PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
MS.SABITHA.P
I YEAR M Sc NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
YEAR 2007-2009.
PADMASHREE COLLEGE OF NURSING
GURUKRUPA LAYOUT, NAGARBHAVI,
BANGALORE – 560 072.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / MS.SABITHA.PI YEAR M.Sc.NURSING PADMASHREE COLLEGE OF NURSING
GURUKRUPA LAYOUT
NAGARBHAVI,
BANGALORE – 560 072.
2. / NAME OF THE INSTITUTION / Padmashree College of Nursing Bangalore
3. / COURSE OF THE STUDY AND SUBJECT / I Year M.Sc Nursing
Obstetrics and Gynaecological nursing.
4. / DATE OF ADMISSION / 22nd May 2007.
5. /
TITLE OF THE STUDY
/ A Descriptive study to assess the knowledge of Primi para mothers regarding the management of minor disorders among new born in selected rural communities of Kengeri PHC, Bangalore.
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
The birth of a newborn is one of the most awe-inspiring and emotional events that can occur in one’ lifetime. After nine months of anticipation and preparation, the neonate arrives amid a flurry of excitement. The new human being affects the lives of the parents and also the other family members.
The newborn baby is totally dependent on his or her caretakers and unable to communicate directly his or her needs. Consequently, close observation and careful examination of the newborn is essential to recognize potential problems before they reach critical.
Newborn period encompasses the first four weeks of extra uterine life. It is an important link in the chain of events from conception to adulthood. The physical and mental well-being of an individual depends on the correct management of events in the perinatal period. Proper care of newborn babies forms the foundation for the subsequent life not only in terms of longevity or survival but also in terms of qualitative outcome without mental and physical disabilities.1
The majority of new born problems are specific to the perinatal period. They cause not only deaths but also substantial morbidity and disability. These problems are the result of poor maternal health, inadequate care during pregnancy, inappropriate management and poor hygiene during delivery, lack of new born care and discriminatory care. If a mother dies during child birth, her baby will have even smaller chance of survival.
Almost two thirds of births in developing countries occur at home and only half are attended by a trained birth attendant. Strategies to reduce new born deaths should therefore also target traditional birth attendants, families and communities as well as health worker within the formal health care system.2
A newborn’s ability to eat and digest food is an essential aspect for the growth and development. Most babies are able to take feedings with normal absorption of the milk followed by normal bowel movements. Difficulty in any of these areas can be a temporary adjustment or a sign of a more serious problem like vomiting, constipation or diarrhea.3
Some minor problems or disorders of the newborn that may cause parental anxiety are common during the first four weeks of life. These conditions are harmless. Some may require minor treatment whereas some disappear spontaneously as the newborn grows. But some conditions need to be differentiated from pathologic problems like benign neonatal thermangiomatosis (BNH) etc.
The common problems among new born include stuffy nose, sticky eyes, Milia, Mongolian spots, constipation, or diarrhea, oral thrush, skin rash, physiologic mastitis, vaginal discharge, Hydrocele, physiologic phimosis and jaundice.4
6.2 NEED FOR THE STUDY
Prenatal and neonatal problems are now the leading causes of death in children under 5 years. The baby may have been born at home or a healthy facility. For babies born at a health facility circumstances around delivery are handled by well trained health workers, while for the one born at home they may not. For all babies, the interval between onset of illness and death can be in a matter of minutes or hours. It is therefore very important for us to recognize and plan for the care of the newborn.
Many household practices were observed which could adversely affect maternal and neonatal health. Among 200 caregivers 70.5% reported home deliveries conducted by local untrained dais or relatives, and most mothers initiated breast feeding only on day 3. More than half of the neonates were recognized with fever, irritability, weakness, abdominal distension/Vomiting, slow breathing and diarrhea as danger sings.5
Discolorations of the skin are very common findings in the newborn. Commonly observed skin lesions with in 48 hours of birth are Epstein pearls (88.7%), Mongolian spots (62.2%), milia (34.9%), sebaceous hyperplasia (31.8%), and erythema toxicum neonatorum (20.6%). Additional skin lesions observed were oral thrush. Atopic dermatitis, seborrheic dermatitis, diaper dermatitis etc,. These observations highlight the importance of repeat examination for the appearance of skin lesions during the neonatal period.6
The incidence of indifferent streptococci in the eyes of neonates less than 6 days old was investigated. The isolation of indifferent streptococci was significantly higher in infants with sticky eyes. Streptococcus mitior and streptococcus sanguis were the most common species in both purulent and non-infected eyes. Streptococcus mutans, a species not normally found in edentulous infants, comprised 14% of indifferent streptococci from neonates with sticky eyes but only 1% of those from infants with non-purulent eyes.7
Physiological jaundice is observed in 60% of the term and 80% of preterm neonates. It usually appears on 2nd and 3rd day and disappears by the 7th to 10th day, a little later in premature neonates.8
Out of 6586 live born babies, 736 babies with jaundice were studied from 1st july 1996 to 30th June, 1997, in a city based medical college nursery. Physiological jaundice was present in 8.92% of all live born babies and accounted for 79.89% of babies with jaundice. Breast milk jaundice and prematurity were next common causes responsible for 5.29% each of all cases with neonatal jaundice. Septicemia caused jaundice in 4.75% cases. Among the babies with jaundice appearing between day 4 and day 7 of life, breast milk jaundice was the commonest cause occurring in 49.25% cases. The last entity surface probably due to exclusive breastfeeding recently initiated in the baby friendly hospital nursery.9
Further, it is felt that an insight to these factors will help the nurse in her nursing field to educate the mothers about the existing factors, their management and prevention of minor discomforts among newborns.
6.3 STATEMENT OF THE PROBLEM
A descriptive study to assess the knowledge of primipara mothers regarding the management of minor disorders among newborn in selected rural communities of Kengeri PHC, Bangalore, Karnataka.
6.4 OBJECTIVES
- To associate the knowledge with the demographic variables.
2. To assess the knowledge among primi Para of newborn regarding management of minor disorders in newborns.
3. To prepare a pamphlet in order to enhance the knowledge of primi para mothers regarding management of minor disorders among new borns based on the findings.
6.5 OPERATIONAL DEFINITIONS
1. Knowledge
It refers to the understanding and ability to answer on management of minor disorders of new borns by primi para mother.
2. Primi Para mother : it refers to a woman who has given birth to her first child.
3. Newborn : In this study it is from birth to under four weeks of age (<28 days),
4. Minor disorder : In this study it refers to a common problem among new borns, namely sticky eyes, stuffy nose, physiological jaundice, Milia, Mongolian Spots, Constipation or diarrhea, Skin rash etc.,
5. Management : It refers to an Act of managing or carefully looked after the minor disorders of newborn.
6.6 ASSUMPTIONS
1. The Primi Para mothers of newborn may have some knowledge regarding the management of minor disorders among newborns.
2. The selected demographic variables may have an influence on primi para mothers knowledge regarding management of minor disorders among newborn.
3. The adequate knowledge of mothers regarding management of minor disorders may have an influence on promotion of healthy newborn practices.
6.7 NUILL HYPOTHESIS
HO1. Mothers have inadequate knowledge regarding management of
minor disorders in newborns.
HO2. There is no significant association of knowledge in relation to
selected demographic variables.
6.8 REVIEW OF LITERATURE
Review of literature is a key step in research process. This refers to the activities involved in searching for information on a topic and developing a comprehensive picture of the state of knowledge on that topic. The written literature review provides a background for understanding what has already been learned on a topic and illuminates the significance of the new study.
Review of literature is a critical summary of research on a topic of interest generally prepared to put a research problem in context or to identify gaps and weakness in prior studies so as to justify a new investigation.10
Review of literature is given under the following headings.
studies related to :-
a. Incidence, etiology and risk factors associated with minor disorders of newborns.
b. Minor disorders among newborns.
c. Maternal knowledge, beliefs and management of minor Disorders among newborns.
a) Studies related to Incidence, etiology and risk factors associated with minor disorders of newborns.
A Descriptive study was conducted on facial and oral inclusion cysts among newborns in university of the north of parana & Londrina, inorder to findout the frequency of milia. Findings showed that milia, alveolar and palatal cysts were prevalent in newborns and were observed in respectively, 31.4%, 28.2%, and 78.8% of the newborns. Those that presented milia were 1.2 times more likely to present alveolar cysts.11
A descriptive study was conducted on custaneous lesions in newborn, in Govt. Medical College / G.N.D. Hospital, Amritsar, India among five hundred newborn babies daily for the first 5days after birth to observe physiological skin changes, inorder of frequency were Mongolian spots in 301 (60.2%), icterus in 128(25.6%), milia in 119(23.8%), superficial cutaneous desquamation in 200(40%), breast hypertrophy in 29 (5.8%) and miniature puberty in 28(5.6%) newborns.12
A study was conducted to elucidate a relationship between inborn errors of metabolism and extensive Mongolian spots in Funda cao Faculdade Federal de ciencias Medias, Brazil. The study concluded that this association may be due to disequilibrium of metabolism during embryonic development, including mucopoly saccharidosis and GM1 gangliosidosis.13
An experimental study was conduted on incidence and bacterial etiology of neonatal conjuctivities in Middelhain hospital, Antwerp. 229 infants and 55 randamly selected infants were investigated before leaving the maternity ward, who have been reveived argyrols eye drops immediately after birth. Findings showed that 26(11%) of the infants had neonatal conjunctivitis before leaving the ward and another 29 infants were reported to have developed sticky eyes/red eyes before leaving the maternity hospital and before 1 month of age. Finally the found that viridians streptococci and staphylococcus aureus were significantly more often from the eyes of the cases with conjunctivitis than from the eyes of the infants with out conjunctivitis.14
A case – control study was conducted to identify risk factors for persistent diarrhea among children hospitalized with acute diarrhea in institute materno-infantil de pernambuco, Brazil. The sample was consisted of 212 infants.
The findings showed that the risk of persistent diarrhea was higher for infants for infants with dysentery, fever at the onset of diarrhea, fasting and taking antibiotics prior to hospital admission. The study concluded that the improvement of environmental conditions and an adequate clinical management of diarrhea may contribute.15
An experimental study was conducted to estimate the correlation between concentration of bilirubin in the umbilical blood and occurrence of icterus in newborns in klinika polozinctwa, Warszawa, among 187 healthy newborns. The umbilical and venous blood was collected and tested. The study concluded that the special care is need for newborns whose concentration of bilirubin in umbilical blood is over 1 mg%.16
b) Studies related to Minor disorders among newborns.
A descriptive study was conducted on neonatal skin disorders in St.Louis Childrens hospital, Nissouri. Almost every neonate had some skin lesion and the most common skin findings were desquamation, sebaceous hyperplasia, milia, toxicerythema, and Mongolian spots.17
A study was conducted on Mongolian spots in the newborn in wake forest university Baptist Medical Centre, USA. The study suggested that they have almost universally been regarded as benign custaneous, manifestations that have no significance and were more often in children with certain inborn errors of metabolism.18
A descriptive study was conducted on diaper dermatitis in St.Lukes Roosevelt hospital centre, New York. Findings showed such eruptions in the diaper area can be sub divided into primary and secondary diaper dermatitis. They usually developed due to moisture, fricition, urine, feces and micro organisms . The most important irritants underlying irritant diaper dermatitis appear to be digestive enzymes persisting in faces, particularly when there are activated by a high PH.19
A study was conducted on hyper bilirubinemia and neonatal jaundice in university of Florence school of Medicine, Italy. The study concluded that normal transitional changes in biliribin metabolism lead to physiological jaundice in many infants, and in some infants these normal changes at birth may be exaggerated resulting in the accumulation of excess bilirubin and development of hyperbilirubinemia.20
A study was conducted on jaundice in the newborn in All India Institute of Medical Sciences, New Delhi, India, Findings showed that neonates on exclusive breast-feeding have a different pattern of physiological jaundice as compared to artificially fed babies.21
A study was conducted on an extradural and subdural hematoma in a neonate in Lokmanya Tilak Municipal Medical College and hospital, Mumbai, India. Findings showed that traumatic brain injury following birth is common in newborn but significant intracranial hematoma following birth injury is not that usual.22
c) Studies related to maternal knowledge, beliefs and management of minor disorders among newborns.
A study was conducted on maternal knowledge and beliefs of infant constipation in Michigan state university. Escanaba, One hundred mothers who delivered infants at a rural community hospital were survived 38% of multiparous mothers reported constipation in their previous children which resolved with all home treatments given, and only 23% of the mothers reported to their physicians. Findings showed all mothers significantly underestimated stool frequency from age’s birth to one week.23