SANDIPANI ACEDEMY

PENDRI (MASTURI) BILASPUR C.G.

M.Sc. NURSING 1ST YEAR

SUBJECT :- CHILD HEALTH NURSING

CASE PRESENTATION ON :- NEONATAL ASPHYXIA

SUBMITTED TO :- SUBMITTED BY:-

MRS R. S. RAMYA RUBINA RASHMI MASIH

M.Sc. NURSING 1st YEAR

Name Of Student - Rubina Rashmi Masih

Year Of Study -Msc Nursing 1st Year

Hospital - District Hospital, Bilapur

DEMOGRAPHIC DATA

Name Of The Patient - Baby Of Deepa

Father’s Name - Mr.Ravi

Mother’s Name - Mrs.Deepa

Age / Sex - 3days / Male

Opd / Ipd No. - 32463 / 24316

Date Of Admission - 20/1 /2012

DateOf Birth - 18/1/2012

Mode Of Delivery - Hospital Delivery

Chief Complaints - My Patient’s Mother Complaints That Baby Refused To Feed And Cry And
Bluish Discolouration Of The Body

Provisional Diagnosis – Neonatal Asphyxia

Final Diagnosis - Neonatal Asphyxia

Date Of Care Started - 21/1/2012

DateOf Care Ended -25/1/2012

PERSONAL HISTORY

Personal Hygiene - Good

Bowel & Bladder Pattern - Regular.Urine Frequency Is 4-6 Times Per Day.

Sleep & Rest Pattern - Restless

FAMILY HISTORY

S.No Name Of Age Sex Relation Occupation Education Health

Family With Status
Member Patient
1 Baby Of 3dayss Male Self - - Unhealthy
Deepa
2 Mr.Ravi 25yrs Male Father Driver 10th Class Healthy

3 Mrs.Deepa 22yrs Female Mother Housewife 9th Class Healthy

FAMILY MEDICAL HISTORY

My Patient’s Family Has No Specific Hereditary Diseases Like Hypertension, Diabetes Mellitus, Cancer
Etc. There Is No Family History Of Communicable Diseases Like Tuberculosis, Aids Etc.

SOCIO ECONOMIC HISTORY

Type Of Family - Nuclear Family

Housing - Pacca Concrete House

Income -Rs. 3000/- Per Month

Earning Person Of Family -Mr.Ravi (Patient’s Father)

Electricity - Available

PRENATAL HISTORY

Prenatal Visits - 3 Times

Gestational Age - Full Term

Immunization Of Mother - Tetanus Vaccination Taken At 7 th Month Of Pregnancy

Mother Had No Other Diseases During Pregnancy.She Was Not Taking Any Type Of Drugs Except Folic
Acid And Iron Tablets During Pregnancy Period.

NATAL HISTORY

Type Of Delivery - Normal Delivery

Immediate Cry - Baby Cried Few Seconds After Delivery

Apgar Score - Within 1 Minute Was 4,After 5 Minute Was 5

Birth Weight - 2.5kg

Initiation Of Breast Feeding - Baby Had First Breast Feeding Within 1 Hour.

POST NATAL HISTORY

After Delivery Both Mother And Baby Had No Complications.

PRESENT MEDICAL HISTORY

Baby Of Deepa Admitted Due To Breathing Diffficulty And Baby Refused To Cry And Feeding.

NUTRITIONAL HISTORY

My Patient Takes Breast Feeding 5-6 Times Per Day In Small Duration.

IMMUNIZATION HISTORY
AGE VACCINE TAKEN
DAY 1 SINGLE DOSE OF BCG.

PHYSICAL EXAMINATION

ANTHROPOMETRIC MEASUREMENT

HEIGHT - 50cm

WEIGHT - 2.5kg

HEAD CIRCUMFERENCE -33cm

CHEST CIRCUMFERENCE -31cm

GENERAL APPEARANCE

Activity - Less Active

Complexion - Fair

Level Of Consciousness - Conscious

HEAD TO FOOT EXAMINATION

HEAD

Hair - Black

Scalp - Soft

Skull – Round Shape

Birth Injury - Absent

Fontenelle – Anterior And Posterior Fontenels Remains Open With Normal Shape

FACE

Eye

Sclera - White In Colour

Conjunctiva - Pinkish

Pupil – Black Colour

Eye Brow – Hair’s Equally Distributed

OphthalmiaNeonatorum - Absent

EAR

Pinna – Curved

Cartilage – Curved And Soft

Low Set Ear – Absent

NOSE

Mucous Secretion – Absent

Nasal Septum Deviation – Absent

Flat Nasal Bridge – Absent

MOUTH

Teeth - Natal Teeth Is Not Present

Lips - Moist

Tongue – Pinkish

Cleft Lip / Palate - Absent

NECK

Enlargement Of Thyroid Gland - Absent

Enlargement Of Lymph Nodes - Absent

Movements – Possible At All Directios

Jugular Vein Distension - Absent

CHEST

INSPECTION - BELL SHAPED, CIRCUMFERENCE IS 31cm

PERCUSSION - NO EVIDENCE OF FLUID COLLECTION

PALPATION - NO PALPABLE MASS PRESENT

AUSCULTATION - WHEEZING HEARD.NO MURMURS HEARD

ABDOMEN

Inspection - No Distension

Percussion - No Evidence Of Fluid Collection

Palpation - No Palpable Mass Present.Liver And Spleen Are Not Palpable.

Auscultation - Peristaltic Sounds Heard

BACK

Spinal Deformities - No Abnormalities Present

Spina Bifida – Absent

EXTREMITIES

Polydactaly - Absent

Syndactaly - Absent
Nail - Developed

Knock Knee – Absent

GENITALS:

Ambiguous Genitalia - Absent

Anus – Not Imperforated

VITAL SIGNS

Temperature – 99f

Pulse - 140 Beats / Minute

Respiration - 40 Breaths / Minute

REFLEXES

(1) ROOTING:-

Stimulation: - Touching Or Stroking The Cheek Near The Corner Of The Mouth.

Response: - Head Turns In Direction Of Stimulation So That The Neonate Can Find Food. When The Breast
Touches The Cheek, Neonate Turns Toward The Nipple.

Diappearence: - 6th Week Of Life When The Source Of Food Can Be Seen. Disappears 3-4 Months When
Awake When Asleep 7-8 Months.

(2) SUCKING:-

Stimulation: - Touching The Lips With The Nipple Of The Breast Or Bottle Or Other Object.

Response: - Sucking Movements That Enable The Newborn To Take In Food.

Disappearrence: - Begins To Diminish At 6 Months Disappears Soon After Birth It Not Stimulates. If A
Neonate Cannot Take Oral Feedings A Pacifier May Be Need To Maintain The Reflex.

(3) SWALLOWING:-

Stimulation: - Accompanies The Sucking Reflex

Response: - Food Reaching The Posterior Of The Mouth Is Swallowed.

Disappearence: - Doses Not Disappear.

(4) GANGING:-

Stimulation: - When More Is Taken Into The Mouth That Can Be Successfully Swallowed.

Response: - Immediate Return Of Undigested Food.

Disappearence: - Does Not Disappear.

(5) SNEEZING AND COUGHING:-

Stimulation: - Foreign Substance Entering The Upper Or Lower Airways.

Response: - Clearing Of Upper Air Passages By Sneezing, The Lower Air Passages By Coughing.

Disappearance: - Does Not Disappear.

(6) EXTRUSION:-

Stimulation: - Substances Placed On Anterior Position Of Tongue.

Response: - Extrusion Of The Substance To Prevent Swallowing.

Disppearence: - About 4 Months.

(7) BLINKING :-

Stimulation: - Exposure Of Eyes To Bright Light From A Flash Light Or Sudden Movement At Object To
Ward Eye.

Response: - Protection Of The Eye By Rapid Eyelid Closure.

Disappearence: - Does Not Disappear.

(8) DOLL’S EYE:-

Stimulation: - Turn The Newborn’s Head Slowly To The Right Or Left Side.

Response: - Normally Eyes Do Not Move.

Disappearance: - When Fixation Develops.

(9) PALMAR GRASP:-

Stimulation: - Object Placed In New Born’s Palm.

Response: - Grasping Of Object By Closing Fingers Around It.

Disappearance: - 6 Weeks To 3 Months. Purposeful Grasp Is Evident At 3 Months Of Age.

(10) PLANTAR GRASP:-

Stimulation: - Touching The Sole At The Foot At The Base Of The Toes.

Response :- Toes Grasp Around Very Small Object.

Disappearance :- 8 To 9 Months In Preparation For Walking May Continue To Be Present During Sleep.

(11) DANCING (STEP-IN-PLACE) :-

Stimulation :- Hold Neonate In A Vertical Position With The Feet Touching A Flat, Firm Surface.

Response :- Rapid Alternative Flexion And Extension Of The Legs As In Stepping.

Disappearance :- 3-4 Weeks. The Neonate Soon The Reefer Can Bear Some Weight On The Legs Without
Stepping.

(12) BABINSKI :-

Stimulation :- Stroking The Lateral Aspect Of The Sole Of The Foot With A Relatively Sharp Object From
The Heal Up To Ward The Little Toe And Across The Foot To The Big Toe.
Response :- Fans The Toes (+Ve Babinski Sign). The Adult Normally Flexes The Toes. The Newborns
Response Is Due To An Immature Level Of Nervous System Development.

Disappearance :- 3-4 Weeks. 3 Months Of Age; Variable.

(13) TONIC NECK (FENCINA POSITION) :-

Stimulation :- Turing The Head Quickly To One Side While The Infant Is Supine.

Response :- Arm An Leg On The Side The Head Is Turned Toward Extend. Arm And Leg On The Opposite
Side Flex. Both Hands May Make Fists.

Disappearance :- 18-20 Weeks. Tonic Neck Reflex Is Replaced With Symmetric Positioning Of Both Sides
Of The Body.

(14) MORO (STARTLE) :-

Stimulation :- Startling The Infant With A Loud Voice Or Apparent Loss At Support Due To A Change In
Equilibrium. The Neonate Is Hold In A Supine Position Above The Table Or Be. The Nurse Supports The
Upper Back And Head With The Other. The Newborn’s Head Is Suddenly Allowed To Drop Backward An
Inch Or So.

Response :- Generalized Muscular Activity Symmetric Abduction And Extension Of The Arms And Legs
With Fanning Of The Fingers. The Thumb And Index Finger On Each Hand From A C Shape. The
Extremities Then Flex And Adduct The Baby May Cry.

Disappearance :- Strong Up To 2 Months. Disappears By 3-4 Months.

INVESTIGATION

TEST IN PATIENT NORMAL

HAEMOGLOBIN 11gm % MALE-13-18gm %
FEMALE-11.5-16.5gm %
WBC 9900/CUMM 4000-11000/CUMM
LYMPHOCYTE 65% 20-45%
MONOCYTE 01% 1-10%
NEUTROPHIL 55% 40-60%
EOSINOPHIL 01% 1-6%
BASOPHIL 0% 0-1%

MEDICATIONS
S.NO NAME OF DRUG DOSE ROUTE TIME ACTION SIDE EFFECT NURSING
RESPONSIBILIT
Y
1 INJ.SODIUM 2Meq IV STAT SYSTEMIC ANTACID - -ASSESS
BICARBONATE .ORALLY NEUTRALIZES IRRITABILITY RESPIRATORY
GASTRIC ACID,WHICH -HEADACHE AND PULSE
FORMS -CONFUSION RATE AND
WATER,NACL,CO2.INCREASE -WEAKNESS RHYTHM
S BI CARBONATE REVERSES - -ASSESS FLUID
ACIDISIS. CONVULSION AND
S ELECTROLYTE
BALANCE
2 INJ.EPINEPHRIN 0.1mg/kg IV STAT CALCIUM CHANNEL - -ASSESS VITAL
E BLOCKERS.ASYMPTOMATIC TACHYCARDI SIGNS
ADRENERGIC AGONIST A ESPECIALLY
THAT STIMULATE ALPHA - HEARTRATE
ADRENERGIC RECEPTORS PALPITATION AND BP.
CAUSING -HEADACHE
VASOCONSTRUCTION -DIZZINESS
-
DIAPHORESIS
3 IV.DEXTROSE 5% 6ml IV STAT ELECTROLYTE NEEDED FOR -HEADACHE -MONITOR
ADEQUATE BLOOD -BRAIN PULSE AND BP
CLOTTING,PREVENTION OF DAMAGE -MONITOR FOR
HAEMORRHAGES - ANY
HAEMOGLOBI BLEEDING
NURIA
-
HYPERBILIRU
BINEMIA

DISEASE CONDITION

INTRODUCTION

A Condition Where A Newborn Infant Fails To Start Breathing On Its Own In The Minutes Following
Birth.Perinatal Asphyxia Or Neonatal Asphyxia Is The Medical Condition Resulting From Deprivation Of
Oxygen To A Newborn Infant That Lasts Long Enough During The Birth Process To Cause Physical Harm,
Usually To The Brain. Hypoxic Damage Can Occur To Most Of The Infant's Organs (Heart, Lungs, Liver,
Gut, Kidneys).
DEFINITION

According To D C Dutta, Birth Asphyxia Is Clinically Defined As Failure To Initiate And Maintain
Spontaneous Respiration Following Birth.

According To Jaypee’s Dictionary, Suffocation Caused By Lack Of Oxygen Due To Failure Of

Breathing,Tracheo Bronchial Obstruction,Environmental Oxygen Lack,Oedema Of The Lungs.

CAUSES

The Following List Shows Some Of The Possible Medical Causes Of Asphyxia Neonatorum .

 Fallot's Tetralogy
 Shoulder Dystocia
 Spina Bifida
 Dystocia
 Hydrocephalus
 Osteomalacia
 Uterine Rupture
 Primary Dysfunctional Labour
 Maternal Short Stature
  Uterine Atony
 Foetal Malposition
 Umbilical Cord Prolapse
 Premature Labour& Delivery
 Post-Maturity
 Placental Insufficiency
 Anencephaly
 Gestational Diabetes
 Cystic Hygroma
 Breech Presentation
 Fibromyoma, Uterine
 Epidural Anaesthesia
 Cephalopelvic Disproportion
 Multiple Pregnancy
 Oligohydramnios
 Neural Tube Defects
 Polyhydramnios
 Vasa Praevia
 Placenta Praevia
 Grand Multiparity
 Patent DuctusArteriosus

PATHOPHYSIOLOGY

When Oxygenation Of The Mother Is Impaired As A Result Of Maternal Diseases, A Previously Normal
Baby Suffers Recurrent Episodes Of Asphyxia Neonetorum Due Toreduction Of Oxygen Supply To The
Fetus Leading To Hypoxia. When This Hypoxia Persists There Is Presence Of Glycolsis Resulting In A
Metabolic Acidosis Detection Of Glucose Reserve Lead, To Brandy Cardiac Causing Anal Sphincture
Relaxation Hence Passing Meconium Stool Liquor. Hypoxia Lead To Gasping And Aspiration Of
Meconium Stained Liquor To The Lungs. In The Uterus The Fetus Lungs Are Filled With Fluid Following
Delivery When The Baby Breaths, Or Gasps Air Is Drawn Into The Lungs And The Liquid Disappear Into
The Periphery Of The Respiratory Tree /System And It Is Cleared By The Pulmonary Circulation, Failure
To Complete The Process Satisfactory Leads To Tachypnoea As The Lungs Expand And Fill With Gas,
Pulmonary Blood Flow Increase Pressure In The Left Atrium Closing The Oval. As Oxygen Pass Through
DuctusArteriosus A Contraction Occurs And Close Arteriosus, If This Does Not Happen Oxygenated Blood
Mixes With Deoxygenated Blood, Baby Remains Cyanosed Although Can Probably Respond To Prompt
Resuscitation.

SIGNS AND SYMPTOMS

The List Of Signs And Symptoms Mentioned In Various Sources For Asphyxia Neonatorum Includes The 6
Symptoms Listed Below:

 Cyanosis
 Bradycardia
 Poor Response To Stimulation
 Hypotonia
 Hypoxia
 Metabolic Acidosis

DIAGNOSTIC EVALUATION
Classically, The Evaluation Of Cardio-Pulmonary Status In The Newborn Has Been Assessed By Apgar
Scoring At 1 And 5 Minutes After Birth. Diagnosis Can Be Objectively Assessed Using The Apgar Score—
A Recording Of The Physical Health Of A Newborn Infant, Determined After Examination Of The
Adequacy Of Respiration, Heart Action, Muscle Tone, Skin Color, And Reflexes. Normally, The Apgar
Score Is Of 7 To 10. Infants With A Score Between 4 And 6 Have Moderate Depression Of Their Vital
Signs While Infants With A Score Of 0 To 3 Have Severely Depressed Vital Signs And Are At Great Risk
Of Dying Unless Actively Resuscitated.

MANAGEMENT

The Treatment For Asphyxia Neonatorum Is Resuscitation Of The Newborn. All Medical Delivery Rooms
Have Adequate Resuscitation Equipment Should An Infant Not Breathe Well At Delivery. Between 1970
And 2000, Neonatal Resuscitation Has Evolved From Disparate Teaching Methods To Organized Programs.
The Most Widely Used Procedure Is The Neonatal ResucitationProgram.If Stimulation Fails To Initiate
Regular Respiration In The Newborn, The Attending Physician Attempts Resuscitation. He May Decide
First To Gently Suction The Oropharynx—The Area Of The Throat At The Back Of The Mouth, With A
Soft Catheter. When Stimulation And A Clear Airway Do Not Result In Adequate Respiration, The
Physician May Give 100 Percent Oxygen Via A Face Mask. If The Infant Is Still Not Breathing, Some Form
Of Artificial Ventilation Is Then Required. The Usual Method Is To Use Mask Ventilation With A
Resuscitator. The Mask Is Applied Tightly To The Infant's Face. If This Procedure Fails, The Infant Can Be
Intubated With A Endotracheal Tube To Which The Resuscitator Can Then Be Connected. The More Severe
The Fetal Asphyxia, The Longer It Will Take Before The Infant Starts To Breathe Spontaneously. If The
Infant Does Not Breathe Despite Adequate Ventilation, Or If The Heart Rate Remains Below 80 Beats Per
Minute, The Physician Can Give An External Cardiac Massage Using Two Fingers To Depress The Lower
Sternum At Approximately 100 Times A Minute While Continuing With Respiratory Assistance.
Adrenaline May Also Be Administered To Increase Cardiac Output. Once The Infant Starts Breathing, He
Or She Is Transferred To A Nursery For Observation And Further Assessment. Temperature, Pulse And
Respiratory Rate, Color, And Activity Are Recorded, And Blood Glucose Levels Checked For At Least
Four Hours.

Treatment May Also Include The Following:

 Giving The Mother Extra Amounts Of Oxygen Before Delivery

 Medications To Support The Baby's Breathing And Sustain Blood Pressure
 Extracorporeal Membrane Oxygenation (Ecmo)

Ecmo Is A Technique Similar To A Heart-Lung Bypass Machine, Which Assists The Infant's Heart And
Lung Functions With Use Of An External Pump And Oxygenator.
ALTERNATIVE TREATMENT

If An Inadequate Supply Of Oxygen From The Placenta Is Detected During Labor, The Infant Is At High
Risk For Asphyxia, And An Emergency Delivery May Be Attempted Either Using Forceps Or By Cesarean
Section.

NURSING MANAGEMENT

NURSING DIAGNOSIS
 Infective Breathing Pattern Related To Low Intake Of Oxygen Evidence By Cyanosis Difficult In
Breathing And Weak Cry At Birth Altered
 Hypothermia Related To Immature Heat Regulation Centre Evidenced By Temperature 36.5
 Knowledge Deficit Related To Baby Care After Hospitalization Evidenced By Parents Verbalizing
Indicating Lack Of Knowledge On Care Of Sick New Born Baby At Home .
 Risk Of Infections Related To Invasive Procedures And Immaturity Of Baby System
 Potential For Impaired Skin Integrity Related To Improper Feeding

S.N ASSESSMEN NURSING GOAL PLANNING IMPLEMENTAT RATIONALE EVALUATIO

O T DIAGNOSIS ION N
1 SUBJ. INFECTIVE BABY WILL -CLEAR - AIRWAY WAS CLEARING - THE
DATA: - BREATHING BE AIRWAY CLEARED OF AIRWAYS AIRWAY
CLIENT PATTERN ABLE TO -GIVE BY WIPING HELPS REMAINED
STATED RELATED TO BREATH OXYGEN NOSTRILS REMOVE CLEAR AND
THAT HE IS LOW WITH EASE. BY AND MUCUS -
HAVING INTAKE OF ATTAIN MASK MOUTH SECRETIONS PATENT
DIFFICULT OXYGEN NORMAL -MONITOR AND ALSO AND OXYGEN
Y IN EVIDENCE BY RESPIRATO VITAL SUCKING MAINTAIN REMAINED
BREATHING CYANOSIS RY RATE SIGNS ½ - OXYGEN PATENT ON
. DIFFICULT IN OF 40-50 HOURLY WAS GIVEN 8 AIRWAY TILL 3.30 PM
OBJ. DATA: BREATHING BEATS / TEMPERAT LITRES - WHEN IT
-CLIENT IS AND WEAK MINUTE URE /MINUTE BY SUPPLEMEN WAS
LOOKING CRY AT BIRTH PULSE FACE TAL WEANED
RESTLESS & AND MASK OXYGEN OF
IRRITATED. RESPIRATIO -VITAL HELP TO THE
N OBSERVATION MEET FOLLOWIN
- MONITOR TAKEN ½ ALL G
COLOUR HOURLY THEN METABOLIS NORMAL
OF 2 M DEMAND RESPIRATIO
BABY HOURLY. IN N
AND 8AM TEMP THE BODY RATE
ACTIVITIES 35.80C PULSE TISSUE AND
IE. 100 -CLOSE OTHER
REFLEXES BEAT/MINUTE MONITORIN VITAL
RESPIRATION G OF SIGNS
24 /MINUTES VITAL SIGNS TEMPERAT
8:30 AM TEMP HELP TO URE 36.5
36.10C DETECT PULSE
PULSE ANY 136/MINUTE
120 ABNORMAL RESPIRATIO
/MINUTE CONDITION N
RESPIRATION AND ACT AS 38/MINUTE
30/MINUTE A
9AM GUIDE IF
TEMPERATUR THERE IS
E IMPROVEME
36.20C NT.
PULSE
130/MINUTE
RESPIRATION
34 /MINUTE

2 OBJ.DATA:- ALTERED BODY KEEP BABY BABY KEPT KEEPING BABY

ON BODY TEMPERAT WARM WARM BY THE BABY TEMPERAT
OBSERVATI TEMPERATUR URE MONITOR COVERING WARM URE
 ON I FOUND E WILL TEMPERAT WITH WARM AND IMPROVED
THAT MY RELATED REMAIN URE CLOTHES HEATING TO
PATIENT IS TO IMMATURE WITHIN ½ AND USE OF THE ROOM NORMAL
HAVING HEAT THE HOURLY AS HEATER PREVENT RANGE
HYPOTHER REGULATION NORMAL GENERAL TO HEAT 36.5
MIA CENTRE RANGE CONDITION MAINTAIN LOSS
EVIDENCED OF 36-370C S WARMTH THROUGH
BY IN IMPROVES THROUGHOUT CONDUCTIO
TEMPERATUR 2-4 HOURS AND N
E 36.5 CONTINUE EVAPORATI
WITH ON
OBSERVATION AND
TEMPERATUR RADIATION
E ½ HOURLY
THEN 2
HOURLY

3 OBJ.DATA:- RISK BABY WILL -HAND -HARD -HAND BABY

ON OF NOT SHOW WASHING WASHING WASHING GENERAL
OBSERVATI INFECTIONS ANY SIGN -USE AND MAINTAININ CONDITION
ON I FOUND RELATED TO OF ANTISEPTIC GLOVING BY G IMPROVING
THAT INVASIVE INFECTION TECHNIQUE ALL PERSONAL AS
LIMITED PROCEDURES BY END OF S STUFF HYGIENE SIGN
ASEPTIC AND HIS STAY IN - GIVE BEFORE AND OF
TECHNIQUE IMMATURITY THE ANTIBIOTIC HANDLING ASEPTIC INFECTION
S CAN OF NEW S THE BABY TECHNIQUE NOTED
CAUSE BABY BORN UNIT - MAINTAIN -TREATMENT S AS VITAL
INFECTION SYSTEM -BABY PERSONAL GIVEN PREVENT SIGNS
WILL HYGIENE UNDER SECONDARY REMAINED
NOT -OBSERVE ASEPTIC INFECTION WITH
ACQUIRE OR TECHNIQUE. - NORMAL
INFECTION MONITOR - ANTIBIOTIC RANGE
S SIGNS IV KILL MICRO- TEMPERAT
OF AMIKACIN ORGANISM URE
INFECTION 600MG OD AND 36.60C
S X 7/7 ENHANCE HEART
-IV BESTRUM QUICK RATE 142/
200MG RECOVERY MINUTE
TWICE DAILY. RESPIRATIO
BABY CORD N
CLEANED. 40/MINUTE
-MOTHER

4 OBJ DATA:- POTENTIAL SKIN CHANGE BABY LINEN ALL NO

ON FOR INTEGRITY LINEN CHANGED THESE SKIN
OBSERVATI IMPAIRED WILL FREQUENC WHENEVER ACTIVITIES EXCORIATI
ON I FOUND SKIN BE Y SOILED HELP ONS
THAT INTEGRITY MAINTAINE TREAT 3 PREVENT NOTED AND
DELICATE RELATED TO D PRESSURE HOURLY EXCORIATIO BABY
SKIN OF MY IMPROPER AREA TURNING N SKIN
PATIENT FEEDING CHANGE WAS DONE WHICH CAN REMAINED
CAN BE BABY BY LEAD INTACT
DISRUPTED POSITION HUGS TO
FREQUENC ALSO PRESSURE
Y MOTHER SORES
SHOWN HOW
TO DO IT BY
MASSAGING

5 SUBJ. KNOWLEDGE BOTH ASSESS HEALTH HEALTH PARENT

DATA: - DEFICIT FATHER PARENTS MESSAGE EDUCATION SHOWED
PARENTS RELATED AND KNOWLEDG S INCREASES APPRECIAT
ARE TO BABY’S MOTHER E INCLUDED. KNOWLEDG ION
ANXIOUS CARE WILL BY -KEEPING E OF
THAT THEY AFTER HAVE THE BABY AND THE
ARE NOT HOSPITALIZAT ADEQUATE ASKING WARM HELPS KNOWLED
AWARE OF ION KNOWLEDG WHAT AND FAMILY GE
CHILD’S CHARACTERIZ E THEY CLEAN TO GAINED
DISEASE ED ON BABY KNOW ALWAYS ADJUST AND THE
CONDITION. BY CARE ABOUT THE -EXCLUSIVES WITH HELP
OBJ. DATA: PARENT AFTER NEW BORN BREAST THE NEW RECEIVED
-PARENTS VERBALIZING DISCHARGE BABY FEEDING BORN DURING
NOTKNOWI INDICATING ON AT HOME THE TIME
 NG ABOUT LACK DEMAND AND OF
HER OF BEFORE PROVIDE SICKNESS
DISEASE KNOWLEDGE INTRODUCTIO GOOD CARE OF THEIR
CONDITION. ON N AS BABY AND
CARE OF SICK OF IT ALSO ALSO
NEW ANY HELP PROMISED
WHILE AT SUPPLEMENT THEM TO TO
HOME ARY COPE CONTINUE
FEEDS WELL WITH
IMMUNIZATIO WITH FOLLOW
N LESS UPS
OF PROBLEMS
THE
NEWBORN ON
DISCHARGE
TO
PREVENT
FROM
INFECTIOUS
DISEASES
WHICH
ARE
IMMUNISABLE
-FOLLOW
UP
CLINIC
AT
PAEDIATRIC
OUT
PATIENT
CLINIC AFTER
2 WEEKS

THEORY APPLICATION

Here I Am Using Bernard’s Theory As My Patient Is Newborn.

Kathryn.E.Bernad
a. Credentials And Background Of Theorist:-
 Born On April 16, 1938
 1956-Prenursing Prof. At Nebrasaka University And Graduated With A Bachelor Of
Science In Nsg In 1960
 Headnurse Position And Became Assistant Instructor In Pead, Nsg
 1961-Master Degree In Boston University
 Also Worked As Private Duty Nurse

b. Theoretical Source:-
 Her Cites Were Florence Nightingale,Virgina,MarthaRogers,Direct Influence On Her
Research And Theory Devt.Bernads Credits Florence And Blake For Beliefs And Values
Making Up The Foundation Of Current Nsg.Practice.

c. Use Of Empirical Evidence:-

 Bernard Continues To Study The Mother-Infant Relationship.Her Research Project
Examine The Nurses Role In Relation To Highrisk Mothers And Highrisk Infant.
 Ncap (Nursing Child Assessment Pro Ject) Formed Basis
For This Model.
Ncast (Nursing Child Assessment Satellite Training) Also Used As Tool For Assessment.

d. Major Concept And Definition:-

 BernadDefindThe Terms In The Diagram As Follows
 Infant’s Clarity Of Cues
 Infants Responsiveness To The Caregiver
 Parents Sensitivity
 Parents Ability To Alleviate The Infant Distress.
 Parents Social And Emotional Growth Fostering Activities
 Parents Cognitive Growth Fostering Activities
 Child
 Mother
 Environment

BERNARD MODEL
Caregiver-parent characteristics. Infant characteristics

 Sensitivity to cues  Clarity of cues

 Alleviation of distress  Responsiveness to caregiver
 Providing growth
 Fostering situation

 Infant’s Clarity Of Cues:- To Participate In A ScfchronousRelationship,The Infant Must

Send Cues To His/Her Caregiver.

 Infant’s Responsiveness To The Caregiver:- Infant Must Send Cues So That Parent Can
Modify His/Her .The Infant Must Also Read Cues So That She/He Can Modify His/Her
In Turn.

 Parent’s Sensitivity:-Parent’s,LikeInfants,Must Be Able To Read Cues Given By Infant.

 Parent’s Ability To Alleviate The Infant’s Distress:- Some Cues Sent By The
Infant,Signal That Assistace From Parent Is Needed.

 Parent Social And Emotional Growth Fostering Activities:- The Ability To Initiate
Socl&Emot Growth Fostering Activities Depend Upon More Global Parent Adaptation.

 Parent’s Cognitive Growth Fostering Activities:-Cognitive Growth Is Facilitated By

Providing Stimulation Which Is Just Above The Child’s Level Of Understanding.

 Child:-Bernard Used The Characteristics OfnewbornBehaviour,Feeding&Sleeping

Patterns,PhysicalAppearance,Temperament&The Child’s Ability To Adapt To His/Her
Caregiver &Envt.

 Mother:- Refers To Child’s Mother Or Caregiver.

 Mother’s Characteristics Include Her Psychosocial , Her Concern About Her Child,Her
Own Health, The Amount Of Life Changes She Experienced,HerExpectations For Her
Child,And Most Important , Her Parenting Style & Her Adaptational Skills.

Environment:- The Environment Represent The Environment Of Both Child And Mother.
Characteristics Of Environment Includes,
-Aspect Of The Physical Environment Of The Family
-The Father Involvement &The Degree Of Parent Neutrality In Regard To Child
Reasoning.

D. MAJOR ASSUMPTIONS:-
Nursing: Defined As Process By The Patient Is Assisted In Maintenance & Promotion Of His Independence
Person:She Describes Person/Human Being.She Speaks Of The Ability To Take In Auditory & Visual &
Tactile Stimuli.
Health: She Doesn’t Define Health But Describes Family As A Basic Unit Of Health Care.
Environment: Includes All Experiences Encountered By The Child,People,Object,Place,Sounds,Visual&
Tactile Sensation.

BERNARD APPLICATION

- MOTHER/CARE GIVER - INFANT CHARACTERISTICS

CHARACTERISTICS
NAME OF MOTHER
-PARENTS SENSITIVITY -CLARITY OF CUES
IDENTIFIED BABY IS CRYING DUE INFANT SEND CUES BY
CRYING,GRIMACE FACE DISCOMFORT
TO HUNGER & WET NAPPY DUE TO WET NAPPY
-ALLEVIATION -RESPONSIVENESS TO CARE GIVER
SLEPT WELL
-PROVIDING GROWTH FOSTERING ACTIVITIES
.CUDDLED THE BABY
.MAINTAINED EYE-EYE CONTACT
WHILE TALKING WITH BABY

PROGRESS NOTES

1st Day -: Patient’s Condition Was Poor

Temp-100f,Pulse-160beats/Min,Resp-60breaths/Min

2nd Day -: Patient’s Condition Had Some Improvements.Patient Cried Frequently.

Temp-99f,Pulse-130beats/Min,Resp-50breaths/Min

3rd Day -:Patient’sBecomecondition More Better.

Temp-98f,Pulse-130beats/Min,Resp-40breaths/Min

4th Day -: Patient’s Activity Level Improved Well.

Temp-98.6f,Pulse-120beats/Min,Resp-40breaths/Min

HEALTH EDUCATION

• Mother Was Reminded Of The Previous Day Health Education And She Could Remember

• Importance Of Keeping Baby Warm And Dry, To Prevent Skin Excoriation And Cold
• Exclusive Breast Feeding On Demand For 6 Months Before Introduction Of Complementary Feeds.

• Maintenance Of General Hygiene To Promote Baby’s Health And Prevent Infection

• Follow Up Immunization For The Baby According To Keeping Schedule As Instructed As The Baby `Had
Already Received The Birth Polio And Bcg In The Ward.

• To Bring Back Baby For Follow Up In Pediatric Outpatient Clinic After 2 Weeks.

• To Take Well Nutritious Diet (Family) To Promote Health And It Will Assist Her Get Enough Milk For
Baby.

• Advised On Family Planning So As To Space Her Delivery

 BIBLIOGRAPHY

1.Dorothy R Marlow & Barbara A Redding; The Text Book Of Pediatric

Nursing;6thEdition;Page No:348-352.

2.Achar’s; The Text Book Of Pediatrics;4thEdition;Page No:112-116.

3.Jaypees;Nurse’s Dictionary;3 rdEdition;Page No:54.