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Pathophysiology : Alteration inthermoregulation.

The preterm infant has a high ratioof body surface to body weight (thebody's ability to produce heat ismuch less than the potential forlosing heat. In addition the preterm

infant has very little subcutaneousfat. Without adequate insulationheat is easily lost from the core of the body to the body surface.Also, the preterm infant has thinner, more permeable skin . Theposition of extension that pretermbabies lie in also exposes them tomore heat loss.

Nursing Diagnosis:

Ineffecctive thermoregulation r/thypothermia secondary todecreased glycogen and brown fatstores.

Assessment:

Temperature was 36.2°C;

Medications:

Related lab tests and treatments:

Outcomes:

The infant will not show signs/symptoms of hypothermia AEB axillary temperature

maintenance of 36.4-37.2°C as well as no

signs or symptoms of respiratory distressduring my shift.

Interventions and Rationales:

1.) Observe for signs and symptoms of cold stresssuch as decreased temperature, lethargy, andpallor. Rationale: hypothermia is associated with

premature newborns due to decreased stores of brown fat.

2.) Provide a neutral thermal environment usinga servo control skin probe. Rationale: the skinprobe measures the infant's core temperatureand adjusts the incubator accordingly.

3.) Allow skin-to-skin contact between motherand newborn. Rationale: maintains warmth of infant and fosters security and bonding.

Evaluation:

Goal met: patient's temperature remained stable

at 36.2°C during my shift.

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Respiratory DistressSyndrome:

Pathophysiology: 

A condition associated withprematurity resulting in adeficiency of functioning lungsurfactant. Without surfactantthe lung collapses after everyexpiration and reinflates withgreat difficulty , requiring thenewborn to generate intense

pressures with every breath.

Nursing Diagnosis:

Impaired gas exchange r/tinadequate surfactant

secondary to immature lungdevelopment AEB preterm

birth, need for resuscitationand mechanical ventilation

and pnueomothorax.

Assessment: 

pt is 25-days old; she is on SIMVmechanical ventilation; she is pinkand well perfused and reactive tolight, sound and touch; she has mildsubcostal retractions; lung sounds arediminished but clear bilaterally; heroxygen saturation is 93% on vent;heart rate is 162 and respirations are60/min. Her weight today is 0.88 kg

and length is 35.6 cm.

Medications: 

caffeine citrate 6.2mg/dose (1 x daily)

albuterol .083%, 0.13mg/dose (Q6-hours)

budenoside nebulizer suspension0.5mg every 12-hours.

furosemide .5mg/kg/dose (Q 12-hours)

*pt received surfactant (1.1mL) indelivery room.

Rel. lab tests and treatments: (6/11/12)

CXR: overinflated lungs, pneumothoraxresolved

suctioning as needed

CO2: 17 mmol/l (13-29 mmol/l)

Ca: 11.2 mg/dL (H) (8.2-11.1 mg/dL)

Hgb: 11.2 g/dL (L) (14-20 g/dL)

Cl: 114mEq/L (H) (103-111 mEq/L)

ALKP: 479 (H) (60-130 units/L)

Outcomes:

The infant will maintain adequate respiratory gasexchange AEB: respirations of 30-60/min; pulse oximetryreadings above 83%; ABG's within normal limits, andshow no signs of respiratory distress by time of discharge.

Interventions:

1.)Assess respiratory rate and pattern as well as lung sounds

Rationale: assessing respiratory effort and pattern will alertyou to signs of worsening or improving RDS; ausculatate lungsounds to

2.)Apply transcutaneous oxygen monitor or pulse oximeter.Record levels hourly. Change site of probe every 3 –4 hr.

Rationale: Provides constant noninvasive monitoring of oxygenlevels.

3.) Monitor fluid intake and output; weigh infant as indicatedby protocol.Rationale: Dehydration impairs ability to clear airways becausemucus becomes thickened. Overhydrationmay contribute to alveolar infiltrates/pulmonary edema.

Evaluation of Plan of Care:

goals partially met; during my shift respirationsremained between 30-60/minute and O2 satsremained above 83%. Patient still on mechanicalventilation.