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Premature infants

Stacy Asante

Created on November 27, 2024

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Transcript

pREMATURE INFANTS

RISKS AND COMPLICATIONS

cHAPTERS

cONTENT

process

GAME

Covering some complications

Choosing one of the complications that I went over and applying the nursing process

Case study game

bACKGROUND

define premature infant

Infant = first 28 days of birth Premature = born before 37 weeks gestation - Late preterm - Early preterm

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SIgnificance to nursing

-Infant mortality rates -"5.61 per 1000" (Ely & Driscoll, 2024) -Costs -More responsibilty

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Causes and risk factors for prematurity

MATERNAL RISK FACTORS

- Lifestyle factors - Diabetes, heart disease, hypertension, preeclampsia, poor nutrition, smoking, alcohol, not receiving early prenatal care Pregnancy complications -Multiple pregnancies, infections, placental issues

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RESPIRATORY

Respiratory Distress Syndrome

Signs - Early - Mental status change- Restlessness - Agitation- Dyspnea - nasal flaring - Grunting - Tachypnea - Diaphoresis - Accessory muscle use

Signs - Late - Bradypnea, - Bradycardia, - Cyanosis, - Intercostal retraction - Ox sat less than 95%

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RESPIRATORY

DX - Chest x- ray - Echocardiogram

TREATMENT- Breathing tube - Ventilator establish an open airway - Apply oxygen using CPAP or BIPAP, - Watch pulse ox - Surfactant administration

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Respiratory Distress Breathing Ex.

QUESTION #1

00:30

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CARDIOVASCULAR

Patent Ductus Arteriosus

Patent Ductus Arteriosus

- Ductus Arteriosus - connects aorta to pulmonary artery

Signs- Continous machine like murmur, - Wide pulse pressure - Heart failure - Fatigue - Sweating

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CARDIOVASCULAR

Dx- Chest X- Ray - Echocardiogram

Treatment - Indomethacin - Invasive surgery - Fluid restriction

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QUESTION #2

00:30

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neurological

Intraventricular Hemorrhage

Signs-Breathing pauses -Decreased muscle tone/ reflexes -Excessive sleep -Lethargy -Weak suck

Grades-Grade 1 : Bleeding in a small area -Grade 2 : Bleeding in the ventricles -Grade 3 : Ventricles are engorged with blood -Grade 4 : Bleeding goes through the ventricles into surrounding tissue

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NEUROLOGICAL

DX- Ultrasound - CT scan - MRI

Treatment - Diuretics - Blood transfusion - Proper oxygen perfusion

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Hydracephalus - Blood vessels in brain rupture - Increased pressure

GASTROINTESTINAL

Necrotizing Enterocolitis

Signs- Abdominal distension- hard and swollen - Diminished bowel sounds - Blood in stool - Feeding intolerance - Lethargy - Bradycardia - Apnea - Shock - Vomiting - Metabolic acidosis -

DX - Blood test - Fecal test - X Ray

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GASTROINTESTINAL

Necrotizing Enterocolitis

Treatment- NPO, TPN - Broad spectrum antibiotics - Resection surgery for bowel

Complications - Peritonitis - Bowel perforation

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QUESTION #3

00:30

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IMMUNE

Neonatal Sepsis

Signs - Fever / low temperature - Tachycardia or bradycardia - SOB - Vomiting - Poor feeding / lack of proper weight gain - Swollen belly - Cold hands and feet - Seizures - Jaundice

DX -CBC - Urinalysis - Chest X - Ray - Ultrasound

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immune

Treatment- IV fluids - IV antibiotics - Supplemental oxygen - Blood pressure medications - Blood transfusions

Complications - Intraventricular hemorrhage - DIC - Thrombocytopenia - Poor feeding - Development delays

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question #4

00:30

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NURSING INTERVENTIONS

Key Interventions- Temperature regulation - Respiratory help - Appropriate nutrition - Infection prevention - NICU'S Role

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Info

cHAPTERS

cONTENT

process

GAME

Covering some complication

Choosing one of the complications that I went over and applying the nursing process

Case study game

NURSING PROCESS : NECROTIZING ENTEROCOLITIS

Assessment Subjective data- Ask parent about signs of pain - Ask about feeding - Ask about changes infant behavior

Objective data-Vital signs - watch temperature and heart rate - Physical assessment - adbomen distention, diminished bowel sounds, tenderness, x-ray findings - Watch for blood in stool, tolerance for feeding

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NURSING PROCESS : NECROTIZING ENTEROCOLITIS

Diagnosis- Imbalanced nutrition related to poor feeding as evidenced by not meeting weight milestones - Acute pain related to inflammation as evidenced by grimacing - Metabolic acidosis related to electrolyte imbalance as evidenced by vomiting

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NURSING PROCESS : NECROTIZING ENTEROCOLITIS

Planning- Ensure patent airway - providing supplemental oxygen - Decrease adbominal distention - If bacterial infection is present - antibiotics - Provide nutrition via TPN - Providing clear education to the parents

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NURSING PROCESS : NECROTIZING ENTEROCOLITIS

Implementation- Monitor Vital Signs - Provide ox if needed - IV fluids to correct metabolic acidosis - Implement NPO status, and TPN - Medication - antibiotics and analegsics - Infection control - hand hygiene

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NURSING PROCESS : NECROTIZING ENTEROCOLITIS

Evaluation- Assess abdomen for reduced distension, improved bowel sounds - Assess for weight gain - Monitor electrolytes for resolved metabolic acidosis - Parents have understood education and know when to make additional appointment

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NURSING PROCESS : NECROTIZING ENTEROCOLITIS

Patient Education- Signs to be reported - Understanding of NPO - Post discharge instructions

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cHAPTERS

cONTENT

process

GAME

Covering some complications

Choosing one of the complications that I went over and applying the nursing process

Case study game

GAME

  • This is Sam Johnson, currently in the NICU
  • We are the current nurse responsible for his care
  • Goal : Assess and find out what complication is affecting the baby.
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Get Report
Complete assessment (Hints)

Think that you figured it out?

CASE STUDY Q#5

00:30

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REFERENCES

Ely, D. M., & Driscoll, A. K. (2024). Infant mortality in the United States, 2022: Data from the period linked birth/infant death file. ). ‌

Medical Centric. (2021). Preterm Birth, Causes, Signs and Symptoms, Diagnosis and Treatment. In YouTube. https://www.youtube.com/watch?v=F_-WL_90a_A

Level Up RN. (2021). Respiratory Distress, BRUE/ALTE, SIDS - Pediatric Nursing - Respiratory Disorders | @LevelUpRN. In YouTube. https://www.youtube.com/watch?v=u4chw8EWZCg ‌

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Patent. (2023, March 16). Patent Ductus Arteriosus (PDA) Recording & Waveform | Eko Health. YouTube. https://youtu.be/bqJIFMdxXoQ?si=_aIotUesz6YVlOW5 ‌

(2024). Aboutkidshealth.ca. https://www.aboutkidshealth.ca/globalassets/assets/ivh_grade2_hus_medimg_pho_en.jpg?width=356&quality=60 ‌

REFERENCES

Intraventricular Hemorrhage. (n.d.). Www.hopkinsmedicine.org. https://www.hopkinsmedicine.org/health/conditions-and-diseases/intraventricular-hemorrhage ‌

What Is Necrotizing Enterocolitis? (n.d.). WebMD. https://www.webmd.com/parenting/baby/what-is-necrotizing-enterocolitis ‌

(2024). Bmj.com. https://ep.bmj.com/content/edpract/102/3/166/F1.large.jpg ‌

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Kim, F., Polin, R. A., & Hooven, T. A. (2020). Neonatal sepsis. BMJ, 371(371). https://doi.org/10.1136/bmj.m3672

Sam's latest report

  • 34 weeks gestation, born 1 full day ago
  • SGA - weight is 1,200 g
  • Delivered due to maternal preeclampsia (c - section)
  • Displays feeding intolerance
  • Recently placed on NPO
  • Started on antibiotics
Vital Signs
Physical Exam

Heart Rate : 109Respiratory: 29 breaths/min Temperature: 99.7 F Ox Sat : 96% on room air

Lungs sounds Adominal sounds Skin inspection - Adominal distention noted, Skin is warm