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Umbilical cord care in newborns Images

Umbilical care

Sponge bath When the umbilical cord is cut, it leaves a stump, which then dries, heals, and usually falls off within 1 - 3 weeks. While the cord is healing, keep it as clean and as dry as possible. In order to keep the cord dry, sponge bathe your baby rather than submersing him in a tub of water. Watch the umbilical cord for infection. This does not occur often, but can spread quickly if it does occur. Signs of infection are: • •

Foul-smelling, yellow drainage from the cord Redness and tenderness of the skin around the cord

Another uncommon problem is active bleeding. This usually occurs when the cord is pulled off too soon. Allow the cord to fall off naturally, even if it is only hanging on by a thread. In active bleeding, every time you wipe away a drop of blood, another drop appears. If the cord does actively bleed, call your baby’s doctor immediately. Sometimes instead of completely drying, the cord will form a granuloma, which is pink scar tissue. This granuloma drains a light-yellowish fluid. This condition will usually go away in about a week, but if not, your pediatrician may need to burn off (cauterize) the granulation tissue. The umbilical cord stump should dry up and fall off by the time your baby is 8 weeks old. If your baby's stump remains beyond that time, there may be a problem with the baby's anatomy or immune system. See the baby's doctor if the cord has not dried up and fallen off by the time the baby is 2 months old.

Cord Care WHAT YOU SHOULD KNOW The stump of a baby's umbilical (um-BILL-uh-cul) cord (at the belly button or navel) usually falls off after 1 to 3 weeks. Signs/Symptoms Watch for infection. If the area near the stump is reddened, swollen, or drains green or yellow liquid, call the doctor. WHAT YOU SHOULD DO • Your baby's umbilical cord should be kept clean and dry until it falls off. Using a cotton ball or cotton tip applicator, put rubbing alcohol on the area where the stump attaches to your baby's skin. The rubbing alcohol prevents infection and helps dry the stump. Do this twice a day, and continue for a week after the stump falls off. • Keep your baby's diaper folded down below the stump area. The air will help dry the stump. Give your baby a sponge bath instead of a tub bath until the stump has fallen off and the area is healed. • The stump may bleed slightly when it begins to fall off. This is normal and should not cause concern. Your baby's belly button should be healed in 5 to 10 days. No special care is needed after this time. Call Your Doctor If... • • • •

The belly button is draining bad-smelling green or yellow liquid. The belly button has a bad smell after it is cleaned. The skin around the belly button is red or swollen. Your baby's temperature is rising.

Seek Care Immediately If... •

Your baby has a high temperature.

What is an umbilical cord? When a baby is still in its mother's womb, it receives nourishment and oxygen through the umbilical cord. After birth, the baby is able to begin breathing and eating on its own and no longer needs the umbilical cord. Shortly after birth, the umbilical cord will be clamped and cut. The piece that remains attached to the infant will be allowed to dry up and fall off on its own. The umbilical cord generally falls off within 1-3 weeks but in some cases it could take longer. It is important not to force the umbilical cord to detach before it is ready. When the umbilical cord is ready to fall off, you will likely find it in your baby's diaper or clothing. How do you care your newborn's umbilical cord? Keep your newborn's umbilical cord clean and dry. Some pediatricians recommend wiping the umbilical cord with rubbing alcohol after every diaper change but many are now recommending that parents simply leave the umbilical cord alone and allow it to heal. Alcohol can irritate sensitive newborn skin and does not necessarily promote faster healing. Fold the top of your newborn's diaper over. The diaper area is very humid and moist and not an idea environment for your newborn's umbilical cord to be in. Simply fold the top of your newborn's diaper over to keep the umbilical cord on the outside. Some newborn diapers have an umbilical cord cut out. These umbilical cord cut outs are often not enough to keep the umbilical cord out of the diaper area so some folding of the diaper may still be necessary. Avoid bathing your newborn until the umbilical cord falls off. Newborn babies do not need much bathing at first. Spit-up can be wiped clean with a damp cloth and a short sponge bath when necessary will keep your newborn clean. http://infant-toddler-health.suite101.com/article.cfm/newbor... 0

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Your baby's umbilical cord stump will change from yellowish green to brown to black as it dries out and eventually falls off - usually within two weeks after birth. In the meantime, treat the area gently. cartman

# Keep the stump clean. Parents were once instructed to swab the stump with rubbing alcohol after every diaper change. Researchers now say the stump may heal faster if left alone. If the stump becomes dirty or sticky, wash it with soap and water and dry it well. Hold a clean, absorbent cloth around the stump or use the low setting on a hair dryer, being careful to hold the dryer a safe distance from the baby. # Keep the stump dry. Expose the stump to air to help dry out the base. Keep the front of your baby's diaper folded down to avoid covering the stump. Change wet or soiled diapers quickly to prevent irritation. In warm weather, dress your baby in a diaper and T-shirt to improve air circulation. # Stick with sponge baths. Sponge baths may be most practical during the healing process. When the stump falls off, you can bathe your baby in a baby tub or sink. # Let the stump fall off on its own. Resist the temptation to pull off the stump yourself, even if it's hanging on by only a thread. Signs of infection During the healing process, it's normal to see a little crust or dried blood near the stump. Contact your baby's doctor if your baby develops a fever or if the umbilical area: * Appears red and swollen around the cord * Continues to bleed * Oozes yellowish pus * Produces a foul-smelling discharge Umbilical cord infections are uncommon. But if your baby has an infection, prompt treatment can stop the infection from spreading. http://www.mayoclinic.com/health/umbilical-cord/PR00046 0

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Postpartum Perineal Care Overview The perineum is the anatomic area between the urethra, the tube that carries urine from the bladder, and the anus. In women, the perineum includes the vaginal opening. This area undergoes a lot of stress and change during pregnancy and delivery, and it needs special care afterward. Many women have a surgical cut called an episiotomy when they deliver a baby. Because an episiotomy lets the baby pass more easily, it may lessen damage to the perineum during delivery. An episiotomy is a clean cut, rather than a tear, so it may heal better. Sometimes the skin tears anyway and needs special care. Some women perform perineal massage during their pregnancy to try to prevent some of the pain and other problems after delivery. This method has not been shown to lessen or prevent any of the symptoms experienced after delivery.

Caring for Your Perineum

How to Care for your Perineum By Stephanie Brown, About.com

See More About: • •

postpartum healthy moms

Proper care of the perineum after childbirth is very important in order to avoid infection and to speed healing of the rectal and pelvic muscles.

Pain and Swelling You may notice some uncomfortable swelling and pain in this area due to the stretching required to deliver your baby. To reduce swelling you can use ice packs. Be sure to wrap the ice pack with a washcloth or other soft, absorbent material. Direct application of ice can damage tender tissue in this area if prolonged. You can also take sitz baths. Your health care provider may have sent you home with a special tub made for this. If not, you can simulate this bath by sitting in a tub with 2-3 inches of warm water for about 15 minutes. If you notice a lot of pain while sitting in the bath, it may be helpful to sit on a doughnut pillow or towels rolled into a doughnut shape. Your health care provider may have prescribed pain medication. It's advisable to take this as directed. You can avoid the pain if you stay on top of your dosing (for example every 4 hours) rather than waiting until the pain starts again before taking another dose. Some providers prescribe ibuprofen which helps not only with pain relief, but helps manage swelling, so you should take continue taking this as long as your provider has recommended, even if you aren't in pain. Other pain relief measures may include sprays like Dermoplast that you can apply after using the bathroom or changing a pad. Some providers also use a foam such as Epifoam to reduce swelling and itching if you've had stitches in the area.

Hemorrhoids Hemorrhoids may occur directly after childbirth as a result of pushing or some time afterward if your muscles have relaxed and you are having to push more during elimination. You can use cotton balls or pads soaked in witch hazel or use Tucks pads to help soothe burning or itching. Use these after you have thoroughly cleansed the area after a bowel movement. If you are having trouble with constipation, try to make changes in your diet to include more grains and vegetables and be sure to drink plenty of water. Sometimes a stool softener may be needed. Colace (or any stool softener containing docusate) is very gentle and recommended by many health care providers.

Discharge and Bleeding You will have discharge and bleeding (also called lochia) for about 4 weeks after giving birth. The changes in this discharge indicate the speed of your healing. Initially the flow will be heavy and a dark red with some clotting. This should last about 3-6 days. After this you will

notice the flow slowing down and becoming lighter in color. By about the second week, the discharge turns from pink to a brown or yellowish color and the flow is very slight. If you notice a large increase in discharge, chances are you should decrease your activity level. Try to get some rest, nurse your baby or massage your abdomen to decrease the flow. If you notice bright red bleeding, an increase in abdominal pain or if you have a fever, contact your health care provider immediately. If you are not breastfeeding, your period will return somewhere around 4 to 10 weeks and will likely be heavier than a normal period. This is not unusual.

Proper Cleansing Make sure to follow any instructions given to you by your health care provider. Here are some steps to proper perineal cleansing: 1. 2. 3. 4. 5. 6. 7.

Always wash your hands before using the bathroom or changing pads. Remove your old pad and dispose of it properly. After using the bathroom, spray or pour warm water over the entire vaginal area. Your health care provider may have provided you with a spray bottle for this and may have also given you an antiseptic soap or solution to add to the water. Gently pat the area dry with toilet paper, making sure to start at the front and end at the back to avoid spreading germs from the rectum to your vagina. After drying the area, use any wipes, sprays or foams required to relieve pain and apply ice pack if necessary. Place a clean pad in place securely and stand before flushing to avoid any of the water from the toilet from contacting your perineum. Always wash your hands after caring for your perineum.

Tips and Warnings

• • • • • •

Take care with the temperature of water applied to your perineum. This area is tender and water that seems warm to your hand could be very painful to your perineum. Unless your doctor has advised you to do so, never use a douche or tampon. Most providers advise that nothing be placed inside the vagina until after your postpartum checkup. If you notice prolonged itching or a very foul smell, contact your health care provider immediately. Do not use powders, perfumes, or lotions on your perineum unless directed. If you feel your stitches have not dissolved within 3 weeks or if the area of your stitches seems to be raw or irritated, contact your health care provider. Perform Kegel Exercises often to help strengthen the muscles in the pelvic floor.

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Personal Care II Baths, Showers, Perineal Care and Backrubs Objectives: After you take this class, you will be able to: 1. 2.

Provide baths, showers, perineal care and back rubs according to the patients’ or residents’ unique needs. Adhere to basic safety, identification and standard precautions principles when providing personal care.

Introduction

Our patients and residents have a right to high quality personal care and hygiene. This class will give you a review about how to provide: • • • •

Baths Showers Perineal care Back rubs

The course called Personal Care I covers mouth care, denture care, hair care, foot care, nail care and shaving. The Special Needs of Some Patients and Residents Our patients and residents are different in terms of how much personal care they can do their own. Some patients and residents: • • • •

can take care of their own personal care needs without our help; others need a little help; some need a lot of help with this care; and still others can do nothing on their own. They need the nursing assistant to provide all of their personal care to them.

Nursing assistants do not have to do anything, other than providing privacy, when a patient is able to do all of their personal care without any help. Self care and independence should be encouraged for these people. Nursing assistants have to give their clients as much help as needed when a patient is not able to provide their own personal care. Nursing assistants must often provide total personal care to patients when they are too young, too ill, too confused or physically unable to do it themselves.

Some Personal Care Principles

When providing personal care to patients and residents: •

wash your hands and put on gloves before you provide personal care. Use standard precautions.

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provide privacy. Pull the curtain. Close the door. Knock before you enter a room if the person is doing their own personal care.

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introduce yourself to the person and tell them what you are going to do before you do it.

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determine the identity of the patient. Accurate patient identification is part of all processes, including personal care.

•

maintain the safety of the patient at all times. Never leave the bed in a high position when you are not next to the bed. Never leave an infant, young child or confused person in a bathtub alone. They could drown even in a little bit of water. Check the temperature of the bath water before you use it. Make sure that grab bars are in place and that they are strong enough to hold the weight of the person. Keep the floor dry. Wet floors lead to slips and falls.

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let the person choose when they want personal care. All patients do not need a bath before lunch. Some may prefer it in the evening.

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observe the patient during personal care. Look at the person. Check their skin condition. Report any skin tears or signs of skin breakdown. Is the skin pale? Is it intact?

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Listen to the person. Do they have any fears or concerns? Are there any changes in their mental state? Are they more or less confused than they were in the past? Are they aware of the day of the week, the date and where they are?

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Feel the person's skin. Is it hot? Is it cold? Is it wet or moist?

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Smell. Does the person have any odors?

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immediately report any unusual findings to the nurse.

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document all personal care. A flow sheet is often used to document personal care and activities of daily living.

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get organized. Gather all the supplies and equipment that you will need.

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make personal care an enjoyable aspect of the person’s life. Treat all your patients with respect and kindness.

Bathing Baths clean the skin and keep it free of dirt, germs and sweat. It is also helps the blood flow in the body. Baths give us a chance to observe the person and their skin. Baths are also very comfortable and relaxing to the client. Most baths are given in the morning but this is not always necessary. People can also shower or take a bath before bed. Let the person choose what they want. A tub bath and a shower may only be necessary every other day if the person chooses this. Other people may need some bathing several times a day. People that are incontinent of urine and/or stool and those that sweat a lot may need to be bathed with a sponge (cloth) bath several times a day.

There are three different kinds of baths that are given in the healthcare setting: • • •

Complete bed bath Partial bed bath Tub bath

Showering will be taught in the next section. A complete bed bath is given completely by the nursing assistant or other healthcare provider. A partial bed bath is one that is shared between the healthcare provider and the client. The client may just need the nursing assistant to gather up the basin, water, cloth and towel or the client may be able to wash their whole body except their back and their feet. If the person needs help washing their back and feet, the nursing assistant will only bathe these areas.

Partial and complete bed baths are given in the bed. Tub baths, with a doctor's order, are taken in a bathtub with or without the help of the nursing assistant. Showers also, with a doctor’s order, are taken with or without the help of a nursing assistant. The temperature of ALL bath and shower water should be 110 degrees and not hotter. Hot water causes burns. Many hospitals, nursing homes and assisted living homes use regulators on showers and thermometers for bathtubs to make sure that the temperature is correct. If you do not have a thermometer, test the temperature of the water on your wrist before you use it. Do NOT ever leave a young child, weak or confused person alone in a bathtub or shower. These people need privacy but they also need close monitoring so that they do not slip, fall or even drown.

When you are helping a client with a partial bed bath or helping a person with a tub bath or giving a complete bed bath, you should follow these steps after you have gotten all the supplies together, washed your hands, put on gloves, checked the temperature of the water, introduced yourself to the client, explained what you are about to do, identified the patient and given privacy: •

raise the bed up to a good working height with the side rail up on the side that you are NOT next to,

•

remove the person's gown and cover the person with a bath blanket to give them privacy and to keep them warm,

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wash, rinse and dry only one part of the body at a time and then re-cover the person with the bath blanket,

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protect the bed linen by putting a towel under each body part as it is being washed,

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wrap the wash cloth so that the ends of the cloth are turned inward and around your hand like a mitt,

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rinse the cloth after each body part,

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change the water when it is no longer clear or it is too cold,

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starting at the top of the body, wash, rinse and dry the one eye from the inside near the nose to the outside using soap if the person wants it,

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rinse the cloth,

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then wash the other eye from the inside near the nose to the outside using soap if the person wants it,

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then rinse the cloth,

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wash the face, behind the ears and the neck,

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then rinse the cloth,

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wash the chest, then the arms and then the hands if you can do both sides of the client as you are standing on one side of the bed. If you have to move to the other side of the bed, take care of one whole side of the patient before moving to the other side of the bed,

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then rinse the cloth,

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wash the abdomen,

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wash the groin using the male or female perineal care steps described below under Perineal Care,

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safely turn the person on their side and wash, rinse and dry their back,

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then rinse the cloth,

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do a backrub with gentle circular strokes from the bottom of the spine up to and around the shoulders using the steps described below under Back Rubs,

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put a clean gown on the person,

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wash, rinse and dry the upper part of the legs down to and including the feet,

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let the feet soak in the water if possible so that foot washing and nail care can be done well,

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place the person in a comfortable position,

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then lower the bed and the side rail,

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clean up all the supplies and equipment.

Showering As with all procedures, including personal care, you must wash your hands, put on gloves, introduce yourself to the client, explain what you are about to do, identify the patient and maintain privacy, standard precautions, caring, respect, comfort and safety throughout the task.

Showering and tub bathing require special safety measures. • • • •

Never leave a young child, a weak or confused person in the shower unattended. Use a shower chair if the client has one and they need it. Keep the floor dry. Use non-skid bath and shower mats.

When you are helping a person with a shower, follow the same bathing steps as above and let the person be as independent as possible. Perineal Care Perineal care is the washing of the genital and rectal areas of the body. Perineal care should be done at least one time a day during the bed bath, shower, or tub bath. It is done more often when a client is incontinent. Perineal care prevents infection, odors and irritation. Perineal care is done when a patient has a urinary catheter in place. It is also done when the client does not have a urinary catheter. Perineal care is done differently for men and women. As with all procedures, wash your hands, put on gloves, introduce yourself to the client, explain what you are about to do, identify the patient and maintain privacy, standard precautions, caring, respect, comfort and safety throughout the task. Perineal care for male patients without a urinary catheter has these additional steps: • • • • • •

fill the bath basin with clean water at 110 degrees, position the male patient on their back, put a protective cover over the bed linen, wash the groin from the front to the back starting at the groin area and then going to the inside of the thighs, then rinse the cloth or use a new washcloth, pull back the foreskin if the patient is not circumcised,

• • • •

wash and rinse the tip of the penis downward while using gentle, circular motions and then the scrotum, rinse the cloth, turn the person on their side, and wash, rinse and dry the rectal area.

Perineal care for female patients without a urinary catheter has these steps: • • • • • • • • •

fill the bath basin with clean water at 110 degrees, position the female patient on their back, put a protective cover over the bed linen, separate the labia and wash, rinse and dry the urethral area first with short downward strokes alternating from side to side and proceeding until the exposed area around the urethra is done, then rinse the cloth or use a new washcloth, wash the groin on the outside of the labia from the front to the back starting outside the labia and then going to the inside of the thighs, then rinse the cloth, turn the person on their side, and wash, rinse and dry the rectal area.

Perineal care for male and female patients with a urinary catheter has the above steps followed by these additional steps: • •

with a clean washcloth and soap, wash the catheter starting at the urinary opening with short strokes to about 4 inches away from the body using a new washcloth, rinse the catheter starting at the urinary opening with short strokes to about 4 inches away from the body

Back Rubs Back rubs should be given with every bed bath and more often. They are also helpful at bedtime to promote relaxation and every time you reposition a person that is unable to move on their own. Back rubs are comforting, they promote blood flow to the back and they prevent skin breakdown. The steps of a back rub are: • • • • • • •

warm the skin lotion in warm water, wash your hands using warm water, put on your gloves, place the person on their side, put the lotion on the palms of both hands, apply the lotion to the person's back, starting at the bottom of the spine and using long, smooth strokes move up to and around the shoulders and then down the sides of the back with special attention to the tail bone area where most pressure ulcers begin.

Summary This class has given you information about some personal care procedures. Take the class called Personal Care I so you can also learn about oral care, denture care, hair care, shampooing, foot care, nail care and shaving. References Pulliam, Jolynn. (1998). The Nursing Assistant: Acute, Subacute & Long-Term Care. New York: Prentice Hall.

Copyright © 2002 Alene Burke perineal care1 Etymology: Gk, perineos, perineum a cleansing procedure prescribed for the perineum after various obstetric and gynecologic procedures. Sterile or clean perineal care may be prescribed. It is done also after elimination and as a routine part of hygiene care (bed bath) using clean technique rather than sterile. method In the sterile procedure the cleansing strokes always move from the vulva toward the anus and from the midline out. After each stroke, the disposable washcloth or pledget is discarded, and a new one is used for the next stroke. A sterile basin, gloves, forceps, pledgets, and pitcher or measure containing sterile solution are used. The draped patient is assisted into position on her back with a bedpan or a disposable pad beneath her buttocks, and 200 to 300 mL of solution is poured over the vulva. Then pledgets moistened with the solution are used to cleanse the area more thoroughly. The pledgets are held with sterile forceps or a sterile gloved hand. The area is dried using sterile pledgets, and the bedpan is removed. The patient then rolls to one side for cleansing and drying of the posterior area. Strokes should always move away from the perineal area. In providing clean perineal care disposable washcloths and a basin or a squeeze bottle of warm water are used. A fresh disposable washcloth is used for each cleansing stroke and each drying stroke. The strokes are always from anterior to posterior. Soap may be used. interventions Perineal care is given at prescribed intervals and after urination and defecation. outcome criteria Sterile and clean perineal care is practiced to remove secretions or dried blood from a wound and to prevent contamination of the urethral and vaginal areas or perineal wounds with fecal matter or urine.