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Comisión de Enfermeros de Gestión
Curso de Enfermería Salta Proceso de atención de enfermería Necesidad de Alimentación en Recién Nacidos Pretérmino 8 de abril de 2009
Lic. María Ester Elldid |
[email protected]
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Introducción
La
neonatología de la mano de la tecnología, la investigación científica científica y la especialización de los enfermeros, logró importantísimos avances, de manera que hoy es posible salvar a prematuros extremos y recién nacidos graves, que poco tiempo atrás no hubieran sobrevivido.
El desafío que tenemos es que esta tecnificación
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Aplicación del Proceso de Atención de Enfermería en RNPT
Método
de resolución científica de problemas en la práctica asistencial de enfermería.
Nos
permite prestar cuidados de una manera racional, lógica y sistemática .
Nos
permite tratar en forma integral al paciente y su familia
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Valoración
de Necesidades básicas
1.
Oxigenación
2.
Nutrición
3.
Eliminación
4.
Actividad
5.
Reposo y sueño
6.
Autocuidado
7.
Termorregulación
8. Aseo Aseo e inte integr grid idad ad de los los tegu tegume ment ntos os 9.
Seguridad
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Valoración
de Necesidades Básicas 1.
Oxigenación
1.1
FR
1.2
Tiraje subcostal
1.3
Aleteo nasal
1.4
Apneas
1.5
Dificultad respiratoria
1.6
Saturación O2
1.7
Relleno capilar
1.8
FC
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Valoración
de Necesidades Básicas
2.
Nutrición 2.1 Abdomen (blando, depresible, no doloroso) 2.2 Residuo ( Presencia, Presencia, Ausencia Ausencia o escaso) 2.3 Tasa de crecimiento (Normal o Disminución) 2.4 Actitud alimentaria
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Valoración
de Necesidades básicas
3. Eliminación 3.1 Diuresis (positiva o negativa, características) 3.2 Catarsis meconial (positiva o negativa) negativa) 4. Acti Activi vida dad d
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Valoración
de Necesidades básicas
7. Termorregulaci Te rmorregulación ón 7.1 Temperatura 8. Aseo e integridad de los tegumentos 8.1 Ictericia de piel y mucosas
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Diagnósticos
de Enfermería
1.
Alte Altera raci ción ón del del pat patró rón n resp respir irat ator orio io R/C disminuci disminución ón de la capacidad pulmonar pulmonar total total S/A colapso alveolar
2.
Alte Altera raci ción ón de la ter termo morr rreg egul ulac ació ión n R/C limitada capacidad de producción de calor S/A elevada relación sup. corporal y peso, bajos depósitos de grasa parda, escaso
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Diagnósticos
5.
de Enfermería
Desequilibrio
nutricional: por defecto R/C incremento del gasto calórico entre 6075 kcl/Kg./d S/A déficit de aporte calórico requerido
6. Alteración del metabolismo de las bilirrubinas R/C recambio y destrucción de las células sanguíneas S/A inmadurez hepática y disminución de la motilidad intestinal.
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Diagnósticos
de Enfermería
11. 11. Alto Alto ries riesgo go de cegu ceguer era a R/C disrupción en el curso de vascularización normal normal de la retina S/A exposición prolongada de oxígeno complementario.
12. Alto Alto riesg riesgo o de alte alterac ración ión en en el neurod neurodesar esarrol rollo lo R/C secuelas neurológicas S/A infarto hemorrágico cerebral.
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Objetivos de los cuidados
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Alimentación de RN prematuros con leche materna en las Unidades Asistenciales de SMG
Leche
de fórmula: Calorías, aporte proteico, calcio, fósforo y Na. Pero Cuando se inicia la alimentación enteral con leches industrializadas existe mayor riesgo de presentar EC N.
RNP sin restricción hídrica: aumento del aporte de LH a 200ml/k/día
Si hay restricción hídrica o insuficiente producción de y fórmula pretérmino
LM:
intercalar
LM
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Administración
Por gavage
Por gastroclisis
Por succión al pecho de algunas tomas, hasta alcanzar alcanzar la madurez y el peso suficientes para succionar todas las tomas 1) Cuando el bebé esta clínicamente clínicament e estable 2) Pesa alrededor de 1000gr.
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Administración
Debemos tener tener en cuenta que se pueden depositar las grasas gr asas en la jeringa por lo que es necesario rotarla Precauciones: Cambiar la guía y jeringa cada 4 horas cuando se administra por gastroclisis. Cambiar la jeringa cada vez que se administra por Gavage
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Bioseguridad Bioseguridad y Control y Control dede Infecciones infecciones Flujo Laminar Introducción Son
equipos que proporcionan una barrera de contención para trabajar en forma segura, manteniendo el área de trabajo libre l ibre de partículas o de agentes contaminantes tales como bacterias que pueden alterar el producto final.
Ob jetivo
general: Definir estrategias para
brindar
el manejo que resulte más adecuado y con el menor
riesgo de contaminación del producto a preparar.
Importante: Establecer horarios horarios de las tareas y así permitir permitir que no haya haya cúmulo de de materiales materiales en la cabina cabina 1. Establecer ( Fraccionamiento de leche materna y luego fraccionamiento de fórmulas lácteas). 2. Utilizar siempre la vestimenta vestimenta correspon correspondiente: diente: camisolín camisolín de tela o descart descartable, able, gorro, gorro, guantes guantes no estériles, barbijos y si es necesario agregar antiparras. 3. Realizar Realizar el mínimo mínimo de interr interrupc upcione iones s mientras mientras la cabin cabina a este este en uso. Siempre mantenga cerrada la puerta de acceso al área (utilizar la ventanilla de acceso con portero eléctrico).
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Bioseguridad y Control de Infecciones Desarrollo 1.
d el proc edimi ento en l a c ab abina
Lave sus manos y antebrazos con antiséptico 2. Apague la lámpara U ltr ltr av iol et a (UV) av iol 3. Colóquese los guantes y limpie y desinfecte todas todas las superficies de la cabina con DDSH®. 4. Retire los guantes y descártelos. 5. Encienda la cabina y permita que el aire fluya fluya 15 minutos con la puerta cerrada. 6. Colóquese el camisolín, camisolín, gorro y guantes no estériles 7. Introduzca en la cabina únicamente el material requerido, previa desinfección con Alcohol al 70% . N o sobr ec arg ar l a c ab abina. 8. Evite procedimientos que puedan alterar el flujo de aire dentro de la cabina. 9. Realice los procedimientos hacia el fondo de la cabina 10. Evite el retiro de las manos del área de trabajo hasta que el fraccionamiento de la alimentación haya finalizado. ba ndejas correspondientes antes de retirarlos de 11. Coloque todo el material fraccionado en las bandejas la cabina. fraccionamie nto de las leches o productos maternizados descarte los 12. Cuando finalice el fraccionamiento
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Conclusiones
Para los recién nacidos a término, la leche materna proporciona una
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Conclusiones
Los fortificantes de componentes múltiples que se producen
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Conclusiones
La leche materna sigue siendo la elección predeterminada para la nutrición
enteral, ya que los estudios observacionales y los metanálisis de los
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Conclusiones
Amamantar ³ Amamantar
es un acto muy complejo del que se hace imposible
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10 pasos de la iniciativa i niciativa Hospital Hospital Amigo de la Madre y el Niño
Paso 1. Tener una política escrita de lactancia materna, que sea periódicamente comunicada a todo el personal.
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