Self-Assessment Questions (SAQs) for Study Session 7

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the following questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.

First read Case Study 7.1 and then answer the questions that follow it.

Case Study 7.1  Atsede’s baby can’t breathe

A 25 year-old woman called Atsede was brought to your Health Post after being in labour for 38 hours at home. Soon after she reached you, she gave birth to a full term baby boy. You assessed the baby and found he was not making any breathing effort, he had no movement of his limbs and his whole body was covered with meconium-stained amniotic fluid. When you dried him and applied tactile stimulation, the baby still didn’t show any effort to breathe.

SAQ 7.1 (tests Learning Outcomes 7.2 and 7.3)

  • a.Is this baby asphyxiated? If yes, what is the degree of asphyxia?
  • b.What are your immediate next steps? Then what do you do?
  • c.Could the birth complication in this newborn have been prevented, and if so, how?

Answer

  • a.Atsede’s baby is severely asphyxiated. The danger signs are that he was not making any breathing effort, or moving his limbs, he was covered with meconium and tactile stimulation had no effect.
  • b.Your next step is to dry him quickly, wrap him warmly, and remove meconium from his mouth and nose with the bulb syringe and a clean cloth. Listen for an apical heartbeat and if it is below 60 beats/minute, begin heart massage, alternating with ventilating the baby at about 40 breaths per minute.
  • c.The birth complication in this newborn could have been prevented by Atsede receiving skilled birth attendance much earlier in her labour from someone who could monitor the signs of fetal distress and refer her for emergency care; 38 hours is too long to wait.

SAQ 7.2 (tests Learning Outcomes 7.4

List the basic equipment you will need in order to resuscitate a newborn with breathing difficulties.

Answer

The basic equipment you will need in order to resuscitate a newborn with breathing difficulties are:

  • Two clean linen/cotton cloths: one to dry the newborn and one to wrap him or her afterwards
  • Plastic bulb syringe to remove secretions from the mouth and nose, especially when meconium is present
  • Ambu-bag and mask to give oxygen directly into the baby’s lungs
  • A person trained in neonatal resuscitation (like you)
  • Heat source (lamp) to provide warmth, if possible.

SAQ 7.3 (tests Learning Outcomes 7.1, 7.2, 7.4, 7.5 and 7.6)

Which of the following statements is false? In each case say what is incorrect.

A  If a newborn cries soon after birth, it is a sign of asphyxia occurring before delivery.

B  Cyanosis means being covered with meconium all over the body.

C  The apical heartbeat can be detected by listening to the baby’s chest with a stethoscope.

D  Gas exchange in the lungs happens when carbon dioxide is breathed in and oxygen is breathed out.

E  Giving the newborn a Vitamin K injection is to prevent eye infections.

F  The recommended ventilation rate for newborns is 40 breaths/minute.

Answer

A is false.  If a newborn cries soon after birth, it is a sign of asphyxia occurring before delivery.

B is false.  Cyanosis means having a bluish colour to the skin because of oxygen shortage (asphyxia).

C is true.  The apical heartbeat can be detected by listening to the baby’s chest with a stethoscope.

D is false.  Gas exchange in the lungs happens when carbon dioxide is breathed out and oxygen is breathed in.

E is false.  Giving the newborn a vitamin K injection is to prevent spontaneous bleeding; tetracycline ointment is given to prevent eye infections.

F is true.  The recommended ventilation rate for newborns is 40 breaths/minute.

SAQ 7.4 (tests Learning Outcome 7.4)

Which of the following ways of stimulating the newborn are recommended, and which are dangerous and not allowed?

  • Slapping the back
  • Rubbing the abdomen gently up and down
  • Squeezing the rib cage
  • Forcing thighs into the abdomen
  • Flicking the underside of the baby’s foot with your fingers
  • Dilating the anal sphincter
  • Hot or cold compresses or baths
  • Shaking the umbilical cord.

Answer

Only two of the ways in the list are recommended for gentle tactile stimulation of the baby:

  • Rubbing the abdomen gently up and down
  • Flicking the underside of the baby’s foot with your fingers.

All the other ways listed are dangerous and should not happen.

SAQ 7.5

Table 7.1 summarises some common health risks to newborns and the immediate essential care to prevent those complications. Some of the boxes have been left blank for you to complete.

Table 7.1 for use with SAQ 7.5

Newborn health riskEssential newborn care
Eye infection

Spontaneous bleeding

Hypothermia

Hypoglycaemia

Answer

The completed Table 7.1 is below.

Table 7.1  Completed

Newborn health riskEssential newborn care
Eye infectionApply tetracycline eye ointment
Spontaneous bleedingInject 1 mg vitamin K intramuscularly
Skin-to-skin contact with mother, blankets and capHypothermia
Early breastfeeding or adequate replacement feedingHypoglycaemia

Summary of Study Session 7