing metabolic rate.
• Dehydration.
• Electrolyte disturbance

Question 6. Physiological jaundice.
Answer:

Physiological jaundice:

Neonatal Jaundice Jaundice is the visible manifestation of hyperbilirubinemia. Clinical jaundice in neonates appears on the face at a serum bilirubin level of 5 mg / dL, whereas in adults, it is diagnosed as little as 2 mg / dL.

The yellowish discoloration is first seen on the skin of the face, nasolabial folds, and the tip of the nose in the neonates. It is detected by blanching the skin with digital pressure in natural light. Neonatal jaundice is also termed as icterus neonatorum or as neonatal hyperbilirubinemia.

Almost 60 percent of term neonates and about 80 percent of preterm neonates have bilirubin levels greater than 5 mg/dl in the first week of life and about 6 percent of term babies will have bilirubin levels exceeding 15 mg / dL

Types of Neonatal Jaundice:

1. Physiological jaundice
2.  Pathological jaundice

1. Physiological Jaundice:

Multiple factors are responsible for the physiological jaundice, which is commonly found in both term and preterm babies. There is elevation of unconjugated bilirubin concentration due to various reasons in the first week of life

The possible mechanisms of physiological jaundice are as follows:

• Increased bilirubin load on hepatic cells due to increased volume of RBCs in polycythemia reduced the life span of fetal RBCs and increased enterohepatic circulation of bilirubin.
• Defective bilirubin conjugation due to decreased enzymatic activity of uridine diphosphate glucurony! transferase ( UDPG – T )
• Defective uptake of bilirubin by the liver from plasma due to decreased ligandin and increased ligandin-binding by other anions.
•  Defective bilirubin excretion due to congenital infection.

Characteristics of physiological jaundice:

• It appears in between 30 to 72 hours of age in term babies and in preterm babies may appear earlier but not before 24 hours of age.
• The maximum intensity of jaundice is found on the 4th day in term babies and 5th to 6th day in preterm babies.
• Serum bilirubin does not exceed 15 mg / dL. 0 sand by 14th dari
• Usually disappears by the 7th to 10th day in term babies and by the 14th day in preterm babies.
• Subsidies spontaneously and no treatment is needed. mother needs to encourage breastfeeding for adequate hydration and reassurance.
• Mine aggravated by prematurity, asphyxia, hypothermia, infections, and drugs

Question 7. Organization of NICU
Answer:

Organization of NICU:

1. Physical facilities:
   • Space
   • Location
   • Floor plan
   • Ventilation
   • Lighting
   • Temperature and humidity.
   • Acoustic characteristics
   • Electric outlets
   • Handling and social
   • Communication Astem
2. Ward personnel:
3. Equipment:
   1. Resuscitation equipment
   2. Bag and mask culture
   3. Oxygen and suction facilities
   4. Catheters, syringes, and needles
   5. Feeding equipment.
   6. Weighing machine
   7. Thermometer
   8. Oxygen hood
   9. Phototherapy unit
   10. Infusion pump
4. Laboratory facilities
5. Procedure manual.

Question 8. Grades Of Neonatal Care
Answer:

Grades Of Neonatal Care:

Based on birth weight and gestational age, a three-tier system of neonatal care is proposed for developing countries.

Level – 1:

• Care About 80 to 90 percent of neonates require minimal care which can be provided by their mothers with support from family members and under the supervision of basic health professionals.
• The neonates weighing above 2000 g or having a gestational age of 37 weeks or more belong to this category. This care can be given at home, subcenter, and primary health centers.
• Essential perinatal care should be provided as basic care at birth, provision of warmth, maintenance of asepsis, and promotion of breastfeeding.

Level – 2:

• Care Neonates weighing between 1500 to 2000 g or having a gestational age of 32 to 36 weeks need specialized neonatal care supervised by trained nursing staff and pediatricians.
• This intermediate neonatal care should be provided by equipped district hospitals, teaching institutions, and nursing homes.
• There should be an arrangement of resuscitation procedures, maintenance of the thermoneutral environment, intravenous infusion, gavage feeding, phototherapy, and exchange blood transfusions. Only 10 to 15 percent of all neonates require this care.
• It should be available at all hospitals where 1000 to 1,500 deliveries take place per year.

Level – 3:

• Care Neonates weighing less than 1500 g or born before 32 weeks of gestation require intensive neonatal care.
• Only 3 to 5 percent of all newborn babies need this care by skilled nurses and neonatologists especially those trained in neonatal intensive care. Apex institutions or regional perinatal centers equipped with centralized oxygen and suction facilities, incubators, ventilators, monitors infusion pumps, etc. are best suited to provide intensive neonatal care.
• High-risk pregnancies that are associated with the birth of high-risk neonates must be identified during pregnancy and referred to an appropriate center for skilled management and better outcomes.
• At birth, detection of high-risk neonates should be done at all levels of the health care delivery system and appropriate referral is essential to different levels of neonatal care for prevention and reduction of neonatal mortality and morbidity.

Question 9. Neonatal Resuscitation
Answer:

Neonatal Resuscitation Introduction:

Approximately 10 % of newborns require some assistance to begin breathing at birth. Less than 1 % require extensive resuscitation measures / The National Resuscitation Program was developed by the American Academy of Pediatrics ( AAP ) in conjunction with the American Heart Association ( AHA ) following the neonate resuscitation guidelines.

According to the National Resuscitation Program, those newborns that do not require resuscitation can generally be identified by a rapid assessment.

The following 3 characteristics:

1. Term Gestation?
2. Crying or Breathing?
3. Good muscle tone?

If the answer to all these questions is ” Yes “, the baby does not need resuscitation. The baby should be dried and placed in skin-to-skin contact with the mother. Apgar scoring should be done simultaneously. If the answer to the above three questions is ” No “, the infant requires resuscitation

Neonatal Resuscitation TABC:

T- Maintenance of Temperature:

• Dry the baby quickly
• Remove wet linen
• Place the baby under a radiant warmer

 1. Establish an open airway:

• Position the infant.
• Suction mouth and nose [ in a few cases also trachea ].
• ET intubation, if needed to ensure an open airway.

2. Initiate Breathing:

• Tactile stimulation to initiate respiration.
• PPV when necessary, using either Bag and mask or Bag and ET tube

3. Circulation:

• Chest compression
• Medications ( if needed )

Nursing Care Of Neonate Long Answer Questions

Question 10. Define Preterm baby

1. Characteristics of a preterm baby
2. Small for date baby

Answer:

Low birth weight Infants

Low birth weight Infants are of two types.

1.  Preterm
2. Small for date

1. Preterm Define:

A baby is born before the completion of the 37th week of gestation, regardless of birth weight.

Features:

Specification:

• Size: A preterm baby is small in size, usually less than 47cm, and weight less than 2.5 kg.
• Posture: The preterm infant lies in a “relaxed attitude”, limbs are extended.
• Head: The head is relatively large, sutures are widely separated and fontanels are large.
• Hair: The hair of preterm is fine, fuzzy, and wooly.
• Skin: The skin of preterm is thin, pinkish, and appears shiny due to generalized edema. It is covered with abundant lanugo and there is little vernix caseosa
• Ear: In preterm infants ear cartilage is poorly developed and the ear may fold easily.
• Breast: The breast nodule is absent or less than 5mm wide.
• Sole: The sole of the foot of a preterm infant appears more turgid and may have only fine wrinkles. The creases are absent
• Female genitalia: The female infant’s clitoris is prominent and labia majora are poorly developed and gaping
• Male genitalia: In preterm male infants, the scrotum is undeveloped and not pendulous, minimal rugae are present and testes may be in the inguinal canal or in the abdominal cavity.
• Scarf: Sign In preterm infants elbow may be easily brought across the chest with little or no resistance.
• Heel-to-Ear maneuver: The preterm infant’s heel is easily brought to the ear, meeting with no resistance
• Small for date baby: A baby whose birth weight falls below the 10th percentile on the intrauterine growth curve is known as small for date or small for gestational age

Classification of Small-for-date:

SFD or SGA babies are of 3 types:

1. Malnourished small-for-date infants: Growth arrest in the later part of pregnancy leads to a reduction in cell size but not cell number, resulting in a small and malnourished baby. Such a baby looks marasmic and has less subcutaneous fat and poor muscle mass.
2. Hypoplastic small-for-date babies: Growth retardation in the early part of pregnancy leads to a reduction in the number of body cells resulting in hypoplastic small-for-date babies. These babies are proportionately smaller in all parameters including head size.
3. Mixed: When adverse factors operate during early and mid-pregnancy, a reduction in both cell number and size occurs leading to mixed small for date babies.