pediatric grand rounds by jamie martin. overview aa female infant aa female infant born on 11/20/12...
DESCRIPTION
Overview Client History and Assessment Client History and Assessment Identification of Nursing Problems and Plan of Care Identification of Nursing Problems and Plan of Care Clinical Teaching Clinical Teaching Research ResearchTRANSCRIPT
Pediatric Grand
RoundsBy Jamie Martin
Overview
AA female infant Born on 11/20/12 at 26 weeks gestation Chronological age: 16 weeks/ 4 months Adjusted age: 2 weeks
Overview
Client History and Assessment Identification of Nursing Problems and Plan
of Care Clinical Teaching Research
Maternal History
37 yo G4P0030 mother Fibroid uterus Cystic fibrosis Elevated WBC count
Client History Extreme prematurity (26 weeks gestation), 920 g
Retinopathy of prematurity
L and R sided MSSA neck abscesses
Respiratory distress syndrome
Large PDA
Anemia of prematurity
Left pnuemothorax
Hypotension
hyperbilirubinemia
Family/Psychosocial History
Mother—student at TCC at time of birth Father—working in Richmond Single parent household? Both parents currently living in Richmond Have “strong support network”
Cultural Considerations
Physical separation Emotional detachment
Primary Medical Diagnosis
Feeding Intolerance related to prematurity
Pathophysiology
Feeding Intolerance measured by: Soft abdomen Absence of abdominal distention Minimum/no aspirated gastric residual Presence of bowel sounds Minimum to no spitting up or vomiting Infant’s continued interest in feeding Consistent behavior pattern
Pathophysiology
Feeding success is measured by the infant’s ability to: Participate in feeding with energy Coordinate sucking and swallowing with adequate pauses
for breathing Maintain vital signs and oxygenation WNL Maintain normal muscle tone in face and body Complete feeding in about 20 to 25 minutes Manage a liquid fluid bolus with minimum or no loss of
liquid from mouth Sustain alertness for feeding Maintain strength and endurance for entire feeding Measure appropriate for age on standard growth curve
Pathophysiology
Anatomic/physiologic disabilities of the premature infant:
Coordination of suck and swallow at 32-34 wks
Poor muscle tone of the cardiac sphincter
Carbs and fats are less tolerated
Secondary Medical Diagnoses
BPD Aspiration GERD Thrush Very large umbilical hernia
Treatment Plan
Thickened PO feeds as tolerated OT Rehab Medications
Nystatin Prilosec Lasix O2
Treatment Plan
OT/Rehab support Pattern Consistency Nipple type Jaw and cheek support Swaddle Enteral feedings prn
Expected Developmental Age
Newborn Norms: Can turn head side to side head lag Strong grasp reflex Clenches hand on contact w/ rattle Follows light to midline Quiets when hears a voice Cries to express displeasure Watches parents’ faces intently as they talk
Developmental Theory
Trust vs. mistrust Sensorimotor Oral
Abnormal Physical Assessment
Neuro: Fussy at times
Respiratory: BPD, upper airway congestion
GI: very large umbilical hernia
Feeds: inconsistent, PO/enteral
Thrush
Altered Vision
Feeding Intolerance
Difficulty Taking PO feeds Aspiration on VSS Treatments:
PO feeds: 6 per day if awake, Neosure 24 kcal PO feeds thickened w/ rice cereal OT Rehab Meds: Nystatin, Prilosec
Impaired Gas Exchange
BPD Upper airway congestion Hx PDA Inactive Treatments:
1/8L NC Suction prn PT Meds: Lasix
Infection
Candida Albicans (thrush) Hx MSSA abscess on R and L sides of neck Long hospital stay Treatments:
Change pacifier daily Clean/Sterile technique HANDWASHING! Meds: Nystatin
Deficient Knowledge, Family
Parents live in Richmond Expressed being overwhelmed with
information Daughter hospitalized since birth (Nov. 20,
2012) Treatment:
Provide education/information via phone Facilitate contact during visits
Risk for Imbalanced Nutrition
Prematurity Feeding intolerance VSS showed aspiration Treatments:
Neosure 24kcal w/feeds 6 times per day PT OT Rehab
Holistic Nursing Care
Traditional interventions Assessments Medication administration Feedings
Holistic Nursing Care
Complimentary/Alternative Interventions Respectful approach Blanket swaddling and nesting Infant Massage
Holistic Nursing Care
Collaborative Interventions Feeding
Nursing OT PT Rehab
Relationship between Nursing Dx
Discharge Planning Family Teaching
Model appropriate feeding techniques Provide opportunity for feeding Educate on infant cues and how to measure feeding success Home oxygen administration Immunizations Car seat safety Medications
Referrals Home Health Care Support groups Plan nursing follow-up
Clinical Teaching
iPhone AppNICU Knowledge Parent
Educatorhttps://itunes.apple.com/us/app/nicu-knowledge-parent-educator/id508051096?mt=8
Clinical Teaching
Current Nursing Research
Current Nursing Research
Current Nursing Research
Current Nursing Research
Current Nursing Research
ReferenceSchlittenhart, J. M., Smart, D., Miller, K., &
Severtson, B. (2011). Preparing Parents for NICU Discharge. Nursing For Women's Health, 15(6), 484-494. doi:10.1111/j.1751-486X.2011.01676.x
Questions?
The End