Registration Instruction for New Nurses (June 2009 Nursing Board Exam Passers)

Those who will register are required to bring the following:

duly accomplished Oath Form or Panunumpa ng Propesyonal,

current Community Tax Certificate (cedula),

2 pieces passport size picture (colored with white background and complete name tag),

1 piece 1” x 1” picture (colored with white background and complete name tag),

2 sets of metered documentary stamps, and 1 short brown envelope with name and profession;

and to pay the Initial Registration Fee of P600 and Annual Registration Fee of P450 for 2009-2012.

Successful examinees should personally register and sign in the Roster of Registered Professionals.The oathtaking ceremony of the successful examinees in the said examination in Manila as well as the previous ones who have not taken their Oath of Professional will be held before the Board on Tuesday and Wednesday, August 18 and 19, 2009, with morning (8:00 A.M.) and afternoon (1:00 P.M.) sessions at the SMX Convention Center, SM Mall of Asia, Pasay City.

All must come in their white gala uniform, nurses cap, white duty shoes, without earrings, hair not touching the collar and without corsage.Oathtaking tickets for the National Capital Region (NCR) and nearby regions will be available at the Philippine Nurses Association (PNA) at 1663 F.T. Benitez Street, Malate, Manila, starting July 29, 2009, Wednesday.

Updated Provincial Schedule:

Baguio__________August 21

Davao __________August 29

Ilocos___________August 22

Legaspi__________August 21

Pangasinan________August 28

Zamboanga/Sulu____August 27

other provincial areas, please keep posted for BON advisory as to the oath taking schedules

Stories of Love and Compassion

Nursing is indeed a profession of compassion.. as Wikipedia would define it, Compassion is a human emotion prompted by enduring pain with others. More vigorous than empathy, the feeling commonly gives rise to an active desire to alleviate another's suffering.. It is what we exactly do right? We somehow always manages to touch other people's lives simply by the therapeutic use of self but haven't you realized lately how others have touched your lives as well?

I am going to share with you two wonderful and heartwarming stories shared by Bo Sanchez from Kerygma.. Hope you too will be touched by the story as I was.

Story 1:

Twins Brielle and Kyrie - born to Paul and Heidi Jackson. Kyrie weighed two pounds and three ounces while Brielle weighed only two pounds. They were placed in a separate incubators.
Kyrie, the bigger baby, responded well to medical procedures, growing well as doctors expected. But Brielle seemed to be in trouble. She had difficulty in breathing and became weaker and weaker.

Doctors did everything to stabilize Brielle's condition but to no avail. Then Brielle's nurse decided to break some rules. She got Brielle and put her in the incubator of her twin sister, Kyrie, and the incredible happened!

The moment the nurse closed the door of the incubator, Brielle snuggled up to Kyrie and automatically her breathing became stable. Her heartbeat stabilized, too. and then Kyrie put her arm around her baby sister.

This happened in 1995. Today, these twin sisters are 14 years old -- both strong and healthy.


Story 2:

One day, a mother came up to her three-year-old son. She said, "Michael, you are going to have a baby sister."
Michael was so happy. And everyday, he sang to his baby sister, morning and evening. "You are my sunshine, my only sunshine. You make me happy, when skies are gray...."

Three months before term, something happened and the baby had to be delivered prematurely. Michael's newly born sister was brought to the ICU. The first week was no good. The doctors told her parents bluntly, "Be prepared for the worst."

The parents cried. For months they were preparing the baby's room -- her crib, clothes, toys -- and now they had to call the cemetery for a burial plot for their baby.
During the entire week, Michael had been insisting, "Mommy, I want to see my baby sister!"

The mother could not tell Michael that his sister was dying and he might not see her because kids were not allowed in the ICU.

When the second week came, the little baby's condition became worse. It then dawned on the mother, "If I dont bring Michael to see his baby sister, he may never see her at all."

So she took him to the hospital.

When the head nurse saw Michael enterig ICU, she warned, "Please do not bring in that child. He is not allowed"

But the mother pleaded and, without the permission of the nurse, brought Michael beside the bed of the little infant. Michael began to sing "You are my sunshine, my only sunshine, you make me happy..."

Almost instantly, the baby's breathing normalized, her heartbeat stabilized. When the nurse saw this, he said to Michael, "Please continue singing. Something's happening"

Little Michael continued to sing, "You are my sunshine, my only sunshine. You make me happy when skies are gray. You never know dear how much I love you. Please don't take my sunshine away."

This is a true story and the baby survived.

All of us are sick -- one way or another. Some of us might be going through tough times now, or disappointments, is depressed or is going through a lot of pain which actually some might not even survive from it.

But come to realize, what we exactly need are these, a little Michael, (our own family), who will always stand by us even through the toughtest trials of our lives, who will continue to inspire us to go through life amidst everything.. and a little twin sister (our friends) who will always be there to hold our hand and give us a comforting hug, a hug of security and assurance that everything will be alright and faith to God Almighty, for only He can make miracles and move mountains..

Have a nice day, Godbless us all!

Practice Test

Hey guys, can you still remember the basics in nursing.. see how well your memory is.. passing score is 7/10! have fun! :)

1. The nurse is caring for a client with burn on his legs. Which nursing intervention will help prevent contractures?

• Applying knee splints
• Elevating the foot of the bed
• Hyperextending the client’s legs
• Performing shoulder range-of-motion (ROM) exercises.

2. A client is diagnosed with metastatic adenocarcinoma of the stomach. The physician prescribed Mitomycin (Mutamycin) with other chemotherapeutic agents for palliative treatment. How hoes Mitomycin exert its cytotoxic effects?

• It inhibits DNA synthesis
• It inhibits RNA sysnthesis
• It’s cell cycle-phase specific
• It inhibits protein synthesis

3. A client is to receive IV Vancomycin. When preparing to administer this drug, the nurse should keep in mind that:

• It may cause irreversible neutropenia
• it should be administered over 60 to 90 minutes in a large volume of fluid
• It should be administered rapidly in a large volume of fluid
• It should be administered over 1 -2 minutes as an IV bolus.

4. The following statement appears on a client’s care plan: “Client will ambulate in the hall without assistance within 4 days.” This statement is an example of:

• Nursing diagnosis
• Client outcome
• Subjective data
• Nursing Intervention

5. When performing an abdominal assessment, the nurse should follow which examination sequence?

• Inspection, auscultation, palpation, and percussion
• Inspection, percussion, auscultation, palpation
• Inspection, auscultation, percussion, palpation
• Inspection, palpation, percussion, and auscultation

6. The nurse is assessing a client with possible osteoarthritis. The most significant risk factor for osteoarthritis is:

• congenital deformity
• age
• trauma
• obesity

7.The nurse administers furosemine (Lasix) to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully?

• Increased in BP
• Increased in Blood volume
• Low serum potassium level
• High serum sodium level

8. When discussing the Food Guide Pyramid with a 75-year old client, the nurse should remember that the guide has been modified for older people. Unlike the standard Food Guide Pyramid, the version for elderly individuals:

• Eliminates the portion of the pyramid for fats, oils, and sweets
• Increases the amounts of recommended milk and dairy products
• Sets upper limits on servings of most food and water
• Includes eight-oz glasses of water at the base of the pyramid.

9. A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client’s care, the nurse should anticipate which measure?

• Administering large doses of oral antibiotics as prescribed
• Instructing the client to ambulate twice daily
• Withholding all oral fluid intake
• Administering large doses of IV antibiotics as prescribed

10. A client gives birth to a stillborn infant at 36 weeks’ gestation. When caring for this client, which strategy by the nurse would be most helpful?

• Be selective in providing the information that the client seeks
• Encourage the client to see, touch, and hold the dead infant
• Provide information about possible causes of the stillbirth only if the client requests it
• Let the child’s father decide what information the client receives

ANSWERS:

1. The nurse is caring for a client with burn on his legs. Which nursing intervention will help prevent contractures?

Correct Answer: A. Applying knee splints

Rationale: Applying knee splints prevents leg contractures by holding the joints in a functional position. Elevating the foot of the bed doesn’t prevent contracture. Hyperextending a body part for any length of time is inappropriate; it can cause contractures. Performing shoulder ROM exercises can prevent contractures in the shoulder but not in the legs.

2. A client is diagnosed with metastatic adenocarcinoma of the stomach. The physician prescribed Mitomycin (Mutamycin) with other chemotherapeutic agents for palliative treatment. How hoes Mitomycin exert its cytotoxic effects?

Correct Answer: A. It inhibits DNA synthesis

Rationale: Mitomycin exerts its cytotoxic effects by inhibiting DNA synthesis rather than RNA synthesis.

3. A client is to receive IV Vancomycin (Vancocin). When preparing to administer this drug, the nurse should keep in mind that:

Correct Answer: B. it should be administered over 60 to 90 minutes in a large volume of fluid

Rationale: To avoid hypotensive reavtion from rapid IV administration, the nurse should infuse vancomycin slowly, over 60 to 90 minutes, in a large volume of fluid. Although neutropenia may occur in approximately 5% to 10% of clients receiving vancomycin, this adverse effects reverses rapidly when drug is discontinued.

4. The following statement appears on a client’s care plan: “Client will ambulate in the hall without assistance within 4 days.” This statement is an example of:

Correct Answer: B. Client outcome

Rationale: A client outcome is short or long-term goal based on projected nursing interventions.

5. When performing an abdominal assessment, the nurse should follow which examination sequence?

Correct Answer: C. Inspection, auscultation, percussion, palpation

Rationale: The correct sequence for abdominal assessment is Inspection, Auscultation, Percussion, and Palpation; because this sequence prevents altering bowel sounds with palpation before auscultation.

6. The nurse is assessing a client with possible osteoarthritis. The most significant risk factor for osteoarthritis is:

Correct Answer: B. age

Rationale: Age is the most significant risk factor for developing osteoarthritis. Development of primary osteoarthritis is influenced by genetic, metabolic, mechanical, and chemical factors. Secondary osteoarthritis usually has identifiable precipitating events such as trauma.

7. The nurse administers furosemine (Lasix) to treat a client with heart failure. Which adverse effect must the nurse watch for most carefully?

Correct Answer: C. Low serum potassium level

Rationale: nurse must monitor the serum potassium level and assess for signs of low potassium. As water and sodium are lost in the urine, m BP decreased, and blood volume decreases, and urine output increases.

8. When discussing the Food Guide Pyramid with a 75-year old client, the nurse should remember that the guide has been modified for older people. Unlike the standard Food Guide Pyramid, the version for elderly individuals:

Correct Answer: D. Includes eight-oz glasses of water at the base of the pyramid.

Rationale: The Food Guide Pyramid version for older people adds a base that includes eight-oz glasses of water to prevent constipation and dehydration. The pyramid sets no upper limits on servings of most food and water. It doesn’t increase the milk and dairy recommendation and doesn’t eliminate the fats, oils, and sweets recommendation

9. A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client’s care, the nurse should anticipate which measure?

Correct Answer: D. Administering large doses of IV antibiotics as prescribed

Rationale: Treatment of acute osteomyelitis includes large doses of IV antibiotics (after blood cultures identify the infecting organism). Surgical drainage may be indicated, and the affected bone is immobilized. The client usually requires IV fluids to maintain hydration, but oral intake isn’t necessarily prohibited.

10. A client gives birth to a stillborn infant at 36 weeks’ gestation. When caring for this client, which strategy by the nurse would be most helpful?

Correct Answer: B. Encourage the client to see, touch, and hold the dead infant

Rationale: When caring for a client who has suffered perinatal loss, the nurse should provide an opportunity for her to bond with the dead child and allow the child to become part of the family unit. Parents who aren’t given such a chance may experience fantasies about the child, which may worse than the reality. If the child has gross deformities, the nurse should prepare the client for these. If the client doesn’t ask about her child, the nurse should encourage her to do so and provide any information she seems ready to hear. The client needs a full explanation of all factors related to the experience so she can grieve appropriately. Letting the child’s father decide which information the client receives is inappropriate.

Oathtaking for New Nurses (June 2009 passers)

(The June 2009 Nursing Board Exam Results has yet to be released but BoN Philippines already announced the schedules that are being arranged for the oathtaking of new nurses who will pass the June 2009 (NLE) Nursing Licensure Exam.
(1)The Oathtaking schedules are being worked out for implementation: August 18 and 19, SMX Convention Center will be the Oathtaking Ceremonies in Manila. And the following assignments have so far been made:

• Areas Identified -- BoN Assigned
  Bacolod --------------Hon. Betty F. Merritt)
  Baguio ---------------Hon. Yolanda C. Arugay
  Bohol ----------------Hon. Betty F. Merritt
  CARAGA ------------Hon. Perla G. Po
  CDO -----------------Hon. Amelia B. Rosales
  CEBU ----------------Hon. Betty F. Merritt
  DAVAO --------------Hon. Leonila A. Faire
  GEN. SANTOS -------Hon. Marco Sto Tomas
  ILOILO --------------Hon. Yolanda C. Arugay
  LAOAG --------------Hon. Perla G. Po
  LEGASPI ------------Hon. Carmencita M. Abaquin
  LUCENA -------------Hon. Perla G. Po
  PAGADIAN ----------Hon. Carmencita M. Abaquin
  PANGASINAN -------Hon. Carmencita M. Abaquin
  ROXAS ---------------Hon. Leonila A. Faire
  TACLOBAN ----------Hon. Yolanda C. Arugay
  TUGUEGARAO ------Hon. Marco Sto Tomas
  ZAMBOANGA --------Hon. Amelia B. Rosales

Additional areas may be adopted by the BoN upon request depending on the capability of the combined forces of PNA and ADPCN to organize and lead the Oathtaking Ceremony in the said area. The BoN on deck for such requests are: Hon. Leonila A. Faire, Hon. Amelia B. Rosales, and Hon. Marco Sto Tomas. The Board of Nursing believes this activity brings government particularly PRC and the Board of Nursing closer to our public/constituents.

(2)The BoN strongly recommends that all Regional Oathtaking Ceremonies apply/follow the “Prototype” Oathtaking Program as used in the National Capital Region (NCR) (with minor modifications as applied in the Regions) as provided for in our Oathtaking Souvenir Program.

(3)The names of all successful examinees released in newspapers of national circulation and
printed by the Board of Nursing in the National Oathtaking Souvenir Program and together with other relevant and timely issuances/articles these are considered “historic documents”. It is therefore strongly recommended that regional oathtaking partners include in their budget the cost of this souvenir program so that every successful examinee/new nurse may avail of the same,
In view hereof, all regional organizing partners are hereby advised to place your orders directly at least 2-3 weeks prior to scheduled Regional/Satellite Oathtaking Ceremonies for timely delivery through the EDUCATIONAL PUBLISHING HOUSE or JADE BOOKSTORE, Manila at Tele-Fax Numbers (02) 288-7278 or (02) 525-0468. The souvenir program cost shall be Php 150.00 each and freight cost shall be borne by the oathtaking host organizer.

(4)For purposes of better synchronicity and organization we advise all our oathtaking partners to keep communications open through:
Ms. Edna Luna, BoN Secretary, PRC Central Office at P. Paredes St., Sampaloc, Manila at Telephone Nos. (02) 735 1534 / 735 4476 / 736 3619 / 736 2250; or The BoN website & BoN
e-mail access address: http://www.bonphilippines.org/ or philnursing7@bonphilippines.org
NOTE: The NCR Oathtaking Ceremonies for New Nurses can be viewed nationwide/worldwide/mobile phone by live streaming through BoN Website.

Very truly yours,
HON. AMELIA B. ROSALES, RN, Ph.D.Member, Board of NursingChair, Oathtaking for the June 6-7 NLE New Nurses
Noted:HON. CARMENCITA M.ABAQUIN, RN, PhDChairman, Board of Nursing

(from nursingcrib.com)

Post Operative Complications

Circulatory Problems

1. Shock – It can be often prevented by attention to fluid balance and the administration of blood or blood substitutes during and after surgery. There are several causes of shock, although it usually occurs as the result of a combination of two or more factors.

Categories of shock:

1. Hematogenic – cause by blood loss
2. Neurogenic – caused by vasodilatation and reflex inhibition of the heart brought about by an insult to the nervous system.
3. Cardiogenic – results from cardiac failure or an interference with heart functions and in myocardial infarction or coronary thrombosis.
4. Vasogenic – caused by diffuse vasodilation; blood circulates poorly through dilated vessels and is not as available to the vital centers (pools in the small vessels and viscera); may occur in anaphylaxis
5. Toxic or bacteremic – thought to be cause by toxic fact that enters the bloodstream from infection
6. Psychic – results from extreme pain, deep fear, or sudden severe emotional disturbance

Signs and Symptoms of Shock:

o The person in shock appears nervous and apprehensive at first, but later become apathetic.
o The skin is cold and moist, and the lips are somewhat cyanotic.
o The pulse is rapid and thready, respirations are rapid and shallow, and the temperature subnormal.
o The blood pressure begins to fall.
Treatment of Shock:
o Treatment of shock, defends on the type of shock and the cause.
o The primary treatment of hematogenic shock is restoration of blood volume.
o Primary treatments for other types of shock might include the following:
1. Checking of the airway and the administration of oxygen,
2. Checking or changing the patient’s position to relieve pain or assist the airway.
3. Attention to urinary volume and medication.

o Some of the drugs commonly used to treat shock are:
1. Ephedrine
2. Phenylephrine (Neo-synephrine)
3. Isoproterenol (Isuprel)
4. Atropine

Recovery and Convalescence:

When signs and symptoms of shocks are noted immediately and treatment is initiated promptly, recovery is usually rapid. The prognosis becomes more guarded if treatment is delayed. Therefore prompt and intelligent recognition of the early manifestations of shock is important.

2. Hemorrhage – Hemorrhage may be either evident (can be seen) or concealed (cannot be seen). Primary hemorrhage occurs at the time of surgery, intermediate hemorrhage occurs within the first few hours of surgery and secondary hemorrhage occurs some time after surgery.

Symptoms of Hemorrhage:

o The patient is apprehensive, restless and thirsty.
o The skin is cold, moist and pale; his temperature falls.
o The pulse rate increases and respirations become rapid and deep.
o As hemorrhaging continues the blood pressure continues to fall, and the patient’s lips and conjunctivae become pallid.
o He will see spots before his eyes and hear ringing in his ears.
o The patient is weak but conscious.
Treatment of Hemorrhage:
o The surgeon must be notified immediately and emergency measures are instituted until he arrives.
o The patient should be given oxygen, and the rate of intravenous drip should be increased.
o His feet should be elevated, if possible.
o Blood pressure should be checked again.

3. Femoral phlebitis or thrombosis – Phlebitis or thrombosis occurs most frequently after operation on the lower abdomen or in the course of severe septic diseases, such as peritonitis and ruptured ulcer. The condition can be caused by several factors, including:
a. Injury to the vein by tight straps or leg holders at the time of surgery.
b. Blanket roll under the knees.
c. Concentration of blood by loss of fluid or dehydration.
d. Slowing of the blood flow in the extremity due to a lowered metabolism and depression of the circulation after operation.

Signs and Symptoms of phlebitis or thrombosis:

o The primary symptom of phlebitis or thrombosis is pain in the calf of the leg with swelling occurring within 1 to 2 days.
o The patient often ha a slight fever, sometimes with chills and sweat.

Treatment of phlebitis or thrombosis:

o The best treatment of femoral phlebitis or thrombosis is prevention. This is done by administration of adequate fluids after surgery to prevent concentration of blood, leg exercise and bandaging the legs with elastic bandages or antiembolic stockings as necessary.
o Blanket rolls or pillow rolls should not be placed under the knees.
o Early ambulation is also important in preventing phlebitis and thrombosis because it prevents the stagnation of blood in the veins of the lower extremities.
o If ordered, intermittent positive pressure breathing (IPPB) therapy may also be beneficial.
o Active treatment of phlebitis or thrombosis includes ligature or removal of the affected veins and the administration of heparin.

Pulmonary Complications

Pulmonary complications are the most serious and most common post-operative complications. They may be avoided in large measure by careful preoperative observation and teaching and by taking every precaution during and after surgery.
It is well known that those patients who have a respiratory disease at the time of surgery are more likely to develop pulmonary complications post-operatively. Therefore only emergency surgery should be performed on a patient with a respiratory disease.

Predisposing causes of pulmonary complications include:
o Preoperative trauma
o Infections of the mouth, nose and throat.
o Irritating effect of the anesthetic, especially either on the respiratory mucous membranes, with a resultant increase in mucus secretion
o Aspirations of vomitus.
o Shallow respirations after the operation because of the pain.
o History of heavy smoking or chronic respiratory diseases.
o Obesity, debilitation, age (very old or very young)
o Smoke inhalation.

1. Atelectasis – when the mucous plug closes one of the bronchi entirely, there is a collapse of the pulmonary tissue beyond the point.

Signs and Symptoms of Atelectasis:
If the lung tissue is involved, the patient will demonstrate the following:
a. Marked dyspnea
b. Cyanosis
c. Prostration and pleural pain (usually referred to lower chest)
d. Fever (common)
e. Tachycardia
f. Anxiety
g. Labored respirations

Treatment of Atelectasis:

o Treatment involved removal of fluid or air by needle aspiration and sedation.
o The incidence of postoperative pulmonary ateclasis has been reduced significantly as a result of the more conservative and judicious use of preoperative and postoperative sedation and by early ambulation of postoperative patients.
o Other pulmonary complications that may occur later in the postoperative period are bronchitis, pneumonia, hypostatic pulmonary congestion, pleurisy, and pulmonary embolism.

Urinary Complications

1. Urinary Retention may occur following any operation, but it occurs most frequently after operations on the rectum, anus, vagina or lower abdomen. The cause is thought to be a spasm of the bladder sphincter. Treatment depends on the individual patient but may include diuretics or increasing intravenous fluids.

2. Urinary Incontinence – is a frequent complication in the aged.

Immediate Care of the Newborn

Image via Wikipedia

Newborns are always and should be handled always with care..

The following are facts and tidbits which are helpful in carrying out the care of the newborn and is essentially important to nurses and nursing students alike to understand by heart..

Goals:

- To establish, maintain and support respirations.
- To provide warmth and prevent hypothermia.
- To ensure safety, prevent injury and infection.
- To identify actual or potential problems that may require immediate attention.
- Establish respiration and maintain clear airway

The most important need for the newborn immediately after birth is a clear airway to enable the newborn to breathe effectively since the placenta has ceased to function as an organ of gas exchange. It is in the maintenance of adequate oxygen supply through effective respiration that the survival of the newborn greatly depends.

Newborns are obligatory nose breathers. The reflex response to nasal obstruction, opening the mouth to maintain airway, is not present in most newborns until 3 weeks after birth

.
To establish and maintain respirations:
1. Wipe mouth and nose of secretions after delivery of the head.
2. Suction secretions from mouth and nose.
Compress bulb syringe before inserting
Suction mouth first, then, the nose
Insert bulb syringe in one side of the mouth
3. A crying infant is a breathing infant. Stimulate the baby to cry if baby does not cry spontaneously, or if the cry is weak.
Do not slap the buttocks rather rub the soles of the feet.
Stimulate to cry after secretions are removed.

The normal infant cry is loud and husky. Observe for the following abnormal cry:

High, pitched cry – indicates hypoglycemia, increased intracranial pressure.
Weak cry – prematurity
Hoarse cry – laryngeal stridor

4. Oral mucous may cause the newborn, to choke, cough or gag during the first 12 to 18 hours of life. Place the infant in a position that would promote drainage of secretions.
Trendelenburg position – head lower than the body
Side lying position – If trendelenburg position is contraindicated, place infant in side lying position to permit drainage of mucus from the mouth. Place a small pillow or rolled towel at the back to prevent newborn from rolling back to supine position.
5. Keep the nares patent. Remove mucus and other particles that may be cause obstruction. Newborns are obligatory nose breathers until they are about 3 weeks old.

Care of the Eyes

It is part of the routine care of the newborn to give prophylactic eye treatment against gonorrhea conjunctivitis or opthalmia neonatorum. Neisseria gonorrhea, the causative agent, may be passed on the fetus from the vaginal canal during delivery. This practice was introduced by Crede, a German gynecologist in1884. Silver nitrate, erythromycin and tetracycline ophthalmic ointments are the drugs used for this purpose.
Erythromycin or tetracycline Opthalmic Ointment:
These ointments are the ones commonly used now a days for eye prophylaxis because they do not cause eye irritation and are more effective against Chlamydial conjunctivitis.
Apply over lower lids of both eyes, then, manipulate eyelids to spread medication over the eyes.

Vitamin K or Aquamephyton

The newborn has a sterile intestine at birth, hence, the newborn does not possess the intestinal bacteria that manufactures vitamin K which is necessary for the formation of clotting factors. This makes the newborn prone to bleeding. As a preventive measure, 0.5 (preterm) and 1 mg (full term) Vitamin K or aquamephyton is injected IM in the newborn’s vastus lateralis (lateral anterior thigh) muscle.

Care of the cord

The cord is clamped and cut approximately within 30 seconds after birth. In the delivery room, the cord is clamped twice about 8 inches from the abdomen and cut in between. When the newborn is brought to the nursery, another clamp is applied ½ to 1 inch from the abdomen and the cord is cut at second time. The cord and the area around it are cleansed with antiseptic solution. The manner of cord care depends on hospital protocol. What is important is that the principles are followed. Cord clamp maybe removed after 48 hours when the cord has dried. The cord stump usually dries and fall within 7 to 10 days leaving a granulating area that heals on the next 7 to 10 days.

Instruction to the mother on cord care:

No tub bathing until cord falls off. Do not sponge bath to clean the baby. See to it that cord does not get wet by water or urine.
Do not apply anything on the cord such as baby powder or antibiotic, except the prescribed antiseptic solution which is 70% alcohol.
Avoid wetting the cord. Fold diaper below so that it does not cover the cord and does not get wet when the diaper soaks with urine.
Leave cord exposed to air. Do not apply dressing or abdominal binder over it. The cord dries and separates more rapidly if it is exposed to air.
If you notice the cord to be bleeding, apply firm pressure and check cord clamp if loose and fasten.
Report any unusual signs and symptoms which indicates infection.
- Foul odor in the cord
- Presence of discharge
- Redness around the cord
- The cord remains wet and does not fall off within 7 to 10 days
- Newborn fever

THE APGAR SCORING SYSTEM

The APGAR Scoring System was developed by Dr. Virginia Apgar as a method of assessing the newborn’s adjustment to extrauterine life. It is taken at one minute and five minutes after birth. With depressed infants, repeat the scoring every five minutes as needed. The one minute score indicates the necessity for resuscitation. The five minute score is more reliable in predicting mortality and neurologic deficits. The most important is the heart rate, then the respiratory rate, the muscle tone, reflex irritability and color follows in decreasing order. A heart rate below 100 signifies an asphyxiated baby and a heart rate above 160 signifies distress.

HEART RATE
0 - Absent
1 - below 100
2 - Above 100

RESPIRATION
0 - Absent
1 - Slow
2 - Good crying

MUCLE TONE
0 - Flaccid
1 - Some flexion
2 - Active motion

REFLEX IRRITABILITY
0 - No response
1 - Grimace
2 - Vigorous cry

COLOR
0 - Blue all over
1 - Body pink, extremities blue
2 -Pink all over

Score:
*7 – 10 Good adjustment, vigorous
*Moderately depressed infant, needs airway clearance
*Severely depressed infant, in need of resuscitation.

ASSESSING THE AVERAGE NEWBORN
Head Circumference 34 – 35 cm
Temperature 97.6 – 98.6 F axillary (anal temp is preferred to check for imperforated anus)
Chest Circumference 32 – 33 cm
Heart Rate 120 – 140 bpm
Respirations 30 – 60 bpm
Weight 2.5 to 3.4 kg
Length 46 to 54 cm