KEMPEGOWDA COLLEGE of Nursing , Bangalore-04
CASE STUDY ON BABY WITH PRE-MATURITY
2nd Year M.Sc Nursing
BASELINE DATA / GENERAL INFORMATION: Name
: B/O Mrs. KAVYA
: 1 day
: Neonatal Intensive Care Unit
: NO 141, Chennaswamy layout ,Bandepalya, Hosur road.
: Mr. Swamy
: Mrs. Kavya
: Home maker
Monthly Family Income
: Rs. 10,000/ month
Date of Admission
: 01 – 04 – 2012
Provisional/ Final Diagnosis
: pre-mature baby with 37 weeks for NICU care
CHIEF COMPLAINTS WITH DURATION The child has born at 37 weeks of gestation. Active , cried immediately after birth. Apgar is 6/10,8/10.saturation is 88%. HISTORY OF PRESENT ILLNESS: Baby is pre-term and not maintaining the oxygen saturation. Shifted to NICU for evaluation. HISTORY OF PAST ILLNESS Significant Medical History
Significant Surgical History
: No significant history in past.
FAMILY HISTORY a) Type of Family
b) No of Members in the family
c) Family Composition : Sl.N o.
Relation ship with the child
Healt h Status
e) Hereditary illness : no history of any hereditary illness. FAMILY GENOGRAM
-female -male -newborn
SOCIO – ECONOMIC HISTORY: a) Housing
: Semi Pucca
: No. of Living Rooms – Adequate
: Monthly rent
f) Water Supply
g) Relationship among the family members : good
PERSONAL HISTORY a) Birth History i). Antenatal History a) Normal
b) Nutrition of the Mother
c) Regular Antenatal Check up
d) Consumption of FST/Folic Acid
e) Deviation from normal
(f) Any exposure to teratogens
Natal History Mode of Delivery
: normal delivery with right medio lateral episiotomy at 37 weeks gestation
: 6/10, 8/10
Place of Delivery
: MSRMH, Bangalore 5
Weight of the body (Preterm)
: 2.2 Kg
Condition of Neonate
: pre- mature needs oxygen
Any congenital deformity
Condition of Neonate Meconium passed within 24 hrs
Any congenital deformity
Feeding Initiation of breast feeding
: Breast feeding is not Initiated due to illness
IMMUNIZATION HISTORY :
Age of the child
Name of the vaccine
Birth (1-7 days)
Baby is not Immunized due to low body weight and poor musculature growth
OPV (O- dose) Hep .B – I dose
Oral 2 drops IM 0.5 ml
DIETARY HISTORY a) Breast Feeding
b) Other Modes of Feeding
c) Present Diet
SLEEPING i) Sleeps in
iii) Problems related to sleep
ELIMINATION i) No. of Urine Frequency
ii) No. of bowel movements
PHYSICAL ASSESSMENT: Vital signs :
Baby has no fever
Baby has Tachycardia 7
30 – 40
ANTHROPOMETRIC MEASUREMENT : SL NO PARAMETERS
FOUND IN CHILD
2.9 3 kg
Baby has low body weight
Baby has reduced length
33 - 35 cm
31 – 33 cm
Mid arm circumference
12- 17.5 cm
Baby has Low mid arm circumference.
PHYSICAL EXAMINATION GENERAL ASSESSMENT Appearance
: Restless, Crying 8
: Supine, flexed position
Foul Body odour
Skin Condition Skin Colour
Turgor and elasticity
: Dark Brown
: Equally distributed
Angle of nail beds
Nail Bed Colour
HEAD AND FACE Shape
: Normal 9
EYES Eye Brows
: Equally distributed
Shape and appearance of eyes - Normal Sclera
: Reacting to light normally
: Not able identify.
Shape and Size
: Not distinguished 10
NOSE External Nose Size
: normal in size
Internal nasal mucosa
MOUTH Lips Colour
: Colour Red
: Normal 11
NECK Range of motion
THROX AND LUNGS Respiratory rate
Increased i.e. 52 breaths/min
Chest Wall movement
ASymmetrical ,has retraction
Asymmetrical air movement.
Breast and Axilla Lymph node
: not developed
: 170 beats/min
ABDOMEN i) Inspection Scar
:presence umbilical cord lesion
: Normal, looks dry, black in colour.
: 20 cm
ii) Palpation Liver
iii) Percussion Ascities
Peristaltic movement: increased GENITALIA i) Scrotum
: Vertebral column
EXTREMITIES Upper extremities
Range of motion
:less, flaccid movement of extremities.
: No 13
Webbing of fingers
Clubbing of fingers
ii) Lower extremities :
Range of motion
dull movement of lower extremities.
REFLEXES: BOOK PICTURE
REFLEXES: Reflexes are involuntary movements or actions that help to identify normal brain and nerve activity. Some reflexes occur only in specific periods of development. The following are some of the reflexes seen in newborns. ROOTING REFLEX: Rooting reflex is poorly Present at birth Disappears by about 4 months after birth
elicited in this baby , may be due to prematurity.
Begins when the corner of the baby's mouth is stroked or touched. The baby turns the head and opens the mouth to follow and "root" in the direction of the stroking. This helps the baby to find the breast or bottle to begin feeding. If this reflex doesn't vanish in 3-4 months, the CNS may be malfunctioning. SUCKING REFLEX Begins about the 32nd week of pregnancy Is not fully developed until about 36 weeks
Sucking reflex is poor in this baby due to
Disappears by about 4 months after birth
Premature babies may have weak or immature sucking ability. A finger or nipple placed in baby's mouth will elicit rhythmical sucking.
Depressed sucking may be due to medication given during childbirth MORO REFLEX: Present at birth Disappears by about 4-5 months after birth Moro reflex is good Often called a startle reflex because it usually occurs when the baby is startled by a loud sound or movement In response to the sound, the baby throws back the head, extends the arms and legs, cries, and then pulls the arms and legs back in. or Baby is held horizontally, then swiftly lowered a few inches, or the head may be lowered a few inches, or a loud sudden noise will make baby's arms fling out and then come together as hands open then clutch. Absence or weakness of this reflex may suggest a severely disturbed CNS. TONIC NECK REFLEX: Appears about 2 months after birth Disappears by about 6-7 months after birth tonic neck reflex can’t be When the baby's head is turned to one side, the arm on that side
elicit in newborn babies.
stretches out and the opposite arm bends up at the elbow Often called the fencing position PALMAR GRASP REFLEX:
Present at birth Disappears by about 2-3 months Stroking the palm of a baby's hand causes the baby to close the fingers
Palmar grasp can be elicited and it is very
in a grasp
strong in this baby. Reflex is stronger in premature babies OR
Baby grasps examiners
By pressing just one of baby's palms, fingers should grasp the object. Absence or weakness of this reflex could reflect an injured spinal cord
fingers when pressure applies on baby’s hand with finger.
or depressed CNS. STEPPING, PLACING OR DANCING REFLEX: Present at birth Disappears by 2 months after birth When dorsum of foot is placed under a table edge, the infant will step, lifting and placing the foot onto the table surface.
Stepping is not well developed due to acute
Holding baby upright with feet touching a solid surface and moving him forward should elicit stepping movements. After 3-4 months, this reflex should vanish. If it reappears, there may be an injury of the upper spinal chord. BABINSKI REFLEX:
Babinski reflex is good.
Baby's foot is stroked from heel toward the toes. The big toe should lift
Baby's foot is stroked from heel toward the toes 17
up, while the others fan out. Absence of reflex may suggest immaturity of the CNS, defective spinal cord, or other problems. Reflex may be seen up to age one, and then reaction will be reversed with the toes curling downward
with the help of knee hammer edge, the bif toe of the baby is lift up and other fingers are fan shaped.
DOLL’S EYE REFLEX: While manually turning baby's head, his eyes will stay fixed, instead of moving with the head. While normally vanishing around one month of age, if it reappears
Doll’s eye reflex is not well developed.
later, there may be damage to the CNS. GALANT REFLEX: While stroking baby's back to one side, her spine and trunk will arch toward that side.
Gallant reflex is achieved when a stroking baby's back to one side ( left) with finger, baby’s spine and trunk arch toward
Absence may indicate spinal injury or depression of the CNS.
PEREZ REFLEX: Firmly stroking baby's spine from tail to head, will make her cry out and head will rise.
Perez reflex is performed due to baby is acutely ill.
If this reflex does not vanish in 4-6 months, baby's CNS may be severely depressed PLANTER’S GRASP: Pressing thumbs against the balls of baby's feet will make his toes flex.
Plantar reflex is good.
Absence of this reflex may indicate damage to the spinal chord 18
This withdrawal reflex is
WITHDRAWAL REFLEX: A pinprick to the sole of baby's foot will make baby's knee and foot flex.
achieved when baby’s sole pricked with needle for blood glucose
Absence of this reflex could indicate a damaged sciatic nerve.
monitoring, baby’s knee and foot flex.
INVESTIGATION Sl. No. 1
< 5 mg/ dl
Baby looks anaemic, cyanosed and has systemic infection
135 – 145 meq/ lr
3.5 meq/ ltr
3.9 – 5.1 meq / lr
99 meq / ltr
98 – 106 meq / lr
7.35 – 7.45
60 – 80
25.2 – 25.6
O + Ve
Chest X- Ray
ABG analysis Baby has respiratory acidosis
CORELATION BETWEEN BOOK PICTURE AND PATIENT PICTURE: SL NO.
Exact cause is unknown
The Exact cause is unknown
Mother got contraction and she was admitted
RISK FACTORS: -
No risk factors are noted
Illness of the mother
Thin, shiny, pink skin
Large head relative to rest of the body Little fat under the skin Thin, shiny, pink skin Veins visible beneath the skin Few creases on soles of feet Scant hair Soft ears, with little cartilage Underdeveloped breast tissue
Veins visible beneath the skin Few creases on soles of feet Scant hair Soft ears, with little cartilage Underdeveloped breast tissue Boys: Small scrotum with few folds. Testes may be undescended in verypremature newborns Weak, poorly coordinated swallowing reflexes
Boys: Small scrotum with few folds. Reduced physical activity and muscle tone (a Testes may be undescended in premature newborn tends not to draw up the verypremature newborns arms and legs when at rest as does a full-term Rapid breathing with brief pauses newborn) (periodic breathing), apnea spells Sleeping for most of the time (pauses lasting longer than 20 seconds), or both Weak, poorly coordinated sucking and swallowing reflexes Reduced physical activity and muscle tone (a premature newborn tends not to draw up the arms and legs when at rest 21
as does a full-term newborn) Sleeping for most of the time Infants will be given warm, moist oxygen. This Management
is critically important, but needs to be given carefully to reduce the side effects associated
a. NICU care
with too much oxygen.
b. Adequate oxygenation
Maintained ideal body temperature by Placing the baby in radiant warmer and maintaining baby temperature between 36.5 – 37.5 C.
Baby is handled Gently and minimal disturbance to baby.
Administered fluids and electrolytes intravenously
First 24 hours: 10 % glucose & water and subsequently add electrolytes
Monitored tissue oxygen saturation continuously by using pulse oxymeter.
Monitored of ABG analysis.
Administred antibiotics and other drugs as per order
c. Supportive care.
Maintained aseptic precautions to prevent infections.
Prepared lactose Feed is given through NGtube and Palada
Surfactant therapy is not yet planned for this 22
THEORY APPLICATION : Ida Jean Orlando conceived her theory from her search for information about the practice of nursing and formulated the Orlando’s theory of Deliberative Nursing Process;
Non verbal response like baby having distress
Perception of need of the baby and prioritise the need
Nurse activity Provided warmer care , oxygen administration, recorded vital signs
This theory is based on the individual’s action. The components of Orlando’s Nursing Process Theory are ;
CONCEPTS OF THEORY 1. Patient behaviour
The baby becomes restless and has retraction
Saturation is less
2. Nurse action 24
The nurse with her experiences tries to identify the reason and checks the vital signs 3. Nurse reaction
After interpreting the behaviour of the baby the nurse administers the oxygen to the baby
Provides the warmer
Starts the iv line
Administer antibiotics according to doctors orders.
APPLICATION OF NURSING THEORY IN NURSING PROCESS Assessment: Assess the causes for RDS by collecting complete histoty of maternal and birth history. -
Estimated gestational age
Maternal contributing factors such as multiple pregnancy, diabetes, nutritional status etc.
NURSING DIAGNOSIS: 1. Impaired breathing pattern related to Atelactasis secondary to surfactant deficiency. 2. Ineffective airway clearance related to fatigue. 3.
Ineffective thermoregulation related immature of thermoregulation centre, less subcutaneous fat.
4. Imbalanced nutritional status less than body requirement related NPO status, inability to take breast milk. Nursing measures:
Administration of oxygen to reduce restlessness caused by respiratory distress. 25
Maintaining ideal body temperature: Placing the baby in radiant warmer and maintaining baby temperature between 36.5 – 37.5 C.
Gentle handling and minimal disturbance to baby.
Fluid management: Infants with RDS also need careful fluid management. Intravenous fluids are administered to stabilize the blood sugar, blood salts, and blood pressure
Maintain acid – base balance:
Administration of fluids and electrolytes intravenously First 24 hours: 10 % glucose & water and subsequently add electrolytes
PRETERM BABY INTRODUCTION Full-term pregnancy lasts 37 to 40 weeks. About 12% of newborns are born prematurely (preterm). Many of these newborns are born just a few weeks early and do not experience any problems related to their prematurity DEFINITION A premature newborn is, by definition, delivered before 37 weeks of development in the uterus. A premature newborn has underdeveloped organs, which may not be ready to function outside of the uterus. CAUSES The reasons for premature birth are frequently unknown. The risk of premature birth is,
Higher among adolescents and older women
Women of lower socioeconomic status
Women with inadequate prenatal care
Multiple fetuses (twins, triplets, quadruplets).
Untreated infections, such as
urinary tract infections sexually transmitted diseases,
Previous premature birth
heart disease severe high blood pressure kidney disease,
Preeclampsia or eclampsia Placental insufficiency
SYMPTOMS o Premature newborns usually weigh less than 5½ pounds (2.5 kilograms) o Some weigh as little as 1 pound (½ kilogram). o Symptoms often depend on immaturity of various organs. For example, some organs, such as the lungs or brain, may not be fully developed. o Premature newborns may also have difficulty regulating their body temperature and the level of sugar in the blood. o The immune system is also underdeveloped. o Physical Features of a Premature Newborn are,
o Large head relative to rest of the body o Little fat under the skin o Thin, shiny, pink skin o Veins visible beneath the skin o Few creases on soles of feet o Scant hair o Soft ears, with little cartilage o Underdeveloped breast tissue o Boys: Small scrotum with few folds. Testes may be undescended in verypremature newborns o Girls: Labia majora not yet covering labia minora o Rapid breathing with brief pauses (periodic breathing), apnea spells (pauses lasting longer than 20 seconds), or both o Weak, poorly coordinated sucking and swallowing reflexes o Reduced physical activity and muscle tone (a premature newborn tends not to draw up the arms and legs when at rest as does a full-term newborn) o Sleeping for most of the time
COMPLICATIONS Risk of complications increases with increasing prematurity and depends in part on the presence of certain causes of prematurity, such as infection, diabetes, high blood pressure, or preeclampsia in the mother. UNDERDEVELOPED BRAIN: These problems include
Inconsistent breathing: The part of the brain that controls regular breathing may be so immature that newborns breathe inconsistently, with short pauses in breathing or periods during which breathing stops completely for 20 seconds or longer
Difficulty coordinating feeding and breathing: The parts of the brain that control reflexes involving the mouth and throat are immature, so premature newborns may not be able to suck and swallow normally, resulting in difficulty coordinating feeding with breathing.
Bleeding (hemorrhage) in the brain: Newborns born very prematurely are at increased risk of bleeding in the brain. Bleeding typically begins in an area of the brain called the germinal matrix and may extend into fluid-filled spaces within the brain called the ventricles. Newborns with very large hemorrhages are at higher risk of having developmental delay, cerebral palsy, or learning disorders, and a few may not survive. 29
UNDERDEVELOPED DIGESTIVE TRACT AND LIVER: An underdeveloped digestive tract and liver can cause several problems, including
Frequent episodes of spitting-up: Initially, premature newborns may have difficulty with feedings. Not only do they have immature sucking and swallowing reflexes, but also their small stomach empties slowly, which can lead to frequent episodes of spitting up (reflux).
Intestinal damage: Very premature newborns may develop a serious complication in which part of the intestine becomes severely damaged called necrotizing enterocolitis
Jaundice: In premature newborns, the liver is slow in clearing bilirubin (the yellow bile pigment that results from the normal breakdown of red blood cells) from the blood. Rarely, very high levels of bilirubin accumulate and put newborns at risk of developing kernicterus. Kernicterus is a form of brain damage caused by deposits of bilirubin in the brain.
UNDERDEVELOPED IMMUNE SYSTEM: Infants born very prematurely have low levels of antibodies, substances in the bloodstream that help protect against infection. Antibodies cross the placenta. Therefore, the risk of developing infections, especially infection in the blood (sepsis), is higher in premature newborns. UNDERDEVELOPED KIDNEYS: Before delivery, waste products produced in the fetus are removed by the placenta and then excreted by the mother's kidneys. After delivery, the newborn's kidneys must take over these functions. Kidney function is diminished in very premature newborns but improves as the kidneys mature. Newborns with underdeveloped kidneys may have difficulty regulating the amount of salt and water in the body. UNDERDEVELOPED LUNGS: The lungs of premature newborns may not have had enough time to fully develop before birth. Such newborns are likely to have respiratory distress syndrome, causing visibly labored breathing, flaring of the nostrils while breathing in, a grunting sound while breathing out, and a bluish discoloration to the skin (cyanosis) if oxygen levels in the blood are low
DIFFICULTY REGULATING BLOOD SUGAR LEVELS: Because premature newborns have difficulty feeding and maintaining normal blood sugar (glucose) levels, Without regular feedings, newborns may develop low blood sugar levels (hypoglycemia). Others become listless with poor muscle tone, feed poorly, or become jittery. Rarely, seizures develop. Premature newborns are also prone to developing high blood sugar levels (hyperglycemia) if they receive too much sugar intravenously, but hyperglycemia rarely causes symptoms. DIFFICULTY REGULATING BODY TEMPERATURE: Because premature newborns have a large skin surface area relative to their weight compared to full-term newborns, they tend to lose heat rapidly and have difficulty maintaining normal body temperature, If they are exposed to a cool environment, premature newborns will generate extra body heat, markedly increasing their rate of metabolism and making it difficult for them to gain weight.
PROGNOSIS Over recent decades, the survival of premature newborns has improved dramatically. For most premature newborns, the long-term prognosis is very good, and they develop normally. However, risk of death and long-term problems begins to increase in infants born before 26 weeks of pregnancy and particularly in those born before 24 weeks. Risks include delayed development, cerebral palsy, and vision impairment.
PREVENTION The best way for premature birth to be prevented is, Ante-natal
The expectant mother should take good care of her own health.
Eat a nutritious diet
Avoid alcohol, tobacco, and drugs
Treat a medical condition. Ideally 31
Early and regular prenatal care
Any complications of pregnancy should be recognized early and treated.
Obstetricians may give drugs to the pregnant woman to slow or stop contractions for a short time.
, may be given to the mother to speed the development of the fetus's lungs to reduce the risk of the newborn developing respiratory distress syndrome and also to reduce the risk of brain hemorrhage. TREATMENT Treatment involves managing the complications of prematurity, such as respiratory distress syndrome and high bilirubin levels (hyperbilirubinemia). Very premature newborns are given nutrition into their veins until they can tolerate feedings into their stomach through a feeding tube and eventually feedings by mouth. The mother's breast milk is the best food for premature infants. Use of breast milk decreases the risk of developing necrotizing enterocolitis. Premature newborns may need to be hospitalized for days, weeks, or months.
CARE OF THE PRE-TERM NEONATE
Immediate care following the birth
The cord to be clamped quickly
The cord length is kept long
The air passage should be cleaned
Adequate oxygen through the hood
Baby should be wrapped the whole body including the head
Intensive care protocol
Maintain the body temperature –place in the incubator
Respiratory support- clear the air passage and oxygen administration
Infection-prevent infection by following aseptic techniques, do not take the baby out from the incubator on and off, minimum handling
Nutrition-can start 2 hous after birth, breast milk by NG feed, palida feed, then to direct breast feeding
Favorable signs of progress
Colour becomes pink
Progressive weight gain
Time to discharge
If the baby gains weight, sucking to breast sucessfully 33
Advice on discharge
Monitoring by the health worker
Follow up schedule
Prescribe the multivitamin drops
Kangaroo mother care
However, the more prematurely newborns are born, the more they are prone to serious
and even life-threatening complications. Extreme prematurity is the single most common cause of death in newborns. Also, newborns born very prematurely are at high risk of long-term problems, especially delayed development and learning disorders. Nonetheless, most infants who are born prematurely grow up with no long-term difficulties. The risk of premature birth is decreased with early prenatal care.
HEALTH EDUCATION: 1. Disease condition: Educated child mother about disease condition, its causes, available treatment, prognosis. 2. Exclusive breast feeding; Explained in detail about importance of exclusive breast feeding 3. Immunization: explained the importance of immunization in their level of understanding to parents. 4. Prevention of infection: Educated mother about importance of hygienic practices in preventing infection to child 5.
Follow up care.
RESEARCH ARTICLE A cohort study conducted to study the Low plasma folate concentrations in pregnancy are associated with preterm birth. 34,480 low-risk singleton pregnancies enrolled in a study of aneuploidy risk, preconceptional folate supplementation was prospectively recorded in the first trimester
supplementation for 1 y or longer was associated with a 70% decrease in the risk of spontaneous preterm delivery between 20 and 28 wk versus 4 spontaneous preterm births, respectively; HR 0.22, 95% confidence interval and a 50% decrease in the risk of spontaneous preterm delivery between 28 and 32 wk versus 12 preterm birth, respectively. However, the risk of spontaneous preterm birth decreased with the duration of preconceptional folate supplementation and was the lowest in women who used folate supplementation for 1 y or longer. The study concluded that Preconceptional folate supplementation is associated with a 50%–70% reduction in the incidence of early spontaneous preterm birth. The risk of early spontaneous preterm birth is inversely proportional to the duration of preconceptional folate supplementation. Preconceptional folate supplementation was specifically related to early spontaneous preterm birth and not associated with other complications of pregnancy.
CONCLUSION: B/O Kavya was admitted to MSRMH (NICU) immediately after birth, due pre maturity. Baby is under observation and treated with all medical measures and nursing care provided, which promote baby to recover from illness and presently baby is taking feed normally with palada and breathing pattern is normal.
1. Ghai OP, Vinod KP, Arvind B. Ghai Essential Peadrics.7th edn. CBS Publishers. New Delhi:2009:Pg:295. 2. Wong DL,Whaley &wong.nursing care of infants and children.6th edn.Mosby.1999.Pg. 841. 3. Dutta DC. Text book of Obsterics. 6th ed. New central book agency: Kolkata;2004.p.458-62 4. CIMS (Current Index of medical specialities). Apr- Jul 2009. India. 5. Ruth VB, Linda KB. Myles text book for midwives. 12th ed. Churchill livingstone; New york :1999.p.432-35. 6. CIMS 7. Annamma J. A comprehensive textbook of midwifery. 2nd ed.Jaypee brothers; new delhi: 2009.p.473-77. 8. Radek B, Fergal D. Malone,Flint T. Porter,David A. Nyberg, Preconceptional Folate Supplementation and the Risk of Spontaneous Preterm Birth: A Cohort Study. http://www.nlm.nih.gobv/medlineplus/ency/article/001563.htm
NURSIN G DIAGN OSIS
On observatio n child is having dyspnea, substernal retraction on breathing and saturation is not is not maintainin g and presence hurried breathing.
Impaired breathing pattern related to atelactasi s secondar y to surfactant deficienc y.
The child will be breath normally and saturation will maintain at normal level.
Assess respirations; note quality, rate, pattern, depth, flaring of nostrils, dyspnoea, use of accessory muscles. Auscultate lungs for presence of decreased or absent breath sounds. Administer humidified oxygen as per order. Assess changes in vital signs and temperature Do suctioning if necessary Monitor arterial blood gases (ABGs). Maintain normal body temperature of baby. Change position of baby 2 hourly. Provide comfort to the baby Give chest physiotherapy if required
Assessed respirations; note quality, rate, pattern, depth, flaring of nostrils, dyspnoea, use of accessory muscles. Auscultated lungs for presence of decreased or absent breath sounds. . Administered humidified oxygen at 4 litre /hr Assessed changes in vital signs continuously with the help of pulse oxymeter Monitored arterial blood gases (ABGs) as per order. Maintained normal body temperature of baby by placing the baby under radiant warmer and maintaining temperature between 36.5- 37.5 C Position of baby changed 2 hourly. Provided comfort to the baby by meeting the basic needs such as feeding, hygienic needs and love and affection.
Baby is maintaining normal saturation And free dyspnoea.
Assess infant’s body temperature.
Assessed infant’s body temperature.
Place the child under radiant warmer
Placed the child under radiant warmer maintain
Ineffectiv Child will be e
and maintain temperature between
and maintain temperature between
36.5 – 37.5 C
36.5 – 37.5 C
Mummified the baby with a warm
blanket to reduce heat loss.
s are cool.
subcutan eous fat.
Avoid touching baby with cold hands
to avoid hypothermia to baby.
Mummify the baby to reduce heat
Monitor the temperature of the
Avoided touching baby with cold hands to avoid hypothermia to baby.
Monitored the temperature of the
warmer and adjust if needed
warmer and adjust temperature to
Warm both hands before touching the
baby to avoid hypothermia to baby.
Hands are warmed and disinfected with germiclean before touching the baby.
n child looks
nutritiona able maintain l status
nutrients as per order.
Provide comfort to the baby by
meeting the daily needs.
lactose feed to baby through NG tube
Give expressed breast milk or prepared palada feedscomfort lactose feed to baby through NG tube
or with the help of palada.
or with the help of palada.
Assess the nutritional status of the child by nutritional assessment.
Assess the nutritional status of the
child by nutritional assessment.
Monitor child weight daily
Monitor child weight daily
Administer fluids, electrolytes and
Administer fluids, electrolytes and
2.2 kg to 2.8
nutrients as per order.
Give expressed breast milk or prepared
Provide comfort to the baby by meeting the daily needs.
Encourage mother to give exclusive -
breast feeding every 2 hourly or on
Encourage mother to give exclusive
demand of the baby.
breast feeding every 2 hourly or on demand of the baby.
Monitor intake output chart.
Encourage diversional therapies while
Monitor intake output chart.
providing food to the child.
Encourage diversional therapies while providing food to the child.
Assess parent’s level of anxiety and
to parents will be
determine how parents copes with
that she is
anxiety. Acknowledgment of the
patient’s feelings validates the feelings
and communicates acceptance of those
Acknowledge awareness of patient’s
Reassure patient that he or she is safe.
Assessed parent’s level of anxiety and determine how parents cope with anxiety.
Mother verbalizes that she is
Stay with patient if this appears
Acknowledged awareness of patient’s anxiety. Acknowledgment of the patient’s feelings validates the feelings and communicates acceptance of those feelings.
free from fear and she is able to cope with
current Explained about child health status, situation. cause for illness and outcome of health status.
Maintain a calm manner while interacting with patient.
Establish a working relationship with the patient through continuity of care.
Use simple language and Encourage parents to talk about anxious feelings.
Avoid false reassurances.
Involved parents in child care. Allowed child to see baby every day.
Used simple language Encouraged parents to seek assistance from the health care provider when anxious feelings comes
On observatio n baby is taken out from the incubator on and off.
Risk for infection related to immature immune system.
Baby will be free from infection.
Assess conditions risk for development of infections Monitor vital signs hourly to know the signs of infections (fever) Keep baby environment clean, hygienic. Follow aseptic measures while performing any procedures ( hand washing, wearing gloves) Wash hands thoroughly with antiseptics before and after touching each baby. Use clean and sterile instruments for baby care. Improve baby’s immune system by providing high calorie feeds to the baby.
Do routine blood investigation ( CRP level, ESR, WBC count, blood culture etc.) Clean all tubings, IV canula site with antiseptic solution every day.
Assessed conditions risk for development of infections Monitored vital signs hourly to know the signs of infections (fever) Kept baby environment hygienically . Aseptic measures used during each nursing procedures
Baby is free from infection as evidenced by normal vital signs.
Hands are washed thoroughly with antiseptics before and after touching each baby. Used clean and sterile instruments for baby care. Administered fluids, electrolytes intravenously. Expressed milk given through palada every 2 hourly. Routine blood investigation done.
All tubings, IV canula site are cleaned with antiseptic solution every day.