MINOR DISORDERS OF NEW BORN AND ITS MANAGEMENT - NURSING ASSIGNMENT

INTRODUCTION

        Neonatal health problems are frequently found ranging from minor physical or physiological peculiarities to the serious life threatening illnesses. Minor problems should not be ignored lightly without adequate assessment of the conditions. Early diagnosis and management of the serious problems help to overcome life long disability and to reduce neonatal morbidity and mortality. Nurses are responsible to manage the minor problems and to detect the serious problems for early and prompt management along with appropriate nursing interventions and support to the mother.

MINOR DISORDERS OF NEW BORN

1. VOMITING

        Vomiting is one of the common manifestations in the neonates. Regurgitation after feeds should not be confused with vomiting. Mucus vomiting often hinged with blood is quite common soon after birth. It is due to irritation often gastric mucosa by the swallowed materials during birth.

Causes:

·        Dietic

·        Over feeding

·        Excessive air swallowing

·        Intracranial injuries

·        Infective gastroenteritis, meningitis, septicemia

·        Obstructive

o       Gastro-intestinal obstruction

o       Oesophageal atresia

o       Pyloric stenosis

o       Cardiospasm

o       Duodenal atresia

Clinical Manifestation

·        Electrolyte fluid imbalance

·        Weight loss

·        Tachycardia

·        Hypovolemia

·        Dehydration

·        Metabolic change (Hypernatraemia, Hypocalcemia)

·        Fatigue

·        Tachypnoea

Diagnostic evaluation

        The newborn that have persistent vomiting must be carefully evaluated to determine the cause.

The diagnostic evaluation is:

·        History from parents

·        Physical examination

·        Laboratory test

·        X-ray

·        Daily checking of weight, urinary output etc

Management

Medical management

        Vomiting is only a symptom of illness and management is corrected towards detecting and treating the cause.

1.   Parenteral fluid and electrolyte therapy may be indicated to correct the resulting dehydration and alkalosis.

2.   Anti-emetic drugs may be given to control vomiting eg. Stemetil, domstal, emset, perinorm.

3.   In case of obstruction the child should be given nothing by mouth and aspiration by nasogastric tube is necessary.

Nursing Management

1.   The nurse should check the vital sign regularly.

2.   The nurse should advice the mother to clean the child.

3.   Recording of urinary output and specific gravity of urine can assist in establishing diagnosis and evaluating complication.

4.   If the problems are one of the improper feeding
techniques, the nurse should teach the parents about corrector feeding technique.

5.   The nurse should prescribe a balance formula, if the problem is caused by incorrect composition of the formula.

6.   Monitor intake and output chart.

7.   Advice not to stop breast feeding.

8.   In order to prevent the aspiration of vomitus, the nurse should turn the head of the child to one side so that it can run into a kidney basin.

9.   The face, skin behind the ears and neck should be kept clean and dry.

10.   In case of hypovolemia.

o       Nurse should check the vital signs

o       Maintain fluid and electrolyte balance

o       Oxygen saturation should be checked

o       Cardiac monitoring should be done

o       Observe for any signs and symptoms of shock

11.   In case of dehydration

o       Check for skin turgor

o       Check the mental status of child

o       Observe for any cyanosis

o       Check the vital sings intervally

o       Check the weight of the baby.

2. DIARRHOEA IN NEWBORN

        The frequent passage of stool in the newborn is known as diarrhea.

Causes of Diarrhoea

        The main causes of diarrhea

·        Infective gastroenteritis

·        Parenteral

·        Dieteric

Infective

·        E.coli

·        Staphylococcus or virus

·        Artificially fed babies

·        Using uncleaned utensils

Clinical Manifestation

·        Frequent watery stools

·        Generally green and containing mucus and blood

·        Colic and screaming

·        Dehydration

·        Sunken eyes

·        Depressed anterior fontanella

·        Circulatory collapse

Parenteral

        The common infective organisms are;

·        E-coli

·        Echovirus

·        Rotavirus

Systemic Infections like;

·        Septicemia

·        Bronchopneumonia

·        Phelitis

·        Meningitis

Dietic

Patient is maily

·        Quantitative

·        Qualitative

Quantitative

Over feeding

        Increased amount or frequent feeds lead under irritation of the gut and intestinal hurry causing diarrhea. The stool is bully with out any mucus.

Under feeding

        It is called hunger diarrhea. There is frequent passage of small green stools

Qualitative

·        Excessive carbohydrate

·        Excessive fat

·        Protein diarrhea

Prevention

·        Maintaining asepsis of the utensils used

·        Maintenance of the regularity and adjusting the amount of feeder

·        Increasing the quantity of the feed as guided by test feeding

Nursing Management

·        Provide psychological support to the parents

·        The baby should be isolated

·        Check the vital signs and skin changes frequently

·        Assess the characteristics of diarrhea and recording of the number amount and consistency of stools

·        Check the colour of the stool

·        Check the smell of the stool, if any faul smell is present that indicates infection

·        Collect the stool from the diaper by using a sterile stick and send the stool for laboratory examination

·        Educate the mother to wash baby’s cloth and dry it in the sunlight

·        General hygienic care should be provided like baby bath, change the soiled diaper etc

·        Keep the perineal area clean and dry

·        Administer drug as per physicians order

·        Educate the mother about prevention of diarrhea home management of diarrheal disease, importance of ORS, dietary management hygienic practices, medical help etc

3. UMBILICAL SEPSIS

        The causative organisms are staphylococci E.coli or any pyogenic organism.

Clinical Features

·        Umbilical discharge

·        The base of the cord stump look moist

·        The periumbilical skin becomes red and swollen

·        Pyrexia

·        Features of toxemia or jaundice

Spread of Infection

·        Periumbilical cellulites with suppuration

·        Thrombo – phlebitis of the umbilical vein with extension of the infection to the liver

·        Peritonitis

Prevention

·        Antiseptic and aseptic precaution should be given

·        The cord is to be inspected once more for evidence of slipping of ligature

·        If the cord is left exposed to the air without any application of dusting powder it dries up and force off much earlier

Nursing Management

·        To provide proper care of the cord at birth

·        The cord should be cut with the sterile precautions

·        The stump and the base of the umbilical stump should be cleaned daily and when contaminated with the spirit swab

·        The cord should be kept dry and free from contamination

·        Clean the umbilical area either with betadine or with spirit

4. OPHTHALMIA NEONATORUM

        It is defined as inflammation of conjunctiva during first three weeks of life.

Etiology

·        Chlamydia trachomatis

·        Bacterial

·        Chemical

·        Viral

Mode of Infection

        This infection mainly occurs during delivery by contaminated vaginal discharge.

Clinical features

Discharge from the eyes it may be;

·        Watery

·        Mucopurulent to frank purulent in one or both eyes

·        The eyelids may be sticky or markedly swollen

Prevention

·        Vaginal discharge during the antenatal period should be treated

·        Maintained aseptic techniques at birth

·        New born baby’s closed lids should be thoroughly cleansed and dried

·        Sulphacetamide eye drop or soframycin eye drop is instilled in to each eye for a few days

Investigations

        The discharge is taken for;

·        Gram stain smear

·        Culture and sensitivity

·        Scraping material from lower conunctiva

·        Culture is special viral media

Nursing Management

·        Baby should be isolated

·        Check the vital signs frequently

·        Observe for the clinical manifestations

·        Instillation of chlormphenicol eye drops or neomycin according to doctors order is used to clear the infection

·        Eye drops should be kept separate for each baby

·        The mother should be free from gonorrhoea infection

·        Prophylactic eye drops should be used

·        For severe infections systemic antibiotic therapy in addition to local treatment may be prescribed by the doctor

5. ORAL THRUSH

        Infection of the bucal mucous membranes and the tongue by the Fungus candida albicans is not uncommon specially in bottle fed babies.

Mode of infection

·        Feeding bottle

·        Teats

·        Nurses hand

·        Mother nipple

        Oral thrush usually appear in the late first week or during the second week.

Clinical Features

·        The infant refuses to take feeds

·        The patches are visible on the mouth

·        Spots on the edges of the tongue are diagnostic

Prevention

        Maternal fungal infection in the vagina is to be adequately treated before delivery.

·        Utensils including feeding bottles and teats are to be properly cleaned before and after each feed

·        The baby’s mouth should not be rubbed vigorously with gauze

Nursing Management

·        Observe for the clinical manifestation

·        Maintain nutritional status

·        Hand washing is necessary before feeding to the baby

·        Avoid contact with infected infants

·        Feeding bottles and teats are to be properly cleansed before and after each feed.

NURSES ROLE FOR PREVENTION OF NEONATAL PROBLEMS

·        Screen out high risk babies and liberal use of elective L.S.C.S in case of contracted pelvis, cephalo pelvic disproportion or malpresentation.

·        In normal delivery the nurses should check the following

o       Continuous fetal monitoring to know fetal distress

o       Episiotomy should be done carefully to prevent injury to the scalp

o       Neck should be unduly stretched while delivery the shoulders 

·        Preterm baby should be delivered with episiotomy and forceps application special care in preterm delivery

o       To prevent anoxia

o       To avoid strong sedation

o       To administer vitk 1mg injection prevent or minimize haemorrhage

·        Difficult forceps and never apply traction during the forceps delivery

·        Proper selection and special care should be give while conducting breech delivery

·        Prevent intracranial injury by never be hasty during delivery of head, episiotomy should be done to minimize head compression and contrasted delivery of head by forceps.

·        Trunk should not be pulled one side

·        Limbs are delivered in a manner and not simply by pulling them out

·        Gentle traction in the proper direction is applied

·        Gentleness in the maneuver and fraction in the proper direction to prevent injuries to the born

·        The nurse who have upper respiratory tract infection should not conduct delivery

·        Immediate care of the new born should be given to prevent baby from hypothermia/infection

·        Unnecessary exposure of the baby should be prevented

·        Reassurance the parents about the common problems of neonates and its prevention

CONCLUSION

        Neonatal health problems are frequently found ranging from minor physical and physiological pecularities to the serious life threatening illness. Minor problems should not be ignored lightly without adequate assessment of the conditions. Early diagnosis and management of the serious problem help to overcome life long disability and to reduce neonatal morbidity and mortality.

BIBLIOGRAPHY

·        Text Book Obstetrics of D.C Dutta,

6^th Edition, Page No.450

·        Myles Text Book of Midwives

14^th Edition

Edited by Diane M Fraser and Margaret N Cooper

·        A Text Book of Child Health Nursing

2^nd Edition