Nursing care of high risk newborn
Section snippetsPLANNING THE NURSING STRATEGYThe first step, once contact is made between the family and nurse, is evaluative. Nursing evaluation can be characterized by three important stages: assessment, diagnosis, and identification of the goals that both the nurse and family wish to accomplish over the course of the relationship. Show
Facilitate Grieving and Crisis ResolutionNursing care can be defined by specific, supportive techniques. The nurse caring for the family of the high-risk newborn must choose the best counseling approach for patients on an individual basis.11 Therapeutic listening helps parents deal with their feelings. Parents of high-risk newborns can become overwhelmed with feelings of grief (denial, anger, withdrawal) and stress (financial demands, family disruption, sleep deprivation, fear, lack of experience with a sick infant). The nurse EDUCATIONEducation is one of the most valuable tools available to the nurse. Effective teaching is based on first acknowledging the parents’ readiness to learn and then establishing their level of understanding and perception of the event, individual learning styles, ability to participate and practice, need for positive feedback, and the appropriateness of the information. Applying these basic learning principes results in a behavior change. Parents often express a desire to learn more about normal IMPROVING COMMUNICATIONThe nurse also acts as an important link between the hospital, the clinic, the community, and the parents. Two-way communication is facilitated if the community nurse takes the initiative to identify herself to the primary provider and elicit current information, either by phone or in writing. In some instances, the nurse may need to assist the parents in advocating for a primary medical provider so that the family will receive consistent, coordinated information, as necessary, the community Infant StimulationInfants who are stimulated, not taxed, are provided with more opportunites to achieve their unique growth potential. The newborn who is given more to see, hear, aild feel will be better able to see, hear, and feel. This infant will take the initiative to bring stimuli input into his world. Human interaction promûtes the parent-infant acquaintance process. Parents leam to recognize their infant’s abilities and how to activate infant behaviors. Indeed, parents are the best eiicitors of such EVALUATIONThe nurse measures the effectiveness of her intervention by observing evidence of increased self-confidence in the parents, success in decision making, and a positive reciprocal relationship between the parents and infant. Appropriate nursing interventions, in this case are those behaviors that nurture parents and foster infant growth and development. Parenting can be enhanced by supportive counseling, education, and appropriate referral to community resources. Evaluation also includes the SUMMARYTerres and Leavitt20 report that parents of high-risk or chronically ill infants express a strong desire to learn more about well-infant care and about the normal expectations for growth and development of their infant. Parents also often raise the issue of their own need for rest, reassurance, and understanding, emphasizing that these requirements generally cannot be met by friends or other family members. Thus, the community health nurse, with her knowledge and skill for providing specialized Meredith Censullo is an assistant professor of nursing at Massachusetts General Hospital Institute of Health Professions. Dr. Censullo is a member of ANA and Sigma Theta Tau. Recommended articles (6)Meredith Censullo is an assistant professor of nursing at Massachusetts General Hospital Institute of Health Professions. Dr. Censullo is a member of ANA and Sigma Theta Tau. Copyright © 1986 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved. The first few months of life, known as the newborn phase, are vital for both the child’s physical adaptation to extrauterine life as the neonate begins to breathe, suckle, swallow, digest, and eliminate naturally. Throughout their first year, infants continue to mature quickly, learning new skills as they engage with their environment. Physical milestones include:
The first week of life is the most fragile. 75% of neonatal deaths occur during this time. Newborn mortality is often related to preterm birth, intrapartum-related issues (birth asphyxia or absence of breathing at birth), infections, and birth abnormalities. The Nursing ProcessNurses are expected to evaluate and monitor the neonate as part of a newborn assessment. This includes an Apgar score, which is a rapid assessment of respiratory and heart rate, muscle tone, reflexes, and color. Later measurements will include height and weight and lab tests. Nurses are also a source of education and support to new parents as they transition into parenthood. The nurse assists parents in feeding, bathing, and learning to respond to the newborn’s cues. Nursing Care Plans Related to Newborn Assessment and CareRisk for Impaired Gas Exchange Care PlanRisk for impaired gas exchange can be caused by delayed or poor adaptation to life outside the uterus. It may also be caused by pre-existing conditions like congenital defects, or acquired disorders like lung infections that develop before or after delivery. Nursing Diagnosis: Risk for Impaired Gas Exchange Related to:
Expected outcomes:
Risk for Impaired Gas Exchange Assessment1. Assess the client’s respiratory status. 2. Note the presence of symptoms of labored breathing. 3. Review the results of
hemoglobin and arterial blood gas (ABG) tests. 4. Assess the newborn’s caregiver’s knowledge of identifying symptoms of respiratory distress. Risk for Impaired Gas Exchange Interventions1. Elevate the head of the bed. 2. Suction the airway as needed. 3. Administer oxygen. 4. Prepare equipment for emergency ventilation. Risk for Hypothermia Care PlanRisk for Hypothermia in a newborn is related to a high surface area to volume ratio. This ratio is higher in low-birth-weight newborns, causing rapid heat loss and hypothermia. It can also be caused by the transition from a warm environment inside the uterus to one that is considerably cooler. Nursing Diagnosis: Hypothermia Related to:
Expected outcomes:
Risk for Hypothermia Assessment1. Monitor the newborn’s body temperature. 2. Assess risk factors. 3. Monitor for cold stress. Risk for Hypothermia Interventions1. Keep the newborn dry and tightly wrapped in a blanket. 2. Provide heat loss barriers. 3. Provide a warm environment. 4. Provide education to the parents/caregiver. Risk for Infection Care PlanRisk for Infection is related to the increased susceptibility to infection. The newborn’s immune system is immature and can not yet protect against pathogens – at least for the first few months. Nursing Diagnosis: Risk for Infection Related to:
Expected outcomes:
Risk for Infection Assessment1. Assess for contributing factors. 2. Assess for presence or absence of immunity. 3. Monitor for symptoms of infection. Risk for Infection Interventions1. Ensure strict compliance to infection control and hand hygiene. 2. Encourage breastfeeding. 3. Monitor caregivers and visitors for any existing illnesses. 4. Provide health teaching about infection control measures. References and Sources
What are the nursing interventions for newborn?These nursing interventions include keeping the baby warm, stimulating the baby to breathe, giving breaths to the baby who isn't breathing well, and performing chest compressions if needed.
Do highDo high-risk infants need immediate care? No. Unlike sick infants, high-risk infants do not need immediate care. However, steps to prevent possible problems should be taken as soon as possible.
What are the highHemorrhagic disease of the newborn - Vitamin K deficiency disorder, a bleeding problem that occurs in a newborn during the first few days of life caused by a deficiency in vitamin K. Hyaline membrane disease (HMD) - see respiratory distress syndrome. Hyperglycemia - high amounts of glucose (sugar) in the blood.
What is the care of the newborn immediately after birth?A newborn baby is wet from the amniotic fluid and can easily become cold. Drying the baby and using warm blankets and heat lamps can help prevent heat loss. Often a knitted hat is placed on the baby's head. Placing a baby skin-to-skin on your chest or abdomen also helps to keep the baby warm.
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