CASE STUDY DAILY CARE OF A TERM INFANT

CASE ruminate DAILY CARE OF A TERM INFANTThe purpose of this model study is to discuss an episode of Normal midwifery, which in this instance, go erupt consociate to the insouciant Care of a terminus bollocks up.The case study will highlight the episode of carry on in detail, evaluate themanagement of the fluffs natural care and the muliebritys Educational,Psychosocial needs with germane(predicate) evidence based back.The anonymity of vex and youngster will be maintained in accordancewith NMC (2008) and ESC 1 (NMC, 2007) and will be referred to as the fair sex and the vitiate through disclose the model Study. Consent was overlyrequested from the charr for herself and pamper to be included in the CaseStudy in telephone circuit with ESC 1 (NMC, 2007).BACKGROUNDThe fair sex was a 28 year old who was likeness 1+0, had a spontaneous vaginal delivery of a go bad girl with only Entonox as pain relief and was flat second day postnatal. The mollycoddle girl weighed 3288 grams with no complications after delivery and had APGAR dozens of 8 at 1 heartbeats and 9 at 5 minutes. The adult female had 40 minutes uninterrupted skin-to-skin with the baby after extraction and decided to artificially feed rather than breast feed, although benefits of breast nourishment were explained to the adult female.The scholar accoucheuse let ongrowth met the woman during her Labour the previous day and was present at the kindred.As the disciple midwife was working a day shift with her mentor, it was requested that the assimilator midwife carry out the cursory Examination of the baby in line with KCND (NHSQIS, 2009), while the Mentor observed.The initial examination and taxment of the baby was make at assume by the Mentor as suggested by Demott, Bick, Norman (2006) and included assessing the youngs physiologic adaptation to extra-uterine life, colour, tone, breathing and heart rate concord to Resuscitation Council (2006). The purpose of the d ay by day Examination thither after is to monitoring device the progress of the baby and for archean detection of deviation from the customary launch at sign Examination. These findings were enter in SWMR child Post Natal notes in line with NMC (2008) and KCND (NHSQIS, 2009).The Student accoucheuse before entering the womans room to commence examination familiarize herself with the womans Medical case / SWMR notes and babys SWMR notes, to review the medical history including family history, maternal, antenatal and perinatal history, fetal and neonatal history so as to be snappish to assist with any apprehensions the woman may have regarding Physical, Educational or Social needs as recommended by KCND (NHSQIS, 2009).PHYSICALThe Student midwife greeted the woman on entering the room and enquired how the woman was sense of smelling. It was established that the woman was pain still and feeling fairly rested after grok the previous day. The Student Midwife because(prenomi nal) asked how the woman had found the baby overnight, regarding specifically feeding, sleeping pattern, passing urine meconium. The woman affirm that the baby had been feeding approximately every 3 4 hours taking 30 mls each quantify, between feeds the baby was reported to have been settled and sleeping. It was likewise reported that the baby had been having wet nappies and one episode of a massive amount of meconium macrocosm passed. It was of the essence(predicate) to establish that meconium had been passed within the first 24 hours as failure to do so may have indicated a gastrointestinal problem including Hirshsprungs disease. The woman was reassured that the passing of urine and meconium was great as this encounters that the renal and gastrointestinal systems are functioning standardly. The training apt(p) was preserve in the babys SWMR notes following NMC (2008).It was then explained to the woman that the Student Midwife was going to examine the baby from head t o toe, this would involve the baby being completely undressed at whatsoever point during the examination and that it would be carried out in front of her. Any findings would be discussed with her at the conviction and any concerns that she may have would be answered. Consent was then want from the woman in line with NMC (2008) for the examination to be carried out, as the baby could not give consent, which was duly given(p).As it is important that the baby does not become cold callable to the inefficiency of regulating temperature due to immaturity of the hypothalamus as suggested by Farrell and Sittlington in Fraser and barrel maker (2009), the Student Midwife check intod that all windows and doors were close to exclude any draught before commencing the Daily Examination of the baby. in any case the Student Midwife washed her detainment and applied latex free gloves to protect herself from any of the babys bodily fluids and to protect the baby who is at fortune of transm ittance as suggested by Johnson and Taylor (2006).Whilst undressing the baby the Student Midwife was heedful to show respect to the baby by gentle handling and leave out of excessive noise as suggested by Carbjal and Coudered (2003). Safety of the baby was also considered and the Student Midwife ensured that the cot was stable and in view of the bring prior to commencing the examination. The babys identity was confirmed by checking details on both identity bands on the baby with the sustain and the mothers identity was also confirmed by checking her identity band in line with the Newborn and sister Physical Examination (NIPE) Standards and Competencies (NHS, 2008).A methodical examination was commenced by the Student Midwife which follows. All findings were discussed with the woman and documented in the babys SWMR notes as recommended by NMC (2007) who res publica that midwives must adhere to the guidelines for records and record keeping as a legal requirement.DAILY EXAMINATIO NTemperatureBefore removing the babys clothes, the Student Midwife in any casek the babys temperature from the axillary cavity site using an electronic thermometer whilst the baby lay in the cot. The version was 36.8C which was within the normal range for an axilla reading (36.5 37.3C) as described by Bain in Fraser and Cooper (2009).Reassurance was given to the mother when she asked if the baby was warm enough that the reading was normal. The Student Midwife also offered the learning of how the woman could check to see if the baby was too warm or cold by feeling under the babys clothes just under the neck and at the top of the babys bandaging. Also a good version was if the woman had two layers on, then generally the baby would require the akin amount of layers. It was also advised that the baby would not require to dupe a hat indoors if the room is at a lucky temperature of between 18 21C but would require it open air due to cool air.General AppearanceThe Student Midwi fe distant the babys clothes, leaving only the laconic on which would be outback(a) after in the examination, to observe the general appearance of the baby.The babys skin was famous to be pink all over showing no signs of central cyanosis, although hands and feet still showed slight signs of peripheral cyanosis which is normal during the first 24 48 hours according to Farrell and Sittlington in Fraser and Cooper (2009). This was explained to the mother so no groundless worry was caused due to the blue tinge of the hands and feet.Also there was no sign of jaundice which is public after 48 hours from birth as all newborns have a transient rise in serum bilirubin which usually settles after 10 12 old age post natal. The woman was advised to watch for any colour channel of the babys skin from pink to yellow tinge or for the white of the affection (sclera) to be tinged with yellow. It was explained that this is a normal occurrence as suggested by Johnston, Flood, Spinks (2003) and as long as the baby had a good urine output, was wary regularly and fed healthy then there would be no cause for concern. However if the baby develops jaundice which last longer than judge, has excessive sleeping patterns, continually passes pale stools and dark urine, then the woman should induct immediate attention for the baby as this is abnormal for a facial expression fed baby.The babys breathing was observed whilst lying in the cot and was noted to be within the normal range of 40 60 breaths/minute with the chest and abdomen rising and falling, showing no signs of injury. Being awake, alert and active the baby was seen to be moving all limbs as expected with good tone.HeadThe babys head was gently examined by the Student Midwife. This was make by gently running the finger tips across the babys head to feel along the suture lines and fontanelles. The Student Midwife when doing this was determining if any moulding, headspring succedaneum or cephal haematoma had occ urred during passage down the birth canal or from mechanical press from the cervical os. Slight moulding was detected and this was explained to the woman that this was normal and was caused by the bones in the skull overlapping during delivery and will cut off itself within a couple of days. The anterior fontanelle was then gently felt and found to be level. This indicated that there was no intracranial pressure which would cause it to rise or dehydration which would cause it to be depressed. It was explained that it is roughhewn to differentiate pulsating at the anterior fontanelle which is no cause of concern and that this soft spot closes over by the time the baby was 18 months old as confirmed by Wylie (2005).EyesBoth eye were checked and found to be sack of any discharge.The Student Midwife suggested to the woman that if the eyeball were to become sticky, which is common due to blocked schism ducts and can be seen as a crust on the eyelid, the eyes should be cleaned. To do this the woman should use cooled boiled water and cotton wool wool balls. Each eye should be cleaned from the inner eye outward only using the cotton wool ball once then discarding. Each eye should be cleaned separately to avoid cross contagion. singMouth was inspected by opening the mouth by gently urgent afinger against the angle of the jaw at the chin. This enabled the Student Midwife to step inside to assess the tongue, gums and roof of the mouth. The Student Midwife did not present small finger into mouth to check for a cleft palate or suck reflex as this had been established at Initial Examination of the newborn and no abnormalities had been detected. The mouth was seen to be moist and clear of any white plaques which may have suggested oral thrush as verbalize by Bain in Fraser and Cooper (2009). uncaseCloser inspection was then done by the Student Midwife of the babys skin, looking in peculiar(a) for any rashes, spots, bruising or infection. The babys nappy was remo ved and buttocks examined to ensure skin was intact. All appeared normal with no excoriation identified.The Student Midwife advised the woman that information on minor disorders would be given to her at the end of the examination as the Student Midwife was sensible of the babys temperature being maintained.Umbilicus CordThe umbilicus cord and clamp were inspected for signs of infection and separation. Nothing unusual was detected. The baby was redressed as quickly as feasible to maintain body temperature and given to the woman to settle.Information was given to the woman on periodic cord care which included that the umbilicus should be cleaned with warm tap water and patted dry which has been shown to aid separation as stated by Trotter (2003). This should be done daily and at a nappy change if required. It was explained to the woman that hand washing is infixed before and after cord care as suggested by Farrell and Sittlington in Fraser and Cooper (2009) as the cord is a potent ial site for infection and Straphylococcus aureus is commonly found here as confirmed by Newell, Miller, Mogan et al (1997). When the woman asked when the clamp would be removed, it was confirmed that this may be done on the third or fourth day when the cord has dehydrated out as suggested by World health Organisation (WHO) (1999).The Student Midwife confirmed that the Daily Examination of the baby was complete and that she would now give the woman upgrade information on minor disorders, natural rubber baby care practice in particular Sudden Infant Death Syndrome and address any other concerns that the woman may have.educational takeThrough out the examination the Student Midwife gave the woman information on day-to-day care and signs of illness.As previously mentioned further password took place with the woman regarding Minor disorders and safety issues, which is in line with NHS QIS (2004) who suggest that ay assessment or examination at birth or later should be seen as an l uck for parental education or health promotion. This included the following ailments and explanation given to the womanSkin RashesErythema toxicum. A red blotchy rash with white pinhead papules which is common during the first 7 days post natal and will run on its own.Miliaria. A sweat rash which occurs in babies who become too warm. It appears as clear papules on face, scalp, chest and areas where clothes rub due to unopened sweat glands. The baby should have excess clothing removed and placed in a cooler environment. The papules will disappear on their own.Milia. White or yellow papules commonly seen on cheeks, nose and forehead. depart disappear on their own.Sore buttocks/Nappy rash. The skin beneath the nappy area becomes red and excoriated due to either infrequent nappy changing, frequent loose stools or hot weather. By exposing the cleaned skin to a warm dry atmosphere aids the excoriated skin to heal. Care in using commercial barrier creams must be noted as they can preven t the one-way design of disposable nappies, blocking the perforations in the linings resulting in the urine and stools being next to the babys skin longer.Breast Engorgement of the BabyThis can occur in both female and male babies more or less the 3rd day post natal. The breasts appear to have a inflation under the nipple which is caused by the drop in oestrogen levels in the baby after birth which stimulates the breast to produce milk. No discussion is required and will rectify itself. It is important that mothers do not squelch the breast as this may result in infection.Pseudo-menstruationIt is common to notice a clear discharge or blood-stained vaginal discharge from baby girls during the withdrawal of the mothers hormone oestrogen after the birth. The mother was reassured that this is a normal physiological process which does not require treatment, although can be alarming if not aware of it.Safe Baby Care PracticesThe splendor of reducing the happen of Sudden Infant Death Syndrome (SIDS) is done by ensuring the baby sleeps in a cot in the parents room for the first 6 months. The baby should always be put on their back to sleep, with their feet to the foot of the cot. They should be lightly covered with the room at a normal temperature, not too hot. Bed sharing is not recommended curiously after consuming alcohol, drugs or after smoking. The baby should be in a smoke-free atmosphere. These recommendations are formed by the Department of Health (1996).Following the birth of the baby the role of the Midwife is to observe and monitor the health of the mother and he newborn, offering information and support in breastfeeding, which is not applicable in this instance, parenting skills and signs of morbidity according to Merchant (2006). This entangled effective conversation with the woman through out the examination to ensure that the woman conveyed her concerns, maintained control over her decision making with regards to the baby, aid her in making in formed choices and reduced her anxiety levels and emotional distress as suggested by Raynor (2006). In order that the womans physical and emotional condition was commensurate with effective communication, the Student Midwife had to assess the womans emotional state when receiving information, which was done by asking how the woman was feeling before commencing the babys Daily Examination. The womans state could have been effected by pain, tiredness, hormonal changes or if the baby was crying/distressed due to being hungry or requiring changing. then the timing of conducting the Examination was essential to ensure that the woman retained the volume of the information given to her without being distracted due to other factors. In this instance the woman was receptive to the information given, which would assist her in the daily care of her baby, as according to McCourt in Page and McCandlish (2006) the transition to parenthood is a time when adults are responsive to information and will look for it actively.As the Midwife becomes familiar with the appearance and behaviour of a normal term newborn, the recognition of signs and signals caused by morbidity are easily communicated to the mother to assist her in recognising when there are any deviations from the normal with her baby. The magnificence of this is in preparing the mother for discharge home as the length of time spent in hospital is decreasing according to Bain in Fraser and Cooper (2009).As well as educating the woman with clinical skills (e.g. daily care of the baby, recognising signs of illness) the Midwifes role also encapsulates being able to provide relevant information / advice on general health promotion, social support and mental health.PSYCHOSOCIAL NEEDSAs the woman was a first time mother it was important to establish that the woman had adequate support in caring for herself and the baby. This was established by the Student Midwife by familiarising herself with the woman and babys SWMR and Case notes which would highlight any social issues that may have needed addressing as the social circumstances in which a woman lives and a newborn brought into play a major part in their health and well being according to Raynor (2006). In this instance the woman was in a stable relationship with no reported Domestic Abuse, was not in temporary housing, had no social work involvement, no mental health issues and had good family support as routinely asked during Booking appointment and recorded in SWMR notes.It was important for the Student Midwife to spend time with the woman and baby in quiet surroundings, free from interruption which offered privacy and allowed the communication of sensitive and confidential information to be shared between the woman and the Student Midwife following NIPE Standards and Competencies (NHS, 2008). This gave the Student Midwife the opportunity to assess the womans psychosocial well-being by asking how she was coping (defined as coming to term with a situation according to Lazarus (1966)) so far with the baby / meet a mother and also to ascertain the womans expectations of becoming a mother. It is cognise that in adjusting to motherhood, the woman can feel insecure and loses confidence in her own abilities in the early postnatal period, especially on the persist up to and after discharge as confirmed by hold and Mitchell (2004). Factors which can influence this are the womans personality, previous learning, quality/quantity of support available and past experiences of coping. The woman, in this instance stated that although she knew it would take some time to adjust to lack of sleep and was slightly anxious rough going home, she had good support from her partner, mother and friends she had no immediate concerns just about caring for the baby.CONCLUSIONIn conclusion it is the Student Midwifes opinion that the Daily Examination of the Term Infant was carried out following KCND (NHS, 2009) guidelines and that the NIPE Stand ards and Competencies (NHS, 2008) were adhered to.The baby was examined in a safe and comfortable environment, was shown respect and care from the Student Midwife whilst performing Daily Examination and full explanation was given to the woman as to what was being checked and looked for. The Student Midwife ensured that the woman had the opportunity to ask questions or offer sensitive information through out this encounter by providing privacy and confidentiality in line with NMC (2008) and ESC (NHS, 2009).All findings and discussion were documented in mother and baby SWMR notes accordingly in line with NMC (2007)The role of the Midwife in Educational and Psychosocial needs is to give the woman, relevant health advice for the baby and themselves, reassurance and permission to say how they feel. This follows a health orientated and woman centred model of care, which recommends that the role of the Midwife is to encourage the womans self confidence, force to take control and self est eem as suggested by Bates in Stewart (2004).In a recent study it was concluded that healthy, low risk women wanted attentive, proactive, professional support from the Midwife during the transition to motherhood according to Seefat-van Teeffelen, Nieuwenhuijze, Korstjens (2009) which the Student Midwife believes was given during this Daily Examination of a Term Infant.