nursing care of the high risk newborn and family
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1. initiation and maintenance of respirations 2. establishment of extrauterine circulation 3. control of body temperature 4. intake of adequate nourishment 5. Establishment of waste elimination 6. Prevention of infection 7. Establishment of an infant-parent
relationship 8. Developmental Care, or care that balances
physiologic needs and stimulation for bestdevelopment
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Position the baby on its'back with the headlooking straight up. Thiswill usually provide forgood airflow.
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RESUSCITATION Establish and maintain an airway
Expand the lungs
Initiate and maintain effectiveventilation
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pass
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Size 0 or 1
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LUNG EXPANSION
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Pulse oximeter- tomonitor oxygen level
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Atropine - reduces bronchial secretions
Calcium Chloride-inc heart contractility Dopamine-inc systemic blood perfusion
Epinephrine-initiates cardiac contractions
Lidocaine-counteracts ventricular arrythmias
Sodium Bicarbonate-corrects metabolicacidosis
Surfactant restores naturally occuringsurfactant to improve lung compliance
Nitric Oxide-vascular dilator
Liquid ventilation (liquidfluorocarbon)-anti-inflammatory, reducesoxygen toxicity and infection
DRUGS USED IN RESUSCITATION
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Ineffective respiratory function ->ineffectivecardiac function
If CR is not audible or below 80 bpm -> startclosed chest massage
Hold infant with fingers supporting the back Depress sternum (1-2cm) with two fingers
Continue lung ventilation
Lung ventilation should be interspersed with
cardiac massage at a ratio of 1:5 If heart sounds not resumed above 80bpm
after 30 secs, 0.1-0.3mL/kg epinephrine isgiven sprayed into ET tube
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Maintaining fluid and electrolyte balance Ringers Lactate or 5% dextrose in water
To maintain fluid and electrolyte levels
Rate should be maintained carefully High fluid intake can lead to or
heart failure
To increase blood volume in case of hypovolemia Signs of hypovolemia:
increased:heart rate Decreased: arterial blood pressure, central venous
pressure(pressure of blood w/n the rt atrium), tissueperfusion
Monitor urine output and urine specific gravity Dehydrated if U.O < 2mL/kg/h
or Urine specific gravity > 1.015 to 1.020
o If with hypotension without hypovolemia >may be given to inc BP
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neutral temp environmentshould be maintainedTo prevent newborn frombecoming chilled:
Wipe the infant dryCover the head with a cap
Place him immediatelyunder a prewarmed radiantwarmer or a warmedincubator or skin to skinagainst the motherTemp should be kept
regulated to maintainaxillary temp of 36.5C(97.8)
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KANGAROO CARE
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If infant experienced asphyxia at birth -> IVFis administered
If RR remains rapid and Necrotizingenterocolitis has been ruled out -> gavagefeeding
Breastfeed if possible If not use expressed breastmilk for gavage feeding
Maintain oral stimulation by giving pacifier
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Immature infants may void and pass stoollater than the term infant BP may not be adequate to supply the kidney
Meconium has not yet reached the end of the
intestine by birth
Document any voidings during resuscitation > proofthat hypotension is improving and kidneys are beingperfused
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Infection> increases metabolic demands > stresses the immature immune system
To prevent:
Skin care
Good handwashing technique and standardprecaution by the personnel
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Prenatal: offer a tour of a NICU Postpartum:
keep parents informed of what is happening duringresuscitation at birth
Allow and urge them to visit NICU
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Anticipatory guidance Support before and after discharge
Assess the level of knowledge about childscondition and development
Give education and referral to a home care agency Evaluate safety of their home
Instruct how to properly transport a preterm infantin a car
Blanket and head support are necessary (small infantdoes not fit securely in a standard infant car seat)