CHAPTER I
INTRODUCTION
The newborn ( neonate ) is a condition in which a newborn with a gestational age of 38-40 weeks . Immediately after birth , the baby must adapt to the environment of the state ektrauteri highly dependent becomes physiologically independent . Many changes dialmi by newborns which was originally located in the intrauterine environment to environment ektrauteri . If the baby is not able to adapt to the environment ektrauteri , will be able to cause death in infants .
The infant mortality rate be the first indicator in determining the health status of children. Infant mortality is the death that occurs shortly after birth until the baby has not been exactly 1 year old . Infant Mortality Rate ( IMR ) per 1,000 live births 35 . The decline in Infant Mortality Rate ( IMR ) and under-five mortality rate ( CMR ) at the same time quite sharp , ie IMR of 51 per 1,000 to 35 per 1,000 live births and the child mortality rate 82.6 per 1,000 to 46 per 1,000 live births in the period same time . The mortality rate of newborns ( neonatal ) slow decline , which is 28.2 per 1,000 to 20 per 1,000 live births .
Newborn mortality rate in Indonesia is still higher than other developing countries . The main cause of newborn deaths in developing countries include asphyxia , airway distress syndrome , infection , and complications of hypothermia .
Infection in neonates is an important cause of the occurrence of
morbidity and mortality during this period . Approximately 2 % of fetuses can be infected in utero and 10 % of newborns infected during delivery or in the first month of life . The incidence of neonatal sepsis is still high and is the leading cause of death in neonates . This is because neonates are susceptible to infection .
Neonatal susceptibility to infection is influenced by various factors , such as skin and mucous membranes are thin and easily damaged , and the phagocytic ability of leukocytes immunity is still low . Immunoglobulins are less efficient and wounds that have not healed umbilicus .
In addition to infection , hypothermia can also pose a risk of death in neonates . Hypothermia occurs due to a decrease in body temperature caused by various circumstances , mainly due to the high oxygen demand and a decrease in room temperature . Maintain body temperature within normal limits is essential for the survival and growth of the newborn . Regulation of body temperature depends on the heat -producing factors and expenditure , while heat production is highly dependent on the biological oxidation and metabolic activity of the body's cells break time .
Seeing the many risks that can cause death in infants , holistic nursing care needs are addressed to the baby and family
CHAPTER II
LITERATURE REVIEW
A. Definition Newborn
The newborn ( neonate ) is a condition in which a newborn with a gestational age of 38-40 weeks .
1 . Less months ( preterm ) : < 37 weeks
2 . Enough not ( at term ) : 37-41 weeks
3 . More months ( post-term ) : ≥ 42 weeks
4 . The low birth weight : < 2500 g
5 . Extremely low birth weight : < 1500 g
6 . Extreme low birth weight : < 1000 grams
B. Physiological Changes
1 . Metabolism
The rate of metabolism when the body is resting showed changes during infancy and children . Metabolism is the highest when the newborn . Glucose is needed for the proper functioning of the brain . Action to clamp the umbilical cord clamping at birth , the baby should begin to maintain blood glucose levels alone . Blood glucose will go down in quick time ( 1 to 2 hours ) on any newborn . Correction drop in blood sugar can be done in three ways , namely through the use of breast milk , through the use of reserve glycogen ( glycogenesis ) , and through the production of glucose from other sources , especially fats ( gluconeogenesis ) .
Newborns are not able to digest food in sufficient quantities to make glucose from glycogen ( glycogenolysis ) . A healthy baby will store the glucose as glycogen , mainly in the liver , during the last months of life in the womb . Infants who develop hypothermia at birth that result in hypoxia will use the stores of glycogen in the first hour of birth . If all the supplies used in the first hour then the baby's brain in a state of risk . Preterm newborns , by month , uterine growth retardation and fetal distress is a major risk , because reduced energy savings or used prior to birth .
2 . Temperature
Body temperature is a reflection of the body's metabolism . Temperature showed a similar reduction from infancy to maturation . Thermoregulation is an adaptive response of the most important baby during the transition from intrauterine life to life ekstrauteri .
Newborns are susceptible to hypothermia caused partly by the central regulation of body temperature in infants is not functioning properly, the body surface is relatively larger baby , the baby's body was too small to produce and store heat . Hypothermia can occur at any time when the surrounding temperature is low and efforts to maintain the baby's body temperature is not applied appropriately , especially in the stabilization period is 6-12 hours after birth .
Hypothermia can cause some negative metabolic consequences such as hypoglycemia , increased bilirubin levels , and metabolic acidosis . This can occur in healthy neonates .
Body heat loss mechanisms in general there are four , namely through :
1 . Radiation
Ie heat loss when the baby is placed near objects that have a temperature higher than its body .
2 . Evaporation
That way the heat loss occurs due to evaporation of amniotic fluid on the surface of the body of the baby because the baby is not dried immediately or after a bath .
3 . Conduction
Namely the loss of heat through direct contact between the baby's body with a colder surface .
4 . Convection
Ie heat loss that occurs when the baby is exposed to ambient air cooler .
3 . Sleep and rest
Sleep is a protective function that allows the tissue repair and recovery . Newborns sleep for a time that is not used to eating and other aspects in treatment . In line with the growing baby , the amount of time spent sleeping will be reduced gradually .
4 . The respiratory system
Immaturity of the lungs primarily reduces the survival chances of newborn babies before 24 weeks of gestation , which is caused by the limitations of the alveolar surface , the immaturity of the lung capillary system , and inadequate amount of surfactant . Two factors that play a role in the stimulation of a baby 's first breath , the first deliveries at the end of hypoxia and physical stimuli outside the womb environment that stimulates the respiratory center in the brain , and the second pressure on the chest cavity , which occurs due to compression of the lungs during labor , which stimulates the entry air into the lungs mechanically . Interaction between the respiratory system , cardiovascular and central nervous system give rise to regular and continuous breathing and pulse are needed for life .
Respiratory effort of a baby 's first function is to secrete fluid in the lungs , pulmonary alveolar tissue develops for the first time that the alveoli to function , there must be sufficient surfactant and blood flow to the lungs . Surfactant production begins at 20 weeks of gestation and the number will increase to 30-34 weeks of gestation . The surfactant reduces surface tension and helps to stabilize the pulmonary alveolar wall so it does not collapse at the end pernapasa .
5 . Circulation System
After birth , the newborn blood must pass through the lungs to pick up oxygen circulating through the body and hold to deliver oxygen to the tissues . To make a good circulation in order to support life outside the womb , two major changes have to take place , namely the closure of the foramen ovale in the heart atrium and closure of the ductus arteriosus between the pulmonary artery and aorta . The circulation changes caused by changes in pressure in the entire vascular system of the body . Two events that change the pressure in the vascular system : first when the umbilical cord is cut , increased systemic vascular resistance and right atrial pressure decreased . Right atrial pressure decreased due to reduced blood flow to the right atrium . This leads to a decrease in volume and right atrial pressure itself. Breathing first lowers vascular resistance and pulmonary right atrial pressure increases . Breathing oxygen at this first cause relaxation and opening of the vascular system of the lungs ( pulmonary vascular resistance decrease lung ) . Increased circulation to the lungs resulting in an increase in blood volume and pressure in the right atrium . With the increase in blood volume and pressure in the left atrium , the foramen ovale functionally closes . Umbilical vein , ductus venosus and hypogastric arteries of the umbilical cord funsional shut down within a few minutes after birth and after the cord is clamped . Anatomical closure of the fibrous tissue takes place within 2-3 months
6 . Gastrointestinal System
Before birth , the fetus at term will begin to suck and swallow . Spit and cough reflex reflex mature well established at birth . Ability term newborns to swallow and digest food ( other than milk ) is still limited . The relationship between the lower esophagus and stomach is still not perfect which resulted spit up in newborns and neonates . The capacity of the stomach itself is very limited , less than 30 cc for a full term newborns . The stomach capacity will increase along with the slow growth of the newborn . Arrangements are often eaten by itself an important example counts the baby breastfeeding on demand . Baby is still immature intestine is unable to protect itself from harmful substances colon . In newborns less efficient at retaining water than the adults, thus causing more serious diarrhea in neonates .
7 . Immune system
Newborn immune system is still immature , thus causing neonatal susceptible to various infections and allergies . Mature immune system that will provide natural and acquired immunity . Natural immune defenses consist of structures that prevent or minimize infection . Here are some examples of natural immunity protection by covering the skin mucous membranes , respiratory tract filter function , colony formation by the skin and gut microbial , chemical protection by the acidic environment of the stomach . Natural immunity is also provided at the cellular level by the blood cells that help the newborn kill foreign microorganisms . But in the newborn 's blood cells are still immature , meaning that the newborn has not been able to localize and fight infection efficiently . Acquired immunity will appear later . Newborns are born with passive immunity contains a lot of virus in the mother's body . Overall antibody response against foreign antigens still can not be done until the child's early life .
C. Examination of the newborn
1 . The Physical Examination
a. posture
Inspection baby before conducting the assessment and review of maternal records presentation , location , and type of delivery .
1 ) Presentation of the head
Arm , lower leg in flexion lightweight , hand- holding . Normal spontaneous movements are usually not bilaterally synchronous .
2 ) Presentation of a perfect butt
Legs straight and stiff . Newborns will show the position in the womb for a few days . Prenatal stress on the limb or shoulder can cause facial asymmetry or cause temporary custody when the limb extension .
b . Vital signs
1 ) Heart rate and pulse
a) visible pulsation in the left midclavicular line IC fifth
b ) pulse at the apex : IC fourth , frequency 120-160 beats / min .
c ) Quality: first sound ( mitral valve and the tricuspid valve closes ) and second sound ( aortic valve and pulmonary valve closes ) .
d ) murmur sometimes occurs mainly on the bottom or on the left of the sternum , the fourth IC ( anatomical foramen ovale closes at about one year of age ) .
e ) must equal the femoral pulsation and strong .
2 ) Temperature
a) axillary temperature of 36.5 o C - 37 , 2 ° C
b ) stable temperature for 8-10 hours setelh birth
3 ) Business and frequency of breath
a) Observation of the baby when the baby is breathing in a resting state .
b ) Calculate the respiratory one full minute .
c ) Listen to breath sounds can be heard without a stethoscope .
d ) Observation effort breath .
e ) Frequency breath 30-60 times / min
4 ) Blood Pressure
a) The cuff blood pressure measurement : the width of a blood pressure cuff affect test results .
b ) Use the cuff 2,5 c , and palpation of the radial pulse .
c ) At the time of birth systolic pressure of 60-80 mmHg and 40-50 mmHg diastolic pressure
d ) After 10 days of age systolic pressure of 95-100 mm Hg and diastolic blood pressure increased slightly .
c . weight
1 ) Weigh at the same time each day .
2 ) Protect the newborn in order not to lose heat .
3 ) abnormal weight loss is 10 % or less of the weight at birth .
d . long
Measure the length of the body from head to heel .
e . Head circumference
1 ) Measure the head circumference at its largest diameter , circumference oksipito - frontal .
2 ) Measurements can be made on the second or third day after the molasses and caput succedaneum subside .
f . bust
Measure the breast line .
g . abdominal circumference
1 ) Measure below the umbilicus .
2 ) Abdomen enlarged after the baby is fed as the abdominal muscles stretch .
h . integument
1 ) Color
a) Inspection of the newborn without clothes under adequate lighting lamps and warm air .
b ) Inspection of the newborn when a state of calm and active .
c ) Check for siaosis .
2 ) Birthmarks
Inspection and palpation to see the location , size , distribution , characteristics , and color
3 ) Conditions
Inspection and palpation integrity , texture , and the presence of edema .
4 ) Vernix caseosa
a) Observation number , color , and smell before the baby is washed or in the lap .
b ) If it is not visible on the surface of the body , check in the axilla and groin area .
5 ) Lanugo
Inspection of the number and distribution of lanugo .
i . head
1 ) Palpation of skin
2 ) Inspection of shapes and sizes
3 ) palpation and inspection of the size of the fontanelle
4 ) Palpation sutures
5 ) Inspection of the pattern , distribution , and amount of hair
eye
6 ) Inspection distance of both eyes
7 ) Inspection of the shape and size of both eyes
8 ) Inspection of the eyelid : size , ferak , and flicker .
9 ) Observation of discharge
10 ) Inspection of the eyeball : shape , motion , size , and presence .
11 ) Inspection of the pupils of both eyes .
12 ) Inspection eyebrows : number and pattern .
nose
13 ) kinds of observations shape, location , patency , and configuration of the nasal bone .
ear
14 ) Observsi size , location , number of cartilage , and the auditory canal open
15 ) respond favorably to the voices and sounds .
face
16 ) Observation of the face as a whole
mouth
17 ) Inspection and palapasi layout , colors , configurations , and lip movement
18 ) Inspection gum color
19 ) Inspection adhesion , movement and size of the tongue
20 ) Observation of the palate .
21 ) Observation of cleft chin
22 ) Observation of the amount and character of saliva
j . neck
1 ) Inspection and palpation of the neck length
2 ) Observation sternokloidomastoideus muscular movement and head position .
3 ) Palpation of the trachea and thyroid gland .
k . chest
1 ) Inspection and palpation of the chest shape , clavicle , ribs , breath and movement .
2 ) Inspection and palpation of the shape , size , location , and number of nipples and breast tissue .
l . abdomen
1 ) Inspection and palpation of the umbilical cord
2 ) Inspection adbomen size and contour abdominal palpation
3 ) Austulkasi bowel sounds and note the number and character of stools and infant behavior during elimination .
4 ) Assess the abdomen during breathing movements .
m . genetalia
1 ) Women
Inspection and palpation of the general appearance , the clitoris , the labia majora , labia minora , vaginal discharge , and urethral meatus .
2 ) Male
a) Inspection and palpation of the general appearance of the penis , urethral meatus , prepuce , scrotum and testicles rugae .
b ) Observation of reflex erection , kremater , and voiding baby .
n . extremity
1 ) Inspection and palpation degrees of flexion , range of motion , movement symmetry and muscle tone .
2 ) Inspection and palpation sleeve : color , integrity , location on the body , the number of fingers , palpation of the humerus , joints , shoulders , elbows , wrists .
3 ) Inspection and palpation of the limbs : color , integrity , long , major gluteal folds , number of toes , the femur , the head of the femur when the leg flexion and abduction , the soles of the feet
o . back
Inspection and palpation of the spine, shoulder , scapula , iliac crest , the base cast back
p . anus
1 ) Inspection and palpation of the place , amount , and the presentation of the anus .
2 ) test for sphincter response
3 ) Monitor for abdominal distention , meconium expenses , expenses in addition to feces from the anal orifice .
2 . Neurologic examination
a. Status consciousness
Status awareness baby can be grouped into 5 status ( Prechtl scale ) :
1 ) Status 1
Eyes closed , regular breathing , no movement
2 ) Status 2
Eyes closed , irregular breathing , no movement of the rough
3 ) 3 Status
Eyes open , no rough movement
4 ) Status 4
Eyes open , there is a movement of rough , do not cry
5 ) Status 5
Eyes open or closed , crying
b . Spontaneous motor activity
1 ) passive tone in the limbs and trunk
Evolving from hypotonia at 24 weeks 'gestation be strong flexor tone at 40 weeks ' gestation , starting from the lower extremities and then the upper extremity .
2 ) active tone in the limbs and trunk
a) Reaction righting
b ) neck flexor tone
c ) Suspension of the ventral
3 ) primary reflexes
The primary reflex activity reflects the brain stem . This reflex is maninfestasi of programming with emphasis on the central nervous system by the higher cortical functions in the future .
a) stepping reflex ( lost at age 3 months )
b ) hand grip reflex ( lost at age 3 months )
c ) grasp reflex foot ( lost at age 3 months )
d ) asymmetric tonic neck reflex ( lost at the age of 6 months )
e ) moro reflex ( lost at the age of 4 months )
4 ) deep tendon reflexes
Deep tendon reflexes can be depressed due to lower motor neuron lesion ( lower motor neurons ) , sometimes increased due to upper motor neuron lesion ( upper motor neurons ) , can be seen asymmetry .
5 ) plantar response
Not significant at age newborns because the normal response can be either flexor or extensor .
NEWBORN CARE D.
1 . Provision of vitamin K
Administration of vitamin K as a prophylaxis against hemorrhagic disease of the newborn . Administered through intramuscular suntika .
2 . Umbilical cord care
a. Always wash your hands prior to treatment
b . Keep the cord dry and exposed to air
c . Clean with water , avoid alcohol because it can slow down the release cord .
d . Fold the diaper below the umbilicus
3 . Breastfeeding
The benefits of breastfeeding for the infant :
a. Breast milk contains all the elements that are useful to the growth and development of infants .
b . Breast milk is more easily digested by babies and do not cause indigestion .
c . ASI provide some sort of immunity to infectious germs and viruses in infants .
d . Breast milk can not cause allergies in infants
C. Examination of the newborn
1 . The Physical Examination
a. posture
Inspection baby before conducting the assessment and review of maternal records presentation , location , and type of delivery .
1 ) Presentation of the head
Arm , lower leg in flexion lightweight , hand- holding . Normal spontaneous movements are usually not bilaterally synchronous .
2 ) Presentation of a perfect butt
Legs straight and stiff . Newborns will show the position in the womb for a few days . Prenatal stress on the limb or shoulder can cause facial asymmetry or cause temporary custody when the limb extension .
b . Vital signs
1 ) Heart rate and pulse
a) visible pulsation in the left midclavicular line IC fifth
b ) pulse at the apex : IC fourth , frequency 120-160 beats / min .
c ) Quality: first sound ( mitral valve and the tricuspid valve closes ) and second sound ( aortic valve and pulmonary valve closes ) .
d ) murmur sometimes occurs mainly on the bottom or on the left of the sternum , the fourth IC ( anatomical foramen ovale closes at about one year of age ) .
e ) must equal the femoral pulsation and strong .
2 ) Temperature
a) axillary temperature of 36.5 o C - 37 , 2 ° C
b ) stable temperature for 8-10 hours setelh birth
3 ) Business and frequency of breath
a) Observation of the baby when the baby is breathing in a resting state .
b ) Calculate the respiratory one full minute .
c ) Listen to breath sounds can be heard without a stethoscope .
d ) Observation effort breath .
e ) Frequency breath 30-60 times / min
4 ) Blood Pressure
a) The cuff blood pressure measurement : the width of a blood pressure cuff affect test results .
b ) Use the cuff 2,5 c , and palpation of the radial pulse .
c ) At the time of birth systolic pressure of 60-80 mmHg and 40-50 mmHg diastolic pressure
d ) After 10 days of age systolic pressure of 95-100 mm Hg and diastolic blood pressure increased slightly .
c . weight
1 ) Weigh at the same time each day .
2 ) Protect the newborn in order not to lose heat .
3 ) abnormal weight loss is 10 % or less of the weight at birth .
d . long
Measure the length of the body from head to heel .
e . Head circumference
1 ) Measure the head circumference at its largest diameter , circumference oksipito - frontal .
2 ) Measurements can be made on the second or third day after the molasses and caput succedaneum subside .
f . bust
Measure the breast line .
g . abdominal circumference
1 ) Measure below the umbilicus .
2 ) Abdomen enlarged after the baby is fed as the abdominal muscles stretch .
h . integument
1 ) Color
a) Inspection of the newborn without clothes under adequate lighting lamps and warm air .
b ) Inspection of the newborn when a state of calm and active .
c ) Check for siaosis .
2 ) Birthmarks
Inspection and palpation to see the location , size , distribution , characteristics , and color
3 ) Conditions
Inspection and palpation integrity , texture , and the presence of edema .
4 ) Vernix caseosa
a) Observation number , color , and smell before the baby is washed or in the lap .
b ) If it is not visible on the surface of the body , check in the axilla and groin area .
5 ) Lanugo
Inspection of the number and distribution of lanugo .
i . head
1 ) Palpation of skin
2 ) Inspection of shapes and sizes
3 ) palpation and inspection of the size of the fontanelle
4 ) Palpation sutures
5 ) Inspection of the pattern , distribution , and amount of hair
eye
6 ) Inspection distance of both eyes
7 ) Inspection of the shape and size of both eyes
8 ) Inspection of the eyelid : size , ferak , and flicker .
9 ) Observation of discharge
10 ) Inspection of the eyeball : shape , motion , size , and presence .
11 ) Inspection of the pupils of both eyes .
12 ) Inspection eyebrows : number and pattern .
nose
13 ) kinds of observations shape, location , patency , and configuration of the nasal bone .
ear
14 ) Observsi size , location , number of cartilage , and the auditory canal open
15 ) respond favorably to the voices and sounds .
face
16 ) Observation of the face as a whole
mouth
17 ) Inspection and palapasi layout , colors , configurations , and lip movement
18 ) Inspection gum color
19 ) Inspection adhesion , movement and size of the tongue
20 ) Observation of the palate .
21 ) Observation of cleft chin
22 ) Observation of the amount and character of saliva
j . neck
1 ) Inspection and palpation of the neck length
2 ) Observation sternokloidomastoideus muscular movement and head position .
3 ) Palpation of the trachea and thyroid gland .
k . chest
1 ) Inspection and palpation of the chest shape , clavicle , ribs , breath and movement .
2 ) Inspection and palpation of the shape , size , location , and number of nipples and breast tissue .
l . abdomen
1 ) Inspection and palpation of the umbilical cord
2 ) Inspection adbomen size and contour abdominal palpation
3 ) Austulkasi bowel sounds and note the number and character of stools and infant behavior during elimination .
4 ) Assess the abdomen during breathing movements .
m . genetalia
1 ) Women
Inspection and palpation of the general appearance , the clitoris , the labia majora , labia minora , vaginal discharge , and urethral meatus .
2 ) Male
a) Inspection and palpation of the general appearance of the penis , urethral meatus , prepuce , scrotum and testicles rugae .
b ) Observation of reflex erection , kremater , and voiding baby .
n . extremity
1 ) Inspection and palpation degrees of flexion , range of motion , movement symmetry and muscle tone .
2 ) Inspection and palpation sleeve : color , integrity , location on the body , the number of fingers , palpation of the humerus , joints , shoulders , elbows , wrists .
3 ) Inspection and palpation of the limbs : color , integrity , long , major gluteal folds , number of toes , the femur , the head of the femur when the leg flexion and abduction , the soles of the feet
o . back
Inspection and palpation of the spine, shoulder , scapula , iliac crest , the base cast back
p . anus
1 ) Inspection and palpation of the place , amount , and the presentation of the anus .
2 ) test for sphincter response
3 ) Monitor for abdominal distention , meconium expenses , expenses in addition to feces from the anal orifice .
2 . Neurologic examination
a. Status consciousness
Status awareness baby can be grouped into 5 status ( Prechtl scale ) :
1 ) Status 1
Eyes closed , regular breathing , no movement
2 ) Status 2
Eyes closed , irregular breathing , no movement of the rough
3 ) 3 Status
Eyes open , no rough movement
4 ) Status 4
Eyes open , there is a movement of rough , do not cry
5 ) Status 5
Eyes open or closed , crying
b . Spontaneous motor activity
1 ) passive tone in the limbs and trunk
Evolving from hypotonia at 24 weeks 'gestation be strong flexor tone at 40 weeks ' gestation , starting from the lower extremities and then the upper extremity .
2 ) active tone in the limbs and trunk
a) Reaction righting
b ) neck flexor tone
c ) Suspension of the ventral
3 ) primary reflexes
The primary reflex activity reflects the brain stem . This reflex is maninfestasi of programming with emphasis on the central nervous system by the higher cortical functions in the future .
a) stepping reflex ( lost at age 3 months )
b ) hand grip reflex ( lost at age 3 months )
c ) grasp reflex foot ( lost at age 3 months )
d ) asymmetric tonic neck reflex ( lost at the age of 6 months )
e ) moro reflex ( lost at the age of 4 months )
4 ) deep tendon reflexes
Deep tendon reflexes can be depressed due to lower motor neuron lesion ( lower motor neurons ) , sometimes increased due to upper motor neuron lesion ( upper motor neurons ) , can be seen asymmetry .
5 ) plantar response
Not significant at age newborns because the normal response can be either flexor or extensor .
NEWBORN CARE D.
1 . Provision of vitamin K
Administration of vitamin K as a prophylaxis against hemorrhagic disease of the newborn . Administered through intramuscular suntika .
2 . Umbilical cord care
a. Always wash your hands prior to treatment
b . Keep the cord dry and exposed to air
c . Clean with water , avoid alcohol because it can slow down the release cord .
d . Fold the diaper below the umbilicus
3 . Breastfeeding
The benefits of breastfeeding for the infant :
a. Breast milk contains all the elements that are useful to the growth and development of infants .
b . Breast milk is more easily digested by babies and do not cause indigestion .
c . ASI provide some sort of immunity to infectious germs and viruses in infants .
d . Breast milk can not cause allergies in infants
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