OJOG  Vol.8 No.5 , May 2018
A Premature Baby’s Nursing Care Plan
ABSTRACT
Introduction: Baby T, is in the 46th day of his life has a 26-year-old mother who has suffered from about hypotyroid and preeclampsia during her pregnancy was born as a preterm baby when he was in 27 weeks’ gestation age by CS. Purpose: This article aimed to introduce the Nursing care plan. Materials and Methods: Place of work: Neonatal Intensive Care Unit/Balcali Research and Education Hospital in Adana, Turkey. Nursing Care Plan for the clinical period from 23.02.2015 till 11.03.2015. Informed consent was obtained from the baby’s family. Results: In addition to this, parents have blood incompatibility, therefore, such combinations of diseases impacted baby in the uterus and delivery happened earlier than expected date. His birth weight was 820 gr (0% - 5% percentile), height 34 cm (10% - 25% percentile), head-circumference 24 cm (10% percentile). The following healthcare needs were identified upon assessment; intubation, oxygene and stimulant support, monitorization, taking blood samples. Apical pulse is rapid and irregular within normal range 148 bpm, weight is 1605 gr, body is long, thin, limp with a slight potbelly. Initially suck/swallow reflex was absent/uncoordinated that’s why he was taking expressed breastmilk throughout orogastric catheter, it has started also oral giving for the couple of days with the development of sucking and swallowing. Reflexes depend on gestational age; rooting well established by 32 weeks’ gestation; coordinated reflexes for sucking, swallowing, and breathing usually established by 32 weeks; first component of Moro’s reflex (lateral extension of upper extremities with opening of hands) appears at 28 weeks; second two components (anterior flexion and audiblecry) appear at 32 weeks. Dubowitz examination indicates gestational age between 24 and 37 weeks. Consequently, this infant shows, palmar grasp, plantar grasp, moro reflex; the only response is the opening of the hand due to 27 gestational age. Apgar score was 4 - 7 (average, need oxygene and stimulant). Respiration was shallow, maintain neutral thermal environment, prevent or reduce risk of potential irregular, diaphragmatic with intermittent breathing 58/min. Conclusion: Nursing priorities should be promote optimal respiratory functioning, complications, maintain homeostasis, foster development of healthy family unit.

1. Introduction

It is both a developmental and situational crisis in which to: give birth, to join of a new member into the family and to accept the new participant’s membership with the cause of any health problem into the hospital. In such a case, the parents find themselves in a confusion without experiencing the happiness of having a child. The birth of a risky baby is a traumatic event for the family and causes the family to live crisis [1] .

The first minutes of the newborn came into the world is very important because it is an indicator of the extrauterine adaptation to life. In order to maintain the health of the newborn, the importance of an effective care in the early postpartum period should not be overlooked [1] . The team involved in the birth should carefully evaluate the first minute of the newborn’s life and examine the statements indicating that the baby’s condition may be compromised. Assessment of these symptoms and appropriate interventions will affect the whole life of the baby [1] [2] .

2. Practise Report

Baby T, is in the 46th day of his life has a 26 year old mother who has suffered from about hypotyroid and pre-eclampsiaduring her pregnancy was born in 07.01.2015 as a preterm baby when he was in 27 weeks’gestation age by CS. In addition to this, parents have blood incompatibility, therefore, such combinations of diseases impacted baby in the uterus and delivery happened earlier than expected date 01.03.2015. His birth weight was 820 gr (0% - 5% percentile), height 34 cm (10% - 25% percentile), head-circumference 24 cm (10% percentile).

The following healthcare needs were identified upon assessment; intubation, oxygene and stimulant support, monitorization, taking blood samples.

Neonatal Assessment Data Base

1) Circulation

Apical pulse is rapid and irregular within normal range 148 bpm.

2) Food/Fluid

Weight less than 2500 (Birth weight: 820 gr, now: 1605 gr).

3) Body long, thin, limp with a slight potbelly

Initially suck/swallow reflex was absent/uncoordinated that’s why he was taking expressed breastmilk throughout orogastric catheter, it has started also oral giving for the couple of days with the development of sucking and swallowing.

4) Neurosensory

Head size large in relation to body; sutures are easily movable; fontanelles are open 2 × 1 cm. Edema of eyelids common.Reflexes depend on gestational age; rooting well established by 32 weeks’ gestation; coordinated reflexes for sucking, swallowing, and breathing usually established by 32 wk; first component of Moro’s reflex (lateral extension of upper extremities with opening of hands) appears at 28 wk; second two components (anterior flexion and audiblecry) appear at 32 wk. Dubowitz examination indicates gestational age between 24 and 37 wk. Consequently, I can say that this infant shows, palmar grasp, plantar grasp, moro reflex; the only response is the opening of the hand due to 27 gestational age.

Infant is responsive to sound and movement. No drooping or paralysis noted in face.

5) Respiration

Apgar score was 4 - 7 (average, need oxygene and stimulant) at birth.

Respiration was shallow, irregular, diaphragmatic with intermittent breathing 58/min.

Grunting, nasal flaring, substernal retractions.

6) Safety

Temperature is stabile but still has a risk for hypothermia.

7) Cry is weak

Face is bruised, baby active, skin slightly translucent with olive undertones, head can be considered normocephalic, milia present across nose, eyes and ears level, nostrils equal, sclera bluish-white, ears are symmetrical well-formed, no lesions noted, clavicles straight and intact, nipples unclear but symmetric, umblical cord dry, no bleeding, buttocks symmetric, sole and buttocks creases present.

8) Sexuality

Male testes descended, rugae absent on scrotum.

9) Elimination

Not observed elimination problem.

3. Diagnostıc Studies

Choice of tests and the expected results depend on presenting problems and secondary complications

1) Serum Electrolytes:

-Na: 136 mg/dl it is susceptible to critical fluctiations (The reference range is 131 - 145 mmol/L).

2) Hematologic tests:

-Hb: 15.6 (The reference range is 13.5 - 21.5 g/dL).

-Htc: 38.5 (The reference range is 42% - 60%)

-Plt: 27,000 (Thrombocytopenia may accompany sepsis). (The reference range is 150 - 350 103 µ/L).

-Wbc: 9300 (which is usually associated with severe bacterial disease) (The reference range is 9 - 30 103 µ/L).

Urinalysis (on second voided specimen): Detects abnormalities, renal injury.

-BUN: 42 (The reference range is 5 - 20 mgr/dl).

-Creatinin:0.77 (The reference range is 0.3 - 1 mgr/dl).

3) Blood type: Infant: A Rh+ Mother: 0 Rh + Father: ARh+ à ABO incompatibility.

4) Blood culture: Identify causative organisms associated with sepsis.

5) Urine-Specific Gravity: 1005 (Ranges between 1.006 and 1.013; elevated with dehydration) , no bacteria

6) Vital values

Temperature: 37.2 C. Pulse: 148/min. Respiration: 58/min. SYS: 72 DIA:38 Mean:51 mmHg. SpO2: 98%.

4. Medıcations/Plan

1) 12 × 16 cc feeding per a day (120 cc/kg).

2) It will be added 5cc eoprotin per 25 cc expressed breastmilk.

3) It will be added 1/4 cc faltomalt per 4 feeding.

4) D vit 1 × 3 drops p.o (10.00 am).

5) Biogia 1 × 5 drops p.o (10.00 am).

6) Santofer 1 × 1 drop p.o (10.00 am).

7) Netira for eyes, 3 × 1 drops (during 3 days) (10:00 18:00 02:00).

8) P.S. The medication is adjusted by the physician according to the condition of the baby.

5. Nursing Prioritıes

1) Promote optimal respiratory functioning.

2) Maintain neutral thermal environment.

3) Prevent or reduce risk of potential complications.

4) Maintain homeostasis.

5) Foster development of healthy family unit.

6. Discharge Goals

1) Maintaining physiological and behavioral homeostasis with minimal external support.

2) Weight 4 1/2lb or greater appropriate to age/condition.

3) Complications prevented/resolving or independently managed.

4) Family identifying and using resources appropriately.

5) Family demonstrates ability to manage infant care.

6) Plan in place to meet needs after discharge

See Table 1 for nursing care plan (Table 1).

7. Discussion

Systematic physical assessment includes the assessment of newborns, initial assessment (Apgar scoring), assessment of extrauterine transition periods and gestational age assessment. Objective evaluation of the baby’s physical condition at birth can be done with the Apgar scoring system. Apgar score is evaluated at 1th, 5th and 10th minutes. The newborn is assessed in five areas, taking into account heart rate, respiration, muscle tone, response to the stimulus and skin tone. The Apgar score is obtained by summing the scores of 0, 1, 2 given in each field. If the Apgar value is between 8 - 10; the newborn is alive and strong, a normal maintenance is sufficient. If value is between 4 - 7 means baby needs oxygen and warning. Value is below 4 means indicates severe oxygen deficiency and the newborn urgently needs resuscitation [3] [4] .

During extrauterine transition period; determination of some irregularities in heart rate, respiration, motor activity, color, mucus production and intestinal activity, diagnosis of gestational age and birth weight are important because these are closely related to perinatal mortality and morbidity. A physical assessment with be very attentive and be systematic is necessary in order to detect normal signs and understand the specific signs of danger in the newborn. Physical evaluation includes assessment of vital findings, taking of body measurements, and physical examination of the from head to foot. A detailed assessment is needed to determine the level of adaptation of the newborn to life and the risk factors that may affect life [4] .

The growth and development of the newborn depends on a loving family and a supportive environment. Some newborns may be premature, with a low birth

(a) (b) (c) (d) (e) (f)

Table 1. Nursing Care Plan for the clinical period from 23.02.2015 till 11.03.2015 of Baby T [5] - [10] .

weight or with a defect. “When the weak and powerless newborns open their eyes to the world, the nurse is one of their best friends.” In assessing the baby’s condition, the baby nurse has a special role. The nurse evaluates of the adequacy and inadequacy of baby’s functions with be systematic. The nurse also provides useful information about whether or not to take the treatment, decide whether to stay in a health center or next to the family [1] .

Having the problem of the health of the newborn can cause the family to live in grief. Parents experience fear and anxiety when they face this sad end. As a result, intervention with professional care in a timely manner will make it easier for the couple to find new strategies and solutions that will help them cope with the crisis.

8. Conlusions

Nursing priorities should be promote optimal respiratory functioning, maintain neutral thermal environment, prevent or reduce risk of potential complications, maintain homeostasis, foster development of healthy family unit [5] [6] [7] [8] .

Starting to early feeding, especially with breast milk, is crucial for the infants. It is also crucial for those who are not breastfeeding, rather whose needs are maintained by a healthcare team. These specially trained people are the newborn nurses who have a key responsibility on infant feeding as a result of their dense interactions with the infants and mothers from the beginning. To be able to fulfill this role, nurses need to know enteral feeding techniques and the nursing care of the enterally fed infants [11] .

As a matter of fact, newborn nursing is a special branch, requiring experience and special training. Thus, a postgraduate nursing education on the current topic is highly recommended [11] .

NOTES

*This study was submitted as a poster presentation at the International Congress on World Summit on Pediatrics (June 22-25, 2017, Ergife Palace Hotel Roma-Italy). This article was the practice of the Child Health and Diseases Nursing course, the academic consultancy of which was carried out by Senay Cetinkaya.

Cite this paper
Cetinkaya, S. and Kusdemir, S. (2018) A Premature Baby’s Nursing Care Plan. Open Journal of Obstetrics and Gynecology, 8, 437-445. doi: 10.4236/ojog.2018.85050.
References
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[7]   Green, A. (2006) Neonatal Intensive Care Nursing.

[8]   Green, C.J. and Wilkinson, J.M. (2004) Maternal Newborn Nursing Care Plans. Mosby, St Louis.

[9]   Olsen, I.E. (2010) Preterm Infant Growth Chart Calculator.
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[10]   Ralph, S.S. and Taylor, C.M. (2014) Nursing Diagnosis Pocket Guide. 2th Edition, Wolters Kluwer, Lippincott Williams & Wilkins, 1-522.

[11]   Tengir, T. and Cetinkaya, S. (2011) Role of Newborn in Newborn Feeding. The Journal of Maternal-Fetal and Neonatal Medicine, 24, 158-165.
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