Book
Routine Care of the Neonatal Unit
- Daily Nursing Care
Includes:
- Monitoring vital signs and growth measurements
- Hygiene care, including:
- Bathing - Diaper area care
- Umbilical cord care
- Skin care
- Eye care
- Providing special care
- Feeding the newborn
- Proper positioning
- Cleaning and disinfecting equipment, supplies, and linens
Preparation for Daily Nursing Care:
- Routine handwashing
- Prepare all equipment and ensure they are functioning properly:
- Measuring tape
- Thermometer and stethoscope
- Stopwatch
- Sterile cotton and gauze
- 70% Ethyl alcohol
- Zinc oxide cream (as prescribed)
- Gloves
- Bathing supplies
First: Vital Signs Monitoring
- Always measure vital signs when the infant is calm for accuracy.
- Includes: temperature, heart rate, respiratory rate, and blood pressure.
- Respiratory rate should be counted **before touching** the infant.
- Vital signs should be taken every 3 hours before feeding if the baby is stable or as directed by the physician.
Second: Growth Measurements
- Weight: Measured every 24 hours if the infant weighs less than 1000g and documented in the growth chart.
- Length: Measured weekly.
- Head circumference: Measured weekly or as ordered.
- Abdominal circumference: Measured every 24 hours or as per physician's instructions.
- Clean tools and return them to storage.
- Routine handwashing.
Third: Newborn Hygiene Eye, Mouth, and Face Cleaning: Done during routine care or when necessary.
Bathing:
- Do not use soap on the face.
- Full body bath 3 times a week (every other day).
**In Incubator: **
- Infants under 1200g or those unstable should not be removed from the incubator; use a soft cloth moistened with warm water to clean the face and diaper area.
**Outside Incubator: ** Bathing is allowed if:
- Infant is stable in bed/incubator
- Not receiving IV fluids
- No open wounds (including the umbilical stump)
**Bathing Precautions: **
- Use a disinfected plastic basin (one per infant).
- Ensure air conditioners and drafts are off during bathing.
- Ideal time: 9:00 AM alongside weight check and linen change.
- After bathing, disinfect tools and return them to their places.
- Record any abnormal signs and notify the physician.
Umbilical Cord Care
- Routine handwashing and alcohol rubbing, followed by sterile gloves.
- Keep the umbilical stump **exposed to air**; fold the diaper below it.
- Clean with 70% alcohol at each diaper change.
- If soiled, clean with warm water before applying alcohol.
Diaper Area Care
- Provided every 3 hours before feeding or when needed.
- Keep the area dry and treat rashes promptly.
Fourth: Skin Care
- Skin must be clean and completely dry.
- Assess skin every 12 hours and document findings.
- Full body washing or disinfectant soaps are not required during routine care.
- Avoid procedures that may damage the skin (e.g., aggressive drying, adhesives).
**Cannula Insertion: **
- Ensure insertion site is visible.
- Use minimal tape for infants <1500g.
**Cannula Monitoring: **
- Monitor hourly for swelling, redness, or leakage.
**Cannula Removal: **
- Remove if inflammation is present.
- Use alcohol-soaked cotton under the adhesive to reduce discomfort.
**Post-removal Care: **
- Apply warm compress and elevate the limb if swollen.
**Electrode Pads: **
- Change every 72 hours.
- Proper placement:
- White: right side - Black: left side
- Green & Red: lower abdomen
- Avoid placing pads on nipples
**Pulse Oximeter Probe: **
- Change site every 4 hours.
Fifth: Eye Care
- Use **sterile cotton and distilled water**, one wipe per eye, from inner to outer corner.
- Dry similarly, and apply prophylactic eye drops.
- Prevent contamination from suction catheters or respiratory secretions.
Sixth: Specialized Care for Preterm Infants
- Based on the infant’s condition: - Temperature regulation
- Suctioning - Blood glucose testing
- Laboratory testing - Oxygen therapy
Seventh: Feeding
- Wash hands routinely.
- Monitor for vomiting; note volume, consistency, and color; inform physician.
- Aspirate stomach contents pre-feeding and document.
- Measure abdominal circumference at the umbilical level before feeding.
- Assess abdomen: soft or distended.
- Monitor bowel movement frequency and stool consistency.
- Monitor urine output.
- Encourage nurse
-infant bonding during feeding.
- Position infant on the **right side** post-feeding to prevent aspiration.
- Record feed times and volumes.
- Report signs of feeding intolerance (e.g., vomiting, abdominal distention, >30% residuals). - Clean and disinfect feeding tools.
- Wash hands again.
**Note: ** Avoid moving the infant after feeding to reduce risk of vomiting.
Eighth: Infant Positioning
- Place a roll under shoulders to keep airway open.
- Position preterm infants in fetal
-like position inside nest.
- Change position every 2 hours:
- Side to side
- Back with head gently turned sideways
- Rotate the entire body, not just the head, to maintain alignment.
**Note: ** Avoid prolonged positioning on the same side of the face to prevent pressure on the ear and potential necrosis.
Ninth: Equipment & Linen Disinfection
- Clean and disinfect incubators, ventilators, and other equipment after each use and between patients.
- Routinely replace and sterilize devices for long-term neonates.
- Items in contact with skin or mucous membranes must be sterilized between uses.
- Incubators must be cleaned daily with **warm distilled water**.
- Linens should be sterile and changed daily or when soiled.
- Mattresses should be wiped with disinfectant during linen changes.
- Wear gloves and wash hands during linen changes.
- Soiled linens should be placed in a covered container and transported to laundry.
- Never use contaminated linens to clean incubators; use sterile towels moistened with distilled water.
