Asphyxia

Assessment of infant at birth is to determine the degree of vitality of the body functions. The degree of vitality is the ability of a number of bodily functions that are essential and complex for infant survival, such as breathing, heart rate, blood circulation and reflexes, primitive reflexes such as sucking and looking nipple. If not handled properly, quickly and correctly the baby's general condition will deteriorate rapidly and may even die. In some infants may be able to recover spontaneously within 10-30 minutes after birth but the baby still has a high risk for disability.


Generally, the assessment used in the newborn Apgar values (Apgar Score). SAREC meeting in Sweden in 1985 advocated the use of newborn assessment parameters in a simple way the so-called value Sigtuna (Sigtuna Score) in accordance with the name of the place of consensus. The assessment in this way mainly to the level of basic health services because only assess the two essential parameters.

The degree of vitality of the newborn according to the value of Sigtuna is: (a) without asphyxia or mild asphyxia value = 4, (b) asphyxia was the value of 2-3, (c) severe asphyxia value of 1, (d) the baby is born dead or dead new " fresh still birth "value 0.

All this is generally to assess the degree of vitality of the newborn Apgar scoring is used. Implementation is quite complex because at the same time birth attendant must assess the five parameters: heart rate, respiratory effort, muscle tone, movement and skin color. the results of research in the U.S. Apgar value is very useful to know a potential high risk infants for mortality and long-term neurological disability such as cerebral palsy. Of the five variables Apgar values only breathing and heart rate are closely related to the occurrence of hypoxia and anoksia. The three other variables more an indicator of maturity of the baby's growth.

Handling of asphyxia in newborn infants aim to keep the airway remain free, stimulates respiration, maintain cardiac output, maintaining the temperature, and provide supporting drug resuscitation. Consequences which may arise in infants asphyxia as a whole experienced the death of 10-20%, whereas 20-45% of the live experience neurological disorders. Approximately 60% of them with severe sequelae. The remaining normal. Neurologic sequelae of cerebral palsy, mental retardation, epilepsy, mikrocefalus, hidrocefalus and others.

Nursing Diagnosis
Impaired gas exchange

Data supporting / contributing factors:
Adequate oxygenation of infants affected by many factors such as prenatal and intrapartal history, excessive mucus production, and stress due to cold. History intrapartal poor prenatal and may result in fetal distress and hypoxia adaptation time of the baby. Gas exchange can also be disrupted by excessive mucus production and airway clearance is not adequate. Stress due to cold increases oxygen demand and may lead to acidosis as the effects of anaerobic metabolism.

Objectives:
Airway free of secretions / mucus, respiratory and pulse within normal limits, cyanosis does not occur, no sign of respiratory disstres.

Intervention:
• Observe the prenatal complications that affect the status of the placenta and fetal (heart or kidney disease, or diabetes PIH)
• Review the status of intrapartal including heart rate, changes in heart rate variability rhythm, PH levels, colors and amount of amniotic fluid.
• Record the time and the treatment given to the mother such as magnesium sulfate or Demerol
• Assess respiratory rate
• Record the state of the nasal pharynx, chest retraction, grunting respiration, rales or ronchi
• Clear the airway; do nasopharyngeal suction if needed, apical pulse monitor during suction
• Place the baby on the Trendelenburg position at an angle of 10 degrees.
• Dry the baby with a soft towel and place it between the arm selimuti mother or warm with a heating unit
• Observe the intensity of crying
• Note the apical pulse
• Give a touch of tactile and sensory stimulation
• Observation of skin color, cyanosis location, assess muscle tone

Collaboration
• Give oxygen through a mask, 4-7 lt / min if indicated asphyxia
• Give medications such as Narcan through IV
• Provide resuscitation therapy