Nursing Care of the High Risk Newborn and Family

7/31/2019 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)

Documents

Nursing Care of the High Risk Newborn and Family