Incubator

Incubator

A heated and humidified apparatus for a newborn, often premature child.

The use of incubators make it possible to provide the required environmental heat to maintain each infant’s body temperature.(35.5-36.5)

INDICATION

1. Infant’s < 2000g for maintaining a constant environmental temperature.

2. Sick infant’s requiring close monitor ex. RDS

3. For isolation ex: whooping cough

4. For convenient and better management

PREPARATION OF INCUBATOR

1. Pre heat the incubator2. Fill the water chamber with 2, 200cc of sterile distilled water so that the humidity can be increased if necessary.3. Set the pre heated incubator to the desired temperature and or as prescribed by the attending physician. -it can be regulated to meet the needs of the individual infant4. Undressed the infant except for a diaper then place infant in incubator through opened access panel.- undresssed the infant so that the flow of air will cantract the body surface.

DO’S AND DON’TS

1. Do not use mercury thermometer in incubator. If the thermometer is accidentally broken inside the incubator , the neonate can be poisoned by the mercury.

2. Minimal opening of incubator portholes.3. Infant servo temperatures are recorded

hourly during the initial critical care stage , and compared with the patient’s for hourly per axilla / per rectum record.

4. Coordinate observations with feeding times unless otherwise indicated by the infant’s condition.

5. Any readings above 37 ‘C and swinging incubator temperatures (indication of unstable temperature control) should be reported.

DO’S AND DON’TS

6. Infant servo control skim probe should be set on the abdominal wall.

7. Infant’s should not be place lying directly on the infant servo control probe leading to excessive fall in incubator temperature.

8. Infants body temperature should be taken every hour until it is stabilized.

9. Infant may be weigh in the incubator daily or according to the physician’s order depending on his size or condition.

EVALUATES RESPIRATION HEART RATE AND COLOR

Apneic/ gasping

Breathing

HR above

100b/m

HR below

100b/mPink

Central Cyanosis

Continue to observe HR RR and color

Indicates need 70 (+)

pressure ventilation w/

90 – 100% Oxygen

Slaps foot, flick heel or

rub back

Evaluates respiratio

nBreathi

ngApneic/ gasping

Provides 100%

O2Evaluat

es Color

Cyanotic

Pink

Slowly withdraws

O2 keeping

baby pink

I- INITIAL STEPS

II- USE OF A RESUSCITATION AMBUBAG AND MASK

RESUSCITATION / VENTILATION- Ventilation of the lungs is

the most important and most effective step in cardiopulmonary resusciatation of the compromised infant.

INDICATION:• Apnea / gasping•HR < 100 beats per minute even if breathing.•Persistent central cyanosis despite 100% free flow O2

1. Select Appropriate Mask- remember, the mask should cover the mouth,

nose tip of the chin but not the eyes.

2. Be sure that there is a clean airway. You want to suction the mouth

- suction one more time to be certain there will be no obstruction to the assisted breath that you will delivering.

3. Position the baby’s head- the baby’s neck should be slightly

extended to maintain an open airway. Placing a simple roll over the shoulders.

4. Position yourself at the bedside- side or head of the baby to use the bag

effectively

5. During the initial stages of neonatal resuscitation, breath should be delivered at a rate of 40 – 60 bpm or slightly < one 3 sec.

- a noticeable rise and fall of the chest is the best indication that the lungs are being inflated

III - CHEST COMPRESSION

CHEST COMPRESSION - Consist of a rhythmic

compression of the sternum that compresses the heart.

INDICATION:

•Compress the heart against the spine•Increase intrathoracic pressure.•Circulate blood to the vital organs including the brain.

1. Chest Compression consists of rhytmic compression of the sternum that compresses the heart againts the spine.

• Increasing the intrathoracic pressure. Circulate the blood to the vital organ of the body

2. Move your hand to compress the chest on 1and 2 and and do not remove your fingers from the surface you are pressing.

• The heart lies in the chest between the lower third of the sternum and the spine. Compressing the sternum to a depth of approximately one third of the anterior- posterior diameter of the chest

Post Partum Fundal Assessment

(palpating and massaging the uterus)

AFTER DELIVERY - the uterus gradually shrinks

and descends into its prepregnant position into the pelvis – known as INVOLUTIONPURPOSE: to identify the uterine size , firmness and descent.

INDICATION : done post partum , post caesarean, post curettage patients.EQUIPMENT:1.Gloves2.Perineal pad3.drapes

PROCEDURE:

1. Explain the procedures to the patient , provide privacy; wash hands and put on the gloves.

2. Teach the patient relaxation techniques(such as Deep Breathing)

3. Encourage the patient’s effort to urinate.

4. Lower the head of the bed until the patient lies supine , if this causes discomfort especially if she’s had CS keep the head slightly elevated

5. Expose the abdomen for palpation and the perineum for observation.

PROCEDURE

6. Gently compress the uterus between both hands( symphisis pubis level and tip of the fundus

NOTE: The level of the fundus above or below umbilicus in fingerbreadths or cm.

7. If the uterus seems soft and boggy, gently massage the fundus with circular motion until it becomes firm. Observe for lochia flow during massage.

8. Notify the doctor immediately if the uterus fails to contract and if heavy bleeding occurs.

9. If the uterus become firm after massage, keep one hand on the lower uterus and press gently toward the pubis.

10. Clean the perineum and apply clean perineal pad.