Newborn Care 5) 2nd layette

- Binder (Optional)- used to restrain the newborn’s knee during

 Separate NICU and Delivery Room- Procedure is performed inside the administration of medications
NICU. - Prepare the (sterile) hypo tray- the inner side is considered sterile,
 There is an infant warmer system where the baby is placed, along with a the outside is contaminated.
small table placed with the equipment.
 Before performing the procedure, make sure to wear closed cap and a Equipment:
mask. - Tuberculin syringe: for injection
- Medications: Ampule for Vitamin K injection, (Terramycin) Crede’s
Prophylaxis
What is immediate newborn care?
- Tape Measure
- These are activities that will prevent the occurrence of untoward effect
- 2 thermometers
in the newborn. Including hypothermia, infection, and bleeding.
- Alcohol swab
Purposes: Also prepare:
 To prevent bleeding from the cord - Kidney basin as a waste receptacle
 To prevent infection of the cord and eyes - The baby’s comb/ brush
 To prevent hypothermia - For the VS, prepare stethoscope (pediatric)
- Working gloves
Before starting the procedure: - CBs in a jar
1. When the mother is about 7cms dilated, the doctor would usually order - Sharps container
the transfer of the mother from the labor room to the DR. During that - Alcohol
time, the nurse must prepare the crib.
2. Disinfect the crib. Cleaning it in and out including the frame. After assembling all the equipment, prepare the jot down notebook.
3. Also clean the mattress and apply new linens.
Information:
4. Prepare 2 droplights beside the crib.
 Name of Institution:
 Name of Patient: Baby (gender), (family name)
 Name of Mother:
 In preparation:
1. Assemble needed equipment.  Date of delivery:
2. Perform medical handwashing.  Time of delivery:
3. Set up the working table/ area in preparation for the coming the baby.
Medications given:
Put all the necessary equipment  Name of ophthalmic ointment and time given.
(Left Handed; Equipment at left side, working area at right)  Vitamin K/ dosage/ route/ time given
- Layette: lay down over the infant warmer
Vital Signs:
 Arrange equipment in order of use (Starting from topmost)  Time:
1) Baby’s dress  CR: (Normal: 120-160bpm)
2) Diaper  RR: (Normal: 40-60 cpm)
3) Bonnet  Temp: (Normal: 36.5-37.5oC- Appropriate for Gestational Age;
4) Mittens and Booties 35.5-36.5oC- Premature)
Anthropometric Measurements and Normal Values:  Weight: 2.5-3.5 kg
  Head circumference: 33-35 cm facing away from you.
 Chest circumference: 31-33 cm - Discard neck on the sharps container.
 Abdominal circumference: 30-32 cm - Aspirate the medication. Lock the syringe needle and remove cap
 Length: 48-53 cm with one hand, aspirate, and then fishhook to return.

MEDICATIONS:
I. Crede’s Prophylaxis  When the patient is about to be delivered, we are now ready to
- Application of ophthalmic ointment to newborn’s eyes to receive the baby.
prevent neonatal blindness or Ophthalmia Neonatorum caused 1. Do medical handwashing and apply alcohol or sanitizer to disinfect hands.
by gonorrheal infection as the newborn passes through the 2. Don working gloves: To protect the nurse from the newborn.
mother’s birth canal. 3. Receive the baby: The baby will be brought to the NICU well-wrapped,
- Name of medication- Terramycin Ophthalmic Ointment, or before endorsed, the pediatrician will be taking the weight. As the receiving
depending on what the institution uses. nurse, take note of the result and record on the jot down notebook
- You can transfer the baby immediately since the warmer is not
II. Vitamin K too far)
- Generic name: Phytomenadione
- Full-term Neonates: 0.1cc/ IM at left thigh (Vastus lateralis)  Once the baby is received:
- Preterm Neonates: 0.05cc/ IM at left thigh (Vastus lateralis)
1. Remove the wrap since a layette has been prepared.
III. Hepatitis B Vaccine (Can give in Lying-in but on hospital not
allowed for STN) 2. Turn baby to sides carefully when removing the wrap.
- 0.5cc/ IM at right thigh (Vastus lateralis)
3. Make sure the surroundings are warm.
 Next, prepare the medications. These should not be prepared very 4. Identify the baby (Check name band esp. GENDER)
early because it is important to maintain the drug’s patency
5. Perform a quick head-to-toe assessment: check for unusualities,
1. Terramycin- Ophthalmic Ointment deformities, and confirm if gender matches what is written on the name
2. Vitamin K- Phytomenadione band.
6. Take the vital signs;
Reminders:  Rectal Temperature (initial), - hold the baby’s legs to support
- Check medication by reading the name of the drug before preparing it, and gently fold to have access to the anus. Insert in a circular
just before administration and after preparation. twisting motion slowly, only up to the tip/ bulb to avoid injuring
- Check for the manufacturing date, expiration date, dosage and the newborn. Place the thermometer on the waste receptacle
characteristics of the medication. after.
- No need to prepare medication ticket for Vitamin K and Crede’s • Option: Proceed to axillary if baby kay nag
Prophylaxis pooped BUT IN RD FOLLOW RECTAL)

 RR- (FIRST SINCE BAKA MAG CRY BABY IF CR UNA )place

 Vitamin K- Phytomenadione (PREPARATION) hand over chest or abdomen and count rise and fall.
- (PREPARE 4 COTTON BALLS; 2 DRY AND 2 SOAKED IN  CR- using pediatric stethoscope
ALCOHOL SHOULD BE PUT IN HYPOTRAY)
- Start by disinfecting the neck of the ampule using a cotton ball and
alcohol.
- Get another CB again, wrap the neck, and break with the mark 7. Administer medications. Vitamin K and Crede’s Prophylaxis.
 - Restrain the baby first; Lock the arms and tuck layette under the little and position the tape measure
buttocks. For the knees, the centerfold of the binder will be placed - Starting with the heel, the tip of the tape measure must be in lined
on top, bring to the back crisscross, back to the front, and knot. with the heel and measured up to the vertex of the head.
- Start with Crede’s Prophylaxis. Double check medication. Open - Position the thumb on the mark of the measurement because we
then discard the first drop in the waste receptacle. need to take the measurement quickly as to avoid prolonging the
- Expose the lower lid of the baby by pulling the cheek downward. baby in the side position.
- Squeeze a little medicine out and apply within the lid from inner to - Return the baby in a supine position and read.
outer canthus. Once done with the anthropometric measurements, place tape measure on the
- Next, administer the Vitamin K injection waste receptacle.
- Locate the site. (Left thigh- middle third of the anterolateral site 90 o
IM) 9. Clean the baby
- Disinfect the site with an alcohol swab starting from inner to outer - Usually, washing of the baby is done 6 hours after birth. So in this
portion. case, we are not washing the baby, but only trying to remove
- Grab a CB and secure between fingers. excess blood and secretions which are commonly found on the
- Using the heel of the palm over the knee to lock gently. vertex, especially when there is episiotomy.
- Do cushion fashion to grasp the muscle and inject. - Using the baby’s comb, remove the excess blood from the head.
- Support the hub, aspirate to check if there is blood. If none, then - Support the baby’s head and neck, then use the brush to remove
slowly introduce the medication. the blood. Do it gently as not to cause injury to the baby.
- After injecting, remove needle, lock the cap, and dispose on the - Once cleaned, place comb on the waste receptacle and slowly
waste receptacle and press only the site until there is no more lower down the baby’s head.
blood coming out. 10. After cleaning, CHANGE THE LAYETTE Lift the baby carefully,
- Remove the restraints. and with one hand supporting the baby, the other is maneuvering
- Unfold the layette on sides the new layette.
8. Take the anthropomorphic measurements - Spread the layette in a diamond form and fold the top part
- Weight is already taken previously. Proceed with the others. downwards.
- Use tape measure for measurements
- Lay the baby’s neck in lined with the folded part and insert both
- Check the head circumference. Use the lower border and it must
arms on the inside spaces.
be in lined with the baby’s eyebrow and the tip of the ears.
- Then put on the baby’s sterile dress.
- Gently support the baby’s head and position the tape measure.
- Insert the arms first, one side at a time. Making sure that the hands
- Measure and read.
are curled into a fist as not to injure the fingers when accidentally
- Next, check the chest circumference.
pulled backwards.
- Place the tape measure in lined with the nipples.
- Slowly turn the baby to the side and insert the excess. Make sure
- Do not pull the measuring tape, instead, gently turn the baby to the
that the tie is also inserted well.
sides and gradually lower the tape measure and position.
- Insert on the other side as well, making sure that the fist is closed.
- Measure and read.
- Tie the cords and make a knot/ ribbon.
- Following the cephalocaudal pattern of growth and development;
- Put on the baby’s bonnet to prevent hypothermia. Support the
(The head is bigger than the chest, and the chest is bigger than the
head with both hands, slowly insert, and lay the baby’s head down
abdomen)
after.
- Next, check the abdominal circumference.
- Fold the bottom part of the baby’s gown for aesthetic reasons, to
- Slowly turn the baby to the sides and gently lowering the tape
make it look nice. Ensure that it is sterile and the cord is placed on
measure in the level positioned just next to the umbilical cord.
top.
- Mark and read. Then remove the tape measure.
- Apply the diaper. Making sure that the diaper should not be placed
- Take the baby’s length.
on top of the cord.
- Turn the baby to the side. Try to gently extend the extremities a
 - Slowly lift the buttocks, supporting both feet. Insert the diaper
below. 3. Equipment such as comb and tape measure are cleaned and dried.
- Again, make sure that the diaper is placed a little lower than the Thermometer is disinfected from stem to bulb before returning.
cord. Rationale: When the diaper is filled with urine, the cord
should not be contaminated. 4. Return all the equipment after.
- Apply the mittens from the back and tie to lock. But before
inserting, try to invert and check underneath for excess thread to 5. Remove the gloves (in the proper manner). Discard in the yellow bin.
avoid cutting the baby’s skin. If there are any excess, try to
remove them. 6. Perform handwashing
- Put on the baby’s booties. Note to be careful on the toes.
- Bring one side of the layette across and tuck excess at the back.
- Fold the lower portion next, then insert the other arm of the baby
on the other side as well.
- Tuck the excess and the baby is now swaddled.
Document Documentation of Medication:
11. After dressing up and cleaning, we may now put the baby in the crib.
Position with the head elevated to prevent increase in pressure. Where to document?
- Slowly put down the buttocks first, then transfer the hand to A. Patient’s chart
support the head. Slowly lower down the baby. 1. Medication Sheet
2. Vital Sign Sheet
12. Once the baby is placed, prepare all the labels and other needed B. Medication Notebook provided in the NICU
things.
13. Before doing aftercare, we may recheck the vital signs. But this time, Medication:
the temperature can be taken axillary. What and where to write:
 Medication sheet- single order/ stat medication portion
14. Check vital signs every 30 minutes.  Date, name of drug, dosage, route or site, time, and nurse’s initial

Example:
After care:
 3/16/2021 Terramycin Ophthalmic ointment applied O.U 7:50 am JG
 3/16/2021 Vitamin K 0.1cc given IM at left thigh 7:55 am JG
1. Begin with the sharps such as the needle and ampule. Dispose them in
 3/16/2021 Hepatitis B vaccine 0.5cc given IM at right thigh 8:00 am JG
the sharp’s container.
-
2. Wrappers and other discarded materials are disposed in the infectious
(yellow) bin.