Following my post on newborn vaccines, I would like to share some of the common illnesses experienced by neonates and infants, along with their corresponding nursing management.

There are a number of common newborn diseases, but I will focus on five, which concerns the respiratory and digestive system.

Constipation

Babies may have difficulty passing stools once they eat solid foods. When this happens, they may refuse to pass as hard stool is painful for them. Newborns,breast fed o formula fed, infrequent bowel movement (less than one per day) can occur. Blood in the rectal fissure can be observed during constipation, as hard stool is difficult to pass. 

Keeping track of the baby’s bowel movements is encouraged to parents. Giving less constipating foods  such as bananas and rice cereals is recommended. Add high fluid and high fiber foods to your baby’s diet. If the baby is receiving formula milk, experiment with different brands until you find one that produces soft stools. A tiny tear in the rectal wall is healed immediately when constipation is managed.

Diarrhea

Diarrhea is having frequent bowel movements and too watery. Often caused by a virus, but a bacterial infection, an allergy, or medication can attribute to the condition. Dehydration is a potential danger of diarrhea, which is why early management is a must.

Newborns who are breastfed may have up to 12 small bowel movements per day. More than this, along with watery output, is considered diarrhea. 

As a nurse, you can educate the mother or parents to rest the newborn or infant’s intestines. Parents must keep track of their baby’s stool so they  can report to the doctor. If any signs of deheydration (lethargy, dry mouth, fewer wet diapers); bloody stool, high fever, and vomiting are seen, medical attention is needed promptly.

Gastroesophageal Reflux (GER)

Gastroesophageal reflux is common in babies because they have an immature valve between the esophagus and stomach. Infants experience different levels of GER, and it occurs when the acidic stomach contents regurgitate back into the esophagus. Pain is then felt by the baby. Vomiting, frequent wet burps, throaty gagging noise, and infant grimace are other signs of GER.

Nurses and physicians instruct parents to give small frequent feedings to their babies with GER. Small meals allow lesser reflux, and frequent ones stimulate saliva production, which balances stomach acid and lubricates esophageal lining. Breastfeding is encouraged since breast milk is easily digested than formula milk. Babies should be place in an upright and quiet position for half an hour after feeding to allow gravity to hold down food.

Colds

Newborns and infants are frequently visited by colds. Most common cause by colds is a virus that causes membranes of respiratory passages to swell and release mucus. Cough, increase breathing pattern, and wheezing may be experienced by the baby. Sleeping and eating pattern of the baby are also affeced since he can have low- grade fever, runny nose, sneezing, and decrease appetite.

Steam therapy is recommended by pediatrician, and nurses must ensure mothers should perform the therapy properly. The baby with trouble breathing, must sit on his mother’s lap in the bathroom with opened hot shower nearby for ten or fifteen minutes. The steam lessens the congestion felt by the baby. Giving the baby extra fluid is highky recommended for colds. Cold medicines are not to be given without going to the doctor first.

Respiratory Syncytial Virus or RSV

Respiratory syncytial virus is a major cause of hospitalization among children under one year of age. It is considered to be a very serious virus of early infancy. It may appear as a common colds with the baby experiencing runny nose, low grade fever, and cough. Wheezing is sometimes obeserve with RSV.  The difference of RSV and colds lie in the duration. RSV ca  last for weeks, and can affect the bronchial passages, causing bronchitis or broncholitis to the baby. Viral pneumonia is a potential danger if RSV is not manage immediately. 

Taking the baby with resoiratory syncytial virua outside into the damp night air for ten minutes can help. Have a no smoking inside the house policy if your baby hasthe condition. Babies who are under three months, and are experiencing signs and symptoms, especially difficulty of breathing, need to be taken to an emergency room.

Do you know other newborn illnesses? Share it on them comments section.

At 1: 15 a.m., a concerned mother rushed into the emergency department, asking me to check her child’s body. The baby was sleeping on his mother’s arm, slightly warm to touch, and two months old. 36. 3° Celsius came through the thermometer ( via axilla). The mother informed me that her son was given vaccine injection at 2 p.m.  in the afternoon. I informed her that slight elevation in body temperature after 24hours of vaccine injection is a common side effect.

In connection to the situation above, I’d like to share a cheat sheet on newborn vaccines and their side effects.

Hepatitis B

  •  Mild rise in body temperature.
  •  Pain at the injection Site

Diphtheria

  • Mild rise in body temperature.
  •  Pain at the injection site.
  • Irritability/ Crying

Polio

  • Mild rise in body temperature.
  •  Pain at the injection site.
  • Irritability.
  • Drowisness.

Tetanus Toxoid

  • Mild rise in body temperature.
  •  Pain at the injection site.

Pertussis

  • Mild rise in body temperature.
  •  Pain at the injection site.

Measles, MMR

 About seven days after vaccination, the following side effects may occur.

  • Fever (can be over 39° C)
  • Cough
  • Runny Nose
  • Puffy Eyes
  • Swollen Salivary Glands
  • Faint red non- infectious rash

Note that a slight rise in body temperature of newborn or infant is expected within 24 hours after vaccination. Pain at the injection site is also a common side effect. Complications of administering vaccines to newborns and infants are rare. If you have any question about your child’s vaccine you can ask your pediatrician or doctor, or nurse.

In case you are confused, newborn vaccines are scheduled and must be followed promptly.

Together with my colleagues, we visited Al Khobar seaside. This was in lieue with the Eid Al Adha commemoration throughout the Kingdom of Saudi Arabia. Our management allowed us to visit Al Khobar. It’s a two and a half ride from Al Hassa, our place of work.

 A humid dry embrace of the wind welcomed us. It’s not like the seaside in my tropical home country, but I appreaciate it. I felt recharged whenever I smell the sea, and hear the waves. 

A park was positioned 200meters away from the seaside. People of different races (Syrian, Sudani, Egyptian, Indian, Filipino, and Saudi) flocked at the park. Adults sat on the grassy ground with the aid of their Arabian carpet, and ate food ( which I’m sure was made to satisfy their ‘original tongue’!). Kids were playing with different rides and slides while shouting gleefully in their language. While others stroll on the sidelines in groups (please note that female and male must not be seen together if there’s no blood or legal relation).

Fast food chains circled the Al Khobar seaside as well. Mr. McDonalds was of course the main attraction. Kudu, Hardees, Baskin and Robbins were the food stalls you can visit when in the seaside. Starbucks for young adults and adults was there as well. We went there to get iced drinks. Our throats needed an iced refreshment after inhaling the humid seaside air! 

I have to add this. On our way back to Al Hassa, we got to play with a selfie stick of our colleague, Rashean. I love how fun was realized in the series of photos we made. Our giddy and silly moments were captured candidly, that I’d treasure forever. 

For a day in our primary healthcare setting, we received more than ten patients or clients for wound care. They’re either with post surgery wound or minor laceration or abrasions due to minor home accidents. They came alone or with significant others, who at times annoy your neurons because of fear.

Wound, abrasion, laceration

As a nurse, your priority is to manage the impaired skin integrity promptly. It will be followed by pain management, and emotional needs of patient/ client and his significant other. The nurse’s goal is to ease the healing process and prevent wound complications such as infection. So the following is the step by step process on how to execute wound care according to two different cases.

Care for Post Surgery Wound

There are two types of surgical wound – healing by primary intention and healing by secondary intention. I’d focus on the secondary because most patient who come to us have this case and the facility I’m working with is classified under primary healthcare setting.

Surgical wounds healing by secondary intention requires dressing for 5 to 7 days, or depending on the size, depth of the wound, level and position of exudates. Nurses are tasked to assess the wound area, and other factors (pain felt and vital signs) before wound care. A nurse cleans the wound with gauze soaked in Normal Saline and Betadine Solution, in a inward to outward motion. Antibactaerial cream is sometimes prescribed by the surgeons or doctors to prevent infection. The cream is placed last before closing the wound with a sterile waterproof dressing pads and crepe bandage. Dressing pads and bandages are selected according to the size and location of the wound. There are some post surgery wounds that require special dressing pads. Some patients we handled brought their own dressing pad because it’s what their doctor prescribed.

Most post op wounds should be cleaned thereafter, but exemptions are done depending on the nature and reason for surgical intervetion.

Care for Minor Laceration and Abrasion

Most of the accidents we experience in our homes are lacerations while cutting vegies or fruits or opening canned goods; and abrasions when we got tangled with our doormat (it happens you know  *wink*). These two classification of wounds are popular in our facility. School children and young adults are our most frequent visitors. 

Care for lacerations and abrasions also depends on its size, depth, location, and other factors. Cleaning the wound area with Normal Saline is a priority. This procedure allows the wound area to be free from dirt and other exudates; and to make it more visible. Inward to outward motion is to be done when cleansing the wound. Betadine and antibiotic cream are placed on the wound. Sterile waterproof dressing pads and crepe bandage are placed to cover the wound. If it’s in the extremeties, we put net bandage to prevent the dressing from falling off. 

At times, our general practitioner perform minor suturing of the laceration. Then wound care is to be done thereafter.

Nursing Care Plan for Wound Care

Video of How to Perform Wound Care

I got a chance to assist an oral surgery today. And I’m thrilled to share it’s nursing management.

Frenotomy, Frenectomy

Screenshot from NIH.gov

Our one month old male patient had ankyloglossia or tongue- tie. His mother noticed him to elicit difficulty during breastfeeding. He cannot latch well to his mother’s nipples. To correct and prevent the child from further harm in the future, our pedia doctor and orthodontic surgeon performed frenotomy.

Background on Frenotomy

Frenotomy is  procedure done to cortect  pediatric disorder called ankyloglossia. It is usually the choice for neonates as it is less invasive and can be done in a dental clinic setting.

The infant may not be given local anaesthetic spray prior to the procedure since infant’s pain is slight. Bleeding is also neglible. Frenotomy improves feeding immediately.

The baby is placed supine with the elbows held flexed securely close to the face. The tongue is lifted gently with gloved finger and thumb so as to expose the frenulum. With sterile scissors, the frenulum is released by approximately 2 to 3 mm at its thinnest portion, between the tongue and the alveolar ridge, into the sulcus just proximal to the genioglossus muscle. Care is taken not to incise any vascular tissue (the base of the tongue, the genioglossus muscle, or the gingival mucosa). There should be minimal blood loss, i.e., no more than a drop or 2, collected on sterile gauze (Ballard et al 2002).

Nursing Management for Frenotomy

As a nurse assigned to an orthodontic surgeon, you have the duties before, during and after the procedure. The following are the nursing management for frenectomy and frenotomy.

Before

1. Ensure that the patient’s guardian or parents are informed by the doctor about their child’s case, and the procedure to be performed.

2. Prepare the needed equipments (e.i. gloves, sterile gauze, Normal Saline, suture kit, surgical scissor, hemostat) for the procedure.

3. Prepare a sterile or aseptic area where you will perform.

During

1. During the procedure always maintain sterility or asepsis. 

2. Hold the baby, especially in the head, firmly. 

3. To remove blood from the baby’s mouth, press two- ply wet sterile gauze.

4. Hand over surgical instruments to the surgeon properly.

After

1. Clean the baby or your patient’s mouth and face.

2. The infant should be returned immediately to the mother for feeding. Reassessment of nipple pain and infant latch should occur post release.

3. Inform the parents about the follow- up check- up.

Reassessment, evaluation and continuing care must be provided to the patient following the procedure. Frenotomy in neonates or babies up to 4 months old can have a recurrence later. 

You must remember that each patient is unique, so let this post be your guide.

I have been planning of what’s my next step would be if my contract as a travel nurse ends. I spent hours after my shift researching online and jotting on a piece of paper or on my notepad what I’ve found. Then at the end of it all, I’ll disregard what I wrote and went to sleep because I have another day (a year to be exact) to plan.

But what if I don’t have another day to plan what’s my next move in life? Will I just keep my plan, and follow it? Or will I just throw them and take the consequences of no- plan- at- all life?

They say, when you wish to step another ladder for your career,you need to weigh on what is/ are esential and what you love to do. I love being a nurse, and I always yearn to explore a new place. So at the moment, I am thinking of lending my hands to a city in a Southeast Asian country like Thailand. I have been wanting to go to a place for a week or a month with a purpose. I just don’t want to visit a landmark without giving something to it. It’s like my heart and soul wish to impart something to anything that have given them gifts of wonder. 

Plan number two is disregarding plan number one. When my contract ends one year from now, I let the wind do its course and see where it will take me. It’s a better idea. But is it?

Oh, God help me.

Dear The NurseWanderer, 

You did not know how the game started exactly. But you knew you are in a game called ‘I Don’t Care You, I Care My Sh*t’. And honey, it’s been your game since 2012. You will shut down yourself from everything, and everyone. You will not answer any communication from anyone even if it’s an emergency case. It’s like you ‘re repressing your humanity.

If you want to be in that game, I won’t give a sermon, so let’s talk about the now.

For more than a week, your Facebook account is not active. Week before you decided to abstain from FB, you deleted your posts from the first six months of 2016. They did not have more likes and boring were your reasons. Your last message thru Messenger was with your sister, telling her about the dried she should deliver to your friend’s mom. You hit ‘Unfollow’ to all your friends so their posts won’t appear on your timeline. Why did all these? Because you just want to?

Two weeks ago, in the flat where you live with your colleagues/ friend, you activated the game. You are not talking to old LadyBug, who was an obsolete dumb bitch; and to your so called UglyBitch friend. LadyBug sold you to be a nanny. I know it’s againts your views but maybe she just wany to help. Or she’s just being old and foggy again so I know you disregard her existence when you see her. Then about your UglyBitch friend. She is your friend, or should I use ‘was’? You shut your mouth after she walked out on you, and you were dismayed by her attitude. I know you were pissed  when you mouthed honest words about her love affair. Who wouldn’t be disgusted to talk to someone who’s busy scribbling on her iPhone while you’re being a true friend?

Six days ago, you heard great words from UglyBitch friend of yours just after taking a bath. I know you wanted to throw that shampoo bottle you were holding, however you refrain from doing so because you are a betch. You went to the bedroom, contemplated your friendship, and decided to move out. You unfriended her in Snapchat, muted her in Twitter, and of course you’re on Facebook abstinence day after. You continued your cold war in the workplace. You dismissed her presence. She’s like an allergen that you put a shield on, avoided the area where she’s at. You heard stories about her attitude from other colleagues, and you refused to deal with their words. She got her shit, you got yours, and you chose to deal with yours.

Today, you decided to write yourself because your mind is in the shore trying to figure out what make you played the game again. So I am hoping by the end of this post, you found what you were seeking. 

xxoo