Self-Assessment Questions (SAQs) for Study Session 6

Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the questions below. 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 6.1 and then answer the questions that follow it.

Case Study 6.1  Postnatal assessment of a female newborn

A female baby was delivered by a 32 year-old mother at a gestational age of 39 weeks. You assess the baby at 28 hours after the birth. She has a birth weight of 3,000 gm and presented with a history of convulsion, no feeding at all and a body temperature of 38.5°C.

SAQ 6.1 (tests Learning Outcomes 6.1 and 6.3)

  • a.How do you classify this baby based on her gestational age?
  • b.How do you classify her according to her birth weight?
  • c.List the general danger signs present in this newborn.
  • d.What is your comment on the body temperature of this baby?
  • e.What will be your final classification of this newborn baby and how should you manage her condition?

Answer

  • a.At 39 weeks of gestation, this baby is classified as a normal term baby.
  • b.The birth weight is 3,000 gm, which is classified as a normal birth weight.
  • c.The general danger signs are no feeding, history of convulsions, and high temperature.
  • d.The temperature (38.5˚C) is abnormal and the newborn has a fever. The normal temperature of a newborn is above 36.5 to below 37.5˚C.
  • e.This baby has three major danger signs (no feeding, convulsion and fever) and is classified as a possible infection. Your management of this baby should be an urgent referral to a hospital or health centre, with advice to keep her warm and feed breast milk on the way.

Now read Case Study 6.2 and answer the questions that follow it.

Case Study 6.2  Postnatal assessment of a male newborn

You assess an eight hour-old male newborn who was delivered by a 27 year-old first-time mother at a gestational age of 31 weeks. He had a birth weight of 1,300 gm, and presented with a respiratory rate of 72 breaths per minute and chest in-drawing. His body temperature is 34.5°C.

SAQ 6.2 (tests Learning Outcomes 6.1 and 6.3)

  • a.How do you classify this baby’s gestational age?
  • b.How do you classify him according to his birth weight?
  • c.Is the respiratory rate of 72 breaths per minute normal or not? What is the normal range of respiration?
  • d.What about the temperature of this newborn? Is it normal?
  • e.What should your management of this newborn be?

Answer

  • A.As the baby was born at 31 weeks of gestation, he is classified as a very preterm baby.
  • B.The birth weight is 1,300 gm, so he is classified as very low birth weight.
  • C.His respiration rate of 72 breaths per minute breathing is abnormal. This newborn has fast breathing. The normal breathing rate of the newborn is 40-60 breaths per minute.
  • D.The temperature (34.5˚C) is abnormally low; the newborn has hypothermia. The normal temperature of the newborn is above 36.5˚C to below 37.5˚C.
  • E.As he is a very preterm and very low birth weight baby, with two major danger signs (fast breathing and hypothermia), he is classified as possible infection. The management should be an urgent referral to a hospital or health centre, with advice to keep him warm and feed breast milk on the way.

SAQ 6.3 (tests Learning Outcomes 6.1, 6.2 and 6.4)

Imagine it is your first visit to a new mother who had a normal birth. You are assessing that her newborn baby is OK, including checking for signs of infection.

  • What would you ask her before commencing your examination of the baby?
  • What would you be sure to look for/check when you examine the baby?

Use Table 6.2 below to help you to organise your answers.

Table 6.2 Assessing a newborn baby.

Questions to ask the motherThings to look for/check in the newborn

Answer

Table 6.2 Assessing a newborn baby (completed).

Questions to ask the motherThings to look for/check in the newborn
Is the mother remembering to wash her hands before breastfeeding, and keeping the baby and herself clean?Do the mother and baby look clean and well? Is the room clean and well kept?
Has she noticed any unusual movements, spasms, of an arm or the whole body?If yes, observe carefully to see if the baby may be suffering from convulsions.
Is her baby breathing steadily and without effort?If the mother is worried, check for chest in-drawing (the baby’s chest sucking inwards deeply at the lower ribs); also check for any signs of convulsions.
Is the mother taking care to keep the umbilical cord stump clean and dry? Has she noticed any ‘smelliness’ from the umbilical cord? See if there is discharge, or redness of the skin around the base of the cord. Remind the mother about the importance of keeping it clean and dry.
Has she noticed any redness or discharge from the baby’s eyes?Was tetracycline (or another approved eye ointment) applied at birth?
Does the baby seem too hot, or too cool?If the baby seems hot take it’s temperature (with a sterile and clean thermometer), but also check if she has it too well wrapped up. If it is cold, check for hypothermia.
Does the mother have any problems with breastfeeding? If yes, check the mother for cracked nipples, or heat in the breast (mastitis or an abscess). If reluctant to breastfeed, remind her how important breast milk is as nourishment for her baby and protecting it from infection.
Does the baby have any signs of a rash? If yes, is it just nappy rash or sweat rash, or are there any pustules (pus filled blisters)? If so, are there more than 10?
Did she or the baby go through any harmful traditional practices following the birth? If yes, check the baby for any signs of tetanus (e.g. muscle spasms) and ask if the mother has been immunized against tetanus.
Does she feel well generally? Is she coping with looking after a new baby?Is the mother getting enough support and is the baby getting all the care it needs?

Summary of Study Session 6