• Common Noticeboard
• 1st Year Nurses
• 2nd Year Nurses
• 3rd Year Nurses
  • Maternity Elective
    • Week 1
    • Week 2
    • Week 3
    • Week 4
    • Week 5
    • Week 6
    • Week 7
  • Paediatrics
  • Mental Health
  • Community
  • High Dependency
  • Perioperative

Simulation Laboratory Activities: Sarah Davies

Sarah’s pregnancy was uneventful. Baby Jane was born at 03.10 on the 18^th October. Jane was immediately put onto Sarah belly. This is an important time for bonding between Sarah, Bill and their newborn daughter Jane. With permission Jane is dried off to prevent evaporation of heat from her wet skin and covered with a dry wrap while still maintaining skin to skin with Sarah. Bill has cut the umbilical cord and a Hollister clamp has been applied.

One minute after the birth Jane had a heart rate of 130 beats per minute (bpm), was crying and actively moving her arms and legs, and had a pink body with blue extremities. At 5 minutes Jane’s entire body was a pink colour, heart rate 120 bpm, respiratory effort good, extremities well flexed and responding to stimuli. When appropriate and at a suitable time for Sarah, Bill and Jane you can now begin your immediate post birth care. Sarah has previously indicated her desire to breast feed so Jane is tried on the breast (this will be explored more in week 4). Jane’s temperature is measured per axilla and was 36.8^oC. Later, and without unnecessary exposure, a weight, height and head circumference and measured on Jane. Jane’s weighed is 3.12kg, height 49cm and head circumference 34cm. Two ID baby labels are placed on Jane, one the arm and one on the leg. After discussions with Sarah and Bill a vitamin K IM injection is given to Jane as a prophylactic treatment against haemorrhagic disease of the newborn.

One hour after the birth Sarah, Bill and Jane are transferred to the postnatal unit. In the first 24 hours after the birth Jane has passed urine and meconium. She has had her hearing test and passed. The newborn screening test is performed 48 hours after the birth and sent off for testing. The cord is inspected and cleansed daily (or after a messy bowel motion) with water and dried thoroughly. The clamp is removed on day 3 and the cord usually separates before day 10 by a process of dry gangrene.

Tutorial Information

Your tutor will demonstrate a head to toe assessment of the newborn, how to perform a bath on the newborn examination and normal characteristics of the newborn.

Simulation Laboratory Activities

• Revise any skills you may have missed last week
• Access and record the information given to give an Apgar score at 1 and 5 minutes
• Unwrap the baby and perform a neonatal head to toe assessment (can be performed in the birth or postnatal unit)

* Note the general appearance of the baby – head size to the body, posture, tone,  skin characteristics, rashes, any birthmarks, presence of vernix or lanugo

Examination of the head

* Head – size and shape of head (location of eyes and ears), hair, any moulding, check anterior and posterior fontanelle

* Eyes – colour, check reaction to light

* Nose – generally nose breather

* Mouth – lips pink, sucking, gag and swallow reflex present, check hard and soft palate, any teeth, tongue proportional to mouth, chin recessed

* Ears – cartilage present in pinna, CNS startle reflex to noise

* Neck – short and straight, symmetrical to shoulders

Examination of the body

* Chest normal shaped, expands and retracts with breathing, breathing sounds, loud cry, breasts flat and symmetric, heart regular rhythm and rate, any murmurs

* Abdomen cylindrical and protruding, umbilical cord stump (note any umbilical bleeding, presence of three cord vessels i.e. two arteries and one vein), femoral pulses, check for inguinal hernia, bowel sounds, micturition, check genitalia (testes present), symmetrical buttocks, anal canal patent, no fissures or tears, trunk C shaped

* Back – spinal column, buttocks, creases

* Extremities- arms/legs – appearance, range of motion, creases, pulses, fingers/toes

* Genitalia - anus, perineum, genitalia, output

Check Reflexes

* Startle, rooting, sucking, grasping, stepping

Behaviour

* Posture, cry, tone, feeding, sleep pattern, handling

• Place the baby on the scales and record a weight. Consider the baby’s weight and the normal range for a newborn
• Using a tape measure determine the baby’s head circumference and length (measurement from the top of the head to heal)
• Consider the normal vital signs of a newborn
• Administer the IM Vitamin K injection to Jane
• Perform a baby bath (normally not performed until Sarah and Jane have settled into the postnatal unit)
• Observe the charts demonstration fetal to neonatal circulation
• Complete your nursing documentation